Profession or Business?
A number of voices in dentistry and in orthodontics have challenged us to decide whether we are in a profession or a business. In these presentations there is an implication that all the virtuous among us would decide we were in a profession, and all the vile among us would decide we were in a business.
It would be interesting to know what aspects of business are so abhorrent. Is it a fear that making use of any business principle in an orthodontic practice would cause one to sink immediately to the level of a tin man or a used-car salesman?
What is there about the word "business" that evokes such revulsion and demands such rejection? Has there never been a business person who was honest and fair, and concerned with the satisfaction of customers? Do all business people sacrifice their very souls to the despicable "bottom line"? Do all business people engage in unethical behavior?
There are some business practices--such as various forms of advertising--that are not deemed appropriate for professionals. Consequently, very few professionals engage in them. But to use that as an excuse to turn one's back on all of management, because business people also engage in it, is counterproductive. The line between business and profession can at times be indistinct, as in some service businesses that involve a considerable amount of advanced study.
A professional person who concentrates entirely on the mechanics while denigrating all practice management may be an excellent technician, but may be giving patients less than an excellent experience. There is more to orthodontic practice than bending wires. The best orthodontic practices are organized efforts to maximize patient satisfaction.
Those who ask us to choose between a profession and a business imply that people who use business methods to conduct an orthodontic practice are only in it for the money, as if having a higher income was in itself a reprehensible goal.
There is an old business measurement called the break-even point. It is the point at which total income just equals total expenses. Expenses are of two types. Some are fixed, such as rent; some are variable, such as supplies used in treating a case. The more cases, the more supplies needed. It is interesting that in orthodontic practice--as the JCO Practice Studies have repeatedly shown--once income reaches a break-even point, additional income tends to exceed the variable costs required to service it. In other words, as income in orthodontic practice rises, overhead rate declines and net income increases.
Doesn't that business principle have a compelling application in orthodontics? One would have to hate money not to think: If I can take on more patients, I can take home a greater proportion of my gross income. There are orthodontists who say they have enough patients and are making enough money. They are in a small minority. When the JCO Orthodontic Practice Studies have asked how many additional patients could be handled without increasing the size of the facility or the number of employees, the answer from a sizable majority has always been 50. But it would take some additional effort to attract those additional patients, and the methods necessary to do so are well within the bounds of acceptable professional behavior.
It is said that to be effective is to do the right things and to be efficient is to do things right. When one is effective, it is said that he or she is professional; when one is efficient, he or she is described as businesslike. The highest level of ethical professional practice can be conducted in a businesslike manner. Indeed, it is happening in orthodontic offices all over the United States.
With the completion of the sixth biennial JCO Orthodontic Practice Study, the first report of which appears in this issue, we can look back on a 12-year period for evaluation of both the economics and the administration of orthodontic practices. If one thing has become clear, it is that the two are related in a number of important ways, and that these relationships have been consistent.