By Dr. Tyler Scott, WCI Columnist
It is both incredibly surreal and profoundly humbling to be writing this article.
When I began reading The White Coat Investor almost 10 years ago, I never could have imagined the scope or magnitude of its impact in my world. An impact not only on my finances but on nearly every corner of my ever-changing life. My jobs, my careers, my wife’s career, where I live, and especially how I live have all been directly and positively influenced by the guidance I have found here. That influence has come from Dr. Jim Dahle and from all of you who comment, post, and contribute across the WCI network. You have collectively made my life better, and I am deeply thankful.
Today, I am grateful and honored to share with you the beginning of my constantly evolving professional and financial story. I don’t expect widespread acceptance of my choices or my perspectives, and I don’t intend to convince anyone of them. Rather, my hope with this post and all future posts is to make a contribution to the accumulated wisdom, levity, and collegiality of this community that has been so useful to me.
With that preamble in place, I now offer the meandering story of my dental career and a few possible lessons learned along the way.
Applying to Dental School Without a Worry About Student Loans
When I began seeking out a dental school spot in the summer of 2007, I was desperately hoping to get into any of the 13 schools where I applied—with the goal of returning to the suburbs of Salt Lake City in 2012 to buy a private practice as a newly minted general dentist.
I gave no thought to the cost of my education since every dentist I knew had given me the same advice regarding student loans: “Just worry about getting in, doing well, and the rest will take care of itself.” I naively and enthusiastically agreed. All that mattered was getting in and then, after four years of training, I would come home to take my rightful place in the pantheon of rich dentists on the east bench of the Salt Lake valley.
Fast forward two years to the end of my first year of dental school at Oregon Health & Science University. My elation and pride at becoming one of the few people in my extended family to graduate college—and the first to attend a post-baccalaureate program—had faded, and mild anxiety about my economic future had begun to build.
I had been in training for less than a year and had already taken out $55,000 in loans just to cover tuition. My wife had secured a good job that was paying our living expenses in Portland, but a change in tort law in Oregon had (allegedly) been the cause of significant increases in tuition. Tuition costs that had been projected to be $40,000 for my first year and $180,000 total when I chose OHSU had quickly become almost $60,000 for the first year and $280,000 for all four.
I knew I was going to be a rich dentist with a 4,800-square-foot house and a boat in no time but still . . . $280,000 felt like a lot.
I started asking the dentists back home how long it took them to pay off $280,000 of debt at 6.9% interest. The looks on their faces when I asked this question were as stupefying as their responses:
“Well . . . ummmmm . . . you see son, I graduated a few years back when things were a little different. My schooling cost about $60,000 total. My parents paid for a good chunk of that, and I borrowed the other $35,000 at 1%. I’m still paying it off; it’s just a couple hundred dollars a month.”
With a resource-scarce elementary school teacher for a mom and a Pakistani immigrant drywall hanger for a dad, I was rich in emotional support. Sadly, the Department of Education accepts neither multicultural parental pride nor unfettered borrower negligence as payment.
Temporarily panicked, I settled my nerves by turning my attention away from debt and toward income. I thought, “This is OK, no problem, if I’m going to owe this much, I just need to start doing the leg work to find a really good-paying job.” Prior to this moment, I had never thought to ask what it costs to buy a dental practice in the suburbs of Salt Lake. My temporary panic adopted some level of permanence when I met with a practice broker who showed me a listing of current practices for sale in my area that ranged from $700,000–$1.2 million.
Combine this with some casual home shopping my wife had done—a few favorites ranged from $400,000–$800,000 (a bargain by today’s comparison)—and suddenly the reality of my dreams came into acute clarity. With a projected first-year income of $150,000–$200,000 in the intensely oversaturated dental market of northern Utah and a looming combined debt of $1.4 million–$2.3 million, even my financially ignorant mind came to an inescapable conclusion.
This is not going to work.
More information here:
Freedom from Student Loan Debt: A Dentist’s Story
Maybe Joining the Military Is an Option (It Was Not)
With Plan 1.0 (move back to Salt Lake City and be joyfully rich) off the table, I shifted gears to Plan 2.0—temporarily move almost anywhere and be contentedly middle class. Step 1 of that plan was to buy myself an emotional support chalupa at Taco Bell and eat slowly while I figured out how to break this news: first to myself and then to my wife. Step 2 of that plan was to get someone else to pay for the rest of dental school.
One of my classmates was in the military. His school was paid for with the HPSP scholarship, and he also received a $20,000 signing bonus, a monthly stipend, and officer pay during school breaks. Perfect!
I did some research and found out that the Army is terrible with lots of open spots, the Air Force is awesome with zero open spots, and the Navy is tolerable with a few open spots. A bunch of paperwork, a trip to San Diego’s naval and Marine bases, a very weird day at something called MEPS (Military Entrance Processing Station), and several interviews later, I was told by my recruiter that I was approved for a three-year Navy scholarship. The Navy would pay for my last three years of school, and I would be a Navy dentist for three years after graduation.
Plan 2.0 was off to a great start.
Then, one day while I was in removable prosthodontics lab making dentures, the dean of admissions got me out of the lab, saying there were some “visitors from the Navy” that wanted to see me. Thinking I was getting some kind of welcome-to-the-club visit and leaving with a logo-emblazoned water bottle, I instead received an hour-long interrogation from the NCIS. Then, my scholarship was rescinded.
Apparently, I didn’t have satisfactory answers to why my dad lived in Abbottabad in northern Pakistan for so many years, who he lived with, who his associates were, and where those associates were now.
I was devastated.
It wasn’t until two years later when President Obama came on TV to tell the world that Osama bin Laden had been located and killed in Abbottabad that I understood why I had been catechized so intensely that day and why the US government didn’t want me on its battleships. In fact, when bin Laden’s compound was shown on the news, my dad called and said, “Hey, I know that place. I used to play cricket and chase goats over there.”
To be clear, my dad is not associated with Al-Qaeda. He’s mostly associated with gin martinis, vinyl records, and Monday Night Football, but alas, I was back to square one.
While confused and disappointed, I was undeterred in my pursuit of finding someone to pay for my exorbitant tuition. Instead of the military, I turned toward the National Health Service Corps (NHSC), a division of the federal government that offers a scholarship analogous to the one I had with the Navy. The NHSC would pay for my remaining training and provide a monthly stipend in exchange for a 1:1 service year payback. The catch is that the service payback had to be at a Federally Qualified Health Center (FQHC), which is almost always located in very rural areas or low-income urban areas. (You may recall that these were both very different than the Salt Lake suburb life I had imagined for myself.) This is because FQHCs are built and funded with the purpose of providing care to uninsured, undocumented, and/or working-poor patients who are unable to access care through the more traditional and familiar American healthcare system.
This became plan 2.1: temporarily move almost anywhere and be contentedly middle class but on the NHSC scholarship plan.
I applied, and I was denied.
I found out later that the NHSC scholarship was incredibly competitive, and scholarships were preferentially awarded to applicants from minority or otherwise marginalized groups. While my dad is from Pakistan and I was raised in a highly-gentrified area of Salt Lake, my lived experience is one of a tall, white, straight, upper-to-middle class, Christian, privileged man, and hence I was not offered the scholarship (correctly so, in my opinion).
So, at this point, things weren’t exactly going according to plan. To be fair, I entered dental school without any plan, and I was getting exactly what I planned for . . . nothing. The old saying, “If you fail to plan, you plan to fail” was certainly proving true in my case.
The one glimmer of hope I had left was something I learned about in my NHSC application process. The NHSC offers a scholarship I couldn't get, but it also had a loan repayment program. At that time, if I worked for an FQHC with an HPSA (Health Professional Shortage Area) score of 18 or higher, I would receive $60,000 of tax-free student loan relief in exchange for a two-year commitment. If I stayed longer, I would receive $20,000 in both years 3 and 4 and then $10,000 per year for years 5 and beyond.
It wasn’t nearly as good of a deal as the scholarship, but it was something. This became Plan 2.2: temporarily move almost anywhere and be contentedly middle class on the NHSC loan repayment plan.
This plan worked out. Well, kind of.
More information here:
How I Went from a Negative Net Worth in My 30s to Early Retirement
Working with the Underserved and How That Made All the Difference
After graduation, we moved with our first child—a brand new daughter—to stunningly beautiful southern Oregon where we bought a four-bedroom house for $220,000 on a 2% mortgage (the monthly payment was $895). I accepted a job at a qualifying FQHC where I was paid $118,000 a year (a stark departure from the $250,000–$300,000 I had been led to believe I would make when I started taking pre-dental classes eight years earlier), great benefits, and a group of young idealistic dentists who were there partially for the loan relief but mostly for the cause of serving the underserved.
I was just there for the money.
In my mind, my wife had married me based on the understanding I would be a wealthy medical professional providing the life we had always seen the doctors in our neighborhood live (she and I met in high school). I could feel the heat of my mother-in-law’s proverbial stare searing a molten hole into my soul while I temporarily failed to bring her daughter back to the homeland. In other words, there was no world in which we were staying in this job for more than a few years.
Fast forward three years to 2015 and everything had changed. We fell deeply in love with southern Oregon, and I fell even deeper in love with public health dentistry.
I was shocked to discover how rewarding it was for me to treat patients who lived on the margins of our society, who had been dealt an impossibly difficult hand in life, and who had lived with the pain and the shame of untreated oral disease for so long. I found such joy in going into our local schools to provide screenings; sealants; fluoride; and, most importantly, oral health education to disadvantaged students. I relished the unpredictability and challenge of taking a modified RV-turned-mobile-dental-clinic into the local pear orchards and providing emergent care to migrant farm workers from all over Latin America. I found so much satisfaction in navigating the myriad social and mental health challenges of removing all the infected teeth of chronically homeless patients and making them a pair of dentures they could be proud to show off with their first toothy smile in years.
Photo via Tyler Scott
I loved working with a team of dentists who were diverse, driven, and immensely talented. My dental skillset grew exponentially being around providers who had such a range of training and experience. To have 5-10 peers to review a treatment plan, look at a radiograph, support me through a new procedure, and just vent to was invaluable.
Stack that alongside Oregon’s expansion of the Affordable Care Act to include dental care which brought along with it the expansion of our clinic, pay raises, increasing wonderful benefits, and the ability to hire more providers, and I had accidentally found my dream dental career.
After five years, I had increased my pay to over $200,000; I had an administrative role at the clinic that was interesting, rewarding, and a welcome break from patient care; and I had received $110,000 of tax-free student loan forgiveness.
During this time, I overheard a conversation between two other dentists about some niche blog that supposedly could help medical folks make better financial decisions. In an attempt to find that blog, I stumbled upon Mr. Money Mustache, and I was immediately absorbed into the FIRE movement.
Not long after, I found the obscure blog my coworkers were talking about, and under the tutelage of Dr. Dahle and MMM, I continued to live on our same budget from dental school; I also eradicated the rest of my $280,000 debt within those same five years.
I ended up staying at this job for nearly 10 years. In hindsight, combining the NHSC loan forgiveness with Public Service Loan Forgiveness (PSLF)—especially with two-plus years of $0 COVID payments—would have been the more optimal strategy. But I didn’t know then what I know now, and I never once regretted being free from the immense burden of those student loans.
Plan 2.2: temporarily move almost anywhere and be contentedly middle class on the NHSC loan repayment plan had morphed into:
Plan 3.0: bask in the supernal satisfaction of public health and joyfully thrive in the majesty of southern Oregon.
More information here:
Paying Off Spouse’s Student Loans Together
Some Takeaways from My Journey
To recap the evolution of my professional career plans:
- Plan 1.0: Move back home and be joyfully rich.
- Plan 2.0: Temporarily move almost anywhere and be contentedly middle class—the Navy plan.
- Plan 2.1: Temporarily move almost anywhere and be contentedly middle class—the NHSC scholarship plan.
- Plan 2.2: Temporarily move almost anywhere and be contentedly middle class—the NHSC loan repayment plan.
- Plan 3.0: Live and love my public health career in southern Oregon forever.
- Plan 4.0: Move back to Utah and make a career change to finance . . . but that’s a story for another day. (Literally for another day. I plan to tell the story of my relocation to Salt Lake and my complete career transition in a future column.)
That is a path I didn’t see coming and one I never could have predicted. It is a path that has brought me tremendous happiness, incredible growth, and profound learning, for all of which I will forever be grateful.
Some possible big-picture takeaways from this meandering journey of mine may include:
- See the end from the beginning. Know what your training will cost, know what getting into your chosen field after training will cost, and know if your desired field and desired place to live can support these costs.
- Have a plan for how you will mitigate and then repay these articulated costs.
- Don’t fret when your plan gets derailed. It’s impossible to know how the twists and turns of life may lead you to a better place than your plan ever could have.
- Consider public health as a viable, long-term career option and not just a way to pay off your loans. It surprised me, and it might surprise you, too.
Some possible small-picture takeaways may include:
- Don’t take peer-to-peer student loan advice from someone that’s been out of training for more than 10 years and/or who holds a Pollyanna view about your future.
- Make plans to visit southern Oregon.
- Don’t play cricket next to terrorist cells.
My journey from aspiring practice owner to wannabe military officer to public health provider revealed what I didn’t know I always wanted from healthcare—peer-to-peer friendships, diversification within my work, and a heart-centered mission that was about something bigger than my long-planned house and boat.
It’s a journey I wasn’t planning on, one I wouldn’t necessarily repeat, and one I will never regret.
Can you relate to this path that was filled with twists and turns? Have you ever thought about working with an underserved population? Have you found wealth that didn't include a high salary because of the work you do? Comment below!
My kid had a college pal- Pakistani parents- who was incredibly frustrated that he wasn’t permitted to join a scientific (Physics major?) visit to an Indian nuclear power plant. His grandfather, a Pakistani general, could probably have explained the reasons. Luckily my childhood stay in Poland (Dad went on sabbatical and took me) didn’t interfere with joining the Army.
Yeah, I was truly shocked when the NCIS investigators told me my family heritage was a contraindication for military service. I never would have imagined by dad’s boarding school location would someday alter the course of my professional life almost 50 years later.
I’m sorry I couldn’t join you as part of our armed forces but I thank you for your comment and for your service.
This article resonated with me a lot. I’m also in the dental field and can recall receiving the same advice from dentists of another generation. Thanks for sharing your story and your take aways!
My experience of the dentists who came before us is one of such genuine support and sincere encouragement. I know they meant only to uplift me in my goals to join them and could only speak to their own experience of debt but ultimately that encouragement gave me an inaccurate expectation about what laid ahead for me (that was my own fault for not doing more research).
Thanks for reading and offering the kind comment.
If you have a nice house (sounds like it is as you said it was a four-bedroom house) for $220,000 with a super low interest rate of a 2% mortgage you might be doing better than someone is San Francisco making $300-$400k but paying 1.5 million for a tiny house. You might have overall more financial wealth 20 years plus.
I think that is definitely true. Jim often counsels readers not to confuse income with wealth. Our net worth is a much better indicator of our wealth than our AGI.
Great piece. Appreciate an honest account of your struggles to get ahead. Let’s not forget that blessings, brains, resourcefulness, hard work and determination helped make this story a reality. We’ve experienced similar struggles paying off school loans. Very proud not to abuse taxpayer dollars to fund our dreams. One criticism regarding “my lived experience is one of a tall, white, straight, upper-to-middle class, Christian, privileged man, and hence I was not offered the scholarship (correctly so, in my opinion).” Sounds like too much time spent in Oregon maybe?
Haha, astute observation Eric. My time in the liberal forests of Oregon certainly had an impact on my perspectives compared to my life before dental school on the conservative slopes of the Wasatch mountains. I like to think those two geographies, along with exposure to an increasingly wide range of socio-economic and cultural demographics, has left me as centrist on most topics.
For me two things can be true at the same time:
1. A merit based cocktail of blessings, brains, resourcefulness, hard work and determination definitely played a large role in my present day success and circumstance. My wife reminds me often of how reticent I am to acknowledge my own hand in the outcomes of my life.
2. The NHSC scholarship that was, at the time, preferentially given to minority students should not have gone to me. So many of my classmates and peers had achieved just as much merit as I had, but had to overcome far greater hurdles than I to do so (the WCI scholarship winning essays are a good example of some of those stories). It’s ok with me if they are ahead of me in line to get some help with their loans. I also totally understand why others would feel differently.
The irony is that I was told one of the rationales for the scholarship being preferentially awarded to students from disadvantaged backgrounds is that they are more likely to stay in public health beyond the 2-4 award compared to other students. I, in my self-diagnosed privilege, ending up stay 10 years which is much longer than the average. So, at least in my case, the underlying assumption was incorrect.
Great story! Thanks for sharing. This resonates with me in many ways: large debt, learning about fire. I’d be interested to hear the changing of careers part of your story.
Thanks Michael. I really enjoyed your recent post on the site about your experience practicing abroad and all the lessons and values that evoked in you, so your kind words are notably meaningful.
I look forward to telling more of my story in the months ahead in future posts and I look forward to meeting you in another context soon!
Yes, quite the small community here. I’m sure I’m missing out on a great time in Arizona this week.
Thanks for reading! That Doctors Without Borders story had been brewing for a decade.
Once again, great post!
awesome story dude! I love how you made these plans to tackle your debt, but as Morgan Housel says:
“Planning is important, but the most important part of every plan is to plan on the plan not going according to plan.”
Looks like this definitely rang true for you! Well done on finding joy in your career and killin the financial game when your plan didn’t go according to plan.
Thanks Rikki! I’ve enjoyed your contributions here for a long time so it’s very cool to know you enjoyed the post.
That quote is so true and applies in so many contexts. We had a plan to hike all over in Sedona this weekend ahead of the WCI conference and we woke up yesterday morning to 5 inches of snow! We had a plan and the plan didn’t go according to plan so we fired up the backup plan and had an amazing time.
Thank you for sharing your incredible journey with this community. I currently live in the midwest and at times have thought about moving to Oregon. At times, stories about all the wildfires have given me pause. I know it’s a big state, but have you had any major concerns or close calls with wildfires (or other severe weather events) in the area? Any advice for someone who is concerned about that? Thanks in advance and congratulations on your success!
Every part of the country has its natural disasters. Earthquakes, eruptions, blizzards, floods, tornados, wildfires, hurricanes, heat waves, dust storms. I mean, is there anywhere that is really exempt? We even had a tornado in Salt Lake a few years ago.
Thanks for the positive feedback Nathan. It is truly appreciated.
Oregon is an outrageously beautiful state and I can only support the idea of moving there (beware the 9.9% marginal state income tax for high earners). As you said, it is a big state and the wildfire issues are felt more in some parts than others.
Dental school was in Portland which is the wet and lush Willamette Valley, a 150 mile corridor that includes Portland, Salem and Eugene. Most of the states population is here and it is generally less impacted by the seasonal fires.
I practiced in Southern Oregon in the Rogue Valley. This area is much sunnier than most assume about Oregon but with that comes a much dryer climate that is heavily impacted by Oregon and California fires. One of the factors in our move back to Utah was the reality that 8 of our 10 summers in that beautiful valley were heavily affected if not out right ruined by week after week of suffocating smoke. In September of 2020 we were told to prepare to evacuate our home as a wind driven wildfire quickly approached our neighborhood.
At the end of day though, as Jim said, all areas of the country have one climatological consideration or another. I’m pretty sick of shoveling my driveway this winter in Salt Lake (I just bought my first snow blower!).
One of the better guest posts I’ve read here. Nice mix of humor while sparing us the usual refrains of aspiring DocBloggers (if I hear “simple but not easy” one more time…)
With a high schooler at home starting to eye her future, your point of seeing the end from the beginning is well taken. Such a large expense as undergrad/professional education must be viewed with an eye towards ROI else one IS planning to fail.
And I completely agree about Oregon. Who knew?
Not just a guest post, Tyler will be a regular columnist. So I’m glad you like his stuff.
That’s great to hear! its a very well written post and he certainly has a talent. Looking forward to his future articles.
Thanks for the kind words and I’m glad to hear you have a personal knowledge of the magic of Oregon.
The ROI conversation about college is a complex one (probably worthy of a blog post). On one hand we could create a mathematically driven spreadsheet with total expenses, interest on borrowed money, and opportunity cost on one side and expected income on the other. That is probably a useful exercise for most considering post secondary education (I know it would have been illuminating for me).
However, how do we quantify the intangibles that some value so much from their college experience; living away from home, meeting so many new people, being exposed to new and different ideas, etc?
I don’t have an answer for that but it would make for good discussion.
As a 1986 DS grad and recent retiree from 37 yrs of dentistry, I can tell you that every dentist feels that the previous generation of dentists had it easy. I “only” had 50k of loans when I graduated, but I also never cleared 100k in income for several years. First job as a dentist paid $13/hr as an independent contractor. As a seller, you find that even the nicest dental building when appraised has very few comps, so you are lucky to get back your original cost. Equipment value is that of a new BMW driven off the lot and vandalized. Goodwill is where you make the profit, but even that varies greatly upon your location. Two different offices netting the same amount can see a difference of 30% to 75% of collections for goodwill valuation based upon location. I got 42% in a nice suburban area, but my colleagues in an urban area will get much more. Dentists in rural areas will be lucky to even find a buyer. So, it has never been easy, and it never gets easier. Dentistry is not all about creating pretty teeth. If you are not able to get into the trenches and get your elbows dirty, then you are in the wrong profession.
Congratulations on your recent retirement! I hope you days free from refining 2nd molar chamfer margins, shade matching composites to adjacent PFMs, and searching for MB2 have left you feeling professionally satiated and neuroskeletally rejuvenated.
I also hope you did not take offense to my portrayal of the well intended advice I received from the dentists who preceded me. I didn’t mean to imply they had it so much easier than me, rather to point out to someone considering dentistry today that the financial path a previous generation took is unlikely to be the path they will follow going forward.
I completely agree that dentistry is not all about teeth. For me, teeth were the medium by which I was able to build substantive connections with patients, staff, and peers all while trying to positively impact the lives of those around me. And that, as you said so well, is best done in the trenches doing the physical and emotional work of healing those who have placed their trust in us to heal them.
Great first column! I’m looking forward to hearing more about your career and experiences – thank you for sharing this.
Thanks Margaret! I have so enjoyed your work here and can’t wait to meet you at the conference this week!
Hello WCI bloggers.
I love this blog on debt and years of education etc. How can we as a society cut on these fees of education and many years of study right on the stem though? on the universities that charge us with these prices?
I was wondering if there has been any experience out there of trade people moving towards becoming a healthcare “privileged” staff.
Discussing for school debt and so on I would like to bring this joke hanging around:
The plumber goes at the doctor’s home and fixes a leaking pipe. He works there 3-4 hours and hands to the physician his invoice — $700.
The doctor, an ER doctor , reading it and thinking of how much he would make for this many hours of work, tells the plumber:
“Hey body, How come this expensive? Myself being a Doctor with all those years of study can not make that much money for this period of time??”
The plumber replies:
“I understand. I could not make that much when I was a doctor, either, that is why I became a tradesperson.
Looking forward to reading your next column:
Plan 4.0: Move back to Utah and make a career change to finance . . . but that’s a story for another day. (Literally for another day. I plan to tell the story of my relocation to Salt Lake and my complete career transition in a future column.)
Thank you for bringing your story in here.
Thanks Ed. I look forward to telling the next chapter of my story in the coming months.
As for your other comment about how to reduce or cap the cost of college and medical/dental training – I have no idea. Someone smarter than me will need to write a post on that. Maybe we can all bully Jim into running for Senate or President and he can introduce the JIMDAHLE 2x Act of 2025 (Jim Insists Medical/Dental Admission cost Halt and Level at Equal to 2x earnings Act).
With the current generation of dental students graduating with $600k+, do you care to share any thoughts on their financial future? Do you think your student debt experience remains relevant with today’s dental students? One commenter stated he graduated with $50k student debt and didn’t clear $100k for several years (so a least a 1:1 student debt to income ratio). Recent graduates might have 2:1 to 4:1 student debt to income ratio. What is sustainable and is the profession disconnected from the financial challenges of current dental students?
All amazing points and valid questions. I have these issues on my list of topics to write about in the future.
Short answers to your questions are:
1. I think the financial future of a current dental student graduating with $600,000+ is…..’uncertain’, is the kindest word I can think of and ‘bleak’ is the most honest word I can summon right now. I have taught at a private dental school here in Salt Lake for better part of the last year and a half and there some students how are approaching that number. Fortunately most dental students in the country have less than $600k in loans. The bad news is that anything above a 3:1 debt-to-income ratio is problematic. Rising tuition rates coupled with dropping compensation rates is a tough combination for current and future dental students.
2. I think my story has some relevance to current dental students inasmuch as I took on a massive student loan burden without a true awareness of how it would impact in my life and without a plan to deal with it in the context of buying a home, a practice, have kids, and live the kind of life we hoped for when I chose dentistry. So many of the dental students I work with have put their head in the sand regarding their loans and that alarms me a great deal.
3. What is sustainable? I think we are approaching or have already gone over the threshold of what is sustainable. I fear that can have insidious and deleterious impacts on our profession in ways we don’t fully understand yet.
4. Is the profession disconnected from the plight of the next generation of dentists? I think they are aware of it but not taking sufficient or urgent enough action to address the issue of tuition costs. I would love to see the ADA lobbying efforts increase dramatically in this area.
Thank you for your thoughtful and candid response. There are preserve incentives in the higher ed financing industrial complex; unlimited capital in the form of the Federal Direct Graduate PLUS program, artificial cash flow safety net for borrowers in the form of income driven repayment (IDR) plans, and once ivory towers (ie, higher ed) taking full financial advantage of the opportunity. A house of cards that will collapse (at some point).
Oops…”perverse incentives”
Yo Tyler,
Happy to see you writing on the WCI blog (Tyler and I went to dental school together).
Dentistry is the best… but I definitely worry about the cost of schooling. It’s gotten much more expensive still even since we graduated. Though I suppose many things have followed a similar path, like housing and health care… and eggs.
The military and NHSC loan repayment can be valuable tools (I ended up receiving an NHSC “scholarship” that Tyler referenced).
Also, practice ownership is another valuable tool and is becoming less common. It offers dentists a higher income ceiling. Obtaining wealth is a marathon not a sprint after all.
I agree about practice ownership becoming less common. The younger generation of dentists seem not to have any interest in ownership. What are some of the reasons, you think?
I am a somewhat earlier-mid-career dentist (39 years old) and really sympathize with dentists starting out right now.
From my view, the reason for lack of practice ownership is primarily financial. I think there are still many young dentists who like the idea of owning their own place, but then they realized that starting a practice from scratch is much more financially risky than it used to be (except maybe in rural settings). Likewise, acquiring an existing practice is more difficult and costly, as we are competing with private equity/corporate groups that never existed before. I think practice ownership still generally provides a high return on investment, but the return is more long-term and the risk is higher than it used to be compared to just being an associate. And running a practice is more difficult/complicated (ie. more expensive) to operate nowadays as well.
It’s the same reason fewer young people own homes and the reason most physicians are employed rather than business owners… Financially there is a barrier of entry that is difficult to justify. Combine that higher cost of business entry with the higher cost of dental school education, and then also the high cost of family housing/mortgage.
I think some reasons the younger generations of dentists may be less interested in ownership are:
1. Financial barriers –
a. Graduating with massive student loan burdens.
b. Housing costs, both renting and owning.
c. DCOs are pushing up the cost of buying into practices (this is an educated assumption and not something I have put a lot of research into)
d. The rapidly changing technology in dentistry (Cone beam CTs, Implant systems, digital radiographs, 3D scanners, etc) make staying up to date in the field increasingly expensive.
2. Generational changes in work life balance –
Many of my dental friends in their late 30s are expressing burnout already from both the physical demands of doing dentistry and the strain of owning a business as it relates to staffing, marketing, book keeping, etc. Most of my dental students talk openly about being willing to make less money in exchange to be able to just work 9-5 and not deal with the stress of owning a business.
I lay much of that blame at the feet of The Commission on Dental Accreditation (CODA) of the American Dental Association for not requiring basic financial and business education in order to be an accredited dental school. Maybe we could learn less about how to identify eosinophils in a microscope and more about the tax advantages of pass through entities and how to operate a safe harbor 401k in our practices.
Dr. T….my long lost classmate, who are you?!? Don’t feel like you have to answer here but feel free to contact me through the list Charlie made last year and hopefully I can see you at our reunion in Portland this summer!
Thanks for reading and for participating in the discussion here in the comments.
Hi Tyler –
That was a great blog, thank you for sharing your experience! I’m a podiatrist in private practice, working in an urban area with colleagues that are doing something similar to you – working in an FHQC, will have their loans paid off after a certain number of years of service. A particular friend of mine who is a podiatrist, looked all over the place for a job, ended up working in a community clinic in Sonoma, CA, the outskirts of the Bay Area. Still expensive COL, but much cheaper than the metro area, and a lot of uninsured agriculture workers. She went from treating high-priced cosmetic clients (she was miserable and left) to patients with real medical problems. Her income did not change much but her happiness did. For me – when I get a demanding entitled patient – it only takes 1-2 of them to ruin my day…
Agreed with you to not take advice from within your own profession, especially if they practice near you. In general – they’re only looking out for themselves, not you.
Great blog – thanks for sharing!
Jenny
Thank you Jenny, I appreciate the kind feedback.
When we think about getting paid in medicine we understandably first think of money. US dollars are the primary medium in which we consider and measure our compensation. I learned really quickly in my dental career that the patients and procedures that can generate the most dollars in dentistry were not in alignment with my core values. I was never going to find meaning and lasting worth in the overtly cosmetic elements of dentistry (i.e. whitening, veneers, etc). I think those patients and procedures are wonderful and valid, and I have no judgements about them, in fact I’m very grateful for dentists you want to do this work.
For me, I made a conscious choice to, in effect, trade US dollars as compensation for the harder to quantify compensation of internal satisfaction. Having a clear financial plan showed me that $40,000 – $80,000 dollars of pre-tax income per year wasn’t going to demonstrably improve my happiness. But I learned that removing the broken and infected tooth of an unhoused member of my community did.
It has been incredibly empowering to choose what types of compensation are most likely to produce self-worth and happiness. I still have work to do in that area but the act of being intentional about it serves to keep me in an abundance mindset regarding the compensation I do get and away from a scarcity mindset about which types I don’t.
Great read! I’m not sure I ever knew all the details of why your Navy scholarship didn’t materialize. Wild! Our kids are still young, but my husband and I regularly discuss how to help them select their future career paths. Neither of us had our financial future in mind when we chose our degrees. Apparently Sociology and Literature don’t lead to prosperous careers, who knew? But then again, dental school, medical school, law school … almost everyone I know who chose those paths are still paying off student loan debt. Meanwhile, I’m debt free with my gothic literature degree.
wow Great I’m looking forward to hearing more about your career and experiences – thank you for sharing this.
You have a true talent for writing! I enjoyed reading your fascinating story with the infused humor, well done. I look forward to reading more of your work!