Working at a Dental Mill

[SugarNaCl]

After graduation in many many years 😉 eventually, I expect rather enormous debt. Of course will have no means to start up practice right out of school, so I just wanted to explore options WELL before I had to.

These dental mill places from what I have heard are not much fun to work at, but I am uncertain how they work since they all say you have to have an "entrepreneurial attitude". I'm uncertain if that just means willing to work hard to establish a clientele for the company or if that means you have to dig to find your own patients.

Also, it seems the salary potential is WAY off. 200K+ isn't even the average among dentists that own private practices.

I guess my question is how much can one expect to make if they work only 40 hours/week like a normal job?

What are these places like?

Thanks

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[denturist]

SugarNaCl, just get on with a dentist that's close to retirement or wants to slow down. Check with some denturist practices. Some are in need of good dentist. Thanks for being here---gary

 

[armorshell]

After graduation in many many years 😉 eventually, I expect rather enormous debt. Of course will have no means to start up practice right out of school, so I just wanted to explore options WELL before I had to.

These dental mill places from what I have heard are not much fun to work at, but I am uncertain how they work since they all say you have to have an "entrepreneurial attitude". I'm uncertain if that just means willing to work hard to establish a clientele for the company or if that means you have to dig to find your own patients.

Also, it seems the salary potential is WAY off. 200K+ isn't even the average among dentists that own private practices.

I guess my question is how much can one expect to make if they work only 40 hours/week like a normal job?

What are these places like?

Thanks

That's where you should start to wonder. If working as an associate at a mill practice regularly paid $$$, you'd think more people would be happy about it. "Entrepreneurial attitude" probably means "willing to compromise care to grind through patients faster."

I mean, or you could just go work for a denturist. I'm on dentaltown and that's seriously the way to go according to most of the practicing dentists there.

 

[toofshucker]

That's where you should start to wonder. If working as an associate at a mill practice regularly paid $$$, you'd think more people would be happy about it. "Entrepreneurial attitude" probably means "willing to compromise care to grind through patients faster."

I mean, or you could just go work for a denturist. I'm on dentaltown and that's seriously the way to go according to most of the practicing dentists there.

Yeah, I think "entrepreneurial attitude" means crown everything.

 

[briansle]

How about Implanting Everything?

 

[NileBDS]

Here's another "mill" thread that was going on a while back, which has helped me gain some perspective on what goes on. This office chain is also considered to be one of the high-end mills, so to speak.

 

[charlestweed]

There is no long-term contract. You only need to give them a week notice (or just don't show up for work) if you want to quit your job. You don’t have to do whatever they (office manager and regional manager who only have HS diploma) want you to do…it is your license that you are protecting, not theirs.

NO non-compete clause. You can set up your own practice and work 1 or 2 days/ a week at a dental mill. When your practice starts to grow you can give them your notice.

How about Implanting Everything?

A lot of dental mills I know do not do implant placement and restoration in their offices. This is because of high turnover of dentists and specialists. Dentist who works for a mill either try to convince his/her patients to get a bridge(s) or refer them out to private OS or perio office for implant(s).

 

[MsPurtell]

Can anyone else with experience add to this thread? I'm in this position right now. I have started looking for a job and I'm getting a lot of calls from mills. We were always told in school that this was NOT the way to go. It's true that there claims seem outrageous....like dentists averaging 250K.

 

[charlestweed]

In California, each dental mill office has at least 2 dentists: one is a managing dentist (must be fast and have good people skills) and the other one is a FT or PT associate dentist (usually a new grad). The managing GP gets a daily rate + monthly bonus (based on production)= approx. 20k/month. The associate GP only gets a daily rate, $450-$600/day = approx. 10-11k/month. No holiday pay.

Pros:
-Good starting salary for GPs….a little bit higher than a lot private practices. Pay specialists (especially OMFS and ortho) very well.
-Lots of part-time positions avail. It's great for DDS who wants to earn extra cash to support his/her new practice.
-Good documentation. Their offices constantly get audited by dental insurance companies; therefore, they make sure that their dentists document everything…ie probing depth charting, update med hx every 6 months, new radiograph every 6 months etc. Like us, they try to do everything to avoid malpractice lawsuit.

Cons:
- Overbooking….most GPs work 9 hrs straight and eat lunch in a hurry. Patients get angry all the time.
- Treat mostly HMO patients… dentists have to upgrade silver to composite, PFM to PFG, deep clean w/ Arestin etc.
- You have to re-do a few cases that were not done properly by previous dentists (fractured PFM porcelain, open margin crown, broken fillings etc).
- Have to deal with bossy manager and regional manager who only have HS diploma.
- Old and low-tech instruments and equipments.
- Managing dentists have to attend stupid meetings once a month w/ company VP, President and CEO.
- Lazy DA's and RDA's. Dentists don't have the power to hire or fire them.

These are pros and cons that my GP co-workers have shared w/ me. I've worked for a dental mill as an associate orthodontist for 6 years.

 

[DrJeff]

Can anyone else with experience add to this thread? I'm in this position right now. I have started looking for a job and I'm getting a lot of calls from mills. We were always told in school that this was NOT the way to go. It's true that there claims seem outrageous....like dentists averaging 250K.

Ask if that's the associate or the senior partner

 

[sgv]

I am working with many dental milling machines. I mostly on CORiTEC 340i machine. The good thinks about that machine is Space saving, easy installation and very compact. Is has automated 10x tool changer & 4-axis milling .

You're an idiot...or a robot

 

[shuckin wizzies]

I have worked with Aspen for over 2 years. I worked as an associate in private practice before that. My experience with Aspen has been good. I'm assuming by "mill" you are inferring a large dental chain. I am the only full time dentist at my office, so it has the feel of a small practice and I spend a lot of my time small talking with my patients. I'm busy and work my tail off, but it's far from a "factory" or a "mill". I think charlestweed is pretty accurate on the pros and cons. The high pay has more to do with the fact that the office is open M-F, and 1 Sat a month (most dentists work 4 days a week). That's an extra 20% right there.

I have never been told by Aspen to over treat a patient. My treatment plans have always been between me and the patient. I have done some pro bono work for people down on their luck. I see more over treating happening in solo practice than anywhere else.

Finding a old dentist that is ready to retire sounded like the right thing to me, but it was a terrible experience. A lot of these older dentists don't understand a new grads financial needs. The dentist that I worked for had never had an associate, and thought that $4,000 per month was average for new grads. When the student loan payment of $3,500 kicks in, it's not so funny anymore.

I'm not trying to sell anyone on Aspen, or any other large dental chain for that matter. But it is a viable option for new grads, and contrary to popular belief it is not selling your soul for money.

 

[sgv]

I have worked with Aspen for over 2 years. I worked as an associate in private practice before that. My experience with Aspen has been good. I'm assuming by "mill" you are inferring a large dental chain. I am the only full time dentist at my office, so it has the feel of a small practice and I spend a lot of my time small talking with my patients. I'm busy and work my tail off, but it's far from a "factory" or a "mill". I think charlestweed is pretty accurate on the pros and cons. The high pay has more to do with the fact that the office is open M-F, and 1 Sat a month (most dentists work 4 days a week). That's an extra 20% right there.

I have never been told by Aspen to over treat a patient. My treatment plans have always been between me and the patient. I have done some pro bono work for people down on their luck. I see more over treating happening in solo practice than anywhere else.

Finding a old dentist that is ready to retire sounded like the right thing to me, but it was a terrible experience. A lot of these older dentists don't understand a new grads financial needs. The dentist that I worked for had never had an associate, and thought that $4,000 per month was average for new grads. When the student loan payment of $3,500 kicks in, it's not so funny anymore.

I'm not trying to sell anyone on Aspen, or any other large dental chain for that matter. But it is a viable option for new grads, and contrary to popular belief it is not selling your soul for money.

http://forums.studentdoctor.net/threads/everything-you-need-to-know-about-aspen-dental.980042/

http://www.pissedconsumer.com/reviews-by-company/aspen-dental.html

edit: it looks like you're already familiar with the first link...

 

[Daurang]

My brother works at a dental mill in NorCal. Everyone must get crowns, sc/rp, peridex irrigation, and periochip. If they refuses, no regular prophy and show them the door! All dentists and hygienists are on 30% commission.

 

[Dr. Dai Phan]

Greetings,

Regardless of your employer (private, corporate...) you need to be in an enviroment where you feel good deep inside that you have provided the right and proper treatment. If you are pushed to overtreat, rush each patient to maximize numbers of patients seen per hour , one day it will come back to haunt you. I guarantee it. DP

 

[ortho lurker]

In California, each dental mill office has at least 2 dentists: one is a managing dentist (must be fast and have good people skills) and the other one is a FT or PT associate dentist (usually a new grad). The managing GP gets a daily rate + monthly bonus (based on production)= approx. 20k/month. The associate GP only gets a daily rate, $450-$600/day = approx. 10-11k/month. No holiday pay.

Pros:
-Good starting salary for GPs….a little bit higher than a lot private practices. Pay specialists (especially OMFS and ortho) very well.
-Lots of part-time positions avail. It's great for DDS who wants to earn extra cash to support his/her new practice.
-Good documentation. Their offices constantly get audited by dental insurance companies; therefore, they make sure that their dentists document everything…ie probing depth charting, update med hx every 6 months, new radiograph every 6 months etc. Like us, they try to do everything to avoid malpractice lawsuit.

Cons:
- Overbooking….most GPs work 9 hrs straight and eat lunch in a hurry. Patients get angry all the time.
- Treat mostly HMO patients… dentists have to upgrade silver to composite, PFM to PFG, deep clean w/ Arestin etc.
- You have to re-do a few cases that were not done properly by previous dentists (fractured PFM porcelain, open margin crown, broken fillings etc).
- Have to deal with bossy manager and regional manager who only have HS diploma.
- Old and low-tech instruments and equipments.
- Managing dentists have to attend stupid meetings once a month w/ company VP, President and CEO.
- Lazy DA's and RDA's. Dentists don't have the power to hire or fire them.

These are pros and cons that my GP co-workers have shared w/ me. I've worked for a dental mill as an associate orthodontist for 6 years.

This basically sums it up. I overhear the office managers lament about how many re-do procedures must be done after a GP doctor leaves yet the office still has no problem finding new patients, I think it's because they accept the low-end insurance that private offices do not accept? I think these re-dos are due to the GP doctor rushing, inexperience, or possibly poor quality labs/materials?

 

[briansle]

These mills exist for the same reason why McDonald's is able to exist. The public doesn't know any better.
Both are extremely bad for your health, but people still go to them.
I'd like to see how the Big Mac is created from beginning to end. From the steroid antibiotic injected beef, to all the other crappy ingredients Americans munch on.

Re-dos however are the GP's fault. Not a material problem, just rushing, inexperience, and overall lack of concern. But this is the kind of environment that Corporate dentistry fosters. I could tell you a story about fighting the good fight, but that would be an entirely new thread.

But I don't think the future belongs to these mills. In the internet age, with "Yelp" and other sources for review, its harder to scam the public. Like most things in corporate America, they don't think long term. Just how to meet their production goals for that month. This type of behavior backfires in the long run. We've seen this already happen in 2008. Who ever thought Lehman bros would fail? The future belongs to enterprising GP's who are surgically competent to place implant retained prosthesis for the retiring baby boomer pop, opening up 3 to 4 group practices, and eventually selling them to up and coming dentists.

 

[ortho lurker]

opening up 3 to 4 group practices, and eventually selling them to up and coming dentists.

You are on the right track. I personally think that the future will be selling successful group practices to the chains however.

 

[briansle]

You are on the right track. I personally think that the future will be selling successful group practices to the chains however.

yea, we call those guys "sell outs"plus chains have found out its cheaper to just build out their own.
take a little less. Be proud of what you built. And hand over your life's work to the new kid. For the sake of your patients and the profession.

 

[Silent Cool]

These mills exist for the same reason why McDonald's is able to exist. The public doesn't know any better.
Both are extremely bad for your health, but people still go to them.
I'd like to see how the Big Mac is created from beginning to end. From the steroid antibiotic injected beef, to all the other crappy ingredients Americans munch on.

Re-dos however are the GP's fault. Not a material problem, just rushing, inexperience, and overall lack of concern. But this is the kind of environment that Corporate dentistry fosters. I could tell you a story about fighting the good fight, but that would be an entirely new thread.

But I don't think the future belongs to these mills. In the internet age, with "Yelp" and other sources for review, its harder to scam the public. Like most things in corporate America, they don't think long term. Just how to meet their production goals for that month. This type of behavior backfires in the long run. We've seen this already happen in 2008. Who ever thought Lehman bros would fail? The future belongs to enterprising GP's who are surgically competent to place implant retained prosthesis for the retiring baby boomer pop, opening up 3 to 4 group practices, and eventually selling them to up and coming dentists.

briansle,

do you foresee the relative death of specialty dentistry?--such that the brick and mortar specialist becomes a thing of the past? Also, do you foresee the end of the solo practice doc?--such that the future is multi-spec. group practice vs. corporate offices?

 

[briansle]

Silent Cool , I appreciate the questions. But by no means am I a forecaster for the future of our profession. Just was posting my personal opinions on mills, as someone who has experience with them, and their future in dentistry. I just feel that corporate offices seem to think that the public is absolutely stupid. And I can't blame them since we do feed our kids Mickey Ds, dairy queens, and other shortcuts to a nice life of Diabetes Type II.

I understand that dentistry has its origins in the barbershop. As long as corporate america can't dominate the hair cutting industry, they won't b able to take dentistry for the same reasons. I mean who ever goes to Supercuts, seriously? You know they're gonna mess up your hair. You go to the same barbershop you always go to. And its usually run by a small business owner. That's pretty much the past/future of dentistry in my humble opinion.

 

[ortho lurker]

I understand that dentistry has its origins in the barbershop. As long as corporate america can't dominate the hair cutting industry, they won't b able to take dentistry for the same reasons. I mean who ever goes to Supercuts, seriously? You know they're gonna mess up your hair. You go to the same barbershop you always go to. And its usually run by a small business owner. That's pretty much the past/future of dentistry in my humble opinion.

Interesting point you made about the comparisons to barber shops and I do agree that corporate dentistry won't completely take over like pharmacy. However, barber students don't have $300,000 in student debt (and rising) that dental students face so future dental grads may not have the same opportunity to open their own stand-alone offices. Looks like group practices will be the wave of the future.

 

[charlestweed]

In California, each dental mill office has at least 2 dentists: one is a managing dentist (must be fast and have good people skills) and the other one is a FT or PT associate dentist (usually a new grad). The managing GP gets a daily rate + monthly bonus (based on production)= approx. 20k/month. The associate GP only gets a daily rate, $450-$600/day = approx. 10-11k/month. No holiday pay.

Pros:
-Good starting salary for GPs….a little bit higher than a lot private practices. Pay specialists (especially OMFS and ortho) very well.
-Lots of part-time positions avail. It's great for DDS who wants to earn extra cash to support his/her new practice.
-Good documentation. Their offices constantly get audited by dental insurance companies; therefore, they make sure that their dentists document everything…ie probing depth charting, update med hx every 6 months, new radiograph every 6 months etc. Like us, they try to do everything to avoid malpractice lawsuit.

Cons:
- Overbooking….most GPs work 9 hrs straight and eat lunch in a hurry. Patients get angry all the time.
- Treat mostly HMO patients… dentists have to upgrade silver to composite, PFM to PFG, deep clean w/ Arestin etc.
- You have to re-do a few cases that were not done properly by previous dentists (fractured PFM porcelain, open margin crown, broken fillings etc).
- Have to deal with bossy manager and regional manager who only have HS diploma.
- Old and low-tech instruments and equipments.
- Managing dentists have to attend stupid meetings once a month w/ company VP, President and CEO.
- Lazy DA's and RDA's. Dentists don't have the power to hire or fire them.

These are pros and cons that my GP co-workers have shared w/ me. I've worked for a dental mill as an associate orthodontist for 6 years.

I posted this in 2007. Things have changed since. Now, most corporate chains in CA pay the dentists the percentage of the collection, which is much worse than the guaranteed daily pay. Last week, I asked a GP friend, who works at the same dental chain with me, to join me for lunch. He told me that he couldn’t. I asked him why not because I saw him standing around doing nothing. My friend replied to me that if he went for lunch, the staff would assign the patients to the managing GP, who also worked there on that day…and my friend would lose the production. Low production = lower pay. That’s just sad.

 

[Silent Cool]

Silent Cool , I appreciate the questions. But by no means am I a forecaster for the future of our profession. Just was posting my personal opinions on mills, as someone who has experience with them, and their future in dentistry. I just feel that corporate offices seem to think that the public is absolutely stupid. And I can't blame them since we do feed our kids Mickey Ds, dairy queens, and other shortcuts to a nice life of Diabetes Type II.

I understand that dentistry has its origins in the barbershop. As long as corporate america can't dominate the hair cutting industry, they won't b able to take dentistry for the same reasons. I mean who ever goes to Supercuts, seriously? You know they're gonna mess up your hair. You go to the same barbershop you always go to. And its usually run by a small business owner. That's pretty much the past/future of dentistry in my humble opinion.

It's funny you mention that because when I was in California, I actually went to a local Supercuts and got some of the best haircuts of my life. Just sayin'. And it was a good deal. I'm not paying $40-50 for a haircut.

 

[Silent Cool]

I posted this in 2007. Things have changed since. Now, most corporate chains in CA pay the dentists the percentage of the collection, which is much worse than the guaranteed daily pay. Last week, I asked a GP friend, who works at the same dental chain with me, to join me for lunch. He told me that he couldn’t. I asked him why not because I saw him standing around doing nothing. My friend replied to me that if he went for lunch, the staff would assign the patients to the managing GP, who also worked there on that day…and my friend would lose the production. Low production = lower pay. That’s just sad.

That's nuts. So he's potentially taking home less than $450 per day? How many years has this guy been out? Do you know what his debt load is like? Does this chain offer any benefits?

I have a friend working for Gentle Dental in Maine, because it was the best place for her to find work. I think she may have recently traded up (ironically) to working for one of the public health clinics, but I'm not sure what she was paid.

 

[briansle]

It's funny you mention that because when I was in California, I actually went to a local Supercuts and got some of the best haircuts of my life. Just sayin'. And it was a good deal. I'm not paying $40-50 for a haircut.

we'll be the judge of that. post a picture of yourself.🙂

 

[Daurang]

It's funny you mention that because when I was in California, I actually went to a local Supercuts and got some of the best haircuts of my life. Just sayin'. And it was a good deal. I'm not paying $40-50 for a haircut.

Why is Supercuts in Cali so expensive? It's $20 when everywhere else nearby is $6-$7. This is in San Jose and Anaheim.

 

[Silent Cool]

Why is Supercuts in Cali so expensive? It's $20 when everywhere else nearby is $6-$7. This is in San Jose and Anaheim.

You mean independent shops are 6-7 bucks? I've never heard of a cut costing that little. In Seattle the indies were around 13-15. I actually thought 20 was a good deal. The independent places in Boston cost ~40 bucks!

 

[Ferneezy]

i throw down $30 for a cut plus tip. looking really, really...really, ridiculously good looking isn't cheap.

take a little less. Be proud of what you built. And hand over your life's work to the new kid. For the sake of your patients and the profession.

this sounds like the kind of dental entrepreneurial model talondriver advocates in hammer's thread. i can get behind this.

 

[charlestweed]

That's nuts. So he's potentially taking home less than $450 per day? How many years has this guy been out? Do you know what his debt load is like? Does this chain offer any benefits?

I have a friend working for Gentle Dental in Maine, because it was the best place for her to find work. I think she may have recently traded up (ironically) to working for one of the public health clinics, but I'm not sure what she was paid.

He graduated in 2003. Currently, he and his wife (also a GP) both work part time for the chains and work part time at their own practice in Orange County. Right after graduation, they worked for the chains in the Bakersfield area. According to him, they did very well up there. They bought a brand new 3000+sf house for only $350k. They then realized it was so boring living in Bakersfield. They later gave up their house (foreclosure) and moved to Orange County, where most of his friends and relatives live. Despite the decline in income, my friend still feels he is very fortunate to be a dentist. Many of his engineer friends have lost their jobs.

I am not sure if he currently makes more or less than $450 a day. Like any other dental offices, there are good days and there are bad days at this particular chain office. He said that he prefers getting paid the guaranteed daily rate like in the old days. We, dentists, don’t usually talk about our salaries. To be honest, I don’t even know how much my own sister makes at her own GP office.

Oh, my barber charges me $8 and she also shampoos my hair. I give her $20 and she’s extremely happy. Her son is also a dentist, who recently spent $400k to build a brand new dental office in TX.

 

[Silent Cool]

He graduated in 2003. Currently, he and his wife (also a GP) both work part time for the chains and work part time at their own practice in Orange County. Right after graduation, they worked for the chains in the Bakersfield area. According to him, they did very well up there. They bought a brand new 3000+sf house for only $350k. They then realized it was so boring living in Bakersfield. They later gave up their house (foreclosure) and moved to Orange County, where most of his friends and relatives live. Despite the decline in income, my friend still feels he is very fortunate to be a dentist. Many of his engineer friends have lost their jobs.

I am not sure if he currently makes more or less than $450 a day. Like any other dental offices, there are good days and there are bad days at this particular chain office. He said that he prefers getting paid the guaranteed daily rate like in the old days. We, dentists, don’t usually talk about our salaries. To be honest, I don’t even know how much my own sister makes at her own GP office.

Oh, my barber charges me $8 and she also shampoos my hair. I give her $20 and she’s extremely happy. Her son is also a dentist, who recently spent $400k to build a brand new dental office in TX.

Yeah, Bakersfield sucks. But the market there is a lot less competitive.

Wow, I have NEVER heard of an $8 haircut. It must be a So-cal thing. I'll bet they drop their prices low so they can collect tips in cash and not report them, because the CA taxes are so high. Clever thinking. The cheapest I have ever been charged for a haircut (pre-tip) was $13.

 

[ortho lurker]

Yeah, Bakersfield sucks. But the market there is a lot less competitive.

Wow, I have NEVER heard of an $8 haircut. It must be a So-cal thing. I'll bet they drop their prices low so they can collect tips in cash and not report them, because the CA taxes are so high. Clever thinking. The cheapest I have ever been charged for a haircut (pre-tip) was $13.

Yeah, my barber also charges $8 a haircut in So Cal where cash is king.

 

[wb1]

Hmm, $450 per day for dentist working in dental mill?
let's just say this is for 8 hrs work. 480/8= 56.25 per hr.

what about gp that work at her own practice?

My mechanic charge a labor rate of $90/hr and the only loan he took out was to buy the shop.

 

[TheWeeIceMan]

Hmm, $450 per day for dentist working in dental mill?
let's just say this is for 8 hrs work. 480/8= 56.25 per hr.

what about gp that work at her own practice?

My mechanic charge a labor rate of $90/hr and the only loan he took out was to buy the shop.

Your mechanic isn't taking home $90/hr. You don't pay overhead working for a dental mill.

 

[Cello]

Mechanics wish they took home $90/hr. You ever notice how many mechanics drive beaten up Trans Ams and Camaros?

 

[wb1]

Not my mechanic! 🙂

One thing about working your butt off and saving for the raining day retirement funds, there should be a good balance to enjoy life along the way with spending hard earned money throughout out the working career.