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100:1 ratio?!
Worth it to specialize?
Started by DS2027
Don't undersell your knowledge and skill. I am a GP. You could give me the same instruments and equipment as an endodontist or OMS, and I would not have the same results. It annoys me when I hear general dentists refer out and tell the patient it's because dental specialists have "specialized equipment".
Agreed, I would also not choose ortho again. Wouldn't touch it with a 10 foot pole.
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JacquesVallee
Full Member
How can you confirm
JacquesVallee
Full Member
OMFS will always come out ahead financially... but age is a massive factor. I'm 35 years old now, I make great money, but it's also a stage in life where no one really cares how much money you make.
I would have much preferred to be earning great money at 27 years old, people care about social status and money at that age.
At 35, I don't care about impressing anyone outside my family. I'll drive a ****ty car. But if I had this money at 27, I'd be living it up and driving a ferrari
I would have much preferred to be earning great money at 27 years old, people care about social status and money at that age.
At 35, I don't care about impressing anyone outside my family. I'll drive a ****ty car. But if I had this money at 27, I'd be living it up and driving a ferrari
JacquesVallee
Full Member
For any dental student reading this, you will almost 100% NOT have one million dollars in the bank by the time an OMFS finishes residency. In fact, you probably won't even have half of your loans paid off. The OMFS will catch up to you financially probably with 1-2 years of pp income.
But that one guy on sdn does it and makes $400k so that can be extrapolated to mean everyone else can
Why go back to my post days later after the thread has moved along? We can agree to disagree and move on.
My point is that with sound financial habits and a willingness to work hard, it can be done. I lived with my parents and worked 6 days a week starting out. Paid off my $250k in loans in just over a year. Invest over $200k per year now. You can hit over $1.7 million in six years at a 12% growth rate investing $200k per year. I’m just using the historical average for a growth fund, not even accounting for the over 25% return I’ve had over the past year.
The beauty of it is this math works for the oral surgeon, too. It works for everyone! Finish residency, live beneath your means, and invest soundly. The sooner you get the money invested, the sooner you’ll have a good amount of passive income kicking in your favor, and the sooner you’ll have flexibility for how you want to live your life. The general dentist has time on their side. The oral surgeon has a higher income on their side. Everyone can win here.
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How much is the average income of anesthesiologists? Can they pull 500k without owning?
A recent grad in general dentistry will probably barely be able to max out a 401k while making small loan payments while that OMFS is in school. No way the average DDS would even be able to come close to saving up a million in that time.. Most would be lucky to save up 100k in that time...
100% yes. Most associates keep 60-80% of production and can produce $3000-$4000/day. I would estimate average income for associates is $5-600,000 if not a little higher
Let’s be clear. I’m in full agreement that the “average” general dentist won’t do it. But for a young dentist who is financially disciplined and intentional, it isn’t that hard to do.
It starts by keeping your loan amount as low as possible. Do well in undergrad. Try to get into as many dental schools as you can. See if you can get some scholarship money. Go to the cheapest option. If you can live with your parents during dental school, do it.
When it comes time to get a job, start early in your D4 year. Interview. Interview. Interview. The more offices you see and more contracts you see the easier it becomes to see what a good practice is and what a bad practice is. Don’t let the corps convince you that 25% collections is acceptable. Look for red flags. Look at the existing schedule to make sure it is busy. Meet with the owner to make sure they seem like a decent person. Ask about what other associates make if they have multiple associates.
If you are able, live with your parents your first year or two after school and throw most of your money at your loans. I get it. You’re 26. You don’t want to live with mom and dad, but it is going to help you SIGNIFICANTLY for the rest of your life if you can pay down your loans aggressively. Once they’re gone it really frees you up to live life how you want to. Save your money to buy a practice. Travel the world. Invest and build passive income. You’re free.
Learn. Even if your very first job doesn’t pay you the highest percent, focus on learning. The job I had on Fridays and Saturdays had a very good mentor who was passionate about teaching. I consider him a friend to this day even though I no longer work there. Smart business move because he knew the more competent that I was, the more money he would make. Take CE in implants or endo. Get the practice you need to feel comfortable with these procedures. There is really no reason why a general dentist shouldn’t be able to do basic endo, basic implants, basic clear aligners, and extractions/bone grafting. Don’t be picky and refer things out just because you don’t feel like doing it. It’s okay if you start out slow. You’ll pick up speed along the way.
The best way to learn is from experience. Your first year out, don’t work 3.5 days a week. Work 5-6 days. The more you do, the more you’ll learn and grow. Your fellow classmates are working hard in residency to hone their skills, so should you.
Once you have the confidence, skills, and speed, recognize your value. Negotiate a raise or start looking for jobs where they’ll appreciate your expertise and compensate you for it fairly.
That’s it. That is the blueprint that I followed. I know other people who did things slightly different. Didn’t live at home, etc. but they worked hard, focused on learning, and focused on being able to offer more than just basic fillings and crowns to their patients.
If you think you’re going to get to $1.7 million in 6 years by doing fillings, prophies, and crowns and not being financially responsible, you have a different thing coming.
$3k-4k total production a day? or is it 60-80% take home you are talking about?
I agree that the economics of a new grad starting in ortho is not great. Too much competition. Worse if you paid alot of money to become an orthodontist. Everyone is doing ortho nowadays. Dental Corps and for profit private ortho grad schools have ruined this once proud, intellectual profession. However ......
The lifestyle aspect of ortho hasn't changed. We are changing lives one smile at a time. I get great joy in seeing the changes in my patient's occlusion and alignment. There is very little stress in practicing ortho. Of course .... this only works if you are financially secure. Financially secure means you graduated with a reasonable amount of debt. Financially secure means you started investing early on.
Sorry I meant $3-4k daily take home from that 60-80% of production
JacquesVallee
Full Member
The barrier of entry to ortho is simply too low now. If you're willing to pay 300k, you will become an orthodontist. It's the exact same thing that's happening with the proliferation of dental schools. Nobody is special if everyone is special. Our profession needs to do a better job of maintaining high standards and gatekeeping.
I don't think there's any way this could be possible. Real MD anesthesiologists who have consistent work, long hours, weekend hours, middle of the night hours, etc. don't make this kind of money. I'm sure they get compensated higher per case than a dental anesthesiologist too.
What someone makes has little to no correlation of what they can produce per day. It has to do with how consistent their work is which relies on supply and demand factors. I have produced over 50k in a day. I have also produced zero in day (including yesterday). I could probably easily produce 50k every day, but in order for that to be possible on a daily basis the population would have to increase by 20 fold with all other things equal.
I can't imagine a world out there where there is enough work for a dental anesthesiologist to be employed by a company, and pay that individual 500-600k, and that company to be profitable. They could easily pay a nurse anesthetist or a real MD anesthesiologist less than that anyway, so why would they compensate a dental anesthesiologist at that rate?
The biggest barrier for nearly all dentists is finding enough work to keep them busy, not by being limited in how much they can produce per day.
Dental anesthesiology is a specialty they seemingly created out of thin air, I'm curious as to how the market will be for them. Anesthesia is a very competitive space in today's world.
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JacquesVallee
Full Member
What the heck did you do in that day as an ortho!? I've produced 50k in an entire month before haha
Created out of thin air? Do some research please. Your wording is quite condescending. Dental anesthesiology has been around for a very long time, it just became officially recognized in 2019. We bill differently than MDs and aren’t working for some company. We are independent providers that bill separate from the dentists providing the dentistry. We can make $500-600k because anesthesia fees are anywhere from $500-$1000 per hour, an we can end up seeing anywhere from 6-12+ cases in a day. And even if you’re working as part of a group you will still keep 60-80% of that production. The market is great and has been for a long time because a majority of MDs done want to do office based anesthesia.
The History of the Specialty of Dental Anesthesiology - PMC
pmc.ncbi.nlm.nih.gov
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Here’s one states Medicaid fees for general anesthesia. Also MDs can’t bill for dental so they can’t get these fees as they are the dental specific codes for Medicaid. Another reason it’s not as common for them to do dental anesthesia
Attachments
Not in my state. It’s closer to $400/hour. I hate this place…insurance reimbursements are absolute garbage.
Big Hoss
Very state dependent. A lot of DAs are cash only as well
Shouldn’t you be saying dental anesthesia sucks instead of letting your secret out hahaha
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I can kind of relate to this, current new grad projected to make over 300k this year working <40hrs a week doing bread and butter. I think specializing would be worth it if you enjoy what you do as it wouldn't feel like a job at all (given you do it for many many years in your career). On the off chance you are thinking of specializing for money, depends on your current situation with debt, family plans, etc.
JacquesVallee
Full Member
You are an outlier. People who make high incomes are significantly more likely to post here than the people (who vastly outnumber you) making 120-130k a year coming out.
I mean the barrier to entry is high and there are only ~30 residency spots in the country. We honestly need more DAs because the need is so high
What are the barriers
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I’ve practiced ortho for more than 20 yrs and I’ve never make that kind of money in a day. For me to produce $50k, I would have to see 300-320 patients a day (each patient pays me around $150 for office visit). The highest number of patients that I had seen was around 100-110 and that was during the golden years ortho. Now, I only see around 60 patients a day.....40 patients on some slow days.
Ortho daily production doesn’t fluctuate like general dentistry or other specialties because we, ortho, don’t get paid a large sum of money when we start a new case. Patients usually pay us a down payment and then make monthly payments.
I didn’t know dental anesthesiology was a good specialty until I started working 1 day a month at my friend’s pedo/ortho office. His wife’s a pedodontist and she hires a traveling dental anesthesiologist. But her dental anesthesiologist is too busy (she’s booked several months out) so she asked my cousin, who’s a MD anesthesiologist to come help 2 days a month.
My cousin’s friend, who’s also a MD anesthesiologist, works full time as traveling anesthesiologist for dental and oral surgery offices. His friend works like a full time dental anesthesiologist…no more hospital work...no on-call….and the dental patients pay him directly (using the Square card reader). And this friend of his introduced my cousin this new gig...and he sold my cousin the traveling kit (which include a monitoring device + syringes + intubation stuff + all the drugs etc). My cousin really likes this new gig. He also works 1-2 days a month at an OS office because this particular OS doesn't want to do his own IV sedation while performing the surgeries.
My cousin’s friend, who’s also a MD anesthesiologist, works full time as traveling anesthesiologist for dental and oral surgery offices. His friend works like a full time dental anesthesiologist…no more hospital work...no on-call….and the dental patients pay him directly (using the Square card reader). And this friend of his introduced my cousin this new gig...and he sold my cousin the traveling kit (which include a monitoring device + syringes + intubation stuff + all the drugs etc). My cousin really likes this new gig. He also works 1-2 days a month at an OS office because this particular OS doesn't want to do his own IV sedation while performing the surgeries.
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JacquesVallee
Full Member
What's the most you've produced in a day?
50k in a day, was something like 8 starts that day. 4 that were on the schedule, the other 4 patients who came in for consults for same day starts. This is not hard to do. I don't think we saw much more than 50 patients that day.
Are you getting production confused with collections? Collections would have been a fraction of that, due to our down payments being low.
Most practice management software calculates production as a start. A start worth 6k, is 6k in production. Some corporates calculate it differently, as in 25% of production at the start, then monthly at x%, then debond will be another %. This is of course for when you pay an orthodontist a % of production, to be able to spread it out monthly. It wouldn't make sense to calculate production like that for a private practice though, way too complicated.
JacquesVallee
Full Member
What percentage of that 50k do you take home as an associate?
I could do 20 ortho starts in a day and have production of $120,000 per day but that doesn't mean market conditions are favorable enough for me to achieve that.Created out of thin air? Do some research please. Your wording is quite condescending. Dental anesthesiology has been around for a very long time, it just became officially recognized in 2019. We bill differently than MDs and aren’t working for some company. We are independent providers that bill separate from the dentists providing the dentistry. We can make $500-600k because anesthesia fees are anywhere from $500-$1000 per hour, an we can end up seeing anywhere from 6-12+ cases in a day. And even if you’re working as part of a group you will still keep 60-80% of that production. The market is great and has been for a long time because a majority of MDs done want to do office based anesthesia.
The History of the Specialty of Dental Anesthesiology - PMC
I'm not sure your background, but it sounds like you are a dental anesthesia resident. If that's the case, I'm happy you are enthusiastic about your field.
However, what my expectations of my career were in my residency have been different than what reality was in the working field. I'm making less money than I thought I would.
My first job in corporate out of residency I was paid 45% of production, and was told I would be busy enough to make around $2,500 per day. It ended up being about half of that because the office I worked out was pretty dead. They just weren't truthful when I asked what production was like. When you get job offers based on production, ask them to run actual production reports for you for the last 12 to 24 months. Wish I would have done that.
Corporations calculate production differently depending on where you work. Many corporations have ortho as a "side gig" where they don't put much energy into giving you good support, so the most you could get is one or two starts per day, with many days not having any starts.
As an owner, 8 starts doesn't really get you that much money. In today's competitive ortho field, many have lowered their down payments. We charge $300 for a down payment. That's a paltry $2,400 in collections, and you are working very hard for that. They will obviously pay you monthly after that.. But in ortho, many patients will end up moving away, or disappearing, or falling behind on paying... So the economic reality of owning an ortho practice it tough. Not only is it hard to get new patients and starts in today's world, there seems to be a race to the bottom as far as fees are concerned in terms of low down payments and low monthly payments.
In the past, people didn't extend their financing past the estimated treatment time. Now it's not uncommon to go 8-10 months past the estimated treatment time... Because people just don't have the money to make higher monthly payments.
First, getting 8 starts a day is very rare. I'd be happy with 2-3 starts day. Yesterday, I had 4 starts at my own office. A day before that, I worked for a corp office and we had zero start..... and only 1 consult and the mom couldn't afford the tx.
Yeah, I may have mistakenly labeled production and collection as being the same entity. I don't use any management software to calculate production and collection. IMO, any type of management software is a waste of money. As an owner, I only care about how much I got paid for that day....whether I make enough to pay my staff and other business overhead....and what my net take home income will be. So I only look at how much I collect for the day that I work.
For the corp office, where I work at, they created some arbitrary numbers like for a start, it's $3500 and for taking ortho records, it's $800 etc. And that how they calculated the production for a day and paid me bonus based on how much I produced for that day. Now that we don't have a lot of starts, they just pay me $75 (as bonus) for every new case I start + a guaranteed daily rate.
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$13k a day and it wasn't at my own office. It was at one of the corp that I've worked for. It's around $6-7k per day on the average at my own office......30-35% overhead.
The working landscape for anesthesia is quite different than ortho or almost any other dental specialty. There’s a very small amount of DAs (and anesthesia provides doing dental) so it’s not hard to be very busy. In our program we spend 8 months working alongside private practice DAs who are very open with their billing, schedules and every other business aspect. All of them consistently see at least 5-6 patients per day, five days per week. In the world of dental anesthesia it’s very achievable to do. Most dental insurances don’t pay for anesthesia, so it’s either cash at time of service or Medicaid, which can vary depending on the state. Some states pay a flat rate per case and others hourly but $400/hr is the lowest I’ve heard. Even then most of the Medicaid peds cases are done in an hour so 6+ cases can be done in a day, if not more. Working with the private practice DAs I’ve seen up to 15 cases in a day. Add on the fact that overhead is less than 10% and it’s easy to see why DA income is so high. Believe it or not, I don’t care. I’m just trying to paint a truthful picture for any interested dental students.
That's incredible. I believe it because the anesthesiologist (MD) who comes into our office charges quite ALOT. I am surprised people are willing to pay it, if I am being honest, especially when you consider the additional risk of a general anesthetic.
I think the salary you posted is completely realistic. Especially when you see that MD anesthesiologists make quite a bit more in hospital systems.
Most make significantly more than that. Check job listings.
If you want to make money, oral surgery is the answer and it's not even close, even with the opportunity cost of residency. Most oral surgeons are in the range of 1m-2m income per year, some higher, some lower. I'm an endodontist, and know a lot of endodontists, oral surgeons definitely make more than endodontists
because oral surgery is not hard
everyone wants the fruits of oral surgery; but no one wants to put in the work
Do you know a lot of oral surgeons
i'm not really concerned with the difficulty. as for no one wanting to put in the work, some 200+ people manage to do it every year 🤷♀️. it's not an easy path, but it's certainly an achievable one if you're willing to put the work in.
