THE EDITOR'S CORNER
In a pair of articles, Orthodontic Economic Indicators in the April issue and Blueprint for Economic Survival in Orthodontics in this issue, I have tried to show the effect on orthodontic practice of three variables over which we have no control--decline in the child population, increase in the number of practitioners doing orthodontics, and inflation--and three variables over which we do have some control--increasing fees, controlling costs, and adding new patients.
Reasonable conclusions may be drawn on how these variables will affect the economics of orthodontics in the next ten years and what this will mean to the activity and income of the average orthodontic practice. Constructing an economic practice model demonstrates the interplay of these factors and suggests specific records and record-keeping methods that orthodontists need in order to know the present condition and trends in the economy of their own practice and make some educated judgments about its future health. The purpose in doing this is not only to have a finger on the pulse of the practice, but to be able to know where the imbalances in the variables may be occurring or about to occur and to know what adjustments to make in order to restore the economic balance of the practice.
Orthodontics has been a growth situation and its economic trends for a long time have been upward. In that situation, few orthodontists saw a need to maintain a group of records which would confirm this. My worst fear is that orthodontists will not recognize soon enough that the economic trends are reversing in their practice and to know how to locate the sources of the problem and how to make adjustments to put the practice back in balance.
It is awfully late along if the only response the orthodontist has to an economic crisis in his practice is to raise fees. Raising fees is one of the important adjustments, but success will lie in knowing when to do it, how to do it and how much to do it, and these are related to the weight of the fee in the balance of economic variables.
I detect far too much of a head-in-the-sand posture on the part of orthodontists. There is a feeling on the part of many that this will all go away somehow, when it is possible to determine that it is not all going to go away. There is a feeling on the part of many that somehow increased third party insurance coverage and increased adult orthodontic treatment will take care of everything, when it is possible to surmise that this is not necessarily so. There is a feeling on the part of many that there is not much point in spending time on the uncontrollable variables since we can't control them anyway, when it is clear that adjustments in the variables that you can control must be in response to the movement of those you cannot control. There is a feeling on the part of many that they will somehow manage to survive all right for the remaining time they will be in practice and not worry about what will happen afterward, when it can be demonstrated that serious imbalances in practice economics may appear in two to ten years depending on the conditions in an individual practice.
Establishing and maintaining the records suggested in the Blueprint article make sense just for the management of a profit-making enterprise. There is no virtue in ignoring profitability. In addition, even if your practice trends are up when the average trends are down, it would be foolhardy to assume that yours will automatically continue to be upward. It would be more responsive to the situation to set up an early warning system, to keep the records and follow your trends, so that you can recognize an imbalance before it is serious and know what adjustment to make in an effort to correct it.
If one were aware of the existence of a practice decline right now, it should be given an A1 priority. It would be appropriate to close up the office if necessary in order to constitute a complete set of records for the past five years and evaluate what they tell you and what to do about what they tell you.
I believe that orthodontists who monitor the economic information about their practices and who are prepared to make suitable adjustments to imbalances as they occur will not have a problem of economic survival. However, those who deprive themselves of advance awareness of economic trends in their practices are unnecessarily placing themselves in grave jeopardy of survival.
