**Editor’s Note: Once again, Dr. Dunn elegantly states the facts while breaking down the official AAO response to her blog post Does Membership Matter? The AAO leadership consistently refuses to hear the cries for help from dues paying members who are in the trenches and struggling against the turning tide. The AAO Board of Trustees is out of touch with reality and they have neither the will nor the ability to change in any meaningful way. It is disheartening to see the same excuses and justifications over and over again from our member organization. **

Dr. Poole,

Thank you very much for your response to my blog (**see below). I did read it in its entirety, although it took me many attempts to actually get through the whole thing. I hope you understand that my article was intended as constructive criticism and my hope was that all involved in the AAO would take some time for some serious introspection. After reading your response, it seems I wasted my time. Your cut and paste, canned answers to my concerns were more than a little insulting.

Don’t get me wrong, I feel that all involved in the AAO have good intentions. But, just like our elected representatives in Washington DC, years spent in a large, antiquated organization have left them out of touch with the constituents. It seems pointless to address each and every point you attempted to make in your rebuttal, so I will focus on what I feel is the most important issue – defending our profession.

I absolutely refuse to “agree to disagree” on the CAP program. My husband and I spend $1600 per year supporting this ineffective program that garners little support from the vast majority of people who are paying for it. I have yet to meet anyone who feels it is effective that isn’t somehow involved in the AAO or one of its constituent organizations. Here are my main problems with your defense of the program:

1. You say that the “hard hitting” message won’t work with consumers based on market research. Well, market research shows that negative political ads are not liked by the public, but guess what? They work. It kills me that you say, “Our outreach keeps orthodontists “in the running” as potential patients consider orthodontic treatment. The goal of the CAP is to increase the market for orthodontic services, and we all benefit from that.” You are basically admitting that you aren’t even trying to show that pursuing orthodontic care with a general dentist is, at a minimum, risky. Your goal should be that pursuing orthodontics with an orthodontist is the ONLY option.
2. It’s laughable that you think I can abandon my current marketing efforts and begin to use the generic AAO materials. Maybe this would work if I was the only orthodontist in the area, but we have an orthodontist (sometimes 2) on every corner of my town. We can’t all send out the same stuff. And honestly, we have general dentists practicing orthodontics that quote the AAO all the time on their websites. Because the message on most of the print materials generally sells orthodontics rather than orthodontists, they can easily copy and modify for their own needs.
3. There are more adults pursuing orthodontic treatment, but I find it hard to believe the CAP program has anything to do with it. It seems far more likely that Invisalign’s massive marketing campaign is the main reason adults are now more than ever considering orthodontics.
4. You say that the public relations campaign drives people to the mylifemysmile website. My practice website has over 2,000 unique visitors per month. I wish I could tell you we have 2,000 new patients every month. Visits to a website as a measure of success is a very poor indicator of effectiveness of message. Can you confidently tell me that all of your new website visitors are empowered to visit an orthodontist and don’t decide to do braces with their “dentist who is also an orthodontist”?

I would love the AAO to be a more proactive organization. Why are we sending Texas money AFTER the judgment that may lead to dentists advertising as specialists after taking a few hotel courses in orthodontics? Why can we not discuss the new school opening in Georgia that is rumored to graduate at least 30 new residents per year and continue to saturate an already saturated market? Why are we not fighting harder against general dentists opening orthodontic only practices throughout the United States? Do-it-yourself orthodontics – that’s your biggest concern? I don’t know where the board practices and what their experiences are, but I worry about the direction and future of our profession every day. I never thought I would get to a point where I would actively discourage my children from entering a profession I love, but here I am. So you suggest I should get involved and become part of the leadership. This gives me great pause as I have found the AAO to be incredibly unwilling to listen. I’ve watched very intelligent people, who I respect deeply, become robotic “yes men” to the AAO after becoming more involved. I realize that you are probably annoyed by me and others who criticize the AAO, but you should be thankful to those who speak up. If we didn’t care, we wouldn’t say anything. You are probably unaware that you have a growing percentage of your membership that are quietly pissed off. Keep doing what you are doing and they will get louder.

Sincerely,

Courtney Dunn DDS, MS

 

** Official AAO Response originally posted as a comment on Does Membership Matter?

Hi Courtney. I saw your post and am glad you wrote. You bring up several points that I’m sure others are thinking. I know AAO President Morris Poole has responded to you. I thought others on this blog may be interested in reading his reply.
Again, good to hear from you. I hope you, Matt and your family are doing well. Please feel to contact me at any time.

Chris

Sent on behalf of Dr. Morris Poole, AAO president.

Dear Dr. Dunn,

Thank you for your thoughtful letter and well-stated comments posted on January 27 at http://orthopundit.com/does-membership-matter/. Your voice is heard by the AAO’s volunteer leadership, and your opinion matters. Your membership in the AAO matters, too. Your membership enhances the collective strength of our organization. To paraphrase the late Helen Keller, we achieve more together than we can alone.

Changing member demographics have long been on the AAO’s radar, and the composition of our membership is informing our programs, communications efforts and planning for the future. We understood quite some time ago that those in the Gen X and Millennial generations, who now comprise 51 percent of AAO members, are less apt to be “joiners,” but have adopted electronic communications, particularly within defined groups. To better serve that segment of membership, the AAO created Communities on aaoinfo.org to facilitate discussions among members, created a member app, added push notifications and text messaging services, incorporated social media to our communications outreach, created robust online learning (CE) opportunities through aaoinfo.org, and added engagement activities at Annual Session that are of particular interest to the Gen X and Millennial segments of our membership.

The evolution in demographics also deeply influenced changes in the nature and duration of volunteer opportunities, so that those who wish to share their expertise for the greater good can do so in ways that are compatible with their busy professional and personal lives, giving as much time as they care to. To encourage involvement with the AAO, the Council on New and Younger Members was established; emerging leaders, young members who provide counsel to the Board of Trustees, have been identified; and invitations are extended to serve on time-limited task forces. We appreciate members’ contributions of time and talent in improving our leadership structure.

The Great Recession was a game-changer. We began to feel its effects in 2008, and in the first quarter of 2009, the AAO began what is now an annual Economics of Orthodontics survey to understand how the economic climate impacts members’ ability to provide care to patients. It was a tough go for many members, and some are still feeling the recession’s aftershocks, especially those in highly competitive urban areas. The good news from the most recent survey is that there is a slight uptick in earnings for members. There was a significant growth in the numbers of adult patients treated by AAO members: up 16 percent from 2012 to 2014.

I agree with your concern about the level of student debt. AAO research tells us it averages $350,000 or more by the time one graduates from their orthodontic residency program. In reality, student debt starts in dental school. That is the time for financial planning to be in place – not after graduating from a residency program. A great deal of debt has already been incurred by the time a student enters orthodontic residency and becomes an AAO member, the point at which the AAO begins member engagement. I do agree that more education is needed. AAO has brought this to the attention of both the ADA and the American Student Dental Association. As students enter residency, we do encourage them to read and heed advice from these organizations, and inform them of the AAO resources available to them to manage their debt. AAO leaders continue to study the issue and devise ways to address it. Both organizations have excellent materials to address and education on debt at the time they enter dental school.

In the meantime, to help our members who are burdened with student debt, AAO called upon SoFi (Social Finance, Inc.). Now in place for two years, it is getting great reviews from members who are lowering their student loan debt by consolidating and refinancing loans.

Practicing after graduation is critical to retiring that debt. To make practice a reality, AAO members have access to the online Practice Opportunities and Careers service. Seekers can find associateships, partnerships, opportunities at Dental Service Organizations and practices for sale. This free service is exclusively for AAO members – it’s a part of our member benefits package. In addition, we offer a career fair at the Annual Session, and we have added virtual career fairs to our armamentarium to assist our members in need of practice opportunities. I encourage a visit to https://www.aaoinfo.org/node/5343 to view a heat map that shows the concentration of orthodontists in markets throughout the U.S. It visually depicts where jobs are and are not available, and serves as a great reminder that there are excellent practice opportunities outside of competitive urban areas along the eastern and western coasts, the Gulf of Mexico coast and the southwestern U.S.

For members who wish to purchase a practice, U.S. Bank was selected as the endorsed practice finance program for U.S.-based members. AAO members receive preferred pricing on conventional and Small Business Administration practice loans. Even with student debt, AAO members are a good risk for practice financing loans.

Perhaps being attentive to member needs is one of the reasons the AAO maintains a high retention of active members (more than 98 percent), and a high rate of student members who opt to continue AAO membership in the year after graduation from an orthodontic residency program (88 percent). AAO members recognize the value of being a part of organized orthodontics. The AAO is the only organization that solely represents their interests as orthodontists. We strive to serve members’ needs in a multitude of areas. We can improve our service to members through leadership from members like you.

Your observation about past Annual Session programs is one we agree upon. The focus was too great on clinical and evidence-based programs, and we needed to broaden our pool of speakers and topics to include marketing, budget management and social media. With input to scientific chairs from task forces who examined Annual Session content, changes have been implemented over the last two years to add cutting edge practice management lectures and bring in new speakers. In 2017, fully half of the speakers will be new to the Annual Session program. And to help members enhance their business acumen, the 2017 Annual Session will feature a Profitability Pavilion to educate members on many aspects of running a practice, with an emphasis on practice marketing and effective use of social media. This will be a popular destination for residents, new and younger members, and even more senior AAO members.

Few of us had in-depth instruction during residency in how to run an orthodontic practice. Since 2012, the AAO has offered online educational opportunities we call “The Business of Orthodontics” Webinar series. These free presentations address subjects that those in business need to know: business strategies, legal considerations, marketing, practice start-up, risk management; and human resources. You can listen live, or you can tap into the impressive library of presentations, accessible through aaoinfo.org. Either way, the information is free to you as an AAO member.

Associations like the AAO often provide access to insurance. Association group insurance plans, created 30 years ago, were excellent when the pool of potential insureds tended to be younger and healthier. Many organizations have gotten out of the group health plan business because they are not affordable due to a higher risk pool. The major medical coverage we once offered members did not meet the needs of members like you, as you searched for coverage that included maternity care, nor did it meet the needs of members who have a pre-existing condition, or who are older. I hope you were able to find suitable coverage. I also hope that your experience with health insurance did not dissuade you from looking into other forms of insurance that are available through the AAO Insurance Company (AAOIC). Our line of professional liability insurance for orthodontists is second to none. It truly is the gold standard, as evidenced by the 52 percent of AAO members who choose AAOIC professional liability insurance. AAOIC also offers many more other insurance products: business owner’s insurance, professional overhead expense insurance, life insurance, employment practice liability insurance, disability insurance, and cyber liability insurance. AAOIC offers competitive rates for our business practice needs. The AAOIC’s goal is to provide members with access to economical insurance coverage.

The strategic direction of the AAO is to recruit members for volunteer leadership positions at the state, regional and national levels who are in the early part of their practice years. This is another way of saying, “We need you Dr. AAO Member.” Yes, you are busy establishing a practice. Yes, you have family commitments. But if you do not step up to the plate of leadership, who will?

I agree that our leadership profile used to skew older. But I am pleased to report that we are making headway in attracting younger volunteers at all levels. It was gratifying last summer when five younger members attended an AAO Board of Trustees meeting. We asked, and they shared their opinions on future directions for the AAO. With much accomplished, the Board will continue this practice. It is also refreshing to see the diversity at the House of Delegates meetings, now a truer representation of AAO members in terms of years in practice, age and gender. We are seeing a similar trend among members of committees, task forces and councils who do the work of the AAO.

We will have to agree to disagree about the AAO Consumer Awareness Program (CAP). Its successes have been well documented in AAO newsletters, and this letter already pointed out the growth in the adult patients AAO members are treating. I think some credit belongs to the CAP’s messaging and that we are hitting the mark with the target audience. Our outreach keeps orthodontists “in the running” as potential patients consider orthodontic treatment. The goal of the CAP is to increase the market for orthodontic services, and we all benefit from that.

The CAP is a means for the AAO to tell our story to consumers/prospective patients. If we do not do it, no one else will do it for us.

The AAO has been criticized by those who feel that the CAP advertising message is not hard-hitting enough. It is a hard-hitting message, but in a positive way. The message has been researched among those in our consumer audience, which is truly the audience that matters. Please know that we also tested messaging that more directly addressed “who should treat.” It was deemed negative by the consumer audience – the very audience that is making the decision about who should treat them. Research, not opinion, guides decisions. So we take the high road and tell the audience who we are, and how they benefit when they choose us to provide orthodontic care. The CAP is successfully delivering that message to our audience.

The CAP is more than advertising, however. It also has a public relations component, which costs less than advertising, but effectively delivers our message in a different way: placements of the AAO’s story through media outlets. Just in the past year, the AAO and orthodontics have been featured in the New York Times, the Wall Street Journal, Reuters, Today.com, Yahoo!Health and Refinery29.com. Many stories alerted consumers to the dangers of do-it-yourself orthodontics. That conversation came about as the result of AAO efforts. Public service announcements on the inadvisability of DIY orthodontics have aired more than 21,000 times, and counting, on TV and radio stations from coast-to-coast. Like advertising, media placements send audience members to mylifemysmile.org to learn more, and to find AAO members near them.

Besides the increased awareness for orthodontists and orthodontics on a national level, which is already a tremendous value for your dues/assessment dollars, CAP materials are available to members to use to promote themselves and their practices. No need to spend money to develop marketing materials – use your budget to buy advertising time or space with AAO CAP TV and radio commercials, print ads, Web banner ads and direct mail postcards. Or tap the public relations materials to promote your practice, including well more than 35 free videos you can use on your website and social media outlets. The AAO provides materials and tips on getting media local media coverage and how to be interviewed. There are how-to guides to help you with outreach during National Orthodontic Health Month and National Facial Protection Month.

To aid component organizations’ marketing efforts, applications are being accepted for CAP matching grants. This is an investment that effectively doubles a component’s marketing dollars and increases audience exposure to AAO members on a more local level. Find further information at https://www.aaoinfo.org/node/5268.

Marketing is one form of advocating for members. In the legislative sense of advocacy, AAO is very active on behalf of members and patients. For example, we are actively supporting passage of the RAISE Act (https://www.mylifemysmile.org/support-raise-act) to improve benefits of flexible spending accounts (FSAs), which are used by one of four patients we serve. Please encourage your colleagues and patients to support the RAISE Act, too. AAO was instrumental in postponement of implementing the Medical Device Tax for two years, which may be applicable to products used in orthodontic practices, a cost that could have necessitated being passed on to patients. The AAO is consistently in Washington, D.C. to represent members and patients at the federal level.

Increasingly, legislative and regulatory actions at the state level can quickly and drastically impact AAO members, their practices and patients. A mechanism has been instituted to aid component organizations to address issues as they arise: the AAO Component Legal Support Fund. As the sole voice speaking only for orthodontists, the AAO can work in concert with component organizations and assemble resources to bring in expert help. We are currently working with the Texas Association of Orthodontists to help protect the health of the public regarding “specialist” advertising by those who practice in non-ADA-recognized specialty areas.

The issue of dental insurance is quite a topic. The AAO advocates for members and patients with insurance companies through other dental organizations. We have two AAO representatives who participate in the proceedings of the ADA Code Maintenance Committee (CMC) meetings, giving us a voice in the CDT code set. AAO’s active participation in the CMC meetings has the additional benefit of putting the AAO in a good light; we are perceived as a “team player” by the ADA, the dental industry and by our peer specialty organizations. The result has been many opportunities to collaborate and work collegially on projects of mutual interest. Our relationship with our peer specialty organizations has provided solidarity and success as votes within the CMC proceedings take place. This exemplifies what Thomas Stallkamp, former president of Chrysler Corporation, once said: “The secret is to gang up on the problem, rather than each other.”

I hope this information helps you to understand that the AAO hasn’t just been “thinking about” many of your recommendations, we have actively been at work on them. And although the efforts are largely behind-the-scenes, the effects are geared toward an improved practice climate for our members, so that members can focus their attention on serving patients.

Can we improve? Of course we can. How can we improve? With your help.

Football coach Vince Lombardi stated that individual commitment to a group effort is what makes a team work, a company work, a society work, a civilization work. Individual commitment makes a professional association work, too. So to that end, I call on you and other AAO members to get involved and forge the AAO into the organization you want it to be. Make the AAO voice for the orthodontic specialty even stronger. Please give serious consideration to sharing your talent and expertise as a volunteer leader. The AAO needs you. If you care to serve, please let us know of your interest and availability.

In appreciation of your support,

Morris N. Poole, DDS
President, American Association of Orthodontists