AAO President Dr Steven Siegel on the 2025 Economics of Orthodontics Survey

Alison Werner (00:05)
Hello and welcome to the Orthodontic Products podcast. I’m your host, Alison Werner. Today we’re joined by Dr. Steven Siegel, the current president of the American Association of Orthodontists to discuss the newly released 2025 Economics of Orthodontics survey. This in-depth report offers a detailed look at the state of orthodontic practice across the U.S. and Canada, covering everything from patient volumes and treatment trends to practice finances, staffing, and shifting business models.

We’ll explore why the AAO conducts this research, how it evolved since the last survey, and what the latest findings reveal about the opportunities and challenges facing today’s

Dr. Siegel, thanks for joining me today.

Dr. Steven Siegel (00:40)
Thank you very much, Alison, for having me. It’s always a pleasure.

Alison Werner (00:44)
Great. Well, before we kind of dip into the findings, can you share the AAO’s goals in conducting this survey and how this edition, the 2025 edition, builds on or differs from the 2023 survey, which looked at 2022 data?

Dr. Steven Siegel (01:01)
Yes, that’s correct. Our 2025 survey looks back a year at the 2024 data. we, ⁓ one of the things we pride ourselves on, which is clearly stated in our one page strategic plan, is that the AAO is data driven. So we always try and do environmental landscapes ⁓ assessment. We do consumer surveys every other year, and we do this ⁓ survey every other year as well.

We have an in-house statistician, Mr. Joe Selby, who helps us with that. So I think we’ve tried to, for the most part, maintain continuity, tweaking some questions a little bit here and there. But for the most part, we feel we can compare apples to apples, looking back on the data over the last couple of surveys.

Alison Werner (01:47)
Okay, so let’s dive into that data then. for the 2025 survey, patient volumes and starts hit record highs in 2024, yet many orthodontists still reported not feeling busy enough. How do you explain that disconnect between industry-wide growth and that individual practice perceptions of demand?

Dr. Steven Siegel (02:07)
Yeah, and that’s a very good question. We’re very delighted that overall the trends do see seem to be upward regarding the metrics of starts and patient exams and things like that. And yet one third of our orthodontists report that they’re less busy than they had been with the last survey. And 36 % say they’re not busy enough. So clearly there’s a wide range of how this is affecting practices. Now, some of it can be explained, I think,

regionally. There are some parts of the country that seem to be doing a little bit better, like the West and parts of the South. And then there are some parts of the country that are not doing quite as well, could be a patient migration, population migration, like the Northeast. But beyond that, there’s a wide variation among practices, as far as ⁓ growth and busyness. And that, think, is ⁓ clearly delineated in this survey.

Alison Werner (02:38)
Mm.

Mm-hmm.

Mm.

Yeah.

Okay. So the survey also shows that nearly half of respondents expect to be practicing in a different modality within five years. What does this say about the future of that traditional private practice and what role does the AAO see for itself in supporting members through these transitions?

Dr. Steven Siegel (03:25)
Well, I would say first and foremost, ⁓ we want and value members regardless of their practice modality. So whether they’re in a solo private-owned practice, a group practice, working as an employee associate, or in a DSO or OSO, they are orthodontists and valued members of the AAO. Now, looking at that data, one of the things that we noted was that 9 %

of the orthodontic respondents plan to be retired within the next five years. And so that’s guys like me, the boomer generation for the most part. And that’s a normal progression and generational change. But I think about six to 8 % of those ⁓ orthodontic respondents presently working in a DSO, OSO, identified that they expect to be in a different practice modality. ⁓

Alison Werner (04:00)
Yeah.

Yeah, I saw that

too and I thought that was really interesting. Yeah.

Dr. Steven Siegel (04:20)
within the next five years. So

knowing that ⁓ probably practice modality, there are more choices and more fluidity than there ever have been within our profession, we try to develop resources that will be of value to all of our members, regardless of their practice modality or their stage in practice. So we have an orthodontic career center on our member website.

We have a practice transition portal where one can go on and can look at the differences of the different practice modalities. We’ve got prototype ⁓ contracts and other legal documents available to all members to help them. We’ve got office design. We’ve got pretty much all kinds of resources for members in any type or stage of practice.

Alison Werner (05:13)
So another thing, ⁓ the survey showed that despite rising patient numbers and salaries, reported gross fee collections and net practice income didn’t increase at the same rate. What factors did you guys kind of see that might be contributing to this divergence?

Dr. Steven Siegel (05:32)
Yeah, I think in that particular metric, 41 % of the respondents reported salary increase. I think 25 % actually saw a decrease, but overall, I think it was a reported 16 % increase. And yet, you’re right, when we look at that particular survey in regards to gross production and net collections, it didn’t seem to keep pace.

So one of the things I do is to complement the information that we have in our survey, I look to other sources as well to both confirm or to try and explain some of the data. So I looked at the Cain Waters report. I looked at information from OrthoFi, from Gaidge. I also look at information from Bentson Copple Patterson and Associates. In fact, I had a nice…

Alison Werner (06:22)
Mm-hmm.

Dr. Steven Siegel (06:25)
conversation with Shannon Patterson a couple of days ago. ⁓ The good news is, ⁓ particularly in what might be the most comprehensive report to complement our survey, Cain Waters reported significant increase in gross production and net collections in 2024. I think it was between 5 and 6%. So I’m going to have to go back this weekend ⁓ or later this week when I’m in St. Louis and

Perhaps sit down and talk to our statistician and try and look deeper into some of those numbers.

Alison Werner (06:54)
Yeah.

Yeah. OK. So the data also revealed persistent disparities in income by gender and ethnicity, even after adjusting for age, hours worked, and ownership status. How does the AAO interpret those findings, and what are the plans to address them?

Dr. Steven Siegel (07:16)
This is something that we’ve been aware of for a significant period of time. And the discrepancy, gender discrepancy in salaries between males and females, some of it might be able to be explained particularly earlier in career. seems that women on average work a couple of less weeks a year than their male counterparts. And certainly throughout a career,

Males tend to own practices at a much higher percent, perhaps 20 % higher than females and ownership, I think, brings with it the benefit of higher salaries. But that doesn’t begin to explain the disparity. And so we’ve tried to ⁓ look into that more deeply. In fact, you know, that was one of the reasons why the AAO ⁓ formed the Special Committee on Women Orthodontists.

Alison Werner (07:46)
Okay.

Yeah.

Dr. Steven Siegel (08:06)
to look at ⁓ these issues, to look at creating pathways to leadership, ⁓ training, ⁓ and to help address the disparity. So one of the things that I think can be helpful is to ⁓ give our women orthodontists the tools needed to help bridge this disparity, such as ⁓ contract negotiations, evaluating a contract.

Again, information on different practice modalities, including ownership. So we hope that this will make a difference over a period of time. It needs to, because salary disparity just based on gender is not right. It is a problem. And we are trying to address it.

Alison Werner (08:43)
Yeah.

Mm-hmm.

Yeah.

And then in terms, yeah, the disparities in terms of ethnicity. Could you talk about that? Yeah.

Dr. Steven Siegel (08:58)
Yes, I was going to say, and the same

is true ⁓ regarding ethnic minorities. They also tend to ⁓ make less than their white counterparts. And, you know, some of the same factors may be at play. And this is going to become very, very critical. The AAO needs to help our members address these disparities because, you know, right now, I don’t know if you know, but ⁓ there are more women orthodontic residents than men.

Alison Werner (09:26)
Yes.

Mm-hmm. Yeah. Yeah, I think so.

Dr. Steven Siegel (09:27)
Yeah, I think it’s like 50, like 54, 58%. And

ethnic minorities are also becoming a larger component of orthodontists, I think up to 30%. And so these are real issues that need to be addressed. And we’ll continue working on them. In fact, just like we formed the Special Committee on Women Orthodontists, a couple of years back, we formed the Special Committee for Inclusion and Engagement. Again,

Alison Werner (09:40)
Okay.

Dr. Steven Siegel (09:54)
to create pathways to leadership, training for ⁓ ethnic minorities, bringing ⁓ more in as speakers and orthodontic meetings. And so these two special committees have done fantastic work over the last three, four years.

Alison Werner (10:04)
Mm-hmm.

Okay, so more of the more orthodontists are planning office renovations according to the survey and new locations, especially among the younger members. What does this tell us about where private practice growth is headed and how practices are investing in their future?

Dr. Steven Siegel (10:30)
Well, I think it’s a very, very good sign. I think it means that ⁓ a lot of our young orthodontists share the optimism that I have in our profession. In fact, ⁓ last year I sold the last of my practices to a very fine young orthodontist who actually is just trying to call me while we’re speaking on our webinar. I’ll have to call him back after. ⁓

He’s moved ⁓ the practice to a better location, I think just a week or two ago opened up and invested quite a bit. He wanted a facility that had ⁓ more of a digital workflow and a digital lab. And I see a lot of young members doing this. I’ve seen some spectacular office designs on social media sites. And I think overall it reflects very well for our profession that.

Our younger members are optimistic about the future. They’re investing in themselves. ⁓ And I feel pretty good about the future of orthodontics.

Alison Werner (11:33)
I wanted to ask you about

data that the survey showed in terms of aligner starts and bracket starts because their bracket starts were actually on the increase while aligner starts were on the decline. Can you talk about that data as you found it?

Dr. Steven Siegel (11:50)
Yes, our survey did indicate that the number of cases being treated with braces was on the upward trend, while those with aligners were downward, I think, over the last couple of surveys. Overall, aligner ⁓ share of ⁓ starts is about 23%. This is in line with information I also ⁓ saw from other sources, reliable sources, on patient trends. ⁓

It was interesting because a few weeks back I was contacted by somebody from the American Dental Association that wanted me to help author an article on the resurgence of braces. So I did a little bit of research with the help of some AAO staff and we saw a lot more ⁓ social media posts by celebrities and braces, by influencers and you know perhaps that has something to do with it. ⁓

Other things, and again, this is conjecture, perhaps a ⁓ number of the population had bad experience with direct-to-consumer aligners, and maybe they’re a little bit shy. ⁓ Compliance can be an issue with aligners versus braces, since they’re removable. And then perhaps orthodontists are starting to see more difficult cases that they would prefer to treat with braces. perhaps orthodontists are steering

Alison Werner (13:02)
Mm-hmm.

Dr. Steven Siegel (13:15)
⁓ more patience towards braces rather than aligners. ⁓ So I think that that would be the way that I would try to explain the trend that we’re seeing.

Alison Werner (13:26)
Yeah. Okay. So a finding I found really interesting is that only one in four orthodontists currently include the AAO’s find an orthodontist tool as a referral source. So how does the AAO plan to kind of increase that adoption of this tool given its impact on patient

acquisition?

Dr. Steven Siegel (13:45)
Yeah, well, that’s the 24 % are those people that actually track it. Yeah, and it all relates to our consumer awareness program, our CAP. You know, as I’m sure you’re aware, it’s the only mass advertising campaign to help educate the public as to what an orthodontist is and why they should see an orthodontist for all forms of orthodontic treatment, both with conventional braces and aligners.

Alison Werner (13:50)
Mm.

Mm-hmm. Yep.

Right.

Dr. Steven Siegel (14:11)
And it’s been very successful given the budget constraints that we do have as a finite association. I think we’ve had 9.6 million views on the consumer website. ⁓ And this drives ⁓ traffic to the AAO locator. So we’re going to continue to advance our consumer awareness. have a new campaign, the Science of Smiles.

I think it has nine advertising pieces. We are working with the oral surgeons and the pediatric dentists to have a campaign called 1-7-15. See your pediatric dentist at age one, see your orthodontist by age seven, see your oral surgeon for wisdom tooth evaluation around age 15.

Alison Werner (15:05)
okay.

Dr. Steven Siegel (15:06)
⁓

So we are working, we’re keeping our foot to the accelerator with our consumer awareness campaign. It’s so important to educate the public. ⁓ And I think we’ve been doing a good job and we need to continue the outreach.

Alison Werner (15:11)
you

Yeah, so just to wrap it up, I’m curious what surprised you most in this year’s data and how is the AAO using these insights to shape future member resources or advocacy efforts?

Dr. Steven Siegel (15:39)
Well, what really surprised me, and again, it’s not just looking at our survey, but again, looking at all of the other data that I’ve really looked at in preparation for this webinar from a variety of sources. And when I look at ⁓ particularly the Gaidge data for the first half of the year is very positive. So I think that we’re in a very, very good position. So what do we need to continue to do? You know, our members always

Alison Werner (15:49)
Mm-hmm.

Dr. Steven Siegel (16:09)
identify advocacy as the number one member benefit. You know, other organizations can put meetings on and provide CE and you can get insurance from a variety of sources, but only the AAO is going to advocate for our profession, our members and our patients. And we have so many important ⁓ issues right now. I think our members really appreciated the AAO’s role in patient health and safety as it related to direct to consumer aligner issue.

Alison Werner (16:38)
Yeah.

Dr. Steven Siegel (16:38)
issue.

we have, you know, teledentistry is an important issue. And teledentistry can be a wonderful part of an orthodontic and dental practice to help facilitate patient interactions and cut down on the number of visits. But we also want to make sure it’s done in a way that protects patient health and safety. No irreversible orthodontic treatment should be done without first, you know, an in-house

⁓ assessment by the orthodontist, radiographs as needed, to start moving teeth without those things can cause great harm. So we are advocating at state and local level to incorporate regulations and laws that protect the patient health and safety while allowing technologic advancement. And the same is through with artificial intelligence now. ⁓ That is, it’s progressing ⁓ exponentially.

Alison Werner (17:35)
Yeah.

Dr. Steven Siegel (17:36)
And it’s going to be a great help, I think, to orthodontists in being efficient and effective when they incorporate the use of AI. But it has to be incorporated responsibly. We always want the orthodontist to remain the human in charge, the one who makes the final decisions. And we’re coming out very shortly with a position paper on the responsible use of AI in orthodontics.

⁓ So advocacy, think, is something that we have done extremely well, amazingly well, given the size of our association. But a lot of it is due to a wonderful advocacy team we’ve put together. And a lot of credit goes to our members. We’ve created a national advocacy network where we have members, know, grassroots effort, boots on the ground, so that we can be not just reactive,

to rules and regulations, but be more proactive as we lobby to benefit our members. And that’s patient health and safety, reducing unnecessary and burdensome rules and regulations, and just helping our members be successful. That’s what the AAO is all about. We’re a member-driven organization, and we’re all about our members.

Alison Werner (18:52)
Well, you definitely follow that up with this member survey, which gives a lot of great data that people can use to figure out where they place in their profession and what they need to pay attention to. So thank you, Dr. Siegel, so much for ⁓ coming on to explain the member survey. And I look forward to talking to you again.

Dr. Steven Siegel (19:09)
Yeah, I

do too. Thank you very much for this opportunity.

Alison Werner (19:12)
Great.