THE EDITOR'S CORNER
There is a growing controversy in orthodontics today over the expanded use of auxiliary personnel. We no sooner got done changing most of the state dental practice acts to permit expanded duties to be performed by auxiliary personnel in order to increase the productivity of one orthodontist by adding hands to perform teachable technical procedures, when productivity started to disappear due to the decline in the number of children available per orthodontist each year.
To the orthodontist who would rather try to solve the economic problems of orthodontic practice by reducing his staff and reducing his overhead, and expanding his own duties to where they were 10 to 15 years ago, the present status of expanded duty auxiliaries is a threat, because it could result in a small number of large practices which could possibly operate at reduced fees and kill off the smaller practices in an area, much as supermarkets put the corner grocer out of business in many instances. It conceivably could happen if orthodontic supermarkets become a better and more reasonable way of delivering quality orthodontic care.
It is not difficult to show that trying to maintain one's standard of living by reducing costs (especially by reducing the number of auxiliaries) is the least effective way to accomplish one's purpose. If you had a practice that had a gross income of $100,000 and it declined by $5000, it would take a $5000 decrease in costs, just to make the same number of dollars before tax; and an $8844 reduction in costs to balance a 5% decrease in gross income and a 5% inflation. It is virtually impossible to think that one's salvation lies in reducing costs, except in cases of extravagance, even though costs should not be neglected as one of the orthodontic economic factors.
If we eliminate reducing costs as a viable solution to a leveling off or decline in gross income, what is left? Only increasing fees and increasing the number of patient starts.
In the July issue of JCO, Bud Schulman published an orthodontic economic index which showed that orthodontic fees have risen on the average 37% in the past seven years. This amount of increase in fees was not sufficient to counteract a 22% decline in patient starts, a 26% increase in costs, and a 46.4% inflation over the same period of time. The result has been a 50% decline in the orthodontist's standard of living. If fees had been increased at a rate that would have maintained the orthodontist's 1970 standard of living, the average fee in 1976 should have increased 250-300% in the seven years.
What, then, are the chances that orthodontic practices will maintain their purchasing power or regain lost purchasing power through fee increases? In many parts of the country, the reverse is occurring. Orthodontists are reducing their fees in an effort to compete. And, government and third parties seem more inclined in the direction of reducing fees than raising them.
If increasing fees is an unlikely avenue for the solution of the economic problems in orthodontics, what is left? Increasing the number of patient starts.
How much of an increase in patient starts would be necessary to maintain the orthodontist's standard of living, not at the 1970 level, but at the 1976 level? It can be shown that it will probably take about 300 case starts a year per orthodontist by 1986, assuming that fees continue to rise at the rate they have been for the past seven years, that costs will remain at a 50/50 level, that income taxes will remain the same, that inflation in the next ten years will only average 6% a year.
If it will require 300 case starts per orthodontist, we will need to have efficient offices with highly trained, expanded duty auxiliary personnel. The real question to which orthodontists ought to be addressing themselves is--Where will the 300 patients come from? How can productivity be restored?
That is the crux of the matter. If we can't raise the 300 patient starts a year, we lose. If things continue on the road and in the direction in which they are now going, with increasing third party activity and increasing amounts of orthodontic treatment by nonorthodontists, it can be estimated that the average orthodontist in 1986 will start 59 child patients a year. That means that he will also have to start well over 200 adult patients a year. Right now, the average office starts about 16-17, which is an increase of about 5 over the previous year.
What are the ways that would make possible an average of 300 case starts per orthodontist by 1986?
1. Orthodontics by those trained in orthodontics, meaning a full 2-year graduate university program or its equivalent.
2. Public information programs to stimulate greatly increased utilization by adults.
3. Orthodontic treatment for all children who need it.
These are achievable goals and they are all in the public interest.
