The last few years have been terribly interesting! Unforeseeable and even unbelievable events seem to have become the norm and the pace of change is ever increasing. Adapt or die has never been more applicable in a time when:

• A DTC aligner company with a brilliant, novel model going from an $8BN valuation to Chapter 11 to ceasing operations and appearing to abandon patients according to the NYT.
• The Big Aligner’s stock price ain’t what it used to be.
• Large Ortho DSO’s C suites clear out without notice over a weekend, the rate of acquisitions and the prices paid for ortho practices appearing to be on the slide industry wide and even the biggest DSOs in orthodontics are cost cutting to the point of getting rid of sterilization techs.
• The Federal government says that non competes are no longer enforceable for healthcare providers (though it is unclear if this includes practice sellers where part of the purchase price was allotted to the noncom), possibly upending the associate doctor game with secondary and tertiary impacts TBD.
• The impact of COVID era craziness in schools has become apparent with many young dentists and orthodontists being less knowledgeable than ever before – not just in technique but in basics like radiographic interpretation and morphology.
• Thousands of dentists and dental specialists holding the bag of DSO stock they traded for their practice in lieu of cash with hopes of 10x returns… watching the economy turn, DSOs struggle and their dreams of early retirement right after their 5 year commitment ends crumble.
• Ortho experts claiming as recently as the SAO at Amelia Island that despite October being down 30 percent year over year across the ortho industry the answer is to raise fees, invest in technology and do more aligners… and worse yet the few orthodontists in attendance agreeing that this is the way to go!
• Orthodontic residency programs continuing to pump out residents at an ever increasing rate, DSOs continuing to buy ortho offices and multiple aligner companies with disparate models trying to fill the void recently opened in the space.

To be clear, I’m in no way casting stones. No one lives in a glassier glass house than I do! That being said, we need to talk about what is going on and what the best options are now – especially for current and soon to be owner/operator orthodontists, dentists and dental specialists. One of the things we humans struggle with is the fact that the world isn’t static. What works today may not work tomorrow so we must constantly adjust based on current events and circumstances.

So the question is, what are you going to do in 2024 to thrive and enjoy life? Where will you be in 3, 5, 10 years? How will you get there? What will you do if your house, your practice, your DSO stock, your investment portfolio isn’t worth what you thought it would be? How do you plan to insure that the biggest asset you have – your practice – continues to be the financial engine that drives your family’s lifestyle?

There is no right answer and even among similar answers the details will vary from person to person. The trick is to make sure you do what is truly good for you and not just what you’ve always done, what has worked in the past or what is easy, comfortable or convenient (unless that happens to be a proven strategy with proven results). We must constantly evaluate our RESULTS with a critical eye! Results are all that matter and generally if we want different results we need to take different actions. As I’ve said over and over, if you are happy with your results don’t change. But the converse is also true.

I don’t have the answers for you. I have pretty good approximations of the answers for me – or at least ones that seem to produce acceptable results for me and mine today. We have been constantly changing for a couple decades now and are very pleased with where we have ended up but that could change again in 2024. Most of us only change when the pain is so great we have no other choice. Trust me I’ve had to make plenty of pain based change and that’s because I’ve probably failed more than any other orthodontist on the planet. However we have also become very good at proactive change based on evaluation of results and modifying our actions accordingly… and this creates a much smoother path forward.

No one knows what the future holds. No one. But if you do what everyone else does, you’ll likely get what everyone else has. In the past that would have been awesome for orthodontists. These days, not so much!

As we close out the year spend some time evaluating where you are, how you got here, where you want to go and how you plan to get there. Be intentional about the important things in life:

• Family
• Friends
• Free time/fitness
• Finances

Ideally in that order of priority! Obviously money is like air – when there is plenty you don’t worry about it but when it’s lacking you cannot think of anything else – so we must make finances the primary concern until we have enough. As the owner/operator of a practice it isn’t difficult to get yourself financially free and even easier to stay there once achieved IF YOU MAKE DECISIONS BASED ON THE MARKETPLACE AND THE RESULTS YOU GET. From where I sit there has never been a better time to be an independent orthodontist delivering awesome results and service at an affordable price. The current marketplace presents more opportunity than any orthodontists have ever had before – people want what we have and are willing to pay thousands of dollars to get it. Will you step up, fill the need in your community and reap the rewards for you and your family?

PS One of my friends who edits/advises on these posts sent me this as part of his revision. Interesting times indeed!