I’ve enjoyed watching the explosion of groups and meetings that has happened over the last year. I love to see more people taking part in the conversation about what orthodontics is and where the profession is heading. One would have to quit practicing to attend all the new meetings that are offered this summer/fall and I’ll admit that it’s often difficult to distinguish among all the offerings when one reads the promos sequentially. The recurring theme, it seems to me, is a return to quality orthodontics, a focus on evidence based orthodontics and the need for quality finishes. If one listens to those promoting these websites, Facebook groups and meetings it would appear that there is a serious lack in the profession and thus a desperate need for orthodontists to engage these groups/meetings/websites in order to raise their game to the proper level. Furthermore the clear implication is that if an orthodontist “achieves quality” (as defined by whatever group we are talking about) then all will be right with the world, their practice will be successful, new patients will pour in, they can maintain or even raise their fees and the general public will thank them for refusing to compromise, race to the bottom, sell themselves short or otherwise change anything that orthodontists have done over the last 30 years. I’m not making this up – I’m not that clever. I’m just looking at what is being said and the obvious implications. Of course I don’t buy it, but, just for fun, I’ll suspend my disbelief for a minute and accept all of this as true.

Let’s spell out the implications:

  1. Orthodontists in general must currently do very poor work if there is such a dire need for improvement and a return to quality and education of our peers.
  2. Orthodontists have long been claiming superiority over other options and have recently upped the ante on this position of differentiation but if all above is true (or even partially true) that means we are being, at best, morally flexible in decrying our awesomeness.
  3. If we orthodontists so desperately need to learn how to do things properly then I assume that means that our results are generally poor and patients have been generally unhappy with their results.
  4. The way to grow/improve your practice is to offer the right bracket, use the right system, take the best photos, show the most cases in the ortho groups and be board certified (even though you can get board certified while in residency where you’ve NEVER EVEN TREATED A SINGLE CASE ON YOUR OWN).
  5. The most successful orthodontists are those who can produce the most cases worthy of showing to peers in groups, the harder the case that you treat and show your peers the better an orthodontist you are, the higher your fee the better the orthodontist and the less patients you see/the smaller your practice/the less assistants you have the more you focus on quality so, naturally the better an orthodontist you are.
  6. All of these considerations/criteria happen in a vacuum – what patients want is irrelevant. Only what orthodontists “believe in” or are “willing to do” is important.
  7. Orthodontists find just about any advice from just about anyone more palatable than a discussion of fees/affordability/convenience in orthodontics.

The truth is that what we do is fairly simple 98% of the time. Put the brackets on (the least expensive brackets that get the job done) reasonably close to the center of the crown, make sure the bracket is reasonably aligned with the long axis and that the distance from the incisal/occlusal to the brackets are well thought out, go through a series of wires (3 or 4 should be plenty for the vast majority of cases – again less expensive is better all things considered), Wear some elastics, close the spaces, remove the braces and retain. Yes, yes, sometimes you have to remove teeth. Yes, I know that sometimes you have an impacted tooth or a missing tooth. Yes, I’m aware that sometimes there are horrendously difficult cases that you may choose to treat and perform herodontics on… BUT an orthodontist should judge oneself on our AVERAGE case not on our best or our worst case. Judge yourself on how often you finish in less than 18 or 24 months and what percentage of your cases take longer than that. Judge yourself on the amount of improvement you’re able to achieve in a short amount of time. Judge yourself on patient satisfaction – all of it – comfort, convenience, time (on time for appointments and finishing the case on time) and even affordability. If you want to compare yourself to other orthodontists then make an agreement to show up unannounced in their office and see what comes in the door (take photos) and then have that orthodontist show up in your office.

I’ve been curious for a long time just why is it so easy for small, struggling practices to claim that large, successful practices are “mills who do terrible work” while claiming that their small office has “quality finishes”? If this is true then why do the largest practices receive most of their new patients from happy customers and why do you have so few patients? Why is this obvious fact so easy for them to ignore?

Look, I’m all for quality but let’s not lose sight of the definition of quality or of what we are doing here. I do darn good work and do it very quickly not because I’m talented but because I’m terribly experienced and very good at the psychology of rendering orthodontic care (and thus getting good compliance). Happy patients are the end all, be all of what we do. Period.

No, stop objecting for a minute and really listen – I’m trying to help you.

Seriously, if you ever want to achieve the big practice and success you secretly desire while saying “I’m very happy with what I have and it’s not about money…” then I can tell you exactly what you need to do. I’ve helped hundreds of people find huge success, it’s easy and I guarantee you’ll have success if you just do these 3 or 4 things to the best of your ability while emulating those who already have success instead of those who tout quality because they can’t grow a practice:

  1. Open your office in a place with high demand and low competition. If you choose not to do that or if you’re already in an office location that is not this then keep all your options on the table – including very attractive pricing with modulation of service.
  2. If you’re already wildly successful then keep doing what you are doing, mind that you don’t accumulate overtime patients (overtime patients are practice killers) and rock on. The friendly, likable, motivated owner/operator model is solid and will be for a long time to come. An associate in a corporate office will have a hard time competing with you. If you are not in this position yet then find someone who is and copy them.
  3. Be nice. Nice to staff, nice to patients, nice to referrals, nice to parents… nice to anyone and everyone you serve or who sends you a substantial number of clients to serve. Don’t underestimate the value of likability. Don’t confuse being liked by orthodontists with being liked by consumers.
  4. Become more efficient, make what you do more comfortable for patients, run on time for appointments and finishing cases, have realistic goals for cases, do solid, good looking work, when the patient is happy, take the braces off/quit piddling around, if the patient is not happy, put the braces back on, if a patient has had braces on for more than 30 months take the braces off (now) and do a braces vacation at minimum and track your overtime patients – do whatever it takes to reduce/eliminate these from your practice.

These are simple but not easy. If you can do these things you will thrive no matter where you are. If you do these things you can charge pretty much what you want within reason and you will still have all the patients you want. If you are unable to do these things then price may be your tool of choice despite what others say. If you can’t/won’t do what it takes to thrive then I fear for you and your practice. No one will do it for you and the so called quality being hocked of late won’t do anything for you other than raise your overhead (since the common definition of quality usually involves buying expensive stuff). Think about it – patients who are unhappy with their orthodontist is not the biggest threat to your office is it? It’s a lack of new patients!!! You already know how to get a more than sufficient result so don’t let peer pressure fueled by those who can’t thrive or those who are selling a “system” convince you otherwise. Work on stuff that is important to your prospective  customers if you want a better chance of getting them in the door. It’s simple logic…

If you have questions on how to implement these things then let me know or come visit. The info here on OrthoPundit (most of it free) will help you. The Progressive Orthodontist Magazine is free and it will help you as well. What I’m advocating is free and/or saves you money. Sure I offer subscriptions to OrthoPundit and our study group but you don’t need to join either to be massively successful. You just have to think like, act like and emulate those who are successful in practice – instead of those just successful in talking about practice.

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