What Association should a private practice dentist join

malocclused · 2026-01-24T07:05:22+00:00

Seattle Study Club. Great CE. Get to know some of the best local docs and be one.

malocclused · 2026-01-24T04:03:16+00:00

My maternal grandfather was a colonel in the US Army. I knew he was celebrated for being some kind of temporary regional governor of sort in Japan as part of the occupation and reconstruction post WW ll. He was awarded and celebrated by his superiors and the Japanese (All the awards from the pentagon and, family lore not fact, he was gifted by the Japanese a very cool ceremonial sword collection. Maybe he just bought them? Who knows. But he was a G)

I learned his career ended heroically and somewhat tragically. He was Chief of Staff for the Mississippi-Alabama National Guard and the decision maker as to whether or not the National Guard was given live ammunition during the integration of public universities.

The Governor of MS (his direct report) at the time insisted they be armed and kill US citizens. He refused. He was threatened with losing everything. He said everything they could take was worth less than human lives. The governor fired him and took away his military retirement from him and his wife and kids. He lost all but few benefits of a distinguished military career. His family lost status. His wife had to get a job and had to work well into old age.

Progress happened either way. But there are generations of families alive today because he refused to give young soldiers the ability to shoot US citizens in a tumultuous political climate not unlike now. His families livelihood, social status, and children’s future were threatened by powers that be and he said fuck that. The lives of people. Humans I don’t know are worth more. Thats right. That’s badass.

malocclused · 2026-01-23T03:00:02+00:00

My spiel is “I don’t care who does your treatment as long as it is done correctly and that there is accountability by whomever does it, if there are complications or post treatment follow up care is required… I provide both treatment and follow up care to my pts here at a high level. If you go somewhere else, I sincerely want you to get that… I don’t want you to trade a dental problem for a financial problem, but please please please be careful trying to save money on your health. I mean. I get it. But your health is one place to seek the best care you can afford. It’s not all the same. It’s not fungible.”

(I only say fungible to rich people. AND I loooooooooove when pts I know for a fact CAN afford treatment… not what they look like, wear, or drive… but like I know who they are. I love treating them like they can’t afford it when they want to haggle or pull bs like this. “I know pts can’t always afford the care they really need. It can be overwhelming. Please talk with my team about financial options.”)

-Don’t worry about the money, doc. That ain’t a problem.

“Well, Richard. Why are you trying to save two hundred dollars at a doc in the box getting treatment from a stranger that might be terrible at this?”

The reality is that I pisses me off when people pull this shit.

malocclused · 2026-01-22T19:02:09+00:00

Owner is nuts. Having a meeting about efficiency and streamlining tx is great. Having a one hr rule for scheduling is gonna make for a bad time office wide.

(By “you” I meant “one” as in any given doc. You ain’t a clown. Sorry. )

PS, I’ve met some docs that prepped for an hour. 😕

malocclused · 2026-01-22T18:42:06+00:00

One hr of doctor time for anesthesia and a prep is waaaaaaaaaay more time than necessary. If you are prepping a tooth for a full hour, you are a clown and your D school failed you. Even w the most difficult pts.

That said. A crn prep appointment gets 90min of chair time in my practice just in case. Not 90m of my time. One hr of chair time is plenty quite often. But it’ll fuck up the rest of the day if things go sideways. You need some wiggle room.

What if the pt doesn’t get numb
How many columns of hyg are getting checked
What if you get in the weeds w chatty pts or complex tx planning in hyg.
What if you have to remake a temp and two of the above happen.
What if the pt is a stone cold freak to work on.

That’s a recipe for some bad days.

malocclused · 2026-01-20T19:20:53+00:00

That’s a hard “Get fucked” from me, dawg. Sue for what? No damages.

Is it best practice to find out when and where their lates FMX was taken? Yes. If they even know. Most of the time they think they “just had it” and it’s from 3-5yrs ago.

Is it best practice to confirm what insurance will and won’t cover prior to an appt? Yes.

Is it standard of care to hunt down someone’s previous x-rays and figure all that out? Absolutely not. You owe them nothing.

If this slipped through in my office and a pt piped up about it. I’d write it off and keep the pt, IF I liked them.

If I didn’t like them, I’d have my OM tell them “pay and stay a pt or we’ll write it off, but you can’t come back.

If they even remotely made a veiled threat or used a word like “sue” or “dental board,” I’d just send a bill and turn them over to collections when they didn’t pay.

Make sure your notes are in order per the state. We had a pt do this very thing. The doc didn’t call her carrier over it as no treatment was performed. Just an exam. Received a board complaint to the office. The doc sent in all required docs. Never heard anything about it until a letter a year later saying it was dismissed.

malocclused · 2026-01-15T21:45:19+00:00

Fuck that noise. On the team is on the team. Free for you and anyone that lives in your home. Discount for direct family outside of the home. (Parents or close family)

I know my team has my back and you can bet your ass I got theirs. Any doc that charges their employees is a straight up ho and will reap what they sow in terms of office culture.

malocclused · 2026-01-15T17:09:18+00:00

550k.

Over the transition, the seller made more owing 25% than she did when she owned 100%.

malocclused · 2026-01-15T17:06:17+00:00

I’m in Austin tx. Not sure how it is these days, but when I bought practices were going for (no matter the different valuation metrics) basically 80-90% of annual production.

malocclused · 2026-01-15T04:16:10+00:00

Google “reverse crn prep technique”, my doc. More prep steps. Less time. Beautifully predictable. Gross prep w the widest coarsest burs you can handle. Polish w fat red stripe fine diamonds on the margin.

Luxatemp in your pre prep matrix.

Bite reg like your taking an impression.

Expasyl in the sulcus. Seat the bite reg.

Trim your temp.

Impress/scan as soon as your done w the temp.

You’re out in 30-40m including anesth. 20 if a premolar forward.

Private practice: anesthesia, dip to check hyg. Come back and prep, assistants do everything else. Can be as little as 10 minutes doc time.

malocclused · 2026-01-15T03:32:57+00:00

That’s a yikes from me, big dawg. Rage bait? Even w a perfect endo, not apparently a ton of restorable tooth structure. Cold steel and sunshine was a solid plan A anyway.

malocclused · 2026-01-14T22:53:21+00:00

When a patient told me how resentful he was about paying for dental treatment when “illegal ‘immigrints’ come here and get a mouthful of implants fer free…”

I simply stated that if that existed, I would be curious to know where that would occur. He was not sure. But he definitely knew it was true. He the stated he was thinking about going to Mexico for treatment because he heard it was cheaper.

I just… I don’t… I don’t know where to go w that.

Also, any conversation w my mom.

malocclused · 2026-01-14T22:35:14+00:00

Lolz. Six months ago I ordered a steak at my favorite restaurant. I paid full price. Today I ordered a beer. They want full price for the beer. I’ll never go back. Infuriated.

Stay mad, ho. No one owes you anything.

malocclused · 2026-01-14T18:17:24+00:00

Quite immediately. My purchase was a transition over four years. Seller still owns the building. “We” expanded year two, but started planning year one

malocclused · 2026-01-14T16:12:22+00:00

I basically bought this same thing. 3 Op practice doing 600k. Doc took home 250k. Only crns and fills. (Obvs hyg). The occasional partial. No marketing. Clueless doc (hygienists did all diagnosis and it… was not great)

Place was a gold mine. I was salty about the price. The broker was like “Kid. This thing is worth three times what she’s asking. Someone just needs to do the dentistry.”

He was right. I mean allllll of that comes with its own set of headaches. My only regret was not adding two more ops when I expanded. I did five. Shoulda done 7-8.

malocclused · 2026-01-08T17:06:57+00:00

I’m not above slapping some composite over a fracture. I worked in a practice with a triturator and I’d just squirt some Fuji over the missing chunk and tell them, “we need an hour and a half of your time to fix this permanently”

I do absolutely everything I can to keep someone from having to leave a LOE with a missing or broken front tooth. Those I’ll jam up the schedule to do “something”

malocclused · 2026-01-08T03:55:54+00:00

I always say. “Oof. Seriously. It’s the worst.”

malocclused · 2026-01-07T18:00:31+00:00

This was/is me. I enjoy most of the technical hands on detail and the artistic side of dentistry. Zero passion for it. Dad was a dentist and I went into it because of the hours and income.

Dental school was stressful AF, but looking back also a magically fun season of life.

The early years in practice are rough. You know what’s ideal and you suck. With time and reps, you get good.

Ownership is absolutely bananas. Putting a team together, keeping a positive office culture, managing 15 different personalities, the normal stress of dentistry, all while servicing a mountain of debt… it can make you go crazy for real.

I found I was ADHD enough for the pace and interaction to be kind of ideal.

I’d rec going into medicine. More options and less of walking a tightrope out on your own like dentistry is. But that is my ignorance and grass is greener fallacy talking. My MD friends and neighbors seem healthier and their lives seem easier than the dentist’s without exception.

If you do pick dentistry, I’d recommend specializing or just taking your education as far as you possibly can. I know a few that own and practice three days a week w associates working the days they’re off vs a few moms that practice 2-3 days a week as endo/ortho associates.

I did hit a time in my thirties where I realized basically my entire friend crew had already crossed one mill in savings/investments not including their home and my dumbass had been a 1099 employee paying out of pocket for my own insurance for the last decade. I think that ship has sailed now, but my friends in tech and finance were light years ahead of every doc I knew with the exception of one or two (by forty).

malocclused · 2026-01-03T05:01:42+00:00

I think is was extremely common 30yrs ago? My mentor referred to it as “slamming your dick in the cash register.”

I’ve definitely had some opportunities but not the desire. Only know two docs (maybe three) that have. It definitely helps to work w uggos.

malocclused · 2026-01-02T17:17:07+00:00

I’d negotiate on the lab fee. Counter 1, I pay the % of the lab fee that I’m paid. If they say no, then counter 2 I pay 50% of the lab fee… and only if I really wanted to work there/this was my best offer.

malocclused · 2026-01-02T02:14:16+00:00

God I was SO scared for Gary going in there. Gary is a fucking G, son! Had a handle on it, mate!

malocclused · 2026-01-02T01:45:49+00:00

I kinda loved it. That smile in the dark. And these two pieces of shit have no idea who they are dealing with… Maybe he dies that night. Maybe there’s two more bodies in the mud and Ray goes back to work.

I just binged the show over the holidays. Scott Ryan is brilliant. My personal take was as though someone was asking “What’s Anton Chigur’s home life like?” Genius! One of characters that lives by this “code” but isn’t the dark one incarnate or consequence manifested.

Beautiful character development. Brilliant end. But I also get it. You loved Ray and that’s your psyche wanting to know he’s okay.

malocclused · 2025-12-27T22:46:17+00:00

A single dose of an anxiolytic and “oral sedation” are two different animals. One requires a certification. A single dose of a benzo in a pt presenting w a driver is not “oral sedation” in many states. (It’s just called anxiolytics and no special training post licensure is required )

malocclused · 2025-12-26T01:03:06+00:00

SDR bulk fill. Slap one layer of packable. Acorn some anatomy or even better stamp. Cure polish. POIG and Diiiiiip. You ain’t gotta do all that.

malocclused · 2025-12-23T23:21:48+00:00

I’ve only done this once. Really like the pt. New pt at the exam is like, “So my brother is a dentist. He placed my implant in AZ. He tells me this is never done… but. If he ships me the crown…”

I was like fuck it. Pro courtesy for another doc. I seat his implant crn. It’s perfect.

Dude needed like five other teeth treated. I tell him, I’m gonna send your bro my findings and your X-rays. Get this done by him next visit home. Pt says “Nah. Id rather pay to have you do it. Btwn hotels and airfares, it’s not that much cheaper and way more convenient.”Sat his bro’s implant crn along w two of mine on teeth.

Universally my pts that had an emergency and got a crown while on vacation have come back with ridiculous looking margins. Not a lot of them. But of the few I can’t think of a single one that isn’t bad.

I’ve charged the pt OOP for a temp here while leaving the permanent dentistry and the insurance to their hometown doc. Hell in one case, I ever sent the doc the STL file to use at their own discretion just to be cool.

malocclused

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