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Where Are the Assistants?

I was talking with a professional colleague the other day about how orthodontists don't yet have a dependable system for selecting good chairside assistants. Despite my own efforts1 and those of others,2 most orthodontists and dentists still fly by the seat of their pants in the selection of personnel.

Although the profession has not collectively expended a great deal of time or effort on this subject--contrast the enormous body of literature on the effects of cervical headgear in Class II malocclusions, for example, with that regarding personnel selection--it remains a prodigious and economically challenging problem. The cost of training a new assistant may be $8,000-12,000,3 even when successful. It is double that when unsuccessful.

My friend, who practices in a metropolitan area, interrupted my lament regarding this lack of resources to tell me how hard it is now to attract anyone even to interview, much less test. His experience, which others in his area confirm, is not that we lack the expertise to select potentially good assistants, but that the profession currently lacks attractiveness to anyone other than fast-food-chain dropouts.

It seems that during the economic boom that began around 1982 and has lasted up to the present, orthodontic assisting as a career has slowly but unmistakably lost what little appeal it once had. Baby Boomers are beginning to retire, and higher percentages of their children have been attending college than in previous generations. Thus, the group from which we ordinarily get most of our assistants--people with minimal education--is growing dramatically smaller. It is true that orthodontists don't have much need for university-trained staff members, except for jobs with special skill requirements, such as dental hygienists. In my 40 years of dentistry, I have had only two college graduates work for me. But now even people with marginal education and skills can take good-paying jobs that don't require hepatitis vaccinations, daily hassles with OSHA requirements, or constant anxiety over the possibility of working in the bodily fluids of people with infectious diseases.

Although the national economic picture and the proliferation of bureaucratic red tape have played important roles in this development, orthodontists simply haven't done enough to make their work attractive. Other industries have increased salaries, broadened benefits, and sweetened retirement packages, but orthodontists have settled for a status quo or worse.

In February 1986, I wrote an essay for JCO about "The Coming Employee Crunch",4 in which I warned that orthodontists would soon face a staff shortage brought about by the demographics already in place, as well as our own reluctance to make employment more attractive with competitive pay increases and enhanced nontaxable benefits. We need wait no longer: crunch time is here. If JCO Practice Study statistics are correct, however, orthodontists have yet to take any collective remedial action.5 The average salary for orthodontic assistants is still one-third less than that offered by comparable commercial enterprises, and smaller percentages of orthodontists than in 1984 offer such common benefits as paid vacations, paid sick leave, paid holidays, and retirement plans. The raises received by staff members between 1994 and 1996 averaged around 4%, while total expenses increased by 18% during the same period. Essentially, orthodontists are still trying to jump the same height, but they haven't realized that the bar has been raised.

JCO Practice Studies have consistently shown that orthodontists with well-trained staffs prosper more than those without them. This distinction will become even more important as the pool of good employees continues to dry up. Once new orthodontic graduates begin to appreciate the value of a highly qualified staff, it will be a major factor in their selection of older orthodontists with whom to associate.

Admittedly, chairside assisting offers little opportunity for advancement. Receptionist or treatment coordinator is about as far as most employees can hope to be promoted, and there is little they can learn in our clinics that will make them particularly attractive or prepared for other, nondental enterprises.

Still, orthodontists are not totally powerless in the competition for desirable employees. They can certainly step up to the plate with comparable pay and benefits and, as additional enticement, make it well known that employees and their family members will be treated in the practice at minimal or no charge. That feature alone could be worth many thousands of dollars to some assistants. They can also make high school and community college counselors aware that they have decent-paying jobs for which people need no previous experience or training. Potential applicants need to know that as employees in a service business, they will not be subject to job-threatening vagaries such as international trade, commodity overproduction, or labor strife. Orthodontists can offer job security, which is high on the list of features sought by today's applicants. They also hold the power to customize jobs with part-time schedules, particular days off, limited daily hours, or specified tasks. An orthodontic job can be challenging and even fun for those who like to work with people, and in the most progressive practices, it offers plenty of responsibility and participation in success of the enterprise.



  • 1.   Westbrook, M. and White, L.W.: Search for orthodontic assistant personality profile, Am. J. Orthod. 94:350-353, 1988.
  • 2.   Green, E.J.: Selection: Hiring and training of dental auxiliaries, Dent. Clin. N. Am. 18:771-788, 1974.
  • 3.   Mayerson, M.: Staff selection and training, J. Clin. Orthod. 24:174-184, 1990.
  • 4.   White, L.W.: Editor's Comer: The coming employee crunch, J. Clin. Orthod. 20:77-78, 1986.
  • 5.   Gottlieb, E.L.; Nelson, A.H.; and Vogels, D.S. III: 1997 JCO Orthodontic Practice Study, Index Publishers Corp., Boulder, CO, pp. 49-62.



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