Whenever a group of orthodontists get together, the topic of transfer patients is bound to come up. It’s amazing that we always seem to receive patients who are in “terrible shape” (treatment wise) who had “an orthodontist who obviously didn’t know what they were doing” yet we honestly believe that every patient under our care and even those we occasionally transfer out are in excellent condition. Every. Single. One. The vast majority of orthodontists flatly refuse to take over transfer cases or make it so difficult that refusal is their de facto policy. We fervently believe we are awesome and use this belief as the reason we are unwilling to take over “someone else’s crappy case”. We also believe we are totally justified in acting this way. But if all of us are doing such an excellent job and all of our patients are so compliant, where are these “terrible cases” coming from? How is it possible for there to be such a stench hanging over orthodontics’ dirty little secret when everyone claims that their $&!^ doesn’t stink? The answer is obvious:

CORPORATE DENTISTRY!

Wrong. Corporate dentistry works with orthodontists who went to the same schools we did, hold the same degrees we do and who were licensed by the same state boards we were. There’s no logical way to pass the buck from the orthodontic profession so long as the law requires that a licensed dentist does the actual diagnosis, treatment planning and work. Sorry to rain on your parade but “evil corporate dentistry” is still us and the orthodontists doing the work claiming “they were just following orders” does not even approach the level of an excuse. So what is the real reason for the problem with transfer cases?

EVERY SINGLE ORTHODONTISTS OUT THERE HAS CASES THAT DON’T GO WELL OR PATIENTS WHO DON’T COMPLY.

Go ahead, try and deny it. Tell me how all your cases are in perfect order and that you don’t even have relapse problems and I’ll call you a liar to your face. Go sell that stuff to residents at your teaching gig because residents don’t know better but remember that by doing so you are costing your students dearly and setting them up for failure by giving them unrealistic and even stupid expectations. Now, get indignant and yell at your computer and claim that your practice is not like the rest. Make a comment on the article and say so… but be sure to include your address so I can stop by unannounced on a patient day and we will see what walks in your door and judge your acumen based on your average patients instead of a few, cherry picked cases you showed to the ABO. Now that we’ve finished with the indignation, let’s get back to the topic at hand, shall we?

We orthodontists do a terrible job of handling transfer cases. We always have and, unless we do something drastic, we probably always will. Yes we have contracts with patients that say they owe us the entire treatment fee no matter where they go. Yes you can enforce the contract and be an unreasonable jerk if you so choose. Yes you worked very hard putting braces on. Yes your time is valuable. All that being said, you should remember that you will likely need to transfer out roughly as many patients as you transfer in – that may be very few if you live in some rural backwater or it may be a ton if you live near a military base or state school, but the flow in is likely to equal the flow out. At minimum you will have to transfer at least one patient out during your career and someone has to accept YOUR transfer case. This should be important to you if you care about the well being of your patient. Do you want your patients treated poorly? In this context does it make sense to bad mouth, complain about, hold up and aggravate patients who are trying to transfer to or from your area? I think not.

For those receiving transfer patients:

Have you forgotten that you are in the community relations business and that there are family, friends, co-workers, neighbors and school associates attached to each and every transfer patient? Is accepting a transfer patient really about money and about “all the work you’ll have to do”? Are you at capacity? If not, don’t you have tons of open chairs and idle employees who are costing you money that you could put to work on a transfer case? Doesn’t it make more sense to use your excess time to treat a transfer case for a reasonable fee and to treat their family well instead of playing Candy Crush? Be nice, be reasonable and work with the appliances that are already on the patient if possible. Don’t charge a full fee. If possible, finish the case for what the patient owes on the original contract (assuming the other orthodontist is being reasonable about that). If none of those options work, offer to charge a reasonable fee or to charge monthly until the case is finished. If you don’t like the way the case looks, take the braces off, do a braces vacation and then treat the case like it’s the first time you’ve seen the case and there was no prior treatment. Take excellent records of all transfer cases (as you do for all your cases) and you have nothing to fear from “liability from earlier treatment” despite what other orthodontists say. You have spare capacity so why not use it to make a friend and be the orthodontist who takes care of people in your area? **As an aside, I like to take records before and after debonding a transfer case.

For those sending transfer patients out:

Be reasonable about how much you are charging the patient for what you have done. Be sure to give a complete set of initial and transfer records to the patient to take with them and send a copy to the doctor who is taking the case over. Use the orthodontic Facebook groups to help the patient locate an orthodontic specialist in the area they are settling and facilitate the transfer by talking to the doctor honestly about the case. Go ahead and do that hard appointment you’ve been dragging your feet on BEFORE the patient transfers – bond the 7s, repo the misplaced brackets, whatever… And BE NICE during the entire process. Being nice costs you nothing!

For Both sending and receiving orthodontists:

Remember that we live in an imperfect world. There are lots of reasons for patients to transfer but we deal mostly with kids who have no control over where they live. Children who have to move mid-treatment often are in, or perceive that they are in, an unstable home environment (perception or reality are essentially the same thing for our purposes). Having a teen in an unstable home environment very often leads to the teen acting out in negative ways in their attempts to attract adult attention. This kind of behavior is not conducive to excellent orthodontic results… Keep this likely scenario in mind when dealing with the patient and when assessing the orthodontics! Most of all:

  • BE NICE.
  • BE REASONABLE.
  • BE UNDERSTANDING.
  • BE CARING.
  • BE HUMAN!

Finally, if we orthodontists won’t be reasonable in sending and accepting transfer cases, how can we blame patients for seeking out PCDs or blame PCDs for doing orthodontics? What choice do we give them? Let’s change how we do transfer cases as a profession. We can do it. You can do it. Set the example in your office and encourage your peers to do the same. Change is simple but not necessarily easy! Someone has to be first. Pay it forward and change the world one smile at a time.

Related reading:

In Town Transfer Patients

12 thoughts on “We Are Failing Our Patients & Fooling Ourselves

  1. A most excellent piece. You hit the nail on the head. We really are in the community relations business and people should stop this high horse mentality. It just makes no sense and serves no one. Very well written Ben. I quite enjoy your straight forward-call it like it is – style.

    1. Thanks for the kind words Amani. We certainly would do well as a profession if we remember how important community relations and being patient centered is to our success.

  2. Ben, I just want to tell you that what you are doing to this profession is amazing. I always used to wonder why people don’t take transfer cases? I have a lot of transfer cases in my practice and all these patients and a parents are a big referral sourge for me.
    I want to thank you for writing these kind of articles and keep reminding us that we are in health”CARE” bussiness.

    1. I’m reminded what a very wise ortho teacher told us in residency- “Don’t give your idea of perfection to a 13 year old with elastics and headgear”. It’s all about striving for excellence and doing the best we can for the patients. Thanks for the keeping that front and center

    2. Well said Anas. We must remember that our first obligation is to patient care. Ironically I’ve found that if you take great care of people the success in business follows.

      1. Amen. It’s that simple! You can’t buy it on the short term with marketing gimmicks. It will always take TIME to build a successful practice by doing the right things day in and day out including transfers. There is no marketing that will provide such a future stream of new patients as this. Great post today!

  3. Yes! To all of it. We have tons of transfers because our area is high in Pharmaceutical Companies & military/ high turnover of employees. We take them all and they are treated as all of our other orthodontic family members. Every patient has family, neighbors, friends. It is not smart business practice not to be the BEST you can be for every single one of your patients!

  4. It is a sad reflection on us that you even have to make such a post—–very well done ,nevertheless.We are not doing neurosurgery ,we need to stop taking ourselves so seriously and have fun {and be nice ,as you said}.

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