Time Is NOT Money
It has become almost an article of faith in our profession that time is money--that time is what the orthodontist has to offer in the marketplace. Other professionals, such as lawyers, may base their fees on actual time spent, but there is no correlation between an orthodontist's income and the number of hours worked a year. The idea that time is money is a half-truth that has led us down paths that tend to minimize the human side of orthodontic practice.
Most orthodontic offices are designed around multi-chair operatories. The original intention in doing this was efficiency of time and motion--to make maximum use of office time. Ingenious plans were devised to shuttle patients from reception room to on-deck area to chair to appointment desk--in one way and out the other. Movement of the doctor and staff from chair to chair was planned to require the shortest distances and create a minimum of congestion. A great many such offices are models of efficiency of time and motion.
That kind of office design was appropriate to a concept of orthodontic practice in which the doctor, in placing appliances and making adjustments, was performing corrective treatment on patients. Paradoxically, this concept has been going on side-by-side with a philosophy that describes orthodontic treatment as a cooperative team effort among doctor, staff, patient, and parent in which orthodontics is performed with people and not on people.
One of the changes introduced by the open-bay operatory was a reduction in communication between doctor and staff and patients and parents. In some minds this was intentional, because "time is money" and the less time spent on conversation the better. To others it was just a necessary development--a casualty of the battle for efficiency. While it is possible to take a patient aside to a quiet place away from the open bay for one-on-one instructions or conversations about cooperation, at one time or another all patients need such attention. The open-bay operatory is a poor environment in which to hold patients' attention for individual instruction or to correct inappropriate patient behavior. It can be ineffective or embarrassing for the patient, contrary to a belief that peer pressure in the operatory promotes conformity.
More than 50 years ago, general dentists, smitten with the idea that time is money, installed time clocks in their operatories. The button was punched and the clock started running when the patient's seat hit the dental chair, and punched again when the patient rose to leave. Under those circumstances, time was money, and patients complained if the doctor spent time in idle conversation or inquired after their health. It proved to be an unfortunate basis for a relationship between doctor and patient, and it was soon abandoned. The open-bay operatory interferes in the human side of therapy as the time clock did. It discourages building relationships.
In opting for multi-chair operatories, we discarded one of the most powerful tools to promote cooperation and motivation--that quiet one-on-one time in the operatory. In a specialty that depends so much on patient education and involvement in the success of treatment, it is folly to abandon perhaps the most important opportunity to promote that success. More time is lost in the average orthodontic office with treatment time overruns than is saved by excessive emphasis on time-and-motion efficiency in the operatory. A healthy concern for proper use of time would concentrate on treatment overruns, and then it might be discovered that an important factor in reducing treatment overruns is making sure that patients understand their treatment and what their appliances are intended to do, and that they appreciate their role in shortening their treatment time and influencing their treatment success.
The open-bay operatory design is also part of a concept that children feel easier and more secure grouped together in one room for their treatment, and that it contributes to the element of fun in the orthodontic office. Whom are we kidding? Orthodontic treatment is not fun. It can be a good experience for the doctor and the patient if a caring personal relationship is developed. If some orthodontists believe they do this best in an open-bay operatory, the chances are that it is more a catering to their own personalities and showmanship than to the needs of the patients. While the doctor's psyche is important, too, such personalities would do even better one-on-one. It is a powerful ability that they have, and it is spread thin among small groups in a multichair operatory. There is a "hi gang" superficiality about an open-bay relationship.
The idea of the open office--an office without partitions separating employees' work spaces--became popular in the business world in the 1970s. That idea gave way to one of semi-openness, with planters and other minimal territorial dividers. Now, a recent five-year study concludes that the open office lowers production and that employees function better with privacy.
In an orthodontic setting, is privacy a more important priority for adult patients than for child patients? Many orthodontists seem to think so. They treat adult patients in individual private operatories. Many others treat adults in the open bay, often together with children. Not many orthodontists inquire whether children or adults like the open-bay environment or whether children and adults like being treated together in an open bay. If those who ask find substantial acceptance of these arrangements, they are missing the point. The real question is: Is the open-bay operatory a suitable environment for optimal delivery of orthodontic care?
Human relations must not be sacrificed on the altar of money, and money is not to be equated with time in an orthodontic practice.