All I hear these days from a very vocal and very unhappy subset of orthodontists are vitriolic accusations and recriminations:

“You’re destroying the profession”

“How dare you betray your profession?”

“Why are you trying to drag the specialty into the gutter?”

“We orthodontists need to get together and protect the profession”

And on and on and on and on…

What did I do/say to elicit such a response? Terrible things like:

  • Believing that consumers should have some input into their treatment and that the paternal model of healthcare delivery is dead.
  • Giving my opinion based on unparalleled experience in orthodontics – much of that hard-won knowledge being the result of failure or near failure that came from blindly applying ancient knowledge to modern problems!
  • Overcoming my initial, knee-jerk reaction to new delivery channels and deciding to embrace imminent change rather than raging against the incoming tide (and encouraging others to do the same).
  • Refusing to believe that just because “everyone agrees” that they are right. Democracy has no dominion over truth.
  • Believing what we orthodontists do is usually elective, non-invasive and largely reversible.
  • Maintaining that clear aligners don’t know if they are delivered in an office or via mail and therefore work the same in either situation.
  • Suggesting that if telemedicine is effective in dealing with life threatening situations then perhaps teledentistry can be effective in orthodontics given the nature of what we do.
  • Refusing to buy into the very popular “case study of one” mentality where confirmation bias allows us to find one fact or situation that supports our beliefs and therefore ignore the bigger picture or the fact that outliers are just that.
  • Refusing to believe that everything done in a traditional orthodontic practice goes 100% right.
  • Refusing to believe that everything done in the new delivery channel for orthodontic treatment goes wrong.
  • Daring to question the validity of the long held but mostly arbitrary Orthodontic Theology largely created by Edward Angle a century ago and blindly followed ever since.
  • Daring to question why orthodontic fees are what they are – our fees are arbitrary and have no basis other than that’s what we have always done. Arbitrary pricing is fine because you can do what you want in your business but holding fast to old pricing models while complaining about a lack of new patients is not smart business.
  • Suggesting that we should modulate service to fit price.
  • Wondering why orthodontists don’t have enough patients even though the economy is on fire.
  • Pointing out that the vast majority of people in this country have very simple, straightforward alignment issues that can be improved quickly, easily and profitably but that we orthodontists rarely see these easy cases because we refuse to have an appropriate fee. This causes the average orthodontist to overestimate the difficulty of the average person’s treatment because only people with serious problems and/or lots of money ever step foot in a traditional office.
  • Question why we orthodontists believe we are entitled to make a fantastic salary while seeing very few patients and refusing to accept the argument that the fewer patients an orthodontist sees the better an orthodontist they are. The medical literature is full of studies which demonstrate that experience is the number one indicator of the likelihood of a successful outcome in any given case.
  • Pointing out that the “quality” argument in orthodontics is a farce. Orthodontists have never and will never agree on what quality treatment means AND we all have cases that don’t finish like we want them to for any number of reasons. Not to mention patient goals and time/money/compliance constraints should be taken into account when judging the successfulness of any given treatment. Putting a few cherry-picked cases out there and claiming that all our finishes look like that doesn’t make it so. You’re not fooling anyone…
  • Refusing to believe that an affordable price correlates with bad treatment.
  • Refusing to believe that an orthodontist cannot be profitable at a much lower price point.

And for my sins I’m apparently going to hell.

Time will tell who is right and who is struggling or dead but if you look at the history of medicine and access to care, the future is pretty clear. It’s just so interesting to me that instead of seriously assessing what we do and why, many orthodontists have decided to put on their blinders, dig in their heels and just ignore the obvious signs that the world is changing. Just because you’ve always done it one way doesn’t lend any validity to your model going forward. Even worse, many orthodontists assume that these changes are harbingers of death for the orthodontic profession when nothing could be further from the truth (and consumer expectation mega trends are not something you can alter anyway). We treat such a small percentage of the population that these changes bring massive opportunity for orthodontists who take the time to understand what is coming and plan accordingly. Oh and who are willing to work for a living. If you choose not to do so then I have zero sympathy for you. If you want to protect the profession, the best way to do that is to align the wants and needs of orthodontists with the wants and needs of our customers! As healthcare providers isn’t that our mandate anyway? How does protecting our jobs and our incomes square with our duties to patients and the public?

One more thing to remember before you head back to your secret Facebook groups to whine and complain that “Burris is at it again”… Remember that I’m not making any of this happen. If I had that kind of power then you might really have something to worry about but, in reality, I’m just reporting what I see. Getting mad at me is like being upset at the weather forecast. And just like the weatherman I don’t always get things exactly right but we both give you a reasonable idea of where things are heading.

If you listen.

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