** WE ARE NOT PROPHETS AND WE DON’T KNOW THAT THE AVERAGE FEE WILL BE $3000 DOLLARS EXACTLY BUT WE DO KNOW THE PRICE FOR TRADITIONAL ORTHODONTIC TREATMENT WILL DECREASE SUBSTANTIALLY. PICK YOUR OWN TARGET IF YOU FEEL YOU HAVE A BETTER HANDLE ON THE MARKET. WE ARE SIMPLY GIVING YOU INSIGHT IN THE HOPES OF HELPING YOU NAVIGATE THE FUTURE OF ORTHODONTICS.

There are generally two ways to enter a swimming pool. The first is to dip your toe in the water; slowly and incrementally easing yourself into the pool. The second is to just take the plunge right into the deep end. We favor the second method and we suggest that you jump directly to the $3000 fee! If you can afford to do so the benefits are numerous:

• A massive marketing advantage – you will be able to slash your marketing budget and utilize a precise internet marketing strategy to fan the flames of the word of mouth wildfire that your “Holy S$!^” price will create in your market.
• You can simplify your pricing and financing structure. One fee pricing is wildly popular with consumers. You can see examples everywhere. Along with a single fee you can have one financing plan. For example, when we went to a $3995 flat fee, we offered only one financing plan.
• You will no longer need expensive TC rooms, their associated equipment costs and the time suck they represent. With a shockingly low price and simple financing, doing new patient visits and discussing financing chairside is the way to go. Our clinical assistants did this and we had a financial coordinator who helped as needed and did recall (though few failed to start at our lower price). If you have not built your practice yet then you can save a massive amount in rent/buildout/purchase by adopting this way of doing things.
• You will no longer need community marketing, logoed giveaways, movie parties or any of that stuff. People will come to you because you made orthodontics affordable.

However, we realize that this concept and the sequelae are terribly shocking and even unbelievable to most of you. Instead of having a knee jerk reaction and saying “you can’t do that”, you need to develop a different mindset, understand the impediments existing in your current practice(s), come to grips with your concerns and fears and then create a roadmap for implementing the $3000 fee.

We’d like to share with you what we see as the common roadblocks in the way of fee reduction and give you a plan for overcoming them.

1. Most doctors spend almost every dime they make and some spend even more than that. If you don’t have any financial reserves then you won’t be able to lower your price, your down payments or your monthly payments. The only way to get through this is to tighten your belt and save some money while working on increasing your practice collections/profitability.
2. Unnecessary Physical Plant, Supplies and Equipment:We have seen colleagues time and time again build lavish practices equipped with unneeded technology and redundant systems. Is Class A real estate required for a successful practice? Maybe. Is a large footprint (square footage) required for seeing more patients? No. Do you have to hire an expensive dental practice design firm (glorified interior decorator) for the office build out? No. Are big ticket items like cone-beam CT machines perceived by the consumer as value-added and will they generate the necessary new patients/revenue to justify their cost? No. Indirect bonding? Wire bending robots? Fancy brackets? No. No. No. We’re not advocating practicing orthodontics out of a quasi-storage unit. What we’re really saying is that when you own and operate a practice there are essential assets and then there are extraneous liabilities. As a rule, anything that increases your overhead should be seriously questioned. The only reason to add an expense in the modern practice is if said expense brings in new patients.
3. Excess Employees: We often visit practices that are overstaffed. It is nice to delegate as much work as possible to others but not at the cost of an increased overhead. Do you need an assistant at every chair? No. Do you need your own lab tech? No. Do you need a full time sterilization technician? No. What about “floater” employees and backup chairs? No. We’re quite aware of the fact that the owner operator of the practice cannot do everything. We’d actually encourage you not to do those tasks that erode your time and don’t increase production and profitability. What we are recommending is that you evaluate the job description and duties of each employee and try to eliminate any redundancy in the practice systems. Extending appointment intervals, having simple/effective mechanics and being decisive cut down on the number of appointments per patient and thus the need for more employees per case start. Also, despite “industry norms”, it is very reasonable for each and every chairside assistant to see 20 patients per chair per day. We know of many offices who do more. Also, having a sterilization tech is contraindicated as it creates delays while waiting on them to do their job. It is much more efficient for everyone in the clinic to “do their own dishes” and have the office manager jump in the sterilization room from time to time if things get backed up. Finally, if you schedule your weeks off a year out and your office employee manual that there will be no paid vacation during patient days then you can cut down on the ridiculous amount of days you work shorthanded by allowing employees to take vacation hurly burly. If you do this then you will no longer need an “extra” employee to make up for the short days.
4. Opportunity Cost of Unused Capacity: Many practices have geared up to increase their practice capacity. This usually is in the form of expenses listed in the first two roadblocks among others.  This is a case where hope has triumphed over experience. For as much as orthodontists desire to be at full capacity, it will almost never be achievable. You can always treat more patients (go visit someone who is doing more if you want to learn how).  So by unnecessarily increasing overhead and not matching it with the needed increase in production, the net profit per case will decrease. Paying for products or services that increase capacity or efficiency or even shorten treatment time is ludicrous in the modern reality unless these products or services bring in a large, new, sustainable and otherwise unobtainable stream of new patients. We caution against trying to build and staff Home Depot when all you need is a neighborhood ACE hardware store. The only justified expenses are ones that attract new patients.
5. Short Appointment Intervals: Will patients disappear if you don’t see them every 4-6 weeks? No. Will you not get paid if you see your patients longer than every 4-6 weeks? No. Will patients break more stuff if you don’t see them every 4-6 weeks? No. We encourage you to space out Invisalign checks to at least 16 weeks and if you utilize our alternative system and mindset; it’s possible not see the patient at all after delivering the aligners (and, in some cases, it’s possible to do the entire procedure remotely). As far as fixed appliances, we also feel that longer appointment intervals are worthwhile. The characteristics of today’s shape memory wires permit the light continuous force applied to the teeth to be sustained for a long period of time (8 to 10 weeks – more 10 than 8). If you see patients sooner than that, you might as well not buy these more expensive arch wires. Think about that patient who ran off for 6 months with an 014 or 018 NiTi wire. What did they look like when you saw them again. We rest our case.
6. Over Diagnosis: The orthodontic residency mindset is to take as many records of the patient as possible and then apply as many analyses as possible to come up with a problem list and treatment plan. People, the real world doesn’t care about your ability to create a slick PowerPoint that demonstrates your knowledge of cephalometrics or your ability to mount plaster models in centric relation! Consumers know what they want and they sure as heck know what they don’t want. We recommend active listening when you meet consumers. They’ll tell you what they want done, what you should use to do it, and how long they’re willing to put up with the program. We’ve never encountered a consumer’s orthodontic wish list being more than 3 or 4 bullet points and if you have, we’d recommend that you refer those high maintenance consumers elsewhere or charge an appropriately high fee (2-3x the normal fee). Now some of you are saying; consumers don’t know what’s wrong with them and it’s our responsibility to tell them. Fair enough, we get your professional ethics. So tell us, how often do you treat orthodontic conditions that aren’t more than just an appearance concern? Don’t you think that a consumer with a dorsal hump or excessive nasal projection wants it pointed out to them by an orthodontist? Maybe they aren’t even concerned about that trait and only want their teeth straightened. Remember that most kids look EXACTLY like one or both parents… The consumer wants you to concisely repeat back to them what brought them in, how they asked to have it done (Don’t deny the consumer something they ask for, e.g.-Invisalign), and how long it’s going to take. Nothing less and nothing more. Don’t confuse your chief complaint with that of the consumer!
7. Complicated and Inefficient Mechanics: Heroes are not more talented than other people; they’re merely willing to work against tremendous odds with little time for forethought and an enduring hope that they will succeed. Only the rare success makes one a hero and the 99 failures are forgotten in the presence of the one Hail Mary success. Orthodontic practice has no place for heroes.  We could go through a litany of clinical conditions and the conventional wisdom for how to treat them; however to enumerate on this is beyond the scope of this post. Suffice it to say, unconventional thinking is needed to succeed in providing efficient and effective orthodontic treatment and meet the demands of the consumer. Simplicity should be your watchword.
8. Overtime Cases: We are amazed at what orthodontists consider an acceptable number of overtime cases. Why are your cases going too long? Are patients not coming in for appointments? Is there an excess breakage problem? Are your treatment mechanics not working? Is there a financial hardship and the patient can’t pay their bill so they don’t come in? It doesn’t matter which of these types of delays are present in your practice, it is how you deal with them that matters. You will never fully eradicate unanticipated delays in treatment, so you have to set up systems to minimize and effectively deal with them. There are several approaches one can take to eliminate repeat offenders. You can have clearly written office policies about the consequences for the disappearing patient; debond, dismissal, or additional charges. The same goes for breakage. Another option is to positively reinforce patient compliance with the plan; also known as cheerleading. As far as mechanical breakdown, that’s all on you.  Orthodontics is the art of the possible not the science of the implausible. Finally it is important to understand that the VAST majority of overtime cases are the fault of the treating orthodontist despite what we like to believe. Indecision, heroism, over diagnosis, a lack of realism, inability to motivate our clients and a refusal to take the appliances off when the patient is happy confound your attempts to run an efficient practice. If a patient hasn’t worn elastics for 30 months then there is no chance they will become compliant by keeping appliances on for 36 months. It’s our fault if we don’t recognize this.
9. Fear: What will my current patients think about a massive fee reduction and new patients paying much less for orthodontic services? Not much. You are in business and consumers understand this. There are always outliers who don’t get it, but as we have told you before, don’t base any decision on the behavior or preferences of outliers. Lowering your fee should be a well-thought out and proactive decision. If you lower your fee as a reactionary move that is not well-thought out, you’re destined to fail. Burris dropped his fees across the board by 2-3000 dollars about a year ago and despite his fears there were very few patients in treatment that were upset about the price drop. The handful of outliers were handled easily and the new price was so attractive that the desire to bring in the next child at the new price fully outweighed the predicted reaction that orthodontists fear. Macy’s and Walmart have sales all the time. If customers buy before the sale they don’t get the lower price and they know that. Same principle applies here. To quote Dale Carnegie, “If you want to conquer fear, don’t sit home and think about it. Go out and get busy.”
10. Failure to Modulate Services to Fit Price: We are not suggesting that you should get paid $3000 for double impacted canines with missing lower 5s. We orthodontists have been dumb or socialist, depending on how you look at it, when it comes to our fees. We make our fees ridiculously high for an easy case. We also hold these cases in treatment much longer than we should to justify our pricing! We also woefully undercharge for difficult cases and are embarrassed when they take longer. Why do we do this? Who knows? Why do we do any of the stupid stuff we do? The point being that it’s unrealistic to have a much lower price point AND do all the things we are currently doing for all the outlier cases we currently undercharge for at $6000. To be successful and treat the bulk of consumers at the new price point, orthodontists will have to be very thoughtful and specific about what we will and won’t do and who we will and won’t treat. This decision will be an individual one tailored to your specific goals, but suffice it to say that should you adopt a lower fee model that sets price and deliverables based on the needs of the average orthodontic client instead of on outliers, you will become a huge referral source for the more traditional orthodontists. By the way, if you cut your fee by half but end up with a huge new patient flow and cut the time it takes to treat the average patient by half, have you really lowered your fees? Have you hurt your profitability? We think not.

After reading this post, we hope that you have a better idea of what roadblocks might impede your progress towards a $3000 fee. Like all things in life, it will take planning, hard work, and time. In the case of disruptive innovations like this one, it is the innovators and early adopters who can achieve the greatest return on investment. If you don’t have a high risk tolerance, ease in and join the late majority (and let us know how that works out for you long term).

Either way, this is coming and you need to decide where you want to be in 2022.

Marc Ackerman

Ben Burris

 

And you may ask yourself

What is that beautiful house?

And you may ask yourself

Where does that highway go to?

And you may ask yourself

Am I right? Am I wrong?

And you tell yourself, “My God! What have I done?”

Talking Heads, 1980