DSO contracts/experience

[dentite24]

How negotiable is a contract with a DSO? If I already have things like disability, malpractice, health, and vision insurance, can I negotiate to not have those things and receive a higher minimum, sign on bonus, or higher collections?
Also, I'm seeing a lot people talk about DSOs trying everything they can to not pay daily guarantee, sign-on bonus, and correct collections... What are the things to look at for to make sure all money is received correctly?

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[2TH MVR]

Just some thoughts on your inquiry. I've been working at a DSO for the last 6 years.

If you are a new grad .... I'm not sure how much negotiating leverage you have. As with any job (Corp or Private) .... you have to prove your worth through measurable metrics which requires actual work time and experience.

I believe sign-on bonuses are paid over the length of the contractual length of employment. There has been some discussion here that the sign on bonuses look attractive at first .... but the reality is that they tie you into a longer term of employment and that your compensation may actually be lower due to the signing bonus.

Are you going to be an Independent Contractor (IC) or DSO employee? Most large DSOs have their own malpractice policy that covers you (as an employee) and them. Not sure that the DSO will take a chance on your insurance. You also do not have to pay for the disability, health, vision insurance unless you want them.

What's more important is to research what percentage of the patients are access. I would shy away from DSOs that treat mostly access patients. Your compensation from these types of patient procedures will be next to nothing.

In an urban setting ... there are plenty of jobs available. Do your research. Visit the offices. Talk to the other docs. Its just a job. Other opportunities will pop up. They always do.

 

[dentite24]

Just some thoughts on your inquiry. I've been working at a DSO for the last 6 years.

If you are a new grad .... I'm not sure how much negotiating leverage you have. As with any job (Corp or Private) .... you have to prove your worth through measurable metrics which requires actual work time and experience.

I believe sign-on bonuses are paid over the length of the contractual length of employment. There has been some discussion here that the sign on bonuses look attractive at first .... but the reality is that they tie you into a longer term of employment and that your compensation may actually be lower due to the signing bonus.

Are you going to be an Independent Contractor (IC) or DSO employee? Most large DSOs have their own malpractice policy that covers you (as an employee) and them. Not sure that the DSO will take a chance on your insurance. You also do not have to pay for the disability, health, vision insurance unless you want them.

What's more important is to research what percentage of the patients are access. I would shy away from DSOs that treat mostly access patients. Your compensation from these types of patient procedures will be next to nothing.

In an urban setting ... there are plenty of jobs available. Do your research. Visit the offices. Talk to the other docs. Its just a job. Other opportunities will pop up. They always do.

I will have a year of AEGD under my belt (implant/wizzie experience) when I start applying.

But, if you deny some of the extra fluff benefits you may not need (due to marriage), do you think you could negotiate higher collections/daily?

What do you mean by access? You mean basically medicaid?

 

[Molar Whisperer]

Like Dr. 2TH MVR mentioned, negotiations will depend on your leverage potential. I would market your implant/wizzie experience, but with only a year under your belt, that leverage may not be as favorable as you like.

I currently work on Medicaid pts. I have no loans and my house is all paid. I make over $200k working 4 days, 30-32 hrs. I'm the in-house "OS" and "endo" guy and the go to dentist for any BS situations. The company gives me any equipment and supplies I need and I had 2 of the best DAs, one unfortunately left the dental industry last week. The big disadvantage working on Medicaid besides lower pay is your colleagues generally are less talented and motivated dumping you all the BS. I recently interviewed at a private office and they want to pay me $150/hr or $300k/yr (if one works 40 hrs x 50 wks). I was hesitant but the owner wanted to sweet talk me again by visiting him tomorrow. My 2 downsides for that practice are the brutal commute and the impending recession when Medicaid will continue to pay your salary (I was getting paid in full during the Covid lockdown).

 

[P7898]

Like Dr. 2TH MVR mentioned, negotiations will depend on your leverage potential. I would market your implant/wizzie experience, but with only a year under your belt, that leverage may not be as favorable as you like.

I currently work on Medicaid pts. I have no loans and my house is all paid. I make over $200k working 4 days, 30-32 hrs. I'm the in-house "OS" and "endo" guy and the go to dentist for any BS situations. The company gives me any equipment and supplies I need and I had 2 of the best DAs, one unfortunately left the dental industry last week. The big disadvantage working on Medicaid besides lower pay is your colleagues generally are less talented and motivated dumping you all the BS. I recently interviewed at a private office and they want to pay me $150/hr or $300k/yr (if one works 40 hrs x 50 wks). I was hesitant but the owner wanted to sweet talk me again by visiting him tomorrow. My 2 downsides for that practice are the brutal commute and the impending recession when Medicaid will continue to pay your salary (I was getting paid in full during the Covid lockdown).

^ That is what is making me stay at my work. A practice with mixed PPO and Medicaid will win in the next year with the way the economy is heading. And keyword here is "debt free". Great income with no debt and medicaid/ppo is a very safe and stable gig. I would not give that up heading into a recession.

 

[2TH MVR]

You guys have a point about the impending recession. All I know is that the general dentists I work with are usually really pissed when their schedules are packed with Medicaid patients. Many have left the DSO for this very reason.

I remember the last recession where elective procedures like ortho was in decline. But. I'm at a point in my life where I really do not care.

As for the OP. Some good advice given here. Maybe start planning for the recession during your negotiations.

 

[schmoob]

I will have a year of AEGD under my belt (implant/wizzie experience) when I start applying.

But, if you deny some of the extra fluff benefits you may not need (due to marriage), do you think you could negotiate higher collections/daily?

What do you mean by access? You mean basically medicaid?

Depends on the AEGD. There are hard chargers out there who go straight to DSO after graduation and will run circles around you as far as production and clinical skill. This is by sheer repetition because they have more endo, crowns, restorative under their belt and they have a year of talking to patients for case acceptance. Also depending on the DSO they may not want you to do the implants/3rds because they have in house specialists who will do it for higher reimbursement.

As far as the benefits go, those are usually non-negotiable other than your daily guarantee. As far as health, vision, disability, etc it’s not something you negotiate, you just choose not to elect those options and your paycheck will be higher because you won’t have those deductions. I would consider electing them though so you have secondary coverage.

 

[Molar Whisperer]

Depends on the AEGD. There are hard chargers out there who go straight to DSO after graduation and will run circles around you as far as production and clinical skill. This is by sheer repetition because they have more endo, crowns, restorative under their belt and they have a year of talking to patients for case acceptance. Also depending on the DSO they may not want you to do the implants/3rds because they have in house specialists who will do it for higher reimbursement.

As far as the benefits go, those are usually non-negotiable other than your daily guarantee. As far as health, vision, disability, etc it’s not something you negotiate, you just choose not to elect those options and your paycheck will be higher because you won’t have those deductions. I would consider electing them though so you have secondary coverage.

In the Pacific NW, insurance companies want to reimburse dentists as little as possible. Therefore, it is not to the ins' interest to pay specialist fees. From my observations, many plans cap about $1500 a year. My sister practices in TX and she is transitioning away from PPOs to traditional FFS. I anticipate she will lose a lot of patients.

For the most part, Dental Corps are crap (I'm not very familiar with Kaiser other than they seem to pay their dentists well and the dentists don't seem overworked). I would stay away from Aspen Dental unless you want to go there short term and get really good with dentures (with the right technicians, cases come back with minimal adjustments). I would also stay away from signing bonuses. First, they withhold about 45% for taxes. If you don't stay for 12 mos, you need to pay back the full pro-rated amount which is minus signing bonus. In other words, the places that offer signing bonuses are total garbage because no dentists want to work there. For example, at Aspen, it is impossible to write good charts (handwritten loose paper) when you are overworked (at one point, 12 pts were waiting on me). When you have a Board Complaint (there were 5 in my name directed at my predecessors and 1 at me), you have to turn in all the loose papers which some will end up missing. I prefer electronic charting with pre-made templates (I cut and paste). My previous supervisor is a Board member and he was gracious enough to specify all the information the Board wants in our charting. You may have to consider between working at a very saturated area with less desirable pay compared to high Cost of Living or more remote areas with favorable income potential.

 

[dentite24]

Wouldn't PPO offices be safe during a recession? I feel like any insurance office is more safe than a FFS practice next year.

 

[2TH MVR]

@dentite24
Curious why you haven't brought up employment with private offices.

 

[dentite24]

@dentite24
Curious why you haven't brought up employment with private offices.

I'm open to either. I feel DSO might be better first year with offering minimums, getting my speed up, and recession proof (PPOs). But I would obviously a good private office if it could offer those things

 

[Molar Whisperer]

Wouldn't PPO offices be safe during a recession? I feel like any insurance office is more safe than a FFS practice next year.

IMO, PPO are the worst when it's not a recession. We had to deal with one from Hawaii (before Covid) and they are always closed (they observe many Holidays and time off). When they do open on Hawaiian time, there phones are always busy. When the economy tanks, employers lay off workers reducing the beneficiaries. Keep in mind insurance companies are there to make money and reimbursements are minus income to them.

I think the most recession proof dental practices are the gov't operated/funded such as Medicaid, Community Public Health, Military, Indian Services, VA, etc. I can't predict when and how severe the next recession is. Hopefully loans and living expenses can be best managed.

I read some of Cold Front's old posts and he is an absolute genius. During the '08-09 recession (sorry if I got the details wrong), he got some real estate on the cheap. (I wanted to get a foreclosed property but I couldn't afford the risks with infant twins and stay at home wife). During Covid, he got into Logistics with Amazon. I presume he hedged the fuel commodity to his advantage.