Let me get this straight… We orthodontists are dying as a speciality and yet we refuse to make any substantial changes to save ourselves. We orthodontists believe we are top 1%ers and our track record of success proves this but at the same time we hate change more than anything in the world because we are entitled, arrogant and intellectually lazy. We orthodontists refuse to see that the world is changing and becoming more interconnected, refuse to see that non-invasive services are being systematically decentralized, refuse to admit that only 3% of the US population having access to orthodontic care annually is unacceptable and yet we still maintain that any change in our speciality that doesn’t immediately line our pockets with zero effort on our part is bad. Worst of all we believe that all of these things are the fault of others! We still believe, as a profession, that seeing less patients is superior to seeing more patients! How elitist is that? How stupid is that? If I didn’t know better, I would think we are planning for our own destruction.
What is happening in orthodontics and what SmileDirectClub is doing is not unique or new. The book The Innovator’s Dilemma describes this scenario in detail and gives multiple examples. It’s a tiny book that you can read in a couple hours so do yourself a favor and read it so you can see the big picture, please. My love of that book is what allowed me to recognize SDC for what it was immediately after I got over my knee jerk reaction of “you can’t do that” and understood the SDC model.
After doing several hundred cases of Invisalign many years ago, I stopped using them and I despised Align and all they stood for – mostly because I didn’t want to pay the lab bills. I didn’t use aligners for 8 years because I refused to admit what the future held and what patients wanted. Align is very good at what they do. Better than orthodontists. They have won the marketing war and patients ask for their product by name as we have discussed before. That’s why I came back into the Invisalign fold at the end of 2015. Align is a publicly traded company. Align understands that to do well they must serve more and more customers and give them the smile enhancement they desire. Isn’t that a good thing? Shouldn’t we do the same as a speciality?
Getting involved with SmileDirectClub makes logical sense for Align, for Invisalign providers and for patients in general. Access to care will be expanded and those who embrace Invisalign enough to be on the doctor locator will be rewarded with an influx of patients captured through the direct to consumer SmileDirectClub network. Those Invisalign providers who are also SmileDirectClub advocates will be doubly blessed! More awareness is good for all who offer orthodontic treatment and as the public understands that orthodontic treatment is available and affordable, new patients will enter the orthodontic market. Increased awareness will increase demand for all types of orthodontic treatment and will benefit everyone, including traditional practitioners who don’t even do aligners. I know you don’t believe that. I know you don’t like what’s going on. I know you can’t stand change. I know you want the good old days. But you must recognize that you have a choice – get on board or don’t. Of course you might also choose the traditional orthodontic response -to do nothing – but you’ve still chosen! I can assure you that if you don’t fill the needs and wants of the public in your area, someone else will. This country was built on that fact. You’ve already missed out on a great deal if you’re just now becoming aware of SmileDirectClub. How much longer are you willing to languish in self deception and intentional ignorance as the world passes you by?

We orthodontists want it both ways but we can’t have it. We can’t despise or resent or disrespect a company or a person and then expect them to give us what we want (especially at the expense of access to care or smart business). We can’t desire faster, cheaper and easier in all products and services we utilize only to be protectionist in our businesses – especially when we are healthcare providers with obligations to the public good! We can’t revel in the fantastic changes in technology and enjoy the benefits they provide in all aspects of our lives while, at the same time, trying to stop anything from changing in our business or our profession. This is just the way it is. Coal miners hate solar energy and taxi drivers hate Uber but they are in the vast minority and they are just plain WRONG. Taking this position is effectively dooming yourself to long term bitterness and failure.

Align is a publicly traded company and they are doing what is good for them. They need to provide for the long term stability and profitability for Align shareholders. Oh, by the way, what they are doing is increasing access to care so it’s really hard to argue with. We orthodontists should also do what is good for us and our businesses (though we have a miserable track record) and do what is best for our patients (we have a kinda sketchy record there too). An easy way to do that is by embracing technology that the public actually wants instead of the stupid nerd gadgets that we love to spend money on or even by being willing to deliver care in a way that the public can access. Only 3% of the US population has access to orthodontic care annually. Is that right? Is that fair? Are we doing our job, fulfilling our oath and serving the public good in allowing that little access to care? If we want to be the undisputed masters of orthodontic care delivery, isn’t it dumb to turn our backs on what will likely be a much bigger care provider network than has ever existed before? Can’t you see where this is going? Haven’t we had this conversation before right here on OrthoPundit? Do you believe me now that Align is involved with SmileDirectClub?

The more we orthodontists push back against increased access to care, the better Align and SmileDirectClub’s direct to consumer position will be from a PR point of view and the more we look like protectionist jerks. Consumers have made it clear what they want, how they want it and what they are willing to pay to get it. Are you willing to meet their needs on their terms or will you stick to the way it’s always been done because… Well just because! The choice of how to run your business is yours just as customers can choose where to spend their time and hard earned money. With great change comes great opportunity. Are you up to the challenge?

*** I thought this was plain to all but there are several orthodontists coming late to the party who aren’t clear how I’m involved in these companies. So, to be crystal clear let me elaborate: I’m very proud to have worked with SmileDirectClub for almost a year and a half unofficially because I love the product and what it stands for. A few weeks ago I joined SmileDirectClub in an official position that is mostly advisory and so new that I don’t have a title yet. I’ve been an ELP for SmileDirectClub for well over a year and I regularly treat SDC cases.
I also love and promote Invisalign. I want to speak for them but they aren’t comfortable enough with me to give me a KOL position yet as I can be a tad controversial. I don’t blame them but maybe one day I’ll work with Align officially. I sure hope so.
Both SDC and Align have paid for promotion/advertising in ProOrtho Magazine.

15 thoughts on “So You’re Mad at Invisalign?

  1. typo? We orthodontists believe we are top 1%ers and our track record of success probes—did you mean proves?

    1. Thanks for letting me know. You are correct. I fixed it! Have a great weekend.

  2. Ben , Any idea when they will be taking on new Doctors ? i have asked to be included over the last few months and all i get is “no new doctors at this time” thanks, bill dabney

  3. You needed to join last year. It is mostly filled now. The ship is going down and the safety boats are full. The remaining orthodontist who are not part of the future (SDC) should consider joining a union of nationwide orthodontist providing services at a steep discount to compete. Ben, thank you for guiding us to join the SCC now the SDC. I am so happy I joined.

  4. The AAO never even sent me an email to join this and they new about this!!! So happy I read your posts.

  5. I just saw this after getting a dozen text messages about this topic in general. My response was ” if you didn’t see this coming, you need to go back to third grade and start over”

    And if you don’t see the opportunity, stick your head back into the sand.

    As usual, Ben nailed it!

  6. Ben – where is your stat re: 3% of population having access to ortho care? 3% about 9.6M people — I don’t understand how roughtly 310M people don’t have access to ortho care?

    1. I came across it while researching Invisalign and trying to decide whether or not to take the plunge and go all in with aligners last year. It’s actually less than 3 percent according to AAO stats. Proof is in the pudding. If 80+ percent of people could benefit from orthodontic treatment and that few do then either 1) no one wants orthodontic care or 2) there isn’t access to care. That’s an easy one to figure out in my book.

  7. As an orthodontist I am not concerned with SDC in its current form because I rarely see the kind of minor crowding/spacing cases that they propose to treat. Most of the general dentists in my area do Invisalign and they tend to treat most of the minor cases and refer me the moderate to difficult cases.

    Dr Burns…do you forsee SDC club keeping to this model or do you think that down the road they will be attempting to treat more difficult cases and even addressing malocclusion?

    1. I think that SDC will follow the well established path outlined in the book The Innovator’s Dilemma. I can’t advise you strongly enough to read it. Despite what Real Orthodontist and others think and say and want, what we do is not that difficult and it’s elective in all but the most severe cases. Anything noninvasive and in high demand will become more and more decentralized. How will that happen? When? I’m not sure but in this country when there is an unmet demand and money to be made then smart people will figure out how to do it. It’s just the way it is. As healthcare providers we should be receptive and even happy to advances that increase access to care to those who have zero access currently. Few take this position but if you do so then you can figure out how to harness the rising tide rather than being drowned by it. Thanks so much for sharing your thoughts and your great attitude.

  8. You are obviously a hack of an orthodontist. Moving teeth and changing occlusion is something that takes great care and skill. Virtual reality movement without a prodffesional checking the results is fraud. You are a sell out and so is the company. The public will find out the truth that you will create open bites ,traumatic bites etc. absolute sell out with no thrush. If you were a real orthodontist you would not make any of these sell out comments. Who knows what they paid you to say these things.

    1. I’m so glad you took the time to share the arrogance that is so prevalent among old school orthodontists. Orthodontists who would rather people have no access. Orthodontists who believe that what you do is correct and everyone else is terrible. This is priceless and I’ll use it as an example in my future writings and speaking engagements where I try to teach orthodontists to stop thinking and being like you. I only wish you had the guts to use your name so I could thank you personally. I must admit, though, the anonymity is the cherry on top of this!

  9. I have never jumped in on these types of discussions but feel it’s time. Might the same be said about short term orthodontics? Our little company has 30K patients a month coming to our website, and 60% do it organically—that is they type in “Six Month Smiles”! Instead of frightening the GP–why not support them in doing the easy cases (case selection is what we preach and teach and will soon offer digital planning services done by orthodontists). For that matter, offer it to your patients as an Orthodontist (I don’t care if it’s us, you can do it yourself), to your point seeing more patients is better for the population and will drive more cases to the orthodontist. Further, STO keeps the doctor patient relationship intact. Take a look at Endo, 15 years ago there was no way a GP should stick a rotating instrument in a canal. Today, the GP both does more endo 9 (with rotating instruments) and refers more endo than ever. Further, while endos “fix” the occasional case for a GP, they are doing the more challenging cases overall which many will tell is what they really want to do and that they are busier than ever. Believe me GPs are scared to embarrass themselves with specialists and are very cautious about the deep end of the pool—they will refer. A best practice in business is to figure out how you would put yourself out of business, before someone else does and change accordingly.

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