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Navigating the Current Economic Landscape for New Endodontists

By Dr. Albert (Ace) Goerig

There is no other way to begin an economics article for residents and new endodontists except to acknowledge the mountain of debt you have. I am certain it dominates your thinking: “How am I going to make a decent living and pay back my debt?” and “How long am I going to live with debt hanging over my head?”

The answer to those questions largely depends on the decisions you make early in your career. The problem is that today’s economic landscape makes those decisions more complicated than ever, and the temptation is to focus on your debt concerns at the expense of future opportunities.

A Revealing Conversation

The long-term effect of a short-term decision is best illustrated in a conversation I recently had with a colleague who is also a coaching client. Originally, for debt and financial reasons, he took an associate position for a corporate group. In his case, it was a general dentistry group, and he was the “in-house” endodontist. It was an easy path into endodontics and came with a built-in group of referrers.

But there were some trade-offs … some that were immediately apparent and some that were revealed over time. The immediate trade-offs were that he traveled between various GP offices, which meant he generally did not have access to CBCT, and he had to carry his microscope with him. He also had to work with a variety of dental assistants in all these offices, none of whom were specifically trained to support an endodontist. He never really had enough extended time with any of them to fully train them himself. Of course, associates in endo practices don’t necessarily face these same challenges.

After that, the trade-offs that were revealed over time had more to do with being an associate/employee. He didn’t have control over his schedule, and he needed to give 3 months’ notice to take any time off (a familiar requirement for most employees in any business). Also, because he wasn’t a partner/owner in the group, he didn’t have any “clout” with respect to changes in office policies, staffing, or investments in better technology, etc. He could make requests or recommendations, but he didn’t have a say in the final decision.

So, it may have been a convenient way to begin earning an income, but over time it was a less than ideal environment to practice endodontics. Ultimately, he came to the understanding that his future in endodontics was in the hands of others, and gradually their business approach and his goals were diverging. They didn’t have the ability to be flexible with him for more opportunities, better lifestyle and success on terms that were becoming more important to him each year. Even though he felt compensated fairly, he also wanted a different future that could only be provided by practice ownership and the benefits of ownership. Today, after making the leap, he’s enjoying incredible financial and lifestyle success as an independent practice owner.

Debt and Professional Choices

It’s easy to say my client should have started out as a practice owner, but life is not that simple. The typical endodontic graduate with the average school debt does not qualify for a loan of the amount needed to buy an average endodontic practice. So that narrows the field of options to starting a new practice, buying a very small practice, or working as an associate (at least to pay down your debt).

Starting a new practice or buying a small practice are the lowest cost entries into practice ownership, but they come with the lowest income at the beginning. That can appear like a big risk compared to your debt load. However, it can be quite quick to grow those practices as a new owner if you get the right advice and coaching from the start and avoid missteps that suppress profitability and prolong your debt.

Bad News, Good News and Associate Options

The bad news is that the cost of borrowing money to start a practice or buy one is going up. Inflation is following a post-pandemic surge, and that’s prompting the federal reserve to hike interest rates. Your ability to finance practice ownership is being further squeezed, so there is even more pressure to earn income quickly and reduce your debt load. That means pursuing an associateship.

When it comes to associate opportunities, there is good news. There is an abundance of opportunities. Endodontists are in high demand in independent practices, corporate practices and GP groups like I mentioned in the story above. Recently, quick scan on the job site indeed.com showed almost 200 available full-time endodontist positions. Even among my coaching clients, we currently have almost two dozen associate opportunities in really great independent practices.

Your goal is to select an associate opportunity that meets your current needs and allows you to be very successful as an associate. Keep in mind that not all associateships are the same. You can easily earn twice as much in some practices than others (even working fewer days). Here’s some tips on what to focus on:

  • Decide where you want to live. Once you’re settled and earning income, it’s a lot harder to move your life. Make sure any associate position you accept does not prevent you from opening your own practice in your desired community, if that is your long-term goal.
  • Evaluate the quality and success of the current practice. If there is a highly productive owner doctor ($1.5M or more in annual revenues and completing six-plus cases per day), then it’s a sign of a practice focused on efficiency and growth. That’s exactly what you want … a practice with a broad-based referral network capable of getting you as productive as the owner doctor as soon as possible.
  • Look at the fee schedule and insurance participation of a practice. Since you will be paid based on a percentage of collections, you are going to make a lot more in a practice where the fees are $1,200 or more per root canal than one where the fees are $800 per root canal.
  • Consider the number of days per week and per year that you will work. Even though you are young and ready to work, endodontics is a demanding profession, and you need time off and a lifestyle, too.

Where to Get Help

Finally, take advantage of resources available to you to help you get started right:

As much as you may feel some uncertainty about today’s financial situation, I promise that you are beginning in an incredible profession. In a very short time period, you can be debt-free and on your path to amazing lifelong success.

Dr. Albert Goerig is a Diplomate of the American Board of Endodontics and a speaker who has lectured extensively in the field of endodontics and practice success throughout the United States, Canada, and abroad. He is the author of over 100 published articles and a contributing author to numerous endodontic textbooks. Dr. Goerig has a private endodontic practice in Olympia, Wash. He can be reached at info@endomastery.com or 1-800-482-7563.