Has the current economic recession affected your practice?
JCO received a robust response to this Readers' Corner survey on the economy. Most of the respondents were in their middle 40s to middle 60s, with 15-30 years of orthodontic practice experience. This indicated that they had been in practice long enough to establish a baseline from which a realistic appraisal of the economic downturn could be made.
Nearly 79% of the clinicians reported that the current recession had affected their practices to some degree. There was little or no indication that the downturn would be catastrophic, but it was obvious that there was cause for concern, even among those who had not yet experienced a decline.
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If you have not experienced a downturn, why do you think you have not?
Two primary reasons were cited by approximately equal numbers of those who had not seen financial declines in their practices: that their local economic conditions had been basically unaffected, or that they relied on strong, aggressive internal-marketing strategies. Another reason given by far fewer respondents was a substantial waiting list of patients on observation. Only a few practitioners said they relied on external marketing or referral promotion to counter the effects of the recession.
If you have experienced a downturn, how has your practice been affected?
Overall, 41% of the affected practices noted a 10-20% decrease in referrals, followed by 36% who reported less than a 10% decline and 23% who had experienced a reduction of more than 20% (Table 1). On the other hand, 44% noted a decline of less than 10% in child case starts, 39% reported a decrease in the 10-20% range, and 16% reported more than a 20% decrease. In adult starts, 41% noted a reduction of less than 10%, while 36% reported a decrease of 10-20% and 23% a decline of more than 20%.
Many of the practices mentioned problems with fee payments, but only 5% said it was a significant concern. Some 20% had not noticed any negative effects on fee payments.
No respondent reported that patient pressure for more limited treatment had increased significantly, but roughly 25% indicated a slight upturn in requests for limited treatment. More than half of the clinicians reported no patient pressure for abbreviated treatment. Furthermore, only about 25% of the respondents said they had received any requests for fee reductions.
If you have experienced a downturn, how have you responded?
The following strategies for ameliorating the effects of the recession were cited, in decreasing order of frequency: increased promotion of dental referrals, cancelled or delayed plans to purchase or upgrade major equipment, reduction of staff or of staff hours, increased external advertising, and separate charges for more services. Only 8% of the respondents said they had agreed to more limited treatment. Only one clinician had reduced fees, while 9% of the respondents had raised their fees.
If you have not yet responded to the downturn, how are you planning to respond?
Clearly, most of the practitioners who had not yet responded to the recession were planning to stay calm and take a wait-and-see attitude. The areas most frequently listed for future action if necessary were increasing the promotion of dental referrals (19%) and reducing staff hours (13%).
How do you handle patients in treatment who no longer can afford to make payments?
Seventy percent of the respondents said they would continue treatment as long as necessary to obtain satisfactory results. Only 6% indicated they would consider discontinuing treatment for non-payment, but even those practitioners generally said they would do so on a case-by-case basis. Many replies indicated that the total fee would not be reduced, but that monthly payments could be reduced in conjunction with an extended payment plan.
Interesting individual comments included:
• "Patients have enough trouble without my adding to it. I will do the best I can to finish the case or debond if the situation warrants. I don't charge for retainers."
• "If a patient is in financial distress, I handle it on an individual basis. Poor cooperators are terminated. Good hygiene and good cooperators are helped with new payment options or, in some cases, reduced or eliminated fees."
• "If no financial arrangements can be made, the patient is given the option to secure another orthodontist, or we will remove the braces, usually at no charge."
• "I feel I should do the best I can during these difficult financial times for my patients. These good and decent people have supported me during the good times, so I can do with less profit and feel better at looking in the mirror during the bad times."
• "What you think about comes about. We choose not to dwell on all the negatives, but celebrate that we get to be a part of this awesome profession and our practice continues to thrive."
JCO would like to thank the following contributors to this month's column:
Dr. William T. Anderson, Orlando, FL
Dr. Lee H. Anschuetz, Rochester, MI
Dr. Wesley H. Ardoin, Lafayette, LA
Dr. Ryan Arnold, Watertown, SD
Dr. Michael P. Arrigo, Boxford, MA
Dr. Ralph K. Bair, Logan, UT
Dr. Thomas R. Bales, Novato, CA
Dr. Robert A. Bard, Gurnee, IL
Dr. Penny Berglund, Edmonds, WA
Dr. William H. Brown, Kinston, NC
Dr. Terry Carlyle, Edmonton, Alberta
Dr. Thomas H. Cartledge, Ormond Beach, FL
Dr. Darrell B. Casada, Louisville, KY
Dr. Robert Y. Chen, Lakewood, WA
Dr. Benjamin F.D. Chikes, Ephrata, PA
Dr. Thomas L. Chou, Los Altos, CA
Dr. Stephen B. Clark, Farmington, NM
Dr. Sheldon L. Contract, Washington, DC
Dr. George Corbitt, Cumming, GA
Dr. Cory Costanzo, Clovis, CA
Dr. Robert DeShields, Strongsville, OH
Dr. Bill Dischinger, Lake Oswego, OR
Dr. James B. Donaghey II, Mobile, AL
Dr. S. Grayson Eddy, Knoxville, TN
Dr. Dawes Edwards, Orangeburg, SC
Dr. David A. Eichel, Cincinnati, OH
Dr. Daniel L. Foley, Beckley, WV
Dr. Lavonne K. Fore, Rome, GA
Dr. Eduardo J. Gerlein, Chevy Chase, MD
Dr. Randy L. Gittess, Winter Springs, FL
Dr. George G. Hartl, West Bend, WI
Dr. Steven P. Hearne, Suffolk, VA
Dr. Barbara Hershey, Durham, NC
Dr. Lisa P. Howard, Scarborough, ME
Dr. Gary O. Inman, Elizabethtown, KY
Dr. N. Ross Irvine, Clyde, NC
Dr. Kenneth B. Kaplin, Arlington Heights, IL
Dr. James R. Karpac, Columbus, OH
Dr. Andrew Kohl, Jamestown, NY
Dr. Larry Layfield, New Braunfels, TX
Dr. Sam W. Levine, Lexington, MA
Dr. Harvey L. Levitt, Westmount, Quebec
Dr. Jennifer L. Martin, Pleasant Hill, CA
Dr. Barry I. Matza, Boca Raton, FL
Dr. Robert B. Meyer, Cary, NC
Dr. Jacqueline M. Miller, Washington, MO
Dr. Thomas L. Munholland, Aurora, CO
Dr. Dennis Nappen, San Diego, CA
Dr. Kaz A. Newman, Poway, CA
Dr. Denise T. Nguyen, Vienna, VA
Dr. Jonathan L. Nicozisis, Princeton, NJ
Dr. Ronald L. Otto, Roseville, CA
Dr. Michael Parker, Delmar, NY
Dr. Walter Parsons, Jr., Roseville, MN
Dr. M. John Pautienis, Hyannis, MA
Dr. Daniel Pearcy, Tucson, AZ
Dr. Gus Charles Petras, Redding, CA
Dr. George F. Pinsak, Monroe, NC
Dr. Kevin Race, Brookfield, WI
Dr. Grace Richardson, Halifax, Nova Scotia
Dr. Stephen D. Robirds, Austin, TX
Dr. Daniel J. Ryan, Essex Junction, VT
Dr. Richard L. Sikora, Normal, IL
Dr. H. Zack Smith, Fayetteville, NC
Dr. Terry Smith, Thomasville, GA
Dr. Ronald L. Sperber, Whitby, Ontario
Dr. Darrell Spilsbury, Henderson, NV
Dr. Thomas M. Stark, Ames, IA
Dr. Robert M. Stern, Cherry Hill, NJ
Dr. J. Douglas Thran, Clarks Summit, PA
Dr. Mark D. Unruh, Bartlesville, OK
Dr. Ronald E. Unterseher, Westminster, CO
Dr. Martin F. Van Vliet, Highland, NY
Dr. Sheldon Waltuch, Edison, NJ
Dr. Stephen Weisner, Methuen, MA
Dr. Carl Wheeler, Toledo, OH
Dr. James F. Willbrand, St. Peters, MO
Dr. Michael G. Willes, Carlsbad, CA
Dr. E. H. Williamson, Evans, GA
Dr. James Zahrowski, Tustin, CA
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DR. SHERIDAN
Dr. Sheridan is an Associate Editor of the Journal of Clinical Orthodontics and a Professor of Orthodontics, Jacksonville University, 2800 University Blvd. N., Jacksonville, FL 32211.