A Year Later

To update everyone on where I am. It’s been a year since getting my board certification and over two years since I started practicing (outside of residency). Easy to say, I love what I do. The lifestyle can’t be beaten. Really. In fact, there is nothing like being in total control of your own schedule. I still put in the hours that I need of course, but on my own terms. I’m more relaxed than I had ever been. Besides, I also never deal with traffic.

As expected, I can tell you that my case load has gone up considerably and I don’t see it going down any time soon. In fact in about two or three years, I see the oral and maxillofacial radiology field will get a large boom. Demand is growing and I bet that soon insurance companies will pick up diagnostic radiology (they will have to, dentists and patients are already starting to demand it). Besides, with CBCT becoming such a huge part of dentistry I can’t imagine insurance companies not wanting to cover their liabilities.

I think once that happens there will be a great shift in diagnostic radiology from analytical to basically ruling out major pathologies. This of course will be a natural progression as more and more graduates are getting comfortable with the technology. They can do their own analysis (implant measurements for example) but most will offload ruling out pathology to radiology. In my opinion this is also where it should be.


  1. It’s been wonderful reading your blog over time. I myself am a Oral Medicine and Radiology final year resident in India wishing to pursue radiology as a career. I cleared my national board and GRE. What would be your opinion on foreign graduates applying for residency in this field in US? I’m looking to apply and needed some guidance. Which schools to apply and what sort of expectation I should keep. Looking forward to you replying.

  2. My opinion is that it tends to be a bit tougher for foreign graduates. Myself I am for it and don’t see anything against it but most school, as far as I can tell, prefer for people already practicing in the US to apply. That being said, there’s really no harm in trying, and especially that you already have a background in radiology this will likely help you. As far as which schools I think you’ll have to research that yourself. There aren’t that many and so I don’t see a reason to not apply to all.

  3. Thank you again for your work. I’ve followed your blog since before you started residency. I was in dental school at the time exploring options. I’m in GP now but considering an endo residency. Your talk about controlling your schedule resonates with me. I don’t like the lack of freedom associated with a patient schedule; I actually get anxious knowing that I HAVE to be there for my patients.

    I decided not to pursue OMFR in part because I feel you had a less than favorable outlook for the field. Especially considering that you were still in general practice. Do you still work as a GP? If so, do you need to for financial reasons? Can you be as frank as possible when discussing hours worked, compensation, and comparison to GP (your previous career) or to other specialties (like endo)?
    Thank you for your help to all of us searching for information.

  4. Well to be clear, as of last year I make more money doing radiology as I did working as a dentist full time in a corporate practice but not more than in a private practice. I still practice GP one day a week, but I also have a ton of student loans (in the tune of half a million). I can live on what I make from radio but it’s nice to have that extra income to pay off my loans quicker. If it weren’t for that I would absolutely concentrate on radiology and move on with my life. That is my plan anyway.

    Comparing with endodontics is tough. Endo is an established field that has been around a very long time. Insurance companies cover it and patients require those services. Right now there is definitely more money to be made in endodontics or any other field; including private practice GP. Radiology is not at all established. It’s new. But if you look at the practice of radiology today compared with three years ago it’s night and day and only getting better. Conebeam CT is becoming, very quickly, a huge part of dentistry. In fact if you read position papers from AAE you’ll see that it is also very quickly becoming the standard of care in endo.

    I made a bet on radiology which so far has paid off for me. I make more money and much more comfortably than I ever did in corporate dentistry. It still has some catching up to do. The difference is I was maxed out as a GP. I was incredibly busy and very successful but I physically could not do more. I also expect that over the next five years I will double my radiology income and I will do it easily and still have room to grow. That is my take.

  5. Thank you for the reply. A few more questions: How many hours/week are you practicing oral radiology? What are you doing most of the time (sitting in front of a computer looking at scans)? From where do you get referrals? What caused your case load to increase? If you are visiting a state in which you are not licensed, can you read scans sent to you from another state which you may or may not be licensed? A clinician (especially a practice owner) has many responsibilities outside of treating patients, what might some indirect responsibilities of an OMFR be (aside from reading scans)?

  6. Where to start.

    1. I work in radiology full time. So I guess 40 hours a week, although I happen to be fast. Very fast. Most days I put in about four hours of concentrated, no distractions, work.

    2. Sitting in front of a computer and reading scans. If I’m in the office, I will do cases between patients.

    3. From other referrals usually. I work with some radiology groups as well but usually clients will refer other clients.

    4. Right now this is being debated, but as it is, I can read scans from any state. Not sure if I’m out of town but I don’t think it matters. It’s not like the knowledge changes. As my liability insurance goes, I am covered for anywhere in the US.

    5. Not sure what you mean by responsibilities? My work is simple, download scans, write reports, upload the report. I wouldn’t have it any other way.

  7. You mentioned you think a lot of flow may come from practitioners wanting to rule out pathology. If a practitioner sees an anomaly in a scan, he/she may refer to an oral surgeon or a pathologist who can physically see the patient. How does an OMFR fit into this?

    Comparing 8 hours in your current GP position with 8 hours reading scans, which is more productive? About how many scans do you read in the 4 hours you put in daily? What is an average fee for reading a scan? Let me know if I’m asking too much. Thanks.

  8. Practitioners include oral surgeons and pathologists. None of them biopsy blindly. They all have at least a panoramic radiograph or a CBCT. Also I don’t get every single case that’s referred to them. I know that they selectively send scans which they have questions on. An OMR fits in the same way medical radiologists fit in. Somewhere in the middle on a lesion, should it be biopsied, monitored? Concern, no concern? Is it part of a syndrome? What about extent? Any missed lesions? Lots of questions to be answered for all types of docs.

    On average, 8 hours of radiology would be more productive for me. But like I said, I’m real fast. I’m not going to get into the specifics of my numbers. I would say that the bottom line is that right now, a private practice GP or an endodontist will make more money. In five years it might be a different story.

  9. Oh, I see. Do most of your scans come from surgeons and pathologists? What do you think makes you fast (were you a fast GP, are you more familiar with a computer than most, special software, refined techniques)? I really like hearing about the freedom you have practicing as an OMFR and that you’re avoiding the see-3-or-4-patients-at-the-same-time situations.

  10. I get from everyone, the majority of my work comes from endodontists, surgeons, orthodontists (in that order) but honestly it’s fairly even from everyone. General dentists not as much because unless they’re placing implants or doing root canals, there’s really very little they can do with the scans.

    Not sure what makes me fast. I’ve always been good with computers and really know how to use word processors inside out. But basically I set up a system that seems to work well for me.

    Freedom is nice. In fact, for me, it’s worth the (in my opinion temporary) pay difference. I know my back feels a thousand times better and I am much less stressed.

  11. I had wondered if there is a market for an OMFR to consult for practices whether building them out as to what hardware/software would result in best quality or going to an established practice to help them improve their quality/practices. Do you see a potential in this? How about other alternatives to academia and reading scans?

  12. I guess there is. We get questions every once in a while on which machine to use for which purpose. But overall I would say that sales reps tend to do more of that. I definitely would not make a business out of that. I assume there are some opportunities out there but if you’re not interested in academia or reading scans (private practice) then I don’t think radiology is a good choice right now. You can always run a mobile CBCT (in a van that drives from office to office). Or even open a radiology center but as far as I’m concerned that’s a losing bet. Eventually most practitioners will have their own machines.

  13. I’m greatly interested in reading scans and part time teaching. I ask about alternatives because I worry that after going through a 3 year residency I may end up back where I was (GP). Say for example that CBCTs were able to take even more narrow fields (a single tooth and the tissues just apical), or intra-oral MRI became viable (SWIFT) leading to very narrow fields that an endodontist may be interested in. Would this kind of progress greatly affect the number of scans referred? Would this be detrimental to your practice? Do these advancements seem obtainable and probable in the near future? Thank you again for your time and help.

  14. Great question. I do think it would affect the number of reports, but in a positive way. These modalities would be a huge boost to the number of cases. MRI is very difficult to read, in fact I know many OMRs who avoid it all together. If SWIFT MRI were to become a normal reality, which would be amazing for dentistry, then your workload will definitely go up. As far as small volume, that already exists and I still get a ton of small volume scans. Also even if other modalities come up, the radiology career isn’t going away any time soon. More than likely it will increase in business. I remember when implants first came out they said that endodontists will no longer be needed. But here we are, they’re still around and I get tons of business from them. It’s kind of the same thing I guess.

    Don’t get me wrong, it’s impossible to predict anything but all I see is a bright future and where I am now vs where I was when I started. It’s been nothing but better. This year is already looking much better than last year.

  15. Do you have current thoughts on MS vs certificate. Specific program thoughts on the 9 (?) programs? A 3 year residency does seem kind of long, how did you feel about it?

  16. Nothing that you probably wouldn’t consider yourself. If you plan on teaching, then an MS is what you’ll need alongside the certificate. If you never ever will teach then I don’t see it as being important. Regarding time, there are two and three year residencies. For me neither option seems like that big of a deal. It is a specialty after all. Medical radiology is 5 or 6 years I think. So we have it better.

  17. Im a foreign graduate recently got accepted at an OMR residency in the US. Unfortunately there’s no funding for us and the tuition cost is roughly near 130,000$. My question is it worth this much investment and want to know earning potential after graduation. Is it enough to pay off this treacherous loan.

  18. Im a foreign dentist recently got accepted to an Oral radiology residency program. Unfortunately we dont get tuition reliefs and my question is the program worth investing more than a 100 grands looking at the job prospects and earning potential.

  19. Dr Sunny, that’s really up to you to decide. The price seems outrageous to me. Can’t believe it’s that expensive, that being said, you’ll walk out an OMR and in the grand scheme 100k of debt isn’t a huge amount here. Regarding pay like I have mentioned before it really varies and I won’t discuss the specifics of what I personally make. Suffice to say I have a lot more than 100k in debt and it seems to pay for itself.

  20. The short answer is yes. The pay depends on whether you go academic or go into private practice. You can always fall back on general dentistry if you need to, and so for me the risk is minimal. But that is something that you will need to decide on. Honestly it takes a bit of soul searching to decide whether it’s worth it or not. The price, IMO, is crazy high but if you’re concerned whether you will be able to pay it back or not I don’t think that will be a problem. Whether you pay it through radiology or through dentistry either way will be doable.

    Regarding jobs, I think the field is significantly expanding. It is my opinion that in five years we will be busier than we can handle.

  21. Very much so. Things have been great for me personally. The market seems to be growing and my numbers clearly show that.

  22. If you don’t mind can I ask you what resources did you use for learning CBCT? Interpretation of the scans plus the software itself.

    We recently acquired a Kodak CS 9300 and residents have to do reporting on their own here as some of the new faculty additions aren’t well versed with the machine so it’s proving to be difficult.

    If you could help in some way.

  23. Hmm that’s a dilemma. One of the best radiology books out there is White and Pharoah’s Oral Radiology Principles and Interpretation. There is also Lisa Koenig’s Diagnostic Imaging: Oral and Maxillofacial. For me personally it was the residency and the lectures. I am very weak when it comes to learning from books and so I didn’t use any. I am hoping someone else can pitch in and answer this question.

    Lectures are what helped me learn and experience from my faculty proved invaluable.

  24. Thanks for your input. I study from these two books only but the problem is we don’t have lectures here and the faculty isn’t experienced.

    Reading books really don’t help in getting the software I think. White and Pharaoh I feel is excellent for description of pathology and even the basic principles but that’s more of a theoretical thing I guess.

    I hope you are understanding where I’m coming from.
    Thanks again.

  25. I agree, the software may be best learned by the manual? Maybe? For me I basically load a volume into the app and play with it. What’s the worst that can happen?

  26. Yeah. That’s what I have been trying to do. We get rotations in cbct here where say for a month, one resident will do the reporting of all the scans that come in the month and get it approved by a faculty member before signing off. Plenty of time to play around I guess.

    Apart from the default carestream software , we got OnDemand 3D as a third party software. Any experience with that? I personally feel, OnDemand shows much better images but the carestream has a much simpler layout.

  27. A month should be good to get comfortable with the software. At the end it’s about your interpretation and diagnosis. The software is just a tool to facilitate that.

    I have used both Carestream and OnDemand. I prefer OnDemand, it’s a bit more advanced but I agree, the interface itself is not very good. They can go a long way with user friendliness. I wish some of these companies would hire me as a UI designer.

  28. Hey there, Thanks for all your post..it is a great window to look into! I am a Pediatric dentist but I have always loved Radiology and the more I see now as a private practitioner, the more I am intrigued by this ever growing field. In your opinion, are there any implications of the benefits or advantages to possibly being dually trained in Pediatrics and Radiology? I have done a Three year residency already and I am the owner of a great practice, I have just always loved radiology and wanted to weigh out if it would be worth going back for another 30+ plus to be dual trained. I too have lots of loans and also lots of kids;) What do you think?

  29. Hi, I think yes and no.

    The yes: I personally know a couple of orthodontists/radiologists and it’s nice to have that background when they’re consulting on cases for other orthodontists. It is a very strong way to attract business. I imagine for you this would also be a similar proposition where you can consult for other pediatric dentists (and even orthodontists).

    The no: when you are also getting cases from outside your specialty. Not that it’s bad, don’t get me wrong. I think it’s great personally but when you’re working on adult cases for example it may not necessarily be an advantage. Is it a reason to not pursue something that you really want to do? Of course not and if anything it will make your background that much stronger on things outside of pediatrics.

    Here’s a scenario that you may consider as a business owner. As your business grows you can hire other pediatric dentists and at the same time you can do your radiology work from the office. Dual income in the same amount of time.

    The question you have to ask yourself is what do you plan to do with your business while in residency? Let someone else run it? Sell it?

  30. Could you update how everything been with you and oral radiology the past year! your blog is very insightful!

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