The Paradox of Our 2025 Annual Practice Survey: When Steady Production Meets Shrinking Profit

Alison Werner (00:05)
Hello and welcome to the Orthodontic Products Podcast. I’m your host, Alison Werner. Today we’re diving into the findings from the latest Orthodontic Products Levin Group Annual Practice Survey, which looks at how orthodontic practices performed in 2025 and what those results signal for the year ahead. In this conversation, we’ll break down what a stable year really means, why profitability is under pressure even when production holds steady, and what orthodontists should be focusing on now as economic uncertainty begins to shape patient behavior, pricing,

practice growth. Joining me is Dr. Roger Levin, CEO and founder of Levin Group, to walk us through the data and share practical strategies for navigating what comes next. And just a reminder, you can find the full survey results and Dr. Levin’s take on them in his article in our April May print issue and online. And now here’s our conversation.

Alison Werner (00:55)
Well, Dr. Levin, it’s great to have you back with us.

Dr Roger Levin (00:58)
fantastic to be here. I can’t wait to talk to you about our survey results from 2025.

Alison Werner (01:05)
Yeah, so as you said, this survey looks back at orthodontic practice performance in 2025, and we’re talking about it. But we’re talking about it a time when the economic environment is shifting. So as we go through these results, how should orthodontists be thinking about applying what we learned in 2025 and what’s happening now as of the beginning of April 2026?

Dr Roger Levin (01:28)
Yeah, well, as you know, Alison, we collect all the data in January for the previous year.

It’s a really great survey. It’s very nationally based. It’s

an N sample, meaning it’s a random sample of orthodontists, not just Levin Group clients or some segment. And we look at the data and then it just depends how fast things are changing. So this

survey is accurate as of December 2025.

Then we have to ask, well, what’s happened since then that might change things? Most years, not much has changed in a few months. This year might be a little bit different as we’ll talk about. So the key is take the information, but don’t assume that what happened in 25 will happen the same way in 2026. Now years ago, yeah, one year wasn’t that much different than the next, but you know, in the last few years we’ve been through COVID, we’ve been through a staffing shortage.

where have a lot of political changes taking place. ⁓ Some of them will have no effect on orthodontics, others might. So the key is take the information and then ask, well, what’s happened in the last few months, which we’ll discuss today to some degree, that might change the trajectory of that information.

Alison Werner (02:45)
Yeah, okay. So at a high level, when you look at this year survey, what are the two or three biggest takeaways orthodontists should be paying attention to right now?

Dr Roger Levin (02:55)
Well, I think for the survey, as I said in the article, I would call it the year of stability. The good news to some degree is that 2025 was a stable year. That doesn’t mean it was a good year. That doesn’t mean it was a profitable year for many orthodontic practices, which I’ll explain later, but it was a stable year. We didn’t see wild swings in production. We didn’t see wild swings in overhead. I would say a lot of these statistics were somewhere between one and 2 % changes.

Alison Werner (03:07)
Mm-hmm. Mm-hmm.

Yeah. Yeah.

Mm.

Dr Roger Levin (03:25)
Um, and so if you like stability, that’s good. It just depends which way you changed, but nobody got terribly hurt by dropping 1.1 % and nobody got rich by growing 1.1 % or richer, I should say. So my first takeaway is that the patient flow was fairly steady. Oddly enough, the number of new patients entering orthodontics increased by a tiny amount.

even though not all practices were more profitable. So one big takeaway is just because you get more new patients doesn’t mean you have more profit and income at the end of the year. The second one was staffing. We know that almost 64 % of orthodontic practices are seeking a team member now. They have a vacancy, so to speak. ⁓ So literally they’ve got a hole to fill, not just.

growth oriented, but they’ve got a hole to fill. Some of them are growth oriented. Most are trying to find the right person. And then I’d say the third takeaway that really always strikes me are fees. Fees barely went up. And that tells me there’s fear. There’s fear to raise fees because unlike the rest of dentistry or many businesses, orthodontics can be price sensitive, meaning

Alison Werner (04:25)
Thank

Mm.

Mm-hmm.

Dr Roger Levin (04:45)
We’re now seeing orthodontic cases from five, six, $7,000. Then we see some orthodontists who are having a price war. They’re coming in at $3,500 to $4,000. Then we’re seeing an Aspen Dental, and this is just a fact, offering aligners at $1,999. And you leave with your first set of trays that day. So you’re locked in once you make, there’s no changing your mind at that point, you’re locked in. So I think the fear

Alison Werner (04:57)
Huh.

Mm-hmm. Yeah.

Dr Roger Levin (05:15)
of raising fees is problematic because if you don’t, ⁓ then the overhead factor begins to play in and profit actually goes down. So those would be three of my biggest ⁓ observations for this year, although there’s a lot more in the survey and the article.

Alison Werner (05:29)
Okay.

Yeah, no, definitely. Well, I want to go back to what you said about stability. know, 2025 was that year of stability, but also you also suggest that the stability might be masking deeper challenges. So what do you think is really happening beneath the surface there?

Dr Roger Levin (05:49)
Beneath the surface, think orthodontics is rising in competition. And because we’re a fragmented industry, the vast majority of orthodontists are in solo practice, and they don’t go to meetings and have economic discussions. They don’t go to meetings, and they’re not in a group that compares their top 20 key performance indicators so they can see how they’re doing. Competition is growing. It’s kind of under the surface, but as it’s growing,

Alison Werner (05:54)
Yeah.

Dr Roger Levin (06:18)
we’re finding that a lot of practices don’t realize the effect it’s going to have on them. The effect being fewer new patient calls, fewer referrals, fewer starts. you don’t also orthodontics has a lagging indicator because you don’t notice a problem sometimes for 12 months. For example, in 2007 and eight, which is a great example of orthodontic production dropped by 10 to 12%.

A lot of orthodontists didn’t feel it in the first year. It’s the end of 12 months when patients have all completed their treatment and half of them are gone, that you start to feel the downturn. So I think like any business, the number one factor is competition that’s affecting orthodontists. Number two, huge, is staffing. I call it a staffing crisis. Some people call it a staffing shortage. I’m not telling any orthodontist something they don’t know at this point.

Alison Werner (06:58)
Right.

Yeah.

Dr Roger Levin (07:16)
but compensation has gone up. Whenever you have a smaller labor pool, compensation goes up, but it’s gone up dramatically. And when it goes up by a lot, it just adds to overhead, which begins to cut into profitability or even things no one talks about the ability of the practice to invest in new technologies or remote monitoring or a second office or a marketing campaign. So you can eat up a lot of dollars on staffing

Alison Werner (07:23)
Thank

Mm-hmm.

Dr Roger Levin (07:46)
And yes, you get a return on investment, but you may be losing on the other equations and that can hurt the practice in a significant way. The last piece is something you and I have talked about quite a bit, the word uncertainty. So I went to a national economic conference recently and one of the top economists in the country who had been a former treasury secretary and it was not Larry Summers for those who pay attention to this stuff. No, he’s good, but it was not him. It was a…

Alison Werner (07:49)
Yeah.

Yeah.

Hahaha

Dr Roger Levin (08:15)
A brilliant man who’d been the CEO and chairman of one of the biggest financial companies in the world. I respect him quite a bit, very straightforward. He said, we’re going to live now economically with more uncertainty than certainty. And by the way, that may apply to everything from geopolitics across the board. All you got to do is turn the TV on any day and the news changes daily and you never know what’s coming.

Alison Werner (08:41)
Yeah, exactly.

Dr Roger Levin (08:43)
In economics, uncertainty doesn’t mean something bad just happened to you. Now, as you and I are talking, gas prices due to the Iran War just went over $4 a gallon. The public notices that. We’ll come back to that. That’s important for orthodontic practices. But uncertainty doesn’t mean bad things are going to happen to you. But it also doesn’t mean bad things won’t happen to you. And I think the biggest underlying fundamental right now

Alison Werner (08:58)
Mm-hmm.

Dr Roger Levin (09:10)
is protecting your practice in times of uncertainty. And again, I’ll quote the former treasury secretary who said, we will now live with more uncertainty than certainty going forward. Again, it doesn’t mean it’s bad, but it also doesn’t mean it can’t be bad.

Alison Werner (09:26)
Mm hmm.

Yeah, OK. All right. Well, we’ll come back to what do you do to protect yourself during those uncertain times. ⁓ But let’s talk about production. So the survey showed that production was essentially flat, but profit performance was more mixed. How should orthodontists interpret that disconnect?

Dr Roger Levin (09:42)
Mm-hmm.

Yeah, this is a new syndrome. mean, you know, it certainly it’s happened a little bit before, but this is a new syndrome where we’re seeing more and more practices. Levin Group, my company is getting more calls from orthodontists for help because their production is up sometimes five, eight, 10%, but their profit is down. Now we are in an era where the average retirement age of a dentist is around 70 years of age.

Alison Werner (09:53)
Yeah.

Mm.

Dr Roger Levin (10:15)
The ADA, think says 68 years and change. Levin group says 70 years and change. So we’re pretty close. Here’s the key. It’s going to go to 75 years for the younger orthodontist. You’re on target to practice until you’re 75. When I say that, when I’m lecturing to orthodontists, there’s an audible groan in the room. Now, yeah. yeah. The young orthodontists are like, my God, I should have been a plumber. So.

But it doesn’t mean you have to, you just have to change the curvature of your career. So if you have a practice that’s growing in production and declining in profit and income, yes, you’re going to practice many years longer and you’re going to have lower income for your lifestyle, your family, your savings, et cetera. So why is this happening? Because overhead is growing faster in these, in many practices than production.

So production this year on average was only up 1.1%. As you said, that’s essentially flat. But if overhead then rises 4 % and production only goes up 1%, that’s a 3 % loss or degradation of income. Now, nobody’s hearing that and panicking, 3%, we can all eat, we can all live. But do it year after year and five years later, now it’s 15%. And I think

I’m sorry, I know orthodontic practice overhead inflation is higher than normal economic inflation. So for people who watch the news or the financial channels and they hear, inflation is 3.5%. I always add at least one and a half percent for dentistry. All the dentistry has higher inflation, not to mention the technology and the subscriptions and the costs and staffing, staffing is up.

Alison Werner (12:09)
Yeah.

Dr Roger Levin (12:12)
you know, somewhere between 15 and 18 % in the last five years. It’s skyrocketed in 22, but it’s continued to rise since then. And as more practices get desperate for staff, they’re gonna throw more money at it. So to answer your question again, production can be up, your fees can be up, but overheads up higher, your income is lower.

Alison Werner (12:20)
Yeah.

Mm-hmm.

Yeah, okay. You outline this idea that practices are splitting into four performance tiers in the article, and you’ve talked about that before, but what separates that top 25 % from the rest in today’s environment?

Dr Roger Levin (12:51)
Well, if you have six or eight hours, I will answer that for you. ⁓ So for those who’ve never heard me speak about this, but I open my lectures at the AAO with this every year. Unfortunately, I was invited this year, but I’m going to be in Japan, which got on my calendar first, my mistake, because I love lecturing at the AAO. But I open my lectures with this slide of four buckets.

Alison Werner (12:54)
You

Dr Roger Levin (13:15)
And in the past, most orthodontic practices were pretty close together on the bell curve. Some were really big, some were not so great, but most of them, you plotted them all out, they were pretty close together. Now it’s diversifying out. And I am certain that’s going to continue. And the top bucket is going to have higher income and higher savings on average than ever before. They are going to be on fire. They are going to be exceptional.

because the opportunities are there. And your question really is about, what are the opportunities? What separates them? And the answer is no longer just because you’re the oldest practice in town or you’re on the right street corner or you have a better logo. First of all, logos never made anybody successful. I don’t know why people get so hung up on their logos. Nike’s logo cost them $500. It’s the second most recognized logo on the face of the earth after Coca-Cola.

Alison Werner (14:03)
you

Dr Roger Levin (14:14)
Logos are good based on what you do with them. But anyway, the point is these practices are going to follow basic fundamentals. They’re going to have outstanding referral marketing and they’re not going to limit it to one area. We get calls all the time for referral marketing for orthodontists. We have a large number we work with and we do a lot in five areas. Patients, parents, social media, referring doctors in the community.

But we get a lot that do no referral marketing with general dentists. And yet, as the data has showed, $3.6 billion a year is referred from general practices to orthodontic practices. And if I say to orthodontists all the time, if you’re not getting referrals from general dentists, it’s not that they’re doing all the ortho, they’re just not referring it to you. Somebody’s getting it in your area. Because we know only about 10, and it’s growing,

But only about 10 to 12 % of general dentists do every orthodontic case they can find. The vast majority, I would say the rest are half and half. Half do a small number of cases, 10, 20, 23 a year. They refer out the rest and the other half do none. There are tons of general dentists that don’t do any Invisalign. We got a call the other day from one of our clients. He has a new associate. The associate wants to get into Invisalign. I said, great, you can do it.

Alison Werner (15:13)
Okay.

Mm-hmm.

Dr Roger Levin (15:38)
I don’t we don’t promote it. You can do it, but I know that within a couple years there’s a good chance they won’t be doing it anymore. They might, but they might not. A lot of general dentists like to play at it. They’re out of school. They don’t know what they don’t know. They haven’t had a failure or 10 and and they they don’t know how to use the technology that orthodontist are using today and the practices aren’t set up that way. So huge referrals are still coming from general dentistry and I.

Alison Werner (15:46)
in

Yeah.

Mm-hmm. Yeah.

Dr Roger Levin (16:08)
encourage every orthodontist to take advantage of all five areas, but don’t leave out those referring doctors because we have referring doctors that send $200,000 a year to one orthodontist. mean, we see this. that referral marketing is number one. Number two is retention of staff. The longer you keep your staff, the more efficient you will be, the more highly trained they will be. We have data showing that the slowest assistant in an orthodontic practice typically costs the orthodontist

Alison Werner (16:20)
Thank

Dr Roger Levin (16:37)
One hour a day. Now the orthodontist don’t know this. They’re not sitting there with stopwatches and measurements like a Japanese assembly line factory where they’re so efficient. They’re timing. You you get one minute and 52 seconds to do that part on the car and the next car piece is coming by. ⁓ They don’t know it, and yet when we do our time studies, we find this all the time. Well, the longer you had your slowest assistant, the more you can train her to. She may never be the fastest, but she can certainly be.

Alison Werner (16:55)
Mm-hmm.

Dr Roger Levin (17:07)
When your front desk can run everything, when they know the scripting for a new patient caller who may or may not make an appointment, to have them make an appointment, their number one job in that call makes a huge difference. So the staff longevity is another very big factor. Debonds. We are getting clients that are 8, 9, 10 % overdue in Debonds. We had one last month, 16 % overdue.

Alison Werner (17:36)
Okay. Yeah.

Dr Roger Levin (17:36)
It’s just sloppy and I don’t mean that in a critical way. It’s not

the opposite of efficient is sloppy. They just weren’t contacting patients overdue waiting for them to call. Well, a D an overdue debond is 100 % overhead. You’re done being paid. You’re done getting profit. You’re now just treating that case. You know for free, but I’m sorry you’re treating it for free at that point, but you’re paying overhead to treat it as a problem. Another factor.

Alison Werner (17:42)
Right.

All

Yeah.

Dr Roger Levin (18:06)
Is dental insurance now orthodontists will say, well, they haven’t lowered mine because in general dentistry, do an annual practice survey in general dentistry also. And we found that about 62 % of practices last year stated that at least one insurance plan had lowered reimbursements. Nobody raised them, but had lowered it. Well, ortho we’re not seeing it lowered, but they’re also not raising it. So.

Every year that they don’t raise it, you lose the amount of inflation, you lose that in profit. So if you have $500,000 in insurance that wasn’t raised, but inflation in ortho went up 5%, you just lost 5 % of that $500,000 in terms of profitability because they didn’t increase it to keep you even. So those are some of the big ones. And then the cost of technology is another big one.

Alison Werner (18:58)
Yeah.

Dr Roger Levin (19:03)
The technology is fantastic today. I find it incredibly exciting, but it’s also expensive. And if you’re not increasing your fees, if you’re not increasing your insurance reimbursements, then the only way you offset that is higher volume of patients. The top practices will have all that in line. They will raise their fees. They will have great staff longevity because they understand how to…

Alison Werner (19:10)
Yeah.

Dr Roger Levin (19:29)
create a great culture and a happy staff and they compensate properly and they can afford to compensate. Some of the lower orthodontic practices can’t afford what staff are now demanding. ⁓ They will have a great referral marketing program to keep patients coming in. The TC process is now critical. mean, TC’s are salespeople. They’re not trained. Do a survey. How many TC’s have any sales background? About 1%. And often that’s like,

Alison Werner (19:57)
Mm-hmm.

Dr Roger Levin (19:59)
working in a clothing store for six months or something like that. Better than nothing, but it’s not, know, to me, the greatest salespeople in the world are insurance agents. And they’re trained, they have courses in every insurance company how to sell. We need that for our TC’s because TC’s are no longer selling ortho, they’re selling value. And lastly, and I think one of the biggest, maybe after referral marketing, the biggest factor

Alison Werner (20:01)
Yeah, retail or something. Yeah.

Yeah.

Thank

Dr Roger Levin (20:28)
is customer service. Ortho must be fun. If I were an orthodontist today, I’m not sure I wouldn’t have a theme park office. I’d have slides. I might have a water park. I might have a roller coaster. ⁓ All I can say is my office would be so much fun that people would want to come there even if they don’t have an appointment. I’m being a little fun and facetious, but I kind of mean it. There’s no way I’d have a traditional office. My office would be

Alison Werner (20:36)
You

Yeah. Mm-hmm. Yeah.

Dr Roger Levin (20:56)
An absolute blast the kids would love it the parents would love it and the adults would say okay I might have a separate adult section that can be a little more boring for them maybe maybe with a margarita bar or something. ⁓

Alison Werner (21:04)
Yeah.

There you go.

Well, you talked about it a little bit there, overhead continues to rise and as you talked about, is outpacing that broader inflation. So you mentioned a few things there that doctors could do to protect their profitability, but is there anything else you would add to that these moves practices could make right now to protect that?

Dr Roger Levin (21:34)
Yeah,

let me address that as a separate question. How do we deal with rising overhead? And the answer is not one that most people immediately come up with, even though it’s very obvious as soon as I say it, you’ve got to increase your production. Overhead is not going to go down. Lowering overhead is a finite process. Now, most practices can probably lower their overhead three to four percent. ⁓

Alison Werner (21:36)
Yeah.

Dr Roger Levin (22:00)
Being offset, my caveat, my comma, but is except for staffing costs. If you get hit with having to hire a new staff person, which often means you’ve got to give raises to everybody. You can’t hire a new staff person at a higher compensation than you’re paying the rest of your staff. They will find out, they will rebel, and they will quit. So very often when we have, you with our clients and they’ve got to hire a new person at a higher compensation,

We have them go back, the consultant checks the staff compensation and tells them what they need to raise it because we’ve seen disasters happen over that. And doctors are funny. They’ll hire the new person to higher compensation and not give higher compensation to the rest of the staff. I get that. It’s painful, but you’re headed to a tsunami eruption coming. So the real answer is you’ve got to raise your production.

Alison Werner (22:46)
Yeah.

Yeah.

Dr Roger Levin (22:54)
And when you raise your production, and I mean adjusted production, because if you participate with insurance, that’s what you’re going to get. ⁓ and most don’t, but if you do, so if you don’t raise your production by at least the amount of the overhead increase, then you’re going to be hurt year after year. So the real question is how do you raise production in an orthodontic practice? These top tier practices, the top 25%.

Understand how to do that. They’re organized. They’re systemized. They’ve got annual actions they take. We love to work with them because we just take we add other actions. We take their actions, put them on steroids and they grow unbelievably. Orthos one business where the bigger you are, the faster you can grow. A lot of businesses, the bigger you are, they try to figure out new ways to grow or though the bigger you are, it’s not automatic, but if you keep the main drivers in place.

Alison Werner (23:34)
Mm-hmm.

Yeah.

Mm-hmm.

Dr Roger Levin (23:53)
It’s like everything else, Allison, you read this in so many books. Do the most important things. Stop doing the little things. Stop doing the easy things. Do the most important things. Because if you do six important things, that’s a whole lot better than doing 46 smaller things.

Alison Werner (24:02)
Mm.

Yeah. All right. So I want to talk about staffing crisis, which you’ve talked about and you’ve been very consistent your messaging. So based on this year’s data, how is there anything you would add to how orthodontists should be rethinking staffing that compensation or productivity?

Dr Roger Levin (24:30)
Well, the concept I come from, and this will be a wake up call for some orthodontists. Now most orthodontists to their credit are team oriented. They like their teams. They make decisions with their teams. The rest of dentistry doesn’t do that. The last people that an oral surgeon would ask for an opinion is a team member. They just go do whatever they want. And most general dentists kind of hide things and then spring it on the team, which is also a bit of a mistake. No transparency there. So orthodontists do pretty well.

Alison Werner (24:40)
Yeah.

Mm-hmm.

near.

Dr Roger Levin (25:00)
The difference between however, liking your team and building an amazing culture is pretty big. Orthodontists need to highly focus. And when I say orthodontists, I’m including office managers. As you know, we’re very focused on the office manager. Now we have a new training program for them because the orthodontist can’t do all this. It sounds great, but at some point in this podcast, the orthodontist listening are going to say, maybe I’ll just shoot myself right now.

Alison Werner (25:13)
Okay.

Yeah.

Dr Roger Levin (25:28)
because it’s so much, it’s just so much to do. So when I talk orthodontist, it doesn’t mean you don’t delegate this to your office manager, but you’ve got to build a great culture. And you don’t build a great culture strictly by attitude. I’m huge on positive attitude. We train something called the culture of positivity. People love it. But there are other factors in that, such as, and I’ll give you some examples.

Alison Werner (25:30)
Right.

Mm-hmm.

Dr Roger Levin (25:55)
Bringing in lunches out of nowhere surprise lunches filling the refrigerator in the staff room with snacks periodically putting a mini a basket of miniature liquors liquor bottles on the staff room table with a note that says take a few home and a joke don’t drink them in the office ⁓ send giving people gift certificates to take their family to dinner having $100 bill under a chair in this during a staff meeting and whoever sitting in that chair gets the $100.

giving people an extra day off for a job well done, sending the staff members flowers at home on their birthdays, contributing sometimes to gas bills if gas is more expensive. We’re recommending this to a lot of our clients today. It doesn’t have to be huge, but it’s showing that you care. And it’s making the practice fun and it’s making it enjoyable because yes, orthodontic teams are pretty good, but they’re not great at customer service. Cause to be great,

Alison Werner (26:36)
Yeah.

Dr Roger Levin (26:54)
Is an actual system. I wrote a book called a wow every patients. It’s a video book. It’s 36 video chapters about 15 minutes each and it ended up. I didn’t expect this. It ended up being my second best selling book out of about 63 books that I’ve written in all these years and I studied the Ritz Carlton Nordstrom and Disney and you and I have talked about this. Well at Ritz Carlton they’ve got 21 principles.

Alison Werner (27:00)
Mm-hmm. Yeah.

Yeah.

Dr Roger Levin (27:22)
that their employees live by. opens with, we are ladies and gentlemen serving ladies and gentlemen. And every shift, there are three shifts a day, every shift starts with a manager going over the next principle. And then when they’re done, they start again. Orthodontic practices need customer service principles. And once they’re in place, that can really help to separate you from everybody else.

Alison Werner (27:48)
Yeah, OK. I want to go back to the data around not enough new patients starts and how that’s one of remains one of the top concerns that respondents mentioned. So what are the most effective ways that practices can address that today? You’ve talked a little bit about that with the referral marketing, but is there anything else that you would recommend?

Dr Roger Levin (28:12)
Yeah, this is where I’m going to give a warning. And again, I’m not gloom and doom, but I try to be practical. try to be, if I were a professor at Harvard Business School, where I’ve taken a lot of programs, I’m going to tell the class what’s really going on, not what they want to just hear. And I think that many, orthodontic practices are in for a real surprise in the next five years in their TC consults.

Alison Werner (28:26)
Yeah.

Dr Roger Levin (28:37)
Now there are plenty of TC consultants out there. They’re excellent. They train the TC’s. We train the TC’s. But I use the term the new treatment coordinator because what parents and patients are going to want is different than in the past. They want value. I am a believer that we’re going to see what I call, it’s a hard, it’s a hard phrase to say, fee wars. Something about the words fee wars are hard. They kind of rock fee wars. What’s a fee? Fee wars.

Alison Werner (29:01)
You

Yeah.

Dr Roger Levin (29:06)
And we’re starting to see it. I got a call from a 36 year old orthodontist last month, asked me what to do. Her fees were $5,400 a case. And the new young male orthodontist who just moved in is giving out certificates to general dentists saying $3,500 a case. Well, he’s probably, I don’t know him. He’s probably got student loan debt. He’s probably got a mortgage. He’s, you know, he’s got bills to pay. He opened a practice.

Alison Werner (29:33)
Yeah.

Dr Roger Levin (29:35)
This is his marketing approach is going to be price based. I think we’re going to see that. think we’re going to see, I know there’s more shopping taking place now because the economy may be good, but it’s not always good in terms of people going to the grocery store. And right now gas prices are, it hasn’t affected ortho. It’s because of the Iran war, it may be over in a couple of weeks and then go back to normal after that. don’t know. I have no idea what’s going to happen.

Alison Werner (29:37)
Mm-hmm. Yeah.

Yeah.

Mm-hmm.

Yeah.

Dr Roger Levin (30:05)
Right

now, nobody knows what’s going to happen. But if gas prices stay at $4 to $5 a gallon in a lot of the country for months, you’re going to start to see some changing behaviors in orthodontics. And the problem is orthodontics to the public is a commodity. I I hate to have to say this. Dentistry is not a commodity. Orthodontics is. And here’s why. My definition of a commodity, and every orthodontist should think about what I’m about to say.

Alison Werner (30:07)
Yeah.

Dr Roger Levin (30:33)
is a commodity is a product or service bought and sold at similar quality based on price. Which means I can get orthodontics from Joe for $5,500. I can go see Sally for $5,100. I can go see Bill for $4,700. And maybe I can go see Jody for $3,500. And when people are shopping,

Alison Werner (30:48)
Mm-hmm.

Dr Roger Levin (31:00)
Sometimes they’re shopping quality. They don’t know how to, they have no idea how to judge quality. We sell a product that you don’t get to see till the end, but they’re shopping price in most cases. And you’ve got to justify your fees today. you, so, you know, we call them treatment coordinators and of course that’s the name TC’s, but I sometimes in lectures to orthodontists say maybe we should call them VC’s not venture capitalists.

but value coordinators, because I think more important than anything else is building value. You’ve got one hour to build a relationship, to convince that parent or patient that this is gonna be fantastic. A lot of TCs have done this job for years. They’re flat, they’re bored, they’re done, they’re just going through the motions, and next, next, next. Well, you they’ve done that for years. There’s no consequence for not getting a patient to start.

Alison Werner (31:28)
Yeah.

Mm-hmm.

Dr Roger Levin (31:55)
And I

don’t like negative consequences, but you know, if the TC has paid on straight compensation and they haven’t changed in the last two or three years, the approach, they are out of date and not being relevant is the worst thing that can happen today to an orthodontic practice. If you’re not relevant in your marketing or you’re not relevant in your consults, because everything else after that is just operations. You know, that’s easy. And when you think about it, yes.

Alison Werner (32:21)
Yeah.

Dr Roger Levin (32:25)
Parents sorry my phone. I have it on silent and it just wants to keep ringing. ⁓ Sorry about that. I put it back on silent again. So at any rate, if you think about it in so many orthodontic practices, a huge percentage of the treatment is by the staff. So people buy the orthodontist, but they don’t really buy the orthodontist. They need to buy the practice and have a real sense of value. Now we promote the orthodontist heavily in the consult.

Alison Werner (32:27)
That’s okay.

Dr Roger Levin (32:55)
But you’ve got to restructure that console almost like a ballet. And that’s how it has to come together.

Alison Werner (33:00)
OK.

I want to go back to what we talking about earlier in this episode, where we talked about recommendations for dealing with this uncertainty that we have right now. What are the top line things you would tell an orthodontist to think about right now?

Dr Roger Levin (33:20)
Well, the reality is we’ve been in consulting to orthodontists since 1985. mean, literally in the first six months, orthodontists became clients. And in 1985, I had this idea about referral marketing. Now, just to make it clear, I’m not pushing referral marketing. We do management, we train office managers, we do referral marketing. And without question, and I would be happy to debate politely anyone,

Alison Werner (33:40)
Mm-hmm.

Dr Roger Levin (33:51)
The total success of an orthodontic practice depends more on referrals than any other single factor. And here’s the proof. If you have incredible referrals and the orthodontist disappears, vaporizes for some reason, and we bring in the next orthodontist who’s same age, same skill level, nice looking orthodontist, man or woman, good location, they’re gonna be just as successful if the referral marketing program is great.

If you have enough referrals, you will always be fine. If you have the right number of referrals, you’ll be better than fine. And you’ll be financially independent by the age of 60 easily. You can stay, you can retire, but you will have a choice. what we’re seeing is referral marketing at Ortho cannot be hit or miss. And the best way to do that is to talk about all five areas.

patients, parents, social media, referring doctors and the community, because even with our clients, we never know which one is gonna produce more, but all five will almost always produce referrals. And it’s great to focus on all five. I mean, we expanded our program well into that years ago because we need everything now. So number one, when you’re facing uncertainty, you never know when it’s going to affect you. Therefore, what’s your plan?

Well, you don’t wait till there’s a negative event, a decrease in production, a decrease in profit to your staff quit and your practice is less efficient. You maximize referral marketing now, whatever’s most important, make sure you have it at the highest level now. Number two, oddly enough, most people don’t talk about is the new patient phone call. The TC process doesn’t begin when they meet the TC.

It begins when they call the practice. Very few practices, almost none listening to us, measure how many new potential patients or parents call that never make an appointment. And it’s a lot bigger than people think. You’re losing opportunity weekly in that way. And then of course, the TC is the key. You’ve got to get the patient to start.

Alison Werner (35:59)
Yeah. Mm-hmm. Yeah.

Mm-hmm.

Dr Roger Levin (36:12)
So you need new value building, you need relationship building skills, you need an incredible positive enthusiasm and energy. The orthodontist has to be on time and be impressive. The TC has to build up the orthodontist. And at the same time, we also need great financial options, including patient financing. Because there are too many parents and patients today

Alison Werner (36:35)
Hmm.

Dr Roger Levin (36:39)
that sit there, they smile, let me think about it. But what they’re really gonna do is go shop to another office because they either can’t afford the down payment or they can’t afford the monthly payments. ⁓ And that’s gonna get bigger if and when we hit a recession. Let me remind everybody, we’ve got about 15 years of the greatest economy in the history of the United States. We took a year or two off with COVID, but since 2009,

Alison Werner (36:49)
Mm-hmm.

Yeah.

Mm-hmm.

Dr Roger Levin (37:09)
and 10, the United States has been on fire. People can get money, they have money, they can get access to debt, they can pay for ortho. We haven’t seen what happens if an economy slows down. again, I’m not gloom and doom, it’s just business cycles. Someday that’s going to happen. Combine that with competition. And we haven’t even talked about DSOs and OSOs yet, and they are serious competitors.

Alison Werner (37:12)
Yeah.

Yeah.

Yeah.

Mm-hmm.

Yeah.

Dr Roger Levin (37:36)
They’re

very serious competitors because they do collective marketing. So they will market to the community, but they’ve got 20 practices in an area to split that marketing bill over. And most of you listen to me have one. So you got to keep everything that brings in and starts patients at the highest level. And then of course, I’ll just say it again, your customer service has to be amazing. If not, you’ll kill everything else.

Alison Werner (37:49)
Yeah.

Yeah.

Yeah. I want to talk about, let’s do talk about the DSO, OSO aspect of this. ⁓ The number of orthodontists reporting that they were part of one in this survey was actually very low. But what trends or what have you seen in terms of that aspect of the orthodontic performance?

Dr Roger Levin (38:13)
Yes.

Well, there two things happening

today. And I won’t name them, but one of the OSOs got into a huge financial trouble. A lot of times you don’t see bankruptcies because a bankruptcy means they just kind of go away. ⁓ Instead, they were bought out for debt. In other words, there’s a whole strategy of buying companies you think you can turn around. You just buy their debt and now you own the company.

And by the way, some of the retired orthodontists that got bought out have come back to work because their equity, equity was part of the deal and that equity it’s called, it went underwater is the expression. It became worthless and therefore they were no longer in a position to be retired. Here’s what’s going to happen. think right now, first of all, we are seeing higher interest rates.

Alison Werner (38:54)
made.

Mm.

Thank

Dr Roger Levin (39:09)
And you money was almost free a couple years ago. Yeah, half a percent. That’s basically you could borrow money for almost nothing to buy whatever all the practices you wanted. Interest rates are higher, so number one, we’re seeing some of the private equity firms pulling back because they’re having more trouble ⁓ borrowing at higher interest rates. Number two, there’s a lot of pressure on these now on some of them for higher profit.

Alison Werner (39:12)
That’s good.

Mm-hmm.

Dr Roger Levin (39:38)
Again, because of interest rates, you’ve to make your debt payments as well. So we’re seeing sort of a it’s happening, but a little bit slower right now because of inflation and interest rates. On the other side, it’s going to continue as some orthodontists get older. They’re going to sell out to a Oso. Some younger orthodontists with a lot of debt aren’t going to go into practice. They’re going to go work for DSOs.

Alison Werner (39:41)
Okay.

Right.

Dr Roger Levin (40:05)
Now we are seeing us a lot of doctors leaving after a few years to open their own practice, but some are going to stay. You know, some people like it. They like working, get up, go to work, you know, have no responsibility besides ortho though and leave. And right now they’re being highly compensated. By the way, they haven’t figured out down the road. That might not be the case, but right now they’re being highly compensated. ⁓ So it’s going to continue. It’s only a question of at what speed.

Alison Werner (40:11)
Mm-hmm. Yeah.

Okay.

Thank

Dr Roger Levin (40:32)
I

have predicted for some time we’re going to hit a 5050 50 % corporate 50 % private practice. I think once we get there it will hover there for a long time. So far it looks like I’m right. know time will tell. As I always say, I love to predict the future. I can’t be wrong yet. So they but they but the good ones are good. They’re profitable. They are investing. They have money. They are growing.

Alison Werner (40:49)
Mm-hmm.

Mm-hmm.

Dr Roger Levin (41:02)
And I think we’re going to see the DSO OSO corporate segment continue to grow. know we will. And they’re another form of competition. It doesn’t mean private practice can’t do extremely well. You’re one practice, two practices, you’re flexible. You can put in referral marketing. You can do all the right things and you can grow very well.

Alison Werner (41:22)
Well, one thing we haven’t talked about yet, and we did ask a question about this, is the role of remote monitoring and teledentistry. So 30 % of orthodontists said that they are using this technology, primarily for ortho checks, retainer checks, and ⁓ some for emergencies. So what’s the big takeaway you had from those statistics?

Dr Roger Levin (41:38)
Mm-hmm.

Yeah, I’d almost like to change the name, not that I can, because I think there should be several names because remote monitoring for retainer checks, remote monitoring. And by the way, I wonder how many people even participate since ⁓ the highest no show rate in the orthodontic practice is an in office retainer check. ⁓ Basically, give them the retainer and say, call me if you need me. ⁓

Alison Werner (42:04)
Yeah.

Yeah.

Dr Roger Levin (42:12)
But, but you know, I understand that there’s a difference between remote monitoring for retainer checks and remote monitoring for, you know, orthodontic treatment checks. Big difference. In terms of little services, yeah, it’s happening, your retainer checks, but what’s not happening, and those are, and those by the way, are not necessarily remote monitoring with all of the AI artificial intelligence data coming in. Those are often.

Alison Werner (42:40)
Mm-hmm.

Dr Roger Levin (42:42)
⁓ You know, tele based type of arrangements. How are you doing? How’s it feel? Smile for me. Great, thank you. Remote monitoring is growing more slowly than I had expected, but I think I understand why now. I’m a fan of it. I think that when you can have longer inter. Here’s the other big tsunami in ortho. If remote monitoring becomes much more prevalent, you’re going to have a lot more open chair time.

Alison Werner (42:49)
Mm-hmm.

Okay.

Dr Roger Levin (43:08)
And now you gotta fill that chair time. Well, the only way to fill it is more referrals or you’ll work less, which might be appealing to some orthodontists. You’ll make enough and work less. And maybe that’s appealing, but you’re going to have a lot of open chair time. The number one challenge. And we’ve done a lot of research, a lot of market research with remote monitoring is the subscription cost. Because if you only do a small amount of it, it’s a loss. Okay. Because now you’re paying for a subscription.

Alison Werner (43:12)
Okay.

Mm-hmm. Yeah. Yeah.

Mm-hmm.

Right.

Dr Roger Levin (43:38)
And if you don’t then make it up on volume of patients, wow, you’re going to have a loss. So there’s a curve, the curve that has two curves have to cross. When do you have enough increased volume to offset the subscription cost? And by the way, it can work really, really well if you go all in. At the same time, a lot of orthodontists don’t want to pay the subscription cost. So we may see…

Alison Werner (43:43)
Yeah.

Hmm.

Mm.

Dr Roger Levin (44:05)
Different models coming out over time. think a lot would be more comfortable with an annual total fee or something like that, but that’s not where we are yet. Number two, when I first looked at remote monitoring, I was like ready to jump off a cliff with excitement until, I still am, but until I realized you can’t do a little bit of it. You know that joke, you can’t be half pregnant. Well, doing a little bit of it doesn’t work because remote monitoring systems are

Alison Werner (44:08)
Thank

Have fun.

Yeah.

Yeah.

Yeah.

Dr Roger Levin (44:35)
different. We have clients doing it and we have many clients not doing it. Remote monitoring systems are different. So now you’re running two different business models under the same roof for the same service. ⁓ So there are challenges with it. It’s coming online, so to speak, no pun intended, much more slowly. Now I’ve seen many dental breakthroughs that came on slowly and then really took off.

Alison Werner (44:47)
Okay.

Mm-hmm.

Dr Roger Levin (45:03)
Digital radiography was one, it came on slowly, it took off. ⁓ intraoral cameras in general dentistry came very slowly. They were also very expensive, prices came down. ⁓ Digital impression taking, it took for, it’s taken 20 years, 25 years for that to pick up steam. I thought that would come overnight. ⁓ It took 25 years to pick up steam. And I think remote monitoring is gonna be a slow slugfest.

Alison Werner (45:13)
Mm-hmm. Yeah.

Yeah.

Dr Roger Levin (45:32)
to grow, I think it will grow. I don’t know if it’ll ever be the standard of care. ⁓ I think there are DSOs that maybe can put it in all, or OSOs that’ll put it in all the offices, we’ll see. But right now it’s only about 10 to 12 % of the orthodontic practices that are doing it in a fairly consistent way. So we’ve got a long way to go there. The benefit is one thing, ⁓ more open chair time.

Alison Werner (45:35)
Mm-hmm.

Okay.

Mm-hmm.

Dr Roger Levin (46:02)
put in more patients, more production, more practicing.

Alison Werner (46:05)
Yeah.

OK. All right. Well, to wrap it up, as we look ahead to the rest of 2026 with some uncertainty, what are the one to two priorities that you think orthodontists should really focus on to make sure they’re on the right side of whatever’s come?

Dr Roger Levin (46:26)
Okay, so number one has two parts to it. Raise your fees at least 5 % per year. But at the same time, improve your customer service. You have got to wow patients. Ortho is an elective procedures. Oh my God, Roger, did you actually say that? Every orthodontist is like, but it is. Nobody ever died from not having ortho, right? We have to keep that in mind. So people can put it off. Oh, by the way, in every recession,

Alison Werner (46:28)
Okay.

It is.

Mm-hmm. Mm-hmm.

Dr Roger Levin (46:55)
They have put it off and most of them never come back. They don’t put it off and get back. They put it off thinking they’ll be back. They don’t come back. So the reality is you gotta raise your fees to keep up with inflation or to exceed it, but you’ve gotta look worth it. How great is your practice? Your scripting, your fun, your interior design, fun the kids have, making parents happy. I mean, we were having…

Alison Werner (47:01)
Yeah.

Right.

Okay.

Yeah.

Mm-hmm.

Yeah.

Dr Roger Levin (47:24)
People, staff members would go out to parking lots during COVID and give mothers water bottles in the summer. you know, there are a million things you can do to have incredible customer service, but you’ve got to raise your fees. No business, I’m sorry.

Alison Werner (47:29)
Mm-hmm. Yeah. Yeah. Yeah. Yeah. Well, tied to

that, my question is, how does offering financing fit into that? Because you mentioned that before.

Dr Roger Levin (47:43)
Well, that’s,

okay, so let me just say this real quickly and then I’ll address that. No business can continue to survive and thrive without raising fees unless costs go down. Well, that’s not happening in ortho. Now, where does financing fit in? It’s a customer service. mean, literally we have our practices telling parents upfront at the beginning of the appointment,

Alison Werner (47:47)
Yeah, go ahead. OK.

Mm-hmm. Yeah.

Thank

Dr Roger Levin (48:11)
that patient financing is available. The problem for orthodontists, and I get it, I definitely get it, is they think they’re already financing, because they are. The payment plan is financing. It’s an interest-free payment plan. Well, first of all, it’s not really interest-free. The interest is already embedded in the fee, so to speak. We’re just not calling it interest. On the other hand, if…

Alison Werner (48:30)
Yeah. Mm-hmm. Yeah.

Dr Roger Levin (48:36)
people are sitting there and they’re struggling. I think I’ve said to you before, Alison, if I were an orthodontist, I’d have the lowest possible down payment. Your cash will suffer a little bit for six months, but then the increase starts will offset that in a gigantic way. But there are lot of people that can’t afford the down payment. But now, and this is a new syndrome in the last five, eight years, there are people that can’t afford the monthly payments. mean, if you look at what

Alison Werner (48:47)
Mm-hmm.

Yeah.

Dr Roger Levin (49:04)
Americans are doing. They’re going to the market. They’re buying the cheaper version of a product in a grocery store. Just to be current, 500 of our TSA people quit during the government shutdown because they weren’t being paid. Well, it wasn’t just that. Many of them were coming an hour to work and gas was going up at the same time. So you had two items in the perfect storm.

Alison Werner (49:08)
Mm-hmm. Yeah.

Dr Roger Levin (49:31)
And they said, I’m not getting paid. I don’t, can barely make my mortgage and I can’t afford the gas. I quit. So again, it’s often factors we don’t know about or think about that count. along those lines, patient financing that give people the opportunity to afford orthodontics is now critical and you will do many, you’re going to give up a certain percentage of your fee, but let’s say, let’s say your profit is 50%.

Alison Werner (49:35)
Yeah.

Mm-hmm.

Mm-hmm.

Dr Roger Levin (50:02)
And let’s say you give up 10 % to get a case you’re not going to get otherwise. That’s still a 40 % profit. Don’t feel cheated because you only got a 40 % profit instead of a 50 % profit. Say, okay, I’ve got a 280 patients at full fee. I’ve got a hundred patients at 10 % down 40 % profit. That’s pretty darn good. And profits going up and you’re offsetting overhead. You’re shortening your retirement date.

Alison Werner (50:12)
Mm-hmm.

Mm-hmm.

Dr Roger Levin (50:31)
life is good. by the way, and you’re paying your team, which is not going to get any easier.

Alison Werner (50:36)
Yeah, exactly. All right. Well, anything else you want to add before we say the end to this? Yeah.

Dr Roger Levin (50:46)
Yeah, I wrote an article recently.

This is an interesting perspective. Real quickly, I said, is your practice an extension of your personal life or is it a business? Now for many years, dentists could just, it wasn’t a business, it was an extension of their personal life. I get up on the weekends, I play tennis, I play golf, I take my family out, I have a barbecue, Monday I go to work.

Alison Werner (50:55)
Mm-hmm.

Dr Roger Levin (51:15)
Money came in, my lifestyle was good, my retirement age looked good, my savings was good. Yeah, I had this gigantic personal life that included my practice. Now, if the practice is just an extension of your personal life and you’re not working on it, you’re not improving it and doing, you and I have talked about a lot of things today that you can do to create great orthodontic practices. And we build all this, and we build consulting programs, this is what we build in. ⁓

Alison Werner (51:35)
Yeah.

Dr Roger Levin (51:44)
to helpful, and this is what I share happily in these podcasts with you, to help people. And if your practice is an extension of your personal life, and for many orthodontists it is, maybe the majority, I don’t have a number, I don’t have data, but I think it’s huge, you’re not gonna work hard enough to grow it. And then you’re gonna be playing catch up at some point. If your practice is a business, you will regularly do what should be done to make it better.

Alison Werner (52:07)
Okay.

Dr Roger Levin (52:14)
And if you will just work on improving it continually, continually, continually, and you know the right things to do, many of which listen to this podcast again, we’ve touched on in this podcast, then the practice is a business and you’re going to do great. And it’s a, but it’s a very different psychology of, yeah, I got this. I play golf. I’m not trying to get better at that. Or maybe I am. I got to practice. It just runs itself, but it doesn’t run itself. And it used to, but it doesn’t run itself anymore.

Alison Werner (52:39)
Yeah.

Dr Roger Levin (52:43)
It’s a

business and treat it accordingly. That would be my parting wisdom.

Alison Werner (52:48)
Well, Roger, thank you again, as always. And to our listeners, be sure to check out the article, which you can find online or in our April May issue of the magazine. Thank you.