THE EDITOR'S CORNER
There are two kinds of shoppers in orthodontics. One kind is shopping for a fee and the other for a diagnosis. Many of us have developed a resentment against both types. We sometimes behave as if there is something wrong or immoral about shopping. This is untrue. A person has a perfect right to shop for the best fee he can arrange and for a diagnosis that he believes will provide the best treatment for his child. If he rejects our fee or diagnosis, the fault, if any, may well be with us. We may not have made clear the correctness of our diagnosis, nor the justification of our fee.
If you do not permit the shopper to decide the fee and treatment plan, and if he pays for the service you provide, you have not been harmed by the shopper. The shopper who pays for the services that he uses should merit no one's scorn or resentment. Resentment should be reserved for the shopper who does not pay the bill for his consultation upon deciding not to go through with the full diagnostic examination, or for the diagnostic examination upon deciding not to go through with treatment. Resentment and a good collection agency.
There are some orthodontists who do not charge a fee for consultation. These may be practitioners who feel that this is a way to build a practice or those who say that their reason is to permit dentists to feel free to refer patients without being responsible for involving them in a fee, especially if the dentist is uncertain that orthodontic treatment may be required at that time.
One of the things that distinguishes a profession from a trade is the level at which its practice is conducted. The unusual investment in education that the professional man has made deserves the recognition of the value of the product of that investment. Free professional consultations are more in the tradition of competitive business practice than of ethical professional practice.
One more comment about consultation fees. We seem to be approaching a stage of development in orthodontics in which technical duties are increasingly being assigned to auxiliary personnel. If we downgrade those aspects of orthodontics such as diagnosis and treatment planning which depend on education, knowledge and experience, by offering them for nothing, we may establish a precedent that we will regret.
How do you handle a shopper? Well, either you tell them or you don't. If you are the first orthodontist to see the patient, insist on a full diagnostic workup before quoting a diagnosis or a fee. If you are prepared to take the records immediately, so much the better. If you are not the first orthodontist to see the patient, you are probably better off quickly outlining a diagnosis if you can, subject to a diagnostic study, and a range of fee. If the diagnosis is unclear, you must insist on a full workup before going into diagnosis or fee. In any case, if you go the workup route be sure to inform the parent what the fee for that is before records are taken.
Some shoppers will arrive with diagnostic records. If they are adequate, use them. You know that the parents didn't steal the records. They were given to them by the first orthodontist. Presumably he was paid for them before they left his office. If treatment has not started, there is no breach of ethics, and the parents are entitled to another opinion. However, it is good procedure to call the first orthodontist. It is a courtesy and you might learn something that you ought to know.
How much time you spend with shoppers may depend on how much time you have and whether you judge that they can be redeemed by some education. However, it would be well to ponder a few statistics. If your office overhead is $30,000 a year and you are working 1500 hours a year, it costs you $20 an hour just to open the door. If you are operating on a 33 1/3% overhead, your income must be one dollar a minute. If you are accustomed to charging $10 for a consultation visit, ten minutes is what you can afford to spend on the consultation. If you haven't made your point in ten minutes, you won't make it in thirty. Have your secretary interfere at the end of ten minutes and end your shopping consultation there.
