THE EDITOR'S CORNER
It was something of a shock to read in the AAO Manpower Report that the average orthodontist felt he could manage 124 patient starts a year, if they were available. The reason that this is a shock is that it is not a very large case load for one orthodontist and three or less auxiliaries; and as rising costs and inflation attack the orthodontist's purchasing power, each orthodontist is somehow going to have to start more than 124 patients a year to generate a satisfactory income.
Productivity is not a dead issue in orthodontics. The decline in the number of children available for orthodontic treatment has had a detrimental effect on productivity. Nevertheless, productivity is still a key to efficient practice. While case load is down in the average orthodontic office, hopefully a turnaround can be accomplished by stimulating increased utilization of orthodontics in both the child and adult populations. We need a restoration of productivity in orthodontics. For the average orthodontist to maintain his 1978 standard of living in 1988 will probably require around 248 patient starts per year per orthodontist, not 124.
For 124 patient starts to be an average goal must mean that the average orthodontist is on a 4-day week, seeing 20 patients a day, with an average interval of 3 weeks between patient visits. It should come as a shock to the average orthodontist that the same case load could be treated in 2 days a week, simply by seeing 30 patients a day with a 4-week interval between visits on the average; or 40 patients a day maintaining the average visit interval of 3 weeks.
Thus, productivity not only means the ability to treat more patients, but also the ability to compress the number of patients available at one office into a smaller number of days. Obviously, there are a great many factors that go into productivity including efficient use of the doctor's time, efficient use of auxiliary personnel, efficient treatment procedures, efficient scheduling, and effective patient management, education and motivation. To these we can add the average time interval between visits as a significant factor among those which determine how many case starts per year an orthodontist can undertake per office day (see chart).
It can be seen that the simple adjustment of the average interval between patient visits from 3 weeks to 4 weeks permits an increase of 33 /3% in the number of patient starts per year across the board, for the same number of days in the office and for the same number of patients seen per day. An increase in the number of patients seen per day, from 20 to 30, results in a 50% increase in the number of possible starts per year, regardless of the average time interval between visits. When both actions are taken, an increase in the interval between visits from 3 to 4 weeks plus an increase in the number of patients seen per day from 20 to 30, it results in a 100% increase in the number of possible starts per year.
Thus, not only is the orthodontist's potential to handle 248 case starts per year easily achieved in these ways, but his productivity in any one office is maximized, making the most efficient use of the days required to see the patients that he has in one location; perhaps freeing him to open a satellite office in another location or otherwise use his non-productive time. This will not only make efficient use of the doctor's time, but also cost effective use of employee time, which is a significant factor in the economic model of an orthodontic practice.
