So you want to be an orthodontist.
You love teeth and want a specialty where you can have a great lifestyle, avoid back
pain, and delegate most of your tasks to your assistants.
Let’s debunk the public perception myths and give it to you straight.
This is the reality of orthodontics.
Dr. Jubbal, MedSchoolInsiders.com Welcome to our next installment in So You
Want to Be.
In this series, we highlight a specific specialty within healthcare, such as orthodontics, and
help you decide if it’s a good fit for you.
You can find the other specialties on our So You Want to Be playlist.
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If you’d like to see what being an orthodontist looks like, check out my second channel, Kevin
Jubbal, M.D., and more specifically our Day in the Life playlist, where we'll be covering
a day in the life of an orthodontist in the future.
Orthodontics is the specialty of dentistry that deals with the diagnosis, prevention,
and correction of malpositioned teeth and jaws.
Although orthodontists are best known for straightening teeth, a more accurate description
of what they do is ensure their patients have a healthy “occlusion,” which includes
proper alignment of teeth, jaws, and the bite.
This means that the teeth are not only straight in the upper and lower jaws, but also fit
well when the jaws close together.
Improper alignment of teeth and jaws can lead to a variety of problems including asymmetric
growth of the jaws, irregular wear, impaction, and early loss of teeth.
In addition, issues such as crowding may inhibit your ability to adequately clean your teeth
and gums which can lead to other issues down the road such as tooth decay, inflammation
of the gums, and loss of bone around the tooth.
Other problems include difficulty with speech, chewing, and swallowing in addition to aesthetic
concerns if the jaws and bite are not fitting together properly.
Therefore orthodontists are critical in developing proper form and function in the oral cavity,
which can ultimately help patients maintain their teeth for longer.
Every patient is different, so it’s the orthodontist’s job to use a combination
of in-person exams and x-ray imaging to develop a personalized treatment plan.
Although most patients immediately think of braces when they hear orthodontics, these
are not the only tools in the orthodontist’s arsenal.
There are a variety of appliances such as aligners, palatal expanders, micro-implants,
headgears, and facemasks, also known as reverse pull headgear, that an orthodontist may use
to improve a patient’s bite.
The tools used will depend on the patient’s complexity and individual needs.
An important method of differentiating an orthodontist’s practice is private practice
vs academic vs community clinics.
Most orthodontists work in private practice.
Some own their practice and take care of the administrative work that comes along with
owning a business.
Others work as an associate at private practices or work at a dental service organization,
or DSO, and only deal with the clinical aspects of orthodontics.
Associate orthodontists have fewer administrative responsibilities while owner orthodontists
juggle both the clinical and business aspects of the practice.
Although owning a practice does come with larger financial profits and no limits on
income potential, there are more stresses associated with owning a business.
On the other hand, associateships are much less stressful but come with income limits.
Other orthodontists choose to stay in academics or go into academics after a career in private
practice.
These orthodontists are often more interested in research and teaching than in the business
aspect of dentistry.
While some academic orthodontists will largely forgo practicing clinical orthodontics in
favor of research or administrative responsibilities, some will oversee complex cases that private
practice orthodontists refer to academic institutions for multidisciplinary care.
For instance, many craniofacial cases and some orthodontic cases requiring jaw surgery
are referred to academic institutions as they require multiple dental and medical specialties.
Lastly, there are community clinics which are largely volunteer-based.
Orthodontists that work in these clinics tend to have a passion for orthodontics and are
either financially stable or work in private practice on the side.
Community clinics often offer limited compensation and have fewer resources and staff, resulting
in more strenuous work for the orthodontist.
Although these practices are not common, they usually serve patients who need orthodontics
as a medical necessity, such as those with craniofacial abnormalities, who cannot afford
to seek treatment in private practice or academic settings.
In terms of compensation, private practice orthodontists will typically make the most,
followed by academic orthodontists, and lastly community clinic orthodontists.
That being said, there is a high degree of variability in compensation, especially within
private practice.
Let’s clear up some misconceptions about orthodontics.
To start, many people believe that orthodontists only treat children.
In reality, orthodontists see a wide spectrum of patients starting from around age 7 to
age 70 and beyond in some instances.
Another common misconception is that anyone who offers braces or aligners is an orthodontist.
This is not true.
Although some general dentists and online companies offer orthodontic services, they
are not the same as an orthodontist.
To ensure proper treatment and avoid permanent damage to your teeth, the surrounding gums
and bone, your smile, and even your facial appearance, it is best to seek treatment from
an orthodontist who has completed an accredited residency program.
Many people also think that orthodontics is an easy specialty.
To a layperson, it may seem that orthodontists just put on braces and straighten people’s
teeth.
In reality, orthodontics is much more complex than that.
Orthodontists have to consider the patient’s bite and where the teeth are most stable within
the bone, which varies from patient to patient.
There is also a great deal of physics and biomechanics involved in orthodontics that
may not be apparent to those outside of the field.
To become an orthodontist, you must first become a dentist, which requires completing
college and four years of dental school.
If you know you want to be a dentist or orthodontist from high school, there are combined dental
programs that reduce the number of years required for college and dental school as well.
After dental school, you need two or three years of orthodontics residency to become
an orthodontist.
There are two types of orthodontics residency programs: academic and hospital-based.
Academic orthodontics residency programs are often affiliated with a dental school and
include both a didactic component and a clinical component as part of their curriculum.
This means that residents will split their time between the classroom and the clinic.
These programs can either be two years or three years in duration.
One of the benefits of completing a three-year program is that they generally include a Master's
degree upon completion whereas many two-year programs do not.
Additionally, a full orthodontic treatment generally takes 2-3 years to complete, so
residents in three-year programs will have the opportunity to see more complex cases
from beginning to end whereas students of two-year programs may not be able to see these
cases to completion.
That being said, there are definite downsides of three-year academic programs, the big one
being tuition.
Unlike medical residencies where you are paid to be there, the majority of academic orthodontic
residencies charge tuition.
These residencies are not cheap either, with some schools charging upwards of $110,000
per year.
Hospital-based orthodontic residencies are, as the name suggests, affiliated with hospitals
instead of academic institutions.
They are generally two years long and, unlike academic programs, are mostly clinical with
fewer didactic and research components.
In addition, many hospital residency programs offer stipends as opposed to charging tuition.
In terms of competitiveness, orthodontics is known for being one of the most competitive
dental specialties, with only around 55% of applicants matching into orthodontics each
year.
To match into orthodontics, you will have to be at the top of your class and have solid
research experience, extracurriculars, and letters of recommendation.
We have an entire playlist going over the most effective study strategies to help you
on your way to becoming a top student – link in the description.
Dental students best suited for orthodontics are often well-rounded and highly motivated.
They tend to be social and enjoy a low-stress environment with a healthy work-life balance.
For orthodontists that want to further subspecialize, there is only one main fellowship option available.
Craniofacial orthodontics is a 1-year fellowship program that provides orthodontists with additional
training and skills in the management of complex craniofacial anomalies.
This includes issues such as cleft lips and palate and other dentofacial deformities.
Craniofacial orthodontists will often work as a part of a craniofacial team, which includes
plastic surgeons, oral surgeons, pediatricians, pediatric dentists, prosthodontists, speech
pathologists, otolaryngologists, geneticists, and neurosurgeons among others.
It should be noted that many orthodontists receive training in craniofacial orthodontics
during residency and will still treat craniofacial patients in their respective practices.
As such, those that pursue fellowships in craniofacial orthodontics are generally passionate
about treating patients with craniofacial abnormalities and want the extra experience,
or they are interested in working in academic or hospital settings.
In terms of compensation, craniofacial orthodontists typically make less than general orthodontists
as they will most likely be focusing on craniofacial syndromes instead of the more bread and butter
orthodontic treatments which are often paid out-of-pocket.
There’s a lot to love about orthodontics.
To start, the lifestyle of an orthodontist is desirable relative to most medical and
dental specialties.
Most orthodontists work regular 9-5 business hours.
The number of days you work depends on the lifestyle you want – some will work only
a few days per month while others work 5-6 days a week.
Although there is generally a tradeoff between lifestyle and compensation, orthodontists
are also at the higher end of compensation relative to other dental specialties.
According to the U.S. Bureau of Labor Statistics, the average orthodontist takes home around
$267,000 per year.
Orthodontics is also less physically demanding than many other dental specialties.
Whereas most dental specialties struggle with strain on the back and hands from lengthy
procedures, much of an orthodontist's work can be delegated to assistants.
As a result, the orthodontist’s main job is to direct the treatment rather than directly
perform the procedures, leading to more downtime during patient care.
Another benefit of being able to delegate work is that orthodontists can see many more
patients per day.
The average orthodontist will see around 30-60 patients per day with some seeing greater
than 100 patients per day.
Patient volumes will vary, however, depending on the size of the practice as well as the
systems that are in place to delegate work to assistants.
Orthodontics is also known for being a relatively low-stress occupation.
There are no life-threatening emergencies and most mistakes are often reversible.
Lastly, the fulfillment of building relationships with patients over years of treatment can
be rewarding as you transform the smile and lower face of the patient.
Although orthodontics is an awesome specialty, it’s not for everyone.
To start, the training to become an orthodontist is long and comes with additional opportunity
costs.
Unlike medical school, residency is not required after dental school.
This means that instead of going out to practice as a general dentist and making a solid six-figure
income, you’ll be committing an additional two to three years to orthodontics residency.
Orthodontics is also highly competitive relative to other dental specialties, meaning that
you will have to work much harder than your peers during dental school to graduate at
the top of your class.
Some people also find orthodontics to be somewhat repetitive.
As a general dentist, you are able to perform a wide variety of procedures; however, once
you specialize in orthodontics, your scope becomes much more limited.
Being an orthodontist can also be socially exhausting at times.
Because much of the work can be delegated to dental assistants, orthodontists see higher
volumes of patients per day than most other medical and dental specialties.
This means meeting and interacting with anywhere from thirty to more than one hundred different
people each day, which can be exhausting – even for the most extroverted of orthodontists.
Lastly, according to the American Association of Orthodontists, approximately 79% of orthodontists
own or share ownership of a practice.
This means putting up with the additional administrative burdens and stress that come
along with owning a business.
How can you decide if orthodontics is right for you?
If you are passionate about teeth and want to help your patients have straighter, healthier
smiles while improving the aesthetics of their lower face, orthodontics might be a good fit.
In terms of personality, you should be at least somewhat social and enjoy being a leader.
You should work well with others and be comfortable delegating tasks to other members of the team.
Lastly, if you want a career that has good work-life balance and are unwilling to compromise
on compensation, orthodontics won’t make you choose between work and family.
Huge shout out to Board Certified Orthodontist, Dr. Jenny Jeon for helping me with this video.
Check her out on YouTube, Instagram, and her other social media platforms - links in the
description.
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Thank you all so much for watching!
To learn more about other specialties within healthcare check out So You Want to Be an
Oral and Maxillofacial Surgeon or another specialty on our So You Want to Be playlist.
And don’t forget to show Dr. Jenny Jeon some love.
Much love, and I’ll see you guys in that next one.