The latest "JCO Orthodontic Practice Study," which reports financial information from the calendar year 2008, has found that orthodontic case starts and median net income have both declined.

Among those surveyed, case starts declined from 222 to 220 between the 2007 to the 2009 study. Gross annual income jumped from $922,500 to $960,000 (a 4% increase), but that was more than outweighed by yearly expenses, which increased 12%—from $500,000 to $562,500.

As a result, overhead rates reached an all-time high of 56%, and median net income among the orthodontists surveyed declined 5%, from $400,000 to $380,000 a year.

According to the US Census Bureau, the median annual income of American households was $50,233 in 2007, the latest year for which information is available.