As a counter to what was put fourth in the Winds of Change article published in Orthodontic Products, I would like to offer a few thoughts. 

This article appears to be a promo for the mutability and efficacy of AAO (yeah right), a dreamy utterance about how great technological advancement in orthodontics is, a fantastical musing about the ability to get a significant proportion of those who control their own patient base to partner with those of us who do not (as opposed to just hiring an employee orthodontist) and an unrealistic position on fees presented as THE stipulated to “proper way of doing things”. I found it very difficult to follow, as I’m sure others did.

The AAO is as resistant to change as any group of people I’ve ever encountered. They have been forced to make minor concessions to crushing reality in the last couple years but our membership organization should not be congratulated on doing so little, so late. Don’t forget those wise gentlemen in charge of the AAO are the ones who allowed the public to be ignorant about what an orthodontic specialist is and are the very same ones who led us to the sorry state the profession enjoys today. Remember #AAOLEADS applies to now AND everything up until now.

Technology in the orthodontic practice is a booming space with vendors of every stripe trying to get their share, but we do not need to encourage residents and young doctors to pay money they don’t have to purchase precision they don’t need, capacity they can’t fill, “cool technology” that patients don’t care about or increased treatment speed that patients can’t afford (think financing terms). Those selling products and the orthodontists paid to represent them have no regard for the financial well being of the residents and orthodontists they are trying to sell. That is all well and good but no one tells the residents or young orthodontists that! Buyers beware!

Pediatric dentists and general dentists will occasionally partner with orthodontists if they don’t know any better but the vast majority of orthodontists don’t bring much to the table other than an opportunity for the PCD or Pedo to capture revenue and referrals. The smart and aware PCDs and Pedos realize this and will hire an orthodontist to work in their office or for a group of offices. This trend will continue to accelerate and though a few orthodontists will do partnership deals, the vast majority will not have the ability to do so. It is far more sustainable long term and more applicable across the majority of orthodontic practices to hire PCDs and hygienists and even oral surgeons and bring them in house or to buy PCD offices and control one’s own destiny and patient base.

As to the advocacy that orthodontists should have high fees, I don’t deny that there will always be ONE guru orthodontist in every region – not even one in every city – who can pull off that positioning and have very high fees and sell based on perceived “quality of treatment”. Most of us cannot. I’m not that guy and never will be. I don’t hate on those who are – good for them – but the idea that more than one practice in a region can pull this off long term is crazy. Advocating that this path is for all or even most orthodontists is insanity and sets unrealistic expectations for residents and young orthodontists who don’t know better. I’m all for solid, sustainable fees. I’m against discounting. But eventually the commodity nature of orthodontics and especially clear aligners will drive the price of what we do down significantly. Those of us who are established cannot blame those who are trying to get a foothold for discounting. This is a free market economy and we cannot act like a guild and should not espouse protectionist ideals.

I’m very concerned about those orthodontists entrenched in the traditional model suggesting to those they teach and those they lecture to that the traditional model is the future. I’m very worried about the fact that residents and young doctors believe they must have all the technology out there to be a good orthodontist without realizing that increasing overhead and decreasing fees are at odds. I’m unhappy that many of those claiming to be practice management and business gurus are not held to a higher standard and cannot do what they preach more often than not. There are many forms of success and practice size isn’t everything, but all embodiments of success should entail collecting more than you spend in your practice!  Many practice management “experts” out there today cannot clear even this low hurdle and yet we say nothing out of politeness.

Shame on us.

I’m personally ashamed of the state of the profession we are leaving for those in school and future generations of orthodontists. Patients are ignorant of who we are, what we do, why we are better than PCDs and that is all our fault.


Link to article:

Winds of Change

2 thoughts on “The Wind of Change

  1. Your comments always ring true with me but this article really struck a chord.
    I have had and am having a great career over 40 yrs-mostly in ortho.
    I really feel that we have ,as a profession ,not stood our ground with organisations {professional},PCD,s ,residency programs etc. etc.
    I fear that voices ,like yours are only just being listened to, with any degree of attention.
    Honesty in dealing with these issues would start with telling the truth, as it relates to PCD,s,AAOetc. and especially residency programs that over saturate the market and are embarrassingly and utterly dated.
    I hope it is not too late to turn things around but ,rest assured,only jettisoning the past paradigms will enable our profession to flourish{if not survive,at least}.
    Andrew Thompson

  2. Couldn’t Agree more with your assessment. Odds are our profession will die because we aren’t willing to fight for it.

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