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Has ortho lost its luster?

Discussion in 'Dental' started by NLB, 03.05.10.


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  1. NLB

    NLB New Member

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    Has ortho lost some of its luster because of a down economy and general dentists hanging on to the simply cases and trying to treat them with clear aligners (Invisalign). Not to mention future technology that might make it easier for general dentists to treat simple cases? Finally, I think it doesn't help that we are cranking out 30 more residents a year then we were 10 years ago. Any thoughts? Has the hay day of ortho come and past?
  2. BlueToothHunter

    BlueToothHunter

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    You are correct in your observation. Orthodontics is no longer in demand as it used to be. I guess the era of highly paid orthodontic associates (relative to other GPs) ended with the collapse of easy credit and home equity loans in America.

    For example, in southern California, if you tried to get any paid job as an orthodontist, you will find yourself competing with new grads, recent grads and established orthodontists in addition to the retired orthos coming out of retirement to fund their ever shrinking retirement funds! Did I mention that there are POS and Six Month trained "ortho" practitioners too?

    It may not be too crowded in other parts of the US... but I hear stories of patients who can't pay, won't pay and recent grads unable to find a fulltime position.

    Still there are more orthodontic graduates each year and I guess that means we are alays in a short supply! Maybe we should all move to rural area!
  3. Ostracized

    Ostracized New Member

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    My dad's a general dentist and he stopped referring out his ortho cases about 4 years ago. It's becoming more common.
  4. charlestweed

    charlestweed

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    Not just ortho…..other specialties are suffering as well. A lot of GPs have had hard times getting new patients because many people are losing jobs and dental/medical benefits. When the GPs struggle, the specialists also struggle. My friend (an endodontist) predicts his income for this year will be 1/2 as much last year income. My wife (a periodontist) places fewer implants. The OS, who does orthognathic surgeries for my patients, also gets fewer referrals from the GPs.

    I think ortho specialty suffers the least from this economic crisis because the orthodontists do not only get new patients from the GPs, they can also get new patients from walk-ins, internal referrals, and referrals from insurance companies.
  5. dentalWorks

    dentalWorks Nights Watchmen

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    Isn't there also these special 6 month seminars which train General dentists in various specialties. I believe Ortho is the most common course taken.

    My sister's friend (also DDS) did one of those programs. He has been handling ortho cases for over 3 years now. Supposily he has over 50 patients, all ortho cases.
  6. OG1

    OG1 OrthoGunner #1

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    It depends on why you want to do ortho. If your only goal is money, then it's probably best to do something else, but I guess that's always the case. Ortho hasn't lost its luster for me because I enjoy the work much more than I did dentistry. I will be much happier practicing ortho than I would have been practicing general dentistry, regardless of my earnings, but that's just me personally.

    Money's obviously important, and I think the nature of ortho has changed in that regard. Urban areas are saturated, while rural areas aren't so much. I think it's more of a necessity to have a satellite practice (or two) these days. I personally intend to go a little more rural than I had originally planned, and that's because I've accepted that things have simply changed. I've heard many times, "Decide where you want to live, and then build your practice and you'll make it work," but there isn't enough incentive for me to swim upstream that hard.

    Plus, we're in a serious recession. Things turn around. There's probably a glut of 13-year-old kids out there whose parents are waiting on braces for them. Also, in a recession, dentists need to take whatever they can get, including everything from every specialty. Ortho will be less worth their time when we're out of a recession.
  7. jay47

    jay47 Think Positively!

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    Well put; I think you put the nail in the coffin on this one.
  8. NLB

    NLB New Member

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    OG1 and Charles Tweed I appreciate your comments. Money is always a factor to some extent. Is anyone concerned that one day Suresmile and other technologies will be affordable enough that GP’s will implement these technologies in their practices? Are these concerns justified? Also, it seems that GP’s are better equipped to survive financially in a recession because they can cherry pick the cases they want from all the specialties. Do you think this is the case? I know it’s rare to see a starving orthodontist though ☺
  9. charlestweed

    charlestweed

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    Of course, money is always a factor. I would have given up the ortho specialty and gone back to practicing general dentistry if my ortho income was significantly less than the GP’s income. $450k in student loans is not a small amount.

    I don’t do invisalign in my practice because I believe I can offer the patients far more superior results with tradional braces….at ½ the cost. Invisalign and Suresmile cannot replace the doctor’s diagnostic and treatment planning skills. And these skills can only be acquired through residency training and years of clinical experiences. You can screw an implant into the jaw bone doesn’t mean that you know how to place implants. You can glue the brackets to the teeth and ligate the niti arch wires to the brackets doesn’t mean that you know how to correct orthodontic problems.

    The GPs cannot get as many ortho cases as we, orthodontists, can because we get referrals from 10+ different GPs in the area. The GP can only get ortho cases from 1 place….his/her own GP office. This is why the GPs have to do other general dental procedures to survive. For orthodontist, we are doing really well with just 2 days/week (because we can see 60-100 patients a day)….and if we want additional income, we can work as an associate (in house orthodontist) somewhere else.
  10. mrlantern

    mrlantern

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    I don't believe that and I don't think ortho will ever lose its luster. Yes, right now the jobs aren't plentiful but all careers change back and forth in cycles. Most people would do ortho even at a GP salary. I personally would do ortho even for 75k/yr but no less. Money isn't everything. The best patients are usually in ortho and the work is generally clean, stress-free, and easier on the eyes and back. And the patients can usually see the results themselves and notice the difference. General dentistry is the trench-work of dentistry and it's very hard to go from the lifestyle of ortho to the lifestyle of a GP.
  11. HuyetKiem

    HuyetKiem Senior Member

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    I don't believe ortho lost its luster. I've sent more patients to my orthodontist after taking more advance ortho CE courses than to any other specialist. Many cases that I will have no business to mess with.

    In this this economic crisis, more advertising and improving customer service are the way to survive. I have seen just a little bit slowing down in patient load at my office. We have patients from 5-6 hrs drive and as far as Tampa, Florida come and seek orthodontic treatment.
  12. NileBDS

    NileBDS SDNator Moderator Emeritus

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    I wouldn't really call it cherry picking (although yes, we are guilty of that too), but call it diversification. When investing money, you don't want to put all your money in just stocks, no? You diversify your portfolio. Some stocks, bonds, gold, CD's ...
  13. TKD

    TKD Member

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    Oh really. Unless you're doing skeletal discrepancies, impacted canines, open bite cases, etc...then ya it's cherry picking.
    The investing example seems flawed to me as well. Apples and oranges.
    I don't refer out any prostho. I cherry pick, endo, perio, pedo. I'm a GP, and I admit it's cherry picking, let's call a spade a spade. If you're wondering, I don't do any ortho because I can't hold myself to the standard of a specialist. Work that isn't cost/time efficient, or can't be done to specialty standards, or I wouldn't do on a family member/friend I don't do.

    If you're wondering I no longer have any student loans, went rural in a FQHC center loan repayment, etc, and also started my own private practice. I'm within 60 miles of 3 major metropolitan areas so not too rural. Plenty of patients, economy hasn't hurt me. My friends in bigger cities are hurting and I hope it's not influencing their practice philosophy.
  14. TKD

    TKD Member

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    Advertising: that's what some self-proclaimed practice management "guru's" keep telling us. No one tells us that sometimes marketing gets us the wrong type of patient.
    I'll tell you what works: word of mouth. Also, referrals from other professionals.
    True story: a highly respected CEO came to my office the other day and under the question (initial paperwork) "how did you find out about us?" He wrote: You were tough to find in the yellow pages. Several other dentists paid for large ads, claiming to be esthetic/cosmetic dentists, and all you had was the free name, number and address line. When I called you had a waiting list. So I chose you.
    Customer service: agreed. By this I don't mean free foot massages, but spending time talking and listening to patients.
  15. mrlantern

    mrlantern

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    Well, I recently met a former classmate who went through prostho training. He thinks GPs shouldn't do any prostho greater than 3 units for bridges, along with complete dentures. He argues that GPs could not perform pros work at the level of a specialist. Since almost every specialists think the same of GPs no matter what the field is, be it endo or ortho or os, I think there's going to be a big problem down the road for all of us.

    Out of curiosity, are you ever planning on expanding the scope of your clinical skills beyond what you learned in dental school? Any future plans on placing implants, sinus lifting, IV sedation, ortho, or etc.?
  16. HuyetKiem

    HuyetKiem Senior Member

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    been there and done that. I'm also a real estate agent and most of my marketing methods are copied from that side of business. It's worked out quite well for us considering the size of my office (4 full time docs, and 17 supporting staffs, with more than 400 active ortho patients). I'm currently spending 3k/month on advertising this year, up from 1k of last previous 2 yrs.
    Last edited: 03.08.10
  17. TerpDentist

    TerpDentist

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    I would disagree with this in that if you want to be a dentist and your only goal is money then ortho is actually a good idea. I know that different sources say differnt things, but as far as sources go, the U.S. Bureau of Labor Statistics' Occupational Employment Survey is pretty good (though this data is from the May 2008 version of that survey).

    http://hotjobs.yahoo.com/career-articles-which_jobs_pay_new_hires_best-1158

    It reports that:
    1. Orthodontists
    Beginning Wage: $100,980
    Median Earnings: $166,400+

    I should say that this is an article focusing on a list of jobs in which even beginners are paid well. So I don't know about max potential earnings.
  18. TKD

    TKD Member

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    To each his/her own I guess. I don't advertise period. I just don't have to, and more importantly philosophically we appear to be on opposite ends of the spectrum.
  19. TKD

    TKD Member

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    My GPR consisted of quite a bit of complex prostho, hence I haven't felt the need to refer. I did 1 minor ortho case in dental school treated with a removable appliance, and none in my GPR. This experience is common - prostho, endo and perio taught in schools and even more in GPR/AEGD has increased substantially. I don't particularly care what a specialist thinks of a GP - all I care about is my quality - which only I really know. And other than what I mentioned, it's not to the level of specialist.
    Yes I do place implants - this is based on me placing around 30 in GPR, and taking some CE and pla- so I cherry pick based on case selection and based on if my inventory has the right system for that case. Refer out the rest.
    Again, it's a time/cost effectiveness decision. The population/dentist ratio where I practice is great. Why jerk around doing sinus lifts, ortho etc etc, when I have a plenty of patients needing procedures that I can do predictably, without stressing, and keeping my overhead reasonable. There's no real profit with these, unless you do a lot. A whole lot.
    I don't know, maybe with some people (and I suspect moreso with students/residents), it's an ego thing. You hinted at this with your assumption of me having a limited scope of clinical skills. To which I say oh great you're a GP who does sinus lifts. That's just great. But I'll tell you what, from a business standpoint, that doesn't make sense. Plus mentally worrying about something that may have been over your training it's not worth it. Now again I'm semi-rural so this works great for me. I work 4 days, and just bought a boat!!! I'm not gloating, but my buddies in cities are not doing that great, and in fact I have just about recruited one.
    Last edited: 03.08.10
  20. nug

    nug Member

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    Now some orthos see between 60-100 patients per day. How many of these are exams (either recall or initial)? So relating to the OP...in this economy, what is considered good number of exams per day for an ortho? 2? 4? 6? 10? 30?
  21. Jyaki

    Jyaki

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    The rumors of the death of ortho is nothing new. Over the course of history, these rumors always spread everytime some new technology was introduced. People thought ortho was dead with the introduction of bonding brackets, straight wire, NiTi wires and Invisalign. But as one Invisalign rep put it, GPs will immediately jump on the band wagon with each new technology and hyped up marketing, but once they begin to realize that they still need to tx plan and fully UNDERSTAND orthodontics to achieve the necessary results, they quickly loose interest.

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