Is It Wise to Advertise?
It has been 10 years since the Bates decision by the Supreme Court gave professionals permission to advertise. Advertising we have seen so far has run the gamut on TV and radio; in newspapers, souvenir journals, buyers' guides, telephone yellow pages; in Welcome Wagon promotions; on billboards and neon signs; by direct mail. Some advertising has been at a dignified level and some has been tasteless and undignified. There has been advertising by individuals, closed panels, associations, and groups of orthodontists in the same community. There has not been a substantial percentage of orthodontists who have advertised--it is still probably less than 5%. It is not predictable whether advertising will increase in the future, but the 1987 JCO Practice Study seemed to indicate a leveling off and even a slight decline. However, the question is still being asked: Is it wise to advertise?
One group of advertisers is aiming to find new orthodontic patients among people who would not normally be seeking orthodontic treatment. Although some of this advertising is on a non-price basis, stressing quality, much of it advertises low price, discounts, free examinations, and premiums or prizes such as 10-speed bicycles. Another group of advertisers is primarily interested in a bigger market share from among the population that has traditionally sought orthodontic treatment--the middle and upper classes. Orthodontists among such advertisers might be emphasizing training, experience, and specialization; non-orthodontists might be emphasizing-one-stop dentistry, special interest in and attention to orthodontics, convenience of appointments, time, place, and--in some instances--lower price.
There is a nagging question in the minds of some orthodontists about whether they should resort to advertising, either in response to the advertising of others in their locality or to try to rejuvenate a flagging practice or just to be first in their community to advertise.
How successful have advertising programs been? Advertisers generally appear to realize an immediate increase in inquiries, with a percentage of these--usually less than half--actually starting treatment. Of those who start treatment at relatively traditional fees, at least half seem to have trouble making their monthly payments and either drop out or are terminated for that reason. That leaves relatively few survivors among those attracted to a traditional setting by advertising, and advertising is usually expensive for such practices.
Is advertising successful in low-fee practices? Probably to a limited extent in appropriate places, but indications are that many low-fee advertisers priced orthodontics too low, did not generate the numbers of patients required by that low fee, and had to raise the fee substantially. When the fee is raised substantially, collection problems multiply and the relative cost of advertising mounts.
While orthodontists in almost all parts of the country report in the 1987 JCO Orthodontic Practice Study that advertising by others in their community is having some effect on their practices, the strength of this effect is generally low. In addition, orthodontists who have advertised report that, on the average, it is not an effective practice-building method. Not only does advertising seem incongruous for a referral-source practice, but it appears to be ineffectual in the experience of those who have tried it.
It seems unlikely that orthodontists who have tried advertising or who may be contemplating it have exhausted all the marketing tactics that are less overt than advertising. They may be looking to advertising as a first resort rather than as a last resort.
It might be said in favor of advertising that it has worked in the business sector for products and services and, therefore, ought to work for professional services. That remains to be seen. It is questionable whether there are economies of scale in orthodontic practices that will permit a lowering of the fee for high-quality service. It seems more likely that high-quality orthodontic treatment will become more expensive because of the demands of greater technology in diagnosis and treatment. It is also questionable that any semblance of ethical orthodontic service can be offered for a fee low enough to attract a large enough number of patients. An unfortunate corollary lies in the inability of orthodontic graduates to open their own practices or to find employment in traditional offices. They may turn to the low-fee advertisers out of economic necessity and, in doing so, perpetuate this mode somewhat longer.
If orthodontic advertising were to increase greatly, orthodontists would divide into at least two groups--those who maintain a high-quality, referral-source, private practice, and those who opt for a more modest-quality, advertising-source practice. The future is brighter for the referral-source practitioner, whose competition in the referral area will be reduced. The future is less bright for the advertising-source practitioner, who is entering an arena of greater competition--not only with other advertising orthodontists and general dentists, but also with a variety of business enterprises that can manage better, market better, advertise more and better, and take advantage of economies of scale that are unavailable to individual practices. This is not an arena that the orthodontist should leap into without a careful assessment of his or her capabilities to compete in that environment. As a quick fix it could be deadly.