Newbie multi-hyphenate: Let's talk money

So, here’s the deal—once you finally wrap up dental school and actually start practicing, you sign your contract with the state agency and everything kicks in. Usually, by the fourth month, they start cutting those reimbursement checks. But my question is, how does that math even work if you're a brand-new dentist and don't have a full roster of patients yet? If they pay out a minimum regardless, what’s the formula? Is it just 1,650 patients times some dollar amount—say, an average of $13—or do they use those tiered brackets like the 0-3 year mark, then 3-18, then 18 plus, and just pick a middle ground to settle on?
Look, if we're talking about an average of $13, that puts us at $7200. If the government is handing over $1,250 a month, plus the nurse gets $6,500 including benefits, and then you factor in maybe $3,000 for rent... the doctor is left with $10,000. Honestly, if that covers the basics, why would anyone even bother trying to build a patient base or spend money on actual supplies?

You first need to have enrolled 950 patients, and after a year, I expect that number to climb to at least 1,500 or 1,600. They aren't just handing out money for nothing. Plus, you clearly don't realize how much supplies and equipment actually cost

and what, they just work for peanuts until they hit that 950 patient mark?

Until you hit $950, stick strictly to the private practice rules.
And there is no way in hell a dental assistant is getting $6,500 out of a $20,000 monthly revenue. The payroll taxes and overhead on those numbers push the actual costs up to nearly double... and that’s just her salary alone.
Electricity, water, gas, and every other utility bill...
Then you've got supplies, which get incredibly expensive if you actually care about quality. We're talking about a decent chair costing at least $40 $0.00, plus the autoclave, instruments, the compressor, or a high-end physiodispenser if you want something reliable. Then there's rent—whether you're leasing or buying the space—furniture, and inevitable equipment breakdowns...
Only after all that do you even look at the dentist's actual pay and the taxes taken out of it. You think $20 $0.00 is a lot? Anyone trying to run a legitimate, serious practice on $20 $0.00 isn't even covering their basic overhead, let alone making a profit.

But honestly, that’s still not a great setup—if they don't land a job right away at the practice of whoever handed over the patients, they're stuck. Like, if the old doc just retires and leaves them hanging, they've gotta deal with those student loans for the first year of work alone... it's a mess.

Starting your own private practice right out of the gate is just bad math. You're looking at hundreds of thousands of dollars in overhead before you even see your first patient, and finding a steady patient base is easier said than done. Even if you find a turnkey clinic to rent, covering those monthly operating costs is a massive uphill battle. Most people start by working for someone else, or if they get lucky, inheriting an existing practice or landing a spot at a community health center. I know plenty of colleagues who spend years just doing locum work without ever securing anything permanent. For beginners, the field isn't exactly easy going.

huh.. so what's the starting pay look like if you land a job at a private practice instead of, say, a county clinic?
I know it’s all about how much business they pull in and what the owner is actually making, but does anyone have a ballpark average?

Aaron Evans3 said:huh.. what’s the starting pay like if you work for a private practice instead of a community health center? I know it all depends on how much business they bring in and their overall revenue, but is there some kind of average?

Hardly any beginners work purely on commission (personally, I don't know a single one, though that doesn't mean they don't exist). Pay usually isn't tied to volume like that. Most people are just signed up at minimum wage, and honestly, half of them probably get a chunk of it under the table.
In the beginning, it's way more financially worth it to work at a public clinic because the salary is significantly higher and everything actually hits your bank account properly.

I wasn't even talking about commissions—I mean, if someone lands a gig at a private practice that's absolutely slammed, they’re probably gonna cough up way more for a doctor's salary. But trying to get a job at a local community health center? Forget about it. It's basically impossible unless someone hits retirement or goes on long-term disability... and even then, you’ve got a massive line of people waiting for that spot. I just think, honestly, if you're getting hired anywhere, it shouldn't be for less than $6,000 a year—unless, obviously, you're opening your own private clinic where everything just depends on how much business you pull in, right?

Don't sweat it; most people are sitting well under 6,000😉

And even if they somehow end up with extra cash, it doesn't change much. Their paycheck says minimum wage, but then there's whatever else they pocket... they walk into the bank thinking they're set, only to realize they can't actually do anything with that money.

Don't try to weigh in when you're only 15.

How am I even supposed to know if someone's running a private gig or going through Medicare? Honestly, I’d much rather just deal with Medicare—I’m not about to tell them I’m working privately and end up having to bill everything out of my own pocket :P

Gerald Smith76 said:Don't come at me with that "you're only 15" nonsense. :P

How would you even know? I might not have even detailed my actual situation above. 🙂

Give me a break 😉

Aaron Evans3, there are contract clinics. You walk in and ask, "Good morning, do you take Medicare?" They say, "Yes, sign me up." Look, private practice is one thing, and being in the Medicare network is another; a doctor can do both, but you know exactly what you're getting with each option.