THE EDITOR'S CORNER
I am absolutely fascinated by the number of orthodontists whose offices have one or more pieces of decor related to Don Quixote. It may help explain why orthodontists seem to take comfort from dreaming impossible dreams.
Orthodontist #1 says: "If I keep on doing fine work and treat my patients to the very best of my ability, my practice won't decline." I am sure that the average orthodontist would hope that it would be this way, but the average orthodontic practice is declining.
Orthodontist #2 says: "I expect the birth rate to increase and that will reverse this trend we are experiencing." There is no basis in fact for such a hope, at least not by 1986. Even a reasonably large increase is likely to have a minimal effect if it were to occur.
Orthodontist #3 says: "If only the schools would stop turning out so many orthodontists, things would be better." Better, possibly. All right, no. The fact is that we are seeing and will continue to see significant reductions in the number of orthodontic graduates; but we can still expect 8400 orthodontists by 1986, and reducing the number of orthodontists could easily result in an acceleration of orthodontic treatment by non-orthodontists.
Orthodontist #4 says: "I always knew how to practice build. Maybe I've let up a little bit on that score lately; but, when the time comes, I will know what to do." He says that in spite of the fact that the time has come.
Orthodontist #5 says: "Adult orthodontic treatment is going to increase tremendously and take up the slack. Look at that large unmet need." Adult treatment will increase; but, so far, it is not accelerating at a fast enough rate and we aren't doing much to make it happen; and, orthodontic practices are declining.
Orthodontist #6 says: "Third party programs will greatly increase the utilization rate of orthodontics, and that will bail us out." With over 25 million Americans covered by dental insurance, orthodontic practices are still declining; there is evidence that third parties encourage orthodontics by non-orthodontists; and third party control could very well be our professional and financial undoing.
Orthodontist #7 says: "If third parties don't bail us out, the government will." It would take an expenditure of 3.3 billion dollars a year by 1986 to support an effective government child orthodontic program and I would guess that it is not going to happen. In addition, this alone would not solve our. economic problem and might on the other hand create additional economic and professional problems.
Orthodontist #8 says: "Well, I don't have that much more time to go. Give me ten more good years and I don't care what happens after that." Even if one were so insensitive as not to care what happens to the specialty and to fellow orthodontists, at the rate we are going the chance of ten more good years is non-existent. With no changes, I think we have something less than five.
I believe that it is suicidal to hold any of these beliefs or any combination of them and to hope, to hope, to hope that everything will somehow come out all right, in face of the facts and of a reasonable interpretation of the future. By themselves, things will get worse, and most orthodontists are not working for constructive change. Most are dreaming those impossible dreams.
In an article entitled "How to Understand and Deal with the Growing Economic Crisis in Orthodontics," I believe I have proven that there is only one avenue for survival in orthodontics. It requires all of the following:
1. A differential between fees for child and adult orthodontics with the adult fee one-third higher.
2. Stimulation of utilization of orthodontic treatment by adults is necessary to produce almost a tenfold increase in adult case starts by 1986.
3. Orthodontic treatment must be limited to those with full 2-year graduate university training in orthodontics or its equivalent.
4. Increased utilization of orthodontics among children, including a good government program, so that no child is deprived of necessary orthodontic treatment because he cannot afford it.
These are achievable goals and these are possible dreams; but, beyond that, if there is only one avenue for survival in orthodontics, I would rather go down fighting for something I believed to be true than to conciliate and concede away in advance all chance of success on the basis of hopes that I hoped were true, but knew in my mind to be false.
The Don's excuse was dementia. What is ours?
