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Booms, Echo Booms, and "Millenni-Booms"

In this issue, we begin a series of articles based on the latest nationwide JCO Orthodontic Practice Study, which has been conducted every two years since 1981. We'd like to thank the hundreds of orthodontists who took the time to fill out and return the questionnaire. The purpose of this ongoing research is to identify specific trends in the practice of orthodontics and to measure the current levels of key variables, such as numbers of cases, patient and practitioner demographics, fee structures, management methods, and other items of general interest. The idea, in short, is to keep our finger on the pulse of the business of orthodontics in the United States.

A number of interesting details came to light in this survey. Just to mention a few highlights, we found that since the 2003 Study, the median gross income has remained the same, the median number of patients treated per day has remained at 50, and the median age of the respondents has stayed at 50. Not everything was unchanged over the past two years, however. Median operating expenses rose by 10% and net income by 4%, accompanied by a slight dropoff in the median overhead rate. There are other findings that point to gradual changes in the way we practice, which you will observe by reading the reports.

One piece of information deserves more comment here. Since the 2001 Study, the average number of new adolescent cases per year has dropped, but the average number of new adult cases has pretty much held steady. The proportion of adult case starts compared to total case starts has had its ups and downs since 1981, but the overall trend is toward an increase in the percentage of adult cases. If this change persists, it portends a significant evolution in the nature of our practices. What's the cause? Are adults now more aware of their appearance? Is it because of the rise of "braceless" orthodontics and the mass marketing that promotes it? The data don't tell us for sure.

One trend that we can examine relatively easily is that of the nation's demographics, based on birthrates. The most pertinent analysis I found on the Internet was at the Department of Education website, http://www.ed.gov/pubs/bbecho00. Predicting the number of children entering school every year is of critical importance for the government and for school districts nationwide. To quote the department's summary*:

"The surge in the number of births after World War II, nicknamed the "baby boom", lasted through the early 1960s. At the peak in 1957, 4.3 million births were recorded, an increase of 19% from 1948.

"In contrast, the 'baby boom echo', which began in the late 1970s, reached 4.1 million births at its peak in 1990, reflecting a 25% increase from 1977. Unlike the decline in the postbaby boom era, when births dropped down to 3.1 million in the early 1970s, the number of births in the post-baby boom echo era is expected to remain fairly stable at nearly 4 million for about a decade.

"Long-range projections by the U.S. Bureau of the Census indicate a rising number of births thereafter, from 4.2 million in 2010 to 4.8 million in 2028, establishing a 'millenni-boom'."

When you examine the graph that accompanies this demographic forecast, you notice a slight decline in births from 1988 through 1993. If you jump ahead 12 years--roughly the average age of an adolescent orthodontic patient--from 1993, to today, 2005, that decreasing sonority in the echo of the baby boom may well be what we are seeing in our current survey. But if the Department of Education is correct, then there is reason for optimism about the numbers of adolescent case starts in the future. There has been a marked upswing in births since 2000--what the Census Bureau calls the "millenni-boom". The birthrate projected after 2010 exceeds even that of the peak year of the original baby boom, 1957. Coupled with the increase in the number of adults seeking orthodontic treatment, for whatever reason, the future looks bright indeed for orthodontists.

The pulse of the business of orthodontics is robust today, and it appears that it is going to get even stronger in the next two decades. Rest assured that we will continue to survey the situation.



  • *Sources: U.S. Department of Education, National Center for Education Statistics, Projections of Education Statistics to 2010; U.S. Department of Commerce, Bureau of the Census, Population Projections of the United States by Age, Sex, Race, and Hispanic Origin, 1995 to 2050.



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