Life of new grad orthodontists

[abc_sf]

For those of you who just graduated from ortho residency, is working in the "real world" what you expected? what are some obstacles/struggles you didn't know before/during residency?

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[juniordentist]

It's hard to make money in ortho. As a dentist I thought "wow 6k -8k for treatment, orthodontist are killing it". Once you realize how many appointments, the overhead, time in treatment, you realize it's actually not easy to make money. Some cases you actually lose money. This is something you don't realize during residency.
Jobs are hard to come by as an associate. When orthodontist get busier, they hire more assistants and do the work themselves. Therefore there are less job opportunities than as a dentist. So the jobs don't pay as well.
The work as an ortho is great. But all other aspects suck. Hard to make money, high debt, competitive.
It is easier to make money staying as a general dentist - work for those 3 years instead of going into debt for ortho and you will be better off financially most of the time

 

[2TH MVR]

It's hard to make money in ortho. As a dentist I thought "wow 6k -8k for treatment, orthodontist are killing it". Once you realize how many appointments, the overhead, time in treatment, you realize it's actually not easy to make money. Some cases you actually lose money. This is something you don't realize during residency.
Jobs are hard to come by as an associate. When orthodontist get busier, they hire more assistants and do the work themselves. Therefore there are less job opportunities than as a dentist. So the jobs don't pay as well.
The work as an ortho is great. But all other aspects suck. Hard to make money, high debt, competitive.
It is easier to make money staying as a general dentist - work for those 3 years instead of going into debt for ortho and you will be better off financially most of the time

Are you an orthodontist? If not .... curious where you are getting your information.

If so. Where do you practice and ow much debt do you have?

Just looking for some perspective.

Overall. Yes. Ortho is no longer the Golden Goose it once was. But from where I am standing .... it is much better than being a GP. Just my opinion as an orthodontist.

 

[juniordentist]

Are you an orthodontist? If not .... curious where you are getting your information.

If so. Where do you practice and ow much debt do you have?

Just looking for some perspective.

Overall. Yes. Ortho is no longer the Golden Goose it once was. But from where I am standing .... it is much better than being a GP. Just my opinion as an orthodontist.

Yes I am an orthodontist, 2 years out. Want to keep anonymous. Buy yes, your version of the profession would be very different to mine. The exact same way dental students need new graduates perspective rather than the experienced dentist who built their practice in a different era

 

[LFA20]

Yes I am an orthodontist, 2 years out. Want to keep anonymous. Buy yes, your version of the profession would be very different to mine. The exact same way dental students need new graduates perspective rather than the experienced dentist who built their practice in a different era

Thanks for the insight. What would you say is the average salary of an ortho associate starting out? and what about 4-5+ years out?

 

[juniordentist]

Thanks for the insight. What would you say is the average salary of an ortho associate starting out? and what about 4-5+ years out?

This is the problem for ortho. Associates generally get a daily rate. 1200-1500 a day is common. So those with 5 years experience aren't really getting any more than new grads as it's all based on daily rate. The daily rates are underpaying the associates. It's pretty unfair tbh

 

[charlestweed]

This is the problem for ortho. Associates generally get a daily rate. 1200-1500 a day is common. So those with 5 years experience aren't really getting any more than new grads as it's all based on daily rate. The daily rates are underpaying the associates. It's pretty unfair tbh

That’s easily 320-400k/yr income if you work 22 days/month…..$450k if you work 6 days/wk. If you work like this for the next 20 years of your life, you should make around $8-9M or around $6-7M post tax, which should allow you to pay off your $6-700k student loan + 4-500k practice loan + $1-2M home mortgage. And you will only be in your early 50s. Man, I wish my starting salary was that high when I graduated. My first job paid me $800/day, which was $200 more per day than what I expected…so I was very happy.

The stress level working as an associate ortho is no where near that of the general dentists and doctors. We, orthodontists, are so spoiled.

 

[juniordentist]

That’s easily 320-400k/yr income if you work 22 days/month…..$450k if you work 6 days/wk. If you work like this for the next 20 years of your life, you should make around $8-9M or around $6-7M post tax, which should allow you to pay off your $6-700k student loan + 4-500k practice loan + $1-2M home mortgage. And you will only be in your early 50s. Man, I wish my starting salary was that high when I graduated. My first job paid me $800/day, which was $200 more per day than what I expected…so I was very happy.

The stress level working as an associate ortho is no where near that of the general dentists and doctors. We, orthodontists, are so spoiled.

I don't necessarily disagree with what you're saying, although 700k student loan and 500k practice loan and 2m house (3.2m total) actually equates to 5.5m over 20 years if you assume 6% loan (just used a loan repayment calculator). So your 6m post tax means after 20 years you only have 500k saved for retirement, which in 20 years is probably not worth much.
Either way, I think that's besides the point. That does get you a very nice lifestyle over 20 years, so i agree with you that its worth it.
But I think that's the wrong question. I think the more important thing to calculate is how does that compare to general dentistry? If you stayed working for 3 years, and avoided 300k extra debt, whilr the orthodontist is in residency, which probably equates to roughly a million dollars? Then, after residency, yes you may earn more, but that extra money you earn is at a higher tax rate. So the dentist earns 275k, the ortho earns 350k, but they maybe only keep an extra 45k post tax? Will they ever recoup that million dollar investment?

 

[charlestweed]

I don't necessarily disagree with what you're saying, although 700k student loan and 500k practice loan and 2m house (3.2m total) actually equates to 5.5m over 20 years if you assume 6% loan (just used a loan repayment calculator). So your 6m post tax means after 20 years you only have 500k saved for retirement, which in 20 years is probably not worth much.

If you pay off all your debts early (instead of the standard 10 yrs for student loans and 30 yrs for home loans), you won’t have to pay the 6% interest. You will pay like 1-2% in interest. With such great income, you shouldn’t have any problem doing that if you don’t waste money on stupid things or put your money in a wrong stock. Also keep in mind that your paid off house, which is part of your net worth, will be worth a lot more in 20 yrs.

Either way, I think that's besides the point. That does get you a very nice lifestyle over 20 years, so i agree with you that its worth it.
But I think that's the wrong question. I think the more important thing to calculate is how does that compare to general dentistry? If you stayed working for 3 years, and avoided 300k extra debt, whilr the orthodontist is in residency, which probably equates to roughly a million dollars? Then, after residency, yes you may earn more, but that extra money you earn is at a higher tax rate. So the dentist earns 275k, the ortho earns 350k, but they maybe only keep an extra 45k post tax? Will they ever recoup that million dollar investment?

400-450k is a great income….even at this current high inflation rate/high student loan debt era….easily puts you in the top 1%. $350k is for those orthos who only work 3-4 days/wk. Yes, I easily beat all of my GP friends, who had 3+ years of head start, in terms of lifestyle and salary. Many of them still have debts. The majority of them have smaller houses and drive less expensive cars. It's hard (very stressful) working as a GP. As an ortho, you can work until you're 70....a good way to semi-retire if you don't have any hobby to keep yourself entertained. The good thing about ortho is you can still maintain great cashflow while you build your own new practice. Most orthos, who work at the corp office (myself included), have their own practices. It's harder for the GPs to do both at the same time: own a practice and work for someone else.

 

[2TH MVR]

Yes I am an orthodontist, 2 years out. Want to keep anonymous. Buy yes, your version of the profession would be very different to mine. The exact same way dental students need new graduates perspective rather than the experienced dentist who built their practice in a different era

No offense, but 2 yrs in the real world is nothing. You hardly have any real world experience. When I graduated from ortho residency ... I had about a 100K worth of total debt. I was unemployed for the 1st 6-12 months looking for the right opportunity. Finally an opportunity presented itself. Bought into a partnership leading to a buyout. Essentially .... I bought myself a job.

Again. You don't mention what your total debt it. Maybe I missed it. Huge debt is going to sour anyone. Also ..... you mention the daily minimums. Lots of variations in the Corps, but most dailys come with bonuses. Mine does. And trust me .... the bonuses make all the difference.

My feeling is that alot of new orthos had a certain vision that no longer exists. Reality is working 5-6 days and travelling to multiple offices. Just ask @charlestweed. I'm 60 yrs old. I continue to work 4-5 days per week. No issues. I enjoy the money and am accustomed to nice things.

I can assure you. At least in the Corp environment .... most of the GPs wish they were orthodontists. Both for the ease of the ortho work and the money we make in comparison to their take home pay.

I have yet to meet a seasoned orthodontist that regrets being an orthodontist.

Be patient, work hard and make the right decisions.

 

[OncePreDent]

No offense, but 2 yrs in the real world is nothing. You hardly have any real world experience. When I graduated from ortho residency ... I had about a 100K worth of total debt. I was unemployed for the 1st 6-12 months looking for the right opportunity. Finally an opportunity presented itself. Bought into a partnership leading to a buyout. Essentially .... I bought myself a job.

Again. You don't mention what your total debt it. Maybe I missed it. Huge debt is going to sour anyone. Also ..... you mention the daily minimums. Lots of variations in the Corps, but most dailys come with bonuses. Mine does. And trust me .... the bonuses make all the difference.

My feeling is that alot of new orthos had a certain vision that no longer exists. Reality is working 5-6 days and travelling to multiple offices. Just ask @charlestweed. I'm 60 yrs old. I continue to work 4-5 days per week. No issues. I enjoy the money and am accustomed to nice things.

I can assure you. At least in the Corp environment .... most of the GPs wish they were orthodontists. Both for the ease of the ortho work and the money we make in comparison to their take home pay.

I have yet to meet a seasoned orthodontist that regrets being an orthodontist.

Be patient, work hard and make the right decisions.

Times are a bit different now. The most interesting addition is DSOs training GD to do ortho (very recent). You have your typical pediatric or GD doing Invisalign. However, some DSOs purchase ortho practices or build new ones. They will hire one ortho to train GDs to practice orthodontic procedures. Eventually, what happened is that the ortho that was originally hired starts getting scheduled fewer days a week because the GD cost 25% less than the ortho. And then that ortho needs to start looking for a new job. So if anyone is a GD out there that is interested in ortho, start looking for some DSOs that do this because they are out there. Also, they typically will have 1 ortho managing 6-8 GD. If you are an ortho in a similar situation, I would be cautious because you will likely be out the door sooner than you might want.

 

[Thehighwind87]

No offense, but 2 yrs in the real world is nothing. You hardly have any real world experience. When I graduated from ortho residency ... I had about a 100K worth of total debt. I was unemployed for the 1st 6-12 months looking for the right opportunity. Finally an opportunity presented itself. Bought into a partnership leading to a buyout. Essentially .... I bought myself a job.

Again. You don't mention what your total debt it. Maybe I missed it. Huge debt is going to sour anyone. Also ..... you mention the daily minimums. Lots of variations in the Corps, but most dailys come with bonuses. Mine does. And trust me .... the bonuses make all the difference.

My feeling is that alot of new orthos had a certain vision that no longer exists. Reality is working 5-6 days and travelling to multiple offices. Just ask @charlestweed. I'm 60 yrs old. I continue to work 4-5 days per week. No issues. I enjoy the money and am accustomed to nice things.

I can assure you. At least in the Corp environment .... most of the GPs wish they were orthodontists. Both for the ease of the ortho work and the money we make in comparison to their take home pay.

I have yet to meet a seasoned orthodontist that regrets being an orthodontist.

Be patient, work hard and make the right decisions.

While I’m no orthodontist and have no input in this thread- I personally feel like any new grad asking about dentistry or ortho should realistically take advice from someone 25-35. Someone that has practice AFTER Covid. Times have changed a lot. And Covid has changed things dramatically. Dentistry before Covid versus after Covid is two different animals.

I’m 35 and I feel like my advice is not relevant to new grads today. My loans were 200-300k I don’t remember and my graduating school now costs easily 500-600k.

I’ve had the fortune and time to invest in the market when things were low and when housing was reasonable along with “cheap interest rates” for practices and mortgages.

Todays new grads graduate with double to triple the debt load, have less reimbursement due to higher inflation and stagnate reimbursement and don’t have the opportunity to buy stocks like apple at 40$ or the spy at 200$ or even a reasonable house for 300-500k- seems like today homes in a decent neighborhood are 700-1 mil plus at 7% rates.

While we old timers have it good, we def can’t relate to younger new grads.

 

[charlestweed]

Times are a bit different now. The most interesting addition is DSOs training GD to do ortho (very recent). You have your typical pediatric or GD doing Invisalign. However, some DSOs purchase ortho practices or build new ones. They will hire one ortho to train GDs to practice orthodontic procedures. Eventually, what happened is that the ortho that was originally hired starts getting scheduled fewer days a week because the GD cost 25% less than the ortho. And then that ortho needs to start looking for a new job. So if anyone is a GD out there that is interested in ortho, start looking for some DSOs that do this because they are out there. Also, they typically will have 1 ortho managing 6-8 GD. If you are an ortho in a similar situation, I would be cautious because you will likely be out the door sooner than you might want.

It's impossible to train dentists to do ortho. Even with formal training, most new grad orthos are clueless after graduation. To be competent in ortho, one has to treat a lot of cases in the real world setting for a couple years. My corp has "forced" the GPs to take on easy invisalign cases....and ask us, orthos, to help them. But many of the GPs try to avoid doing any type of ortho tx and refer cases to me. It's their license and they don't want to take risk.

 

[charlestweed]

While we old timers have it good, we def can’t relate to younger new grads.

Yes, we old timers can relate to younger new grads. That's why we recommend the young grads to work 5-6 days/wk....and not to waste any time (ie taking a gap year....taking time off to travel etc). We, old dentists/orthodontists, could get away with working 3-4 days/wk (or attending private dental/ortho schools) because of less student loans and lower cost of living. Young grads don't have such option. I wouldn't recommend this dental/orthodontic profession to any person who wonders if he/she can work 4 or less days/wk....and take time off to travel.

That's why my wife and I continue to work to save for our kids because we know they won't have it good like us, old timers.

 

[OncePreDent]

It's impossible to train dentists to do ortho. Even with formal training, most new grad orthos are clueless after graduation. To be competent in ortho, one has to treat a lot of cases in the real world setting for a couple years. My corp has "forced" the GPs to take on easy invisalign cases....and ask us, orthos, to help them. But many of the GPs try to avoid doing any type of ortho tx and refer cases to me. It's their license and they don't want to take risk.

I promise you it is happening right now. I wouldn't say it is impossible to train dentists to do ortho. All orthos start out as dentists. There are many GD that would prefer to do ortho work rather than GD if they are able to. I have heard from a few orthos that going to ortho residency is pointless (depending on the residency) and would have been better off working for an ortho directly for 2 years rather than doing residency (though you don't get the ortho certificate). GP typically do the "easy" ortho procedures, I haven't seen a single dentist that doesn't offering Invisalign in their offices. The pediatric dentists that I've shadowed all offer both braces and Invisalign, but of course they aren't going to have as much knowledge as someone who graduates from an ortho program & solely does ortho treatment.

The issue is GP, DSOs, and corporate do not care for the patient's overall care. If they did, they would refer every single ortho treatment to an orthodontist who specializes in ortho (if accessible). Which isn't the case. They care more about turning a profit which is sad for the patients well-being & impacts the overall trust in dentists when issues arise. While talking to orthos they have come across countless cases where a GP or a Smile Direct Club company offered aligners and severely messed up the treatment. I think it can be comparable to extracting wisdom teeth. When a patient needs their wisdom teeth extracted most of the time they are referred to an OS because the OS can provide the best care for your patients and has more knowledge & skills than the GD on wisdom teeth extractions.

 

[charlestweed]

I promise you it is happening right now. I wouldn't say it is impossible to train dentists to do ortho. All orthos start out as dentists. There are many GD that would prefer to do ortho work rather than GD if they are able to.

GPs and pedo have done ortho tx on their patients for years. Invisalign has been around for years. These are old news. The orthodontists still handle most of cases. I know many practicing GPs and pedos who decided to back to school for ortho despite having already done a lot of ortho cases in their practices. They still want to have that precious piece of paper….it’s called “ortho certificate.”

I have heard from a few orthos that going to ortho residency is pointless (depending on the residency) and would have been better off working for an ortho directly for 2 years rather than doing residency (though you don't get the ortho certificate). GP typically do the "easy" ortho procedures, I haven't seen a single dentist that doesn't offering Invisalign in their offices. The pediatric dentists that I've shadowed all offer both braces and Invisalign, but of course they aren't going to have as much knowledge as someone who graduates from an ortho program & solely does ortho treatment.

In any profession, there are always some unhappy people who express their negative opinions. There are unhappy dentists, unhappy orthos, unhappy engineers etc. If it is pointless to get a formal training, then why so many try to get into ortho? Why do ortho programs like Georgia have no problem filling all their seats?

The issue is GP, DSOs, and corporate do not care for the patient's overall care. If they did, they would refer every single ortho treatment to an orthodontist who specializes in ortho (if accessible). Which isn't the case. They care more about turning a profit which is sad for the patients well-being & impacts the overall trust in dentists when issues arise. While talking to orthos they have come across countless cases where a GP or a Smile Direct Club company offered aligners and severely messed up the treatment. I think it can be comparable to extracting wisdom teeth. When a patient needs their wisdom teeth extracted most of the time they are referred to an OS because the OS can provide the best care for your patients and has more knowledge & skills than the GD on wisdom teeth extractions.

Wrong. I've worked at the corp for 20+ years. GPs at the corp do care. It’s their own license that they are practicing under. Nobody wants to get sued. Corps don’t want to get sued either. Just like private practices, they want to keep patients happy. Happy patients = more word-of-mouth referrals. Therefore, corps only hire orthodontists who have that precious piece of paper (ortho certificate). And corps have pushed all of their GPs to refer patients to their in-house orthos. They have tried to push GPs to do invisalign and failed. My corp partners with Smile Direct Club….and they also partners with Henry Schein’s Reveal Clear Aligners. So far, both of these partnerships have gotten nowhere…..the majority of my cases are still the traditional braces….only 1-2 % are clear aligner cases.

 

[Thehighwind87]

I think the biggest elephant in the room is the debt load. The most debt ridden dentists that I’ve heard about is ortho for some reason. Two 1 mil+ debt ones on YouTube.

Besides that, if you can keep your debt low- somehow- then I can see it being worthwhile. I wouldn’t go to any profession for 1 mil dollars. In addition, even though dentists tend to be complainers- I would say anyone that understands the magnitude of 500-1mil of loans starts to understand how deep of poo-pop they are in and become unhappy.

100k like 2th mvr would be the dream tho.

 

[OncePreDent]

GPs and pedo have done ortho tx on their patients for years. Invisalign has been around for years. These are old news. The orthodontists still handle most of cases. I know many practicing GPs and pedos who decided to back to school for ortho despite having already done a lot of ortho cases in their practices. They still want to have that precious piece of paper….it’s called “ortho certificate.”

In any profession, there are always some unhappy people who express their negative opinions. There are unhappy dentists, unhappy orthos, unhappy engineers etc. If it is pointless to get a formal training, then why so many try to get into ortho? Why do ortho programs like Georgia have no problem filling all their seats?

Wrong. I've worked at the corp for 20+ years. GPs at the corp do care. It’s their own license that they are practicing under. Nobody wants to get sued. Corps don’t want to get sued either. Just like private practices, they want to keep patients happy. Happy patients = more word-of-mouth referrals. Therefore, corps only hire orthodontists who have that precious piece of paper (ortho certificate). And corps have pushed all of their GPs to refer patients to their in-house orthos. They have tried to push GPs to do invisalign and failed. My corp partners with Smile Direct Club….and they also partners with Henry Schein’s Reveal Clear Aligners. So far, both of these partnerships have gotten nowhere…..the majority of my cases are still the traditional braces….only 1-2 % are clear aligner cases.

We can agree to disagree.

The ortho office that I worked in for years must be different than your corporate offices and what you are seeing. We would consistently see patients that had Invisalign from GD or Smile Direct Club (at-home aligner) treatments, and the orthodontists would be extremely disappointed with how they treated their patients. Disgusted. I don't think it is the most ethical thing in the world to say you, as a GD, know how to provide Invisalign, charge the patient $2k-$4k, only to have them go out to an orthodontist after being in aligners for +4 years of treatment with the GD. Every year there are 1,000s to 10,000s cases are reported for mistreatment across dentistry (not solely ortho). Also, there are countless lawsuits with home-aligner Smile Direct Club because of how poor the treatment is for the patients. Byte is another newer at-home aligner company that we saw in the office that didn't have the best results, wouldn't be surprised if they had lawsuits as well.

Sorry, just to clarify, I do think that GP care for their patient's health in either private practice or corporate settings. Some of the best dentists out there work in a corporate office, and some of the worst work in private practice. All I am trying to depict is that when it comes to the patient's best interest, dentists don't always prioritize the patient's welfare first. If that were the case, GP would always refer to someone that they believe can do the procedure better than themselves, whether it is for a root canal, implants, braces, etc. Additionally, there wouldn't be DSOs out there training GD to solely practice ortho to save 25% per dentist they hire. They would hire only orthodontists that have gone through at least 2 years of training in residency. Nor would there be private Orthodontic clinics that are GD who didn't complete a residency. My GD was saying how he would cringe every time a patient called him their "orthodontist". If a dentist is truly putting their patients' welfare first as a dentist, they would want to make sure their patients receive the best treatment possible, and that doesn't always happen in the real world.

Think about it for medicine:
If you were going downhill skiing, you wipe out and injure your hand. Would you rather go to your general family medicine physician or go to a sports orthopedic physician that solely deals with these types of injuries every day?

One of my friends decided to get their wisdom teeth extracted from a GD. While she was undergoing the procedure the GD couldn't extract one of the wisdom teeth because the GD wasn't an expert in those extractions. Less than a mile away from the office is an OS clinic that literally specializes in Wisdom teeth extractions (I shadowed their office a few times, my brother also worked there as an assistant). It was the most common procedure in their office. They were able to pop wisdom teeth out like it was nothing without using a drill (they said the recovery was better for the patients). I was amazed by how skilled they were while I shadowed them. But if you are a general dentist and you know for a fact that someone else can perform the procedure better for your patients, why the heck are you doing it! You want your patients to have the best care possible than refer.

I'm not saying that every dentist does this, but it seems like it happens more frequently than it should, especially for ortho treatments.

 

[charlestweed]

We can agree to disagree.

The ortho office that I worked in for years must be different than your corporate offices and what you are seeing. We would consistently see patients that had Invisalign from GD or Smile Direct Club (at-home aligner) treatments, and the orthodontists would be extremely disappointed with how they treated their patients. Disgusted. I don't think it is the most ethical thing in the world to say you, as a GD, know how to provide Invisalign, charge the patient $2k-$4k, only to have them go out to an orthodontist after being in aligners for +4 years of treatment with the GD. Every year there are 1,000s to 10,000s cases are reported for mistreatment across dentistry (not solely ortho). Also, there are countless lawsuits with home-aligner Smile Direct Club because of how poor the treatment is for the patients. Byte is another newer at-home aligner company that we saw in the office that didn't have the best results, wouldn't be surprised if they had lawsuits as well.

Sorry, just to clarify, I do think that GP care for their patient's health in either private practice or corporate settings. Some of the best dentists out there work in a corporate office, and some of the worst work in private practice. All I am trying to depict is that when it comes to the patient's best interest, dentists don't always prioritize the patient's welfare first. If that were the case, GP would always refer to someone that they believe can do the procedure better than themselves, whether it is for a root canal, implants, braces, etc. Additionally, there wouldn't be DSOs out there training GD to solely practice ortho to save 25% per dentist they hire. They would hire only orthodontists that have gone through at least 2 years of training in residency. Nor would there be private Orthodontic clinics that are GD who didn't complete a residency. My GD was saying how he would cringe every time a patient called him their "orthodontist". If a dentist is truly putting their patients' welfare first as a dentist, they would want to make sure their patients receive the best treatment possible, and that doesn't always happen in the real world.

Think about it for medicine:
If you were going downhill skiing, you wipe out and injure your hand. Would you rather go to your general family medicine physician or go to a sports orthopedic physician that solely deals with these types of injuries every day?

One of my friends decided to get their wisdom teeth extracted from a GD. While she was undergoing the procedure the GD couldn't extract one of the wisdom teeth because the GD wasn't an expert in those extractions. Less than a mile away from the office is an OS clinic that literally specializes in Wisdom teeth extractions (I shadowed their office a few times, my brother also worked there as an assistant). It was the most common procedure in their office. They were able to pop wisdom teeth out like it was nothing without using a drill (they said the recovery was better for the patients). I was amazed by how skilled they were while I shadowed them. But if you are a general dentist and you know for a fact that someone else can perform the procedure better for your patients, why the heck are you doing it! You want your patients to have the best care possible than refer.

I'm not saying that every dentist does this, but it seems like it happens more frequently than it should, especially for ortho treatments.

Like I said before, gd and pedo offices have offered ortho tx for years.....long before I started my ortho residency. Invisalign was introduced at around the time when I started my residency. I am used to all these competitions. And I have done well despite all of these. You shouldn't have the general viewpoint of the specialty based on a few opinions of a few unhappy orthodontists.

IMO, the main reason ortho is on the decline is the openings of new ortho programs that pump out more new ortho grads every year. Another reason is the higher student loan debt, which makes it a lot harder for young grads to succeed. They will have to work longer to pay off debts and become financially independent. I wouldn't recommend this specialty to any person who is older than 35-40 yo....unless he/she is single, has no kid and has saved enough $$$ (from his previous job) to pay for his/her own ortho residency training.

 

[Big Time Hoosier]

If they did, they would refer every single ortho treatment to an orthodontist who specializes in ortho (if accessible).

Should they do this with endo, prosth, etc…?

Big Hoss

 

[Big Time Hoosier]

My biggest grind with ortho, as a pediatric dentist, is that I see way too many patients who should have been debonded due to hygiene noncompliance but aren’t because the ortho doesn’t want to be known as the one who kicks people out of braces. The market is so competitive for them that they can’t risk this. “Congratulations! Your teeth are now straight, but they’re absolute garbage.” Literally just saw a teen last week who’ll need endo on #7 to #10 because the teeth are bombed out. They’ve been seeing the orthodontist every 4-6 weeks and the ortho didn’t say anything?! And the week before it was a kid who’ll need endo on #20 and #21…

Big Hoss

 

[blablabla1]

It's hard to make money in ortho. As a dentist I thought "wow 6k -8k for treatment, orthodontist are killing it". Once you realize how many appointments, the overhead, time in treatment, you realize it's actually not easy to make money. Some cases you actually lose money. This is something you don't realize during residency.
Jobs are hard to come by as an associate. When orthodontist get busier, they hire more assistants and do the work themselves. Therefore there are less job opportunities than as a dentist. So the jobs don't pay as well.
The work as an ortho is great. But all other aspects suck. Hard to make money, high debt, competitive.
It is easier to make money staying as a general dentist - work for those 3 years instead of going into debt for ortho and you will be better off financially most of the time

I just finished residency, so I can't speak to your experience as a private practice orthodontist. But the claim that "jobs are hard to come by as an associate" seems suspect to me. There are endless opportunities out there on the AAO career center and additional listings on sites like Indeed and LinkedIn. I literally received unsolicited requests to join certain practices as an associate that I turned down due to it being in a location that I did not want to be at. But those opportunities were there for the taking if I wanted them.

The pay is really good so long as you negotiate well, far more than what the average general dentist makes. Especially since most associate jobs pay per diem, so cases such as challenging, slow-moving impacted canines that normally would lose you money aren't really a factor. Even though the 1200-1500 range is the most common, I know a good number of new grads from different residencies negotiating offers for 1600-1800 per diem too, but this is very location dependent. And as mentioned before, start and debond bonuses that many per diem contracts offer make a huge difference in overall pay

 

[carabelliscusp]

I just finished residency, so I can't speak to your experience as a private practice orthodontist. But the claim that "jobs are hard to come by as an associate" seems suspect to me. There are endless opportunities out there on the AAO career center and additional listings on sites like Indeed and LinkedIn. I literally received unsolicited requests to join certain practices as an associate that I turned down due to it being in a location that I did not want to be at. But those opportunities were there for the taking if I wanted them.

The pay is really good so long as you negotiate well, far more than what the average general dentist makes. Especially since most associate jobs pay per diem, so cases such as challenging, slow-moving impacted canines that normally would lose you money aren't really a factor. Even though the 1200-1500 range is the most common, I know a good number of new grads from different residencies negotiating offers for 1600-1800 per diem too, but this is very location dependent. And as mentioned before, start and debond bonuses that many per diem contracts offer make a huge difference in overall pay

I'm not doubting these stats, because I truly have no idea what the market is like at all for new grad orthos or orthos in general, but 1600-1800 per diem is a shocking statistic based on everything else I heard about ortho as a field

 

[P7898]

I don't necessarily disagree with what you're saying, although 700k student loan and 500k practice loan and 2m house (3.2m total) actually equates to 5.5m over 20 years if you assume 6% loan (just used a loan repayment calculator). So your 6m post tax means after 20 years you only have 500k saved for retirement, which in 20 years is probably not worth much.
Either way, I think that's besides the point. That does get you a very nice lifestyle over 20 years, so i agree with you that its worth it.
But I think that's the wrong question. I think the more important thing to calculate is how does that compare to general dentistry? If you stayed working for 3 years, and avoided 300k extra debt, whilr the orthodontist is in residency, which probably equates to roughly a million dollars? Then, after residency, yes you may earn more, but that extra money you earn is at a higher tax rate. So the dentist earns 275k, the ortho earns 350k, but they maybe only keep an extra 45k post tax? Will they ever recoup that million dollar investment?

I did the same math myself for specializing vs having low dental school debt and being a GP. It makes more financial sense a lot of the time to stay a GP unless 2 year paid ortho residency or paid OMS residency.

Oh yeah do not forget to factor in saving for retirement!

 

[P7898]

My biggest grind with ortho, as a pediatric dentist, is that I see way too many patients who should have been debonded due to hygiene noncompliance but aren’t because the ortho doesn’t want to be known as the one who kicks people out of braces. The market is so competitive for them that they can’t risk this. “Congratulations! Your teeth are now straight, but they’re absolute garbage.” Literally just saw a teen last week who’ll need endo on #7 to #10 because the teeth are bombed out. They’ve been seeing the orthodontist every 4-6 weeks and the ortho didn’t say anything?! And the week before it was a kid who’ll need endo on #20 and #21…

Big Hoss

I come across this a lot too. Patient has large build ups with endo treated teeth and the ortho wants to keep the brackets on and not put the patient in crowns... bro. I told him I would use Emax and he could bond them back on but if the teeth break in ortho due to movements - they might not be save-able.

 

[paamp]

No offense, but 2 yrs in the real world is nothing. You hardly have any real world experience. When I graduated from ortho residency ... I had about a 100K worth of total debt. I was unemployed for the 1st 6-12 months looking for the right opportunity. Finally an opportunity presented itself. Bought into a partnership leading to a buyout. Essentially .... I bought myself a job.

Again. You don't mention what your total debt it. Maybe I missed it. Huge debt is going to sour anyone. Also ..... you mention the daily minimums. Lots of variations in the Corps, but most dailys come with bonuses. Mine does. And trust me .... the bonuses make all the difference.

My feeling is that alot of new orthos had a certain vision that no longer exists. Reality is working 5-6 days and travelling to multiple offices. Just ask @charlestweed. I'm 60 yrs old. I continue to work 4-5 days per week. No issues. I enjoy the money and am accustomed to nice things.

I can assure you. At least in the Corp environment .... most of the GPs wish they were orthodontists. Both for the ease of the ortho work and the money we make in comparison to their take home pay.

I have yet to meet a seasoned orthodontist that regrets being an orthodontist.

Be patient, work hard and make the right decisions.

Question for you and @charlestweed , can you expect any equity on the backend for your own clinics if you go the hybrid private practice+corp route? I would imagine you probably have to be ok sacrificing that if you run low overhead offices right?

 

[emergentmd]

I am a doc with 3 kids all currently going through Invisilign/expanders at 7-8K a pop with dental insurance paying nothing. I can afford it but this is an insurmountable burden for most people as dental insurance pays very little if anything.

I have dentists friends all doing invisilign at half the cost and if I could not afford it. They all have the same equipment and weekly monitoring scans.

I don't see how this will not be a huge threat to orthodontists especially most are told they can be treated with ligners.

 

[Big Time Hoosier]

I am a doc with 3 kids all currently going through Invisilign/expanders at 7-8K a pop with dental insurance paying nothing. I can afford it but this is an insurmountable burden for most people as dental insurance pays very little if anything.

I have dentists friends all doing invisilign at half the cost and if I could not afford it. They all have the same equipment and weekly monitoring scans.

I don't see how this will not be a huge threat to orthodontists especially most are told they can be treated with ligners.

An orthodontist told me a few years back that surrounding the 08-09 recession, production for orthodontists in general went down nearly a third. I can’t back it up with a citation, but I believe it when the vast majority of treatment is entirely elective. I bet plastic surgery got hit fairly hard during that same time frame for exactly the same reason. When the choice comes down to a roof over one’s head or straight teeth, the answer is pretty clear. Makes me wonder what happens to ortho when this current financial house of cards comes crashing down…

Big Hoss

 

[charlestweed]

Question for you and @charlestweed , can you expect any equity on the backend for your own clinics if you go the hybrid private practice+corp route? I would imagine you probably have to be ok sacrificing that if you run low overhead offices right?

Just like a general practice, you can sell your ortho practice to a younger grad. If you own the building, you can charge him rent.....or sell the building to him if he also wants to buy it. The problem is when you are near your retirement, you won't work as hard and as a result, your practice will lose a lot of patients. It won't be worth as much as when you were in your prime years.

You can also sell ortho charts to another local ortho in the area.....and simply walk away.

Most ortho offices are not opened 5 days a wk like the GD offices because an ortho can treat high patient volume per day and they only need to work a few days days per month. So most ortho offices are a "hybrid" model. Most orthos work PT at their own office and PT at either their 2nd (or 3rd or 4th) office or for the corp as associate. It's the the same for other specialties (endo, period, os, pedo) as well.

 

[charlestweed]

I am a doc with 3 kids all currently going through Invisilign/expanders at 7-8K a pop with dental insurance paying nothing. I can afford it but this is an insurmountable burden for most people as dental insurance pays very little if anything.

I have dentists friends all doing invisilign at half the cost and if I could not afford it. They all have the same equipment and weekly monitoring scans.

I don't see how this will not be a huge threat to orthodontists especially most are told they can be treated with ligners.

The treatment fee can be financed over the 2-yr period (low down payment and low monthly payments), which helps make the treatments more affordable for many parents. Most of my patients both at my own office and at the corp office, where I work part time for, are from low income families.

Not all cases can be treated with Invisalign. Extraction, canine impaction, congenitally missing teeth, orthogthatic cases, which are more than half of our cases in our offices, are better treated with the traditional braces. There are orthodontists who treat extraction cases with Invisalign but these cases are way too complicated for most general dentists (and even for me) to handle. Proper diagnosis and treatment planning are very important in ortho....and these skills can't be taught/learned over night....it takes years to acquire. Frequent monthly office/adjustment visits are very important in ortho….and each case needs to be monitored carefully by the orthodontist. As a parent, would you want your child’s teeth to be fixed by some AI device? I wouldn’t.

 

[Pablo Sanchez]

Here are two examples.

The first is Student A. The second is student B. Both students went to the same dental school and graduated with $250k in debt. Reasonable.

Student A went straight out and practiced as a GP. Student A made a reasonable amount, let’s just say $200k per year for three years while student B was in ortho residency. After taxes, Student A took home about $140k per year for the three years student B was in ortho residency. Student A lived off of $50k per year and put $90k towards loans/investments. After 3 years, they have paid off their dental school debt. They are now 29, still taking home $140k per year without any debt.

Student B also graduated with $250k of debt. At today’s current interest rates of grad plus loans (8%), by the time they graduate from residency the balance on that $250k is $315k. They took out an additional $200k for ortho residency. So when they graduate they are $515k in debt.

So at the age of 29, Student A has no debt and is taking home $140k.

Student B has $515k in debt. They make $1350 per day. 5 days per week, 50 weeks per year, student B makes $337,500 per year. They’re in a higher tax bracket than student A. They take home $220k per year after taxes. So student B is making about $80k more than student A per year at the age of 29. But the interest on Student B’s $515k in loans is over $41,000 just for that first year. So JUST TO MAINTAIN the $515k in debt AND MAKE NO PROGRESS IN PAYING IT OFF Student B will have to pay $41,000. This leaves Student B with a $39k advantage in income over student A each year, but student B has $515k of loans to pay off. Good luck!

The real key is that both students have high incomes and can choose to spend their money how they want to. Both students can be smart and invest their money wisely, and end up very well off. Or they can be dumb. For me personally, being 30 with that much debt sounds dreadful.

***Realistically, both students work 3.5 days per week because “their friend’s dad was a dentist and only worked 3.5 days per week” and take 3 vacations overseas per year because they have to keep up with their friends on instagram, and both end up broke.***

The point is, the field of dentistry will give you the opportunity to make massive amounts of money regardless of what path you take. Specializing or not. It depends what you do with your money and how hard you’re willing to work. New grad orthodontists have a lot of potential if they can be financially sound.

 

[P7898]

Here are two examples.

The first is Student A. The second is student B. Both students went to the same dental school and graduated with $250k in debt. Reasonable.

Student A went straight out and practiced as a GP. Student A made a reasonable amount, let’s just say $200k per year for three years while student B was in ortho residency. After taxes, Student A took home about $140k per year for the three years student B was in ortho residency. Student A lived off of $50k per year and put $90k towards loans/investments. After 3 years, they have paid off their dental school debt. They are now 29, still taking home $140k per year without any debt.

Student B also graduated with $250k of debt. At today’s current interest rates of grad plus loans (8%), by the time they graduate from residency the balance on that $250k is $315k. They took out an additional $200k for ortho residency. So when they graduate they are $515k in debt.

So at the age of 29, Student A has no debt and is taking home $140k.

Student B has $515k in debt. They make $1350 per day. 5 days per week, 50 weeks per year, student B makes $337,500 per year. They’re in a higher tax bracket than student A. They take home $220k per year after taxes. So student B is making about $80k more than student A per year at the age of 29. But the interest on Student B’s $515k in loans is over $41,000 just for that first year. So JUST TO MAINTAIN the $515k in debt AND MAKE NO PROGRESS IN PAYING IT OFF Student B will have to pay $41,000. This leaves Student B with a $39k advantage in income over student A each year, but student B has $515k of loans to pay off. Good luck!

The real key is that both students have high incomes and can choose to spend their money how they want to. Both students can be smart and invest their money wisely, and end up very well off. Or they can be dumb. For me personally, being 30 with that much debt sounds dreadful.

***Realistically, both students work 3.5 days per week because “their friend’s dad was a dentist and only worked 3.5 days per week” and take 3 vacations overseas per year because they have to keep up with their friends on instagram, and both end up broke.***

The point is, the field of dentistry will give you the opportunity to make massive amounts of money regardless of what path you take. Specializing or not. It depends what you do with your money and how hard you’re willing to work. New grad orthodontists have a lot of potential if they can be financially sound.

Good description.

 

[Thehighwind87]

Here are two examples.

The first is Student A. The second is student B. Both students went to the same dental school and graduated with $250k in debt. Reasonable.

Student A went straight out and practiced as a GP. Student A made a reasonable amount, let’s just say $200k per year for three years while student B was in ortho residency. After taxes, Student A took home about $140k per year for the three years student B was in ortho residency. Student A lived off of $50k per year and put $90k towards loans/investments. After 3 years, they have paid off their dental school debt. They are now 29, still taking home $140k per year without any debt.

Student B also graduated with $250k of debt. At today’s current interest rates of grad plus loans (8%), by the time they graduate from residency the balance on that $250k is $315k. They took out an additional $200k for ortho residency. So when they graduate they are $515k in debt.

So at the age of 29, Student A has no debt and is taking home $140k.

Student B has $515k in debt. They make $1350 per day. 5 days per week, 50 weeks per year, student B makes $337,500 per year. They’re in a higher tax bracket than student A. They take home $220k per year after taxes. So student B is making about $80k more than student A per year at the age of 29. But the interest on Student B’s $515k in loans is over $41,000 just for that first year. So JUST TO MAINTAIN the $515k in debt AND MAKE NO PROGRESS IN PAYING IT OFF Student B will have to pay $41,000. This leaves Student B with a $39k advantage in income over student A each year, but student B has $515k of loans to pay off. Good luck!

The real key is that both students have high incomes and can choose to spend their money how they want to. Both students can be smart and invest their money wisely, and end up very well off. Or they can be dumb. For me personally, being 30 with that much debt sounds dreadful.

***Realistically, both students work 3.5 days per week because “their friend’s dad was a dentist and only worked 3.5 days per week” and take 3 vacations overseas per year because they have to keep up with their friends on instagram, and both end up broke.***

The point is, the field of dentistry will give you the opportunity to make massive amounts of money regardless of what path you take. Specializing or not. It depends what you do with your money and how hard you’re willing to work. New grad orthodontists have a lot of potential if they can be financially sound.

The only thing I disagree with is the comment “dentistry allows you to make massive amounts of money.”

Dentistry provides you a stable enough income where you can invest in other avenues of resources- housing- stocks- where you can make a good return and make massive amounts of wealth.

That’s they key part. It allows you to have “enough” income to invest some and hopefully get wealthy that way.

Dentistry in itself- focusing purely on that- is a LOSING gamble. Every year your fixed costs go up while your revenue stays the practically same. Compound this 10 years and you take a 20% haircut due to inflation (inflation running at 2% x 10 years). 200k 2013 could buy much more then 2023 200k. Covid is a prime example of this: 2021-22 was an average of 12.7 inflation. Let me ask you this- did your practice accumulate 12.7 increase over those years? On a 1 million dollar practice that is 1.127 million. 127k more collections production. I’m pretty the answer to that is most likely no. So guess what you probably took at 12.7% paycut.

What did keep up was outside investments a hedge.

If you don’t hedge outside dentistry you will be screwed. I keep my practice up and running but I don’t look for it for wealth- I look outside dentistry for wealth.

And yes there might be some dentists who decide to open 3 practices run 7 ops and work 7 days a week- but the fact is- it’s still an uphill battle because every year it will get harder to generate the previous years numbers unless you have some magical practice that is ffs/oon and raises prices 2-3% year over year…. Which would mean you are probably charging 1500-2000$ for a crown which I mean the average person would prob find an in network dentist and pay 1/3 that cost

 

[Pablo Sanchez]

The only thing I disagree with is the comment “dentistry allows you to make massive amounts of money.”

Dentistry provides you a stable enough income where you can invest in other avenues of resources- housing- stocks- where you can make a good return and make massive amounts of wealth.

That’s they key part. It allows you to have “enough” income to invest some and hopefully get wealthy that way.

Dentistry in itself- focusing purely on that- is a LOSING gamble. Every year your fixed costs go up while your revenue stays the practically same. Compound this 10 years and you take a 20% haircut due to inflation (inflation running at 2% x 10 years). 200k 2013 could buy much more then 2023 200k.

If you don’t hedge outside dentistry you will be screwed. I keep my practice up and running but I don’t look for it for wealth- I look outside dentistry for wealth.

And yes there might be some dentists who decide to open 3 practices run 7 ops and work 7 days a week- but the fact is- it’s still an uphill battle because every year it will get harder to generate the previous years numbers unless you have some magical practice that is ffs/oon and raises prices 2-3% year over year…. Which would mean you are probably charging 1500-2000$ for a crown which I mean the average person would prob find an in network dentist and pay 1/3 that cost

Yes, this is what I meant by massive amounts of money. It’s a pretty reliable path to be making between $200-300k while in your late twenties. If you’re smart with that $200-300k and invest it, you can be in your 60s with 10s and 10s of millions of dollars.

 

[emergentmd]

The treatment fee can be financed over the 2-yr period (low down payment and low monthly payments), which helps make the treatments more affordable for many parents. Most of my patients both at my own office and at the corp office, where I work part time for, are from low income families.

Not all cases can be treated with Invisalign. Extraction, canine impaction, congenitally missing teeth, orthogthatic cases, which are more than half of our cases in our offices, are better treated with the traditional braces. There are orthodontists who treat extraction cases with Invisalign but these cases are way too complicated for most general dentists (and even for me) to handle. Proper diagnosis and treatment planning are very important in ortho....and these skills can't be taught/learned over night....it takes years to acquire. Frequent monthly office/adjustment visits are very important in ortho….and each case needs to be monitored carefully by the orthodontist. As a parent, would you want your child’s teeth to be fixed by some AI device? I wouldn’t.

I understand that financing is an option, I was given the same but if I had a choice of 8K orthodontist vs 4K GP then I would go GP if money was an issue which is for most.

This is the same thing that happens in the house of medicine when money can be made. If it can be done by less specialized people, it will be done and most would not care/know the difference. Derms/plastics used to make a bunch of money from botox, then any specialists jumped in, now the are run by NPs with just MD oversight. This could easily happen to Ortho.

Eventually you will have GP just do Ortho/ligners if margins are worth it. Even with my kids Orthodontists, I see the doc for like 2 minutes.

 

[Thehighwind87]

Yes, this is what I meant by massive amounts of money. It’s a pretty reliable path to be making between $200-300k while in your late twenties. If you’re smart with that $200-300k and invest it, you can be in your 60s with 10s and 10s of millions of dollars.

100%. Sucks that you can’t just focus on your business and be set but I guess other careers are that way to- take the excess and invest and retire early.

If you do the math- if you buy one share of spy a day and assume it’s 7% return… on 20 years it becomes 4.5 million and in 30 years it’s 10 million dollars.

400 dollars a day is 2k a week 8k a month 96k a year. On a decent practice running at 200-300k income- a dentist can afford this over their career of 20-30 years and end up with a 4.5-10 mil brokerage.

That’s how you get wealthy. Not through dentistry but outside dentistry. The only real dentists that I personally think are making bank$$$$ is omfs and endo to be honest. And yes we know- if you are an older dentist in the field or specialty- you are making bank too. I’m referring to new grads.

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And that is exactly what I do.

 

[Molar Whisperer]

I understand that financing is an option, I was given the same but if I had a choice of 8K orthodontist vs 4K GP then I would go GP if money was an issue which is for most.

This is the same thing that happens in the house of medicine when money can be made. If it can be done by less specialized people, it will be done and most would not care/know the difference. Derms/plastics used to make a bunch of money from botox, then any specialists jumped in, now the are run by NPs with just MD oversight. This could easily happen to Ortho.

Eventually you will have GP just do Ortho/ligners if margins are worth it. Even with my kids Orthodontists, I see the doc for like 2 minutes.

I totally get you. My dad before he passed and brother are physicians. I hang out with more physicians than dentists. From the outside, it would make more sense to go to the GP rather than ortho as most people do not have the means to drop tens of thousands. In my 25 yrs practicing dentistry (not as an orthodontist), I've seen irreversible damage from failed ortho. I've seen irrev bone damage, root damage, internal pulpal space that looks like soap bubbles on x-rays, canted teeth, and unintended facial profile changes. To be fair, all of the above disasters were from orthodontists and not from GPs. You're basically paying for experience and all their schooling much like physicians. About 20 years ago, I got my nose cauterized by an ENT. He spent a little over a minute giving me Local Anesth and less than 10 seconds burning off my damaged vein. The total cost was about $650 and my out the door was about $95. I should have had my wife do it..."now honey, I need you to hold this soldering iron..."

The price of dentistry from the outside may seems outrageous. It may seem like we're a cartel that cheaper 3rd world dentists can't enter. I've told patients that this little device (Apex Locator) which looks like a cheap gaming handheld costs over $1200. Dental supplies and equipment can't be sold to medical doctors and barbers so they need to mark it up and it hurts us all. We're probably structured about 5 to 10 years behind medical trends so we'll be experiencing a lot of your similar hardships. To be realistic, dentistry will never seem as vital as medicine. [SORRY TO DERAIL THE POST]

 

[charlestweed]

I understand that financing is an option, I was given the same but if I had a choice of 8K orthodontist vs 4K GP then I would go GP if money was an issue which is for most.

IMO, $8k is a lot for ortho treatment. But hey, this is capitalism. The orthodontists can charge their patients any fee they want. The question is will the patients be willing to pay for the treatment. Most corp offices don’t charge that much…only in the $4-5k range….and they employ licensed orthodontists. The expansion of corp offices + increase in competition have helped bring down the cost of ortho treatments. It’s just like what you see with Tesla Motor…..they are no longer the EV king (well, they are still but not as great as before)….they have to reduce the prices in order to compete against other EV companies.

The expansion of dental corp offices is a double edge sword: it has hurted many private ortho practices but it has also helped create jobs for new grad orthos, who have a lot of student loan debts. Thanks to the stable job at the corp, I was able to open my own office without having to take out a lot of loan (only $75k). With the stable income flow from corp office, it's less stresful to run my own office. And with the low overhead, I can pass on the low cost treatment to my patients. My fees are actually lower than the GP fees.

This is the same thing that happens in the house of medicine when money can be made. If it can be done by less specialized people, it will be done and most would not care/know the difference. Derms/plastics used to make a bunch of money from botox, then any specialists jumped in, now the are run by NPs with just MD oversight. This could easily happen to Ortho.

My cousin, who is a MD anesthesiologist, has also complained about the mid-level providers. Orthodontists will still be needed because they have to be there every month to diagnose and tx plan. And a lot of times, the tx plan has to be modified based on movement of the teeth...and patient's jaw development. These specialized skills are not easy to be taught at school. These skills can only be gained from years of practicing ortho.

Eventually you will have GP just do Ortho/ligners if margins are worth it. Even with my kids Orthodontists, I see the doc for like 2 minutes.

Like I said before, not every case can be treated with invisalign. A lot of cases have to be treated with traditional braces. A lot GPs who offer invisalign tx at their offices, still have to refer certain cases out to orthodontists. That's because they know the limitations of Invisalign and they don't want to lose sleep over these cases. Nobody wants to get sued.

Even with my kids Orthodontists, I see the doc for like 2 minutes.

Yup, 2 minutes….or much less….easy job… easy money….and it’s fun. This is why so many dental students and practicing dentists want to specialize in ortho despite the huge cost of education. If you diagnose and tx plan the case correctly, everything should be quick and easy.

 

[emergentmd]

Your missing the point. Ortho looks like a great job until the 8K goes down to 2K once everyone/corporate jumps in. VC will start ortho practices if they can make $500 off each pt.

 

[charlestweed]

Your missing the point. Ortho looks like a great job until the 8K goes down to 2K once everyone/corporate jumps in. VC will start ortho practices if they can make $500 off each pt.

I’ve been in this profession for 20+ years. So far I’ve seen the fees keep going up over time. I paid $2300 for my ortho tx when I was a 2nd year dental student. When I graduated from ortho school in 2001, the average fee was around $4-5k. And now it’s $6-7k. I've charged much less, and I've done fine.

 

[Thehighwind87]

Your missing the point. Ortho looks like a great job until the 8K goes down to 2K once everyone/corporate jumps in. VC will start ortho practices if they can make $500 off each pt.

You know how the new hot thing in the stock market is AI? Well I wonder if AI will play a more significant role in ortho. Invisalign etc uses computer models and generates trays. I wonder as the advance of AI moves forward whether it will take away more market share from orthos and into the hands of GPs paying for Invisalign type of services that incorporate AI.

 

[Thehighwind87]

I’ve been in this profession for 20+ years. So far I’ve seen the fees keep going up over time. I paid $2300 for my ortho tx when I was a 2nd year dental student. When I graduated from ortho school in 2001, the average fee was around $4-5k. And now it’s $6-7k. I've charged much less, and I've done fine.

When I was in dental school I remember that one of the professors teaching me Invisalign basics. He told me that while it was good to incorporate into the practice- he also told me about how a colleague in ortho saw how it was changing the profession and made a big bet on it and retired early.

Did you ever see Invisalign as a big disrupter back in the day and want to invest in it? A 100k bet 20 years ago would have grown 2287%. 2.387 million

 

[2TH MVR]

I am a doc with 3 kids all currently going through Invisilign/expanders at 7-8K a pop with dental insurance paying nothing. I can afford it but this is an insurmountable burden for most people as dental insurance pays very little if anything.

I have dentists friends all doing invisilign at half the cost and if I could not afford it. They all have the same equipment and weekly monitoring scans.

I don't see how this will not be a huge threat to orthodontists especially most are told they can be treated with ligners.

"Same equipment and weekly monitoring scans". There's more to moving teeth than just making them straight. Proper Diagnosis. Proper Txplan. Just diving in and straightening teeth is a recipe for poor results and lack of long term stability. What do you want? A really good specialist with years of wisdom or the dentist who does aligner tx part time, allows the LAB to make all the movement decisions, has the cool scanner (everyone has those scanners these days. I do? Anyone can move teeth. Trained specialists understand etiology for the malocclusion and can make a proper diagnosis.

Is the threat there? Of course. Orthodontics is no longer the same proud specialty. Now. Orthodontic outcomes (mostly GPs and of course some ortho specialists) are average. At one time .... the goal for ortho outcomes was board quality results. There was actual GP/Orthodontist corroboration on giving a mutual patient the best possible outcome. I don't see this anymore. And of course. Who loses? The patient.

Question for you and @charlestweed , can you expect any equity on the backend for your own clinics if you go the hybrid private practice+corp route? I would imagine you probably have to be ok sacrificing that if you run low overhead offices right?

I don't see ortho practices (especially saturated cities) retaining a high equity value at sale time. I was fortunate to have sold both my practices, but at 50% of what I thought they were worth at the time. Too many players in the ortho tx arena. I do like the hybrid model ala @charlestweed . Be diversified. It's not a bad life. I actually enjoy travelling to the different offices. Keeps things interesting. I recently moved (downsized) and now .... my new commute is only 20-30 minutes for each office. I currently work in 4 locations and possibly 1-2 more soon. Same DSO company. Been there for 6 years. I enjoy the autonomy. I can practice good, high quality orthodontics. No reason to leave. Enjoying the low stress environment.
Maybe another 5-7 years and then I'll call it quits. Not sure. I love what I do.

 

[gryffindor]

Aligners will never take over. Americans want a pill to solve their problems, not diet and exercise. Aligners require absolute compliance to get a good result. And on the truly hard cases, they can't move teeth as well as braces. Personally I've moved away from aligners and offer them sparingly to new consults.

As a new grad, focus on doing good ortho. Don't cut corners, don't take shortcuts. Clean up that excess adhesive. Take good photos. Consult your colleagues if you're stuck. It's ok if you don't know it all. We didn't either, but the resources out there to ask each other clinical questions is so much easier now than when the rest of us olds graduated.

 

[knband25]

As someone who wants ortho, this thread is really helpful!

 

[Babsciguy]

Helpful but discouraging. Currently debating Oral Surgery and Orthodontics. Worried about both professions haha. Orthodontics is more suited for me, but I am so worried about going into something that may not be worth it ten years from now.

 

[OncePreDent]

Helpful but discouraging. Currently debating Oral Surgery and Orthodontics. Worried about both professions haha. Orthodontics is more suited for me, but I am so worried about going into something that may not be worth it ten years from now.

Why would you be worried about oral surgery? I completely understand ortho, but I think OS is a great area to go into. Enlighten me lol

 

[SirBrotherJam]

My biggest grind with ortho, as a pediatric dentist, is that I see way too many patients who should have been debonded due to hygiene noncompliance but aren’t because the ortho doesn’t want to be known as the one who kicks people out of braces. The market is so competitive for them that they can’t risk this. “Congratulations! Your teeth are now straight, but they’re absolute garbage.” Literally just saw a teen last week who’ll need endo on #7 to #10 because the teeth are bombed out. They’ve been seeing the orthodontist every 4-6 weeks and the ortho didn’t say anything?! And the week before it was a kid who’ll need endo on #20 and #21…

Big Hoss

As an endodontist, I don't mind this …. It's a rather interesting point, @Big Time Hoosier, that the seems to have been avoided by the orthos on this tread.

 

[lol105]

Helpful but discouraging. Currently debating Oral Surgery and Orthodontics. Worried about both professions haha. Orthodontics is more suited for me, but I am so worried about going into something that may not be worth it ten years from now.

OS has no competition from GD. And no other dental specialty can really do what they do.

Now I don't know about ENT and plastic encroaching OMFS.. but I doubt that's a big problem