2001 JCO Orthodontic Practice Study, Part 2: Practice Success

In the first article in this three-part series (JCO, October 2001), we discussed trends in ortho­dontic economics and practice administration over the 11 biennial JCO Orthodontic Practice Studies, and we summarized the methodology of the current Study. The complete results, method­ology, and questionnaire are published separate­ly (2001 JCO Orthodontic Practice Study, Index Publishers Corp., Boulder, CO, 2001).

This month's installment will cover the fac­tors that appear to be related to practice success in terms of net income and numbers of case starts. Most of the tables in this section use mean figures because means are required for tests of statistical significance. Elsewhere in the Practice Study, most of the tables use medians, which are less influenced by extremely high and low responses and thus may be more representative of the average practice. Throughout the Study, the annual practice data, including income and numbers of cases, refer to the calendar year pre­ceding the survey--in other words, to the year 2000.

Net Income Level

As in our previous surveys, the Practice Study respondents were arbitrarily divided into three net income categories to allow comparisons among them: high (more than $500,000), moder­ate ($300,000-425,000), and low (less than $235,000). About one-quarter of the respondents fell into each category; the remaining one-quar­ter were omitted from these tables to help sharp­en the differences among the three net income groups. It should be noted that each of these practices was owned by one orthodontist, since multiple-owner practices were excluded from the main Study results.

The high net income practices demonstrat­ed considerably more efficiency than the others, as in every previous report. Compared to the low income group, the high income group reported more than three times as much gross income, nearly five times as much net income, and near­ly three times as many active cases--with a sig­nificantly lower overhead rate and a significant­ly higher net revenue per case (Table 8). The high net income practices achieved these results with fewer than twice the number of total employees and only slightly more satellite offices, total chairs, and annual hours worked compared to the low net income practices. There were no significant differences among the three groups in percentages of adults, patients covered by third parties, patients with third-party financ­ing, or managed-care patients.

Although many of the practices in the low income group had apparently been established for less than six years or more than 20 years, there was no significant difference in overhead rate according to years in practice (Table 9). This table is the first in the JCO Studies to separate respondents who had been in practice for 21-25 years from those in practice for more than 25 years. It continues to show a decline in revenue and case starts after 20 years in practice, although the dropoff in active cases seems to occur later.

When respondents in the three net income categories were divided geographically, the Middle Atlantic and East South Central regions had the highest percentages of respondents in the high net income group (Table 10). The West North Central region showed the lowest percent­age of low net income respondents, and the New England and Pacific regions reported the highest percentages of low net income respondents.

There was no significant difference in fees or financial policies among the net income groups, although high net income practices charged somewhat higher fees than the other practices did (Table 11).

Management Methods

Every management method listed on the questionnaire was associated with greater mean numbers of case starts for users than for non­users (Table 12). The differences in case starts were statistically significant for 17 of the 26 methods--the same number as in the 1999 Practice Study.

The high net income practices were more likely to use each method than the low net income practices were, except for written job descriptions and post-treatment consultations (Table 13). Only monthly contracts-written reports, however, showed a significant difference in usage among the three income categories.


Routine delegation of every task surveyed, as opposed to delegating occasionally or not at all, was also associated with greater mean numbers of case starts (Table 14). The differences in case starts were statistically significant for every task except removal of residual adhesive, inser-tion of bonds, adjustment of archwires, progress ­reports, and post-treatment conferences.

The respondents in the high net income category delegated each task more routinely than the practices in the low net income category did (Table 15). The differences in delegation among the three net income groups were statistically significant for x-rays; cephalometric tracings; impressions for appliances; fabrication of bands, bonds, and removable appliances; adjustment ofremovable appliances; and patient instruction and education.

Practice-Building Methods

There were no significant differences in either usage or effectiveness ratings of practice­-building methods among the three net incomegroups, as in the past two studies (Table 16). The most popular methods among the high net income practices (used by two-thirds or more)were: treat adult patients, on time for appointments, on-time case finishing, no-charge initial visit, letters of appreciation to general dentists,letters of appreciation to patients and parents, andfollow-up calls after difficult appointments.

The most successful practice-buildingmethods might be those rated good (3.0) or betterby the high net income practices that usedthem. These were: change practice location, opena satellite office, follow-up calls after difficultappointments, improve case presentation, ontime for appointments, on-time case finishing,improve staff management, no-charge initialvisit, open one or more evenings per week, lettersof appreciation to patients and parents, andimprove patient education. Conversely, the methodsrated fair (2.0) or worse by the low netincome users were: radio advertising, newspaperadvertising, yellow pages boldface listing, directmailpromotion, lingual orthodontics, practicewebsite, and seek referrals from staff members.

(Continued in the December issue)


Dr. Gottlieb is Senior Editor of the Journal of Clinical Orthodontics, 1828 Pearl St., Boulder, CO 80302.


Dr. Nelson is Director and Research Consultant, Nelson Associates, Nederland, CO.


Mr. Vogels is Managing Editor of the Journal of Clinical Orthodontics, 1828 Pearl St., Boulder, CO 80302.

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