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The slow decay of dentistry

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4 hours ago, VivaColombia said:

Going rural doesn't necessarily mean it is a rewarding decision. Someone on this forum mentioned that rural and underserved areas are prone to saturation pretty quickly, especially if 1 or 2 dentists move into rural settings where the population is small and stagnating/declining. Also, not everyone can go rural for even a year or two if they have a family in the city, etc. 

Recently, I've heard about a lot of students from the northwest part of the GTA (Mississauga, Brampton, Caledon area) having their parents pay for the full cost of dental education (~400-500k) by using their retirement funds, selling land from back home, re-mortgaging houses, etc. So these students essentially graduate with minimal debt by going to Australia/US/Canadian schools and then settle down quite easily. Combined with the increased number of immigrants coming into Canada (specifically the GTA) with foreign dental degrees and lots of $$$, ultimately this is compounding the saturation issue. A friend of mine went to India recently and all he saw were multiple billboards stating "have a BDS (dental degree), practice in Canada. 3 exams, 20x salary increase, raise your family wealthier". Now that's concerning...

It's a hell of a lot more rewarding than staying in the city. By rural I mean population centres of 30-50k. If you're an associate in a smaller city like that and you aren't making 250+ then you're doing it wrong. Hell, there's cities in Canada with population >200k where you can easily make 250k as an associate. 

That billboard just pisses me off. 

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1 hour ago, Everclear said:

The reason practice ownership is next to impossible now is not because of the expansion of dental corps. But because of the increased dentist:population aided by the influx of ITDs. ITDs do not carry anywhere near the debt that Canadian/US/Aus/NZ grads do. This gives them more financial leverage in the eyes of the banks. Most ITDs, on average, seem to be more interested in owning (particularly multipractice ownership) than the average Canadian/US/Aus/NZ grad. Maybe because they’re typically older and have owned a practice in their home country? But the fact that they only have maybe 30-40k debt vs 250-500k debt that the Canadian/US/Aus/NZ grads have is a very understated advantage. No disrespect towards our ITD colleagues, their equivalency exams are tougher than the regular NDEB exams but they do have less liabilities in the eyes of the bank.

 

I don’t understand the desire for Canadian/US to remain practicing in Canada under these current conditions. You make more as a dentist in the US period.

I did not consider the ITD angle but what you say make complete sense. For domestic grads, buying a practice outside of the city may be the only realistic option.

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2 hours ago, Lvl3sonly said:

I did not consider the ITD angle but what you say make complete sense. For domestic grads, buying a practice outside of the city may be the only realistic option.

Have you looked at buying practices outside of Toronto? They are generally just as expensive. The “Toronto type” valuation of practices has spread to most of Canada. 

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3 hours ago, Everclear said:

Have you looked at buying practices outside of Toronto? They are generally just as expensive. The “Toronto type” valuation of practices has spread to most of Canada. 

I'm in bc and that hasnt been my experience over here 

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10 hours ago, VivaColombia said:

A friend of mine went to India recently and all he saw were multiple billboards stating "have a BDS (dental degree), practice in Canada. 3 exams, 20x salary increase, raise your family wealthier". Now that's concerning...

Sure... they can come here, but are patients willing to see them?  I have come across many patients who refuse to see dentists trained in non-Western countries and people who have accents.  I worked in a practice with a dentist from India.  He's an excellent dentist, and I would have him treat me if need be.  However, I came across a lot of patients in the system that would say "do not book with Dr. XYZ as per patient's request".  Upon further investigations, patients had be complaining that they could not understand the dentist and could not develop a dentist-patient relationship.  Most FTD's will cater to their own communities, which may never have been accessible to you in the first place. 

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37 minutes ago, McMarauder said:

Sure... they can come here, but are patients willing to see them?  I have come across many patients who refuse to see dentists trained in non-Western countries and people who have accents.  I worked in a practice with a dentist from India.  He's an excellent dentist, and I would have him treat me if need be.  However, I came across a lot of patients in the system that would say "do not book with Dr. XYZ as per patient's request".  Upon further investigations, patients had be complaining that they could not understand the dentist and could not develop a dentist-patient relationship.  Most FTD's will cater to their own communities, which may never have been accessible to you in the first place. 

Except in super rural areas where patients don't have much choice. You see a lot of ITD's out there.

This is common though, and rapport is the single greatest value asset in dentistry. You can teach a monkey to do a filling. But you can't teach a monkey to connect with the patient to get them in the chair. My patients don't come to me because I'm an incredible dentist (I'm pretty average). They come to me because of how they feel when I talk to them.

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16 hours ago, cleanup said:

Except in super rural areas where patients don't have much choice. You see a lot of ITD's out there.

This is common though, and rapport is the single greatest value asset in dentistry. You can teach a monkey to do a filling. But you can't teach a monkey to connect with the patient to get them in the chair. My patients don't come to me because I'm an incredible dentist (I'm pretty average). They come to me because of how they feel when I talk to them.

same.  A significant portion of my appointment time is spent just chatting... i could be a lot more productive if I didn't talk, but I'm not sure a lot of these patients would come back.

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21 hours ago, #YOLO said:

Got @Steins;Gate saying he getting offered 700k for 4 days a week 1 hour from toronto, or 550-770k for 5 days a week in the city, as a dental student tho..

Every PM he has ever sent me is about money.

None of those numbers make sense, never mind the premise of a dentist being paid on salary unless they work in a hospital or for a public health service, for the military, a prison, etc. 

There are a few people from U of T that I avoid associating with (both in, above and below my class) because of their unhealthy, twisted obsession on climbing some imaginary ladder, making more money, seeing more patients, doing more things than everybody else. They're like that kid who got busted for padding his resume with tons of fake publications (I don't know the whole story and I won't go into that, whatever). Most of them were highly academic, high achieving folks in high school & undergrad, and tried to keep that up in dental school and may very well have done so. I just find it sad that you have nothing else to hang your hat on. If they lost their ability to achieve academically or in the realm of dentistry, they'd have nothing. No confidence, no self worth, no wits about them.

There's a hell of a lot more to life than the bubble/echo chamber that this entire place is. Just saying.

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You just tore that guy a new one hahah

I agree. Money is necessary but not everything. Especially when you’re a dentist and already making a lot more than most Canadian citizens. 

 

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8 minutes ago, Chaxon said:

You just tore that guy a new one hahah

I agree. Money is necessary but not everything. Especially when you’re a dentist and already making a lot more than most Canadian citizens. 

 

That wasn't directed at him necessarily, I don't know the guy. It's just an impression. But I personally know people like that and I never knew why I didn't really vibe with them or get along with them well. Then I realized it's because they're just in a completely different headspace, one where the only things that matter to them are external, superficial measures of 'success' and one-upping everyone around them. I know I often sound like the cynical old man around these parts trying to bestow 'perspective' out of some misplaced sense of righteousness, but truthfully it's because I used to be that guy, and when I found myself unhappy, stressed, too hung up on the opinion of others of myself, what I achieved, how productive I was, my grades, my bank account balance, I did a 180 and I gave it all up, improved myself, worked on my values & principles rather than my GPA or pocketbook, and let things play out as they should. Strangely enough, as a result of doing that, I work less, make more, connect with people better, and have a lot more fulfillment in my life. I'm also much more clear and careful about what I want. And ultimately, I realized that I didn't really care all that much about all the superficial shit; I was just conditioned to care about it; in the end, it's fruitless. Happiness, contentment and a sense of self come from within. Stop chasing it in money, dentistry, letters behind your name. I couldn't give two shits if you made $5 million last year. To me, a more important question is when was the last time you helped someone? Inspired someone? Made their day better? Mentored someone? Keep it in perspective; if your life is just about school, work and maybe money, then in my opinion, your life sucks.

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Very true.

I feel like the competitive nature of the field is what drives those thoughts. You need good marks and have to outcompete a shit lot of other students over so many years. Later you’ve got to compete for jobs, patients, and specialities if you choose. Obviously salary is determined by those factors too.

When you’re immature you consider people through that competitive lens. Some people just mature later than others, or never at all hahah.

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4 hours ago, Chaxon said:

Very true.

I feel like the competitive nature of the field is what drives those thoughts. You need good marks and have to outcompete a shit lot of other students over so many years. Later you’ve got to compete for jobs, patients, and specialities if you choose. Obviously salary is determined by those factors too.

When you’re immature you consider people through that competitive lens. Some people just mature later than others, or never at all hahah.

The significant number of individuals in dental school with this mentality made my experience very unenjoyable.  I lived with a classmate for 2 years, and everyday they would come home and constantly brag about how perfect their preps were, how well they scored on their last practical exam, how they've already made contacts for a potential associateship after graduation.  There was never a conversation that was not one sided.

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Saw someone post this about dentistry in Brazil:

In Brazil, they deregulated dental education and allowed as many private schools to pop up as they wanted to. 
All in the name of "access to care", "removing the barriers" and "social justice" of course. 
Now they proudly have about 245,000 dentists, or 15% of all the dental manpower in the world. 
As a result, there are more stray dogs roaming the streets in certain areas than dentists and this is not a job that is well regarded and pays well anymore.
I, for one, came across a few Brazilian dentist desperados happy to work as lab technicians or assistants in Australia just to be able to buy themselves more time and get their foot in the door over here. All were as poor as church mice, I even rented my house to a couple of them.
So much for "social justice".

 

Canada will be next?

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38 minutes ago, Everclear said:

Saw someone post this about dentistry in Brazil:

In Brazil, they deregulated dental education and allowed as many private schools to pop up as they wanted to. 
All in the name of "access to care", "removing the barriers" and "social justice" of course. 
Now they proudly have about 245,000 dentists, or 15% of all the dental manpower in the world. 
As a result, there are more stray dogs roaming the streets in certain areas than dentists and this is not a job that is well regarded and pays well anymore.
I, for one, came across a few Brazilian dentist desperados happy to work as lab technicians or assistants in Australia just to be able to buy themselves more time and get their foot in the door over here. All were as poor as church mice, I even rented my house to a couple of them.
So much for "social justice".

 

Canada will be next?

If true this is just stupid legislation, it has nothing to do with social justice. No need to attack the concept of social justice unnecessarily

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15 hours ago, Everclear said:

Saw someone post this about dentistry in Brazil:

In Brazil, they deregulated dental education and allowed as many private schools to pop up as they wanted to. 
All in the name of "access to care", "removing the barriers" and "social justice" of course. 
Now they proudly have about 245,000 dentists, or 15% of all the dental manpower in the world. 
As a result, there are more stray dogs roaming the streets in certain areas than dentists and this is not a job that is well regarded and pays well anymore.
I, for one, came across a few Brazilian dentist desperados happy to work as lab technicians or assistants in Australia just to be able to buy themselves more time and get their foot in the door over here. All were as poor as church mice, I even rented my house to a couple of them.
So much for "social justice".

 

Canada will be next?

Brazil already taken over the leadership at a certain school, without Canadian licenses even

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On 6/12/2019 at 4:57 PM, Everclear said:

Have you looked at buying practices outside of Toronto? They are generally just as expensive. The “Toronto type” valuation of practices has spread to most of Canada. 

This is true for practices up to 2 hours outside Toronto and also generally for practices that do well. Toronto and GTA in general gets a premium just for location however. However things are unfortunately changing fairly rapidly as there is a lot of private equity (think deep deep pockets) interest in acquisition of hundreds of clinics in one sale. The dentistry landscape as we know it (sole owner) is changing and ownership may not be something that maybe available to future graduates like it once was. 

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22 hours ago, human instinct said:

This is true for practices up to 2 hours outside Toronto and also generally for practices that do well. Toronto and GTA in general gets a premium just for location however. However things are unfortunately changing fairly rapidly as there is a lot of private equity (think deep deep pockets) interest in acquisition of hundreds of clinics in one sale. The dentistry landscape as we know it (sole owner) is changing and ownership may not be something that maybe available to future graduates like it once was. 

Race to the bottom! See you guys there.

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Who would do something about it?

The dental associations are powerless and afraid of coming off as protectionist.

The regulators explicitly don’t serve the interests of dentists.

Politicians see dentists as fat cats and love to see new immigrants working in professions.  

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2 hours ago, Chaxon said:

If this is as apparent as you guys believe wouldn’t someone be doing something about it? 

Or are you guys just hyping it up? Hmm..

 

 

Its very hard to regulate free market. It's an issue of supply, demand and economies of scale. Big corps believe that there is much to be improved as far as efficiency goes in operation of dental clinics. Since they see an opportunity, they will continue to invest. 

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