The answer is obvious. Or it should be. We orthodontists think it is obvious, but our actions often say otherwise. “What the heck are you talking about Burris?” I can hear you saying. I’m glad you asked because I want to talk about the difference between what we believe we do, what we actually do and the messages we send patients on purpose or otherwise.

Would you rather have $250 or $5000?

5K of course! Well, unfortunately, not all of us act like it:

• When we charge for records at a new patient appointment, we are putting up obstacles, making it more difficult patients to start treatment and, in essence, we are valuing the $250 records fee over the full case fee. I know you don’t believe it but that is exactly what you are doing. “My time is valuable and they should pay to see a professional” I can hear you saying, but I have a better analogy. Imagine you want to buy a new car. You drive to the dealership and as you get out of your car to look at the new models a sales person says, “Whoa tiger, I need you to fill out all these forms and pay me $250 before you can look at options and before we can tell you anything about price and financing.” How do you think you would react? How is what we do any different?
• Even worse than charging for records is charging for new patient visits. I know this is less common than it used to be but there are still some who charge for the first NP visit and many who charge after a missed NP appointment. The reasoning is still the same and it’s still dumb. If you have more patients than you want to treat then go ahead and charge for a new patient visit but, if not, you might want to decide which you want more – the $250 new patient visit fee or the $5000?

Do you want the 99% or the 1%?

Again, this sounds like a no brainer but I’ve seen multiple occasions where orthodontists worry so much about credit card or bank processing fees that they put the full fee in jeopardy over 1%! For example:

• An orthodontist near me actually started forcing patients to do bank drafts and credit card drafts quarterly instead of monthly to save on fees by doing transactions 1/3 as often. Patients hated this and we got a ton who came to us, told us so, and started with us. Theoretically charging quarterly is sound and should make no difference but in the real world, most families can’t budget quarterly and it’s a deal killer.
• I hear from orthodontists all the time who want to restrict credit card use in their practices. I understand their motivation and I would also prefer that patients use auto-drafting of a bank account instead of credit cards in my practices (but I like the NSF motivation more than I like the 1%). However, refusing to accept a credit card can be a big hindrance to selling a case these days given the points, miles and cash back that people earn on credit cards and it’s another way that we orthodontists tend to value the 1% over the 99%. We should be knocking down barriers to treatment instead of building them up!

Do you want all of nothing or part of something?

I’ve been guilty of this one as much as anyone and perhaps more. Let me give you a couple examples of what I mean:

• In the past, I refused to do Invisalign, charged a higher fee than I did for braces or charged a very high down payment in order to convince people to choose braces instead of Invisalign. I believed that it was not worth paying the Invisalign lab fee to get a case and for a while I even convinced myself that it wasn’t worth it at all to do Invisalign. It’s not useful to judge past decisions with current knowledge and it’s difficult to evaluate past positions based on the new reality but, either way, I’ve changed my opinion of Invisalign because I want part of something instead of not selling a case. Align has won the marketing war. They have gone direct to consumer and people ask for Invisalign by name. Being an Invisalign provider brings in new patients I would not otherwise get and there are patients who will not be happy in anything but Invisalign. These days I’ll take the start and my part of the fee and understand that the lab fee is the costs of marketing and doing business.
• I used to charge extra for clear brackets or WildSmiles. Patients like these brackets, we have patients who ask for them and that is awesome. However, when I charged extra for these products, I added a barrier and essentially valued the 1% above the full case fee. That was dumb and I don’t do it any longer.

You can run your practice any way you see fit. You’ve earned that right and I’m not suggesting otherwise. What I am suggesting is that sometimes we do things that we think are a good idea when they are really dumb and counterproductive. I know I have and still do!