It’s amazing to me that we, as a profession, still don’t consider keeping braces on people beyond estimated treatment time a bad idea. It IS a terrible idea for many, many reasons – mainly because having braces on more than 24 months is BAD FOR PATIENTS’ oral health but also because it means we suck at our job and destroys the trust patients showed us by starting treatment. AN OVERTIME PATIENT IS AN UNHAPPY PATIENT. Unhappy patients degrade your business and will ultimately be the death of it. It is so simple to avoid this issue becoming definitive for our practices but we refuse to acknowledge the problem and deny the root cause.
So the AAO and Gaidge put out these stats based on what AAO members are willing to admit. After several years in a study group that collects practice numbers on members annually I’ve grown a healthy skepticism for self reported stats and I KNOW that there is almost always a wide gulf between what is reported and reality when orthodontists talk about our practices… I don’t believe a word of this report – I especially don’t believe the patients past estimated completion date stats.* An overtime rate of 23.6 percent is ridiculously high and extremely detrimental to any practice but most of the practices I’ve seen are actually in the 30-40 percent range when it comes to overtime patients. Most doctors/offices extend treatment time in their software for patients past estimated date so this hides the real number (and makes us feel better because the red line disappears). But patients know better. They remember what you told them.** The important part to understand and acknowledge here is that we do a terrible job of delivering on our promises even if you believe what I consider to be a gross underestimate of the percentage of overtime patients (the 23.6 percent reported by Gaidge). What if FedEx or UPS had this kind of failure rate? What if any of the vendors you deal with – your lab for example – failed to deliver on time at this rate? You’d be furious and you’d stop using them immediately. Yet we do this to patients every single day, don’t think twice about it and cannot understand why patients are attracted to different, disruptive models. As I’ve said many, many times – orthodontists are like taxi drivers!
Can you not see the issue here? Don’t you understand that this is a MAJOR threat to your practice and your business and your relationship with patients? Overtime patients are death for a practice’s reputation and overhead. You can’t afford either of these millstones tied around your neck! I don’t care much about broken bracket rates as there is no cost to additional appointments unless you are at capacity (and almost no one is) and patients who have a couple broken brackets tend to finish faster because of the extra visits. I also don’t care much about no-show rates other than to point out how few new patients the average practice schedules a month. BUT overtime patients are a huge, huge, huge deal that we, as a profession, must address if we hope to remain viable long term.
After insuring you get enough new patients in the door and that you start enough cases, controlling how many overtime patients you have is the most important thing you can do. If you consciously make a decision to refuse to have overtime patients you’ll work less, make more and, most importantly, have much happier patients. An overtime patient is an unhappy patient. Period. If they haven’t done what needs to be done in 18 or 24 months they won’t do it in 30 or 36 or 42 or 48 months and holding them in braces is just stupid. Ideal is stupid. What we do is Enhancement and the result that patients want is Straighter. PLUS, orthodontists are not perfect! We cannot work miracles and there is no such thing as a perfect case. Get over yourself and deliver the best you can in the time you promised. Your patients will thank you…
*To be clear I don’t blame the AAO or Gaidge for the lack of accuracy I suspect is present – they can only go on the numbers they are given by members.
**Oh, BTW, for those of you who think you’re clever and give a “range of time for case completion” know that patients only focus on the low end while you only focus on the high end so this is a recipe for disaster and increasing the number of patients who perceive they are overtime when you do not. For example, if you say, “We will complete the case in 18-24 months” at the new patient visit, the patient will only hear 18 months and you will only see 24 months so you are setting yourself up for failure. FWIW
*** You should monitor your overtime patients daily in the morning meeting, by running a “patients with a zero balance report” weekly and by doing everything you can to finish patients on time every single day. If you allow patients to run you over on scheduling so it’s crazy at your office after school you’ll never finish cases on time.