AAO Secretary-Treasurer Dr Michael Sherman on navigating modern operational complexities and cultivating practice sustainability.

By Alison Werner

Orthodontics has traditionally enjoyed a reputation as one of healthcare’s premier “lifestyle specialties.” With generally predictable schedules, a lack of overnight calls, and relatively few acute medical emergencies compared to other medical fields, the profession has long been viewed as an ideal blend of clinical reward and personal flexibility. However, the reality of the profession today presents a much more complicated and demanding picture.

Michael Sherman, DDS, MSc, MBA, orthodontist and secretary-treasurer of the American Association of Orthodontists (AAO), notes that while those traditional features still exist, the label of a lifestyle specialty belies the intense, multifaceted pressures modern practitioners face. Today’s orthodontists are not only healthcare providers responsible for delivering excellent clinical outcomes, but they are also small-business owners navigating an increasingly volatile economic and operational landscape.

The Shift from Clinical to Operational Demands

When examining the root causes of practitioner fatigue today, the conversation inevitably turns away from the chair and toward the back office. The clinical challenges of orthodontics—managing treatment progress, ensuring patient compliance, and addressing unexpected complications—have always been foundational to the profession. What has fundamentally transformed is the business environment surrounding that clinical care.

“Both clinical practice and practice management contribute to stress, but compared with a decade ago, the greatest increase has come from the growing complexity of running a modern orthodontic practice,” Sherman explains.

Today’s orthodontists must seamlessly transition from clinical experts to effective business leaders, employers, technology adopters, and educators. They are forced to contend with rising overhead costs, intricate regulatory and cybersecurity requirements, heavy technology investments, and mounting insurance-related administrative burdens.

Furthermore, the marketplace has become significantly more competitive. The rise of direct-to-consumer orthodontic products and aggressive marketing by nontraditional providers have heightened public awareness, but they have also forced specialists to spend more time educating patients about the critical value of doctor-led care. Patients are also arriving at consultations more engaged but often misinformed, pulling data from social media and artificial intelligence platforms. While an informed patient can strengthen the doctor-patient relationship, correcting misinformation requires additional time and energy from the practitioner.

“Most orthodontists entered the profession to care for patients and transform lives through healthy, confident smiles,” Sherman says. “The clinical challenges of orthodontics haven’t changed nearly as much as the demands of running a modern practice, and that’s where the greatest source of stress has shifted over the past decade.”

The Weight of Workforce Management

Among the myriad of operational pressures, staffing shortages and the ongoing demands of workforce management stand out as the most significant threats to a practitioner’s professional well-being. The traditional model of long-term, decades-spanning team stability has become increasingly rare. In its place, many practices find themselves caught in a relentless cycle of hiring, onboarding, and training.

This continual turnover requires substantial time, energy, and financial investment, often diverting the doctor’s attention away from patient care and strategic practice growth. The impact is pervasive across all practice modalities, from solo and small-group practices to larger corporate structures.

When a key staff member leaves unexpectedly or calls in sick, the orthodontist frequently has limited options for coverage. Consequently, the doctor must personally absorb those additional operational responsibilities.

“This can create significant stress, professional isolation, and uncertainty,” Sherman notes. “Orthodontists depend on highly coordinated teams to manage a large volume of patient interactions while maintaining exceptional standards of care. Staffing disruptions force orthodontists to balance clinical responsibilities with workflow management, scheduling challenges, and team oversight, often all at once.”

Over time, these cumulative demands contribute heavily to increased mental fatigue, emotional exhaustion, and a heightened risk of professional burnout.

Navigating Career Stages and Financial Pressures

While the overarching goal of maintaining a successful practice remains constant, the specific sources of stress evolve significantly over the course of an orthodontist’s career.

For new graduates and early-career orthodontists, the primary hurdles are heavily financial and professional. Many enter the field burdened by substantial educational debt, which can delay practice ownership and influence early career decisions. Those who do pursue startups or practice acquisitions must navigate massive capital investments while simultaneously trying to build patient volume and referral networks. They are also thrust into leadership roles—a skill set rarely taught in clinical training programs.

As practitioners move into their mid-career phase and become established practice owners, the focus shifts from building to sustaining. Here, workforce recruitment and retention dominate their concerns. Mid-career orthodontists must dedicate increased attention to compensation structures, workplace culture, and employee development. Concurrently, they face the pressure of continually adapting to evolving technologies and digital workflows while managing ever-rising operating expenses.

For orthodontists approaching retirement, the challenges pivot toward transition and legacy. Practice succession planning has grown increasingly complex as ownership models within the dental industry evolve and fewer young practitioners pursue traditional solo practice ownership. Retiring doctors must carefully plan to meet their ethical obligations, ensuring a seamless transition of care for active patients, all while trying to preserve the financial value of the practice they spent decades building.

Ultimately, regardless of the career stage, external economic pressures add another layer of complexity to these professional hurdles. Sherman highlights that “economic uncertainty has made some families more cautious about healthcare spending, which can delay treatment decisions and create additional financial pressure on practices.” Despite these shifting marketplace dynamics, the core objective for practitioners remains unchanged. The ultimate goal, Sherman notes, is “creating a professional environment that allows orthodontists to provide exceptional patient care while maintaining financial stability, personal well-being, and long-term career satisfaction.”

Technology: Efficiency Versus Complexity

Technology is frequently touted as the ultimate solution to practice inefficiency and workplace stress, but it serves as a double-edged sword. Innovations such as digital intraoral scanners, advanced imaging, digital treatment planning, and in-office 3D printing have undeniably improved diagnostic accuracy and streamlined workflows. Remote monitoring technologies, when used appropriately, enable doctors to track progress between appointments and reduce unnecessary office visits.

However, technology is not a magic bullet. Every new platform requires significant financial investment, comprehensive staff training, workflow redesigns, and ongoing maintenance. Furthermore, digital tools can inadvertently raise patient expectations, creating the false impression that biological tooth movement is faster or simpler than reality dictates.

Crucially, technology has also eroded the boundaries between the clinic and personal life.

“Digital technologies have impacted nearly every professional career, making it easy to bring work home and thus blurring the line between work and home,” Sherman says. “Orthodontics is not immune to this. Many orthodontists work on digital treatment plans or view remote monitoring files after office hours.”

When practice owners care deeply about their patients and their staff, the urge to be constantly responsive is strong. Disconnecting from questions and clinical requests during standard office hours can be difficult, which inevitably pushes a significant portion of the digital workload into the doctor’s personal time.

Building a Healthy Practice Culture

To prevent technology and operational tasks from consuming a practitioner’s life, successful offices focus heavily on their internal environment. Practices that are successfully navigating today’s complex digital and operational landscape share common traits: they are highly intentional about leadership, culture, and adaptability. While operational systems are vital, the most resilient practices recognize that long-term success ultimately depends on people.

Effective leadership in the modern orthodontic office looks different than it did in previous generations. In the past, the orthodontist was expected to be the absolute expert in every single area of the practice. Today, given the rapid evolution of technology and business operations, successful doctors understand they cannot do it all alone. Learning how to outsource training and connect staff with outside mentors has become a critical leadership skill.

Furthermore, today’s workforce often has different expectations regarding job tenure and workplace culture. Successful orthodontists anticipate this by building efficient training processes that acknowledge the potentially shorter lifespan of an employee, rather than relying on the outdated expectation of lifetime loyalty.

When implementing new initiatives, transparent communication is paramount. If a doctor returns from a continuing education course eager to implement a new technology but fails to consider the staff’s perspective or workflow, the reaction can quickly become adversarial. The leader must clearly articulate the implementation plan and explicitly detail how the new tool will benefit the team.

“Thriving orthodontic practices invest in culture,” Sherman says. “They prioritize respectful communication, teamwork, and professional development. Regular team meetings, opportunities for staff input, ongoing education, and recognition of employee contributions help create an environment where people feel valued and engaged.”

The Importance of Mentorship and Community

As the business side of practice ownership threatens to outweigh the clinical joy that drew many doctors to the specialty, the risk of professional isolation grows. When asked for his primary piece of advice for practitioners feeling overwhelmed by these operational demands, Sherman points directly to the power of connection.

“Mentorship is critical,” Sherman advises. “Reach out to someone you feel comfortable with and ask how they would handle it. Orthodontists are often the only person in their role in a practice—but we are not alone. Any challenge experienced by one orthodontist is almost certainly not an isolated incident.”

Building a supportive community through in-person meetings, continuing education events, and peer networking allows practice owners to learn from one another and collaboratively develop solutions to shared challenges.

Photo: ID 317640730 © Yuri Arcurs |   Dreamstime.com

Alison Werner is chief editor of Orthodontic Products.