Practicing DDS - Ontario, Canada - Feel free to AMA

[uwo2008PG]

Hi All,

I was clearing out my old bookmarks from years past, and recall lurking these forums back in the mid 2000's prior to starting dental school and then a bit during school. It is quite a blast from the past reading these forums and seeing many familiar questions and concerns. I thought it'd be a nice opportunity to give some feed back and answer any questions. I see many concerns regarding the past, present, and future of dentistry and am happy to help answer to the best of my ability.

Some context:

- Grew up in Ontario and did my undergrad in Ontario

- Graduated from UWO dental and have been practicing for about 10 years - first half as an associate and the second half of that as an owner/operator in a smaller centre

- Practice is just me and 2 hygienists, but with nearly 3000 patients we are looking at a potential associate as the practice is growing steadily

- I have experienced the scares of independent hygiene in the mid 2000's, foreign credential concerns of the early 2010's, to the increasing corporitization that is the current reality

- Have been involved at the governance level on the ODA council shortly after graduation, so I can give some small insight on what is going on behind the scenes (not confidential, just people but not be aware the massive lobbying effort that is occurring and who the responsible actors are - for example the equivalency process is not a CDA, ODA, or even RCDSO issue per se, but is a fairness initiative coming from the federal government that touches on human rights issues)

A couple caveats:

- It has been a while since I applied to dental school - so my advice there may not be relevant. I applied when UWO still accepted me with only 2 years of undergrad! I think you need a degree now so that shows how long it has been.

- I do appreciate my privacy, so to be as open as possible with answers (especially if they pertain to finances), I will answer them freely, but may not be comfortable divulging too many personal details like my name, date of birth, last 3 digits of my credit card and so forth!

- I also appreciate your privacy too, so if you have a question you'd prefer to PM me (do they still have that system?), then feel free to do so, but I'll ask for your consent to post the question and answer (sans name attached) so more people can learn. I found from my time at courses, if there is one person asking a question there are often 20 others thinking so it would be helpful to share as much as we can

Anyways, I am by no means a definitive source of information, and I trust there are other experienced dentists that can help, but this forum was helpful for me in the past and I think it'd be great to pay that forward nearly 15 years later. Once in dental school, I also encourage people to look into Dentaltown forums. A wealth of information to be had there and I joined while still pursuing my DDS.

I'll likely check in every couple days until interest dies down!

Take care,

Fellow Colleague

[uwo2008PG]

Thank you so much for doing the Q&A. I just wanted to know what a practising dentist thought about the current state of dentistry. Are you feeling the effects of increased foreign accreditation and the corporatization, or you sort of "isolated" from it once you own a practise and build a patient base (albeit in a small centre - does that mean rural location)? 

Is it still possible to be successful in dentistry despite the student loans and saturation? What would you recommend a future graduate do once he earns his license so he can maximise his chances for success (go rural, go north, enter ownership asap, specialize, do a bunch of CE, etc)? 

And finally, do you recommend pursuing dentistry still or would you tell people to steer away and try their luck in medicine or other careers, like many people on the dental forums seem to recommend!

 

You touch on something I have discussed with many young prospective or dentists training and I sympathize with you guys. I will first say that concerns about dentistry go back decades and nearly every generation thinks that something will bring upon the end of dentistry: 50's - fluoride | 60's - potentially being tied up in Medicare | 70's - xylitol will mean no more sugar needed | 80's - saturation with increasing class size | 90's economic stagnation | 2000's - independent hygiene and expanded practice hygienists in the USA, and so on.

That is not to say your concerns are not valid, they are. It is something I am trying to actively fight within the profession because oversaturation brings out the worst in people who should be colleagues. The increase in marketing and advertising is also something that I think borders on unprofessional. If we want to be regarded like surgeons and doctors of the oral cavity, please act like it and don't put up billboards and offer free whitening. Unfortunately, the proverbial genie is out of the bottle, and saturation is going to be an issue, but dentistry will persevere and can be rewarding, but it is more difficult than in the past and just hanging up a sign with your name on it (which was not possible in my time, but my old boss did in the 80's).

To answer your questions:

Are you feeling the effects of increased foreign accreditation and the corporatization, or you sort of "isolated" from it once you own a practise and build a patient base (albeit in a small centre - does that mean rural location)? 

Even in a town of 10,000 to 20,000 I feel it. However, it helps my practice, but hurts me with what they do. We have 5 practices here. 1 is part of a multipractice corporation, 2 are recent foreign credentials direct challenge, and 2 are local graduates. Our practice has grown because many patients have left the other practices to come to us because they have heard good things via word of mouth, like seeing people who live in the areas they work (many live in the city and have apartments for work here Monday to Thursday), and we tend to be conservative like the last generation of dentists, while there is trend for very expensive treatment plans some patients are uncomfortable with because it was not like that before. We do absolutely no advertising other than a website. So we are not isolated, and feel it all the same, but it has in a weird way helped our practice, but I wish it didn't. I would prefer others be reasonable. It just saddens me to see billboards, and adverts in mailers which I have not had up here before.

Is it still possible to be successful in dentistry despite the student loans and saturation? What would you recommend a future graduate do once he earns his license so he can maximise his chances for success (go rural, go north, enter ownership asap, specialize, do a bunch of CE, etc)? 

I think it certainly is, but successful is a relative term. I am very happy with the way the way my career has progressed, but not everyone may like my course.I think entering ownership ASAP can be quite daunting, and while some may be prepared, I certainly was not. I think a few years as an associate in a smaller centre where you can hone your skills, and also potentially learn the business side, even by osmosis, is helpful. I think ownership is lovely and one of the best steps I have taken, but it took me 5 years to get there, and I also wanted to pay off my student debt.

And finally, do you recommend pursuing dentistry still or would you tell people to steer away and try their luck in medicine or other careers, like many people on the dental forums seem to recommend!

Great question, and one I have mused with my wife whether I would recommend my son or daughter to enter this field. I say yes, but with a caveat that you are aware you will be the small town pharmacy in a world of Shopper's Drug Marts. If you are prepared to take on that role, it is immensely rewarding. Fortunately, here that resonates well with patients. It can be challenging to see what others are doing, but keep your head down, do good work on your patients who are your neighbors, and it is immensely rewarding professionally and personally. I really enjoy what I do, and financially I am doing well. I just hope future grads have the same opportunities to have good rural associateships, and possibility to buy a practice like mine. I will never sell my practice to a chain or corp. Partly because I don't want my patients to have to deal with that, and because I want the next generation of you guys to have the same chance I did - even if I net 20% less.

[VivaColombia]

Few questions:

1) How has covid changed your practice and what is the outlook from your perspective? Is it better for you since you aren't in an urban setting? Is corporate takeover going to accelerate since they have capital emerging post-covid?

2) How do you feel your classmates found themselves practicing in other settings if you're still in touch with them? Satisfied, unsatisfied, etc.

3) If you could go back, would you specialize?

[uwo2008PG]

Hi, I saw your post in the dental forum. Can you share how much an associate can expect to earn first few years out and how much you can expect to make as an owner? I know it's hugely variable but it doesn't hurt to ask. 

For sure, the variability is huge and context means a lot. I worked Monday to Friday - 8 to 4 as an associate at 40% collections. It was a standard practice with a mild mix of ODSP, OW, CINOT (Government plans that pay you 40% of normal fees so you don't really take much home). At first, I was quite slow and would say I still am by dental standards. I started at 11-12k monthly take home, and when I left my associateship it was between 14-20 per month.  My last year as an associate I make 185k. Upon owning a practice that has about doubled, but the practice cost me about $750,000. Still a good investment of course, but there is a cost to ownership, and I have gray hair now. Prior to COVID we were on pace for $900,000 annual billings at about 55 to 60% overhead so nearly $400,000 take home. Prior years were around $800,000, but overhead was less since there were plenty of infection control changes that increased the cost to deliver care. We began to work more Fridays since I started booking out too much in advance so that explains the increase in productivity, so it came at the cost of long weekends.

[uwo2008PG]

51 minutes ago, VivaColombia said:

Few questions:

1) How has covid changed your practice and what is the outlook from your perspective? Is it better for you since you aren't in an urban setting? Is corporate takeover going to accelerate since they have capital emerging post-covid?

2) How do you feel your classmates found themselves practicing in other settings if you're still in touch with them? Satisfied, unsatisfied, etc.

3) If you could go back, would you specialize?

1) I think there are 2 considerations to COVID. The short term practice interruption for about 3 months and then the longterm regulatory implications. For the short term, yes it is rough, since we went from 30-40 patients a day to seeing just 2-3 emergencies three days a week. I haven't done the May numbers, but in April I lost $14,000. Although much of that was March's lab bills, payroll taxes prior to lay offs, and material expenses, so Imagine May would be less of a hit since we had fewer staff, less material used and no lab cases. The short term hurts, but in the long run it will just be a blip on the radar and we'll recover. A 3 month hit will not affect my 30 year career. However, there is some concern about longterm regulatory changes increases the cost to deliver care and therefore increasing overhead. These longterm recurring costs can be a concern. At one point, I calculated I'd have to spend an additional $100,000 alone per year on disposable gowns when they skyrocketed from 25 cents each to $15 each. However, fortunately, the RCDSO has stepped back those requirements and I always want to remind people this is all a transition still as we are still tackling with COVID. The most recent guidelines are much more reasonable and I am cautiously optimistic going forward and the practice will remain healthy. I think being in a rural setting is better for me professionally and also personally as I am not exposed to the more unfortunate aspects of dentistry such as excessive marketing nearly as much. I don't think COVID will have a huge impact on corporations taking up practices. Don't get me wrong, this does concern me, and I hope more small operations remain so future guys like you have a chance to buy in, but they have hurt too from COVID and they are very sensitive to finances. So ultimately, I personally think COVID will be a net neutral regarding the corporitization of dentistry, but I am still concerned about the corporate model.

2) Most of my classmates who I catch up with at convention seem to be doing well. Most have their own practices, and while some have their ups and downs, everyone seems to be doing well. Although keep in mind, people sometimes don't like to share if they are struggling, but I think everyone is where they want to be whether that is owning a practice, or working as an associate and leaving work at the door and spending more time with family. Always fun to have a few beers and share some common gripes but also reflect on how lucky we are in the grand scheme of things.

3) I personally wouldn't, but that is because it would involve be having to live in a big centre, which I prefer not to. I also really like the variety that general dentistry gives me, as I can get bored doing the same task repeatedly. I like going from a molar endo, to a special needs check up, to some simple class II restorations. But if I had to do molar endo, or class II fillings all day every day I'd get burned out. I do have some mild concerns that the increase in general dentists will result in dentists feeling pressured to perform more procedures that were traditionally referred out to specialists. You even have entities like Smile Direct entering the market place. However, I am not a specialist so I can not comment on how they are doing. And for what it is worth, an ortho friend in a bigger centre is still doing well and says Smile Direct doesn't threaten him, and he doesn't want to treat patients who don't appreciate what he brings to the table, and he is doing quite well. So overall, I'd say if you have a passion for a specialty, go for it because it will make you more fulfilled personally and professionally. Do what brings you happy  Great things about dentistry is you can help others, feel great about it, feel like you've accomplished something, and still have the time and means to enjoy a decent living with family and friends.

[uwo2008PG]

 I hope you are doing well. What is your opinion on dentists who are graduated from Australia and Ireland dental schools? Are there any biases against them? Most importantly, are such graduates readily employable by owners? 

Thank you for the question and offering to share it publicly. This is a great question, and I can say there are two aspects to it, but also I do have to somewhat tread carefully because of course no one wants to come off as xenophobic. My personal opinion, is like any other dentist, I would want to meet the person, and get to know them, and see if they are a good fit for our practice. I do not care too much about Australia or Ireland vs USA vs Canada. I also did not think too highly of my dental education at UWO because once we got on the clinic floor we were lacking some cases for all students to get a truly comprehensive education. I don't hold North American education as some paragon of higher learning.

However, I do know there is some bias speaking from colleagues regarding some foreign grads, but that tends to be moreso people who do direct challenge not Canadians studying abroad. This bias stems from some language barriers, difficulty communicating with patients, and in some areas the doctor-patient relationship takes on a different tone than in Canada and that may not be harmonious with your practice or patients. But we can't generalize because I have some specialists who are ITDs and they are amazing, and then there's the guy in your class who will be voted most likely to be disciplined by the RCDSO. How I miss UWO haha

So as such, I don't see why someone from Australia or Ireland would be any more or less employable than a UWO grad from what I have seen. Perhaps a grad from there could chime in on how their transition to private practice went. At the interview, I'd probably be more intrigued how their education was structured compared to mine at UWO, asked what procedures they did, what they enjoyed doing etc. I wouldn't hold a preference either way. I think the only bias that may exist is implicit since UWO grads tend to gravitate to UWO grads, but that's more of an ice breaker thing or just a friend of a friend knows someone who needs an associate. And even that effect is so minor that I wouldn't sweat it.

[McMarauder]

Thanks for starting this thread @uwo2008PG!  Even though  I have been practicing for 5 years now, I have found your answers interesting.
 

In response to your last post, I wanted to share my experience as an Australian grad, and as someone who had Australian work experience as a dentist seeking employment in Canada.  I have come across a couple of job postings that specifically asked for "Canadian Trained" dentists or "Canadian Experience", however my wife (also a dentist) and I were able to get multiple interviews, and job offers.  This is also true for our classmates that returned to Canada following graduation.  For the most part, people took my 2 years of Australian work experience at face value, which gave me an advantage over new graduates.  My classmates and I agree that our training has prepared us well to manage Canadian patients and I think Australian graduates, for the most part, are starting gain a positive reputation in Canada .

[Waves]

Thanks for doing this Q&A. You mentioned that your clinical experience wasn't the best at UWO and I can certainly agree with that, so what did you do to help you gain confidence while practicing as an associate? Are there CE courses that you took or would've taken in hindsight pre- and post-graduation? What are things we can do to help bring us up to speed? If you were hiring a new grad as an associate today, how much importance would you place on clinical experience and/or what would you want to know?

[uwo2008PG]

14 hours ago, McMarauder said:

Thanks for starting this thread @uwo2008PG!  Even though  I have been practicing for 5 years now, I have found your answers interesting.
 

In response to your last post, I wanted to share my experience as an Australian grad, and as someone who had Australian work experience as a dentist seeking employment in Canada.  I have come across a couple of job postings that specifically asked for "Canadian Trained" dentists or "Canadian Experience", however my wife (also a dentist) and I were able to get multiple interviews, and job offers.  This is also true for our classmates that returned to Canada following graduation.  For the most part, people took my 2 years of Australian work experience at face value, which gave me an advantage over new graduates.  My classmates and I agree that our training has prepared us well to manage Canadian patients and I think Australian graduates, for the most part, are starting gain a positive reputation in Canada .

Happy to hear it has all worked out! And for sure, I recall a trend maybe 4 years ago or so that people required "Canadian experience." I am not too sure what they meant by that because most domestic graduates would be ruled out. Fortunately, I checked just now on the ODA job board and I saw only one job specifying where the training or experience came from. I can say that personally I would take Australian or Irish education and experience at face value. I think you also hit the nail on the head that as a positive reputation is being built this become a non issue. Heck, depending on how good the schools in Australia are, it could even be a positive!

[uwo2008PG]

6 hours ago, Waves said:

Thanks for doing this Q&A. You mentioned that your clinical experience wasn't the best at UWO and I can certainly agree with that, so what did you do to help you gain confidence while practicing as an associate? Are there CE courses that you took or would've taken in hindsight pre- and post-graduation? What are things we can do to help bring us up to speed? If you were hiring a new grad as an associate today, how much importance would you place on clinical experience and/or what would you want to know?

I guess I should preface that dentists complaining about their alma mater is as old as time itself. Overall, I enjoyed my experience in dental school, but yes, towards the end we were lacking prosthodontic cases and were rushing to complete cases. Some students graduated with only 2 crowns completed. Now, I need to say the number itself doesn't mean much in the sense that a couple crowns with a really challenging professor that makes you cast it yourself it likely worth more than half a dozen with a laissez faire attitude. The numbers do not mean everything, but of course you need some clinical exposure.

I still emerged with a decent degree of confidence, but I was lucky that in my associateship my principal dentist didn't put pressure on how long to book for procedures or how to deliver care, so I was able to slowly but confidently build up speed and comfort. I also practiced in a rural area that had a high need for restorative, surgery, prosth, and endo so I was able to do a variety of procedures. To this day I do everything from molar endo, to complete dentures, to biopsies, and wisdom teeth. Of course, I still refer out the more challenging cases.

The most important CE for me has been Larry Gaum's oral surgery course, a mini implant residency (I dislike the term, it was like 8 three day weekend sessions, but very good and comprehensive), and nitrous oxide minimal sedation course. I have also taken orthodontic courses and attend study clubs. I think the great thing with dentistry is you can lean more into things you enjoy and refer out things you don't to associates or specialists. Except tough fillings, no getting away from those! Pre graduation CE.. great question. Technical courses are tough because they are very expensive, albeit good, but you don't have the opportunity to put your skills to use within dental school so perhaps best saved until you graduate. Otherwise didactic courses are good, but nothing that your profs may not already be teaching you. Often it is the same person! I did take my nitrous oxide course 2 months before graduating so I could hit the ground running. I am sure there is some good within dental school CE, but I didn't take much. I still think attending things like the ODA ASM is great though. If anything just to check things out, meet people, take some interesting light CE.

If I was hiring a new grad, the biggest thing I would want to know is what do they enjoy doing and to see if they would be happy in our practice. For example, we do lots of extractions, and it would be good if you enjoy them. I am more than happy to step in to help for a hard case, or give a demo of how to do something, but I would want the associate to be interested in doing them. I know new grads won't be experienced, I wasn't. But if someone has passion, and is eager to learn and grow I do hope they get an opportunity to do so. Ultimately, I want new grads to be given the same opportunities I was. We all have to start somewhere.