What Do the Findings Say? The 2023 Orthodontic Practice Survey Deep Dive

Alison Werner 0:04
Hello and welcome to the Orthodontic Products podcast. I’m your host Alison Werner. Today we have back with us Dr. Roger Levin at the practice management consulting firm, Levin Group. He’s here to help break down the findings of our third annual orthodontic practice survey. Dr. Levin, great to have you back.

Dr Roger Levin 0:21
Alison, it’s wonderful to be back. I love doing the survey with you. I’m glad it’s our third year and I’m looking forward to our conversation today.

Alison Werner 0:29
Great well, as I said, this is now the third year and the survey asked orthodontists to tell us how their practices fared the previous year. So we’re gonna be looking at 2023. Before we dive into the details and get into your advice to doctors and staff who are facing some of the challenges reported, what was your overall assessment about how orthodontic practices fared as businesses in 2023?

Dr Roger Levin 0:52
Yeah, if I had to pick one word, and I like to do that, I would say stability. Things were fairly stable. We had a pandemic, we had a rapid rise in overhead in 2022, the biggest rise in overhead in any single year, in the last 40 years. And in 23, it went up a little bit more. But production in practices in 22, and 23 was fairly stable, we’re going to see that it’s down a little bit. It’s not all it’s not gloom and doom. But I would say it was a year of stability that this is the first year since 2020, that we are back to a more normal landscape. normal scenario, we don’t have any huge problems, even the economic problems are limited, although the fact that people are seeing some issues with their everyday goods like eggs and milk and things like that where we’re seeing a little bit of a production drop. But I want to be positive. Any practice that looks like right now can use the year 2023 as a launching pad to do really well. That’s great.

Alison Werner 1:58
Okay, good. Okay, so let’s start by going through some of the findings. And let’s start by talking about production. How to 2023 stack up against 2022?

Dr Roger Levin 2:09
So I love data and statistics. And you can make them sound like a lot of different things. The fact is, that production overall dropped in orthodontics in 2023. Now, as I said, it’s not gloom and doom, it dropped by about 4.7%. So nobody has to panic, if I start panicking, so I don’t panic, but I would panic. When I hear me to practice this down 10% or more, if they’re down 10% in a year. Any of you listening to this, that’s when you really need action and help and turn around. You don’t want that to get worse. I’m not real concerned about the 4.7%. And I’m not not concerned because it’s a one year data point. The question as I wrote in the article that you’ll be publishing is, is this the beginning of a trend, I’ve talked a lot about orthodontics, getting a little bit more competitive. I mentioned in the article, one of the biggest DSOs in the country now offers orthodontics through its general dentists at $1,999. They have their own branded aligner. So whenever you see competition, you’ve got to pay attention to see how you’re stacking up. The one comment I make always is your goal is to increase production every year. It doesn’t have to be by a lot. But if you can do that, if you can increase production every year, you are going to be somewhere between good and great as a practice.

Alison Werner 3:35
Okay. And you talked a little bit before about how we’re kind of stabilizing in terms of you know, those those, you know, different those unique years of 2021 2022 because of the pandemic and everything. But one of the things that is happening or kind of looks like it’s happening in 2023 is that that pent up demand due to the pandemic and all the savings that was built up is kind of disappearing, and we’re kind of righting the ship basically,

Dr Roger Levin 4:03
Right. If I were an economist looking at orthodontics of the last few years, it would be impossible to get a handle on it because the pandemic was so unusual. In 21, the pent up demand many of our client orthodontic practices had record years even though they were shut down for four to six weeks. And they were exhausted by the end of the year. In 2022, overhead skyrocketed and there was still huge pent up demand coming in, people deciding to have ortho. What what happened to some degree was that people weren’t spending money. So they were sitting at home saving. They weren’t spending it on travel, luxury, entertainment or restaurants. So there was all this extra money. It wasn’t the, you know, 12 or $1,400 they got from the government that let them do it though. It was all the savings. But by 23, we know that savings is disappearing right now. How do we know that because credit card debt now is back to an all time high, when nobody, nobody puts interest on their credit cards if they have discretionary income to spend. So we have definitely bumped up against the excess savings that people could use for ortho. And now we’re back to doing orthodontics only for people that really want it, not people who in the past wouldn’t have gotten it, but they had extra money so they decided to get it. So I think that is a definite contributory factor to the slight drop in production in 2023.

Alison Werner 5:35
Okay, so keeping that in mind and kind of some of the other economic headwinds, what strategies can practices employ to continue to grow that production?

Dr Roger Levin 5:45
Well, here’s what’s interesting, you know, I’m 39 years into this job. So I’m, I’m almost at halfway in my career at this point. And, and I love I love looking at the numbers over the years because it tells us so much. The average practice in 2023, produced $1,535,000 and change. But we know because I’ve built these models over and over and over. And we’ve worked with over 4700 orthodontist since 1985, worldwide, mainly US but worldwide, we know that any solo orthodontist can produce $2 million a year in four days a week, comfortably. We see we see people, a small number, but we see people that do that in three days a week. You know, ortho has what I call the volume factor. Unlike the rest of dentistry, you can put a lot of volume through. And later probably toward the end, if I’m anticipating your questions, I’m going to talk about how you might be able to double or triple the orthodontic practice without working one more minute. But for now, the main point is there’s a big gap a half a million dollars or 25% between where the average practice is and where it can be. The other way to say it is most orthodontic practices could easily increase production by $500,000 if they have the right strategies and referral marketing in place, and that’s an enormous, enormous opportunity.

Alison Werner 7:15
Okay. Okay. So let’s go back and talk about practice overhead and what the findings for this survey reported or showed, and I know it said you wrote that overhead was on the rise. So yes, what did what did practices report for this year?

Dr Roger Levin 7:32
Yeah, well, I’ll start with the good news. The good news is that the overhead rise was pretty small in 2023. It went up about eight to 9% in 22. It went up another one to 3% in 23. Not not bad, it’s slowing down. You know, based on what I know about production, and my career has been dedicated to identifying systems and strategies to grow production. Based on what I know about that, which is fairly deep, we can make up for a one to 3% overhead increase in production in any given year. But 59% of the orthodontic practices survey did report, they had higher overhead and only a smaller number 13% reported that overhead had actually gone down. So it’s not a surprise, you know, the cost of everything is up. And the increased costs from 22 due to supply chain due to staffing heavily, I’ll get to staffing in a moment, those costs are not going to come back down. So we must increase production to offset them. What I teach, which is very well proven at this point, is lowering overhead is good, but you can probably only lower it about three to 4%, maybe five or six in rare cases. But you know, if you’ve got waste, you need to eliminate the waste. The problem is overhead reduction is finite, you can only go so far. And once you’ve done it, you’re done. You can only fire an assistant once can’t fire her twice or three times. If you’re trying to save money, but production can increase infinitely it can go up two percent 5% 20%. Again, most orthodontists underestimate their real potential, which unfortunately means they’re not as protected, that profit goes down. The problem is if overhead goes up, and it’s not offset by production, at least equally, profit goes down. So we’re seeing a lot of practices that even increased production and profits still down three or 4% a year. So what you want to do is understand that lowering production is a limited gain rate. I’m sorry, lowering overhead is a limited gain. Raising production is an unlimited gain. You can grow at 12% in a year or a lot of our clients grow at 18% the first year and the second year 18% each. then that’s going to offset any two or 3% increase in production with a 13 or 14 or 15% increase in profit. So, overhead’s going up, it’s going to stay up. Why? Staffing is a crisis. It’s a different podcast for us to do someday, Allison. Yes, I get every dentist I talk to every new client that comes in is struggling with staffing. And I could I could list the top 10 negative factors of the staffing situation today. Bottom line, we’ve got a shortage. It’s not going away anytime soon. It, I think it’s with us for at least 10 years, and I can’t see beyond that. So we need better systems, smoother running practices, more technology to offset labor. But in the meantime, staffing is up about 10%. And that means production has to go up at least 10% to offset the staffing increase. It’s not going to come back down. So if anybody’s waiting for it to reverse, it’s going to go up more, it’s not going to come down. We have some real challenges in staffing, which are number one, there are people who are afraid to work in medical and dental because of they’re still worried about COVID. I know most people are saying, oh, it’s over. But there’s still people who are worried. Number two, a lot of people now want to work from home at least three days a week, those people are not taking jobs in orthodontic offices. So they’re off the table. And number three, we had about six to 7% to 8% of our orthodontic staff retire at all ages, they just decided that they’re done. And I guess unless they become financially challenged, they’re not coming back. So we have a smaller labor pool. We’re hiring less experienced people that need training, and the costs are way up for all of that. And if you look at minimum wage, now there are articles every day now about minimum wage in California. It’ll be the rest of the country, $20 an hour for fast food. That’s a that’s a 25 to 50% increase in labor. We’re only a 10% in orthodontics right now.

Alison Werner 12:15
Okay. Okay. So that it’s time to start figuring out other other strategies. Oh, yeah, absolutely.

Dr Roger Levin 12:21
Again, you want to we can talk about this later, if you want. But you want to keep the staff you have that’s the best way to avoid all the other pain?

Alison Werner 12:30
Yeah, well, I think that the message here is we’re going to do a separate episode on just staffing. So look forward to that. Stay tuned.

Dr Roger Levin 12:37
I’ve been doing a lot of work in that area, because we have to.

Alison Werner 12:40
Yeah, yeah, I know. Yeah. Well, let’s talk about patient volume and what the survey found, because that does tie in to dealing with, you know, countering overhead, you do need to get that production up. So you need that patient volume to be up. So was it up? Or was it down?

Dr Roger Levin 12:54
Well, it 72% said it was the same or up? Which is interesting, because if production’s down, you know, little under 5%, how is volume the same? And the answer is several things. Number one, the volume of referrals does not always reflect the volume of starts. So referrals may have been steady, and we’re going to talk about that I know. But the starts may be down we have more shopping, we have more options, we can go to a DSO staffed by general dentists, we can go to general dentists who are doing aligners. And that’s really interesting when we get to where referrals are coming from. This was a really interesting finding. But six, it’s interesting that 72% said that their volume was about the same. So I found that interesting. But in reality, their volume wasn’t rising. And it may be that if you don’t have more patients, a higher percentage converting to starts, then you need higher volume to make up that difference. So the fact that we don’t have higher volume is the thing to really pay attention to don’t get comfortable saying, Oh, I’ve got the same number of referrals or consults. And by the way, it’s not in this survey. In another look, we found that up to 16% of parents or patients that call an orthodontic office, never make an appointment for a consult. Nobody tracks that. So we didn’t ask it in the survey because nobody would know. But we did take a hard look at a large number of client offices and new clients so that it was random. And we found that when we start with them, many as they start tracking, have a number of calls coming in that do not schedule for consults. And they’re asking questions like well, how much is ortho or how long will it take or do you do this type of procedure? The front desk staff are not well trained to handle those questions. We need scripting for that.

Alison Werner 14:55
Okay, so that they the inquiry from the from the prospective patient snd our consumer is changing.

Dr Roger Levin 15:00
Right and the front desk staff and they’re very nice people, I have great respect for them. But they are only good right now at the standard basic new patient calling and wanting to make an appointment. They’re not good at building, it’s not something they can learn it, they can easily learn it. Yeah, but they’re not good at building value in the mind of a patient that has questions. So every practice should at least write scripts for the top six or seven questions that you get from a new patient call or this is this is now a good idea. In the future, it’s going to become critical.

Alison Werner 15:07
Right? It sounds like it, especially as you know, consumers now can, to a certain extent can better comparison shop, even just online to get you know, what are the average prices in my region? Or, you know, they do have those ads from those DSOs? Like Aspen. Yeah, it’s freely advertising very publicly advertising what they charge. So

Dr Roger Levin 15:55
we’ve gone from years ago saying things like, well, we’ll tell you that when you come in, and that work back then to focusing on value building, the new patient call is the first step of what Levin Group calls the new patient experience. And if you don’t get that, right, you have missed the boat in a big way. And your start rate, they may not come in, they may not show up. And they may not accept treatment all higher, if you don’t have a great new patient experience and value building process in that first phone call. So the front desk person has to think of themselves as the first treatment coordinator they meet. And then they come in and they meet the second treatment coordinator. That’s how I view it today.

Alison Werner 16:36
I think, yeah, that actually that actually makes a lot of sense. So. Okay, well, so let’s break down the sources of new patients. What were, what did respondants say?

Dr Roger Levin 16:47
Yeah. So I want to warn everybody, there’s a lot of bias out there about referrals from general dentists, we, you know, and I want to warn you, this is data. This is not my opinion. But this year, it was a change as the number one source of referrals. The number one source was from referring doctors. And it’s this is really interesting, because what we show in our surveys is that approximately 3.6 billion with a B, $3.6 billion of revenue is referred each year from general practices to orthodontists. Now, may have been more five years ago, we’re only in our third year Alison of doing this with you. So we don’t really know. But the number one source of you know, 38% of patients were coming from referring doctors. So I, I want to be careful because that’s the kind of we do we have a whole program and referral doctor marketing, and I don’t want to sound like I’m leaning towards something, because that’s what we do. This is complete data completely objective. But I encourage people build your referral marketing also, for referring doctors. Don’t say they’re doing all the ortho or they don’t refer. We find a lot of new clients who tell us that they’re not getting referrals from general dentists because the GPs are doing all the ortho. We find two things. One, they’re not getting referrals, but the GPs are not doing all the ortho they might do some, they’re referring it to other orthodontists. And a year later, were getting lots of referrals from referring doctors, they had just never focused on it. And since it didn’t just automatically happen, or it didn’t happen after a few strategies, they decided, well, this isn’t going to work, and they gave up on it. Well, if you’re not doing anything, there’s a very good chance you won’t get referrals from referring doctors. I’ll read you the list, which I have in front of me after after referring doctors, number two was referrals from existing patients. So a lot of dentists think they’re just orthodontists rather think they’re just so well known in the community. And they may be, but it’s really referrals from the parents and patients that are a huge segment. So you don’t want to just have, you know, little little contests for the kids. You want to have, you know, eight, nine, 10 different strategies. We have offices right now giving out the new Apple virtual reality glasses. Now they’re $3,500. So you don’t buy 10 of them. What you do if you buy one, and you make it a six month contest, where people can enter the win, and then it’s $3,500 over six months. So for some practices, that’s a great idea. Third, was referrals from existing adult patients. Now that’s going up regularly. You know, in the past, adults were not the big referral sources, because we didn’t have aligners. They didn’t want to do bracket and wire. And honestly a lot of orthodontists don’t like treating adults because you know, they’ve got an opinion they are not as easy as the kids. They don’t come in with their air pods and never have to talk to you to talk to. So the adult, I’ve said for years the adult market was the greatest unexplored frontier and I’m predicting that this adult referrals are going to grow as a percentage of practice referrals every single year from here on for a long time. Third was social media. But it’s not growing. It’s interesting. Social media is so hot, with orthodontists. And I like it, and you should have it, don’t misunderstand me. But number one, it’s hit or miss. I, we get new clients who are doing well with social media and we get new clients who are not doing well with social media from the same social media companies that they work with. So nobody has, you know, every social media company I talked to, because we get called a lot would you recommend us to your clients, and they always kind of come at it from because we’re, we have this secret way of doing things that gets results, everybody thinks they have the secret sauce. And the truth is, there’s no secret sauce, or we would all know it because everybody be reading about it or publishing it online, or Google would tell us or whatever. But social media is important. But it’s not growing as a referral source. It’s flat, which is fine. And it’s a little bit up from 22. It went from 12% and 21, to 9% and 22, back to 12%. So if you only look at last year, and the 22 and 23, you might say it’s up 3%. That’s a true statement. But it’s only back to where it was in 21. And again, I spent a lot of time looking at this data to try to understand it. And finally, the thing that dropped off, interestingly, was community activity. Yeah, right. Now, I have different theories. And I don’t know which ones right because I don’t have any data yet. Okay. orthodontists spending less on community activities, because of the pandemic or ortho which is over mostly, or orthodontists spending less because things are more expensive. Or, or is it just less effective, and people are relying on other sources for their referrals going forward? I don’t know yet. But I’m gonna be really interested. I made a note next year, the first thing to look at is referrals from community because if it’s flat or down, then that’s a new trend that we’re looking at. It could have just been an off year. I don’t know.

Yeah. So what’s your overall takeaway from this information about referral sources?

Well, my takeaway hasn’t changed, just like investing your money, diversify. Don’t spend all your effort, we meet people that only focus on the patients, we meet people that only focus on social media. And that’s great until it runs out. And usually, they don’t realize it’s running out till about three years late. orthodontists have what I call a three year mentality, we don’t wake up and pop up with a sign that says, Oh, I have a problem till about three years in, and then and that, then it takes longer to reverse. So number one, I would diversify between referring doctors, patients and parents and include a subset of adult patients, the community and social media. But I would not do it evenly 25% 25, 25, 25. Based on this data, I would put more investment into referring doctors, I would put the next most investment into patients, the third investment into social media, and then the fourth investment into community, I would stay with the community, but I would back that down quite a bit based on what I see here. Now, having said that, you have to monitor your referrals, you got to understand referral marketing, you need a minimum quantity. The big secret here is not just to have quality, you know, a good social media campaign of high quality doesn’t do it. You got to have quantity. How many times do you have to touch referring doctors? How many times do you have to touch parents, patients and adult patients? How many impressions do you need with social media? You know, back in the old days, when we only had print advertising, the you may remember this, they said it took 17 times see an ad for the ad to be effective. Well, social media, it could be 78. For all we know, you’ll we just don’t know. So based on this, I would definitely stay diversify, but I reallocate where I’m emphasizing. And if I were a new orthodontist, I would go out of my way to build my general dental referrals, even if they’re doing ortho, most of them are definitely not doing all the ortho by any means.

Alison Werner 24:31
Yeah, right. Okay. Okay. So now let’s switch to challenges and we’ve touched on a few of these already, but we asked orthodontists to identify their top challenges for 2023.

Dr Roger Levin 24:43
Here you go.

Alison Werner 24:46
Yeah,

Dr Roger Levin 24:47
This comment first. I am a huge believer in the economic law of supply and demand and in almost every survey I’m ever involved in and we’re involved in others and the rest of it industry. We do surveys for William Blair, the largest Wall Street analysis firm to analyze public companies. So they want all the data, they engage us for proprietary surveys. I always start before I interpret by asking, does the law of supply and demand apply here? So what does that mean? For many years and back when I was in practice, as a general dentist, everybody did well. And we all thought we were brilliant and good at it and great practice builders. But to a large degree, we were fortunate that the supply of dentists and orthodontists was low, relative to the demand for services. So it’s not a matter of being lucky. But the fact is, we always we all look brilliant, when the supply is low, and the demand is high. Well, that’s shifting now. And it’s shift, it’s past the neutral point, it’s starting to shift where, and I’ve talked about this with you before 25% of practices are going to have better careers than ever in history. And the next 25 are going to have good careers. The next 25 are going to have much tougher careers and the bottom 25 may not even make it they may end up selling and working for someone else. We are seeing that fragmentation. So we have challenges today. And the biggest challenge is not enough patient starts. Well, sure because if I have enough patient starts, then nothing else matters. I’ve got I’ve said forever, the only two things that really mattered and building a world class ortho practice, are the number of referrals and the number of starts, everything else is just operations. Yeah, every orthodontist can do most of the cases really well. You have to have patients. So yes, patient starts was right. And these are not my rankings. These are ranked, we have eight, I’m gonna read all eight. We have eight challenges that were ranked by the orthodontist in our study, and this is what they reported. Yeah, so challenge number one, not enough patient starts. Well, what that really means is not enough new patients. And it wasn’t reflected heavily in the data, but they may be feeling something. And I’ve always said when orthodontists feel something’s wrong, they’re usually right. People will call me and say, I just feel like we’re slowing down and their practice is still stable. But when you feel it, you’re just ahead of the curve. In most cases, you’re right. So if you’re feeling something, you’re probably right. So number one, not enough new patients starts that was reported by 71% of the respondents. Number two, rising overhead, well, that’s a vestige of 2022. If we stay stable from here on, then a couple years, the fact that it’s higher than in 2022, everybody will forget that and just say, Yeah, we’re

Alison Werner 27:47
Kind of flatline.

Dr Roger Levin 27:48
Flatline, that’s, that’s a great word. And you don’t want to do that. And Alison you summed up the whole thing beautifully, better than I could. Number three, ability to and it’s interesting ability to retain and hire clinical staff. Now, why is that so interesting? Because in the general practice survey we do separately from this, it’s published in a general practice publication, this was number one, staffing was number 1 in 2020, number one in 2021. Number two in 2022. Overhead took the number one spot, but back in 23, back to staffing being number one. So I was kind of surprised to see this as third, but 48% said they staffing is a huge challenge. But we also know that 64% of orthodontic practices are currently looking for one or more team members to add either as replacement or additive. Number four competitive threat for GPS, 38% said that, that is more subjective. I my theory I could be wrong. My theory is they’re more focused on it because they’re annoyed about it. They don’t like GPS doing ortho. It means they’re not referring to the orthodontist. They don’t feel the GPS necessarily have the skill set, which is kind of true in that a lot of GPS do aligners because the AI is in the trays artificial intelligence. But not because the GPS like me have any additional ortho training. So I think there’s a bias there. But either way, as I’ve said to many orthodontists get over it and deal with it because it isn’t going away. Number six, declining insurance reimbursements, always a challenge. Seven, competitive threat from DSOs. That one’s going to move up that one’s going to get bigger, because DSOs like ortho and they’re just starting to add more and more of it. And some of the big GP DSOs are starting to add specialists as well. And number eight, competitive threat from direct to consumer. Well interesting, that that was number 8 all the way down at a lowly 6% because it’s basically gone. Will it come back? Who knows? Yes, not here now, I would worry more about AI and aligners allowing GPS to be, you know, just distributors for aligners to their patients. That’s a reality that I talked about in my lectures.

Alison Werner 27:48
Yeah, that’s a good point. And so maybe that’s something we have to look at in the future surveys is that,

Dr Roger Levin 29:43
Well, there’s a company out there, I know, we’re gonna get to this, so I want to do it now. But they’ve got like, 126 data points now. Not not for aligners, but under, but for monitoring. And I’m studying monitoring really deeply because it’s going to be a huge factor. And a lot of orthodontists are still in the denial stage. And I’m not an orthodontist. I don’t tell people how to practice. I look at market forces. And in my career, I’ve been very fortunate and looking at market forces and saying, Okay, this is something that’s going to explode with growth once it hits the inflection point. But again, my point was not that it’s AI driven. AI is going to play a bigger and bigger role in the whole world plus orthodontics.

Alison Werner 31:14
Yeah, absolutely. Absolutely. Well, one of the things you break out in the article is you do go a little more in depth on dealing with the staffing challenges, which, you know, in this year survey did start it came in at number three. So you identified three, sorry, four opportunities, or no, actually, I’ve got four for the top answers for Yep. Okay.

Dr Roger Levin 31:39
So, here’s what’s really important. Staffing is not a shortage, it is a crisis. And even if your production is not dropping because of it, which does happen, the rest of your staff is exhausted. So if we had six or 12 hours, I can talk about staffing from every dimension plus burnout. I’ve read four textbooks now on burnout, just to understand the difference between fatigue, frustration and burnout. And again, that’s not for today. My main message is you want to focus on staff longevity, you want to measure that every year. And I can give you many, many, many things to do. But let’s go through the four. What four things did orthodontists say. This isn’t, today’s podcast is not about what Roger thinks. If, if you think Alison, it’s very important if I think it today it’s not. It’s it’s about what did our respondents say. And they came up with four key things that they’re doing to try to retain their staff. Number one, increasing base compensation. Okay, that’s a no brainer, because you’re not people aren’t gonna take jobs if you don’t pay them enough. And everybody knows, with full transparency, what everybody’s making. And if any of you have an illusion, that your staff is not sharing their compensation every day at lunch, then you are living in the Dark Ages. They they know exactly what everyone’s making. There’s, there are new laws. Now in many states where you have to publish the compensation in your ad by law, and it’s going to go national, it’s going to be everywhere. Yeah. Remember, it is a labor market, everything happening is in favor of labor. And I don’t take sides I have to deal with what’s happening. A lot is gonna be a lot of regulations going toward labor. For, here’s an example, we have a client in California, that had to pay a fortune to a 20 year employee who quit because they never gave her 10 minute breaks on the regulation cycle and she came back and sued and a lot of money. It was not small money there. There are laws on when you get breaks how long lunch has to be in different states, every state is different. But pay attention. Yes, the number one increasing space compensation. Number two, providing more bonuses and bonus, the word bonus, you have to be careful, has a lot of different meanings. I’ve written a book on bonuses. And it’s it’s one type of bonus. But there are many there bonuses on compensation, their bonuses on number of conversions, there are bonuses on completing cases on time, and overdue debonds, there are bonuses on collections. You tailor the bonus to what you need to focus on in your practice. Right now, if you put if you put a gun to my head and say, Well, what is the best bonus? Now that I’ve said, well, there isn’t just one, it would be a production based bonus for the team where everybody shares equally over a certain amount. So a bonus is not a giveaway, and the Christmas bonus is not a bonus. Nobody cares. Nobody thanks you. It’s the 27th paycheck. If you’re if you give Christmas bonuses, it’s just expected. Number three adding technology for productivity enhancement. This is going to be big and technology. It’s early. It’s very early despite all the workflow technology, I am now studying workflow technology, and how it can increase production and efficiency and even replace certain labor and certain functions. And the reality is that technology is going to be essential. Simplest example, you walk into a McDonald’s, there are no cashiers, you order at a kiosk, and then you pick up your order. Why? Why is that happening? Well, originally, it started to save money in the testing phase. But now because they can’t get people to work there, and higher minimum wage is getting very painful. And finally, number four, offering more and better employee benefits, there are people to health care is a fortune. There are people that want health care, they want to a lot of orthodontists do not give dental benefits, which is kind of ironic.

Alison Werner 35:54
Yeah, I’ve heard that. I’ve heard that.

Dr Roger Levin 35:58
You know, general dentists can give it because they can do most of that stuff. You know, it’s there’s a cavity or whatever. But a lot of orthodontists don’t get dental benefits. Vacation time is going to become more important. You can’t give this benefit, but working from home is a benefit that a lot of employers are giving in the business world or working from home part time, or paying part of a gas allowance or things like that. So there are a lot of different benefits and you need to tune into what matters to your orthodontic team, because that’s how you keep them. What matters to your team is very important. So those are four items that are being reported by our respondents. I agree with all of them. If as a as the CEO of a consulting firm, these are all great ideas.

Alison Werner 36:45
Okay, all right. It’s good to know that they’re on track there. Okay, so let’s talk about starts and orthodontic fees. So the average number of total starts per orthodontists for, let’s say bracket and wires we reported 204 is the average number of starts per orthodontist; average fee for complete treatment for brackets and wires was 6,287. And then clear aligners, we had 83 average annual starts per orthodontist and an average fee for complete treatment $6,467.

Dr Roger Levin 37:18
Well, first thing is what’s happening with aligners. Again, anything I do an ortho, what’s the aligner effect, I call it I look at that intensely. It was fairly flat and growth last year in orthodontic practices. There is going to be an explosion; I’m still predicting five years from now, it might be as high as 70%. Everything’s getting better the AI is getting better. The biggest companies done 22 million plus cases if I’m in the ballpark anyway. We know so much more. We can do it for teens, we can do it for younger kids, now. It’s, again, market forces, it started with adults. Then aligners went to teens, and it went to younger and eventually we’ll be doing them in utero. So probably the next few years, but the point. So it’s very interesting aligners have not grown as much in ortho. Obviously, they’re 95% plus in general dentistry, because that’s all they can do. But having said that, I think aligners in the next few years I’ll be shocked if these numbers don’t explode, as because they’re more and more parents and patients that are just not going to tolerate anything else. They want aligners, and there’ll be practices that are more than happy to do that for them, if your practice doesn’t. What’s really interesting are the fees. You know, we first started with aligners, partly because of that $1,800 lab fee that was out there, everybody put a much higher aligner fee than a bracket wire fee. They also didn’t have the competition was between orthodontic practices, not all these other service delivery models. Well, now that that’s changed, I’m not surprised that the bracket and wire fee and the aligner fee are pretty close to within a couple $100 of each other. And that’s the big takeaway: Watch your fees because you are competing. You could you don’t have to have the highest fees, you have to have higher volume, which means more systems, better staff training, more scripting, better run practice, more efficiency. You can be very profitable that way, but if you raise your fees too high, you’re gonna lose a lot of cases and the tolerance, where I still predict we’re gonna see orthodontic practices with two tiered fees where the sixty 62 and 6,400 is the high end. Listen, I know there $10,000 cases out there, and maybe half of that might be the lower end and I think we’re gonna see both. Again, market forces otherwise, what practices will start doing it when they don’t have enough starts. We’re not there yet. I hope we never get there. But unfortunately, I think we’re going to get there.

Alison Werner 39:51
Yeah. Okay, so now let’s look at the changes in patient visit intervals. So the time in between checks. So for let’s see, treatment for bracket and wire for in person visits we’ve got seven weeks is the average time between visits; for for remote monitoring visits for bracket and wire, we’ve got eight weeks, and then clear aligners, we’ve got 10.1 weeks for in person visits and 14.7 for remote monitoring visits. So what’s the takeaway here?

Dr Roger Levin 40:21
Well, there’s several takeaways. First of all, it’s up a little bit. And you know, bracket and wire, seven weeks, remote monitoring, eight weeks, I want to tell everyone, before I make any more comments, I’m not speaking clinically. We have never told an orthodontist how to practice. That’s not what we do. But we can tell them what’s happening out there. And it’s very interesting with aligners, 10.1 weeks, and remote monitoring, 14.7. So let me tie some thoughts together, remote monitoring is going to grow very, very quickly. It will become part of every ortho practice in the country, or 90% of them, and in within five years. It’s just there. Now, anybody listening that doesn’t like remote monitoring—and that’s a lot of you, I understand that today. But remember, we didn’t like aligners when they first came out either way, if we don’t like a lot of things when they first happened. Yeah, I’m gonna predict that this is going to be huge. The market forces are there. I’m studying it, it’s getting, it’s getting better monthly. A lot of practices have no idea how to manage it. They don’t know how to put in place a remote monitoring staff member; they don’t know how to make it work. But it’s going to come. And we’re, it’s so important. We’re starting to incorporate how to manage it into our consulting because we’re there; but you know, again, I don’t I don’t want to be behind for people. And if somebody doesn’t need it fine. But we’re putting in our program how to deal with it, because we’re there. So, but here’s, here’s what I’m going to say and this is my opinion. Now. It’s a mistake. These intervals are way too short. I think we’re going to find I have clients very fine orthodontists very dedicated, very smart, where it’s with aligners, it’s 18 weeks between intervals, but with remote monitoring, it’s 24 to 28 weeks, we even have somebody at 32 weeks, and as far as I know they’re highly dedicated. They’re not we know they’re not getting negative feedback because we survey patients in our program. And again, ultimately, they want a beautiful smile. I always explain to orthodontists and TCS, forget everything else, gear everything toward one thing, the beautiful smile. But these intervals are going to grow. And I encourage orthodontists take a hard look at making them longer. You don’t you know, I’m not telling you had a practice, if you don’t believe in it, that’s fine. But otherwise, you’re only at this cycle because of basic habits and your comfort zone. But with remote monitoring, everything’s going to change. We have a company in Europe, also for dental, dental and ortho consulting, and in Europe, there are orthodontists that see the patient for the start and everything else is remote monitoring. Now, I’m not promoting that. That’s not my role. I’m not a clinician, but Europe’s way ahead of us in terms of the intervals, and they’re comfortable with it. Now somebody might say, well, they’re not as high quality as we are. I’m gonna challenge that we won’t know for a little while, but I think they’re just more open to this particular methodology of interval setting.

Alison Werner 43:29
Okay, well, you we also ask the question of how what type of appointments doctors are conducting remotely. So the number one type of appointment was the orthodontic check. Then we did new patient consults, retainer checks, emergencies and then new patient exam. What kind of was your takeaway from that?

Dr Roger Levin 43:48
Oh, it makes perfect sense. I think orthodontists often view the check as of minor importance. Now if you’ve got to change a wire or something, that’s fine. But the orthodontic check is just that it’s a check. And it’s, that’s an orthodontist do most of the afternoon. Check, check check. Frankly, a lot of staff members can do it pretty well. So 72% are using some type of monitoring or teledentistry for checks and ortho is the only part of dentistry really using teledentistry, it’s under 3% in general practice. It’s not going anywhere. You know, during the pandemic, everybody was predicting where it was going to go and wanted to invest in the companies. And these aren’t microchips. Now teledentistry is going to have a very minor role in general practice, oral surgery, endo, perio, pedo. But for ortho, it’s fantastic. You can save so much time. I love it for checks. I would do as many checks as you can remotely. In terms of the new patient consult

Alison Werner 44:48
What about that?

Dr Roger Levin 44:48
Well, here’s the thing, be careful. The technology is fine. But we don’t know what happens when you don’t have a live meeting and room consult and relationship. I am very concerned about practices is trying to do their new patient exams and consults remotely, I think that I don’t think that’s going to be good. You need to get that parent and patient in to select you. Third retainer checks. I have said for 30 years again, my opinion, do twp, and they and by the way, they won’t show up for the second one anyway. So 50% on retainer checks don’t come in on average. Think about that. 50% though. So they’re just a waste of time, they eat up chair time you’re never getting back. You’re losing it permanently. So I love it for retainer checks. I think I think remote monitoring for retainers will be over 70% within five years easily. Emergencies, fantastic. Because what you’re really determining is, do they need to come in? That’s all and how quick. Yeah, is it emergency? Yeah, stop blowing up your schedule and do a remote exam. And finally, the new patient exam. Again, be careful. Right now, I would advise clients get new patients into your office so you can control the incredible new patient experience. And they start with you. So but ortho checks that’s only going to rise and rise rise. That’s the easy one. And that’s almost double the next closest remote monitoring.

Alison Werner 46:25
Okay, so another issue that came out of the survey findings was we found that almost one quarter, 22% of orthodontic practices do not have a full time treatment coordinator. What’s the takeaway from…

Dr Roger Levin 46:40
It’s the first time we’ve asked that, and I was shocked. I was absolutely shocked the way we asked it. If you don’t have a TC, get one. Number one, they will save the orthodontist so much time you know, even though ortho goes chair to chair to chair, you still have to look at it from a doctor production standpoint. Every time a doctor is at a chair that’s production. Every time a doctor is at a consult that’s not production. So excuse me kind of sneeze there. So we want orthodontists in the main clinical area with parents, patients and adult patients as much as possible. We the throughput, the volume we can put through is much bigger in most ortho practices. Remember, let’s cycle back to the beginning. They’re mostly running $500,000 a year, production below potential. So you want to get a TC. Number two, the TC is going to spend more time. These are hour consults, you build relationships, you learn about the parent, the patient, you learn why they’re there, you build commonality. And what we teach, and we teach it minute by minute, step by step, build a relationship. It’s not just a sales job, it is building a relationship to build trust to get a start. That’s what you really want. You want mom going home and 80% of the time it’s mom saying to her husband, we this is where we need to go, this is the right place, we’re not going to another place for $400 less, because the husband wasn’t there. It’s typically the husband, when mom comes home and says oh, we went to the orthodontist today this is get another opinion. So you know, because even in our equal world, husbands do a lot more of the daily checking account, they’re watching some of the money and and men are often more likely to bid it out. Especially if they didn’t hear the presentation. So you need a TC that’s trained exactly what to do. And the TC’s today are not the TCs of even five years ago. They need to understand there’s competition out there you need to be building your scripting to incorporate why come here before anybody asks you or doesn’t bother to ask you. So the TC today has to build value, not just explain orthodontics, you can’t take a former assistant and stick them in that role with no training and expect them to do well. This is a professional sales position to build relationships engender trust, and create starts and then measure them and measure them and measure them.

Alison Werner 49:18
Okay, so what’s your overall message to our listeners and our readers?

Dr Roger Levin 49:27
Well, I started by saying the word from this survey is stability. And that’s a good thing stable is good, but stable doesn’t stay stable. And when I look at the trends between an economy where some basic goods and staples are costing more money, and that’s what people look at, in an in a competitive landscape where we have DSOs and general dentists doing more with aligners. We have ortho only DSOs but we’ve got the big boys and orals as I call them starting to bring in more ortho because it’s lucrative. We’ve got staffing challenges, and which even we put aside the frustration, and headaches, we’ve got higher overhead that needs to be offset by higher production. So my message is, if there was ever a time to organize your practice, streamline it was systems, get everything in place as if you were declining, even if you’re not, this is that time, because right now we’re stable. So you’ve got time to get it right. But if we happen to go into some decline, as I think a lot of practices will in the next few years, not, I’m not gloom and doom, not tomorrow. But the best time to build is before you have a problem. And it’s also easier and faster. But I’ll end where I started. Any practice can do well, if it applies the right methodologies and systems and practice management. But you can’t just rely on that economic law of supply and demand anymore. It’s not as much in our favor as it used to be.

Alison Werner 51:06
Yeah, absolutely. Well, Dr. Levin, thank you so much for taking the time to break this all down for our readers and

Dr Roger Levin 51:13
our listeners. Thank you, Alison, is always a pleasure to be with you.

Alison Werner 51:17
Great well, and to those of you who want to learn more about the survey, it will be in our upcoming April/May issue, which will if you don’t get it in the mail, then you can also find it at the AAO at our booth. And you can also find the article online and we’ll have a link to the full article with this podcast. If you go visit our website. So thank you for joining us. And thank you again, Dr. Levin. As always, thank you for joining us. Be sure to subscribe to the Orthodontic Products podcast to keep up with the latest episodes. And be sure to check out orthodontic products online dot com to keep up with the latest industry news. Until next time, take care.

Transcribed by https://otter.ai