working in corporate vs private practice-how to choose for a new grad

Discussion in 'Dental Residents and Practicing Dentists' started by cherryblossom, Aug 4, 2012.

  1. cherryblossom

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    If you were a new grad and had the choice of working in a fee for service emergency clinic vs a corporate practice, where would you choose? I'm thinking corporate offers more mentoring so it may be better for a new grad? but a fee for service practice you can earn a lot more since there is no medicaid, etc.
     
  2. ziptree

    ziptree DDS
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    Don't support corporate dentistry. IMO, corporate dentistry does nothing for the future of the profession. Corporate dentistry offering mentoring? I don't think so, unless you mean they'll have the money to pay for your CE courses.

    Don't follow the money -- provide the same quality of care for your patients that you would put in your own familys' mouths and the money will come.
     
  3. HupHolland

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    AGREE 100%!

    Corporate style practices are bringing down the profession. You have the ability to not contribute to this. Also, many private practice owners frown upon those that have worked in the corporate setting and will pass on hiring in favor of someone with experience in a more traditional, patient-centered private practice.

    In other words, think of a corporate job as a black mark on your resume when applying for a better position later.

    Hup
     
  4. Subcharge

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    screw corporate dentistry. lets make it our explicit goal to bring em down!!!
     
  5. Halcion

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    I agree with what everyone has said. However, with the state of the economy, and fewer dentists retiring as planned, many are unable to hire associates and keep them busy. I worked in a private practice setting for 3 months before switching to corporate. I loved everything about the practice I was in, the dentist I worked with, and the patients that I saw, but we parted ways because the office wasn't busy enough for two doctors, leading to not enough income to support myself and my loan payments. Unfortunately, many people are running into similar situations. You have to do what you have to do. And just because you are working in corporate does not mean you have to compromise your standard of care. I do not, and my patients love me for it. Granted, corporate may not always like the fact that I don't have huge production days every single day, but I know that I am doing good work, and I am able to sleep at night.

    Having worked in corporate now for almost a year, I can honestly say I have thoroughly enjoyed my experience. I have worked alongside two dentists with ample experience who I learned a great deal from before being assigned to my own office as the only dentist.

    But I agree whole-heartedly with corporate offices bringing down dentistry. But until the economy picks up and people can pay for the recommended treatment, and dentists can afford to retire or hire an associate, many new grads and others included are forced to work in a corporate setting.
     
  6. HupHolland

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    Kudos to you for not compromising your standard of care; however, most new grads cave because don't know any better and have dollar signs in their eyes.

    But, as long as people work for these corporations, they will continue to exist. It's as simple as that. The general public will continue to flock to them because of their "free exam and x-ray" promotions. Little do they know, they will be diagnosed with conditions they don't have (moderate/severe chronic perio) and overtreated (SRP). It's disgusting.

    I made a choice to never work for a corporate dental practice, and instead work for a patient centered, relationship based private office. When I leave the office everyday, I feel good knowing that I'm not leading dentistry down the same path of our optometrist colleagues.

    Hup
     
  7. charlestweed

    Dentist Gold Donor Verified Expert Verified Account 10+ Year Member

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    :thumbup:It's easy for the predents and dental students to say bad things about corporate offices when they haven't had to deal with the reality of paying back the student loans and supporting the family. Good dentistry depends on the doctor's hand skills, clinical judgement and his/her ethical standard, not on where he/she works. I've seen bad dentistry and over-diagnosed tx plans that come from many private practices as well.
     
  8. charlestweed

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    Why blame the corporate office for over-treatment planning? The corporate owners and the office managers are not the one who do the diagnosis and tx planning. The people you should blame are the licensed associate dentists who work there. They are the ones who do all the diagnosis and tx planning. If the associate dentists think the company they work for is forcing them to do unethical work, they don't have to stay there. They can leave anytime.

    Corporate offices continue to exist not because new grads continue to apply for jobs there. They continue to exist because they offer things that many private practices don't offer....such as accepting HMO plans and medicaid, flexible payment plans, late office hours, weekend hours, multispecialty services etc. If you want to destroy corporate offices, then start offering the same things that the corporate offices are offering.
     
  9. Halcion

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    Although I agree with majority of what you mentioned, there are actually corporations out there who do not allow the new grad docs to do their own dx and tx planning. I interviewed for a job that flat out told me I wouldn't be able to do my own tx planning... that they would "over see me, and guide me, and do a lot of the treatment planning, especially at the beginning." Screw that. Needless to say I did not even consider that place. Some corporations tell you what to do even if you don't agree, and if you don't do it, they get rid of you and find someone who will... I hear of this mainly with pediatric corporate mills, but it does happen in other corporate offices/big group practices. And as far as over-diagnosing... it happens everywhere... probably a bit more in corporate than private practice. I'll give an example... the hygienists do majority of the perio charting... I do it though if I get the chance because I know that they will have 5 mm pockets when in fact they are 3 mm because they are hard pressed for diagnosing SRP because corporate wants them to be doing SRP. I had a 22 year old come in the other day who had a history of SRP. I had never seen this patient before. It was clear to me that this patient did not need SRP. They had 2 isolated 4mm pockets at their last exam and recommended local SRP 1-3 teeth. No associated bone loss whatsoever, no calculus... mild inflammation... pseudo pocket, due to residual cement from a crown that was done. Anyways, the patient didn't need SRP or maintenance and the front office tries to tell me the patient has a history of SRP so they have to be maintenance. Not if I don't think they do. They don't like my answers all the time, but it's not their license. If you are a new grad and go into corporate, you really have to hold your ground and not cave in to what big money corporate CEOs want you to do. No one can ever fault you for doing what you think is right because it is your license on the line, and if they do, you don't want to work for them anyway. And as far as the money is concerned... in corporate you have to work your tail off to make what your daily guarantee was for 3 months or whatever the agreement is. I go home exhausted on days where I did a ton of work, but because many patients are HMO, I will do $6000 (FFS) and produce maybe $2000 (HMO) and get 27-29% of that. Money is important, but it isn't everything. For me, it has been the experience... getting my speed and efficiency up, doing tougher extractions I might not have done otherwise, but we have an in-house oral surgeon who can bail me out if it needed. Fortunately, I've only had to be bailed once. I've learned a ton of ortho tx planning by chatting with our in-house orthodontist over lunch... lots things I wouldn't have had the opportunity to do. And I am getting to see a ton of kids because many general dentists with the corporation I work for won't see them because they are HMO. I do $500 FFS tx and get maybe $100 production if I'm lucky. But for me, I'm getting to work on kids that no one else will see. And when days are slow, $100 is better than $0. I still refer out when necessary, but I get the experience of doing lots of SSC/pulps, extractions, and space maintainers. Anyways, I understand that as long as people like me keep working for these big companies, they will still be around. Are they bad for dentistry as a whole? Yes. But I wouldn't have a job to pay the bills otherwise right now. So until there are private practice jobs available, practices for sale, loans to be given to start your own practice, corporate dentistry will still be around.
     
  10. HupHolland

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    :thumbup: respect.

    Hup

    ps - I don't know what area of the country you are in, but I'm ~1 month into my first associateship and produce on average $3000/day and take home 27% of that.... so close to $900/day or $180k/year working 4 days/week and 2 weeks unpaid vacation. I do all my own tx planning, work 8-5pm with 1 hour for lunch and never feel like I'm on roller skates. I'm not posting this to brag, but instead to prove to all those that think corporate is the only way to go out the gates that there are GOOD OPPORTUNITIES in private practice for new grads!
     
    #10 HupHolland, Aug 8, 2012
    Last edited: Aug 8, 2012
  11. Halcion

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    You are in a very good situation.

    It would have been great if my first associateship straight out of school had worked out. It was 4.5 days, 1 hour lunch, 30% collections (98-100% collections/month average at the office). But there just weren't enough patients to keep me busy.

    I currently work for a corporate dental practice as the only dentist (which is a huge plus in corporate) in the office with 1 full-time hygienist, 1 part-time hygienist, and 2 assistants. I work 5 days a week. That is the one thing I would change... I would love to cut back to 4 or 4.5 days. I am paid 27% of production. If I diagnosed what many dentists do who are in corporate for the money, I could make a ton, but I prefer quality over quantity. You are definitely making more than me, which is great that you have such a wonderful opportunity. I'm kinda jealous :) I am averaging probably around $600/day (take-home) which is not comparable to a good private practice opportunity without HMO plans. I must say for being only 15 months out of school, and doing $600/day on HMO plans, is not too bad. But again, there are days I make $1400 and there are days I make $300. It all averages out. I wish I would be getting more experience with molar root canals, but for me, it's not very motivating when an HMO plan only allows us to charge a patient $125 for a molar root canal. The best part is doing full mouth extractions. I did 12 extractions the other day and delivered an immediate denture. Thank goodness they were really easy to get out because I made $120 off the extractions. Yes, $10 per extraction. It sucks, but I am getting valuable experience and doing things I'm not sure I would be doing if I were an associate in a private practice, where the owner dentist would get all the good cases. I guess it just depends. But kudos to you. I wish I had an opportunity like you. But for now mine is good because I am applying to pediatric residency right now, and hopefully that works out. If not, I will be looking to buy or start my own practice in a year or two.
     
    #11 Halcion, Aug 9, 2012
    Last edited: Aug 9, 2012
  12. yappy

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    Just a predent here. But since we're talking about corporate I thought I would chime in my experience.

    The other day I got the opportunity to speak with a new grad MBA who got a new job - you guess it - at a corporate dental chain. He told me a little about his new job and their structure. He said they're having difficult growth because of poor dental ins reimbursement. Their model being that they accept a lot of poor ins and try to spread losses via their size and decrease overhead through their buying power.

    It made me think that if dentists could figure out a way to incorporate some level of poor paying insurance into their practices it would take even more steam away from their offices. Indeed, a board of dentists in my community are doing just that. They started a cash/caid/care office that runs a low overhead and they each spend a little time there each week seeing this population. It's a tight ship and they even incorporate students to help out with sterilization so they don't need to employ anyone.

    I guess the take home I got was that the corporate guy wasn't evil. Through our discussion it became clear that he thought he was filling a need in the market. He shared that later on he plans to get his MPH and plans to go on to bigger and better things in public health but this corporate job was just a job. It seems like if dentists traditional offices cannot see these patients someone else will find a way. I think setting up a low cost community clinic is a worthy project in that it helps out that patient population and hurts corporate dentistry.

    EDIT: Also, it motivated me to get some business training while in UG. Next term I have a flexible sched and decided to take accounting & finance. I don't expect to become a master but I figure learning to read a balance sheet and other accounting products is worth the effort.
     
  13. charlestweed

    Dentist Gold Donor Verified Expert Verified Account 10+ Year Member

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    Several years ago when I was still a rookie orthodontist, I usually wondered why the parents kept on sending their kids to the chain clinics, where I used to work at, for ortho tx. The waiting rooms were always super crowded. The wait time to see an orthodontist was very long. When the patients called the office for appointments, it usually took them 5-10 minutes before they could talk a live receptionist. Broken ortho brackets were not repaired the same day….the list of bad things at the corporate offices goes on and on. I later realized that the reason why these patients continued to choose corporate offices over private offices was because most private ortho practices didn't accept their insurance plans and medicaid plan. The ortho fees at private practices were too high for many patients. Another reason why the patients continued to choose the dental chain was because I, the associate orthodontist who worked there, consistently produced great treatment results.

    After realizing all of these, I decided to set up my own private office near the corporate offices to compete against them. Like corporate offices, my office accepts medicaid and several HMO plans. My office offers very flexible interest-free payment plan. My office targets mainly the poor working class patients…. the kind of patients that most other private ortho practices don't want to treat. The patients are much happier here at my office than at the dental chain clinic…..we have friendlier staff, better communication, shorter wait time, lower treatment fees (yes, even lower than corporate office's fees)

    By keeping the overhead low, I am able to make more than what I make at the corporate offices. Corporate offices only pay me 15-20% of what I produce for them. At my own office, I earn 50-55% of what I collect from my patients.

    My own business wouldn't be as successful as it is right now if I didn't work for the dental chain. Working for different corporate offices (SmileCare, Western Dental, BrightNow Dental) has taught me a lot of things.....good things and bad things. I tried to bring into my office the good things that I learned from working at the chain. I've learned that I can still provide good quality care without having to have all the expensive high tech gadgets. I learned how to keep the overhead low when I started my own office . I've learned how to work more efficiently. I've learned how to treat the dental chains' assistants with respect so they can help me deal with the busy schedule....and work as a team. I've learned how to diagnose the ortho problems and to come up with a tx plan as quickly and accurately as possible. Busy schedules at the dental chain also helped me come up with more effective ortho mechanics so I can move patients' teeth faster with shorter appointment time.
     
    #13 charlestweed, Aug 10, 2012
    Last edited: Aug 10, 2012
  14. Halcion

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    :thumbup::thumbup::thumbup:
     
  15. Silent Cool

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    CT, would you mind saying what your typical take-home income is (pre-tax, after practice expenses/overhead) and how that compares to the typical take-home for other Orthos in your area?

    thanks
    :cool:
     
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  16. djeffreyt

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    Um. Did anyone else notice she said an emergency FFS clinic in her original OP question? Cause I would work in corporate Over an emergency clinic any day. Emergency means most of your day will be fix a filling, extract a tooth, or start an rct that may never return. You wouldn't be getting a long standing doctor patient relationship like a FFS private family dental practice. It's mostly walk ins who have severe decay and may not be able to afford more expensive care. The experiences would probably be fairly limited though you'd probably get some great pain diagnostic skills out of it

    And private and corporate can both be bad. I've worked in both, and some of the worst over diagnosis I ever saw was from a private FFS/PPO dentist. Some corporate I worked at pressures your diagnosis, but if you are strong willed you don't let them and sometimes you whet in trouble and fired. Others leave you alone to do your job the way you see fit. Those are the ones I think are actually a great benefit to both patients and doctors
     
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