You get what you pay for…

This was never more true in orthodontics than today. Though we try and ignore the fact, there is an implied agreement between orthodontists and our customers that transcends the contracts signed at the beginning of treatment. An agreement based on price. A customer paying a high price in a high end practice expects to receive concessions from the orthodontists. If you doubt this, just think of all the times parents or patients have said, “I paid X-thousand dollars for this and I want…”.

This is not a bad thing in and of itself but it can be detrimental to your practice depending on your mindset. The median orthodontist believes they are a top 1%er and feels they deserve “to get paid for their time” and that “their time is valuable” and that an orthodontist is their price. This is your prerogative but it’s vital that you understand the consequences and expectations that arise from having a high fee, “high end” orthodontic practice.

• You will attract the most demanding and often the most entitled patients/parents.
• It’s very difficult to deny patients when they demand after school appointments.
• It’s very difficult to deny patients when they show up late.
• It’s very difficult to deny patients when they make demands for special concessions on retainers, seeing the doctor when the office is not seeing patients, complaints/disputes about/with staff members (regardless of fault).
• Clients will expect to be seen on time – even if they show up late.
• It can be difficult to get paid by this “high end” clientele.
• It can be very difficult to schedule vacation time when your kids are out of school because you’ll feel obligated to be open when the kids are not in school – your clientele will demand that you are.

There is nothing wrong with any of these issues in and of themselves – all businesses have to make concessions to their clientele in a competitive market and consumers want what they want so you either accommodate them or you don’t. Many orthodontists consider these concessions to demanding patients to be part of doing business. That is fine and dandy and if you’re going to charge high fees and present yourself as the premier office you probably should have that exact mindset. The problems arise when we orthodontists claim to be the best and demand the highest fees but forget the implied obligations this market position entails. I see a lot of this happening of late and if you doubt me just spend some time on any of the orthodontic Facebook complaint parties (ahem… I mean ortho study groups).  Whenever orthodontists gather online or in person the conversation will always turn to how “if the price of braces kept up with inflation they would cost $30,000” or “the Kodak study shows that if you reduce your fee you work harder for less money” (ignoring that Kodak went broke) or “I’m not willing to join the race to the bottom” or “my fee is based on my overhead and I can’t afford to charge less” (ignoring that there is zero basis for what orthodontists charge other than history) or “Orthodontics is not a commodity” (spoiler alert: it is) and on and on and on. We orthodontists believe we are our fee – the higher the fee the better an orthodontist we are. This belief is just as silly as the idea that the less patients you see the better an orthodontist you are and both misconceptions will hamstring the majority of the profession.

There is another way and a different set of implied agreements between orthodontists and patients however. If an orthodontist chooses to make their fee very reasonable then the implications to consumers/patients are also clear.

• If a consumer wants braces at this price, then it will be on the orthodontist’s terms and the patient will have to adapt not the other way around.
• The level of customer service will likely be lower.
• The responsiveness of the office will likely be lower.
• The awesomeness of the office will likely be lower.
• The doctor may not be as awesome as other offices.

Though not ideal or necessarily true for any given office, none of these implications are bad in and of themselves – they are logical and spring from a consumer’s willingness to deal with inconvenience or reduced service for a better price. Walmart has built an empire on this philosophy. An empire that Dollar Stores and Amazon are in the process of disrupting.

But here’s the catch. The sweet spot for orthodontists comes when you are able to offer an attractive price along with an awesome office, great service, great finishes and a fun atmosphere. This situation creates the ultimate lifestyle practice where you can practice when you want, how you want and provide excellent service and finishes.

What is an attractive price? What is attractive enough to do what you want, how you want to do it? These are not easily answered or the same everywhere in the country. The answer also depends on how far you want to push the “do whatever you want to do” in your office. For the purposes of discussion I’ll give you a few generalizations here – these are generalizations only and don’t account for variations in your area or orthodontists who have already figured out that value pricing is a good idea:

• In major metro/urban areas in the US you are looking at a 2800-3500 price point to get significant attention.
• In suburban areas not too far from the coast or major metro areas you will probably need to be in the 3800-4500 dollar range
• In the Midwest and some of the west and in areas where orthodontists don’t really want to be you can be in the 4800-5400 dollar range.
• For all of these you will need to be in low end (or even less than that) to enable your practice to see patients only during school times. For example at Smiley Face – a location I consider a very desirable metro area – we are at 2998 for braces and have had both an excellent new patient flow and little resistance to our hours being 9 am -3 pm. We also are closed for my kids’ spring break, three weeks in June, a week in July, the week of Thanksgiving and two weeks over Christmas/New Years but its not an issue at our price point.
• I think it’s a good idea to be just under the nearest thousand. For example, the difference between $5200 and $4995 is not large in terms of dollars but it’s huge in terms of perception.
• If you aren’t going to lower your price enough to make a difference in your customer’s eyes then don’t bother. There is almost no difference between 5400 and 5200 in the eyes of most consumers.
• If you’re doing very well, getting all the starts you want and have the lifestyle you want then DON’T CHANGE A THING!

THERE IS ZERO BASIS FOR WHAT WE ORTHODONTISTS CHARGE. You can say your overhead is such and such and this is why your fee is what it is but that’s backwards. Almost all orthodontists set our fees based on what others have done and do and the overhead is just a product of the fact that we have so much profit built into the historical fees. That’s fine if you can get paid that much but as downward price pressure continues and as the orthodontic profession is disrupted by direct to consumer treatment with clear aligners you may want to revisit your core beliefs on the subject. FWIW

If you like talking about this kind of thing or even if you think it’s total BS and want a chance to question what I’m saying then check out The Smiley Face Experience on Facebook. Membership is free to any dental professional and I welcome scrutiny along with new ideas. Have a great week.