Why waste money and time for residency?

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Because a GOOD residency teaches skills not taught in dental school. Because many new grads these days aren't getting the proper clinical exposure they ought to be getting and many are not prepared for the real world. Because many private office owners will not hire a new grad without a residency.

It's sad to see many schools charge 400K to 500K in tuition, yet deliver unprepared new grads. Even basic skills. A residency combats that. In the old days, a residency wasn't really needed because new grads were far more prepared than today.
 
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Why waste money and time for residency?
We can earn enough now after graduation, why to go with residency and school again? I understand it for OMFS but other specialties are...

It depends on the person/dentist. Some people have more interest in a field than others. Some are motivated by money - so they specialize. Some don’t know what they want and just keep going in the education ladder and specialize. Others specialize because of the title (I’m a specialist).

Personally... you couldn’t pay me enough to specialize. Dentistry was an insurance policy for me; to protect myself against economic downturns/recessions. It’s just a hat of many hats in my closet.
 
Three more years at graduate school to learn Prostho for instance really doesn't make sense. Getting up early, going to work for free, some schools are being led by jerks. Then new examinations and board certification and ...
We can earn money and live our life for that time and get closer to open the office sooner.
I totally forgot, we have yet to pay for the tuition also. Think before signing in. THINK
 
Specialists earn much more working fewer hours.
Yes, specialists do get paid more for each of the procedures they perform. A perio earns $1500-2000 for spending 15-30 minutes to place an implant. An OS earns $2000 for spending $20-30 minutes to take out 4 wisdom teeth. An endo earns $2k for spending an hour to do a molar endo. An ortho earns $150-200 per patient, per month for doing nothing (he/she simply looks at the teeth and the staff do all the manual labor). To earn similar amount, $2000-3000, a general dentist would have to do at least 10-15 fillings and spend much longer time to do them. General dentists do have to work harder to earn similar amount....unless he/she hires an associate to do the work for them.....passive income.

The question is do specialists have enough patients to keep them busy and to allow them to make more money than general dentists? At my busiest office, I only have 350 active patients to keep me busy 5 days/month. To get more patients, I open 3 additional offices. And even with 4 offices and 800 active patients, I only need to work 12 days/month (11 days/month before the Covid.....I had to add 1 more day at one of the offices in order to spread the patients out more to meet social distancing guideline) to take care of my patients. I work for the corp office 11 days/month and see about 600 active patients there. Most specialists I know don't work at one office. They travel to multiple offices. Specialists' incomes depend on how hard they are willing work, how picky they are about the job offers, and the number offices they are willing to travel to.
 
Yes, specialists do get paid more for each of the procedures they perform. A perio earns $1500-2000 for spending 15-30 minutes to place an implant. An OS earns $2000 for spending $20-30 minutes to take out 4 wisdom teeth. An endo earns $2k for spending an hour to do a molar endo. An ortho earns $150-200 per patient, per month for doing nothing (he/she simply looks at the teeth and the staff do all the manual labor). To earn similar amount, $2000-3000, a general dentist would have to do at least 10-15 fillings and spend much longer time to do them. General dentists do have to work harder to earn similar amount....unless he/she hires an associate to do the work for them.....passive income.

The question is do specialists have enough patients to keep them busy and to allow them to make more money than general dentists? At my busiest office, I only have 350 active patients to keep me busy 5 days/month. To get more patients, I open 3 additional offices. And even with 4 offices and 800 active patients, I only need to work 12 days/month (11 days/month before the Covid.....I had to add 1 more day at one of the offices in order to spread the patients out more to meet social distancing guideline) to take care of my patients. I work for the corp office 11 days/month and see about 600 active patients there. Most specialists I know don't work at one office. They travel to multiple offices. Specialists' incomes depend on how hard they work and the number offices they are willing to travel to

I am wondering how hard is it to find jobs at multiple offices assuming that a particular specialist is willing to travel up to 1-1.5 hrs one way?
 
As others have said, people specialize for the professional distinction, interest in their field, to deliver a higher level of care, and for financial reasons.

Many dentists attend extensive CE throughput their careers; imo specializing is a way for people to front load their learning.

I think residency and specialties are good for the public because, quite honestly, there are too many chuckleheads in this field doing a disservice to patients by trying to be "super". Having said that, I'm regular a GP.

EDIT: Some specialists I work with also have mentioned they enjoy being specialists because they didn't like bread & butter general dentistry. Some of the common complaints I've heard is not liking the multitasking that GPs must do in a busy office and having to do many different types of procedures. Also, a huge plus for being a specialist is having patients t'd up for procedures before they ever reach your door. The last one is huge because by the time I've referred a patient to my specialists they're already vetted, educated, and sold on the service I'm sending them there for.

brb need to go specialize.
 
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I am wondering how hard is it to find jobs at multiple offices assuming that a particular specialist is willing to travel up to 1-1.5 hrs one way?
It's not too bad if you live in a more populated area, where there are a lot of corp and general dental offices. With more offices that are looking to hire in-house specialists, you have more choices and don't have to drive very far to work. Last month, my corp fired one of the orthodontists in our group. This orthodontist got another job offer a few days later at another corp office down the street. He's in his mid to late 60s.
 
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I am wondering how hard is it to find jobs at multiple offices assuming that a particular specialist is willing to travel up to 1-1.5 hrs one way?

Might not be a far enough drive time. Worked in an office where the OS drove about 2.5 hours without traffic to get there.

Shadowed at an OS office where a prosth was working PT driving 2 hours without traffic.

It should not be understated how hard it can be to find a good office. Most single doctor offices don’t have enough patients to support any specialists (600-1500 active charts is the typical 1 doc, 1 FT equivalent hygienist private practice).
 
Why waste money and time for residency?
We can earn enough now after graduation, why to go with residency and school again? I understand it for OMFS but other specialties are...

All of the specialities are worth the time and effort. Ortho my not be worth the expense if you’re maxing out loans.
 
Might not be a far enough drive time. Worked in an office where the OS drove about 2.5 hours without traffic to get there.

Shadowed at an OS office where a prosth was working PT driving 2 hours without traffic.

It should not be understated how hard it can be to find a good office. Most single doctor offices don’t have enough patients to support any specialists (600-1500 active charts is the typical 1 doc, 1 FT equivalent hygienist private practice).

Oh my god. More than 2 hours? Were they paid well at least? I dont know if I can do that.
 
Oh my god. More than 2 hours? Were they paid well at least? I dont know if I can do that.
When I was still at Western Dental, I met an orthodontis who lived in Utah and flew to Arizona every month to work at one of the Western Dental offices. He had a private practice in Utah but he wanted to make more. That was more than 15 years ago when there weren't as many ortho programs as there are today.

My wife's co-resident has a practice in CA. He took the Nevada board. Nevada board used to be one of the most difficult boards to pass.....you had to set up and make denture on a live patient. After he passed the NV board, he flew to NV every month to place implants at a couple of dental offices there.

My brother is a GI doc. In addition to working at his regular job, he flies around the country to give lectures for the drug companies. There have been nights that he has to sleep at the hotels away from his wife and kids.

It's not uncommon for people to travel (either by cars or by planes) long distance to work. No pain no gain. Got to do whatever it takes to pay off the debts as soon as possible, especially when you are young and healthy. It's still much better than working as a GP.....practicing general dentistry is stressful. There are several newer cars (Tesla, Mercedes, Cadillac, Acura, even some Huyndai models) that have self-driving feature that significantly helps reduce the stress of the daily commute.
 
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When I was still at Western Dental, I met an orthodontis who lived in Utah and flied to Arizona every month to work at one of the Western Dental offices. He had a private practice in Utah but he wanted to make more. That was more than 15 years ago when there weren't as many ortho programs as there are today.

My wife's co-resident has a practice in CA. He took the Nevada board. Nevada board used to be one of the most difficult boards to pass.....you had to set up and make denture on a live patient. After he passed the NV board, he flew to NV every month to place implants at a couple of dental offices there.

My brother is a GI doc. In addition to working at his regular job, he flies around the country to give lectures for the drug companies. There have been nights that he has to sleep at the hotels away from his wife and kids.

It's not uncommon for people to travel (either by cars or by planes) long distance to work. No pain no gain. Got to do whatever it takes to pay off the debts as soon as possible, especially when you are young and healthy. It's still much better than working as a GP.....practicing general dentistry is stressful. There are several newer cars (Tesla, Mercedes, Cadillac, Acura, even some Huyndai models) that have self-driving feature that significantly helps reduce the stress of the daily commute.

Thank you so much for sharing your stories. You definitely answered my question. I now think that I should accept the reality and be ready to travel long distance in the future. I guess that may be the future of all specialists, traveling a lot to cover multiple offices.
 
Oh my god. More than 2 hours? Were they paid well at least? I dont know if I can do that.

they were paid a percentage of collections...just as most dentists are. Drive 2 hours and do no dentistry = maybe you get a daily base if you’re lucky.
 
they were paid a percentage of collections...just as most dentists are. Drive 2 hours and do no dentistry = maybe you get a daily base if you’re lucky.

driving two hours isn’t ideal, but it’s not that easy for a specialist to put together a full time, productive schedule at other people’s offices within 25 miles of his or her home.
 
Why waste money and time for residency?
We can earn enough now after graduation, why to go with residency and school again? I understand it for OMFS but other specialties are...

As others have said, people specialize for the professional distinction, interest in their field, to deliver a higher level of care, and for financial reasons.

Many dentists attend extensive CE throughput their careers; imo specializing is a way for people to front load their learning.

I think residency and specialties are good for the public because, quite honestly, there are too many chuckleheads in this field doing a disservice to patients by trying to be "super". Having said that, I'm regular a GP. I also sleep well at night knowing I don't practice out side my skill set.

I agree with yappy that going to residency will train specialists to deliver higher levels of care. However, I feel badly for the recent grads. I work with an orthodontist who owes over $800k student loans in my DMO. He was telling me how hard it is to justify the ROI especially in a saturated market, lower insurance reimbursements, and competition from various clear liners. There are a lot of alternatives to residencies such as various implant workshops/mini residencies, John Kois and Frank Spear learning institutes, and Cliff Ruddle and John West endo workshops. I was one of the "chuckleheads" that did full time GP endo for 9 years. My previous DMO flew me and my DA out of state (where I was also licensed) to do 8 molar endo cases and returned home that night (it was a 30 min flight). My head was probably too big as that DMO took great care of me until 3 years ago when they fired me.
 
Why waste money and time for residency?
We can earn enough now after graduation, why to go with residency and school again? I understand it for OMFS but other specialties are...

So. It's all about earning enough? That's it? No need for specialists since GPs can treat all dental procedures with their vast knowledge from DS, weekend CE and limited experience.

People choose residency (AEGD,GPR) to expand their knowledge base beyond what they were taught in DS. People choose specialty residencies due to interest in a certain field, possibly a dislike of doing general procedures .... and maybe more money.

Plenty of examples of GPs earning more than specialists and vice versa. But generally speaking .... the specialists on average are going to make more money.

Now. If you have to attend one of those super expensive residencies to be a specialist. From an economic perspective .... I agree with you.
 
I agree with yappy that going to residency will train specialists to deliver higher levels of care. However, I feel badly for the recent grads. I work with an orthodontist who owes over $800k student loans in my DMO. He was telling me how hard it is to justify the ROI especially in a saturated market, lower insurance reimbursements, and competition from various clear liners. There are a lot of alternatives to residencies such as various implant workshops/mini residencies, John Kois and Frank Spear learning institutes, and Cliff Ruddle and John West endo workshops. I was one of the "chuckleheads" that did full time GP endo for 9 years. My previous DMO flew me and my DA out of state (where I was also licensed) to do 8 molar endo cases and returned home that night (it was a 30 min flight). My head was probably too big as that DMO took great care of me until 3 years ago when they fired me.

800k is ridiculous. If you’re going above 400k total debt for ortho, I think it’s best to just find another specialty or stick to being a GP
 
It depends if money is what matters most to you. For me, even with a lot of debt, going into ortho means having a job I genuinely look forward to waking up for every day. I may not be rich, but I will be happy.
Are you suggesting there is more to life than this abstraction we call money?
 
A lot of schools really do not teach more in graduate programs. Just more patients.
Some schools are very good like Penn but a lot of them are just really a waste of time and money. Rethink about where you want to invest your youth time. I really do not recommend studying Prostho in Michigan or Florida, I am sure you will regret it.
Prostho and Perio at UCSF is also the same waste of time. Do your research before applying.
 
Not really. Insurance pays specialists significantly more to complete the treatment so the dental office wants to employ the specialist if the plan is for the specialist to be in-network at the office.

I agree that Insurance will pay specialists more but I'm not sure how significantly more you are mentioning. Bottom line for insurance companies is to make money. They don't make money by paying dentists what we deserve. "In network" means agreed upon discounts on insurance reimbursements usually 50-60% full fees. Insurance companies are savvy and can be ruthless. They know in a saturated market, they have the upper hand. I'm sure I'll get a lot of hateful pitchforks, but when times are tough and people worry about keeping their homes and their jobs, specialists will get hit harder than GPs.
 
A lot of schools really do not teach more in graduate programs. Just more patients.
Some schools are very good like Penn but a lot of them are just really a waste of time and money. Rethink about where you want to invest your youth time. I really do not recommend studying Prostho in Michigan or Florida, I am sure you will regret it.
Prostho and Perio at UCSF is also the same waste of time. Do your research before applying.

Where are you getting this information?

For those who say that the graduate school will teach you more. REALLY they do not.
Watch osteocom - The Dental Learning Platform
and you will understand a lot of techniques and much more than the graduate school.
Just give it a try

Your bias against graduate schools is obvious. What happened? Did you apply and weren't accepted?
 
Not really. Insurance pays specialists significantly more to complete the treatment so the dental office wants to employ the specialist if the plan is for the specialist to be in-network at the office.

What is the difference between insurance reimbursement for a prosthodontist on a crown or a denture versus a GP?
 
Where are you getting this information?



Your bias against graduate schools is obvious. What happened? Did you apply and weren't accepted?
Talking as a tenure track at this point. graduate years are fortunately passed.
Just think about your future.
 
What is the difference between insurance reimbursement for a prosthodontist on a crown or a denture versus a GP?

In my area in the Pacific NW with extreme satuation, the typical payout of most ins is about $1200 to $1800 a year. That doesn't cover much of Prosth where cases I'm aware of usually run about $20k to $50k. Unfortunately very few can afford Prosth in the area and much less during Covid.
 
Talking as a tenure track at this point. graduate years are fortunately passed.
Just think about your future.

My future is just fine. Been there. Done that. You just sound like you have an ax to grind. I will agree that attending residency AT ALL COSTS to become a specialist is questionable from an economic perspective. But to suggest that there are better ways ( FOR PROFIT dental CE, FOR PROFIT consultants) to learn specialized procedures as compared to actual graduate residencies. Nah.

If you strongly feel you have a point. Explain the reasoning behind your post. Right now it just sounds like an internet rant.
 
What is the difference between insurance reimbursement for a prosthodontist on a crown or a denture versus a GP?

Prosth is a bit different because they're usually dealing with multiple units. Since insurance limits the benefit to $X/year (where X is almost always less than $2,500), prosth are usually OON. I only know a handful of prosth, and all of them are OON.
 
Prosth is a bit different because they're usually dealing with multiple units. Since insurance limits the benefit to $X/year (where X is almost always less than $2,500), prosth are usually OON. I only know a handful of prosth, and all of them are OON.

Yeah this tracks with my experience. I don’t refer to prosth often at all, but when I do, it’s for full mouth rehab (VOD loss), or implant retained dentures. Usually insurance is a drop in the bucket and these patients are paying cash.
 
You never even give a try to what others say. This website teaches you perfectly. There are millions of free CE out there. If you do not try it you will not know. As someone said, it is just already ranting here.
 
For those who say that the graduate school will teach you more. REALLY they do not.
Watch osteocom - The Dental Learning Platform
and you will understand a lot of techniques and much more than the graduate school.
Just give it a try
You never even give a try to what others say. This website teaches you perfectly. There are millions of free CE out there. If you do not try it you will not know. As someone said, it is just already ranting here.
You need to work harder on your marketing technique.
 
Yeah this tracks with my experience. I don’t refer to prosth often at all, but when I do, it’s for full mouth rehab (VOD loss), or implant retained dentures. Usually insurance is a drop in the bucket and these patients are paying cash.

Do you not think you could handle full mouth crowns with loss of VDO? I understand the implant retained dentures.
 
I tend to disregard much of the BLS statistics in 2020, especially with the COVID pandemics.

How much do Periodontists and Endodontists make in today's climate? What's the job outlook for these 2 specialities in general?
 
Why waste money and time for residency?
We can earn enough now after graduation, why to go with residency and school again? I understand it for OMFS but other specialties are...
You're absolutely correct in asking why? Why someone would want to do just one thing in dentistry is mind boggling to me, but to each their own. I am a GP out of dental school 2.5 years with 2 practices doing well. Everybody has their own niche though, so I get why someone would want to specialize.
 
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I tend to disregard much of the BLS statistics in 2020, especially with the COVID pandemics.

How much do Periodontists and Endodontists make in today's climate? What's the job outlook for these 2 specialities in general?
It depends on how hard a perio/endo is willing to work and the number of offices he/she is willing to travel to. Specialists get paid by the number of days they work per month and the number of cases they they treat per day. The more offices they travel to, the more cases they will get, and the more money they will make. There is a wide range of incomes. Some work as little as 3-4 days/month and make less than a GP and some work as many as 6 days/week and make more than $1 million. Unlike general dentists, they usually don't work full time 5 days/week at 1 location because there are usually not enough patients....unless they are practicing in a town that has lot of referring GP offices and zero competing specialist.
 
You're absolutely correct in asking why? Why someone would want to do just one thing in dentistry is mind boggling to me, but to each their own. I am a GP out of dental school 2.5 years with 2 practices doing well. Everybody has their own niche though, so I get why someone would want to specialize.
People specialize because they don't like to do things that they hate. For me, I hate extractions, doing endo on a patient with limited mouth opening, packing cord and taking PVS impression, and doing fillings on crying kids with overprotective parents etc. I like doing the same easy thing every day....more predictable, fewer headaches, lower overhead, lower physical stress on my body, fewer complaints from patients and less chance of getting a lawsuit etc. And of course, $$$ is the number 1 reason.....for me...not sure about others.
 
It depends on how hard a perio/endo is willing to work and the number of offices he/she is willing to travel to. Specialists get paid by the number of days they work per month and the number of cases they they treat per day. The more offices they travel to, the more cases they will get, and the more money they will make. There is a wide range of incomes. Some work as little as 3-4 days/month and make less than a GP and some work as many as 6 days/week and make more than $1 million. Unlike general dentists, they usually don't work full time 5 days/week at 1 location because there are usually not enough patients....unless they are practicing in a town that has lot of referring GP offices and zero competing specialist.

Do you feel that most perios are moving towards travelling specialty in major cities? Or do you mean having a private office and going to GPs to ask for referrals?
 
Do you feel that most perios are moving towards travelling specialty in major cities? Or do you mean having a private office and going to GPs to ask for referrals?
All the periodontists I know do both: work part time at their own private offices and travel to work at GP offices or at corp offices. This is not the new trend. Most of these periodontists graduated 15-20 years ago. I am an orthodontist and I too have to travel. It only takes 20-30 minutes to place an implant, 30-45 minutes to do 1 quardant osseous surgery, 30-45 minutes to do a connective tissue graft etc. They can easily book 8-9 of these cases in one 8-hour day and produce the same as what an average GP can produce in 1 week. The overhead to keep their offices opened only 1-2 days/wk is also much less than if they have to open their offices 5 days/wk. And for the other free days in the week, they travel to work at other offices to make more money. The GP owners and the corp offices usually save for them at least 5-6 cases to keep them happy.
 
Travelling to different offices is not bad. I'm covering for another Corp ortho .... so for the next couple of months .... I'm travelling to his 3 ortho locations. In addition to my 3 Corp offices .... that's 6 different locations.

I actually enjoy the variety. Different patients. Different staff. Different dentists. Breaks the week up. Computer systems are all the same. Plug and play. All these offices are 45-65 minutes each way. I enjoy the drives. Listen to spotify. Just enjoy the journey.

I purposely bought a little fuel efficient compact suv for the commutes. In a couple of yrs I will trade the car in for a small inexpensive electric car.

The major issue with having multiple private offices is the LEASE. I've made the mistake in the past of leasing a retail space only to use it 2-3 days per week. The office just sits empty the other days. Not very efficient. If you have multiple private locations as a specialist .... might be better to share space with another specialist. Just makes better financial sense with less overhead. Sharing space with a GP may bring out some referral politics with other GPs. Hell ...just having your specialty office right NEXT door to a GP can bring out some referral politics. Thank goodness I don't have to deal with these political referral issues anymore.

So. Travelling as a specialist shouldn't be looked at negatively. You're diversified which spreads the economic risk.
 
People specialize because they don't like to do things that they hate. For me, I hate extractions, doing endo on a patient with limited mouth opening, packing cord and taking PVS impression, and doing fillings on crying kids with overprotective parents etc. I like doing the same easy thing every day....more predictable, fewer headaches, lower overhead, lower physical stress on my body, fewer complaints from patients and less chance of getting a lawsuit etc. And of course, $$$ is the number 1 reason.....for me...not sure about others.

well you could elect to refer extractions and endo if you wanted to as a GP. Also I agree that money is the goal but the sky is the limit if you’re a successful GP having multiple practices. It’s hard to own multiple specialty clinics. I haven’t seen it done anywhere where I’m from.
 
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