No, I’m not talking about the fact that we both are hired help who are paid to get people from where they are to where they want to be. Neither am I talking about the fact that all taxis look the same and the public cannot tell them from one another or from other types of transport. I’m not even talking about the fact that we both have massive unused capacity and free time but refuse to alter our business model or pricing to take advantage of that. Orthodontists are most like taxi drivers in our shared arrogance, entitlement, self-righteousness, hypocrisy and stubbornness. Allow me to explain.

When Uber burst upon the scene a few years ago no one really paid it any mind. In fact Uber went unnoticed by most of the population for an incredibly long time. I stumbled across the ride-share service relatively early on one cold night in Chicago after attending a dinner at the Mid-Winter dental meeting. It was snowing and there were NO CABS to be had but somehow cars kept showing up, as if by magic, to pick up others leaving the event. Finally I grasped a shocked gentleman getting in one of these cars by the arm and asked him “What’s going on here? How did you get a car?”

“Uber” he said while pulling away to get out of the cold damp.

“Uber?” I asked not quite sure I’d heard correctly. 

“Uber” he repeated and slammed the door. 

Well I spent quite some time pondering what “Uber” could mean while waiting hours to finally get a ride but the next day I figured out what was going on and how to sign up. I’ve been an avid Uber rider ever since. Anyone who’s ever tried Uber with an open mind will almost always choose Uber when presented a choice and a level playing field. 

So what? What does this have to do with orthodontists I can hear you asking. Everything. 

A year or two after this experience, people became widely aware of Uber and there was a huge backlash from taxi drivers trying to protect their livelihood and also from those who benefited from the status quo. Taxi drivers were honestly convinced that Uber was a bad thing, that Uber was unprofessional, unsafe, untested and a danger to the public. Taxi drivers scoured the news and internet for unhappy Uber customers or examples of freak occurrences when someone using or driving for Uber had a major problem and used they these rarities to confirm their belief that Uber was bad and unfairly stealing their customers. Taxi drivers never once stoped to ask why a startup could gain critical mass unnoticed and solely via word of mouth. Taxi drivers never considered that Uber might be filling a need that taxis did not. And taxi drivers damn sure never considered the possibility that they were being out competed by Uber because taxis generally suck. 

I travel a fair amount and it seems that taxis are the same the world over – unsafe drivers who look at customers as an inconvenience while trying to run a trip without starting the meter and taking you the long way so they can maximize the cash in their pocket while scaring the hell out of you by driving their cab like they stole it just moments before. Then then taxi drivers deny that their credit card machine works and once you force the issue, they want to charge extra for using a credit card while intentionally taking forever because they are mad that you, the customer, aren’t paying them in the manner they prefer. I won’t belabor the lack of cleanliness or timeliness, the smelliness or other issues that taxis regularly display. I only bring up the common problems that plague taxi cabs to point out why Uber might be attractive and to suggest that if taxis focused more on doing what they do better they might not lose as many customers to Uber. 

When getting out competed it makes sense for one to look at how to improve, right? Hell no! We human beings are not so silly as to follow logic – and so taxi drivers set out to harass, intimate and even brutalize those drivers who dared to sign up with Uber. Next taxi drivers went to government agencies and convinced some to write tickets, arrest and sue Uber and their drivers even though doing so was anti-competitive and bad for consumers. It’s interesting to think how they made this occur and curious until you remember that taxi drivers have traditionally paid municipalities big bucks in fees and taxes… 

So what happened to Uber? What happened to taxi drivers? You probably know but for completeness allow me. Uber continued to soar and overcome almost every obstacle placed in their way because they were on the right side of access and affordability. That’s what this country is all about! And taxi drivers? Well for the most part, taxi companies either improved or they didn’t – most improved to some degree once they realized that Uber wasn’t going anywhere (except in Las Vegas and Orlando and other places taxis are still a protected or have a monopoly – for now). The value of taxi medallions went down but surprisingly enough, there was never the feared taxi-apocalypse or massive unemployment that the anti-Uberites predicted. Despite the best efforts of taxi drivers, Uber was not proven less safe than traditional taxis. I suspect the opposite is true but it doesn’t matter.  I, for one, would pay more for Uber for all the reasons listed above but Uber does transport better and still costs way less than taxis. 

So what the hell does this have to do with orthodontists?? 

SmileDirectClub has followed the same path in orthodontics that Uber did in transportation. For almost 3 years now SDC has grown through word of mouth and internet marketing with very few orthodontists even aware of its existence. The few orthodontists aware of SDC say things like “you can’t do that” or “that’s against the law” or “the state board will stop them” or “the AAO should do something about this!” The first time I saw an SDC Facebook ad I commented saying “You can’t do that, that is practicing dentistry!” But when the SDC model was explained I saw that SmileDirectClub was an ingenious and legal way to massively increase access to while lowering cost and that SDC would make orthodontics available to the masses. I was alone in my views for the most part. Apparently I still am. For years now I’ve tried to get the orthodontic community to recognize that SDC is filling a need we are not and convince orthodontists to engage SDC to learn about what we obviously don’t know. I’ve failed and orthodontists have gone to state boards and organized dentistry to seek relief – just like taxi drivers. They have failed by and large but that hasn’t stopped orthodontists from blaming SDC for our inability to compete in this space. It couldn’t possibly be us at fault, could it? We orthodontists do what we do “the right way” and put out “quality work” and do things “properly” and anyone who does anything else is endangering the public. Aren’t they? All my friends agree it is so…

As SDC grows and utilizes more marketing, orthodontists are becoming aware of its existence (the Invisalign deal certainly gave SDC big credibility in the eyes of orthodontists too) and this awareness is sparking more backlash and cries for governmental protection for the beleaguered orthodontic guild and editorials that claim no treatment is better than the obviously traumatic results SDC must provide. These cries of foul play will have less impact than those from the taxi drivers about Uber and we should be twice as ashamed for trying to deny access to HEALTHCARE to the vast majority of Americans that we orthodontists have traditionally refused to help. I particularly love it when orthodontists complain that SDC and/or Invisalign are acting out of “self interest” and not “caring about orthodontists”. As if the act of trying to destroy SDC, block access to care and maintain our pricing is not us orthodontists acting incredibly selfishly!

So what can we do??

If you’re an orthodontist and you want to do something about your eroding market share and sagging sales, stop blaming SmileDirectClub for our shortcomings and figure out how to offer more services more affordably and more conveniently to more people. It’s much easier to change ourselves than to try and force others to conform to our worldview. 

You are entitled to nothing. 

You deserve nothing. 

You are owed nothing. 

None of us are. 

You are smart though. Prove it by figuring out how to deliver a service that people want within the time and money constraints they demand. Or don’t. It’s up to you but SDC is not what ails orthodontics.

We orthodontists are.