It shouldn’t be but practicing orthodontics and running an orthodontic business is generally considered  very stressful by orthodontists. Conceiving, implementing and getting Smiley Face running was no less so for the first couple months but in the last few weeks something has changed. Now that it’s become obvious that the Smiley Face model will fly (knowing something will work and seeing it work are two different things), a weight has lifted leaving Bridget and I surprised that for the first time in our careers we have almost zero stress. We were talking about this and we started listing the “most stressful things in orthodontics” as a way to help identify and possibly remedy this for others. Below is the list and our thoughts on them FWIW:

  1. Fear – In general humans are fearful creatures. Orthodontists are like human beings only more so. As career students we have lived in fear of those who had total power over our present and our future and somehow this rubs off on our post-graduation consciousness as well. This generalized, nebulous fear permeates everything we have and want and fear to lose to such a degree that it takes on a life of its own. The fear becomes a living thing that exists of and for itself – it doesn’t need a reason to exist or a cause and this is why we list it separately and first. It’s vital that we recognize our fear, find the source so we can eliminate or ameliorate it and realize when there is no legitimate source so we can extinguish the fear itself. This is harder than it sounds given our decades of conditioning but once you identify the fear, recognize it for what it is and gain proper perspective your life will change for the better and those who you love will notice. Bridget and I have finally stripped away the fear that’s nagged us our entire career and we can tell you it’s certainly worth the effort!
  2. Expectations without control – One of the toughest things to deal with is to surrender control while maintaining responsibility. We see this often with young orthodontists and residents who tell us they are going to open up or buy an office in an area that is less than ideal for any number of reasons because their significant other or spouse or their families want them to be there. Making multi-million dollar, decades long business decisions because your SO’s family wants you to live near them is dumb for lots of reasons but mostly for the stress it introduces to your life. Basically you’re doing what you’re told by people who have no knowledge or skin in the game but you’re still the one who will be held responsible should things go wrong. It’s a terrible situation and one you should avoid at all costs or you’ll have to live with it for quite some time. Another, more common occurrence of expectations without control causing stress happens when a parent or patient dictates how you will treat but still holds you responsible for achieving the end result they have in their mind’s eye. This is a HUGE stressor for orthodontists and happens almost daily in most offices. The only way to avoid this is to either take control of treatment decisions and clearly define the parameters or allow the patient/parent who wants to dictate treatment to go elsewhere. From what we’ve seen neither happens often so we sit in our offices and stress over cases we can’t treat the way we want to and then get a hard time for a lackluster result. That sucks for everyone involved and rarely has a positive outcome. Bridget and I have struggled with this for years, getting better and better at stopping it on the front end but it’s only been recently that we no longer tolerate expectations without control. The resulting sense of freedom is AWESOME!
  3. The after-school appointment battle – I don’t think I have to spell this one out or explain anything. Either you control your schedule or it controls you. The latter is far more common in orthodontic offices. Where we practiced in Arkansas the kids who didn’t miss school didn’t have to take final exams so they were VERY motivated not to miss school. Bridget and I took a harder and harder line on this issue for years to try and get it under control but at Smiley Face we eliminated the problem entirely because we no longer have after school appointments! That’s right, I see patients 9-3 so it’s not an issue! How can I do this? We offer an awesome product at an unprecedented price so we don’t have to conform to the demands that high fee practices do.
  4. Competition – If you go on any of the orthodontic Facebook groups or listen to orthodontists talk at meetings it’s obvious that orthodontists are scarcity minded and see the total number of potential patients as finite. In this view of the world, every patient you get is one less than I can have. Not only is this wrong but it’s ironic seeing how many orthodontists talk about the alleged “quality” of given patients. There are many consumers out there that most orthodontists would never let in their fancy office but they don’t want “those people” going to a competitor either! Crazy. As I’ve mentioned many times before we only treat about 4 million orthodontic patients a year according to the AAO. That’s a little over 1% of the 320,000,000 Americans (and the population is growing at almost 1% a year). We aren’t even scratching the surface and if you make what we do affordable then you’ll have all the patients you could ever want and more. This is what we are doing at Smiley Face.
  5. Playing the referral source game – Courting dentists and pediatric dentists and playing nice and going to lunch and delivering holiday baskets sucks. But it’s still the best way to grow/maintain the traditional practice and many orthodontists rely so heavily on the traditional referral system that they can’t afford to do anything but kiss ass (if you’re one you better keep doing it until you have an alternative established BTW). I understand. I did it for years. It’s stressful enough to have to suck up to dentists but it’s incredibly stressful to watch one suggest or do treatment on a patient that isn’t in the patient’s best interest. I’ve never been able to stomach such things or keep my mouth shut when a dentist is doing a wallet biopsy so you can guess how well that went over with referrals (ahem, former referrals). The great news is that with Smiley Face I don’t care a feather or a fig what dentists, pediatric dentists or anyone else thinks about what I do. I have tons of happy patients who know I look out for their bests interests already and the detractors (there will always be detractors) are non-issues. When you get on the right side of access to care, put patients first and always do what is right for the person in front of you, you can’t lose!
  6. Fear of losing referral sources – I know we already mentioned fear and the many forms it takes but this one is special. It sucks to have your livelihood tied to someone who can arbitrarily decide to cut you off or bring in an orthodontist or goodness knows what else. I haven’t done this for quite some time and we don’t worry about that at Smiley Face as I’m sure you’ve guessed already. Our model and pricing and market positioning brings in all the patients we need.
  7. Staffing – Staffing will always be stressful. The more you simplify your systems (admin and treatment) then the easier it is to train new staff. The easier it is to train new staff then the less the ones you have can hold you over a barrel. As long as you can’t be held hostage then it just comes down to you doing what you agreed to do (pay them their wages, provide a fun/safe workplace and be a great orthodontists) and what they agreed to do (their jobs, on time, with a smile, the way you ask them to do it). If either of you don’t hold up your end then you part ways. Simple. Unfortunately we orthodontists make this much more complicated than it needs to be and stress is the result. At Smiley Face we work hard, make people smile and have fun. When either party stops having fun we go our separate ways – no harm, no foul, no hard feelings. Life is good!
  8. Keeping up with the Joneses – This is what the orthodontic Facebook groups are really all about aren’t they? What kind of brackets you use, what kind of 3D printer, cone beam, Invisalign status, Damon status, number of offices, etc.? Right? We orthodontists lie about our fees because we think saying we charge 6000 dollars makes us a good orthodontists BUT if you take the average orthodontist and divide their collections in the last year by the number of starts in the last year I’m betting the math won’t back up what we say we charge! And this is crazy – why discount in secret to “sell the case” instead of letting people know we will do braces for much less. You’re probably doing it already as I’ve discussed before and this is but one example of many dumb things we do because we think it matters what other orthodontists think (like they are telling you the truth about their practices to begin with). Other orthodontists don’t pay your bills or see your patients. Do what is best for you and your customers and ignore the noise. If you’re going to listen to someone make sure it’s someone who is successful in practice not just good at speaking at meetings. Being free of what other orthodontists think is an awesome place to be!
  9. Money (more accurately, a lack of money) – “It’s not about the money” I hear over and over and over from orthodontists. The irony being that the ones who say it the most care about money the most and often have the least. It stands to reason. Look, at least be honest with yourself. You did all that schooling so you could have a great life, plenty of money and lots of family time. There is nothing wrong with doing well by doing good. Plus if you ever find you make too much money you can always give it to someone in need. Stop denying money is important just because you’re not making as much as you would like. The words you use have meaning and impact your actions and thus your results. Resolve to be a problem solver – solve as many problems as possible for as many people as possible and you’ll reap the financial rewards AND have happy customers. There are lots of people out there with tooth alignment problems who could use your help if you’d only give them access. That’s what Smiley Face is all about and we are rocking!
  10. A lack of family time – The clientele you choose to serve, the hours you choose to keep, the cases you choose to treat and 1000 other decisions determine how much work, effort, time and stress you have to put into your practice. These in turn dictate how much quality time you have with the family and, perhaps more importantly, how exhausted you are during the time you have. You set your schedule. You decide who to treat. You have the control (theoretically) but we orthodontists all too often surrender control due to our fear of not starting patients or getting patients in the door or looking like an outlier to other orthodontists. Nothing is more important than your family. Your kids aren’t getting any younger and neither are you or your spouse. Let go of “the way we have always done it” and try “the way that makes what you do affordable and attractive to the most people” and you’ll be shocked by the change if you can do it. Smiley Face has shown us that.
  11. Social media exposure – This probably falls under the fear realm but it’s important and highly visible these days. I wrote about this the other day in detail. Having a bullet proof model and doing well while doing good makes this issue negligible. Not because you won’t have negative encounters but because a track record of doing good is the best defense.

Look, if you have a great practice and a great life and you’re happy and have low stress then DON’T CHANGE A SINGLE THING. If you’re like most orthodontists I meet in person or have met online then perhaps it would be a good idea to at least start identifying your stressors and see what you might do to remove them. What have you got to lose? Oh and for those of you who are unhappy, stressed and struggling but still think you know better I might mention that in addition to several cases we treated for free we started 32 contracts last week alone in our startup office that’s been open two and a half months… I’m really good at what I do but I’m not the reason we are getting so many leads and starts. The Smiley Face model throws out all the things we orthodontists have always done for no good reason and adds logical systems to solve orthodontic problems for as many people as possible. It’s an unstoppable combination and the only thing stopping you from doing the same thing is your mindset.

7 thoughts on “Key Stressors in the Orthodontic Office

  1. Ben,
    I love the smiley face business model and I really think it would work well in my area. What are the case selection criteria? I know you don’t use TC’s so how do you select your patients in order to maintain your low stress, high success outcome?

    1. Case selection is key so you’ve picked a good topic. I am shooting for an average of 12 months in treatment for the cases I choose. Over time I’ll track this and know for sure but right now that means mostly that I don’t do missing lateral cases unless we are closing space, impacted canine cases unless we are removing them, I don’t do extraction cases for AP change (I’ll do exts for space issues), I don’t do Brodie bite cases, impinging deep bite cases, or anything that I’ve learned the hard way will take forever. I don’t mind doing surgical cases as they are generally easy. If I encounter a case that I can’t treat here or don’t want to treat I refer them to a local orthodontist and explain to the patient or parent that I’m set up to take care of 90-95 percent of cases but their case is too difficult for me to handle. The 6 or 8 cases that I’ve referred out have understood or seemed to. They get that I’m not offering to do the most difficult cases at such a low price point. Make sense? Answer your question?

  2. What do you charge for Invisalign Full case? $3000 too?!

    1. I charge $1999 for aligner treatment but it’s not “Invisalign full treatment”. I’ll do simple cases that don’t require attachments or refinements or IPR with clear aligners. I’ve got a lot of experience in treating these cases thus way.

  3. Great read!
    Do you have a designated staff to handle insurance claims? or you let the patients submit their own claims themselves so you cut the cost of hiring additional staff?

    1. Our team submits them. I don’t think it’s realistic to expect the patients to do it themselves. Only about 25 percent of the patients we treat have an insurance benefit.

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