The Future of Orthodontics

Before World War II, orthodontics was a treatment for the rich. As a matter of fact, the great mass of people didn't know the specialty existed. There were few orthodontists and their fees were high. A practice that started fifty patients a year was indeed a "very large" practice.

Then the public became aware of orthodontics and wanted more. The desire for treatment moved down the economic scale. Treatment requests came not only from the upper class, but also from the upper middle class, and thus a whole new and larger market was opened. Then the largest move of all occurred. The middle-middle class decided that they, too, wanted their children treated orthodontically. Again, a vast new market unfolded in the 1960's.

Along with the public's desire for treatment came many significant improvements in the quality of treatment and delivery of services. This manifested itself in slightly higher fees for much better treatment. These changes also increased the number of patients an orthodontist could treat. That number kept climbing until now it is not unusual for a solo practice to start two hundred patients or more a year.

Is the Future as Bright as the Past?

Where does orthodontics go from here? Is the future as bright as the past? The future is not as bright as the past, since there are four important negative actions taking place and only one positive action. Let us examine them.

First, there are now seven thousand orthodontists practicing their specialty. Ten years ago, there were about four thousand. Ten years from now, there will probably be twelve thousand orthodontic specialists.

Second, the population of children within the age of orthodontic treatment is presently estimated to be four and one-half million. In ten years, that number is expected to be not more than three and one-half million. This is a reflection of the trend toward smaller families, or even no families. Furthermore, the age of children starting in treatment has moved downward in the last decade, thus reducing the number of older children needing treatment.

Third, economic conditions today, and probably for the future, are not as bright as they have been in the past. Orthodontic treatment can be classified as a delayable expense. It is proving to be that. People who would gladly undertake treatment for their children in so-called normal times are now not doing so. Will economic conditions improve in the future? Probably. However, we are faced with a reduced living standard, and perhaps orthodontics will be part of that reduction. American factory workers are faced with world competition and that means a reduction in what can be bought with an hour's work. Undoubtedly, orthodontics will take its place along with boats, vacations, second cars and other major purchases as items that will be foregone by some people.

Fourth, a change is evolving in inter specialty relations. Pedodontics is moving surely and swiftly into orthodontics. This is probably diverting one of the best referral sources of patients for the orthodontic specialty. This move will probably continue and accelerate in its effect. There is some movement presently to combine the two specialties for the future. This may be the ultimate outcome. It seems logical that the children who need orthodontic treatment will, to a greater degree, be treated by practices that treat large numbers of children. This may not be a happy thought for many orthodontists to contemplate, but it may nevertheless prevail.

So, we have four NO'S . . . and the YES?

One Positive Factor

The one "yes" represents the increase in third party participation in orthodontics. It should continue to grow. However, it doesn't seem possible that it can grow faster than the four negative factors that will adversely affect practice sizes. And so we are faced with fewer patients per orthodontist in the coming years.

Perhaps at this point we should add one area that could be stimulated to encourage practice growth. That is adult orthodontics. The public is just becoming aware that adults can be treated. This special area can grow rapidly with proper effect.

There are many millions of adults who would love to have their teeth straightened, if only they knew that they could. Education of the general dental community to recognize and suggest orthodontic t re a t m e n t for adults is the key to this vast source of potential patients. To repeat, education of the general dental community is the key.

Must All Practices Decline?

Will all practices diminish? Not at all. Aggressive practice builders will still be able to develop substantial practices, just as aggressive people produce better in all other endeavors of life. However, the median practice size will reduce and fewer practices will grow to large size.

For two decades now, the primary challenge to orthodontists has been to increase efficiency of self and staff in order to treat patients who wanted treatment. A pervading complacency developed in the profession when it came to practice building. Those days are gone. The greatest mission for practitioners in the future will be practice building.

Is all this distressing? It certainly should be. We are just entering this new competitive era. The orthodontist who remains complacent will find himself starting fifty or fewer patients a year. A new resolve, a new level of self discipline, a new standard of performance for self and staff must be the order for the future.