How To Be Successful As A Modern Dentist

[grennelln]

Hey Guys/Ladies,

I've been checking out these forums since about my senior year of high school (I'm now a senior in college applying for dental school). I've wanted to be a medical doctor since I was about 6, but recently switched to dentistry so that I can hopefully start a family earlier and reap some of the lifestyle benefits available in that career (regular work hours mainly), and I can still travel around the world and help people. Good deal, right?

So, I'm in the application process right now and I'm starting to get cold feet. The debt load if I get into my in-state university after living expenses and interest will come out to about 320K. On an average dental salary, the payments to get payed off in 6-7 year simply doesn't add up. BUT, I want to own a practice, and I know that there are some practice owners out there that come out of school, buy a practice 2-3 years later and crush it. They tend to have no problems paying the loans back.

My question here is, do any dentists here that own a private practice have advice as to how I can get to your position? Is there something the top echelon of dentists are doing that puts them head and shoulders above everyone else, and is it something that I can learn to do? How can I strengthen my business skills while in dental school? Is it crazy to basically bet on myself to come out and run a very successful practice within the first 5-6 years of graduation? I believe I have the drive and ability to get there, but some people are morbid as ************************ about the career and some times its hard to tell the difference between the people sitting around wishing for the "old dentist lifestyle," or if they're people working their asses off that simply can't get it done under today's student debt load and the environment of current dentistry.

 

Thanks!

[q-school]

 

I'm not a dentist but I know many successful ones.

what I can tell you is that almost everyone going through higher education has the same concerns that you voice.  if dentistry is your passion, go for it.  although you are young, you are asking wonderfully insightful questions and that curiosity, planning, and preparation will allow you to be successful.

the rules change over time.   plans have to adapt in response.  there will always be a need for dentists.  the ones that get (imo) into trouble are the ones that cannot be flexible.  for instance, if you have to live in one area only, that might limit your income potential and ability to get out of debt.  otoh a wonderful practice opportunity may pass into your lap by chance.    just cause someone runs a highly successful practice does not guarantee that you should join them--they may be rich because they don't pay well!  sometimes your goals at 25 are different than at 35.

when you have all the debt and no ability to control your life, it is easy to get down.  don't let the negative talk sway your decision.  many of them will feel differently in five years and ten years.  it is also a stressful time in many lives, with getting married, buying houses having kids, etc etc.  lots of adjustments during that time period. 

it appears you have all the tools and ability to obtain information to make your own informed decisions.

 

best of luck to you.

 

[The White Coat Investor]

grennelln wrote:

Hey Guys/Ladies,

I’ve been checking out these forums since about my senior year of high school (I’m now a senior in college applying for dental school).

Click to expand...

That was a quick trip through college. This forum is less than 2 years old. 

[grennelln]

Was speaking more specifically of the blog and website, which I came upon by someone’s recommendation as a senior (2013). I misspoke by using the term forum, my apologies. Either way, thank you for putting this together. I’m currently reading through your book as well.

[RosieQ]

I would advise that you be very careful. I'm an Emergency Medicine MD engaged to a general dentist and our financial lives are very different as a result of our respective career and education choices. I went to a public state school and got some good scholarships and was able to pay off all of my minimal debt during residency, and now have a job making over 300k per year working 15-16 shifts per month. Several of my peers with more debt have to worry about it more but still have a very viable path towards repayment that isn't debilitating. On the other hand, my fiance went to a private school for her DDS, took on about 350k in student debt and has been on IBR ever since, with total debt now over 400k. She works a "regular schedule" 9-5 that you allude to but has been increasingly dissatisfied. Take this all with a caveat since it's second hand, but we have talked about it quite a bit.

In general, I think that dentistry is a terrible financial decision overall unless you are very careful about how you are going to pay for it. Only veterinary medicine is worse when it comes to student debt as a relation to expected post graduation salary. Pharmacy seems more middle of the road for debt/income while MD still has a rather positive outlook for now if you go into various specialties and avoid primary care.  For dentistry, your 9-5 job and 6 figure income won't amount to much if you are making huge debt payments and living on 40k per year after the rest is sucked into debt payments. Alternatively, you could do IBR/PAYE or other income driven refinancing and have a balanced life paying 10-15% of your extra income to debt for the next 20 years. Think about that from a taxation standpoint. Your marginal tax rate on 150k in income would be 28%+state (5-9%)+10% student loans+potential medicare taxes depending on spousal income=almost 50% of the income from your next shift going to taxes. Basically if you don't work you don't live "the good life" that you were planning on by going into dental school, and if you do your daily rate is cut in half and looks pretty paltry in comparison. Add to the fact that  the general tasks are very repetitive and wrist/elbow/shoulder and neck pain are incredibly common among dentists and it's a tough career to recommend. 

How much can you make as a dentist? For us, her offers were generally about 100k right out of dental school, or about 120-130k as an associate with some experience or working in public health/community clinics- with slightly higher offers for rural locations. Public health had better benefits and better work hours and a set 9-5 sort of schedule with paid days off, all holidays etc. Medicaid in Texas pays higher for dental work so salaries are generally higher there. Private practice dentistry has the potentially for much higher returns but also a lot more risk. You can buy into a practice, taking on 200k-1 million of additional debt that you now have to service. We know several dentists that are making 170-250k per year in private practice just having started out. The difference? They work 60-80 hours a week 6-7 days per week and have minimal time for vacation. If they don't work they don't get paid. On an hourly basis, an employed public health position works out to be a similar $/hr proposition. The opportunity to make a lot of money comes from buying a poorly managed practice at a good price and then flipping it (I think of it as similar to a home remodel and house flipping). You can develop a good and efficient practice if you are a good business person and then sell for a healthy profit years later. This comes mainly from efficiencies in practice management and how good you are in business, not from dentistry itself. Additionally, you can take your developing business and employ associates that you pay a lower wage and those with several associates and multiple practice locations start to make very good livings into the 300k-600k or above with addition of various high profit procedures (implants, sedation dentistry, wisdom teeth extractions etc). However these people seem to have been killing themselves for years and are in their 40s-50s and have taken a lot of risk along the way. There are many more stories of failed practices, people who got burned out and went back to public clinics or associate work and just gave up and are unclear about what to do with their debt among our peer group. You would be far better served picking another career with a higher income to student debt ratio that would also afford better quality of life. My fiance certainly wishes she had gone the MD route at this point, or at least something outside of dentistry. 

Assuming that you are set on dentistry, I do have a few other suggestions to make things more manageable. First option is public service loan forgiveness, working at a nonprofit for 10 years while on a qualified repayment plan and your debt all goes away. Take this promise with a grain of salt. It's an unsustainable program that I fully expect to get cut or adjusted in the coming years. The first qualifying applicants are due for forgiveness as of this month so watch the news closely to see if this is a program we can continue to rely on. My fiance is going this route and has about 5 years left. She was able to combine a separate program for loan repayment through NHSC or though Indian Health services and several states have their own programs that can essentially make your monthly payments while you are waiting for loan forgiveness. Essentially, once you are in one of these programs its almost like you "have no debt" since someone else has given you a grant to make the payments and you can then invest or live on your regular salary. It'll just be a slightly lower salary than private practice, and 2-3x lower than what you could have received working for a tech company these days with a bachelors degree and a bit of experience accounting for stock grants etc. 10 years of commitment to a program that hasn't been confirmed is a big gamble, but one of the best routes to take unless you want to move to Texas, work like crazy and live simply for 5 years to pay off the debt.

Alternatively, several of my fiance's graduating class went into the military and seem to be very happy with that decision. It's important to note that the best time to commit to this in terms of covering your loans is after you have been accepted to dental school but before you start. Apply early as they fill up too and then you are out of luck. Loan coverage and sign-on bonuses shrink dramatically if you are approaching the end of your training. You can then serve a 4 year commitment and it's over pretty quickly, and most people we know have really enjoyed it. One of our friends did 2 years in Arizona and is now on the California coast and will be done this year with no debt remaining. Salary is even lower in the military (70-80k range for dentists?) but enough to live on, you can get a housing stipend or live on base and it's not bad. If you have a partner who can go with you it can really be fun. We have another set of friends who are a couple and both dentists. They work at a military base in Japan and have been loving it with lots of time to enjoy the culture and a good jump off base for travel in East and SouthEast Asia. They are also now done with their commitment and loan free.  Hopefully that provides you with a bit more information. If you love dentistry then there are options, but just be very careful. You need to be good at business, take on lots of debt or have lots of family support and you need to work very hard for many years to get ahead. Chances are you could have put in a similar amount of work and have had a very successful non medically related business instead, but if you love doing dentistry then more power to you. Good luck!  Also keep in mind that all this advice is from an interested and invested future spouse of a dentist and not from someone who "made it to the top" with a successful business who is just killing it financially and loving their life in dentistry. We don't know anyone like that, but I too would be curious to see the responses and see how they made it work and if they would recommend the career for applicants. 

[ddscook]

My advice, get into d.school first and focus on getting through it. Don't borrow any more money than you need and live as frugally as possible. Your opinions and thoughts will change so much in those 4 years.

It's an awesome profession and I love what I do. Good luck

[ddscook]

RosieQ wrote:

I would advise that you be very careful. I’m an Emergency Medicine MD engaged to a general dentist and our financial lives are very different as a result of our respective career and education choices. I went to a public state school and got some good scholarships and was able to pay off all of my minimal debt during residency, and now have a job making over 300k per year working 15-16 shifts per month. Several of my peers with more debt have to worry about it more but still have a very viable path towards repayment that isn’t debilitating. On the other hand, my fiance went to a private school for her DDS, took on about 350k in student debt and has been on IBR ever since, with total debt now over 400k. She works a “regular schedule” 9-5 that you allude to but has been increasingly dissatisfied. Take this all with a caveat since it’s second hand, but we have talked about it quite a bit.

In general, I think that dentistry is a terrible financial decision overall unless you are very careful about how you are going to pay for it. Only veterinary medicine is worse when it comes to student debt as a relation to expected post graduation salary. Pharmacy seems more middle of the road for debt/income while MD still has a rather positive outlook for now if you go into various specialties and avoid primary care.  For dentistry, your 9-5 job and 6 figure income won’t amount to much if you are making huge debt payments and living on 40k per year after the rest is sucked into debt payments. Alternatively, you could do IBR/PAYE or other income driven refinancing and have a balanced life paying 10-15% of your extra income to debt for the next 20 years. Think about that from a taxation standpoint. Your marginal tax rate on 150k in income would be 28%+state (5-9%)+10% student loans+potential medicare taxes depending on spousal income=almost 50% of the income from your next shift going to taxes. Basically if you don’t work you don’t live “the good life” that you were planning on by going into dental school, and if you do your daily rate is cut in half and looks pretty paltry in comparison. Add to the fact that  the general tasks are very repetitive and wrist/elbow/shoulder and neck pain are incredibly common among dentists and it’s a tough career to recommend. 

How much can you make as a dentist? For us, her offers were generally about 100k right out of dental school, or about 120-130k as an associate with some experience or working in public health/community clinics- with slightly higher offers for rural locations. Public health had better benefits and better work hours and a set 9-5 sort of schedule with paid days off, all holidays etc. Medicaid in Texas pays higher for dental work so salaries are generally higher there. Private practice dentistry has the potentially for much higher returns but also a lot more risk. You can buy into a practice, taking on 200k-1 million of additional debt that you now have to service. We know several dentists that are making 170-250k per year in private practice just having started out. The difference? They work 60-80 hours a week 6-7 days per week and have minimal time for vacation. If they don’t work they don’t get paid. On an hourly basis, an employed public health position works out to be a similar $/hr proposition. The opportunity to make a lot of money comes from buying a poorly managed practice at a good price and then flipping it (I think of it as similar to a home remodel and house flipping). You can develop a good and efficient practice if you are a good business person and then sell for a healthy profit years later. This comes mainly from efficiencies in practice management and how good you are in business, not from dentistry itself. Additionally, you can take your developing business and employ associates that you pay a lower wage and those with several associates and multiple practice locations start to make very good livings into the 300k-600k or above with addition of various high profit procedures (implants, sedation dentistry, wisdom teeth extractions etc). However these people seem to have been killing themselves for years and are in their 40s-50s and have taken a lot of risk along the way. There are many more stories of failed practices, people who got burned out and went back to public clinics or associate work and just gave up and are unclear about what to do with their debt among our peer group. You would be far better served picking another career with a higher income to student debt ratio that would also afford better quality of life. My fiance certainly wishes she had gone the MD route at this point, or at least something outside of dentistry. 

Assuming that you are set on dentistry, I do have a few other suggestions to make things more manageable. First option is public service loan forgiveness, working at a nonprofit for 10 years while on a qualified repayment plan and your debt all goes away. Take this promise with a grain of salt. It’s an unsustainable program that I fully expect to get cut or adjusted in the coming years. The first qualifying applicants are due for forgiveness as of this month so watch the news closely to see if this is a program we can continue to rely on. My fiance is going this route and has about 5 years left. She was able to combine a separate program for loan repayment through NHSC or though Indian Health services and several states have their own programs that can essentially make your monthly payments while you are waiting for loan forgiveness. Essentially, once you are in one of these programs its almost like you “have no debt” since someone else has given you a grant to make the payments and you can then invest or live on your regular salary. It’ll just be a slightly lower salary than private practice, and 2-3x lower than what you could have received working for a tech company these days with a bachelors degree and a bit of experience accounting for stock grants etc. 10 years of commitment to a program that hasn’t been confirmed is a big gamble, but one of the best routes to take unless you want to move to Texas, work like crazy and live simply for 5 years to pay off the debt.

Alternatively, several of my fiance’s graduating class went into the military and seem to be very happy with that decision. It’s important to note that the best time to commit to this in terms of covering your loans is after you have been accepted to dental school but before you start. Apply early as they fill up too and then you are out of luck. Loan coverage and sign-on bonuses shrink dramatically if you are approaching the end of your training. You can then serve a 4 year commitment and it’s over pretty quickly, and most people we know have really enjoyed it. One of our friends did 2 years in Arizona and is now on the California coast and will be done this year with no debt remaining. Salary is even lower in the military (70-80k range for dentists?) but enough to live on, you can get a housing stipend or live on base and it’s not bad. If you have a partner who can go with you it can really be fun. We have another set of friends who are a couple and both dentists. They work at a military base in Japan and have been loving it with lots of time to enjoy the culture and a good jump off base for travel in East and SouthEast Asia. They are also now done with their commitment and loan free.  Hopefully that provides you with a bit more information. If you love dentistry then there are options, but just be very careful. You need to be good at business, take on lots of debt or have lots of family support and you need to work very hard for many years to get ahead. Chances are you could have put in a similar amount of work and have had a very successful non medically related business instead, but if you love doing dentistry then more power to you. Good luck!  Also keep in mind that all this advice is from an interested and invested future spouse of a dentist and not from someone who “made it to the top” with a successful business who is just killing it financially and loving their life in dentistry. We don’t know anyone like that, but I too would be curious to see the responses and see how they made it work and if they would recommend the career for applicants. 

Click to expand...

There's no such thing as a free lunch. If you are only willing to work 9-5 M-Fri without any extra legwork in any field you will not be the highest paid. 

 

I graduated w 250k at 6.8% debt, I moved to a LCOL area and worked like a 'resident' but made 'attending' salary. I worked 2 full time private practice jobs, 60 hours/week (which is still less than a medical resident as you know), 6 days/week for 3 years and fully paid off my entire loan balance while simultaneously paying off $100K of my husbands private medical school debt. After 3 years I now work a chill 30 hr/week schedule and still make a great living for only having gone to school for 8 years +1 year residency. 

I disagree that dentistry is hard to make money in. I think if you're willing to bust your ****************** like physicians are during residency then a dentist can do just as well. I don't like that so many new graduate dentists want to start living the good life without wanting to put in the effort to deserve it. You don't just graduate with an 8 year degree and start making 300K/yr, our counter part medical school graduates have to study 3-6 years longer than us to be getting to the point of making 300K/yr if they choose the right specialty (plus during those 3-6 years of residency they are worked like dogs). So I beg to differ with you; if you are willing to work hard in dentistry, it can be a VERY rewarding career - both financially and in terms of work/life balance! 

[RosieQ]

ddscook wrote:

RosieQ wrote:

I would advise that you be very careful. I’m an Emergency Medicine MD engaged to a general dentist and our financial lives are very different as a result of our respective career and education choices. I went to a public state school and got some good scholarships and was able to pay off all of my minimal debt during residency, and now have a job making over 300k per year working 15-16 shifts per month. Several of my peers with more debt have to worry about it more but still have a very viable path towards repayment that isn’t debilitating. On the other hand, my fiance went to a private school for her DDS, took on about 350k in student debt and has been on IBR ever since, with total debt now over 400k. She works a “regular schedule” 9-5 that you allude to but has been increasingly dissatisfied. Take this all with a caveat since it’s second hand, but we have talked about it quite a bit.

In general, I think that dentistry is a terrible financial decision overall unless you are very careful about how you are going to pay for it. Only veterinary medicine is worse when it comes to student debt as a relation to expected post graduation salary. Pharmacy seems more middle of the road for debt/income while MD still has a rather positive outlook for now if you go into various specialties and avoid primary care.  For dentistry, your 9-5 job and 6 figure income won’t amount to much if you are making huge debt payments and living on 40k per year after the rest is sucked into debt payments. Alternatively, you could do IBR/PAYE or other income driven refinancing and have a balanced life paying 10-15% of your extra income to debt for the next 20 years. Think about that from a taxation standpoint. Your marginal tax rate on 150k in income would be 28%+state (5-9%)+10% student loans+potential medicare taxes depending on spousal income=almost 50% of the income from your next shift going to taxes. Basically if you don’t work you don’t live “the good life” that you were planning on by going into dental school, and if you do your daily rate is cut in half and looks pretty paltry in comparison. Add to the fact that  the general tasks are very repetitive and wrist/elbow/shoulder and neck pain are incredibly common among dentists and it’s a tough career to recommend. 

How much can you make as a dentist? For us, her offers were generally about 100k right out of dental school, or about 120-130k as an associate with some experience or working in public health/community clinics- with slightly higher offers for rural locations. Public health had better benefits and better work hours and a set 9-5 sort of schedule with paid days off, all holidays etc. Medicaid in Texas pays higher for dental work so salaries are generally higher there. Private practice dentistry has the potentially for much higher returns but also a lot more risk. You can buy into a practice, taking on 200k-1 million of additional debt that you now have to service. We know several dentists that are making 170-250k per year in private practice just having started out. The difference? They work 60-80 hours a week 6-7 days per week and have minimal time for vacation. If they don’t work they don’t get paid. On an hourly basis, an employed public health position works out to be a similar $/hr proposition. The opportunity to make a lot of money comes from buying a poorly managed practice at a good price and then flipping it (I think of it as similar to a home remodel and house flipping). You can develop a good and efficient practice if you are a good business person and then sell for a healthy profit years later. This comes mainly from efficiencies in practice management and how good you are in business, not from dentistry itself. Additionally, you can take your developing business and employ associates that you pay a lower wage and those with several associates and multiple practice locations start to make very good livings into the 300k-600k or above with addition of various high profit procedures (implants, sedation dentistry, wisdom teeth extractions etc). However these people seem to have been killing themselves for years and are in their 40s-50s and have taken a lot of risk along the way. There are many more stories of failed practices, people who got burned out and went back to public clinics or associate work and just gave up and are unclear about what to do with their debt among our peer group. You would be far better served picking another career with a higher income to student debt ratio that would also afford better quality of life. My fiance certainly wishes she had gone the MD route at this point, or at least something outside of dentistry. 

Assuming that you are set on dentistry, I do have a few other suggestions to make things more manageable. First option is public service loan forgiveness, working at a nonprofit for 10 years while on a qualified repayment plan and your debt all goes away. Take this promise with a grain of salt. It’s an unsustainable program that I fully expect to get cut or adjusted in the coming years. The first qualifying applicants are due for forgiveness as of this month so watch the news closely to see if this is a program we can continue to rely on. My fiance is going this route and has about 5 years left. She was able to combine a separate program for loan repayment through NHSC or though Indian Health services and several states have their own programs that can essentially make your monthly payments while you are waiting for loan forgiveness. Essentially, once you are in one of these programs its almost like you “have no debt” since someone else has given you a grant to make the payments and you can then invest or live on your regular salary. It’ll just be a slightly lower salary than private practice, and 2-3x lower than what you could have received working for a tech company these days with a bachelors degree and a bit of experience accounting for stock grants etc. 10 years of commitment to a program that hasn’t been confirmed is a big gamble, but one of the best routes to take unless you want to move to Texas, work like crazy and live simply for 5 years to pay off the debt.

Alternatively, several of my fiance’s graduating class went into the military and seem to be very happy with that decision. It’s important to note that the best time to commit to this in terms of covering your loans is after you have been accepted to dental school but before you start. Apply early as they fill up too and then you are out of luck. Loan coverage and sign-on bonuses shrink dramatically if you are approaching the end of your training. You can then serve a 4 year commitment and it’s over pretty quickly, and most people we know have really enjoyed it. One of our friends did 2 years in Arizona and is now on the California coast and will be done this year with no debt remaining. Salary is even lower in the military (70-80k range for dentists?) but enough to live on, you can get a housing stipend or live on base and it’s not bad. If you have a partner who can go with you it can really be fun. We have another set of friends who are a couple and both dentists. They work at a military base in Japan and have been loving it with lots of time to enjoy the culture and a good jump off base for travel in East and SouthEast Asia. They are also now done with their commitment and loan free.  Hopefully that provides you with a bit more information. If you love dentistry then there are options, but just be very careful. You need to be good at business, take on lots of debt or have lots of family support and you need to work very hard for many years to get ahead. Chances are you could have put in a similar amount of work and have had a very successful non medically related business instead, but if you love doing dentistry then more power to you. Good luck!  Also keep in mind that all this advice is from an interested and invested future spouse of a dentist and not from someone who “made it to the top” with a successful business who is just killing it financially and loving their life in dentistry. We don’t know anyone like that, but I too would be curious to see the responses and see how they made it work and if they would recommend the career for applicants. 

Click to expand…

There’s no such thing as a free lunch. If you are only willing to work 9-5 M-Fri without any extra legwork in any field you will not be the highest paid. 

 

I graduated w 250k at 6.8% debt, I moved to a LCOL area and worked like a ‘resident’ but made ‘attending’ salary. I worked 2 full time private practice jobs, 60 hours/week (which is still less than a medical resident as you know), 6 days/week for 3 years and fully paid off my entire loan balance while simultaneously paying off $100K of my husbands private medical school debt. After 3 years I now work a chill 30 hr/week schedule and still make a great living for only having gone to school for 8 years +1 year residency. 

I disagree that dentistry is hard to make money in. I think if you’re willing to bust your ****************** like physicians are during residency then a dentist can do just as well. I don’t like that so many new graduate dentists want to start living the good life without wanting to put in the effort to deserve it. You don’t just graduate with an 8 year degree and start making 300K/yr, our counter part medical school graduates have to study 3-6 years longer than us to be getting to the point of making 300K/yr if they choose the right specialty (plus during those 3-6 years of residency they are worked like dogs). So I beg to differ with you; if you are willing to work hard in dentistry, it can be a VERY rewarding career – both financially and in terms of work/life balance! 

Click to expand...

I agree with this and feel like it's consistent with what I said above. You can totally do well in dentistry however there will be sacrifices involved with a lot of hard work for 3-5 years at a minimum, and I feel like contrary to medicine it requires that you make a series of sound business decisions and have a good feel for practice management rather than just being a good dentist on the patient care side. As you mentioned, moving to LCOL or higher need area is also super important and lead to less flexibility with regards to future income and practice location. The finances of setting up a new practice in San Francisco with a dentist every 2 blocks and sky high real estate costs are going to be very different than rural Texas. As an MD there are just fewer risks. You have to save and pay of med school debt, but your salary is all set up for you. As a dentist in private practice you usually have student debt and a big practice loan and a lot of multifactor work from keeping staff happy, advertising, stocking, patient management, fighting with insurance etc in addition to patient care and if you make it out the other side, pick up a few associates and then cut back you can be all set. It's not for everyone, so I just urge caution before jumping in. I don't think most dental school applicants these days have a clear idea of what they're getting into. 

[q-school]

RosieQ wrote:

ddscook wrote:

RosieQ wrote:

I would advise that you be very careful. I’m an Emergency Medicine MD engaged to a general dentist and our financial lives are very different as a result of our respective career and education choices. I went to a public state school and got some good scholarships and was able to pay off all of my minimal debt during residency, and now have a job making over 300k per year working 15-16 shifts per month. Several of my peers with more debt have to worry about it more but still have a very viable path towards repayment that isn’t debilitating. On the other hand, my fiance went to a private school for her DDS, took on about 350k in student debt and has been on IBR ever since, with total debt now over 400k. She works a “regular schedule” 9-5 that you allude to but has been increasingly dissatisfied. Take this all with a caveat since it’s second hand, but we have talked about it quite a bit.

In general, I think that dentistry is a terrible financial decision overall unless you are very careful about how you are going to pay for it. Only veterinary medicine is worse when it comes to student debt as a relation to expected post graduation salary. Pharmacy seems more middle of the road for debt/income while MD still has a rather positive outlook for now if you go into various specialties and avoid primary care.  For dentistry, your 9-5 job and 6 figure income won’t amount to much if you are making huge debt payments and living on 40k per year after the rest is sucked into debt payments. Alternatively, you could do IBR/PAYE or other income driven refinancing and have a balanced life paying 10-15% of your extra income to debt for the next 20 years. Think about that from a taxation standpoint. Your marginal tax rate on 150k in income would be 28%+state (5-9%)+10% student loans+potential medicare taxes depending on spousal income=almost 50% of the income from your next shift going to taxes. Basically if you don’t work you don’t live “the good life” that you were planning on by going into dental school, and if you do your daily rate is cut in half and looks pretty paltry in comparison. Add to the fact that  the general tasks are very repetitive and wrist/elbow/shoulder and neck pain are incredibly common among dentists and it’s a tough career to recommend. 

How much can you make as a dentist? For us, her offers were generally about 100k right out of dental school, or about 120-130k as an associate with some experience or working in public health/community clinics- with slightly higher offers for rural locations. Public health had better benefits and better work hours and a set 9-5 sort of schedule with paid days off, all holidays etc. Medicaid in Texas pays higher for dental work so salaries are generally higher there. Private practice dentistry has the potentially for much higher returns but also a lot more risk. You can buy into a practice, taking on 200k-1 million of additional debt that you now have to service. We know several dentists that are making 170-250k per year in private practice just having started out. The difference? They work 60-80 hours a week 6-7 days per week and have minimal time for vacation. If they don’t work they don’t get paid. On an hourly basis, an employed public health position works out to be a similar $/hr proposition. The opportunity to make a lot of money comes from buying a poorly managed practice at a good price and then flipping it (I think of it as similar to a home remodel and house flipping). You can develop a good and efficient practice if you are a good business person and then sell for a healthy profit years later. This comes mainly from efficiencies in practice management and how good you are in business, not from dentistry itself. Additionally, you can take your developing business and employ associates that you pay a lower wage and those with several associates and multiple practice locations start to make very good livings into the 300k-600k or above with addition of various high profit procedures (implants, sedation dentistry, wisdom teeth extractions etc). However these people seem to have been killing themselves for years and are in their 40s-50s and have taken a lot of risk along the way. There are many more stories of failed practices, people who got burned out and went back to public clinics or associate work and just gave up and are unclear about what to do with their debt among our peer group. You would be far better served picking another career with a higher income to student debt ratio that would also afford better quality of life. My fiance certainly wishes she had gone the MD route at this point, or at least something outside of dentistry. 

Assuming that you are set on dentistry, I do have a few other suggestions to make things more manageable. First option is public service loan forgiveness, working at a nonprofit for 10 years while on a qualified repayment plan and your debt all goes away. Take this promise with a grain of salt. It’s an unsustainable program that I fully expect to get cut or adjusted in the coming years. The first qualifying applicants are due for forgiveness as of this month so watch the news closely to see if this is a program we can continue to rely on. My fiance is going this route and has about 5 years left. She was able to combine a separate program for loan repayment through NHSC or though Indian Health services and several states have their own programs that can essentially make your monthly payments while you are waiting for loan forgiveness. Essentially, once you are in one of these programs its almost like you “have no debt” since someone else has given you a grant to make the payments and you can then invest or live on your regular salary. It’ll just be a slightly lower salary than private practice, and 2-3x lower than what you could have received working for a tech company these days with a bachelors degree and a bit of experience accounting for stock grants etc. 10 years of commitment to a program that hasn’t been confirmed is a big gamble, but one of the best routes to take unless you want to move to Texas, work like crazy and live simply for 5 years to pay off the debt.

Alternatively, several of my fiance’s graduating class went into the military and seem to be very happy with that decision. It’s important to note that the best time to commit to this in terms of covering your loans is after you have been accepted to dental school but before you start. Apply early as they fill up too and then you are out of luck. Loan coverage and sign-on bonuses shrink dramatically if you are approaching the end of your training. You can then serve a 4 year commitment and it’s over pretty quickly, and most people we know have really enjoyed it. One of our friends did 2 years in Arizona and is now on the California coast and will be done this year with no debt remaining. Salary is even lower in the military (70-80k range for dentists?) but enough to live on, you can get a housing stipend or live on base and it’s not bad. If you have a partner who can go with you it can really be fun. We have another set of friends who are a couple and both dentists. They work at a military base in Japan and have been loving it with lots of time to enjoy the culture and a good jump off base for travel in East and SouthEast Asia. They are also now done with their commitment and loan free.  Hopefully that provides you with a bit more information. If you love dentistry then there are options, but just be very careful. You need to be good at business, take on lots of debt or have lots of family support and you need to work very hard for many years to get ahead. Chances are you could have put in a similar amount of work and have had a very successful non medically related business instead, but if you love doing dentistry then more power to you. Good luck!  Also keep in mind that all this advice is from an interested and invested future spouse of a dentist and not from someone who “made it to the top” with a successful business who is just killing it financially and loving their life in dentistry. We don’t know anyone like that, but I too would be curious to see the responses and see how they made it work and if they would recommend the career for applicants. 

Click to expand…

There’s no such thing as a free lunch. If you are only willing to work 9-5 M-Fri without any extra legwork in any field you will not be the highest paid. 

 

I graduated w 250k at 6.8% debt, I moved to a LCOL area and worked like a ‘resident’ but made ‘attending’ salary. I worked 2 full time private practice jobs, 60 hours/week (which is still less than a medical resident as you know), 6 days/week for 3 years and fully paid off my entire loan balance while simultaneously paying off $100K of my husbands private medical school debt. After 3 years I now work a chill 30 hr/week schedule and still make a great living for only having gone to school for 8 years +1 year residency. 

I disagree that dentistry is hard to make money in. I think if you’re willing to bust your ****************** like physicians are during residency then a dentist can do just as well. I don’t like that so many new graduate dentists want to start living the good life without wanting to put in the effort to deserve it. You don’t just graduate with an 8 year degree and start making 300K/yr, our counter part medical school graduates have to study 3-6 years longer than us to be getting to the point of making 300K/yr if they choose the right specialty (plus during those 3-6 years of residency they are worked like dogs). So I beg to differ with you; if you are willing to work hard in dentistry, it can be a VERY rewarding career – both financially and in terms of work/life balance! 

Click to expand…

I agree with this and feel like it’s consistent with what I said above. You can totally do well in dentistry however there will be sacrifices involved with a lot of hard work for 3-5 years at a minimum, and I feel like contrary to medicine it requires that you make a series of sound business decisions and have a good feel for practice management rather than just being a good dentist on the patient care side. As you mentioned, moving to LCOL or higher need area is also super important and lead to less flexibility with regards to future income and practice location. The finances of setting up a new practice in San Francisco with a dentist every 2 blocks and sky high real estate costs are going to be very different than rural Texas. As an MD there are just fewer risks. You have to save and pay of med school debt, but your salary is all set up for you. As a dentist in private practice you usually have student debt and a big practice loan and a lot of multifactor work from keeping staff happy, advertising, stocking, patient management, fighting with insurance etc in addition to patient care and if you make it out the other side, pick up a few associates and then cut back you can be all set. It’s not for everyone, so I just urge caution before jumping in. I don’t think most dental school applicants these days have a clear idea of what they’re getting into. 

Click to expand...

possibly fewer risks depending on specialty and location, but certainly longer training period for average physician versus dentist.  is there is bimodal distribution of incomes rather than a normal distribution?  it sure seems like a lot of dentists here are doing pretty well.  and congrats to them.

 

 

[MrsIMDoc]

I am a woman physician married to a dentist.  I think it is much harder for a woman in dentistry compared to being a woman physician.  Try taking a maternity leave while you are a dentist owner, that sounds like a disaster.  As a physician you can find jobs that are part time and that allow you to take a maternity leave.  Furthermore the income as a primary care physician is still in general higher then a non-owner dentist (associate or community health). 

 

[triad]

I like the autonomy of being my own boss and not having to answer to administration.  I choose the schedule that works for me (I'm a night owl and most of my days start after noon).  I agree with above posters that it is riskier then medicine and at student debt levels over 300k I don't think its the best choice.

[grennelln]

triad wrote:

I like the autonomy of being my own boss and not having to answer to administration.  I choose the schedule that works for me (I’m a night owl and most of my days start after noon).  I agree with above posters that it is riskier then medicine and at student debt levels over 300k I don’t think its the best choice.

Click to expand...

This has always been the biggest draw to dentistry for me. I was 50/50 split on medicine and dentistry because I love the work in both careers and see the significance in both, but the opportunity for autonomy and to be my own boss, so to speak, sort of tipped the scale at dentistry.  Thank you for your suggestion. I am currently considering my options, and I will think long and hard before accepting this much money for any career. I may take the MCAT during my current approaching gap semester to have it in my back pocket in case I decide to make the switch. Thanks again

[grennelln]

ddscook wrote:

RosieQ wrote:

I would advise that you be very careful. I’m an Emergency Medicine MD engaged to a general dentist and our financial lives are very different as a result of our respective career and education choices. I went to a public state school and got some good scholarships and was able to pay off all of my minimal debt during residency, and now have a job making over 300k per year working 15-16 shifts per month. Several of my peers with more debt have to worry about it more but still have a very viable path towards repayment that isn’t debilitating. On the other hand, my fiance went to a private school for her DDS, took on about 350k in student debt and has been on IBR ever since, with total debt now over 400k. She works a “regular schedule” 9-5 that you allude to but has been increasingly dissatisfied. Take this all with a caveat since it’s second hand, but we have talked about it quite a bit.

In general, I think that dentistry is a terrible financial decision overall unless you are very careful about how you are going to pay for it. Only veterinary medicine is worse when it comes to student debt as a relation to expected post graduation salary. Pharmacy seems more middle of the road for debt/income while MD still has a rather positive outlook for now if you go into various specialties and avoid primary care.  For dentistry, your 9-5 job and 6 figure income won’t amount to much if you are making huge debt payments and living on 40k per year after the rest is sucked into debt payments. Alternatively, you could do IBR/PAYE or other income driven refinancing and have a balanced life paying 10-15% of your extra income to debt for the next 20 years. Think about that from a taxation standpoint. Your marginal tax rate on 150k in income would be 28%+state (5-9%)+10% student loans+potential medicare taxes depending on spousal income=almost 50% of the income from your next shift going to taxes. Basically if you don’t work you don’t live “the good life” that you were planning on by going into dental school, and if you do your daily rate is cut in half and looks pretty paltry in comparison. Add to the fact that  the general tasks are very repetitive and wrist/elbow/shoulder and neck pain are incredibly common among dentists and it’s a tough career to recommend. 

How much can you make as a dentist? For us, her offers were generally about 100k right out of dental school, or about 120-130k as an associate with some experience or working in public health/community clinics- with slightly higher offers for rural locations. Public health had better benefits and better work hours and a set 9-5 sort of schedule with paid days off, all holidays etc. Medicaid in Texas pays higher for dental work so salaries are generally higher there. Private practice dentistry has the potentially for much higher returns but also a lot more risk. You can buy into a practice, taking on 200k-1 million of additional debt that you now have to service. We know several dentists that are making 170-250k per year in private practice just having started out. The difference? They work 60-80 hours a week 6-7 days per week and have minimal time for vacation. If they don’t work they don’t get paid. On an hourly basis, an employed public health position works out to be a similar $/hr proposition. The opportunity to make a lot of money comes from buying a poorly managed practice at a good price and then flipping it (I think of it as similar to a home remodel and house flipping). You can develop a good and efficient practice if you are a good business person and then sell for a healthy profit years later. This comes mainly from efficiencies in practice management and how good you are in business, not from dentistry itself. Additionally, you can take your developing business and employ associates that you pay a lower wage and those with several associates and multiple practice locations start to make very good livings into the 300k-600k or above with addition of various high profit procedures (implants, sedation dentistry, wisdom teeth extractions etc). However these people seem to have been killing themselves for years and are in their 40s-50s and have taken a lot of risk along the way. There are many more stories of failed practices, people who got burned out and went back to public clinics or associate work and just gave up and are unclear about what to do with their debt among our peer group. You would be far better served picking another career with a higher income to student debt ratio that would also afford better quality of life. My fiance certainly wishes she had gone the MD route at this point, or at least something outside of dentistry. 

Assuming that you are set on dentistry, I do have a few other suggestions to make things more manageable. First option is public service loan forgiveness, working at a nonprofit for 10 years while on a qualified repayment plan and your debt all goes away. Take this promise with a grain of salt. It’s an unsustainable program that I fully expect to get cut or adjusted in the coming years. The first qualifying applicants are due for forgiveness as of this month so watch the news closely to see if this is a program we can continue to rely on. My fiance is going this route and has about 5 years left. She was able to combine a separate program for loan repayment through NHSC or though Indian Health services and several states have their own programs that can essentially make your monthly payments while you are waiting for loan forgiveness. Essentially, once you are in one of these programs its almost like you “have no debt” since someone else has given you a grant to make the payments and you can then invest or live on your regular salary. It’ll just be a slightly lower salary than private practice, and 2-3x lower than what you could have received working for a tech company these days with a bachelors degree and a bit of experience accounting for stock grants etc. 10 years of commitment to a program that hasn’t been confirmed is a big gamble, but one of the best routes to take unless you want to move to Texas, work like crazy and live simply for 5 years to pay off the debt.

Alternatively, several of my fiance’s graduating class went into the military and seem to be very happy with that decision. It’s important to note that the best time to commit to this in terms of covering your loans is after you have been accepted to dental school but before you start. Apply early as they fill up too and then you are out of luck. Loan coverage and sign-on bonuses shrink dramatically if you are approaching the end of your training. You can then serve a 4 year commitment and it’s over pretty quickly, and most people we know have really enjoyed it. One of our friends did 2 years in Arizona and is now on the California coast and will be done this year with no debt remaining. Salary is even lower in the military (70-80k range for dentists?) but enough to live on, you can get a housing stipend or live on base and it’s not bad. If you have a partner who can go with you it can really be fun. We have another set of friends who are a couple and both dentists. They work at a military base in Japan and have been loving it with lots of time to enjoy the culture and a good jump off base for travel in East and SouthEast Asia. They are also now done with their commitment and loan free.  Hopefully that provides you with a bit more information. If you love dentistry then there are options, but just be very careful. You need to be good at business, take on lots of debt or have lots of family support and you need to work very hard for many years to get ahead. Chances are you could have put in a similar amount of work and have had a very successful non medically related business instead, but if you love doing dentistry then more power to you. Good luck!  Also keep in mind that all this advice is from an interested and invested future spouse of a dentist and not from someone who “made it to the top” with a successful business who is just killing it financially and loving their life in dentistry. We don’t know anyone like that, but I too would be curious to see the responses and see how they made it work and if they would recommend the career for applicants. 

Click to expand…

There’s no such thing as a free lunch. If you are only willing to work 9-5 M-Fri without any extra legwork in any field you will not be the highest paid. 

 

I graduated w 250k at 6.8% debt, I moved to a LCOL area and worked like a ‘resident’ but made ‘attending’ salary. I worked 2 full time private practice jobs, 60 hours/week (which is still less than a medical resident as you know), 6 days/week for 3 years and fully paid off my entire loan balance while simultaneously paying off $100K of my husbands private medical school debt. After 3 years I now work a chill 30 hr/week schedule and still make a great living for only having gone to school for 8 years +1 year residency. 

I disagree that dentistry is hard to make money in. I think if you’re willing to bust your ****************** like physicians are during residency then a dentist can do just as well. I don’t like that so many new graduate dentists want to start living the good life without wanting to put in the effort to deserve it. You don’t just graduate with an 8 year degree and start making 300K/yr, our counter part medical school graduates have to study 3-6 years longer than us to be getting to the point of making 300K/yr if they choose the right specialty (plus during those 3-6 years of residency they are worked like dogs). So I beg to differ with you; if you are willing to work hard in dentistry, it can be a VERY rewarding career – both financially and in terms of work/life balance! 

Click to expand...

These are all excellent perspectives. Thank you so much for taking the time to write the long replies. To hear the perspective of a MD future spouse watching from the outside is incredibly interesting and something I have not heard before, so thanks RosieQ.

Ddscook, congratulations on getting out of that much debt so quickly! Your story is an inspiration to me, and something I will aspire towards once I get to that point. 

 

[Molar Mechanic]

Edited due to oversharing.  Sorry.

[Practice]

<p>I would advise that you be very careful. I'm an Emergency Medicine MD engaged to a general dentist and our financial lives are very different as a result of our respective career and education choices. I went to a public state school and got some good scholarships and was able to pay off all of my minimal debt during residency, and now have a job making over 300k per year working 15-16 shifts per month. Several of my peers with more debt have to worry about it more but still have a very viable path towards repayment that isn't debilitating. On the other hand, my fiance went to a private school for her DDS, took on about 350k in student debt and has been on IBR ever since, with total debt now over 400k. She works a "regular schedule" 9-5 that you allude to but has been increasingly dissatisfied. Take this all with a caveat since it's second hand, but we have talked about it quite a bit.</p>
<p>In general, I think that dentistry is a terrible financial decision overall unless you are very careful about how you are going to pay for it. Only veterinary medicine is worse when it comes to student debt as a relation to expected post graduation salary. Pharmacy seems more middle of the road for debt/income while MD still has a rather positive outlook for now if you go into various specialties and avoid primary care. For dentistry, your 9-5 job and 6 figure income won't amount to much if you are making huge debt payments and living on 40k per year after the rest is sucked into debt payments. Alternatively, you could do IBR/PAYE or other income driven refinancing and have a balanced life paying 10-15% of your extra income to debt for the next 20 years. Think about that from a taxation standpoint. Your marginal tax rate on 150k in income would be 28%+state (5-9%)+10% student loans+potential medicare taxes depending on spousal income=almost 50% of the income from your next shift going to taxes. Basically if you don't work you don't live "the good life" that you were planning on by going into dental school, and if you do your daily rate is cut in half and looks pretty paltry in comparison. Add to the fact that the general tasks are very repetitive and wrist/elbow/shoulder and neck pain are incredibly common among dentists and it's a tough career to recommend. </p>
<p>How much can you make as a dentist? For us, her offers were generally about 100k right out of dental school, or about 120-130k as an associate with some experience or working in public health/community clinics- with slightly higher offers for rural locations. Public health had better benefits and better work hours and a set 9-5 sort of schedule with paid days off, all holidays etc. Medicaid in Texas pays higher for dental work so salaries are generally higher there. Private practice dentistry has the potentially for much higher returns but also a lot more risk. You can buy into a practice, taking on 200k-1 million of additional debt that you now have to service. We know several dentists that are making 170-250k per year in private practice just having started out. The difference? They work 60-80 hours a week 6-7 days per week and have minimal time for vacation. If they don't work they don't get paid. On an hourly basis, an employed public health position works out to be a similar $/hr proposition. The opportunity to make a lot of money comes from buying a poorly managed practice at a good price and then flipping it (I think of it as similar to a home remodel and house flipping). You can develop a good and efficient practice if you are a good business person and then sell for a healthy profit years later. This comes mainly from efficiencies in practice management and how good you are in business, not from dentistry itself. Additionally, you can take your developing business and employ associates that you pay a lower wage and those with several associates and multiple practice locations start to make very good livings into the 300k-600k or above with addition of various high profit procedures (implants, sedation dentistry, wisdom teeth extractions etc). However these people seem to have been killing themselves for years and are in their 40s-50s and have taken a lot of risk along the way. There are many more stories of failed practices, people who got burned out and went back to public clinics or associate work and just gave up and are unclear about what to do with their debt among our peer group. You would be far better served picking another career with a higher income to student debt ratio that would also afford better quality of life. My fiance certainly wishes she had gone the MD route at this point, or at least something outside of dentistry. </p>
<p>Assuming that you are set on dentistry, I do have a few other suggestions to make things more manageable. First option is public service loan forgiveness, working at a nonprofit for 10 years while on a qualified repayment plan and your debt all goes away. Take this promise with a grain of salt. It's an unsustainable program that I fully expect to get cut or adjusted in the coming years. The first qualifying applicants are due for forgiveness as of this month so watch the news closely to see if this is a program we can continue to rely on. My fiance is going this route and has about 5 years left. She was able to combine a separate program for loan repayment through Digital Dentistry At Southpoint or though Indian Health services and several states have their own programs that can essentially make your monthly payments while you are waiting for loan forgiveness. Essentially, once you are in one of these programs its almost like you "have no debt" since someone else has given you a grant to make the payments and you can then invest or live on your regular salary. It'll just be a slightly lower salary than private practice, and 2-3x lower than what you could have received working for a tech company these days with a bachelors degree and a bit of experience accounting for stock grants etc. 10 years of commitment to a program that hasn't been confirmed is a big gamble, but one of the best routes to take unless you want to move to Texas, work like crazy and live simply for 5 years to pay off the debt.</p>
<p>Alternatively, several of my fiance's graduating class went into the military and seem to be very happy with that decision. It's important to note that the best time to commit to this in terms of covering your loans is after you have been accepted to dental school but before you start. Apply early as they fill up too and then you are out of luck. Loan coverage and sign-on bonuses shrink dramatically if you are approaching the end of your training. You can then serve a 4 year commitment and it's over pretty quickly, and most people we know have really enjoyed it. One of our friends did 2 years in Arizona and is now on the California coast and will be done this year with no debt remaining. Salary is even lower in the military (70-80k range for dentists?) but enough to live on, you can get a housing stipend or live on base and it's not bad. If you have a partner who can go with you it can really be fun. We have another set of friends who are a couple and both dentists. They work at a military base in Japan and have been loving it with lots of time to enjoy the culture and a good jump off base for travel in East and SouthEast Asia. They are also now done with their commitment and loan free. Hopefully that provides you with a bit more information. If you love dentistry then there are options, but just be very careful. You need to be good at business, take on lots of debt or have lots of family support and you need to work very hard for many years to get ahead. Chances are you could have put in a similar amount of work and have had a very successful non medically related business instead, but if you love doing dentistry then more power to you. Good luck! Also keep in mind that all this advice is from an interested and invested future spouse of a dentist and not from someone who "made it to the top" with a successful business who is just killing it financially and loving their life in dentistry. We don't know anyone like that, but I too would be curious to see the responses and see how they made it work and if they would recommend the career for applicants. </p>

Really though out post with some great advice. I really like your ideal of buying a poorly managed private practice and flipping it. I always like to find a value and beaten down assets. With a dentistry practice, you'd probably have to rebrand. It's a bit unconventional idea to do this "flip", but the conventional was is no good alternative either. Seems the way to go would be to get through schooling with as little debt as possible, then spend working wherever you can until you find this and under valued practice for sale, and rebrand it. And then get good at marketing to grow it, then sell it. You'll have to work your butt off, but it could be worth it financially.