A New Study Confirms That Ghosting During the Hiring Process Has Hit Crisis Levels

By: Shannon Patterson, CPR, CMSR
Kolbe Certified™ Consultant
Director of Practice Opportunities

Ghost·ing (noun). The practice of ending a relationship with someone suddenly, and without explanation, withdrawing from all communication. 

“Ghosting” is a term most of us have heard of and often we associate it with dating, but in the last eighteen months, we have seen this behavior trickle into the interview and hiring process. In the beginning, we thought it was due to the pandemic. Candidates were all scrambling on where they should be and what opportunities would be “safe” post-pandemic, so it was understandable. What we didn’t realize was that this behavior would become what candidates view as “normal” during their job search. 

Indeed, one of the largest job aggregation sites, recently confirmed in a survey what we have long suspected – “ghosting”, has become a widespread common practice among candidates looking for opportunities. Let’s face it, the interview process is not always fun; it is often an uncomfortable dance for both the candidate and the potential employer. 

So why would a candidate “ghost” a potential employer? The answer is pretty simple and relates back to dating. Candidates hope that by “ghosting” a potential employer that the employer will “get the hint” that the candidate is no longer interested in the job opportunity. In doing this, the candidate avoids a tough face-to-face conversation to tell the employer he/she is no longer interested. 

The harsh reality is that our culture of busyness combined with technology allows us to avoid having tough conversations. I am not talking about the texts and emails that fall through the cracks, but rather when we look at our phone and flat out ignore answering or replying because we want to avoid communicating and giving bad news.  

Candidates are often afraid that providing any type of negative feedback to a potential employer might come back to bite them in the future and potentially harm their reputation as they look for other opportunities. It might seem easier to just keep quiet and hope that the potential employer stops reaching out.  However, the best option is to communicate and simply let the employer know that you are still actively interviewing and you have not made a final decision. It is important to understand that most employers have invested a lot of time, money, and effort to find candidates. If you have lost interest or decided to pull out of an opportunity, providing feedback in a constructive way to that employer can help tremendously as the employer continues to search for a doctor. 

So regardless of the reason you decide to decline a job offer, you need to be upfront and honest so that you don’t burn bridges and tarnish your reputation.  Providing a reason and being polite with potential employers will help them remember you positively, and, believe it or not, might help you in your future career moves. Below are some graceful ways you can politely decline a job offer: 

1) Choose a form of communication that makes you most comfortable when you break the news. If you feel you will become nervous and panicky on a phone call then a polished email would be a better option. However, it is often best when turning down a job offer to use the same method of communication, they used to extend it. 

2) When turning down a position it is imperative to be as appreciative and thankful as possible, so preface your rejection with appreciation and start with “thank you”. It is important to remember employers have invested a lot of time and energy into the interviewing process. Ex; “Thank you so much for this job offer and for the opportunity to get to know you and your team better.”  

3) It is important to be clear that you are not accepting the offer and why. Again, you want to do this in a gracious manner but be explicit on why you are passing on the opportunity. Ex; “However, I have to decline the opportunity.” 

4) Provide an honest, brief, and specific reason you are declining the offer. This is the part most candidates want to gloss over, but the employer deserves feedback on why you are not accepting the position. You don’t have to go into great detail but be prepared to provide a few key points, whether you are going with another opportunity, the practice culture wasn’t the right fit, the location wasn’t ideal, or if the pay was not where you needed it to be. You can soften the blow by providing a detail or two about what you liked about the practice. Ex; “I have decided to accept a position closer to my family in North Carolina.”

5) If the opportunity was a good one, offer to provide them a recommendation with other job seekers. This demonstrates that you care about them and their practice although it wasn’t right for you. 

6) Express your desire to stay connected, because you never know where your connections might lead to in the future; orthodontics is a small world. Ex; “Again, I truly enjoyed meeting you and your team and I look forward to staying in touch.”  

Deciding not to move forward with an opportunity or decline a job offer is never easy, but communicating politely and professionally will make you feel a lot better in the end. Ghosting a potential employer can potentially damage future relationships and hurt your reputation, so create a favorable image of yourself that leaves the door open for any future opportunities.

What Will the 2020 Census Reveal About America?

By: Shannon Patterson, CPR, CMSR
Kolbe Certified™ Consultant
Director of Practice Opportunities

The new census data will show us that our nation is experiencing stagnate growth, with an aging population and a declining birth rate. With fewer births, more deaths, and uneven immigration the 2010-20 decade was the smallest decade of growth in U.S. history including the Great Depression of the 1930s.

Let’s look at what factors have contributed to the slow growth rate in the U.S. population.

Declining Fertility Rates and More Deaths
Unfortunately, the past decade reveals a nation with unprecedented growth stagnation and a steep decline in the under-18 population. As our nation continues to age and baby boomers reach retirement, the gap between births and deaths narrowed with the number of births outnumbering deaths nationwide by fewer than 1 million for the first time in decades. Between 2010 and 2019, our millennial generation aged into adulthood resulting in an astonishing decline in our under-18 population, and the census projections indicate that our 65-and-over population will have a higher growth rate than our youth in the next decade. If any of you have listened to my lectures in the past you have heard me reference this as the “graying of America.” The newly released data shows that thirty states saw decade-wide population losses in their youth led by California which lost over 400,000. However, Texas gained more than 500,000 young people. We also saw four states Vermont, Maine, West Virginia, and New Hampshire have more deaths than births last year.

Immigration
Our population growth not only comes from natural births but also from foreign immigration. The estimated number of people moving to the U.S. annually from other parts of the world has steadily declined in the last four years. In 2016, the final year of the Obama administration an estimated 1,046,709 people moved to the United States from abroad. In 2019 that number fell to 595,000 due to the federal restrictions during the Trump administration.

Our states also experience population growth and loss by “domestic immigration” or “out-migration” this is when residents move from one state to another. In the past decade, the Northeast lost 2.5 million residents who moved to other regions in the U.S., led by the state of New York which lost over 1.3 million residents over the past nine years. The second-largest exodus of residents due to out-migration is the Midwest, with over 1.6 million people relocating to other states. Of those 1.6 million, over 865,000 residents left the state of Illinois. California ranked third in out-migration losing over 912,000 residents but gained over 1 million foreign immigrates from abroad. Why did these states (California, New York, and Illinois) experience the biggest domestic out-migration shift in the nation? Demographers suggest that we saw this population shift due to the states’ high tax structure and unaffordable housing. Many of these residents relocated to other parts of the country that offered a better economy with lower taxes and affordable homes.

On the flip side, other states benefited greatly as residents crossed state lines. Texas takes the top spot gaining over 1.1 million domestically and another 818,000 coming from abroad since 2010. The state of Florida also saw tremendous growth with 1.2 million residents moving in from other states. Five other states grew by 15% including Utah, Idaho, Nevada, Colorado, and Arizona. The data also shows that Oregon, Washington, North Carolina, South Carolina, Georgia, and North Dakota grew by 10%. States that experienced moderate growth included Virginia, Tennessee, Oklahoma, South Dakota, Minnesota, Nebraska, Montana, and Massachusetts – the only New England state to benefit from out-migration. Four states including West Virginia, Illinois, Connecticut, and Vermont showed absolute population losses over the decade. The state of West Virginia exhibited population losses for seven years in a row, while Illinois and Connecticut did so for six years, and New York for four years.

What Do These Demographic Trends and New Data Show Us?
It certainly indicates that we have an aging workforce. Perhaps more impactful is the shifts in state populations that will likely have consequences when the U.S. congressional districts reappoint seats based on the new census data. After all, the constitutionally mandated purpose of the decennial census is to apportion members of the U.S. House of representatives in each state based on population. Right now, the projected redistribution of our population indicates that Texas could gain three seats and Florida could gain two. Five other states could gain one congressional seat including Arizona, Colorado, Oregon, Montana, and both Carolinas. A whopping ten states are projected to lose a seat including; Minnesota, Illinois, Michigan, Ohio, Pennsylvania, New York, Rhode Island, West Virginia, Alabama, and most notably California which could lose a congressional seat for the first time in history.

It also indicates that, over the next decade, the two factors that contributed to our nation’s slow growth rate – low birth rates and increased deaths – will continue as the population ages. As baby boomers continue to age into retirement our nation will depend on the youth populations to increase, which will most likely come from immigrants and their children. The census bureau projects that after 2030, immigration will account for more than half of our nation’s population growth. This means as we head into the next decade immigration is something, we should all pay attention to because it will be a vital contributor to our nation’s economic health. As our nation continues to age and our population growth stagnates, the 2020s will become a crucial period for all of us to understand the role of immigrants and how they fit into our society and workforce.

As an orthodontist, it is important to understand and pay attention to the changing patient population around your practice. For example, if your target market is based on adolescents watch the population shifts in your elementary and middle schools; if your target market is based on income and jobs in the area be aware of companies’ growth and/or relocation status; or if you experience a population boom from immigration understand those new resident’s ethnic background. As a practice owner understanding the population shifts and demographic character changes in your community is extremely beneficial if not crucial as it allows your practice to make adjustments in marketing for future patient acquisition.

Associate/Employee Compensation Models for Orthodontists

Orthodontic Associate & Employee Orthodontist Compensation Models

By: Shannon Patterson, CPR, CMSR
Kolbe Certified™ Consultant
Director of Practice Opportunities

We get at least one inquiry a day about associate compensation either from an associate/employee orthodontist or a potential employer. In the past, the answer to this question wan average salary range, but the pandemic changed the compensation model for many employers. Now in 2021, instead of “What is the average annual salary for an associate?” we are hearing “Is it better to have an income guarantee (salary) or be paid based on a commission of production/collections?” 

One of the first questions I ask a potential associate/employee is “What is most important to you when you consider your overall compensation model?” This is somewhat of an emotional question for many associates because often these two models offer ‘certainty’ versus ‘incentive.’ 

What you have to ask yourself is, “Am I comfortable taking a risk for more income potential?” “Do I want to be compensated more when I increase production?” “Or do I prefer to have a higher daily rate out of the gate and know exactly what my income will be on an annual basis?” 

When considering your compensation model – consider these three areas:

1. Direct Compensation – Income guarantee which is paid either as an annual salary or a per diem 

2. Indirect Compensation – Benefits such as health insurance, continuing education, association dues, licensure reimbursement, and PTO

3. Deferred Compensation – Retirement plans such as 401K or profit-sharing 

When looking at these three factors you must decide what is most important to you. 

Let’s explore the two most popular types of compensation models in the orthodontic industry – production-based (PB) vs income guarantee (IG). It’s critical to understand the difference between these models in order to make an informed decision that’s best for you and your long-term plans and goals.

If you are a highly-motivated orthodontist, the PB compensation model may be very lucrative but you should also understand the model and formula on which you will be paid. I am receiving an increasing number of calls from associate doctors that are being offered to shift to this model after 12 months of employment. This provides you an opportunity to understand what your income potential will be, since you can examine the previous production average for the prior twelve months, minus adjustments (discounts, write-offs and insurances, and your benefits), and calculate the percentage you are being offered with the adjusted production. 

Currently, the most popular model is a hybrid model of both an IG (income guarantee) and a PBI (production-based incentive) plan. This is a shift we have seen employers make post-pandemic. Many potential employers are offering a lower IG rate but a higher PBI plan. How does this plan work and what exactly do you need to know? 

First and foremost, you must understand the production goal and what metrics are available for you to monitor this goal. Second, recognize, how many days per month you will work to meet this goal.

As an example, let’s say your potential employer sets a $100K monthly production goal, and you are working 16 days/per month. Simply divide $100K by 16 (clinical days worked) which equals $6,250/per day. To meet your goal, you must produce $6,250/per day which equals about 1.2 starts per day.

You must also consider the conversion rate in the orthodontic practice. If it’s 60% then you will need to see at least three new patient (NP) consults each day. When an employer hires you, they not only want you to see current patients – which is where the IG comes in – but they also expect you to see NP consults. Can a new orthodontic graduate handle three to four NP consults per day? I am sure many of you look at this and say “Of course I can. That’s easy. I can see two new patients in the morning and two in the afternoon, right?” Well, that depends…

Let’s do a bit more math. How many patients are in the clinic? If there is an average of 50 clinical patients/per day it will allow you to spend more time with each NP consult to warrant a good conversion. But what happens if you are expected to see 80-100 clinical patients/per day? This might cause a bit of a struggle for a new graduate – balancing the clinic and spending the appropriate amount of time with NP exams/consults. 

So, what are some things you should note when visiting a practice to ensure you can handle the patient flow and hit your production goals? Ask any consultant and they will tell you systems, systems, systems! A practice expecting you to hit high production goals must have good systems and teams to help you meet expectations. 

The difference between a well-trained Treatment Coordinator (TC) and a mediocre one can be detrimental for a new graduate. If you have a great TC and you see three-to-four NP consults/ per day, you will most likely be looking at a 70% conversion rate – which makes your target income potential reasonable. If you are considering joining a practice, ask to examine the schedule – not just for that day, but for the week and month. Find out how many NP consults the practice normally sees on a daily or weekly basis, to make sure you have a reasonable opportunity to start new patients. Another consideration is the practice’s target market. Is the practice marketing and advertising to patients who are willing to commit to treatment or are they marketing to attract shoppers? This is important to know before you join, if the majority of your income is production-based. 

If you join a well-established orthodontic practice with a well-trained team that attracts the right new patients, participating in a PB compensation model versus a higher IG can be very lucrative. 

Based on recent trends, the odds are good that associate compensation will continue to shift toward productivity. The more you produce the higher your income potential. Specifically, with DSO and OSO models, paying based on production bonuses shifts the risk from the employer to the associate and helps maintain healthy productivity. 

So, as you interview for potential associate opportunities be sure to weigh the differences between any production-based or income guarantees you may be offered. Do your homework and ask questions of your potential employer to understand whether or not the offer works for you. 

Student Loan Payment Freeze Extended Through September 30, 2021

By: Shannon Patterson, CPR, CMSR
Kolbe Certified™ Consultant
Director of Practice Opportunities

Following President Biden’s executive action signed in January, the Education Department extended pandemic relief for about 41 million federal student loan borrowers through Sept. 30, 2021.

In March 2020, borrowers were granted a reprieve on their loan payments and interest was set to 0% and collections of defaulted federal student loans were paused. Congress initiated this relief in the CARES Act. Before Biden’s executive action, the relief was set to expire on Jan. 31.

All of the deadline changes have been challenging for many borrowers. Research from the Pew Charitable Trusts found that 40% of borrowers did not know when their loan payments were set to resume. The research also found that borrowers are struggling financially due to the pandemic: Almost 6 in 10 borrowers with paused payments reported to Pew that it would be difficult to begin making their payments if they had to do so in the next month.

There are still a number of details surrounding student loan repayment that have not been clarified. The Education Department had previously confirmed that borrowers in an income-driven repayment plan would not have to recertify their income before Jan. 31, noting that these borrowers would be notified individually of a new recertification date. However, the Biden administration has not yet addressed how the latest extension of relief may affect that, so it is important for buyers to stay informed. If you’re not sure what types of student loans you have, contact your loan servicer to find out. If you have an online account with your loan servicer, you can also check there to see whether the benefit was applied to your account. To find out what type of loans you have, follow these steps:

  1. Visit gov/login.
  2. After you log in with your username and password (FSA ID), you will be able to see your loan(s) listed on the StudentAid.gov Dashboard.
  3. Click “View Details.”
  4. Scroll down to the “Loan Breakdown” section. If your loan(s) is owned by ED, you will see “DEPT OF ED” before the loan servicer’s name. These are the loans eligible for the 0% interest rate.

The extension of the payment freeze has provided relief to borrowers in the short term and offers a longer runway before repayment starts, but what happens next? Will there be permanent relief with permanent loan forgiveness? Some democratic congress members support a plan to cancel up to $50,000 of outstanding federal student loans per borrower, although Biden’s proposal is only canceling $10,000 in debt for students who work in national or community service. 

Right now, it is unclear what the Biden administration will do next but borrowers should pay attention. Our biggest piece of advice is, if you can afford it, keep making payments or even increase your monthly amount during this period to pay off your loans faster and lower the total cost of your loan over time. 

2020: A Year in Review

Though segments of the Wall Street economy thrived, this year has been a challenging year for much of the service side of the economy, and orthodontists were no exception. In most states, they were forced to shut down their offices for six to eight weeks. Residency programs sent students home and virtual classes and mee

By: Shannon Patterson, CPR, CMSR
Kolbe Certified™ Consultant
Director of Practice Opportunities

The last twelve months have been interesting, to say the least, and, like many of you, I am looking forward to saying goodbye to 2020 and welcoming in a new year. We all grew tired of the words furlough, quarantine, closed, canceled, paused, postponed, re-start, PPE, PPP, and bounce-back as the entire planet was consumed by the pandemic, and life as we all knew it was altered, perhaps forever. While it has been an extremely challenging year, it has also taught us many lessons. The first and most important being how to adapt in times of change. 

Though segments of the Wall Street economy thrived, this year has been a challenging year for much of the service side of the economy, and orthodontists were no exception. In most states, they were forced to shut down their offices for six to eight weeks. Residency programs sent students home and virtual classes and meetings took over, while our pets at home were thrilled, it left many of us very concerned about the future of orthodontics. As we wrap up the end of 2020, this is what we have learned:

1. Most practices rebounded strongly even after shutting down for 6-8 weeks (and in some cases up to 12 weeks) during the pandemic. At first, we thought this was pent up demand accumulated during the shut-downs, but as the months have gone on we continue to see trends where practices have had continuous growth through year-end. In most cases, the June-December period of 2020 was up substantially compared to the June-December period of 2019.   

2. Practices quickly adapted and added virtual exams to stay connected to established patients. This technology allowed practices to decrease the distance between themselves and patients during a very challenging time. We feel strongly this is not going to disappear once social distancing is lifted. The pandemic has only accelerated a move toward teledentistry that was already taking hold; we expect it is here to stay.

3. We have seen multiple practices invest in software such as Dental Monitoring, Smile Snap, Rhinogram, and others which allow for patient interaction and case tracking often resulting in fewer patient appointments, a trend that patients are embracing.

4. Interestingly, practice overhead rates are down in most practices this year by 5-10%.  There are several reasons for this, but perhaps the biggest is the tightening of our collective belts which resulted in better management of our expenses than before the pandemic.

5. Job seekers saw a big shift to a remote interview process with virtual interviews versus on-site interviews. We feel this has enhanced the interview process for both parties allowing more time to get to know one another during the interview process. I would encourage all of you to embrace this trend and take advantage of this technology as part of your due diligence process. 

6. Although some associate salaries took a dip early on during the pandemic, we are now seeing many of those associates hit year-end, new-patient start goals attached to their production incentive bonuses. We would say the orthodontic specialty is enjoying full employment again.

7. The job market is still very strong for new doctors with both private practices and DSOs hiring and offering competitive compensation packages. If you are looking to make a change in your career, now is a good time to investigate potential opportunities. 

8. We’re all in this together, it was amazing how many webinars and online events took place in our industry to help one another and share ideas on how to pull through the pandemic. We believe this will continue and suggest you take full advantage of learning from others and sharing insight and ideas. This idea of “we’re better together” is one of the key truths emerging from this pandemic year. By sharing ideas, solutions, fears, and hopes – we all coped and performed much better than we would have alone. 

For decades to come, we will remember the year COVID-19 struck. It was a year to remember whether we liked it or not. However, endings bring us closer, teach us lessons and prepare us for the future. Our industry grew stronger from this year’s events and we should never forget that we’re all in this together. You’re not alone and someday soon we’ll be able to visit, learn and laugh together again. 

The New Future of Teledentistry

By: Shannon Patterson, CPR, CMSR
Kolbe Certified™ Consultant
Director of Practice Opportunities

When I started to research what topic to write about in this month’s Insight edition, I ran across the article below in Becker’s Dental Review, published November 24, 2020. Upon reading this article, I decided it is too valuable not to share with our readers. As we all know the future of teledentistry is very important to the health and reform of dental and orthodontic practices. The dental industry was already in the grips of change before the pandemic started, but it definitely accelerated teledentistry. I hope this article will provide you all with some good insight.  


MouthWatch CEO: National teledentistry policy needed to eliminate ‘Swiss cheese’ coverage map

Published November 24, 2020

The efficiency and convenience offered through teledentistry services is something patients will continue to seek long after the pandemic ends, according to Brant Herman, co-founder and CEO of Metuchen, N.J.-based teledentistry company MouthWatch.

Teledentistry services have been adopted by more dentists than usual since the pandemic began, as the technology offered by companies such as MouthWatch help dentists conserve personal protective equipment, mitigate infection risks and reach patients who cannot easily visit a dentist in-person.

November survey results from the DentaQuest Partnership show 75 percent of dental providers predict an increased reliance on teledentistry in coming years. Mr. Herman, who co-founded MouthWatch in 2012, agrees with this prediction, as he believes technology that allows providers to connect virtually with patients improves a practice’s efficiency, reach and customer service.

Here, Mr. Herman shared his thoughts about teledentistry with Becker’s Dental Review.

Editor’s note: Responses have been lightly edited for clarity and flow.

Question: Teledentistry saw increased growth this year due to the pandemic. Why will teledentistry remain important after the pandemic is over?

Brant Herman: The jury is still out on how long the pandemic will last, how many spikes will occur or if there will be additional closures and emergency care only restrictions. If we’ve learned anything, it’s that dentistry is very vulnerable in these types of situations.

Teledentistry can help DSOs and group practices adapt to almost anything that disrupts the typical day-to-day operation — whether it be another pandemic or a natural disaster. Furthermore, patients were already primed for this type of convenience from their healthcare providers, and COVID only accelerated their desire for this type of connectivity and convenience.

In addition, the pandemic has taught us that efficiency and scalability are of the utmost importance. For the immediate future, groups and DSOs will need to do more with less — to squeeze every drop from the orange, so to speak. When you are forced to see fewer patients on any given day, you need to supplement this new standard operating procedure with a viable alternative, such as teledentistry.

When used in the current post-COVID-19 environment, teledentistry can help preserve and improve the bottom line. It can also make it easy for patients to feel connected to your practice when not in the chair. When the veil of the pandemic is lifted, the efficiency and scalability of teledentistry can propel dramatic growth.

Q: What do you have to say to patients who fear they won’t receive quality care from a virtual visit?

BH: A virtual consultation can’t replace every personal encounter with your dentist, but it can significantly reduce the time and travel required for routine consultations, oral health coaching, treatment plan presentations and certain post-operative check-ins. Busy people appreciate this, and who’s not busy these days?

What’s more, transitioning some in-person visits to virtual equivalents whether synchronous or asynchronous, reduces the risk of infectious disease transmission, not only during a pandemic, but during the traditional cold and flu season. When you combine virtual consultations with prioritized in-office visits, you’ll receive a higher level of care that you will soon begin to prefer.

Q: What are the biggest challenges facing the teledentistry field right now?

BH: There are several that come to mind. First, there’s the perception that video conferencing and teledentistry are synonymous, when only a robust, HIPAA-compliant platform designed specifically to enhance the dental work flow, improve peer-to-peer collaboration and enable smartphone-friendly patient encounters should be considered a true teledentistry solution. Unfortunately, COVID-19 has prompted a gold rush of “teledentistry lite” applications.

Second, not all teledentistry consults have to be live video. This is time consuming, especially as practices are busy managing patients. A platform with integrated messaging and video conference allows for efficient consultations that can become video visits when needed.

The lack of a cohesive and formalized national teledentistry policy perpetuates a Swiss cheese coverage map of optimal access to care. If every state had favorable, non-restrictive teledentistry regulations and standards, we would eventually have an oral care infrastructure that will have a positive impact on the overall state of health in America. There should also be more widespread insurance reimbursement policies.

Lastly, the perception that DSOs and group practices don’t need to make a long-term investment in teledentistry because they believe it won’t be useful after the pandemic subsides. Truth be told, going back to inefficient workflows, infectious disease vulnerability and patient inconvenience will be like going back to foot pedal-powered dental drills. Who wants that? What’s more, FaceTime won’t work for the long haul and teledentistry can be used for much more than covering for a doctor when they’re on vacation.

© Copyright ASC COMMUNICATIONS 2020. Becker’s Hospital Review, published November 24, 2020. https://www.beckersdental.com/teledentristry/36155-mouthwatch-ceo-national-teledentistry-policy-needed-to-eliminate-swiss-cheese-coverage-map.html 

Determining Your Career Path After Orthodontic Residency

By: Shannon Patterson, CPR, CMSR
Kolbe Certified™ Consultant
Director of Practice Opportunities

You have taken that step in identifying a career that appeals to you, but deciding your next step may still be the missing piece of your puzzle. There are many factors you need to examine and decisions you need to make as you approach your final year. You should be asking yourself a few questions:
 
Where Do I Want to Live?
This is extremely important for those who have a family. Being in agreement about where you would like to practice is a decision that should be made with your spouse. Does the community culture align with your beliefs and values? Ask yourself if the area meets your interests and financial needs. Making sure you and your family will be “happy” is a key factor when deciding where you want to practice. 
 
What Are My Short-Term and Long-Term Goals?
Making a career plan takes time and effort on your part. Commit to establishing your expectations and objectives as you seek an opportunity. Remember who you are and why you chose this career.
 
Do I Want to Practice as an Associate in a Private Practice?
Ask yourself if you desire mentorship from a senior doctor. Do you see yourself working with this potential employer? Do your personalities “mesh”? Make it a point to visit the practice and see if the culture is a good fit for you. Observe the interaction between the staff and the patients. Can you see yourself practicing in that environment?
 
Am I Willing to Work for a DSO (Doctor Service Organization)?
If you are wanting to focus solely on orthodontics, corporate may be a better choice. In some cases, you can negotiate a schedule and salary that are guaranteed regardless of the organization’s ups and downs. As with a private practice, just be sure to find the right fit.
 
Would I Like an Equity-Minded Associateship Opportunity?
This is an opportunity to consider for an orthodontist that desires to own their own practice in the somewhat near future. You are able to come in as an associate and “get your feet wet” by getting to know the patients and learning about the ins and outs of the practice you would one day be a partner in. Understand that non-competes in most states will be required and are enforceable.
 
Should I Purchase an Orthodontic Practice?
Financially speaking, is this possible for you? This path does allow you the ability to control your own schedule and usually maximize income. However, the freedoms of having your own practice come with a price. As a small business owner, you have many responsibilities that come along with that title and there are many resources available for you to get help in these areas.
 
This is an important decision that simply comes down to making sure you stay true to yourself by seeking the best opportunity for you and your family. Know who you are, choose a location, identify the right practice, and begin your journey in confidence.


The insights above address many questions to ask yourself when determining a long-term or short-term orthodontic career path. You are not alone on this journey, there are many reputable companies providing guidance when exploring all the available career options, including Bentson Copple & Associates! 

Whether you are a new resident, a resident approaching the completion of your orthodontic program, an experienced doctor seeking a new opportunity, or looking to purchase a practice – our experienced placement specialists are here to help you!
 
Our Placement Services are provided at no cost, and our candidates can expect a high-level engagement process with our recruiters, who are knowledgeable about the opportunities they represent and current industry trends. Our team is here to help make your future orthodontic journey as successful as possible! We also have an up-to-date, comprehensive list of available orthodontic jobs and career opportunities on our website, that range from orthodontic practices for sale, associateship positions, and orthodontic employment opportunities – both full-time and part-time.

Physician Mortgage Loans: Flexible Home Mortgage Lending for Doctors & Dentists

By: Shannon Patterson, CPR, CMSR
Kolbe Certified™ Consultant
Director of Practice Opportunities

You just finished orthodontic residency. You have borrowed hundreds of thousands of dollars to pay for your education and you are about to move to start your new career. Can you afford to buy a home when you get there?

Many of you have borrowed more for school than you will earn in your first two years of your employment but you are about to start a career that promises job security and a high salary, so can you afford to buy a home? What are your options? One option I recently heard about is a “physician mortgage loan” and I want to share this information with young doctors who are starting their careers but also have a desire to have some equity in a home.  

What is a physician mortgage loan?

A physician or “doctor” mortgage is a special loan program that a lender puts in place to attract high-income clients by allowing health care professionals such as doctors and dentists to secure a mortgage with fewer restrictions than a conventional mortgage. The physician loan program is a low to no down payment mortgage designed for physicians, dentists, and other eligible medical professionals. The program is a great home financing option for doctors because they offer jumbo loan balances and relaxed debt-to-income ratios without private mortgage insurance (PMI). PMI is typically required for loans where the down payment amount is less than 20%. Physician home loans are also known as doctor loans, doctor home loans, and doctor mortgage loans. 

Does an orthodontist qualify for physician loans?

Yes, all physician loan programs are available to medical doctors with M.D. or D.O. degrees and some are available to dentists and orthodontists with D.D.S. or D.M.D. degrees. Lenders and banks realize that becoming a doctor or dentist is a long process, so the lending criteria can vary depending on how far along the borrower is in training or career development. Physician mortgage loans are primarily for doctors purchasing their first home or refinancing a primary residence. They are not intended for purchasing a second or vacation homes. 

How does a physician mortgage loan work?

Physician loans differ from conventional mortgages in three ways: They don’t require PMI, which traditional loans do require.  On large loan amounts, the PMI can add hundreds of dollars to the monthly payment, a physician loan frees up that money so it can go toward other expenses including student debt.  Physician loans are also more flexible with debt-to-income ratios and they accept residency contracts as verification of employment. 

Debt-to-income ratio: When lenders review a mortgage application, typically they scrutinize the borrower’s debt-to-income (DTI) ratio, which is the percentage of monthly income that goes toward paying off debts.  Applicants with a high DTI are flagged riskier than applicants with a low DTI.  We are all well aware that orthodontists, especially early in their careers, will have a high DTI ratio due to education debt in the six-figures, making it difficult to qualify for a mortgage.  However, some physician loan programs do not count medical/dental school debt if the payments are deferred or in forbearance for a certain period, this reduces the DTI making it easier to qualify for a loan. 

What do you need to qualify for a physician loan?  

You will need employment verification and proof of income. Mortgage lenders typically require borrowers to prove that they’re working and earning income. Typically, loan applicants that are about to be hired but have not actually worked do not qualify for a loan. However, physician mortgage loans are the exception. Lenders will allow the borrower to show an employment agreement as proof of employment even before their job begins and some lenders will even lend to borrowers that work as independent contractors.  

How do you find a physician loan?

When getting any type of mortgage, it is always best to shop around, starting with the bank or credit union with which you already have a relationship. Unfortunately, many lenders tend to keep this program secret and the information is not easy to find, below is a list of Physician lenders who extend their programs to Dentists (DMD/DDS):

Bank of Nashville (AL, FL, GA, SC, TN, NC, and MS) 

Bank of America (All 50 states) 

Regions Bank (TX, IA, MO, AR, LA, IL, IN, KY, TN, MS, AL, GA, FL, VA, NC, and SC) 

SunTrust Bank (AL, AR, DE, FL, GA, MD, MS, NC, SC, TN, VA, WV, and DC parts of NJ and PA) 

Lake Michigan Credit Union (Michigan Only) 

BBVA/Compass Bank (AL, AR, AZ, CA, CO, FL, GA, ID, KS, LA, MA, NM, NV, OK, OR, PA, RI, TN, TX, VA, and WA) 

Horizon Bank (MI, IN, and IL)

 

Burnout Syndrome: Signs, Symptoms, & Strategies

Orthodontist Burnout Syndrome - Signs, Symptoms, & StrategiesBy: Shannon Patterson, CPR, CMSR
Kolbe Certified™ Consultant
Director of Practice Opportunities

Practicing orthodontics is an important and rewarding career path that attracts some of the nation’s brightest and most driven individuals. Unfortunately, it is also an increasingly challenging and stressful profession with a high rate of job burnout. Sadly, through the years our firm has been involved with transitions that lost an orthodontist due to suicide, and it’s absolutely heart-wrenching. Something I have noticed in the last year is that burnout is on the rise for younger orthodontists and even residents due to financial stressors, student loans, uncertain work future, and the ever-changing dental landscape.

Let’s start with understanding why dental providers are more prone to professional burnout, anxiety, and depression. Two major reasons are the nature of their practice and their personality traits. Orthodontists work in a high risk and emotionally charged profession, characterized by long hours and physical demands, but most importantly many of you have a self-imposed unrealistic demand for precision and perfectionism. A research study conducted on dentists based on the Meyers Briggs personality test showed that dental providers tend to be ISTJ or ESTJ, which are often considered to be the “type A” personalities. Don’t take that the wrong way, that “type A” personality is what got you through years of a demanding education but also means you may be more likely to experience burnout.

Burnout Syndrome is characterized by emotional exhaustion, loss of enthusiasm for work, feelings of depersonalization, and a low sense of accomplishment. Unfortunately, it doesn’t take years to develop this syndrome, younger doctors, and even residents can experience these feelings. Staying self-aware and learning to identify the emotional, physical, and behavioral signs of burnout will help, the most common symptoms of burnout are:

• Loss of motivation
• Feeling helpless, trapped, or defeated
• Detachment
• Increased cynical or negative outlook
• Decreased satisfaction or sense of accomplishment
• Feeling tired and drained most of the time
• Tiredness that does not respond to adequate rest
• Withdrawal from responsibilities
• Isolating from others
• Procrastinating
• Skipping work or coming in late and leaving early

How can you combat burnout? First, do not be reluctant to ask for help or more importantly be ready to offer support to a colleague who is showing signs of burnout. At some point in your dental career, you will experience burnout and it is important to remember this does not make you a bad or weak leader/orthodontist. What you are experiencing is temporary and treatable and you should not fear negative professional repercussions for seeking guidance and mentorship if you are struggling with these feelings. There are excellent self-assessment tools on the internet that can help you recognize whether you are suffering from burnout, just google “professional quality of life scale”. The assessments are often free and can give you valuable insight into your current state of mind.

As a new orthodontist, you can be proactive as you start your career by remembering that burnout is easier to prevent than to treat, so practice self-care and recognize the symptoms. If you start to feel twinges of procrastination, exhaustion and isolation seek guidance whether it’s with books, podcasts a mentor or a friend find a way to inspire yourself to get back on track and back to doing what you love “straightening one smile at a time”!

Addressing Gender Gap Pay: Why Some Employers May Treat Female Providers Differently

Addressing Gender Gap Pay: Why Some Employers May Treat Female Providers Differently

By: Shannon Patterson, CPR, CMSR
Kolbe Certified™ Consultant
Director of Practice Opportunities

During the past few decades, there has been a significant increase in the number of women entering dentistry. While pediatric dentists continue to lead the charge with a whopping 52% of providers being female, the orthodontic industry is also making headway with females representing 31% of the workforce. According to the 2019-2020 Survey of Advanced Dental Education, females represent 69% of all pediatric dental residents and 52% of all orthodontic residents. And for the first time in history, more females (195) than males (193) graduated from orthodontic residency in the United States in 2019-2020.

While we continue to expect the percentage of female providers in these specialties will increase in years to come, what effect has the growth had on gender gap earnings? The answer may surprise you.

According to a 2017 study from the ADA Health Policy Institute, male dental providers earned as much as 54% more than women in 2010. Even after controlling for observable characteristics including age and hours worked, the difference would still be 36%, or what the study’s authors call the “unexplained difference.” The study also looked at wages in medicine and law over a 20-year period. It found that despite accounting for observable characteristics there continues to remain a large, unaccountable earnings differences between men and women among all three of these professions.

Why would there be a gap in earnings between male and female dental providers with similar hours worked, experience, specialty, and practice ownership status? Would a potential employer compensate a female less for the exact same work schedule as her male counterpart? Let me put it this way, would a female provider enter into an associateship or partnership arrangement with less favorable terms than a male counterpart willingly? The answer to these questions may very well be yes.

Studies show that female providers often accept lower compensation packages than their male counterparts, especially in their first job post-residency. Let’s look at some historical data. According to the ADA study, historically, male providers tended to be self-employed (80% compared to 45%) and worked about four hours more per week than their female counterparts did. However, the study also found that by 2010, men and women worked the same number of hours a week and the number of female owners was up to 50 percent while male owners had fallen to 73 percent. If that is indeed the case, why does the wage gap still exist?

The ADA commentary article also referenced the book “Lean In: Women, Work, and the Will to Lead” by Sheryl Sandberg, chief operating officer at Facebook, who writes how women approach work differently than men, particularly when it comes to salary negotiation. The reality is that female providers may simply be less aggressive during contract negotiations and just accept an offer given to them. Women may simply define success differently and money may not be their driving force.

However, there is actual evidence of a wage penalty for motherhood in the workforce. With all else being equal, there is a negative relationship between a woman’s wage and the number of children she has. According to OECO (Organization for Economic Co-operation and Development) data, the penalties averages to about a 7% wage reduction per child. On the flip side there is also evidence of a fatherhood premium; a positive relationship between a man’s wage and the number of children he has. However, when you compare men and women with the same educations, working full-time in the same capacity the gender gap in earnings has largely disappeared. It is often several years after accepting a position and the arrival of children that the gender gap in earnings shows up. If a woman chooses to move to part-time employment in order to spend more time at home it is when she returns to work full-time that she may accept a lower wage compared to the wage she would have earned had she stayed on full-time. It is important to note that if you work less hours you may have less experience and therefore you will possibly see a wage difference.

It is important to remember that, if a female provider works less than her male counterparts, it is reasonable to be paid less. However, if you find that you work the same number of days and hours and you still make less you might consider asking for a higher compensation rate. Remind your employer that you took on just as much student debt as your male counterpart therefore you have the same financial needs.

Tips for advocating better pay:

1. Remember you are always your best advocate. If you don’t stand up for yourself, no one will! Remind your employer that you received the same education, work the same schedule and you should receive the same pay.

2. Don’t be afraid to negotiate for a higher salary before accepting a position.

3. If you have an income guarantee or daily rate gently remind your employer that it should be the same for candidates who have the same experience and work the same schedule. However, if you receive a production incentive it will be up to you produce and meet the pre-determined goals the employer/practice has set.

4. If you are in a group practice be sure that you are seeing as many new patients as your male counterparts so that you can meet your production goals. Understand who and how the new patient exams are scheduled.

5. Know your worth! If you are active in the community and close to referring doctors be sure your employer understands the goodwill and referrals you bring to the practice.

Also, be sure to study up or even consider contacting a career coach on how you can develop and understand negotiation techniques advocating for better pay. Understanding the gender gap in pay has never been more important because the tides are shifting ladies.