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The Future Of Dentistry Is Cr*p...

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Medicine. Finance. Entrepreneurship.

 

None of those are easy careers, but the first is much more stable, the second is much more lucrative, and the third provides you a lot more autonomy. Oh, and they all have the same financial potential as dentistry, if not more.

 

Medicine is facing issues with employment outlook - many specialties are tough to find full time positions. Sure it is stable but I believe being an owner of a dental practice is also stable since you dictate your own employment. Med might have the same financial potential as dents but how many hours a week do they work for it? Does it match up $/hr compared to dental?

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If you think the industry can withstand more and more people adopting this model, you're wrong.

 

There's always going to be tiers to this. Associates, working evenings, weekends, seeing kids & disability folks, slugging it with their bodies to make a living. If everyone tries to become the dental tycoon type, then indeed, we will see that race to the bottom that everyone fears.

 

I think that's just natural selection. Consider coffee shops, the coffee industry cannot withstand 20+ coffee franchises, so some business must loose out while other reach new height. We have successful Starbuck chain, and not so successful Second Cup, and that's normal part of doing business ;)

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I think you talk about dentistry from the clinical side but miss out the business side of the field. A dentist can focus on the clinical side and earn an income based on associate percentage; or he could "upgrade" into a CEO running the clinic (or multiple clinic) in a corporation model :) As an old saying "Where there is a will, there is a way"

 

I am pretty happy (and comfortable) with my associate dentist position at the moment, but an associate position does not satisfy my entrepreneur spirit.

I know this question was raised but I think comparing with other professions is distracting from our own issues, as the vast majority of us don't have first hand experience in other fields.

 

Good on you for having that entrepreneurial spirit, but a "CEO style" path is not the norm and will never be. So while that may be a good choice for a few individuals (ie self benefiting), it is not realistic to have students or pre dents believe that it is a viable sustainable path for the whole industry.

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Cleanup has delivered a thoughtful, and well written piece. I will offer my own perspective. 

 

Cleanup, you seem to be a matured mind, and I will take the liberty of assuming you are ok with me commenting on your words. 

 

 

Finances are a real concern.

 

True.

 

But if they're bothering you this much, let me tell you that there are much, much easier ways to have a lucrative career. 

 

Agreed. If you're into the money, you probably can figure out a better path. However, if you're in it for the career and love for the actual job, medicine is probably you're only other reasonable option. But even that's a fairly different career with only partial overlap. 

 

Let me reiterate a few points that are at this point bloody horse carcasses.

 

No one can predict your income. It will depend on too many things to mention here. But it is relative. Let's say you could earn very little, and let's define very little as at or below $100,000 annually. Let's define a lot as at or above $200,000 annually, in your first year of practice.

 

Even if you're on the high end of this made-up scale (you're making "a lot" of money), how are you getting there? To generate $200k of income, given a 40% share of collections, you need the following:

 

You have to produce about $41000 in billings per month, or $10250 per week. If you work full-time (4-5 days) that's about $2000-2500 per day.

 

This is excluding lab fees. If your billings of $2000-2500 per day include lab fees, you will see your share shrink dramatically. A typical lab fee for a crown (which you might bill about $1000-1100 for) is between $300-500. Lab fees for removable prosthetics are usually less, but nevertheless, you're not receiving all 40% of that $2000-2500. If you want to produce $41000 a month AFTER lab fees, you either have to be doing nearly entirely restorative, endodontic, surgical dentistry, or you need to actually be producing more like $45000+ a month with your prostho work factored in, which means your billings should actually average $2250-2800 a month. That is a dramatic jump depending on how fast you are. An extra $250-300 in billings could just be a filling or two, but that filling or two could take you an extra hour a day.

 

In the industry, we look at the NPF, or net professional fees. This is your billings, less lab fees and any other deductions. It's true, when you do dentistry that involves lab work, the lab component of the fee charged to the patient is reduced from your billings to get to your NPF, of which you are paid your 40%. But doing work like crowns, or bridges, or implants, or dentures - these are all higher fee procedures. Sure, if I do a $1050 crown, the lab fee may be $350. But I also billed for a crown, which takes a total of 1.5-1.75 hours (1 hour first appointment for preparation of crown, impression and making a temporary crown, 30 minutes next appontment for cementing the crown). 

 

My point is that although lab fees are deducted, if you're doing procedures with lab fees they often pay well. Your mileage may vary based on your clinical speed, the patient (eg. a denture patient that comes back for 15 adjustments) etc. But net billing $350 per hour isn't that difficult. That's two fillings per hour. That's a crown. 

So let's assume you're working typical full-time 7-8 hour days. $2800 in 8 hours is billing $350 an hour. No problem right? Once again that's just a couple fillings per hour!

 

This is assuming a few more things. 1. You're fully booked. If you have gaps in your schedule, suddenly to stay on track you need to be billing more like $400-500 an hour when you're actually seeing patients. 2. You're seeing patients that actually bill the full fee, ie. no ODSP, OW, Healthy Smiles, other government benefit programs. These patients aren't any different in the amount of time they take to work on (in fact one could argue they take longer because they often have poorer oral hygiene and worse states of oral health), but they are drastically different in how you're compensated. I did an enormous MOB today that took about an hour and 3 carpules of composite. I made about $35. So that hour, I made less than the hygienist in the chair next door, and I took on a hell of a lot more professional liability as well. A lot of dental clinics (arguably, the grand majority) will see these patients. How many you see will once again cut into your bottom line. In fact, it's probably even worse for the principal. After paying me, paying the assitant, paying for the cost of the materials (exceptionally high, trust me), as well as the opportunity cost of having that chair with a government assistance patient in it vs. an insurance or fee-for-service patient, I guarantee you social assistance patients essentially generate close to zero income for the practice. 

 

ODSP, OW (social services) pay 1/3 to 1/2 of what I dentist normally bills a patient with private insurance. The practice you work for might net $0 for your work on these patients. However, you still get paid something (albeit very little), and this is part of the 'giving back' that we like to toss around in healthcare. If everyone refused social services patients, where would they have their care done? They do have higher rates of no shows, dissatisfaction, more oral disease etc. but I take this as part of the job. 

 

Let's tack on a few more assumptions we'll have to make: your billings are consistent month-to-month. This isn't true in the least. Summer months are slow. Holidays are slow. Patients cancel, don't show up, leave you hanging. You will have slow days, weeks, months. You will struggle to keep your numbers consistent, because that's natural.

 

Yes. Slow times can be boring, no shows are the worse. I try to look at my overall billings in a quarter rather than day to day. I expect that billings will be all over the place day to day and look at the big picture. 

 

Now the non-numerical side of the equation: dentistry is tiring and stressful. Let's say everything I just mentioned is A-okay. You're busy. You're booked. You see very few disability, social assistance patients. You have a nice, fulltime, well-rounded schedule.

 

Are you fast? Are you efficient? Can you do this without burning out? Do you like interacting with patients? How do you deal with complications and when things go wrong? When patients are upset? When staff are upset? When patients are nervous, anxious, don't trust you, or think you hurt them?

 

After an 8-10 hour day of seeing patients, I am completely spent. I am fortunate enough to be busy to the point where I don't eat lunch or dinner some days, but when I get home, I just pass out, and I do it again tomorrow. This is not simply due to being busy, or the physical nature of the job; it's also due to the stress, and to the constant expectation of you to be operating at 100%. You cannot (and I stress cannot) let your staff, patients or the public know that you're tired, that you're stressed, that you want to go home, that you need a break. You're the doctor, you're the professional, and you need to be speaking, presenting and acting well in order to give your patients the best care. This, above all else, is tiring.

 

Dentistry is tiring, and physical. No denying that. However, I would not say across the board that dentists are just zonked out, drained to zero, and exhausted. I have my tiring days. Days where you bend. But I try to maintain posture, I stretch between patients, I work out on evenings and weekends to keep me physically fit, and strong, and overall I don't think I'm so exhausted I can't function. Some days I just want a beer (or many) and to watch tv, but that's ok. Some days I really am just beat and want to sleep. I'd still take that over sitting at a computer. 

 

I do doubt MDs feel this physical stress like dentists do, though. 

 

Quite simply, if you're expecting 'easy money' from this career, it's not going to happen. I can guarantee you even if you're on the high-end of first-year associate income, there exist much, much easier ways to do it, that don't stress you out ("That screaming kid was crying so much the nitrous wasn't working! I had to turn them away!"), exhaust your body ("My neck feels awful! Gotta keep going though", keep you up at night ("I hope that patient's okay. She was in a lot of pain."), or demand that you work hours that fit the public rather than your prerogative ("It's the weekend and I wish I was with my girlfriend, but I've got to go in to work"). 

 

I'm not trying to be all doom-and-gloom, but the pessimism, for lack of a better phrase, does not come from nowhere. This is not an easy job, and the economic landscape is only making it worse. I can guarantee that if making a good income is your primary goal, you should do something else.

 

This is a very important point. "if making a good income is your primary goal, you should do something else."  I think a big thesis of Cleanup's post is that there are probably easier ways to make a good income. Distilled down, you need to ask yourself truly, "why am I pursuing dentistry?". If it's because of just the income, I'd also say do something else. If it's to make a good income AND I love the day to day work of a dentist, then keep headed in the same direction, pursuing dentistry. 

 

The last thing I wanted to mention is that the trend in dentistry these days is a heavy shift in treatment-planning focus. You didn't have to be doing a lot in order to make a good income back in the day. The landscape has changed. People are aggressive, they over-treat, they utilize this method, that tactic to "sell" more dentistry to the patient. It is sometimes beneficial. It is often borderline quackery or unethical. These things wouldn't be happening if the economic future of our profession wasn't in jeopardy. Yes, people will always need dental work, but we have more and more people doing it, and each of them is trying to do more and more of it themselves. I don't want to be around when the final straw breaks the camel's back.

 

Unethical dentists is a concern of mine as well. Dentists that feel the squeeze and try to find new ways to increase their income by overtreating patients. It's unfortunate, but I know it happens out there. My principals and I have talked about this, and we overall think it's a short term "solution" - meaning if you overtreat your patients, and you keep doing this, it will come back to you. Patients will elave and go to the dentist they know does conservative, ethical dentistry. This is likely partially idealistic viewing, but we've had patients refer us their friends because they know we're honest and have their best interest at heart. 

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I'll conclude by saying that I am not trying to be dentistry's knight in shining armour here. 


 


I am not denying that many (most?) dentists feel that they are not busy, that they have down time. But here's the golden nugget - you don't need to be busy in dentistry to make a good income. It's all because of how highly we are compensated per procedure. 


 


Let's take dentist Dr. Sam. 


 


Scenario 1: Dr. Sam is practicing in 1997. The stock market is approaching all time highs, the economy is good, and Sam has lots of patients. He works at a bustling practice, and is the only associate. It's 1997, so no internationally trained dentists can get licensure here without going through qualifying programs, not many Canadians going to American dental schools, the population to dentist ratio is high - Sam is busy! Very little down time. 


 


In 1997, Sam earns $350,000-400,000 in a year! Oh boy!


 


Scenario 2: Dr. Sam is practicing in 2016. He works in Oakville and Woodbridge, he couldn't find full time work at one clinic, as each clinic only needed a part time associate. He has down time in between patients, does a filling or two, a recall or two, and is on his phone a lot in between patients. He reads the news, facetimes his cousins, gets out his favorite book, etc. He ends up making $155,000 in a year. 


 


If Sam was practicing in 1997, and in 2016 - boy would he be disappointed! He used to earn $400k per year, but now he only earns $155,000 - ouch! I'm sure he's telling all the new grads how bad it is, how slow it is, how there are no patients, how he makes no money. 


 


But if you ask me, he's still doing pretty good! And you might respond by saying his income is going to track down further? What if he makes $120k or $90k? It's possible. That's why you should only do dentistry if you're in it for the career, not the money. If you're in it for the career, then if you only have the patients required to earn $90k, you earn your $90k and enjoy working a condensed schedule. It's crazy how little you'd have to work to earn $90k, you could mostly be relaxing - and then all the physical stress of dentistry goes away since you're no longer working physically that hard. It's like a balancing scale - if you work hard, then you must be earning a lot. If you don't work hard (either by choice or by lack of patients), then you're still earning amazing money for the time that you're working, and you'll earn a great income for doing relatively little work. 


 


Dentistry is not the same as it was in the golden era. But it's still very high paying. I can do two fillings in 30 minutes, and get paid $430, of which I get 40%. I might be not busy, but I only need to do that a few times in a a day to make great money. 


 


/end. Just my perspective, your mileage may vary. I think dentisrty is a great profession, and a field where great clinicians, who care about their patients can make a great living doing a great job. 


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Scenario 2: Dr. Sam is practicing in 2016. He works in Oakville and Woodbridge, he couldn't find full time work at one clinic, as each clinic only needed a part time associate. He has down time in between patients, does a filling or two, a recall or two, and is on his phone a lot in between patients. He reads the news, facetimes his cousins, gets out his favorite book, etc. He ends up making $155,000 in a year. 

 

 

This is the reality in more and more areas - especially in urban centres.

 

I can't tell you how much netflix and redditing I do during the work day.  I'd rather be billing.  There's rarely a day when I'm booked to capacity and often enough I'll ask why I even bothered coming in (besides my contractual obligations).

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I consistently see jobs for MD's paying over 300k a year (stable income, which is a big +) and those are the easy residencies to match into (FM, etc). 

Don't kid yourself. The AVERAGE family billings might be 300K, but that is halved by overhead. Averages are called averages for a reason, and you'd be looking at around 150k take-home in FM, generally.

 

Other specialties pay more, but you're giving up 5 years making low wages working long, long hours.   Your concerns about autonomy, lifestyle, etc., would be even less addressed than in something privately run, like dentistry. And the employment outlook with most specialities is not too great, from what I've gathered

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Don't kid yourself. The AVERAGE family billings might be 300K, but that is halved by overhead. Averages are called averages for a reason, and you'd be looking at around 150k take-home in FM, generally.

 

Other specialties pay more, but you're giving up 5 years making low wages working long, long hours.   Your concerns about autonomy, lifestyle, etc., would be even less addressed than in something privately run, like dentistry. And the employment outlook with most specialities is not too great, from what I've gathered

 

I can show you the link of the jobs I've been seeing, but I'm pretty sure that's your take home pay (before taxes), no? I just picked some of the first ones I saw in the job bank. if it's not the case and there is overhead, how come it's so high? 50% seems a little too much and I consistently hear people saying MD's take home pay is ~225k AFTER taxes and everything (for Family med).

 

http://www.jobbank.gc.ca/jobposting.do?searchstring=doctor&action=Search&id=20693464&source=searchresults

http://www.jobbank.gc.ca/jobposting.do?searchstring=doctor&action=Search&id=20689103&source=searchresults

http://www.jobbank.gc.ca/jobposting.do?searchstring=doctor&action=Search&id=20758221&source=searchresults

 

 

Correct me if I'm wrong. 

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check out this article ( http://www.theglobeandmail.com/life/health-and-fitness/health/how-much-are-canadian-doctors-paid/article7750697/it does a good job explaining how much doctors actually make vs what they bill OHIP. The media makes it seem like doctors get away like bandits when in reality its not all that great after you factor in the extra years of schooling, overhead, tuition etc... and to bring it back to the subject of this thread a quote that caught my eye was "Canadian doctors have an average annual income (before taxes) of a little more than $225,000"  so your stat member_225 is before taxes, after taxes it cuts that figure down to about 140K (not incorporated etc) and I know a bunch of owners who make more then that annually with relatively less work  

 

 If your too lazy to read the whole article at least check out this infographic, http://www.theglobeandmail.com/news/national/average-gross-fee-for-service-payment-per-physician/article7824173/?from=7750697. it gives you a good breakdown of salaries for each specialty and you will see the FM isn't all that profitable 

 

As its been said no less the a million times now this thread if its the money your chasing neither medicine nor dentistry are really as lucrative as people like to make it seem, you got to love your job regardless if its medicine or dentistry :wub: for it to really be worth it. 

 

And on a side not if your trying to decide whether you go into medicine or dentistry based on financial compensation I wouldn't recommend it, after talking to my cousins one a doctor another a dentist they individually came to the same conclusion the end being that there really isn't an easily identifiable trend, some doctors make more but study longer, some dentist study less and earn more, some doctors study more and earn less and there really isn't an easy conclusion that will guide your decision making, just pick the one you like more.   

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Anyways, let's all agree that an associate working full time should be able to make at least 110-120k (stable)... And IMO, with that amount of money, you should be able to live comfortably. Doing something you like and making more than 94% of the population is NOT a bad situation.

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Don't kid yourself. The AVERAGE family billings might be 300K, but that is halved by overhead. Averages are called averages for a reason, and you'd be looking at around 150k take-home in FM, generally.

 

Other specialties pay more, but you're giving up 5 years making low wages working long, long hours.   Your concerns about autonomy, lifestyle, etc., would be even less addressed than in something privately run, like dentistry. And the employment outlook with most specialities is not too great, from what I've gathered

 

If you're a family MD with an overhead of 50% you're doing something terribly wrong. It should be closer to 20-25%.

 

And from what I recall, the average Ontario GP bills more like $400k.

 

Most people operate within a group/corporate scenario now. Overhead is lowered even further as a result. Dentistry often does the same.

 

However, typical dental overhead for a solo practitioner is between 55-70%. The more niceties and tech patients expect, the more it trends toward the higher end of things.

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If you're a family MD with an overhead of 50% you're doing something terribly wrong. It should be closer to 20-25%.

 

And from what I recall, the average Ontario GP bills more like $400k.

 

Most people operate within a group/corporate scenario now. Overhead is lowered even further as a result. Dentistry often does the same.

 

However, typical dental overhead for a solo practitioner is between 55-70%. The more niceties and tech patients expect, the more it trends toward the higher end of things.

 

Mind sharing the link where you got that information? 

 

From all the sources I've checked, the average billing for family doctors in canada is around 250k. 

 

https://www.cma.ca/Assets/assets-library/document/en/practice-management-and-wellness/2015-Chapter3_Medical_billing-e.pdf

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Mind sharing the link where you got that information?

 

From all the sources I've checked, the average billing for family doctors in canada is around 250k.

 

https://www.cma.ca/Assets/assets-library/document/en/practice-management-and-wellness/2015-Chapter3_Medical_billing-e.pdf

My bad. I think I was actually misremembering. $375-400k is the average of all Ontario MDs.

 

I do have a sneaking suspicion that anything reported by the OMA, CMA, ODA etc are low estimates though. there is a special interest in underreporting these things for sure.

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My bad. I think I was actually misremembering. $375-400k is the average of all Ontario MDs.

 

I do have a sneaking suspicion that anything reported by the OMA, CMA, ODA etc are low estimates though. there is a special interest in underreporting these things for sure.

 

Yea I agree, maybe for tax reasons. But that applies to everything, medicine, dentistry, etc. 

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When it comes to debt repayment, I think most health care professions have reasonable ways out in terms of paying back. Might take half a decade but Dentist have very low-unemployment rates under 1%! That's amazing! And you're working in setting of your choice. I was reading stories about debt and how people attending universities/colleges have to work multiple jobs and it's not even in their desired fields of study because no work is available to pay it back. I'm starting dental school in September and yeah I'm worried about the burden of debt but let's be realistic and not so greedy. 

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Oh good grief.

It's not greedy to be concerned about the financial realities of a career, especially one in decline, especially one you just signed on to pay a small fortune to be part of.

 

The issues at hand are important and relevant to our profession as a whole, and not just about how fancy a car you can hope to buy.

 

It's good to know what to expect and to be okay with that, but it's not greedy to worry about it and the pitfalls you will need to be aware of to avoid the worst scenarios.

 

I like these threads because dental students *should* care about the state of their profession.

But yes, it is good to focus on the positives, and there are many.

 

This is exactly why I started this thread and what I had in mind. Couldn't have said it better myself. 

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Oh good grief.

It's not greedy to be concerned about the financial realities of a career, especially one in decline, especially one you just signed on to pay a small fortune to be part of.

 

The issues at hand are important and relevant to our profession as a whole, and not just about how fancy a car you can hope to buy.

 

It's good to know what to expect and to be okay with that, but it's not greedy to worry about it and the pitfalls you will need to be aware of to avoid the worst scenarios.

 

I like these threads because dental students *should* care about the state of their profession.

But yes, it is good to focus on the positives, and there are many.

Oh good grief is right! 

 

I completely agree, be as pragmatic about finances as possible, especially about the career you're choosing for the rest of your life or I hope so. It is good to know what to expect. I was in a position where I was offered a seat in the US with the costs being 400,000 USD for all 4 years. Turned it down without another offer elsewhere. Anyone borrowing more than 250,000$ CAD for dental school should stop and think about it. 

 

Yeah the realities are that the profession is on a decline and it is getting tough out there but when I see Dental students and Dentist lamenting on this forum about not having a 6 figure salary or the prospect of such, it angers me. Get real with your comparisons. Instead of looking up to professions all the time: medicine...etc. Take a look down (financially). Yeah we may have to go through 4 more years of school and take on more liability but that doesn't seem like much with what you're getting in return (low unemployment, work availability until your 60, and financially rewarding-anything over 75K doesn't increase happiness apparently). That to me is greedy.

 

I appreciate posts like Cleanup with all the billing costs and intangibles because that's what people should know going in. 

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Oh good grief is right! 

 

I completely agree, be as pragmatic about finances as possible, especially about the career you're choosing for the rest of your life or I hope so. It is good to know what to expect. I was in a position where I was offered a seat in the US with the costs being 400,000 USD for all 4 years. Turned it down without another offer elsewhere. Anyone borrowing more than 250,000$ CAD for dental school should stop and think about it. 

 

Yeah the realities are that the profession is on a decline and it is getting tough out there but when I see Dental students and Dentist lamenting on this forum about not having a 6 figure salary or the prospect of such, it angers me. Get real with your comparisons. Instead of looking up to professions all the time: medicine...etc. Take a look down (financially). Yeah we may have to go through 4 more years of school and take on more liability but that doesn't seem like much with what you're getting in return (low unemployment, work availability until your 60, and financially rewarding-anything over 75K doesn't increase happiness apparently). That to me is greedy.

 

I appreciate posts like Cleanup with all the billing costs and intangibles because that's what people should know going in. 

 

I agree as well, but it's good to inform people about what they're getting into, so that they won't feel like they made a quick decision into doing something they will regret for the rest of their lives. Conversations like these are not meant to persuade people to completely ditch dentistry, but make them think twice about what the profession entails and what they can expect. 

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