Endo Mastery

Options for new endodontists


Last week at the AAE meeting in Phoenix, I spoke to a lot of young endodontists about the challenges they are facing. Overwhelmingly, it is a financial precipice for these doctors, who are sitting on a mountain of debt as they try to get started in the profession. With 83% of the dental class of 2021 having student loans and the average debt load of over $301,000, young dentists are caught between the proverbial rock and hard place. Young endodontists have even more debt on average when you add in the financial burden of their residency.


Education is, of course, an investment in your future. But it is an investment that needs to begin producing a return right away after graduation. Servicing that debt is an immediate need, as well as supporting your cost of living. So, for new endodontists, they need to act quickly and, more importantly, in the right direction that sets up their entire professional future.


Most of the young doctors I spoke to have the goal to eventually own their own practice. However, their educational debt greatly affects their ability to get financing, and buying an “average” endodontic practice in every way (average productivity, referrals, staff and facility) is even out of range.

Start Ups and Associateships

Faced with this limit, there are really only two options. The first option is a cost-controlled start up consisting of an affordable location, minimized square footage, essential equipment and minimal staff. With a start up, you avoid paying for goodwill in a buyout, which means you’ll be starting with a zero referral base. Your life from day 1, will be about marketing, marketing, marketing to develop referral relationships.


A lot of doctors choosing the start up route make some pretty fundamental mistakes that cost them a lot of unnecessary expense and stress at the beginning. Real estate and leasing mistakes, over-equipping beyond the essentials, under-trained team members, poorly set up practice systems, and none of them obviously have any realistic experience in dental referral marketing. It can be a long row to plow without careful planning and support.


The second option when faced with financial limits is to associate in a practice, at least as a stepping stone while you pay down your debt and save money. The challenge with associating is determining what your income could be in the practice you join. You want to be in a practice that is ready to grow quickly by expanding clinical capacity. Otherwise, you could end up in a practice where you only complete two cases a day (or less!) on average, and you end up spending most of your time twiddling your thumbs (with your take-home pay reflecting that reality).


There are specific criteria that are helpful for associate doctors to determine if a practice is ready for them and can get them busy quickly. The first criteria is whether the practice is already successful at an above average level. If an “average” doctor completes only 3 to 4 cases per day, a truly associate-ready practice will have an owner doctor who is completing at least 50% more cases (5 to 6 cases per day).


Above average productivity is a sign of two important things that every associate wants to find in an employing practice. First, that the practice knows how to market and build referral relationships. Second, that the practice has figured out how to be efficient and productive clinically. That’s what will drive your income most as an associate, and that’s why associates in Endo Mastery-coached practice typically earn 2 to 3 times as much as associates in other practice environments.


Finally, I should mention the corporate vs. private practice landscape. Corporate entities are building their presence in the profession, and they are on a hiring spree for associates. I would suggest you use the same criteria to evaluate corporate positions. Focus on the specific practice you would work in, how truly associate-ready is it, how many cases will you complete daily, at what fee and collection ratio (since your compensation is percentage driven on collections). Also, keep in mind that working for these organizations adds another layer of management and oversight above you. Carefully consider whether the corporate culture is something you want to live with.

Your Career Start Options

There are a lot of questions about starting out and it’s hard to find clear answers. To help solve this problem, Endo Mastery has launched a free Career Start program for endodontic residents and new endodontists. This program features twice-monthly videos and a free one-day livestream seminar in June: “Pathway to Your Ideal Success in Endodontics”.


Whether your focus is new practice start up or associating, the Career Start program will give you some very practical information to make the best choices, plus crucial financial guidance to eliminate debt quickly and maximize your income. We’re really excited about this program. It’s something we’ve wanted to do for a long time, and we hope you join us!


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