Agree she should go into dentistry, would recommend fellowship in orthodontics (every kid gets braces today) or oral/maxillofacial surgery Huge bucks, very little liability, no call, great lifestyle. We are the crazy ones for continuing to play the game and let others set our fees
Agree, all the dentists I have known did two to three times better than I ever have, and they have time to enjoy it, never on call. Would strongly encourage my child to go to dentistry instead, almost no risk of getting sued (yet) and not much cognitive stuff to worry about.
I dunno--my dentist, who has done very well for years, is not doing as well in the current climate--had to let one of his employees go. Routine dental work is not seen as a priority in financial crunch times. People are going to put off getting crowns and veneers and root canals, as well as regular cleaning. Extraction is going to trump restoration.
I keep wondering if/when dentists are going to fall under the obummascope.
several friends are oral surgeons............they make more in a quarter than I make in a year..................take vacations several times a year..............have three and a half day weeks during the summer so that they can live on their big boats and deep sea fish............never late to a child's game or recital...........no doubt, I picked the wrong profession.
A good friend is a dentist for one of the native american tribes. He works 4.5 days per week, mainly pulling teeth. Gets $150,000 per year plus full bennies and full loan repayment.
dentists saw the writing on the wall and pulled out the whole ins scam. so coverage is limited to set amount. use to be able to get orthodenture coverage but haven't seen that in a while. so you pay 30/mo for dental coverage for a max of 1000-1500 coverage. oh, and it covers getting your teeth cleaned.
on the flip side , unless you specialized, i agree with the above---the ave dentist does not do too well (unless his practice is in an affluent community and also does some cosmetic work).
I agree with Sermo Doc 11. Cosmetic procedures and the dental surgeries make mega bucks. I would tell my kid to be a dentist if he wants to go into a health field.
My dentist is going to be putting Lumineers on my front upper and lower teeth, and I expect I will be financing her trip around the world with the profits. She has a credit agency involved with her practice that allows me to make monthly payments without interest. Cosmetic is cash only, obviously. No middle man dictating what she can make. She is doing well for herself. She is originally from Iran, and her family fled that country in the late 70s. She has a good bedside manner and puts me at ease.
People are willing to pay their dentist for vanity reasons (who likes to smile with yucky teeth?) and because it hurts so darn much when a tooth or gums get diseased.
However, many people are afraid of the dentist, and I keep hearing ads about "sedation dentistry" to bring the fearful ones in.
From the post "How do dentists get away with this?" (getting paid what they bill for what they do)
- like they are doing something wrong, expecting to be paid.
THE REASON THEY GET PAID IS THAT THEY REFUSE TO ACCEPT GOVERNMENT ASSIGNMENT. They don't work if they don't get paid. It's rare that anyone dies from a toothache, so they "get away with it."
The original questions were "Is there something we can learn from the dentists? What are they doing right?"
We can learn to not allow insurers to take over our businesses. Many dentists do not accept insurance at all - they bill you, and it is up to you to seek reimbursement from any dental insurance you have. Of the dentists that do accept insurance, I do not know of a single one who accepts assignment. In EVERY case, the dentist still holds the patient accountable for the total amount of the bill. Very few of them offer insurance discounts, very few of them joined dental HMOs a decade or so ago, and I've never heard of a dentist accepting capitation. And they learned all that from watching what happened to US.
My dentist is doing very well for himself, which has translated into lots of high tech in his office, which I definitely appreciate. He and I talk business. He says:
Dentists are economy sensitive as people put off treating stuff that doesn't hurt.
Dental practices run like real businesses and can adjust their overhead to the prevailing revenue stream.
Even patients with dental insurance understand that the full bill will be paid - ie balance billing is the psychological norm.
They were SAVED by EXCLUSION from federally funded health care.
People will pay cash, and lots of it, for orthodontia, veneers, and teeth whitening. It's "worthwhile" to pay for appearance enhancement. Back when dentists did primarily fillings, extractions, cleanings, taking care of tooth abscess, etc. they weren't doing as well. In fact, in the '80s, many prominent dental schools closed. The dentists have restyled their profession, decreased their numbers, and are savvy with billing. And they don't give it away for free. Plus, they're not tied to a hospital. No unfunded mandates from a multimillion $ CEO, and a cadre of clipboard toters.
And how many orthodontic emergencies are there at 3 am?
The other advantage to dentistry - people actually come in for their preventive exams. But to really do well, yes, they are going into the cosmesis - veneers, whitening, etc. Until the advent of the elective procedures, they were losing out in a big way with preventive therapies (brushing, flossing and especially flouride and sealants.). And, there are easier orthodontics so adults are going back.
Even when you have what YOU consider a dental emergency, the new dental folks don't think so. My dentist is older than I am - sold his practice to two guys just recently out of dental school. I broke a tooth - literally had half of it in my hand - on a Saturday night. Called the office Monday morning. Nobody asked me if I was having any pain (yes) The only thing they told me was that their first appointment was a week from Thursday.
Something weird is going on in my mouth, because I did it again 4 months later. About a week after I started my implant from the filling / failed root canal / extraction by the oral surgeon. I just called them and told them to tell Dr. Joe that plans were changed for my appointment on Friday because I broke another one.
I lost a filling last Friday. Late at night. Good thing I have an appointment tomorrow. Guess I'll just schedule a bunch of appointments. Until I can find another dentist.
When I ask my patients, many of them with dental insurance don't come in for preventive dental care.
I think many people have a phobia for dentists, and some simply think they are fine because they brush/floss and don't have dental pain.
Yet, I unfortunately look into patient's open mouths and see the results of neglect.
It isn't my guy, it's the new front office staff. I told him about it. He, unfortunately, has no control over it at this point. Will ask him tomorrow if there is any way I can communicate directly with him. e-mail perhaps?
He goes to our church, and my husband is the organist. They also sing together in a local college choir. I may have to send messages that way.
And, yes, I am looking around. 20 years is hard to give up.
I think that the reason the Dentists have been able to prosper is that they are not absolutely essential. People live without teeth all the time. Try that with your liver.
And to think I got into dental school and turned it down to go to med school. Every time I leave the house at night to do a delivery , I think about how much easier it would have been. I'm encouraging our son to consider denistry.
OK lets understand one fact. Dentistry is a bargain!!!!
Lets make dentistry like the MD model for a second.
You have a toothache:
1- go to the dentist, they tell you that you have a hole in your tooth
2- they send you to the radiology department for an x-ray, you wait an hour for the reading to be done
3 - you go back to the dentist - thet read the radiologists report and sends you to the surgeon
4- you go to the surgeon to have the tooth fixed.
5- you return to the surgeon for a follow up visit
6- go home and wait for the next toothache
The fact that you all are missing is the staggering inefficiency of the medical way of doing things. 90% of all dentistry is handled by the GP dentist under one roof (initial visit, radiology, surgery, follow up, prevention, etc,etc)
What would a filling cost if done by the medical model? And yes, veterinarians have taken the same lesson from dentists. The next time you complain about how much dentistry costs remember just how many services are being performed in one visit.
I think that all physicians should earn 7 figure salaries. The more invasive and dangerous the more money should be made. I personally think that general surgeons should earn at least $2M/year based on the life-saving services they provide.
Now put dentistry in context. If a practitioner earns based on the degree of severeity they treat then dentists should stay in the $300K range and physicians should be $1M+. This is not fantasy!
Imagine the quality people that medicine would attract then. A corporate CEO earning millions when they will never save a life? What is more important than keeping someone healthy and alive.
A previous entry told of a pediatric hospitalist hope to get $120K for a salary. That is insane!!
sorry Sermo Doc 22 but just because surgeons save with their hands doesn't make it more important than any other physician skill....be it cognitive or mechanical based.
Dentistry is expensive but it's not ultra-expensive the way some medical care is. Health insurance becomes necessary for the possibility of ultra-expensive illness, then insurance companies squeeze the reimbursement across the board.
Also, medical care is seen as more of an entitlement than dental care is. It's like asking why WalMart gets everything they bill for when we don't. It's a whole different ball of wax, because neither dentists nor WalMart sell anything necessary for survival.
I do not know of a single dentist who I went to school with in undergrad who had not been rejected or decided not to apply to medical school at that time (1978) due to the knowledge that they had not chance in hell to get in. Now they are rubbing our noses in it. I think I should not accept insurance payments for dentists when they use my services. Let them feel the actual full charges of my medical care.
My dentist, a very nice guy, works M-Th, no call no holidays. Has like 4 dental hygeinists who work for him, mostly cleaning teeth and some cosmetic stuff.
He makes a fortune, is calm, relaxed, unstressed...
Dentistry for sure in 2010 is a better career choice than medicine!
Vets are NOT doing well now... they use to be really rich, but economy has hit them hard... I have several unemployed vets in my primary care practice now.
Cheaper to put foofoo or fifi in the pound, then to give them their insulin or pay for their chemotherapy!
I implemented in my practice a lesson I learned from my dentist.
I have all patients give me a credit card at the time they register as my patient whether they are insured or not. After insurance has sent us the EOB, we run the credit card for the remainder owed. We do not send the patient a bill hoping to be paid. We send an invoice informing them that we ran their credit card. My outpatient practice therefore has almost no bad debt. My only bad debt comes from hospital work.
This is no secret anymore. Of course dentists are doing better than physicians! Very reasonable schedule and great income.
Most general dentists make way more that PCP's working half the time. If you specialize in dentistry, you can even make more. I have an oral surgeon friend who has his own practice working 9-10 months out of the year making over $500,000 per year (5 years in practice and he bought a sweet $1.5M house in the DC area). He is very marketing savvy which may explain his success. Another endodontist friend makes $300,000 per year. Don't think she's ever worked a weekend in her life.
When I was in med school, a friend wanted to go to dental school after medical school and begged the Dean of the dental school to let him do only the last two years, since the first two are similar. He was not successful and now he is an overworked and unhappy physician.
Kind of sad but this is no one's fault but ourselves. I think we are a strange (special?) breed of human beings.
I honestly believe that most physicians that went to Medical School didn't do it for money. Those that did will never be happy.
Having said that; a few more verified examples: Starting Pedodontics salary $250K in Denver Oral Surgery $500K in Iowa Big outcry in Iowa a few years age when Dentists were only being paid 75% of fees; but MD/DO's have to take 40% and like it.
We did our first year of medical school with the dental students and back then I remember thinking "Why would anyone want to be a dentist when they could be a doctor instead". Years later I realize the answer, $$$$$$$$$.
The Wall Street Journal had an article about this 2-3 years ago. They profiled an internist who was making 150K per year, while his dentist neighbor was knocking down about 500K. To add insult to injury, the internist worked 80 hour weeks at a furious pace with frequent call, while the dentist only worked 3 1/2 days a week. LIfe is not fair, is it?
Okay, friends---let's lighten up and chill out. Time for a little tongue 'n cheek humor in addressing our stature and income. Let's roll out the descending prestige and income status as we compare to our "peers":
Dentists $$>>Veterinarians $$>>Chiropracters $$>> Optometrists $$>>Hospital Adminstrators$$>>Pharmaceutical area sale managers$$>>Physicians$$ >>
UPS route delivery guy (but closing in quickly!!)
I understand that Waste Management pays quite well, but they prefer experienced "G-men"!! But, hey, no one can say that we're in it for the money, right??!!
A lot of posts on this topic! Dentistry does seem like a great profession, and I'm certainly going to encourage any of my kids who think they might like it to do it.
I wonder, though, why there's such a high reported suicide rate among dentists? Maybe it's from the stress of working in a office with that many women......
Sorry, but I hope most of you did not go into medicine just for the money. Personally, I can't imagine the horror of going through the day seeing nothing but teeth. Our lives, incomes, etc. certainly aren't perfect , but we are much better off than most other workers for the most part. Where is everyone's humility - why do so many think that just because they have the md behind their names it makes them better than everyone, deserving of unending riches etc.?
My son is a dentist and receives more gross income every month than I do but has to pay almost 2/3 of what he earns for overhead..He pays for expensive equipments, receptionist,rent for the office with 3 units for high tech dentistry .He does fine especially he is married to an OB-Gyne whose income is less than he does
I think the fact that's lost here is the reason most dentist make so much is that an overwhelming part of the practice is optional. People who don't have dental insurance don't show up to the ER requiring treatment that costs in the millions of dollars. At most, people without insurance need a tooth pulled with a little local and 15 mins of the dentist's time. They are generally not required to care for people without an ability to pay. In our hospital they won't even see pts as an inpatient. We call the ENT guys to pull abscessed teeth. So while it's absolutely true that they make much more money and have better lifestyles, their practice patterns are very different from most of us (save, perhaps Cosmetic Plastic Surgeons and Dermatologists). That said, I'm sure its a great career for young people to have I just think looking back that I'd probably be bored cleaning teeth all day long...
PS I once had an old surgeon tell me "People will complain as loud as they can about me charging them $300 for a lifesaving appendectomy but if I did breast implants, they would happily line up for $2000 each!" I think that sentiment plays large to the success of "cosmetic dentistry".
My father, now retired, is a dentist. The overhead is huge! And the salary like an average FP. When the economy is down, prophylaxis go from every 6 mo to every 18 mo. Grass always looks greener on the other side. It's a great profession...but it's different...and you still have to work hard to make a good living.
I am an internal medicine hospitalist and my wife is a general dentist. She works 3 days per week, 8-5, with no after hours duty of any kind, every single night off and every single weekend off. Her hourly wage is significantly higher than mine is, but I would never consider trading jobs with her.
I did not go into medicine to make more money than anyone else. I went into medicine because I enjoy it, and I can make a good living doing it.
One consideration about going into dentistry is the cost of dental school. When my wife graduated from dental school (in 2005), her student debt for 4-years of dental school + the required dental tools they make you buy was just over $200,000.
I'd be happy to have my wife chat with your daughter about the pros/cons of dentistry vs medicine if you would like. My wife was originally pre-med, but switched to pre-dentistry in her junior year of college. She definitely does not regret the decision.
@ Sermo Doc 29: Thank-you ! Great idea to take pt's credit card up front, & ask them to sign a statement letting me balance bill them for the remainder. I am going to implement this starting Monday!
Yes, I'm trying to encourage my niece to go into dentistry. Just paid $16k to my dentist for work on 1 family member.
Two of my brothers are dentists and my other brother is an anesthesiologist. We agree we should have gone into dentistry. The quality of life is the issue. They both work four days a week and have no call or weekends. They do no billing and have three employees. I have 6 and that is mostly for billing.
they do well becuase 1. no insurance 2.cash basis 3.shorter,predictable hours plus fridays off 4.effeciency--2-4 patients at a time 5. awareness of overhead costs 6. can lease equiptment to themselves and take depreciation through sepatate cirp. 7. may own their own office and rent to self. 8. immediate hands on control of the whole office 9. can easily get into the cosmetic end if desired
We have let the government and insurance get us this far. They keep fixing our reimbursement rates - most of these folks are not even doctors and they dictate what we get paid . we should all opt out of this system and dictate our own terms !
Most dental meetings cover the financial aspects of their practice; in medicine this is almost a taboo. Dentists are better off in their return on investment since they have only 4 years of school plus 1-2 in residency then get to go to work right away.
The job is boring and probably has its nasty parts, but they get paid and have a great PR campaign (see your dentist twice a year). I bet they are fighting any cost savings that would result from only seeing your dentist once a year.
They've got a racket all right, and all of us are the captive payors for it.
One bogus thing is telling everyone to use soft toothbrushes, whereas harder bristle brushes definitely clean the teeth better.
And then there's the x-rays, which I've been dutifully getting nearly every year of my life for what *#@&#!(^# reason? I just started refusing the xrays and my dentist nearly refuses to see me, saying it's important for screening for potential problems. To which I say "bullsh....."
And lastly, most of their work is done by the hygienists.
I have stopped going to Dentists for the last few years and I am no worse for it. For years I was told that I had Periodental disease, gum recession etc. I saw 3 Periodentists and went dutifully to the dentists 3 times a year. Then I got fed up with their greed and I said I will only go if I had problems. Lo and behold I have been fine. Look at how they have conned the public into having children have fillings in their milk teeth when everyone knows that all those teeth will fall out. When they start giving me the BS about tooth xrays I simply say " Buddy there is only one real doctor in this room!" Stay away guys! or let your kids do dentistry.
It's tough though to start a dental practice. The initial set-up costs are outrageous as are many of their on-going expenses. They are raped as badly as we are when their equipment needs repair. A savvy businessman can make money in Dentistry OR in Medicine. It helps though to park your conscience at the door and find a marketing gimmick to sell procedures, whether they be dental implants or breast implants.
Dentists do well because they don't sign contracts that pay less than will accept.
If you don't like what an insurance company or .gov plan pays you, exactly whose fault is that? If you look at the last page, you will see a signature. It will match the one on your driver's license.
They have a different professional ethic. It is not unethical to pull an ugly tooth just because the patient wants it done. Trying doing a tonsillectomy 'just because'.
They also believe dentistry is a business first. They sleep just fine with the knowledge someone's tooth is rotting off at the gumline because they don't want to pay to have it fixed. I had a local oral surgeon run a credit app with CareCredit on a patient in the ER with an abscess. Bad credit, so the patient couldn't get financed. So he gave them a script for Keflex (at half the recommended dose) and told them to go to the university hospital ER if ti got worse.
I had three or four dentists in my medical school class. To contrast, I met a Canadian dentist on a cruise a few years ago. He had three or four physicians in his dental school class. Look at your state's medical and dental programs. Then you will know for sure which way to go.
I remember discussing this issue from medical school onward. It just doesn't seem right that dentists charge the same amount or more for a general checkup as some doctors and they are only taking care of one part of the body. One difference is that they can immediately fix problems right then and there whereas doing procedures is dependent on the training for doctors.
I don't find any difference between the knowledge and professionalism of oral/maxillofacial surgeons and physician specialties. I think that's a great way to go for those wanting to do surgery.
Fx, rt., 2nd, upper molar,considered a 'dental emergency',back in 1994,ended up costing me $4,800.Sometimes they create cavities with the pointed probes,just to fill them.Most of them could not get into med school but who's laughing now?
Dentistry is a good profession - my father's an oral surgeon and my wife is a general dentist. For most practitioners dentistry is more of a cash business than one that relies completely on insurance coverage - but most dental procedures are elective. It is therefore sensitive to the general economy and how well financially the patient population being served is doing.
A friend of mine was a past president of the ADA. He pointed out that one of the main reasons that organized dentistry has done better than medicine is that the profession has held together. The sub specialties in dentistry have not been allowed to break away from the the ADA the way that sub specialty societies have broken away from the AMA and compete with each other allowing outside groups to divide and conquer dentists as has happened in medicine with surgeons/internists/radiologists etc all seeing their interests as being different from each other.
A Maker's Mark Manhattan sounds just right about now !!!
Its 5:14 pm on a cold freakin' at the end of jan. evening in central joisey down da show're. Home after a hellish week of managing 6 cases of vasculitis all in critical care units.
Steroids are not just for baseball players !!!
I hugged my 16 y.o. who is in a biotech high school prepping for those god forsaken SATs I took 30 years ago. Daughter 13 going to bed early tonight so she can be fresh for her competitive entrance exam for entrance into a marine science and technology academy.
Figuratively, I perform route canal on myself sans anesthesia on myself daily to keep up with the New Jersey cost of living.
My brother 43 is a general dentist who employs an orthodontist, a cosmetic dentist, and 3 hygenists. When he calls me I don't know if its from Maui, Copacabana Beach or Long Gylendh NY.
I got accepted into Georgetown Dental School in 1983. I told the admissions officer "All my life I have wanted to become a dentist and not a doctor." His response was that a dentist is a doctor. Then he showed me the exit sign in the lobby to leave the building.
If you spent as much time and effort as I have over the years cleaning up after oral surgeons and dentists you would feel very different.
After hours dental abscesses and jaw fractures in the uninsured are deemed ENT problems. Funny how the time of day and ability to pay applies only to dentists.
I frequently consult on patients of oral surgeons with severe odontogenic infections. Needless to say, they make 10x what I make for caring for the patient [they get cash, I get whatever their insurance company deigns to pay.] Guess who the nurses call if thee is a problem at night?
Want to drive a Bentley, Orthodontics is the way to go . These guys are inthe7 figures plus. No call, boats houses,etc. Hurts. I work 100 times harder and make 100 times less.
Excuse me, but the dentists I know and work with earn every cent, they just aren't on sermo bitching about how much doctors make. If you aren't happy in medicine, leave.
As I was leaving my endodontist (who by the way looks like he's 17) his receptionist told me my fee was $900 for the 1 hour root canal. Of course, I immediately took out my check book and paid the bill.
As I was walking out of the building, I was thinking about what had just transpired. If I got out of bed at 2 am, drove to the hospital to evaluate his mother (more likely his grandmother) in septic shock in the ICU and I spent 2.5 hours saving her life, I could bill Medicare $560 (99291 x 1, 99292 x 2). I would get paid $482. Which would you rather earn? $900/hr during the regular business hours or $192/hr in the middle of the night? Not to mention, saving a life vs saving a tooth.
Was at my dentist's this week $508 for 2 fillings and a cleaning. Most round here don't take insurance and patient's have to claim themselves if they have insurance, which is what we should be doing.
However my dentist said their business is down 20-25% because of the recession and they are also constrained by rising supply costs and falling amounts they can charge and still get patients. A dentist I know in a more rural area is struggling, down to 3 days / week and most of his > 65 yr old patients have cut back to getting the bare essentials done and ask for discounts.
Ref : vets - both my small animal and my horse vet say business is down a lot, my horse vet had to open a small animal clinic 2-3 days a week to stay afloat.
The reason that most dentists get paid is because they ask for it, and as a group... they all do. If docs did the same thing, instead of prostituting ourselves to managed care and the government, you would be amazed at the fact that you get paid for your work. Dentists don't have allot of insurance coverage to contend with. Thy are directly connected to the patient and the bill.
However, the grass isn't always greener. What may seem like a money tree, really is hard work. Making payment arrangements and following up. I will say that every patient that is referred to me from their dentist, actually does pay their bill.
Great discussion. I certainly agree. I work all the time, cover nights and weekends. I have to repeat ABIM exams in sleep, IM, PUD, CCM every ten years! And reimbursement is lousy.
Physicians are paid less and work harder and, most importantly, have less time to spend with their families. Somehow, in this country, a fancy dental office that charges outrageous fees gets more respect from patients. I get people who bitch about their $10 co-payment.....
The point here is that Dentists were never stupid enough to sign up for "managed care". Their malpractice premiums are laughable. I didn't go into medicine to get rich, but I'd never dreamed that I'd be poor! Maybe we should go back to billing like the dentists do. But that would require that we all tell our slaveSermo Doc 88s to bug off. That will never happen.
True story- I applied for the DAT exam as well as the MCAT just in case. Did great on the MCAT so was not really worried but my friend convinced me to come down and sit for the DAT when he was taking it. Night before, I ran into some college buddies and stayed out LATE but my friend woke me up for the exam and I took it. Tired and woozy, I got >90%ile on the DAT and it was like preschool compared with the MCAT. Bottom line- last time I saw my dentist freind, he picked me up in his new BMW and told me his house was paid, BMW paid and that for every flyer he mails out he can expect $300 in new patient charges for each stamp he buys. We provide more necessary services but gosh why should I still have >100K debt after 8 years of practice in primary care? I guess I should be thankful that I still have a job in this economy but I really wish I had applied to dental school!
Check the suicide statistics. Very high for dentists. Higher than physicians for sure. Can you imagine having to spend your whole day mucking around with people's teeth? No wonder they kill themselves.
Money is nice and alluring but in the end most of us just spend what we make anyway.
Live within your means.
When is the last time someone stopped a dentist in the grociery store and said "Oh you're Dr. DeJong. Remember us. You saved my mom's life last year when she came to the ER with her heart attack."
There is no substitute for that sort of fulfillment and reward. That's really what makes life worth living. Doing something significant, intriguing and challenging. Most people actually do appreciate us greatly. We make a comfortable living. We save lives, improve quality of life and alleviate suffering.
Medical school was the still right choice for me, despite all the screwed up third party payor games.
I would give anything to be able to go back and do dentistry instead. Better hours, better pay, less BS. My father was a dentist and foolishly talked me out of it, for which I am still angry with him. I think there can be great reward, fulfillment, etc in dentistry so unfortunately that argument of physicians improving lives doesn't hold water. What's unfortunate is that if this current climate persists, the 'best and the brightest' will no longer be going into medicine, as it's not the smart thing to do....
What planet have you been on? It's taken you this long to notice? When I went to med school, the students who couldn't get into med school went to dental school.
In the late 80's early 90's, physicians failed to stand up for themselves against aggressive price cutting. The AMA has sold us out, along with physicians who won't stand up for each other. I belong to my ASAPAC, donated to Scott Brown (hooray!), write letters, but looking at the donation levels from my fellow anesthesiologists, I am disappointed, to say the least.
I tell other physicians to stick together like the dentists do. But the Birkenstock crowd has the nerve to attack other physicians as "greedy" as they look to trade their night call away, and figure out how to economically and physically squeeze their colleagues. All the while failing to see they if they lift up their brothers and sisters, medicine will be better off in the long run, for everyone, including their patients. Including the fact the physician will gain better respect in the long run.
I am paid less from Medicare than one pays to have their car fixed per hour, and can be working in the middle of the night with 14-16 hour days. Do you want that for your kids? Physicians have a stupidly blind eye towards sticking together and saying no, and the payment system exploits that. It would be so simple to just say no, but look at our out of touch mostly academically based leaders who seem to co-opt our financial health.
wow great thread!! The inputs range from the inspiring to the close-minded but it certainly is fair and balanced.
To all the whiners....YOU ARE MISSING THE POINT!! Dentists get paid for what they do. MDs DO NOT!
Society has created a sledgehammer called the Hippocratic oath and beats you down with it everytime you even think about sticking your hand out for more money.
It would be nice if all physicians belonged to the "Birkenstock" crowd and gave everything away for free with no concept of what they sacrificed to become docs.
Its not wise for society to hang their hats on that proposal. Soon there will be no docs (good ones) left. Look back on all the comments about "I wish I had..." MY kids will go to dental school...,etc.
What should you be paid to save a life? More than a root canal? Incidentally on numbers that Sermo Doc 61 provided, You left out the overhead that an endodontist pays which is from 50-70%, so that root canal actually netted about the same as saving his mother's life in the ICU.
So for all of you docs who dont wear Birkenstocks, wake up!!!! You are slave labor and society should not expect much more of the free ride they are getting from you.
On top of that...to be vilified by the President for being greedy (too many frivolous tonsillectomies) should be enough to make you go to dental school.
The massa has come down and told you that you dont deserve the three meals per day for picking cotton. No, you should be happy with two!
This is an easy one. The government seeks to control what is sees an essential expense. Medical care is essential and it is very expensive. Dental care is a great thing to have, but is nowhere nearly as ESSENTIAL to life and death. So the government does not attempt to control (although it does regulate it.) If you don't believe me just look at the individual areas of medicine. The goldmines of medicine are the nonessential services like cosmetic plastic surgery, LASIK surgery, and varicose vein surgery. Bariatrics used to be a gold mine until the government started to see the medical importance of it. The other variable that dentists don't have to deal with is the hospital. Doctors' reimbursement steadily approaches zero as medicare and insurers pay more and more to hospitals every year. We get the short end of the stick. As I've said before, you ain't seen nothin' yet. Better be storing nuts and seeds now, because there will be important decisions to be made in the future for many of us..........
Yes. Dentistry and othodontics are a lot like medicine. Depends on whether you buy your equipment or lease it. Depends on when you buy and what price you paid for your building. My sister-in-law finished orthodontist's training at the peak of the real estate prices, bought a building. My brother is still supporting her practice 3 years later (yes she has lost money every year for 3 years). The payments they have made leave them with a very small amount of equity in the building (they research newer, cheaper buildings at least every other month). She will do well if and when the economy improves. Just so you know it's not all wine and roses.
ps. her malpractice costs for the year are so low they don't even show up on their financial software!
Endodontists charge (& get) ~$800 on avg. for a root canal that takes ~30min... They make ~5X what I make a year... I know of 1 that is now learning to do dental implants b/c he said he thinks he can double or triple his income, b/c he can do 2 - 3 an hour & charge >$2K each... He works ~40hrs/week & takes at least a week off every quarter...
Expensive dental procedures are at least 10x-100x cheaper than some expensive medical procedures (root canals or implants vs 60days in ICU or 5 rounds of latest chemo). Nobody can afford that and that is where insurance comes in.
As far as I know there is no government sponsored dental insurance. Or am I wrong.
I wish I could balance bill and make my patients get the payments from insurance. I would even help them... for an hourly fee...
Like most others who have commented on my post, I went into medicine with the emphasis of helping HUMANity and not for the huMONEYty part. However, I agree with majority of you that enough is enough. We have been used and abused by the government and third party payers. I am not looking to be wealthy,all I ask is fair reimbursement for the services, I render. Like everyone, I have bills to pay and kids that are in college. Commodities and good prices are steadily going up but our reimbursement is going the other way.
I posted this to show my daughter but she is giving me a hard time. I don't even know if I can get her to read my post and your comments .She says she is in her sophomore year with a double major in Biology and Art History as her pre-med course.She is telling me that she would need to put in an additional 2 years to be able to qualify for dental school. I disagree. I don't know what else to tell her . I want her to open her mind to other possibilities. I would not mind her persistence with pursuing medicine if I know that she knows what's she in for. A good number of her friends want to go into medicine also. I may be cynical but most of them have been influenced by shows like HOUSE or GRAY's Anatomy which are hollywood's version of medicine NOT the real world.
THANK YOU FOR YOUR COMMENTS AND WORDS OF WISDOM. If there is anyone else who would like to share their thoughts, you are welcome to do so.
I recently talked a young college grad out of going to medical school - the happiest moment I've had all year. Felt like I really accomplished something...........
Call me an idiot, but I much prefer telling people that I'm a doctor...as opposed to a dentist. I'm honestly surprised how many docs haven't figured out how to manage their business. You must can the insurances that don't pay appropriately,can medicare and medicaid. If you live in a locale that you think you can't do that,then you need to move. Yes, I work my ass off, but make very good money-have a resort home,loads of crap,4 kids, racehorses...and I have to drag my butt at god-awful hours frequently to the hospital and frequently for walk-ins that don't pay...but call me crazy, I like being a doctor,maybe I'm deluding myself but I think its still prestigious,and also call me old school but I kinda like that. And I'm only in my late 40's.
Two things:
First, dentists were never included in the Medicare. This of course promotes all the various diseases that begin with poor oral health, costing more in the long run, but it allowed dentists to stay independent.
Next, and perhaps more significant, dentistry requires lots of very expensive supplies.
I would suspect that the retail markup on the various ceramics and other supplies that are used could justify a high percentage of the charges. As a non-surgical physician, I use very few supplies and, as we all know, brain power is the cheapest stuff around.
I am an oral and maxillofacial surgeon and practice the full scope of my specialty. As a licenced physician and dentist in the state that I practice in, I bill both medical and dental plans depending what I'm treating whether I'm a provider for the patient's insurance or not. If I'm not a provider, I have more control of the reimbursement because I'm out of network. I'm on staff at my local community hospital and do take call a third of the month, and treat my fair share of late night medicaid/medicare and uninsured mid-face, orbital, and mandible fractures, as well as odontogenic infections due to decayed teeth (just FYI Isledoc34- you can die from a odontgenic infection, its usually an acute airway issue and sepsis). I can see Sermo Doc 52s frustration with the minimal or lack of reimbursement for services render late in the evening on the medical insurance side, because they can only bill an E&M code and likely eat the surgical management of a dental issue. Most medical insurance do not cover anything dental related definatively, and Sermo Doc 52s won't know that the claim was denied until 2 months after the fact. At least for an odontogenic infection, if I admit the patient for IV antibiotics and hydration, I can file an E&M claim to medical insurance and also file a claim to the patient's dental insurance if I do a dental procedure (i.e., extraction of tooth or I&D of an of an odontogenic facial/neck space abscess) because I am also a licenced dentist and balance bill the patient. Now how often do I see the balance? Seldomly. Most of the time, the patient's I see in the ED are freebies.
As for my private practice. I'm very selective of the contractual agreements I enter into with either medical or dental insurance nowadays. When I first started my practice, I was a provider for everything that was out there. My accountant credentialed me with everything the hospital took that I was on staff with. What I found out was that your "negotiated reimbursement" i.e., 70%-105% of Medicare was never negotiated with you, but told to you "that is what your going to get" if you want to see some patients. This percentage is based on how many MD's in your specialty are in the community that you are practicing in. The very institiution that we as physicians depend upon for payment is what is strangling us with all the contractual rules and regulation that we have to deal with. When third party payers annually review what their exclusions and reimbursement are going to be, they follow medicare. I have one full time staff member in my office just to file and chase down these claims, and I may possibly need hire another. Needless to say four years into practice, I have dropped several plans.
In general with dental insurances, there's usually an annual limit ($1,200-$2,000), and if the patient's treatment plan exceeds that "pot of money", a dentist can balance bill the patient for the difference whether or not they are a provider for that particular plan. Another difference, is If I do two dental procedures (CDT) in the same setting whether under local or IV sedation, I don't have to subsquently take half off of each additional procedure as I would do if I was billing CPT codes to their medical insurance (i.e., excision of three maliganant lesion on the head and neck with immediate rotational flap reconstruction).
There are some general dentist who do not take any insurance and is strickly fee for service, but that is far and few between. Most general dentist have to take some insurance to supplement their monthly cash flow to cover their overhead. Look, it is what it is. Dentist do get reimbursed better in the current situation whether they take insurance or not, and it is because as a whole the dental community has resisted manage care, but it is slowly trickling in.
As a good measure, I think all off us should review our contracts with third party payers annually and evaluate if they are worth keeping. I am by no means saying patients in one panel is worth more or less as compare to another panel with your expertise in managing their health or asking you to violate your Hippocratic Oath. We all went into the health field to help people, but we are all either running or part of a small business. I see so many of my dedicated MD friends burning out at different stages of their careers working more hours and taking on more risks with extenders for less reimbursement.
Having gone through both medical and dental school, I will strongly encourage my kids to look into careers in dentistry. Now if they chose medicine or something else, I've done my part.
Sermo Doc 80 needs face time with third party payers and his local politicos.He or she gives insight to what needs to be addressed. Its not BO but Barak Hussein Obama that needs to grasp the impact of how he is trying to transform the structure of american society. Third worldism is his mantra.
Many dentists over treat unnecessarily for the sake of the almighty dollar. I was going to a wealthy dentist for years who found 3,500 dollars worth of restorations needed which raised my suspicions. I sought a second opinion from a reputable practicing dentist who was a professor at the local dental school who found no dental work needed. Five years later, no pain, no problem, no excessive bills. Beware the dentist who finds a lot wrong with your teeth and tries to justify a big expense. Seek a second opinion.
Reader's Digest did a study years ago where they had several dental school professors evaluate a guy's teeth, decide what kind of work he really needed, then sent him to several dentists around the country for evaluations to see if they could find an honest dentist. The ONLY one who didn't recommend unneeded work was a dentist in the town where I live.
Interesting topic. BTW, when I entered medical school, the urban legend was dentists had the highest suicide rate by profession. Well, that doesn't appear to be true. The suicide statistics appear to show white male physicians leading the pack.
I dread the Dental Bill more than the visit or drilling! Seems like the Dents are adding more frequent procedures like whitening, measuring erosion, fluoride Rx, more x-rays and reurn visits for "hygienists!
Sermo Doc 82 is right, get a second opinion before you embark on an endless path of unnecessary work!
On my last visit, the hygenist offered to check for oral cancers for an additional small fee. As I recall, she looked at my mouth with a special (UV?) light. Nothing found, thank goodness.
thankyou Sermo Doc 80
for 25 + years i have watched my collegues discourage their kids from going into medicine.. and now i am watching debt slaved younger docs doing the same.. i told the kid that we needed great docs to take care of us in old age and this is what the kid remembered..
BUT there are TOO many docs coming out with UNDergrad AND medschool Debt that is excessive and UNDERREPorted BY AMA ( surprise! surprise!) this is INSANE STRESS ON THEM IN THE environment where they will have to work like slaves to pay off debt, then be behind on saving for Their kids college ( who will not get help since they have too hi salary And be behind on setting aside for retirement.. For Females this is BIGGER Problem as , if they are LUCKY , they will need to take some time off for Bearing children... SO, Dentristy does have huge advantage for FEMALES.. still ..
big advantage they still have is being able to be solo and buy their office so end up with cheaper office as older and asset worth something..
so KEY here is for kids to go to med school if THEIR FOLKS can pay completely Or they can get scholarshiped .. which is mostly minorities now or kids who have divorced single moms with no income.. ..right now the PAs and RNPRs are being pumped out like crazy.. mostly on online ed rather than real ed in hospitals and med students who are paying 50-100K tuition and costs are EDUCATING those working for 100K .. this is INSANE.. this continues in Residency where the Residents get paid 1/4 of what the lower level providers do and the Residents have BETTER BACKGROUND and knowledge to Teach the Employees.... so WHARPED NOW AS TO VALUE.. here too.. not just lose a tooth or or a heart!!
My "family dentist" refused to fill the cavity of my 8 yr old daughter and referred us to a pediatric dentist. We found out we needed a consult then the tooth filling. My wife insisted our dentist fill it and he reluctantly did it. My 10 year old needs a tbaby tooth pulled and he referred us to an oral surgeon.
He just moved to a beautiful new office and flies his own plane. Cosmetics must be paying very well.
The grass is always greener on the other side of the fence.
Sure there are specialists making large sums of money in all fields, medicine and dentistry.
Here's a breakdown from: mdsalaries.blogspot.com "This is how the average figures of a general dentist in USA would look like:
• Houston, TX: $132,000/-
• Los Angeles, CA: $143,000/-
• Miami, FL: $126,000/-
• New York, NY: $150,000/-
• Seattle, WA: $140,000/-"
Complare that to :
mdsalaries.blogspot.com Primary Care Pays too...
• Houston, TX = $152,000/-
• Los Angeles = $165,000/-
• Miami, FL = $168,000/-
• New York, NY = $170,000/-
• Seattle, WA = $155,000/-
or how about allergists:
mdsalaries.blogspot.com • Houston, TX: $225,000/-
• Los Angeles, CA: $245,000/-
• Miami, FL: $217,000/-
• New York, NY: $256,000/-
• Seattle, WA: 239,000/-
National Average: $215,000/-
i think some dentists make a lot of money and some don't. the dental subspecialties like endodontics, orthodonture, and cosmetics do very well. my dentist, who did a 1 yr residency in cosmetic reconstruction works 3 1/2 days/wk (off friday) and i would guess about 3X the salary of the top 2 categories in the above post.
Here's a couple of tidbits from 2008 survey that the ADA sends out to their members and put out on their website:
The average gross billings per owner dentist in 2007 was $713,100 for a general practitioner and $1,049,320 for a specialist.
The average net income for an independent private practitioner who owned all or part of his or her practice in 2007 was $205,960 for a general practitioner and $353,280 for a specialist.
Source: 2008 Survey of Dental Practice—Income from the Private Practice of Dentistry
www.ada.org
Dentists were smart. In the 80's when HMO's were negoitiating with physicians, dentists universally balked. That is the reason why we physicians are in the situation we are in. Crisis. We can learn from what dentists do now. They don't necessarily participate in government insurance. Some do, but the majority do not.
Sounds like many of you are unhappy about your decision to go into medicine. If you want to earn more, work less, and work on peoples' teeth all day, why not bag medicine and go back to school... in Dentistry?
It seems to be more stable for dentists. Many of us primary docs simply want stability, and the opportunity to see patients while having a reasonably good livelihood. These years (all of the years I've been in practice) have been unstable, decaying like a rotting molar. The "solutions" proposed for us sound like something we'd read about in a child's story: a fairy godmother magically provides gold bullion (or perhaps gold fillings) for the masses of grateful Americans.
However, whenever I look in people's throats and see their teeth, I am thankful I'm not a dentist. :- p
No not fair.We save lives for peanuts,dentists save teeth for good money.They have been smarter not allowing ins and govt to interfere with pricing and collecting balance from patient,usually upfront before procedure.Our problems could be improved just by allowing balance billing.All the contractual write offs are killing us.
Because they are smaller piece of the pie, means they can have the whole piece. Doctors are a bigger pie and much bigger target.
I keep wondering if/when dentists are going to fall under the obummascope.
on the flip side , unless you specialized, i agree with the above---the ave dentist does not do too well (unless his practice is in an affluent community and also does some cosmetic work).
Also, they don['t have the AMA at cross purposes with the practicing dentists.
Or how about veterinary? We took our cat to a veterinary oncologist. They have sub specialists
My dentist is going to be putting Lumineers on my front upper and lower teeth, and I expect I will be financing her trip around the world with the profits. She has a credit agency involved with her practice that allows me to make monthly payments without interest. Cosmetic is cash only, obviously. No middle man dictating what she can make. She is doing well for herself. She is originally from Iran, and her family fled that country in the late 70s. She has a good bedside manner and puts me at ease.
People are willing to pay their dentist for vanity reasons (who likes to smile with yucky teeth?) and because it hurts so darn much when a tooth or gums get diseased.
However, many people are afraid of the dentist, and I keep hearing ads about "sedation dentistry" to bring the fearful ones in.
- like they are doing something wrong, expecting to be paid.
THE REASON THEY GET PAID IS THAT THEY REFUSE TO ACCEPT GOVERNMENT ASSIGNMENT. They don't work if they don't get paid. It's rare that anyone dies from a toothache, so they "get away with it."
We can learn to not allow insurers to take over our businesses. Many dentists do not accept insurance at all - they bill you, and it is up to you to seek reimbursement from any dental insurance you have. Of the dentists that do accept insurance, I do not know of a single one who accepts assignment. In EVERY case, the dentist still holds the patient accountable for the total amount of the bill. Very few of them offer insurance discounts, very few of them joined dental HMOs a decade or so ago, and I've never heard of a dentist accepting capitation. And they learned all that from watching what happened to US.
Dentists are economy sensitive as people put off treating stuff that doesn't hurt.
Dental practices run like real businesses and can adjust their overhead to the prevailing revenue stream.
Even patients with dental insurance understand that the full bill will be paid - ie balance billing is the psychological norm.
They were SAVED by EXCLUSION from federally funded health care.
And how many orthodontic emergencies are there at 3 am?
But to really do well, yes, they are going into the cosmesis - veneers, whitening, etc. Until the advent of the elective procedures, they were losing out in a big way with preventive therapies (brushing, flossing and especially flouride and sealants.). And, there are easier orthodontics so adults are going back.
Something weird is going on in my mouth, because I did it again 4 months later. About a week after I started my implant from the filling / failed root canal / extraction by the oral surgeon. I just called them and told them to tell Dr. Joe that plans were changed for my appointment on Friday because I broke another one.
I lost a filling last Friday. Late at night. Good thing I have an appointment tomorrow. Guess I'll just schedule a bunch of appointments. Until I can find another dentist.
Been going to this guy for over 20 years.
I think many people have a phobia for dentists, and some simply think they are fine because they brush/floss and don't have dental pain.
Yet, I unfortunately look into patient's open mouths and see the results of neglect.
And laser, find a new dentist.
He goes to our church, and my husband is the organist. They also sing together in a local college choir. I may have to send messages that way.
And, yes, I am looking around. 20 years is hard to give up.
Lets make dentistry like the MD model for a second.
You have a toothache:
1- go to the dentist, they tell you that you have a hole in your tooth
2- they send you to the radiology department for an x-ray, you wait an hour for the reading to be done
3 - you go back to the dentist - thet read the radiologists report and sends you to the surgeon
4- you go to the surgeon to have the tooth fixed.
5- you return to the surgeon for a follow up visit
6- go home and wait for the next toothache
The fact that you all are missing is the staggering inefficiency of the medical way of doing things. 90% of all dentistry is handled by the GP dentist under one roof (initial visit, radiology, surgery, follow up, prevention, etc,etc)
What would a filling cost if done by the medical model? And yes, veterinarians have taken the same lesson from dentists. The next time you complain about how much dentistry costs remember just how many services are being performed in one visit.
I think that all physicians should earn 7 figure salaries. The more invasive and dangerous the more money should be made. I personally think that general surgeons should earn at least $2M/year based on the life-saving services they provide.
Now put dentistry in context. If a practitioner earns based on the degree of severeity they treat then dentists should stay in the $300K range and physicians should be $1M+. This is not fantasy!
Imagine the quality people that medicine would attract then. A corporate CEO earning millions when they will never save a life? What is more important than keeping someone healthy and alive.
A previous entry told of a pediatric hospitalist hope to get $120K for a salary. That is insane!!
Also, medical care is seen as more of an entitlement than dental care is. It's like asking why WalMart gets everything they bill for when we don't. It's a whole different ball of wax, because neither dentists nor WalMart sell anything necessary for survival.
When will we begin to take lessons from other health professions??
The problem we have is that MOST physicians need to opt out of accepting insurance for this to work for all of us.
#3 [=future unclear]
+
#6 [=cosmetic medicine is profitable medicine]
+
(#5?]=uncertain if T or F]
+
Cf. Sermoan comments.
He makes a fortune, is calm, relaxed, unstressed...
Dentistry for sure in 2010 is a better career choice than medicine!
Vets are NOT doing well now... they use to be really rich, but economy has hit
them hard... I have several unemployed vets in my primary care practice now.
Cheaper to put foofoo or fifi in the pound, then to give them their insulin or pay for their chemotherapy!
I have all patients give me a credit card at the time they register as my patient whether they are insured or not. After insurance has sent us the EOB, we run the credit card for the remainder owed. We do not send the patient a bill hoping to be paid. We send an invoice informing them that we ran their credit card. My outpatient practice therefore has almost no bad debt. My only bad debt comes from hospital work.
WE SHOULD ALL DO THIS!
Most general dentists make way more that PCP's working half the time. If you specialize in dentistry, you can even make more. I have an oral surgeon friend who has his own practice working 9-10 months out of the year making over $500,000 per year (5 years in practice and he bought a sweet $1.5M house in the DC area). He is very marketing savvy which may explain his success. Another endodontist friend makes $300,000 per year. Don't think she's ever worked a weekend in her life.
When I was in med school, a friend wanted to go to dental school after medical school and begged the Dean of the dental school to let him do only the last two years, since the first two are similar. He was not successful and now he is an overworked and unhappy physician.
Kind of sad but this is no one's fault but ourselves. I think we are a strange (special?) breed of human beings.
Those that did will never be happy.
Having said that; a few more verified examples:
Starting Pedodontics salary $250K in Denver
Oral Surgery $500K in Iowa
Big outcry in Iowa a few years age when Dentists were only being paid 75% of fees; but MD/DO's have to take 40% and like it.
Dentists $$>>Veterinarians $$>>Chiropracters $$>> Optometrists $$>>Hospital Adminstrators$$>>Pharmaceutical area sale managers$$>>Physicians$$ >>
UPS route delivery guy (but closing in quickly!!)
I understand that Waste Management pays quite well, but they prefer experienced "G-men"!! But, hey, no one can say that we're in it for the money, right??!!
I wonder, though, why there's such a high reported suicide rate among dentists? Maybe it's from the stress of working in a office with that many women......
I did not go into medicine to make more money than anyone else. I went into medicine because I enjoy it, and I can make a good living doing it.
One consideration about going into dentistry is the cost of dental school. When my wife graduated from dental school (in 2005), her student debt for 4-years of dental school + the required dental tools they make you buy was just over $200,000.
I'd be happy to have my wife chat with your daughter about the pros/cons of dentistry vs medicine if you would like. My wife was originally pre-med, but switched to pre-dentistry in her junior year of college. She definitely does not regret the decision.
Yes, I'm trying to encourage my niece to go into dentistry. Just paid $16k to my dentist for work on 1 family member.
(I'm just trying to get rid of the cognitive dissonance due to forking over thousands of dollars for the lumineers. : - B )
uuh, yeah, someday I'll shave off my forehead horn and tweeze the unibrow, but teeth are more important.
The job is boring and probably has its nasty parts, but they get paid and have a great PR campaign (see your dentist twice a year). I bet they are fighting any cost savings that would result from only seeing your dentist once a year.
One bogus thing is telling everyone to use soft toothbrushes, whereas harder bristle brushes definitely clean the teeth better.
And then there's the x-rays, which I've been dutifully getting nearly every year of my life for what *#@&#!(^# reason? I just started refusing the xrays and my dentist nearly refuses to see me, saying it's important for screening for potential problems. To which I say "bullsh....."
And lastly, most of their work is done by the hygienists.
If you don't like what an insurance company or .gov plan pays you, exactly whose fault is that? If you look at the last page, you will see a signature. It will match the one on your driver's license.
They have a different professional ethic. It is not unethical to pull an ugly tooth just because the patient wants it done. Trying doing a tonsillectomy 'just because'.
They also believe dentistry is a business first. They sleep just fine with the knowledge someone's tooth is rotting off at the gumline because they don't want to pay to have it fixed. I had a local oral surgeon run a credit app with CareCredit on a patient in the ER with an abscess. Bad credit, so the patient couldn't get financed. So he gave them a script for Keflex (at half the recommended dose) and told them to go to the university hospital ER if ti got worse.
I had three or four dentists in my medical school class. To contrast, I met a Canadian dentist on a cruise a few years ago. He had three or four physicians in his dental school class. Look at your state's medical and dental programs. Then you will know for sure which way to go.
I don't find any difference between the knowledge and professionalism of oral/maxillofacial surgeons and physician specialties. I think that's a great way to go for those wanting to do surgery.
A friend of mine was a past president of the ADA. He pointed out that one of the main reasons that organized dentistry has done better than medicine is that the profession has held together. The sub specialties in dentistry have not been allowed to break away from the the ADA the way that sub specialty societies have broken away from the AMA and compete with each other allowing outside groups to divide and conquer dentists as has happened in medicine with surgeons/internists/radiologists etc all seeing their interests as being different from each other.
Its 5:14 pm on a cold freakin' at the end of jan. evening in central joisey down da show're. Home after a hellish week of managing 6 cases of vasculitis all in critical care units.
Steroids are not just for baseball players !!!
I hugged my 16 y.o. who is in a biotech high school prepping for those god forsaken SATs I took 30 years ago. Daughter 13 going to bed early tonight so she can be fresh for her competitive entrance exam for entrance into a marine science and technology academy.
Figuratively, I perform route canal on myself sans anesthesia on myself daily to keep up with the New Jersey cost of living.
My brother 43 is a general dentist who employs an orthodontist, a cosmetic dentist, and 3 hygenists. When he calls me I don't know if its from Maui, Copacabana Beach or Long Gylendh NY.
I got accepted into Georgetown Dental School in 1983. I told the admissions officer "All my life I have wanted to become a dentist and not a doctor." His response was that a dentist is a doctor. Then he showed me the exit sign in the lobby to leave the building.
What a freakin' more on.....me that is.
If you spent as much time and effort as I have over the years cleaning up after oral surgeons and dentists you would feel very different.
After hours dental abscesses and jaw fractures in the uninsured are deemed ENT problems. Funny how the time of day and ability to pay applies only to dentists.
As I was walking out of the building, I was thinking about what had just transpired. If I got out of bed at 2 am, drove to the hospital to evaluate his mother (more likely his grandmother) in septic shock in the ICU and I spent 2.5 hours saving her life, I could bill Medicare $560 (99291 x 1, 99292 x 2). I would get paid $482. Which would you rather earn? $900/hr during the regular business hours or $192/hr in the middle of the night? Not to mention, saving a life vs saving a tooth.
However my dentist said their business is down 20-25% because of the recession and they are also constrained by rising supply costs and falling amounts they can charge and still get patients. A dentist I know in a more rural area is struggling, down to 3 days / week and most of his > 65 yr old patients have cut back to getting the bare essentials done and ask for discounts.
Ref : vets - both my small animal and my horse vet say business is down a lot, my horse vet had to open a small animal clinic 2-3 days a week to stay afloat.
However, the grass isn't always greener. What may seem like a money tree, really is hard work. Making payment arrangements and following up. I will say that every patient that is referred to me from their dentist, actually does pay their bill.
My dentist charges an arm and a leg.
I really should change and become a dentist.
spend with their families. Somehow, in this country, a fancy dental office that charges
outrageous fees gets more respect from patients. I get people who bitch about their
$10 co-payment.....
Money is nice and alluring but in the end most of us just spend what we make anyway.
Live within your means.
When is the last time someone stopped a dentist in the grociery store and said "Oh you're Dr. DeJong. Remember us. You saved my mom's life last year when she came to the ER with her heart attack."
There is no substitute for that sort of fulfillment and reward. That's really what makes life worth living. Doing something significant, intriguing and challenging. Most people actually do appreciate us greatly. We make a comfortable living. We save lives, improve quality of life and alleviate suffering.
Medical school was the still right choice for me, despite all the screwed up third party payor games.
In the late 80's early 90's, physicians failed to stand up for themselves against aggressive price cutting. The AMA has sold us out, along with physicians who won't stand up for each other. I belong to my ASAPAC, donated to Scott Brown (hooray!), write letters, but looking at the donation levels from my fellow anesthesiologists, I am disappointed, to say the least.
I tell other physicians to stick together like the dentists do. But the Birkenstock crowd has the nerve to attack other physicians as "greedy" as they look to trade their night call away, and figure out how to economically and physically squeeze their colleagues. All the while failing to see they if they lift up their brothers and sisters, medicine will be better off in the long run, for everyone, including their patients. Including the fact the physician will gain better respect in the long run.
I am paid less from Medicare than one pays to have their car fixed per hour, and can be working in the middle of the night with 14-16 hour days. Do you want that for your kids? Physicians have a stupidly blind eye towards sticking together and saying no, and the payment system exploits that. It would be so simple to just say no, but look at our out of touch mostly academically based leaders who seem to co-opt our financial health.
To all the whiners....YOU ARE MISSING THE POINT!! Dentists get paid for what they do. MDs DO NOT!
Society has created a sledgehammer called the Hippocratic oath and beats you down with it everytime you even think about sticking your hand out for more money.
It would be nice if all physicians belonged to the "Birkenstock" crowd and gave everything away for free with no concept of what they sacrificed to become docs.
Its not wise for society to hang their hats on that proposal. Soon there will be no docs (good ones) left. Look back on all the comments about "I wish I had..." MY kids will go to dental school...,etc.
What should you be paid to save a life? More than a root canal? Incidentally on numbers that Sermo Doc 61 provided, You left out the overhead that an endodontist pays which is from 50-70%, so that root canal actually netted about the same as saving his mother's life in the ICU.
So for all of you docs who dont wear Birkenstocks, wake up!!!! You are slave labor and society should not expect much more of the free ride they are getting from you.
On top of that...to be vilified by the President for being greedy (too many frivolous tonsillectomies) should be enough to make you go to dental school.
The massa has come down and told you that you dont deserve the three meals per day for picking cotton. No, you should be happy with two!
If you don't believe me just look at the individual areas of medicine. The goldmines of medicine are the nonessential services like cosmetic plastic surgery, LASIK surgery, and varicose vein surgery. Bariatrics used to be a gold mine until the government started to see the medical importance of it.
The other variable that dentists don't have to deal with is the hospital. Doctors' reimbursement steadily approaches zero as medicare and insurers pay more and more to hospitals every year. We get the short end of the stick. As I've said before, you ain't seen nothin' yet. Better be storing nuts and seeds now, because there will be important decisions to be made in the future for many of us..........
Haven't autopsied anyone yet who died from a little dental cavity and everyone has one sooner or later!
Started storing the nuts and seeds when BO began running for office and haven't stopped yet! The battle began when BO walked into the WH!
ps. her malpractice costs for the year are so low they don't even show up on their financial software!
As far as I know there is no government sponsored dental insurance. Or am I wrong.
I wish I could balance bill and make my patients get the payments from insurance. I would even help them... for an hourly fee...
I posted this to show my daughter but she is giving me a hard time. I don't even know if I can get her to read my post and your comments .She says she is in her sophomore year with a double major in Biology and Art History as her pre-med course.She is telling me that she would need to put in an additional 2 years to be able to qualify for dental school. I disagree. I don't know what else to tell her . I want her to open her mind to other possibilities. I would not mind her persistence with pursuing medicine if I know that she knows what's she in for. A good number of her friends want to go into medicine also. I may be cynical but most of them have been influenced by shows like HOUSE or GRAY's Anatomy which are hollywood's version of medicine NOT the real world.
THANK YOU FOR YOUR COMMENTS AND WORDS OF WISDOM. If there is anyone else who would like to share their thoughts, you are welcome to do so.
First, dentists were never included in the Medicare. This of course promotes all the various diseases that begin with poor oral health, costing more in the long run, but it allowed dentists to stay independent.
Next, and perhaps more significant, dentistry requires lots of very expensive supplies.
I would suspect that the retail markup on the various ceramics and other supplies that are used could justify a high percentage of the charges. As a non-surgical physician, I use very few supplies and, as we all know, brain power is the cheapest stuff around.
As for my private practice. I'm very selective of the contractual agreements I enter into with either medical or dental insurance nowadays. When I first started my practice, I was a provider for everything that was out there. My accountant credentialed me with everything the hospital took that I was on staff with. What I found out was that your "negotiated reimbursement" i.e., 70%-105% of Medicare was never negotiated with you, but told to you "that is what your going to get" if you want to see some patients. This percentage is based on how many MD's in your specialty are in the community that you are practicing in. The very institiution that we as physicians depend upon for payment is what is strangling us with all the contractual rules and regulation that we have to deal with. When third party payers annually review what their exclusions and reimbursement are going to be, they follow medicare. I have one full time staff member in my office just to file and chase down these claims, and I may possibly need hire another. Needless to say four years into practice, I have dropped several plans.
In general with dental insurances, there's usually an annual limit ($1,200-$2,000), and if the patient's treatment plan exceeds that "pot of money", a dentist can balance bill the patient for the difference whether or not they are a provider for that particular plan. Another difference, is If I do two dental procedures (CDT) in the same setting whether under local or IV sedation, I don't have to subsquently take half off of each additional procedure as I would do if I was billing CPT codes to their medical insurance (i.e., excision of three maliganant lesion on the head and neck with immediate rotational flap reconstruction).
There are some general dentist who do not take any insurance and is strickly fee for service, but that is far and few between. Most general dentist have to take some insurance to supplement their monthly cash flow to cover their overhead. Look, it is what it is. Dentist do get reimbursed better in the current situation whether they take insurance or not, and it is because as a whole the dental community has resisted manage care, but it is slowly trickling in.
As a good measure, I think all off us should review our contracts with third party payers annually and evaluate if they are worth keeping. I am by no means saying patients in one panel is worth more or less as compare to another panel with your expertise in managing their health or asking you to violate your Hippocratic Oath. We all went into the health field to help people, but we are all either running or part of a small business. I see so many of my dedicated MD friends burning out at different stages of their careers working more hours and taking on more risks with extenders for less reimbursement.
Having gone through both medical and dental school, I will strongly encourage my kids to look into careers in dentistry. Now if they chose medicine or something else, I've done my part.
Thank you for a very balanced and insightful response from your dual background.
BTW, when I entered medical school, the urban legend was dentists had the highest suicide rate by profession. Well, that doesn't appear to be true. The suicide statistics appear to show white male physicians leading the pack.
Sermo Doc 82 is right, get a second opinion before you embark on an endless path of unnecessary work!
for 25 + years i have watched my collegues discourage their kids from going into medicine.. and now i am watching debt slaved younger docs doing the same.. i told the kid that we needed great docs to take care of us in old age and this is what the kid remembered..
BUT there are TOO many docs coming out with UNDergrad AND medschool Debt that is excessive and UNDERREPorted BY AMA ( surprise! surprise!) this is INSANE STRESS ON THEM IN THE environment where they will have to work like slaves to pay off debt, then be behind on saving for Their kids college ( who will not get help since they have too hi salary And be behind on setting aside for retirement.. For Females this is BIGGER Problem as , if they are LUCKY , they will need to take some time off for Bearing children... SO, Dentristy does have huge advantage for FEMALES.. still ..
big advantage they still have is being able to be solo and buy their office so end up with cheaper office as older and asset worth something..
so KEY here is for kids to go to med school if THEIR FOLKS can pay completely Or they can get scholarshiped .. which is mostly minorities now or kids who have divorced single moms with no income.. ..right now the PAs and RNPRs are being pumped out like crazy.. mostly on online ed rather than real ed in hospitals and med students who are paying 50-100K tuition and costs are EDUCATING those working for 100K .. this is INSANE.. this continues in Residency where the Residents get paid 1/4 of what the lower level providers do and the Residents have BETTER BACKGROUND and knowledge to Teach the Employees.... so WHARPED NOW AS TO VALUE.. here too.. not just lose a tooth or or a heart!!
Why are hygienists checking for cancer...that's what the Dentist is trained to do.?
So now, the hygienists are taking over the Dent's role, like the NPs and Docs???
What a wonderful world!
He just moved to a beautiful new office and flies his own plane. Cosmetics must be paying very well.
The grass is always greener on the other side of the fence.
Sure there are specialists making large sums of money in all fields, medicine and dentistry.
Here's a breakdown from: mdsalaries.blogspot.com
"This is how the average figures of a general dentist in USA would look like:
• Houston, TX: $132,000/-
• Los Angeles, CA: $143,000/-
• Miami, FL: $126,000/-
• New York, NY: $150,000/-
• Seattle, WA: $140,000/-"
Complare that to :
mdsalaries.blogspot.com
Primary Care Pays too...
• Houston, TX = $152,000/-
• Los Angeles = $165,000/-
• Miami, FL = $168,000/-
• New York, NY = $170,000/-
• Seattle, WA = $155,000/-
or how about allergists:
mdsalaries.blogspot.com
• Houston, TX: $225,000/-
• Los Angeles, CA: $245,000/-
• Miami, FL: $217,000/-
• New York, NY: $256,000/-
• Seattle, WA: 239,000/-
National Average: $215,000/-
The average gross billings per owner dentist in 2007 was $713,100 for a general practitioner and $1,049,320 for a specialist.
The average net income for an independent private practitioner who owned all or part of his or her practice in 2007 was $205,960 for a general practitioner and $353,280 for a specialist.
Source: 2008 Survey of Dental Practice—Income from the Private Practice of Dentistry
www.ada.org
However, whenever I look in people's throats and see their teeth, I am thankful I'm not a dentist. :- p