I was reading a Reddit thread recently about dentists who are struggling financially. One of the posters said they should warn pre-dents on forums like this, and another said it would be a waste of time. Anyway, it reminded me of this thread.
My personal feeling is that you can still succeed as a dentist, but now is not a great time to be a dentist for many. In some places, hygienists are earning more than dentists. In fact, at
some offices (emphasis on some), hygienists are being offered up to $100/hr, which works out to $800 per day. A brief search on Indeed reveals that this is more than many associate dentist jobs are offering for a daily guarantee. In many offices, associates are paid 1099 without benefits, while hygienists are W-2 with benefits. Even when the hygienist is earning $65/hour (which is common now), and the dentist is making $90/hour (also common), it really becomes $90 (minus) benefits (minus) your share of payroll taxes. Also, the dentist has much higher student loan debt burden. You get the idea.
So, here are some things I've personally seen / experienced / learned from so far since graduating in 2020. I think it will also serve as insight to those who may be wondering if dentistry is for them. Sorry for the length, but hopefully it is useful to someone.
1) I know a classmate who took home close to $800k his first year out of school. He is the extreme exception, and the kind of guy everyone hopes (and assumes) they can replicate. The fact is, he does 5-minute SRPs (he runs a no-hygienist model) and 20-minute molar root canals, MB2 be damned. In other words, he doesn't care how his dentistry turns out, he just wants to make a lot of money. He profits greatly at the expense of his patients, and the entire profession. I don't advise that anyone aspires to be like this. So, when you hear stories about the baller dentists making absurd amounts of money, there is usually more to the story. He also worked 6 days per week, 12 hour days. He is a machine. Few people have that kind of energy / stamina in this field.
2) One of my best friends is making ~$500k to work medicaid peds. He is happy, but bored. He wants a change, but can't find a job that will pay as well in general dentistry without being an owner (more on ownership to follow). He is also working 6 days per week, though he recently cut back on hours to strike a balance with his personal life. He is working hard to maintain his enthusiasm for dentistry by taking advanced CE on procedures he doesn't perform in his current practices. His most productive procedure is fillings. He can churn out half a mouth in 1 hour, and I've seen him run a schedule with 62 patients by himself. I don't know how the hell he did it, except that there was a huge amount of delegating going on, and a severe shortage of supervision.
3) My former dental school partner is doing lots of fixed full-arch implants cases with a major DSO where he is an "owner." He talks a big game (most implant dentists do), but keeps changing practices. One month he's making bank, doing full arch all day, the next month he's at a new practice because he admits he wasn't making money at the last one. Bragging, inflating income, all of these things are taken to an extreme in this profession. I've learned to take everything I'm told with a grain of salt, and you should too, including the numbers I'm sharing here that were shared with me, which I feel are likely to be true, but could be total BS.
4) When it comes to corporations and groups, ownership probably doesn't mean what you think it means. When corporate chains, or even group practices lure you in with the promise of "ownership," just understand what they are really giving you is a stake in the business. Your stake does not guarantee you any decision-making power, and it does not mean you will be treated with any more respect than an associate. In fact, sometimes it's even worse. Your sister's wedding? Dr. Cello, you do realize that your production is 24% lower than this same period last year, do you really think that now is the time to be traveling to weddings? If you were an associate, sure, but now you're an owner, and this P&L just isn't adding up Dr. Cello... Also, there is a certain large DSO that will tell you they are doctor-owned. They aren't. I sat in on their quarterlies when they tried to sell me a practice, and they are on their 3rd round of funding from Wall Street, and the majority of the DSO is owned by outside investors, just like everyone else. But you don't know that until you pull back the curtain. This group also lures "owner" dentists into investing their money into sidecar investments through the DSO, which, if anyone remembers the Enron scandal, should know that is a bad idea, especially when we are rapidly approaching the end of the chain of Greater Fools who will buy practices at a loss.
5) Speaking of curtains, implant centers make heavy use of them. A mentor of mine was working for a big implant group, with an insane contract and NDA, but what I gathered is that the group charges the doctors in months where they spend more than they make. So, when their marketing costs exceed their income, the doctors have to pay the DSO to run marketing the next month. Also, I know that one month this particular doctor produced $530k, from a $130k ad spend. But, the following month they lost hundreds of thousands of dollars, and he was on the hook for (his) part of it. Some months he made bank, other months he got wrecked, and he ended up quitting well short of the contract period because it was financially untenable. They keep hiring new grads to take over, and I'm sure they are great about sharing the same $530k month they shared with me when trying to entice me to replace this mentor after he left.
6) A former classmate of mine has a couple of offices now, and he is producing very nicely out of one of them by being the discount dentist. He competes on price, and apparently offers a great experience based on his reviews (600+ in a few months
). He showed me his financials, and his production is amazing. $260k one month, when the practice was producing only $50k the same month a year ago. But, he wrote off $70k that month, spent a ton on marketing, and his collections are on the low side. Lots of dentists talk about production, but the number that matters at the end of the day is how much you are taking home. I'm sure he is doing very well, I'm just saying that there is more metrics / practice analytics than just production. This dentist falls into the same camp as a lot of dentists you hear about on podcasts like Shared Practices. Basically, he bought a diamond in the rough. The previous owner was ailing, might actually have passed away, but in any case, he had slowed way down, and was underdiagnosing. He brought in a timid associate who was watching everything and doing nothing. You can buy these offices, with a full book of active patients, and immediately churn out tons of dentistry, but it takes careful analysis and a bit of luck. You also have to be prepared for what George Hariri coined "the honeymoon phase" that happens 6-12 months later when you run out of dentistry on the existing patient base. If you don't have tons of new patients flooding in, then you will see a big decline in revenue when once you have treated all the stuff the previous dentist was watching / ignoring.
7) Another classmate of mine started her own implant center. I'm told she is absolutely crushing it. She may be the unicorn who does high quality dentistry, at an affordable price, with an exceptional service, but I don't know much about her practice. All I know, is that she is spending a ton on marketing, but getting more than a 10x on the ROI. Clearly, her marketing is dialed in. That may be the most important thing young dentists need to learn: marketing. If you can't market your amazing and expensive procedure, it doesn't matter. Don't rely on dental marketers, because most of them are really bad at what they do. In fact, I'm convinced that most dental marketers couldn't compete in other fields, so they came to dentistry because we are willing to pay more for less. Most dental marketers are great at marketing themselves to dentists, and bad at marketing dentists to patients. They use flawed analyses to lock you into restrictive and punitive contracts (I know a dentist who is being sued for $15k because he bad-mouthed his previous marketing company), then fail to deliver meaningful results from exorbitant marketing spends. When you start working with dental marketers, you need to know the difference between cost/lead, cost/click, and cost/conversion. You need to know what a sales funnel is, and how marketers should be targeting the sales funnel. Basic concepts can help you sort the posers and pretenders from the real deal.
8) On the flip side of the income scale, I also know of dentists who don't make much money. One of my best friends was working a corporate job and made $90k. A former co-associate moved to Texas and was making ~$70k. He was locked into a 1-year contract, and at the end of his 6-month guarantee was making close to nothing. One guy I know only works weekends and has devoted the rest of his week to BJJ, so I guess he doesn't care to earn more than he does. A former classmate was a traveling doctor for a large DSO, and was struggling to break $110k. I know several dentists who are making $110-$120k and working 4 days. They get into the job, get complacent, and then just stay because it's easy, or because they are happy enough making what they make, and doing what they do.
9) A former co-associate of mine got a screaming deal on a jump-start practice. The previous dentist fled the country on tax evasion charges and never came back. Practice sat vacant for months before the bank offered it up for an insanely low price. I think he got the office with 5 ops, CBCT, supplies and equipment, for under $200k. That's the kind of deal that sets you up for life. But, dude got extremely lucky. Some people get lucky, that doesn't mean you can't still be successful.
10) In our 3rd month in practice, my startup produced $76k. I was very proud. It would be easy to share that number with the world, and leave out that in our 4th month we only produced $28k. This happens a lot in this field. People tell you their best numbers, and leave out the bad. You hear $76k/month and project that out and say something like, "wow, you built a $900k / year startup in only 3 months!" No, we didn't. The fact is, dentistry is very up-and-down. You have great months where you are way in the black, and bad months where you don't get paid. This is especially true for startups, where you have no stable patient base or cash flow.
11) You need to look beyond fillings and crowns. But accept the fact that you may discover that there are things you thought you wanted, and later find out you don't. I have learned to do lots of things now that I'm 4 years out of school, including big full-arch cases. I thought that I really wanted to do those cases. I wanted to be a full-arch implants guy. But, I have been having my mentor do the more complex the cases for me and let me place transnasal / do a lateral sinus augmentation with placement, all while he guides me. But honestly, I prefer to just have him do the cases. In fact, if I could keep him busy enough, I would rather partner him in and let him do all of the big cases, so I don't have the stress of preparing for them, or fixing them when they go catastrophically wrong. And believe me, they do go catastrophically wrong, no matter who does them. We get revision cases from specialists, and it's important not to throw them under the bus. I promise you, one of your patients will end up in their office, and the last thing you want that doctor thinking is, "oh, that's the guy that threw me under the bus last year when that AO6 case showed up in his office for a 2nd opinion." This one has been tough for me, because I tend to say what I'm thinking, even without intending it to come across the wrong way. Learn to filter your thoughts before speaking to patients. Also, resist the urge to bash fellow dentists when invited to by a patient. You could be next.
12) Running a business is hard work. Very hard work. It is the main reason I've avoided taking on bigger cases right now. It is very difficult to be jumping in to an all-on-4 case one minute, then fixing timesheets and submitting payroll the next minute, or talking to an employee about their excessive bathroom usage at inopportune times. It is doable, but I didn't find it enjoyable, and it saps my energy. For many you, there may come a day where you have to decide between being the owner, or doing the big technical cases. Most of the big technical dentists around me have joined up with DSOs, or decided to retire from clinical dentistry and focus on entrepreneurship for this reason. It's a lot to manage the business and big complex cases. Emotionally, psychologically, and even physically, it can be very taxing.
13) As an owner, I've been burned many times, and made every mistake imagineable. I've lived fast, and learned fast. Speed kills. I've had to fire 3 people in 16 months and have hired 8. I spent $2,500 on a marketing company that got me 1 patient. I also spent $4,300 on another marketer who came highly recommended and got me 0 leads. I hear she may have just put another dentist out of business. I have found some good, and many terrible marketing companies. The same can be said for many of the vendors we work with as dentists. Hell, I'm still looking for a decent accountant. Being the owner is hard, because it's all on you. No new patients? That's your problem. Spending too much on supplies? That's also your problem. Didn't register for the state's unemployment insurance program in time? That's definitely your problem. Accountant forgot to file your taxes? Still your problem. Read the book Extreme Ownership, and live that book in your practice. Hold people accountable, but remember that you are the one who is accountable at the end of each day.
14) Some patients are just not worth it. Get rid of them. I started a case on a lady in temps, and she told me that she just didn't want to go back to the previous dentist. Imagine my surprise when the dental lab told me they wouldn't work with her because she is a nightmare patient and they dismissed her months ago when she did the same case with 2 previous dentists. When the lab fires a patient, you should too. I didn't, because I'm probably still too naive and eager with running a startup, but it bit me hard. When the red flag appears, just kindly invite them to see someone else because you don't think you can meet their expectations. Take the L to win.
PS - It was mentioned earlier that having a spouse who is a physician is an advantage. It is, and it isn't. I have the advantage of not needing to earn income because my wife can support our family. However, my wife is a subspecialist, which means we have to live in a large urban area for her to have enough patients. I would have been more than happy to open / buy a practice somewhere rural, but that wouldn't work with her career. I had also planned to join the air force and do HPSP, but again, that doesn't work with her career. Also, the stakes are waaaay higher. If I were to open / buy a practice by myself, and my wife has little or no income, then going bankrupt sucks, but not as much as if I drive us into bankruptcy and we lose all of the assets my wife and I have built up over the years. And though it may seem unlikely that a dentist could go bankrupt, it happens more often than you think, and dental practices are hungry beasts with tons of overhead. Remember where I said we made $28k in June? Well, we lost almost $30k from overhead. How many people can absorb those kinds of losses long-term and not go bankrupt? We were 4 months old, with limited working capital. It was a nightmare, and the most stressful period of my life. The second most stressful period was when one of our double-arch AOX patients changed his mind two weeks before surgery and demanded a refund. The fact is, ownership is tough, but startups are risky and require balls of steel, a high level of risk tolerance, and a very supportive partner.
