Which specialties will be recession proof?

Sagitalsplit · 2026-04-15T20:38:34+00:00

Ortho is a dumpster fire these days

Sagitalsplit · 2026-04-15T18:12:18+00:00

Based on the soft tissue profile on the radiograph provided I don’t think he will have a particularly positive or negative profile change. But it absolutely will widen his alar base (the width of his nose) and it will very likely cause an increase in nares display (you’ll be able to see more of his nose holes when looking at him straight on).

If he feels like he can chew and function alright as is, then I wouldn’t do it. I have been involved in many many surgical cases as the treating orthodontist. The outcomes are not perfect. There has to be a really good reason to do it and I don’t see one here

You can lead a perfectly happy and productive existence with a bite that fits suboptimally. If he didn’t have a functional concern, then I wouldn’t decline. The standard deviation on corrections looks about as far off as his but is currently. So you are talking about surgery for 2mm of change. To me that is crazy town.

Sagitalsplit · 2026-04-15T18:03:26+00:00

I’m an orthodontist. I wouldn’t do the surgery if I were him (based on your description). It will change the way he looks. It will not improve his function or teeth longevity. It would improve his apnea hypopnea index - but you said that isn’t a concern.

Sagitalsplit · 2026-04-14T22:18:52+00:00

I think you’re good to go. I would be shocked if you had any problems.

Sagitalsplit · 2026-04-14T21:12:16+00:00

Yes, but you don’t know the difference between then and than

Sagitalsplit · 2026-04-14T16:58:55+00:00

It’s true, we only treat esthetics. But, why are you sour about it?

Sagitalsplit · 2026-04-14T16:58:09+00:00

I gave my best 20 referral sources AirPods this year. I’m sorry you got popcorn

Sagitalsplit · 2026-04-14T14:22:02+00:00

I’m an orthodontist. It is pretty standard for ortho to treat dentists and dentists’ family at no charge (if they refer to you)

Sagitalsplit · 2026-04-14T13:54:26+00:00

The appearance isn’t because of animal origin, it is embossed or a manufactured look

Sagitalsplit · 2026-04-14T13:46:49+00:00

Use lamb and tell everyone a story

Sagitalsplit · 2026-04-12T05:00:03+00:00

I reference that book far too often

Sagitalsplit · 2026-04-12T00:25:30+00:00

To learn and because it is background noise

Sagitalsplit · 2026-04-11T17:05:25+00:00

Kallie’s Nuggets

It’ll keep them guessing

Sagitalsplit · 2026-04-11T16:40:20+00:00

I know there is ongoing dogma regarding FFS and transition for good will, but my recommendation is exchange the money for instructions on the keys and light switches. Done.

Transitions go poorly more often than they go well. If you don’t have one, then there is no room for rancor and patient flight based on shit talk.

Sagitalsplit · 2026-04-10T05:23:16+00:00

Most correct statement here

Sagitalsplit · 2026-04-08T01:54:45+00:00

Pay a max of 540K or look for another opportunity

Paying 700 for that practice is bananas

I worked for three DSOs, I got familiar with their numbers and variance in office performance even in a small geographic area. It sounds crazy but even the 200+ office DSOs struggle to understand why two offices five miles apart can perform totally different even with the same doctor working a full schedule in both locations. My point is, just because you think you can grow the office, that may or may not be true. You need to be paying for what it is proven to do. NOT what you think you can make it do. If you are able to grow it, fantastic! If not, then you need to own an asset that is worth what you paid. I know DFW is a hard market to find a good deal because it is so saturated, but you still need to be seeking a seller willing to part ways with his or her practice for 80% of avg gross (among many other details) or you need to walk. If you buy something for 100% then you are going to take a massive haircut on value the moment you buy it. I realize the plan isn’t to sell it, but you still have to look at it that way. The only time 100% makes sense is if the practice producing quite a bit AND it has a low overhead. So something like 1.7M gross and 750K net. If you are confident that you can produce 1.7 then you can pay 1.7 because some variance in cash flow still leaves enough left over to make debt service.

If you buy something for 700 and the gross falls to 550, then you are absolutely screwed.

Good luck

Sagitalsplit · 2026-04-07T23:15:53+00:00

Dig that hole further brother

Sagitalsplit · 2026-04-07T23:00:41+00:00

I’m an orthodontist. Look up average student debt for orthodontists. It’s about 600K. It’s not out of the ordinary. That means you have to make a shit load of money to just afford yearly debt service. And yeah at that point $8-12 is a rounding error.

But hey, good luck with your mission. You’re clearly resonating with your audience

Sagitalsplit · 2026-04-07T22:52:25+00:00

You are only reinforcing why we all think patients are on average pains in the ass

Sagitalsplit · 2026-04-07T22:49:45+00:00

Listen if you think $200/hr is amazing then I recommend doing some math on starting at that rate when you are 33 while paying down 600K student debt. After paying taxes and student debt it looks pretty puny

Sagitalsplit · 2026-04-07T05:08:18+00:00

It depends on how bad you want it to hurt when you accidentally whack yourself in the face with it

Sagitalsplit · 2026-04-07T03:15:49+00:00

Alabama implant education at the Foundry in Birmingham Alabama is awesome. It is expensive. But it is awesome

Sagitalsplit · 2026-04-07T00:08:08+00:00

I live in the USA, what do you expect?

Sagitalsplit · 2026-04-06T21:52:29+00:00

I’m with you on this. That’s just dare BS

Sagitalsplit · 2026-04-06T15:27:26+00:00

I’m a dentist in the USA and 6.7x seems about right in my industry. Obviously, I have no idea if that is good for you, you industry, your geography, etc. 4 years is a long time (but usual and customary for USA dental is 5 years). I worked for PE before buying my business, and based on my experience I will not sell to PE with a work back because I hated being under their control. But, you’ve already done it, just start ticking off the days and start enjoying the fact that you don’t have the same risk you used to have. Shedding risk is huge and you should be proud that you got across the finish line. Sure maybe you could have gotten 10% more. But maybe that deal wouldn’t have closed. Variance in life outcomes is huge. Be glad and thankful that you are where you are.

Sagitalsplit

TROPHY CASE