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Expert Opinion: Orthodontics and Global Economics Wm. Randol Womack, DDS Editorial Director, Orthotown Magazine

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Dr. Ron Roncone is recognized internationally as not only a respected orthodontist but also as the "Guru of Marketing." While teaching more than 500 seminars worldwide, he has been responsible for a large number of innovations in the practice of orthodontics. Ron was gracious enough to spend a few minutes on the phone with me addressing his take on the economic crisis we face in orthodontics today.

Dr. Roncone, for those who don't know you, could you please tell me what you are involved with? Give me a little background about where you are right now and what's happening with you.
Roncone: For the last eight or nine years I've been practicing about 90 days a year. I lecture about 70 days on all kinds of things. I have a one-year in-office course that is 12 days over a period of a year. I'm out of the country lecturing in Europe, South America, Canada and Asia probably 20 to 25 days and I'm all over the country at this point. Since the first of the year I've had speaking engagements in Atlanta, Texas, Quebec City, Venezuela, Amsterdam, Pittsburgh and the AAO in Boston. After that I go to Paris. It's been a lot of speaking so far this year. It has been a good mix that I've enjoyed over the past years, the mix that I have had keeps me interested.

What are your main requests when you speak? What are you speaking about and what do people want to hear from you?
Roncone: Actually it is a combination of management, marketing, organization systems and mechanics. I lecture a lot on In-Ovation products, a lot of which I use. We developed a lingual self-ligating bracket and we use that as a minor tooth movement, the social six, however, we also use the major appliances for lingual cases and that's also self-ligating. It's been interesting because in England the health-care system has changed. They are no longer paying for orthodontics, however they never paid very much in the first place. When I go to England they want me to talk about marketing and that sort of thing. France wants me to talk about mechanics; Italy wants me to talk about a combination. Germany wants me to talk about a combination there but they're just sort of stuck in their own way. When we used to have programs that were basically all clinical, we have had people say, "No we really want you to talk about marketing as well."

What has worked is a combination of clinical and marketing and management and how they really are necessary for each other. You have to have good mechanics in order to market properly and manage properly. In the old days if you were a good manager, it allowed you to do the type of mechanics you wanted to do. About 15 years ago things changed. If you have good clinical skills and you are efficient and effective in what you do, it allows you to be a good manager. I talk about the combination and how they are both necessary to accomplish the other.

The reason I wanted to interview you is because you visit so many places and because we are in this economic crisis. The crisis is not just happening in the United States, and I know you could testify it is a global issue. What are your observations about orthodontic practices both here and also around the world?
Roncone: For some time I used to go to Japan about three times a year. In 1982 when I first started going there they wanted to make sure I was talking just about clinical stuff. They did not want me to talk about marketing; it was almost socially unacceptable for an orthodontist to talk about marketing and management. In the early- to mid-1990s when I started going, I said, "I understand, I wont talk about marketing," and they said, "Oh no, please, the economy is very bad. Please talk about marketing. We need many patients." So 4,000 years of history have gone by because of a recession. They're still in a recession and they haven't come out of it. There are some practices that are doing very well and have been able to overcome that, but many are hurting. In fact, most countries are hurting significantly. The government-run practices do OK. However, England has decided it is not going to pay for four out of the five classifications of malocclusion so, for the people who normally get treatment for nothing, they do not get it for nothing anymore. They are not getting anything.

Germany is mired down. In order to do a full case, you have to go for four years. The more wires you change the better it is; the more loose brackets the better it is; because you get paid the equivalent of $65 to place a new bracket. They don't want to hear about after-treatment or keeping brackets on because it doesn't do them any good. But there are some practices that always do well.

In the United States, most of the people I talk to whose practices are down are down anywhere from 10 to 20 percent. There are some enormous practices that are down about 50 percent. There are some people who are holding their own and there are some practices that are still thriving; by thriving I mean they're seeing five to seven percent increases. I'm sure there are practices I don't know about that are doing very well, just as there are practices that are going bankrupt. With most practices, the more heavily involved in insurance you are, it really becomes the problem. When people no longer have insurance because they got fired, that cuts down on your starts. In addition to that, the people who also get fired or laid off cannot pay. The practices that are heavily in insurance – and I don't mean HMOs – are not doing well at all. I started my own private practice in 1974 when Jimmy Carter was president and inflation was 17 percent and interest rates were around 24 percent. I didn't know how bad it was because I had nothing to compare it to. It was very slow and I just thought that was always the way it was. Now, in all the years I have been in practice, I have not seen the economy impact orthodontics the way this one has. Nothing has even come close to this.

When you encountered slow times in the past, what changes did you find were effective? What could someone do today to be effective in these sorts of conditions?
Roncone: The number-one critical element is having a superb recall system. There are a lot of practices whose recall systems are awful. I know people who do Phase I treatments and they are lucky to get 25 or 30 percent of those people to Phase II because they just don't keep track of them. Keeping track of those people and keeping track of people who have not started is key. In the past when the economy got tough, orthodontists, dentists and businesses in general made their financial arrangements tougher. Ordinarily I want to get 20 to 40 percent down because the patient might not have any money but, in this crisis, it's absolutely the opposite. You don't ask for money down. There are a lot of people who would love to pay you, they just don't want to put $1,000 to $2,000 down with monthly payments because they're not sure if they're going to lose their jobs or their houses. They don't want to make an expensive commitment. They would like to be able to tell you what they can afford each month. I think offering them no down payment routinely works. They have to get tough. The first thing we do is go to our recall system and inform patients and former patients that we are still around, that we are available and have great payment plans and for those people we'll even discount our fee slightly. If you are not good at collecting money then you don't want to do this. However, if you have a good system of collections, then it is one of the best things that anyone can do in their practice.

What is your opinion of outside financing like CareCredit and others like that?
Roncone: We have used Orthobanc and some of the credit companies. As long as there is no recourse and they are not too tough in collections or they interfere with your patient communication, I think they are fine. It is a relatively small amount of what we do. So we offer it if they want to because I think we need to be as flexible as we can and give as many options to the patient as we possibly can.

If a practice's income is decreasing, what should a doctor do about expenses? Do you really need to take a second look at what you are buying, what you are doing and things of that nature?
Roncone: Yes, I really do think that we need to look what we are buying and that we don't buy things we don't need. We should even look at renegotiating contracts. My office employs staff members that haven't always been necessary – especially when I'm traveling. We used to pay our staff for four days a week even when we weren't seeing patients but we don't do that anymore. We have cut back hours that are unnecessary and I think orthodontists need to do that. I think that staff members have to make sure that they are contributing to the practice and the bottom line, especially now. It gives doctors cause to take a look at what they have done in the past and what they are doing now and see if they can really afford to do the things they have always done. We would like to see overhead in the 40-percent-or-under range, which is possible to do when you only buy what is necessary, you cut back on staff where possible and when you renegotiate contracts.

The last decade has been pretty good for orthodontics. Do you think that what is happening now will make orthodontists more conscious of being wiser about how they manage their expenses and practice?
Roncone: I do. It is amazing what some people have told me. They cut huge portions of their practice and they have cut staff members who have been with them a long time. They have cut back on most things. Because they are faced with something most of them have not been faced with, in the long run, I think it is sort of a good thing to get overhead under control. I have even taken a serious second look at all of it in my practice.

I think these changes being made are going to be maintained. I don't think doctors are going to be so lackadaisical about how much staff they have or how much they are going to spend on expenses because that is just not going to work going forward.

Now a lot of people have open time in their schedule, how would you suggest orthodontists manage the open time in a positive way?
For a really long time I've felt that orthodontists have scheduled inappropriately. Let's say there's a practice that is open five days a week. By scheduling properly, without changing patients, I bet that practice could change into a three-and-a-half day or four-day practice. Here is where things like self-ligating brackets come in. They are not causing patients to finish faster, it is the wires that do that, but what it does do is shorten the amount of time that you see patients in the chair. So going longer intervals between appointments and actually scheduling doctor time is important. There is no such thing as an average day. I have these types of appointments and over a six to 10 week interval I need to spend X amount of hours doing these kinds of appointments. We do those procedures at the same and appropriate time. Scheduling properly can really do good things for a practice. There should not be holes. You can do things so that you are working fewer days and fewer hours of the day. You don't need to work an eight-hour day and have holes in them; just work six hours. You can do whatever you want to do; it is your practice. We see patients at 6:30 a.m. and finish at 3 p.m. We also have 7:00 days and 8:00 days. Nobody ever misses a 6:30 a.m. appointment. They don't like them, but they don't miss them. It is amazing what you can do to tighten up. You can see tons of patients in fewer hours and fewer days and you can still be flexible: Work Monday, Tuesday and Wednesday one week; Wednesday, Thursday, Friday the next week. It's the same if you have two offices. You can schedule office A every other Wednesday and office B the other Wednesdays.

What about Internet marketing, Web site marketing? How do you feel those elements fit into today's program?
Roncone: I certainly think it is an adjunct. I don't think it will ever take over or be what many people think. What surprises me is that we will get maybe four patients a month from the Internet. I didn't think I would get anybody from the Internet. We have our own Web site and we update it. It is just sort of there to look at but I never thought I would get very many patients. So 48 patients a year, times $7,000 to $8,000 a case equals a lot of money from the Web site. It is certainly worth it to have something there. It doesn't have to be super spectacular but it has to be easy to get through and when people look at it, they have to understand the message you are trying to get across. I certainly think it is one of the things we can use in marketing.

What kind of summary of advice would you give practices of all sizes? What is the bottom line?
Roncone: Invisalign is certainly something people want. In addition, I tell them about the Innovation LMTM [lingual minor tooth movement] where in anywhere from eight to 16 weeks you have their teeth straightened, but this is only for cosmetics. It is not a true functional orthodontic treatment. We can finish in a few weeks, the fee people will pay is significant and they will do it even in these times.

But, without a doubt, number one is to be in communication with the patients who are already in your practice where there are potential starts. Don't forget about those. In terms of marketing, there are external marketing things that can be done in terms of educational materials that are mass mailed to people in specific categories. I think this is the time for orthodontists to sit back and have a true marketing plan. Instead of having 120 practice promotion ideas, they really need to sit down and develop a true marketing plan. So don't forget about the patients you have there. Many of us have had thousands and thousands of families in our practice and it certainly doesn't cost much, in some low-key way, to let them know you are still around and what you offer.
Interviewee's Bio
Dr. Ronald M. Roncone received his undergraduate degree at Marquette University and pursued graduate study in physiology and neuroanatomy at Marquette University School of Medicine, while simultaneously obtaining his dental degree at the same university. He obtained two postdoctoral certificates from Harvard School of Dental Medicine and the Forsythe Dental Center. Dr. Roncone practices orthodontics in San Diego County, California. He has specialized in adult treatment (aesthetics, surgical, and TMD) as well as "early" treatment for children. While teaching more than 500 seminars worldwide, he has been responsible for a large number of innovations in the practice of orthodontics. He is widely known among orthodontists as the "Guru of Marketing".
Orthotown Magazine
November 2025
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