Why do people specialize? Why not just become a super GP?

[Biofilm preventer]

Since technically general dentists are able to do almost any procedure as long as they take C.E courses, why does not everybody choose to do this?
im naive in this obviously but I’m just curious

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[giannis]

Salary as an associate.
I don't see why you would if you want to own a practice though. Like you said, CE courses or find a mentor.

 

[Biofilm preventer]

Salary as an associate.
I don't see why you would if you want to own a practice though. Like you said, CE courses or find a mentor.

You’re saying just become a super GP?

 

[giannis]

You’re saying just become a super GP?

Personal preference

 

[RYost234]

Gonna take a wild guess here.. Maybe they prefer the procedures in a certain specialty over the rest?

 

[sobertiger]

The fees and reimbursement rates are higher for specialists even if it's the same procedure.

 

[TanMan]

Reasons? Lower volume (compensated with higher patient procedure), able to stay in more saturated areas, failed as a GP, and/or truly love that specific part of dentistry.

The SuperGP fad was there about a decade ago. The aspect of GP I love the most is that I can do whatever procedure I want and send off the ones that I don't want. Trust me, you don't want to do all procedures unless you're starving.

 

[0Mik3cho]

Reasons? Lower volume (compensated with higher patient procedure), able to stay in more saturated areas, failed as a GP, and/or truly love that specific part of dentistry.

The SuperGP fad was there about a decade ago. The aspect of GP I love the most is that I can do whatever procedure I want and send off the ones that I don't want. Trust me, you don't want to do all procedures unless you're starving.

What does it mean to fail at a GP?

 

[TanMan]

What does it mean to fail at a GP?

Too slow to make money, bad at business, multiple divorces (being a specialist won't save you from this one), or a combination of bad personal and professional circumstances.

 

[4thgen]

Lawsuits.

 

[2TH MVR]

Is it really possible to be a master of all dental procedures? A SUPPPPPER DUPPER GP. Is there enough weekend CE to equal 2-3 years of accredited training? Not saying it is impossible, but common sense should prevail here. A specialist has spent years of additional training, years of experience to do ONE dental procedure very well. One. A specialist lives and breathes that single procedure EVERY, single day. All of the CE that a specialist attends is to further that single minded training.
So many applicable analogies. You have a roof leak. You gonna call a handyman to fix it .... or a bonded, licensed, experienced roofer? A loved one has prostate cancer. You gonna call your trusted primary care physician who attended some weekend CE or an Oncologist?
The term SUPER GP came into vogue for those dentists treating patients in rural areas with NO specialists available. These dentists were doing their best to treat patients to the best of their abilities. A necessary situation.
You've heard it stated many times. A GP can do any specialty procedure. Of course ..... that GP will be held accountable to the standard of care attributable to that procedure if done by a specialist.
Lets take aligner tx. Most companies require limited patient records. I know one aligner company that only requires impressions (or digital) and a bite registration. No ceph. No pano. No peri-apicals. No cephalometric evaluation. No diagnosis. No real treatment plan. Just send them the limited stuff and "their" lab techs do the rest. So ... if something bad happens (lawsuit) .... do you have all the records that an orthodontist would routinely take to defend your position?
Go through a malpractice suit just ONE time. It will change the way you think.

 

[MGA100]

Is it really possible to be a master of all dental procedures? A SUPPPPPER DUPPER GP. Is there enough weekend CE to equal 2-3 years of accredited training? Not saying it is impossible, but common sense should prevail here. A specialist has spent years of additional training, years of experience to do ONE dental procedure very well. One. A specialist lives and breathes that single procedure EVERY, single day. All of the CE that a specialist attends is to further that single minded training.
So many applicable analogies. You have a roof leak. You gonna call a handyman to fix it .... or a bonded, licensed, experienced roofer? A loved one has prostate cancer. You gonna call your trusted primary care physician who attended some weekend CE or an Oncologist?
The term SUPER GP came into vogue for those dentists treating patients in rural areas with NO specialists available. These dentists were doing their best to treat patients to the best of their abilities. A necessary situation.
You've heard it stated many times. A GP can do any specialty procedure. Of course ..... that GP will be held accountable to the standard of care attributable to that procedure if done by a specialist.
Lets take aligner tx. Most companies require limited patient records. I know one aligner company that only requires impressions (or digital) and a bite registration. No ceph. No pano. No peri-apicals. No cephalometric evaluation. No diagnosis. No real treatment plan. Just send them the limited stuff and "their" lab techs do the rest. So ... if something bad happens (lawsuit) .... do you have all the records that an orthodontist would routinely take to defend your position?
Go through a malpractice suit just ONE time. It will change the way you think.

Well said.

 

[luisfigo]

It's really hard to do all things well AND fast. Some GP's figure out it doesn't make sense to do the root canal build up and crown in 2+ hours when they can just do a couple of crowns in that same time and make the same money, while letting a specialist do the root canal. Some people like predictability, they want to be the ultimate answer for all things in that specialty. It takes a long time to become a super GP and by the time you get there you may be slowing down and not actually want to do everything. Go shadow a prosthodontist and see how many tools he has for all the implant systems, it takes a lot of knowledge and experience to get there for those guys, now multiply that across all the specialties.

 

[Life of Pablo]

Reimbursement rates are lower for GP's, liability is higher, procedures take more time than referring out to a specialist etc. Not to mention the increase in overhead. You're better off having specialists come to your practice 1 day a week and taking a cut.

 

[LaughingGas]

because I hate doing 20 + min fillings and get paid crap.

 

[Sweet_Tooth]

See, I used to think this way too, only after starting dental school (and I'm still only a D2) did I realize how much more efficient it is for you to focus on just one job, rather than to spread yourself thin and try and become a jack of all trades. The only time that model would really ever be applicable is in, like @2TH MVR said, rural places where you're one of the only dentists in the area and so you become a one stop shop for a lot of pts that wouldn't be able to get to specialists even if you referred them. The reality is a lot of us won't be practicing in regions like that, most of us will be in places where specialists are actually easily available, and the reality is that even most patients will want to go to someone more experienced and with better credentials than you when it comes to certain procedures like endo, extractions, etc

Not only does being a "super GP" make you less efficient, it makes you produce lower quality work too. It's like multitasking. Research has shown that multitasking = efficiency is a myth, trying to do three tasks at the same time means all 3 of them don't get done as well as they could've been done if you had just focused on one task at a time. It's the same reason why me and you don't grow our own food or build our own houses, to give two examples. You have to hone in on the job that can only be done by you, and conserve your resources by focusing on getting good at only performing that job. Everything else can (and should!) be outsourced for efficiency, allowing you as a GP to become excellent at providing basic bread and butter dentistry

 

[gryffindor]

I graduated dental school with barely any ortho knowledge. This was around the time that the "X Month Smiles" braces "system" was becoming a thing. (The "X" stands for a number between 5 and 7.) I remember seeing GP's post their cases and thinking "wow, this is so impressive!" Then I got into an ortho residency and spent 3 years doing nothing but looking at faces and occlusions and thinking about how to move teeth and why to move them. I started to see things from a completely different perspective and was embarrassed that I ever thought X Month Smiles was even a valid treatment choice to offer to a patient. Specilalizing was the right choice for me. I'm much better and focusing on a small subject and knowing everything about it than trying to dabble in everything.

 

[CB2022]

I may be in the minority with this opinion, but I wanted to specialize in undergrad. Only after starting dental school and working as an assistant for a while did I realize that I would rather become distinguished at many types of procedures and perform continuing care. In the past year, I have pretty much decided becoming a GP is the right move for me. This choice was dependent on a lot of factors though. I value multiple personal relationships with patients, so being able to keep up with their lives and be a support system for them is important to me. I also enjoy something different every day, so I would like to become good at multiple advanced procedures - molar rct, ortho, and implant placement just to name a few. Owning a business is a priority to me too, and being a GP makes this easy. On top of all this, I am NOT someone that values the education side of dentistry, and I frankly can not wait to be done with my education. I'm so burnt out that I think a residency could possible take a major toll on my mental/physical health. I have good grades and everything (top 20% of my class), so I believe getting a residency would be attainable if I set my mind to it, but I frankly don't want to. It's a choice that comes down to your own personal preference. Don't let someone talk you into specializing just for the salary, but if you get into dental school and hate most of the stuff you are doing, specializing may be the right move for you.

 

[Lane138]

I'm a young endodontist. I knew from the get-go (even while applying to dental school) that I knew I wanted to specialize; I've always want to do the best the procedure can be done. In dental school you learn so many topics so broadly it's impossible to delve into a topic with any depth. All through dental school I naively thought endo was just doing root canals, so what's the point of spending 2-3 years studying just how to do one procedure? BOY was I wrong! A residency gives you a more comprehensive view. No CE course, even week-long hands on ones, can't give you that perspective. Another main reward is that you do make more money than as an employee general dentist. That being said, if you have to take out an additional 400k to do a residency (i.e. endo or ortho) then it may not be financially worth it. I was also drawn to endo specifically because I see one patient at a time, for 60-90 minutes each, and can focus my attention on them. I have more time to help patients and educate them, when their general dentist only spent 10 minutes with them before bouncing them to me. Even when I worked as a general dentist I disliked the prospect of having to bounce between chairs, do hygiene checks, etc.

Downside of specializing-- I do miss doing extractions and sometimes other aspects of general dentistry. You have to deal with finicky and unreasonable referring dentists and the toughest patients (This is a big one). You have more years of schooling while your GP friends are already making a paycheck.

For me, the rewards of specializing outweighed the downsides. I love my job. (I also love sitting at home for 2 weeks not working)

 

[bracketbuster68]

I may be in the minority with this opinion, but I wanted to specialize in undergrad. Only after starting dental school and working as an assistant for a while did I realize that I would rather become distinguished at many types of procedures and perform continuing care. In the past year, I have pretty much decided becoming a GP is the right move for me. This choice was dependent on a lot of factors though. I value multiple personal relationships with patients, so being able to keep up with their lives and be a support system for them is important to me. I also enjoy something different every day, so I would like to become good at multiple advanced procedures - molar rct, ortho, and implant placement just to name a few. Owning a business is a priority to me too, and being a GP makes this easy. On top of all this, I am NOT someone that values the education side of dentistry, and I frankly can not wait to be done with my education. I'm so burnt out that I think a residency could possible take a major toll on my mental/physical health. I have good grades and everything (top 20% of my class), so I believe getting a residency would be attainable if I set my mind to it, but I frankly don't want to. It's a choice that comes down to your own personal preference. Don't let someone talk you into specializing just for the salary, but if you get into dental school and hate most of the stuff you are doing, specializing may be the right move for you.

How will you set up your office to accommodate various workflows (GP bread and butter, ortho, implants, etc.)?

 

[DocMon16]

Is it really possible to be a master of all dental procedures? A SUPPPPPER DUPPER GP. Is there enough weekend CE to equal 2-3 years of accredited training? Not saying it is impossible, but common sense should prevail here. A specialist has spent years of additional training, years of experience to do ONE dental procedure very well. One. A specialist lives and breathes that single procedure EVERY, single day. All of the CE that a specialist attends is to further that single minded training.
So many applicable analogies. You have a roof leak. You gonna call a handyman to fix it .... or a bonded, licensed, experienced roofer? A loved one has prostate cancer. You gonna call your trusted primary care physician who attended some weekend CE or an Oncologist?
The term SUPER GP came into vogue for those dentists treating patients in rural areas with NO specialists available. These dentists were doing their best to treat patients to the best of their abilities. A necessary situation.
You've heard it stated many times. A GP can do any specialty procedure. Of course ..... that GP will be held accountable to the standard of care attributable to that procedure if done by a specialist.
Lets take aligner tx. Most companies require limited patient records. I know one aligner company that only requires impressions (or digital) and a bite registration. No ceph. No pano. No peri-apicals. No cephalometric evaluation. No diagnosis. No real treatment plan. Just send them the limited stuff and "their" lab techs do the rest. So ... if something bad happens (lawsuit) .... do you have all the records that an orthodontist would routinely take to defend your position?
Go through a malpractice suit just ONE time. It will change the way you think.

I agree with this but only to a certain degree. I don't agree with a GP can do any specialty procedure. A GP certainly can't do an orthognathic procedure that OMFS can do and I would even say that a GP isn't going to resect a large Ameloblastoma, OKC, or other pathological tumor. There are certain procedures that GP's can't do. This is stating the obvious as your are an orthodontist and know this.

I also wanted to add to your last paragraph about complications with ortho procedures as you mentioned and any other procedure. Even with CE courses, can a GP manage complications that a specialists could or can? I would go to say...likely not unless they do a solid AEGD or GPR program. I agree with your last statement about the malpractice suit too...just one will really put things into perspective for someone. I really think that GP's have to think about what they want their "niche" to be in practice, stick to it, kill it, and they can do really well and provide awesome services for their patients. Just my .02

 

[Molar Whisperer]

As a GP who was doing only endo for my previous corporate employer, I had the best job. Although my fees were lower than an endodontist, I was producing over a million and I wasn't that busy. I had an endodontist mentor who I would refer all the nightmare cases. He wanted me to go to endo residency. He said that a super GP is a "jack of all trades, master of none." I heard that during a down economy like now, many patients decide on extraction as opposed to saving their teeth and that scared me. I like the freedom to do any procedure and refer the high risk cases. The specialists are usually the end of the road providers since they usually can't refer out the losers. If you like the prestige, usually higher income, and don't mind the extra loans and lost income and time during specialty residency/training, then being a specialist may appeal to you.

 

[New_Vegas]

Since technically general dentists are able to do almost any procedure as long as they take C.E courses, why does not everybody choose to do this?
im naive in this obviously but I’m just curious

Because a general dentist can't do any procedure a specialist can. As mentioned already, you won't find a single GP doing orthognathic surgery. GPs only correct mild class I/II occlusion for ortho..

It would be terrifying to try to attempt to do complex perio surgeries with only a CE course (better have really good malpractice insurance too). You just don't get any experience doing that in dental school. As far as doing simple perio procedures, like crown lengthening, yeah that's probably a possibility.

Also there are a lot of costs associated with doing "specialty procedures". If you are doing molar endo you should probably invest in a microscope. If you are doing implants you should probably invest in CBCT.

And there's the issue of efficiency. If it takes you 2 hours to take out someone's impacted third molars, your time would definitely be better spent elsewhere. Not to mention those are risky procedures and a lot can go wrong. I've once was assisting a second year oral surgery intern attempt to take out a single partially impacted third molar, he struggled. A lot, in fact he had to get bailed out by one of the residents. Can you imagine doing that on a real patient? Failing in the middle of a procedure would be horrifying and imagine losing the patient's trust when you have to refer that patient to a specialist to bail you out.

 

[Alpha Centauri]

If you want to make money, find 2 or 3 procedures and do them WELL.

 

[TanMan]

The best thing about being a GP - picking the easy cases to maximize your productivity. Hourly fees and case difficulty don't necessarily scale up linearly (or logarithmicly). As a GP, you have the ability to optimize your procedure mix to maximize your profitability. In dentistry, every minute counts because you only have so many minutes in a day. Here's an example of what 3 minutes costs you:

RCT in 17 minutes v. 20 minutes at 1k each, completing in 17 minutes yields an hourly rate of ~3530 whereas 20 minutes yields 3000. Just some food for thought. Just because you can do a procedure doesn't mean you should. Always think about the productivity of the procedure on whether you should punt or keep.