So I’ve had more than my share of sleepless nights of late and my sleep cycle always revolves around what is going on in two areas:
1) My relationship with my wife and kids.
2) What’s going on in our business?
The great news is that Bridget and the kids are healthy, happy and they give me more love and joy than I ever expected to experience in one lifetime! The good news is that I’ve finally resolved the big issue that’s kept me up night after night after night for the last couple weeks…
That’s right. You guessed it. I’m going to fully embrace Invisalign in all my practices.
I’m certain that those who know me well and even those who have only casually observed what I’ve been up to for the last decade will raise an eyebrow at this turn of events.
“Burris, that doesn’t make any sense!! You’ve railed against Invisalign for years and now you’re doing a 180? You’re worse than a politician!” I can hear you saying. And you’re not wrong in one model of the universe where belief possession is the norm. In that model, we know what we know and do what we do because it’s RIGHT and to change or to admit the world has changed is tantamount to admitting we were wrong and that we are a failure. Most of us orthodontists see the world this way so take comfort in the fact that most of your peers agree with you.
I can’t argue. I’ll stipulate to all you are thinking.
I have been against doing Invisalign in my practice for a long time because I couldn’t reconcile the additional cost, the additional equipment and the cash flow issues with my practice model. However, if you’ve paid attention at all then you already know that I’ve changed my practice model tremendously in the last couple years – so this move isn’t out of line when you think about it. For starters, long before it was cool I decided to go aggressively direct to consumer in my marketing to reduce reliance on referrals from dentists. Once I had grown large enough and had become diversified enough to be self-sustaining, I decided to bring hygienists into my Ortho offices in an attempt to increase access to care while growing my business. I’m sure I don’t have to tell you how that went over with the local PCDs. Fast forward a couple years and we are now Arkansas Dentistry & Braces and we have dentists, oral surgeons, pediatric dentists and hygienists in house alongside our orthodontists. Last week I dropped my specialty license in the state of Arkansas to level the playing field and make it legal for me to see hygiene and ortho at the same time. No one, especially the dentists, thought I would ever do so. This week we made the decision to go all in with Invisalign… You see the pattern here? Do my “wild and crazy antics” make more sense in this larger context? I sure hope so because it’s scary as hell out here on the cutting edge.
I usually keep my blog posts short but I know you want more detail on the reasons I’m making this move because we are, by nature, detail people. Remember you asked for it!! Here is the short list of things I’ve been mulling over for the last 8 years. The facts and thoughts that culminated in this week’s big decision:
- There are 300 million people in the US, and a study in 1996 (before the clear aligner market was in existence) found that 49% would not consider going to see the orthodontist because they don’t want braces. Of the 150 million who would consider braces, only 2 million people start treatment each year. That’s about 1.3% of the people considering braces who actually end up getting them.
- It seems that orthodontists are clawing and scratching for our share of the 1.3% of possible patients because braces are our appliances of choice – the DOCTOR’S choice not the patients’.
- This tends to give doctors a sense of scarcity instead of abundance.
- The latest numbers available show that the orthodontic industry has grown 11% in the 5 years (going from 2.6 million annual starts in 2009 to ~2.9 million annual starts in 2014) while Align has grown >110% in that same time.
- Realizing that within the ~2 million annual starts in North America, Clear Aligners were 15% of the business in 2009 and in 2014 that number was 20% – what % of all orthodontic starts do you think Clear Aligners are now and will be in 5 years? Will it be 30%? Or will it be 50%? How well positioned are we to capitalize on this changing market trend? The size of the pie is growing, while the clear aligner share of the pie grows as well. And why shouldn’t I get more than my fair share of that?
- The national trend is consistent. GP referrals to the orthodontist have declined over the last 5-7 years and the rate of decline is accelerating
- The cause doesn’t appear to be that they are doing more Invisalign – Align’s business with the GP’s isn’t growing as fast as we all think
- Pediatric Dentist practices increasingly are taking on in-house orthodontists and therefore referring out less (or not at all).
- Straightwire is becoming more popular among PCDs
- DSO’s are playing a significant (and growing) role in reducing the GP referrals in the market (every GP practice that they purchase is one less referral source)
- When OrthoClear entered the market in 2005-2006 there was a measurable impact on the percentage of Clear Aligners in the overall orthodontic market because there was more BUZZ in the marketplace as a result of increased competition. All current indicators lead to more growth in clear aligners: Orchestrate, ClearCorrect, Smile Care Club, etc.
- In a 2011 Harvard Business review article titled “Reinvent Your Business Before It’s Too Late”; it recognizes the importance of innovation (or reinvention) before the business plateaus in order to stay ahead of the industry/competition curve.
- The article notes that “making a commitment to reinvention before the need is glaringly obvious doesn’t come naturally. But that’s exactly when to take action.”
- There are several examples of major brands that have been wiped out by technology changes in their industry. Here are 4 Reasons Kodak, Blockbuster, Blackberry, Yahoo & Other Major Brands Fail:
- Inability to acknowledge the change in their business/industry
- Inability to react to changes and innovate
- Inability to stay ahead of the times – not adjusting to the marketplace or technology of competitors.
- What Got You Here Won’t Get You There
- Innovation and patient demand DO NOT care about Dr. X in ABC town. Demand drives the market.
- I’ve reduced costs in all areas of the practice and now my goal is to drive top line growth (a la Michael Raynor) and skate to where the puck is going (a la Wayne Gretzky)
- Invisalign is a category creator and spends millions each year creating demand and driving that demand into practices… why not leverage this?
- I have GPs in place and Invisalign will cater to the GP side, which is mostly adult patients.
- Doing Invisalign allows me to get bodies in the door for Ortho and convert them into a hygiene patient and treat the necessary restorative issues over the course of the patient life cycle.
- Invisalign is applicable to and desired by the masses- most adults don’t want braces and not every adult needs a crown or implant yet 74% likely have crooked teeth.
- I’m looking for practice growth on the GP side. Invisalign will be essential. Practice growth begets practice growth and bigger PCD practices means more Ortho referrals.
- Increase conversion- patient preference plays a role in conversion.
- Enhanced patient experience which increases in office referrals – Patient is sitting up in chair and short visits offer doc ability to make eye contact, build rapport and drive a positive culture in office.
- Less chair time increased starts without the need to increase fixed expense (associates) – hopefully this will make up for my lab bill and the time I have to spend on the computer.
- Ability to control the treatment time and keep cases on track despite turnover or different doctors working on the same patient. Avoiding overtime is a constant struggle, as you know.
- Ability to have aligners delivered in hygiene or by a GP. I’m just a PCD in Arkansas now after all!
- Fewer emergencies
- Invisalign works well in rural and remote offices and reduces the days that I have to have an orthodontist there.
- Improvements in scanner technology and Invisalign mechanics make using Invisalign much easier and more effective.
I could go on but I won’t.
Bring the thunder tell me why you agree or disagree and why my assessment and action plan are wrong. Help me find the best practices I’m missing and point out the holes in my thinking so I can avoid missteps. Life’s an awesome adventure. Glad you’re along for the ride. I’m not afraid of dentists or big box dentistry doing Ortho… They should be scared that I’m doing Invisalign and dentistry!