Why Do They Go?
Why do 40 to 50 percent of orthodontic referrals fail to start treatment? If you are like the average orthodontist, those numbers appear to apply to you, and this may be the single most important question you can ask.
First, of course, you must determine as accurately as you can what the actual percentage is in your practice. No matter what the percentage, there will almost always be room for improvement. Some orthodontists have asked the question, "Why do they go?" and have interviewed non-starters in an attempt to find out the answers. Many of them do not believe the answers they get are the real ones, and they discount the whole procedure. A big mistake. All the answers are worth careful consideration and remedial action.
A number of non-starters say that money is their problem. For some it is, and it pays not to encourage those whose money problems will result in non-payment. But many people who say that money is a problem may actually have a problem with the rigid payment terms in the average office--25 percent initially and the remainder in 18 or 24 months. The remedy for such people is to offer them more lenient fee payment arrangements, perhaps a smaller initial payment or no initial payment and up to three years to pay the balance. In this light, orthodontics is probably affordable for almost anyone who is referred. The case start is more important to the practice than the longer payment term.
Many people who say that money is the problem simply choose not to spend their money on orthodontics. They balance their perceived need against the time, money, and possible discomfort, and opt out. It is an axiom that, by and large, people afford what they want to afford, so such people may not have been given sufficient reason to have orthodontic treatment. Some offices seek acceptance first, which does not work well with people who want more information about diagnosis and treatment. It is especially important if case presentation is delegated to be sure that the person doing it knows what he or she is talking about.
Some say that inconvenience was their reason for not starting treatment. While many orthodontists have located their main offices and satellites to be convenient for patients, not many have paid attention to convenient office hours and convenient appointments. With most men and more than half the women in society working today, there is reason to accommodate their need for convenient appointments.
Orthodontists may have to rethink their antipathy to evening and Saturday hours. Also, many of the scheduling practices that may have been useful in the past are now outmoded. Allocating certain hours for certain kinds of appointments and doing like things at like times probably cannot be justified if it interferes with the convenience of working adults and results in their rejection of treatment.
Some people must have a second opinion. There is a lot of propaganda to that effect, chiefly coming from insurance companies, and people who have not had a strong referral or a strong case presentation or who have difficulty making decisions are prone to get a second opinion, or even a third. Many such people are too embarrassed to return to the first orthodontist, and either stay at the second or third one or simply fail to have treatment.
Some people are genuinely turned off by their reception at an office. It may be a personality mismatch with the orthodontist or a staff problem. It is true that you can't win 'em all, but you shouldn't lose too many of these.
Some people say they might be moving in the next couple of years and therefore hesitate to start treatment. Others actually are concerned about what might happen if you were to die or be incapacitated or retire or move. All orthodontists should have arrangements to cover such eventualities, and patients should be informed about them.
In orthodontics it pays to ask non-starters their reason for not starting. It may be a simple misunderstanding that can be rectified, but more important, it may result in elimination of a whole class of deterrents to acceptance of treatment.