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Orthodontic Education in Crisis Dr. Clark Colville and Dr. David Paquette

Start Discussion More by Dr. David Paquette (2)More by Clark D. Colville, DDS, MS (3)
Many orthodontists are aware of the troubles facing orthodontic residents, be they financial, faculty shortage, program duration, opportunities upon graduation, etc. Until solutions can be found, it is still necessary to figure out what the problems are and in what order they should be treated. To that end, Orthotown Magazine asked two of the specialty's more outspoken practitioners, Drs. Clark Colville and David Paquette, to share their thoughts and perspectives on some of the issues affecting the current state of orthodontic education and what awaits new grads.


Why the Crisis Now?
by Dr. David Paquette

To paraphrase Dr. Lysle E. Johnston Jr.'s foreword in the book Self-Ligation in Orthodontics by Theodore Eliades and Nikolaos Pandis, it might seem strange for a practicing clinical orthodontist to comment on the crisis in orthodontic education. I disagree. I have watched with some interest and curiosity the fretting and wringing of hands surrounding the paucity of young and even mid-career academics in our established orthodontic departments throughout the U.S. I make a point of distinguishing between teachers and academics, because their roles are quite different. A teacher disseminates information to students, an academic is one whose primary role is to dig through piles of rubble and find the truth behind what is being taught. I suggest that there are plenty of would-be teachers, and yet a severe scarcity of those with a desire to enter the role of an academic.

Why would this be? For years we have revered the great minds in our universities: Moyers, Proffit, Gianelly, Johnston, to name a few. These were department chairs who left an imprint on their students. Why was that true? I believe it was partly due to what Malcolm Gladwell describes in his book The Tipping Point as the "stickiness factor." Gladwell makes the argument that to make something stick, i.e., become memorable and meaningful, is partially dependent on the nature of messenger. His classic example is of the two messengers sent out to warn the populous surrounding Boston after the Boston Tea Party, William Dawes and Paul Revere. Most only recall Revere, however, because he had the personality and networking ability to have his message become sticky.

So why the crisis now? I have heard time and time again that it is a matter of money. Put quite simply, those in private practice make more than their contemporaries in academic positions. Johnston said the "coin of the realm" of academic pursuit has lost its value when no one pays attention to research anyway and simply does whatever they feel is expedient at the moment.

Although it may be a contributing factor, I think the problem is not solely due to money. Given the current state of the economy, residents are graduating with the prospect of not being able to practice their newly acquired skills; the jobs aren't out there and the banks won't lend them money to build their own practices. Those who are finding jobs are signing on for approximately half the salary of their classmates of only two years ago, and the earlier recent graduates are finding themselves with curtailed hours or outright dismissal from their associateships. Given the sudden surplus of unemployed recent graduates I would think the vacant faculty positions would be filled almost immediately. If that were the case, the word would have spread like wildfire at the recent American Association of Orthodontists (AAO) Annual Session in May. So why would these young graduates choose to work as hygienists or not work at all, rather than go into academics?

I believe the problem is two fold. The first is the systemic attitude of Gen Xers. According to Tammy Erikson's article "Ten Reasons Gen Xers are Unhappy at Work" on Harvard Business Online, "GenXers tend not to trust institutions in general and deeply resent the Boomers' confident assumptions that they will be motivated by the same things that Boomers have long cared about."

Those of you who know me are aware that I have lectured at the majority of orthodontic departments in the U.S., as well as multiple local, national and international meetings. I have never presumed to be the expert on anything. I do try to stay current and maintain a constant vigilance and observational overview of our specialty. I have always felt a great desire to be one step ahead, primarily for selfish reasons in that it allows me some small influence with the manufacturers on the development of possible therapies that I will eventually incorporate in practice. I consider myself to be what Gladwell refers to as an innovator. Another reason I lecture is to take advantage of the opportunity to try out my concepts on large groups. In doing so I return to my practice to refine and make in course corrections, from which I believe my patients benefit. This is not evidence based in the classic sense, however I have learned much over the years from the "hecklers" in the audience.

That brings me to the second problem we face: There is a drastic and obvious disconnect between some contemporary educational leaders' positions and the outward stated purpose of our educational institutions.

During the past 10 years I have lectured at numerous orthodontic departments, either by specific invitation of the department or as a guest lecturer. There have been multiple occasions where not only was the department chair not present – either to meet me or introduce the framework of the topic to the residents – there were times I never saw a faculty member at all! I have grown used to it over the years, but when I ask residents who will follow cases with the information I presented, more often than not, the latchkey residents would tell me, "No one." In fact sometimes they were preemptively told the techniques I described did not work, even though no one in the department had any experience whatsoever with said techniques.

Quite frankly that is academic dishonesty at it's worst. If Lysle Johnston is correct and the coin of the realm of the academic has been devalued, and I believe he is correct, I would say it is due to the unfortunate perfect storm of the attitude of the GenXers combined with circle-the-wagons attitude of those in some orthodontic departments who are more interested in protecting their turf than they are in inspiring the open-minded search for the truth that defined the revered giants of our specialty.

OK, Now What?
by Dr. Clark Colville

Five years ago I began teaching part-time at the orthodontic residency program from which I graduated more than 17 years ago. I was motivated by the opportunity to give back to the profession that has done so much for me, and at the same answer the call to ensure a future for our orthodontic profession (we were told there was a crisis in orthodontic education).

During the past five years I have observed, and participated on many levels, looking for solutions to this crisis. The AAO, AAOF and many constituent societies of the AAO have funneled significant amounts of money into the university programs to shore up the faculty salaries and encourage development of a new group of young academicians. While the dollars are well intended, these dollars have been more symbolic than cathartic, a band-aid on a gaping wound. While all the money distributed has been timely and useful for the orthodontic programs, the problem still exists. Ultimately, the solution to fund the orthodontic programs will have to come from each school's respective alumni.

And what a double-edged sword this will be. At a time when most state-supported schools are looking for any place to make budget cuts, nothing would make sweeter music to the dental school deans' ears than to find out the alumni were financially able and willing to provide significant support to the orthodontic program. Here's the quandary. Donate to the program and watch its budget get cut by the dean, or don't donate and watch the quality of the program suffer as fewer funds are made available each successive year? How do we win with either scenario? It may be quite some time before any state-supported dental school actually sees a budget increase. Belt-tightening will be model for the foreseeable future.

Ultimately, our orthodontic programs are in our hands – the working orthodontists out in the trenches. Consider your orthodontic program the same as you would a church. It will function best when supported by all its members. And what does the church ask of you? Donate your time, talent, and money – on an ongoing basis. While everyone may not have the time or inclination to teach or share their orthodontic experience, most orthodontists have the ability to give a little. I don't mean on a one-time basis – it needs to be ongoing for as long as one is practicing. It doesn't take a lot, $1,000 dollars per year. If all the working graduates from a single program gave this amount annually, it would add $100,000 to $200,000 to the annual budget for each program. That would make a difference, on an ongoing basis. The department chairs of the respective programs were ecstatic at the one-time gift from the AAO – a $40,000 contribution. Think what an additional $100,000 per year could do, year after year.

Many orthodontic programs have developed entities to channel money into their respective programs to meet the needs that cannot be met through the university. It makes a big difference when the alumni unite to support these entities. The new and younger graduates get the picture immediately. They recognize the benefits of supporting these programs and start a habit of donating regularly upon graduation. For those who are many years removed from their residency program, the need might not seem urgent. Don't delay. The need is there and can only be met by everyone participating. This is not an issue that the AAO, the AAOF, or our state legislators will ever fully resolve. Support the AAOF – it is providing hospice care for the entire orthodontic education programs across the country. Your residency program needs an immediate transfusion – and you have the matching blood type for your program.

The crisis in our orthodontic education programs appears to be faculty salaries, but a bigger problem exists. Where are graduating orthodontic residents going to find practice opportunities in the current economic climate? There is no doubt the bar has been raised in terms of academic qualifications. The students today are extremely bright, with GPAs and test scores that shoot right off the top of the chart. They are also very naïve in terms of real-world experience. It was shocking to find out that most residents have accumulated debt in excess of $100,000. Even more shocking is that most are somewhat cavalier about the debt incurred. After all, they are all going to be rich doctors, right? Reading a little Dave Ramsey could go a long way to adjust their idea of what a rich person looks and acts like. Some residents who are ready to move into the real world have never held a job of any kind. There are residents who have matriculated directly from universities, thru dental school and on into orthodontic residency without ever having worked an hourly wage job. This was unheard of among my fellow orthodontic residents. Debt was avoided at all cost, and most of us shared stories of working multiple unsavory and uninteresting jobs at the same time while in dental school. Many worked weekends while in orthodontic residency programs. Not so today.

In the past, real-world dental experience was looked upon favorably for candidates wishing to enter the orthodontic residency program. Twenty years ago it was common for incoming orthodontic residents to have some actual dental experience in the military, private practice or a general practice residency program. It was not uncommon to see residents with eight to 10 years experience heading back for postgraduate orthodontic training. This is not the case today, and that is unfortunate. The experience gained from having seasoned practitioners added to the overall postgraduate training of each class and was invaluable. It also created a more humble orthodontist when they returned to serve the public in private practice. Recognizing what a difficult task it was to be a jack of all trades and a master of only a few made one realize what a blessing it was to be accepted to an orthodontic program. Not having that experience lends itself to a lack of empathy for the daily trials and tribulations of those we "expect" to graciously send a pipeline of patients for us to treat. Is it any wonder that GPs are referring less and less?

With the debt mounting, where are today's residents going to find opportunities to practice? Is it our responsibility to create opportunities for these new graduates? Not likely. A large number of practices are barely treading water. Orthodontists are practicing longer due to the sudden readjustment in their retirement portfolios in the past couple years. Others are choosing to return to work after giving retirement a shot. In reality, there are not enough large, growing practices to absorb the number of residents who are entering the marketplace each year. For most orthodontists today, taking on a new associate will generally mean taking a pay decrease, in addition to financing the sale of the practice.

The good news is that opportunities still exist – if graduates are willing to seek them out. A sense of entitlement appears to be affecting some of the recent graduates; based on the limited range of their search for practice opportunities. Reports of recent graduates practicing as hygienists make no sense, unless one feels they are owed an opportunity to practice in a specific geographic location. The rules are changing. The traditional boutique practice of the past might not be the practical or reasonable practice model for the future. Collaboration with other non-orthodontic specialists or large GP practices might make more sense. Changes in the health-care laws might make the current orthodontic delivery model obsolete.

Bottom line, orthodontists currently in practice can't shoulder the whole load. We have a responsibility to give back to the profession and support our orthodontic programs in some form or fashion. However, we don't have the means to support our orthodontic programs, provide opportunities for new graduates, provide all the answers to access to care, and shoulder the oncoming tax burden that is looming just around the corner. But knowing so many of the wonderful people in this profession, we will give it our best shot.
Authors’ Bios
Dr. David Paquette earned his DDS degree from the University of North Carolina at Chapel Hill and his masters in orthodontics from St. Louis University. Prior to orthodontics he earned a pediatric degree and became a Diplomate of the American Board of Pediatric Dentistry. He is also a Diplomate of the American Board of Orthodontics. Dr. Paquette received the Milo Hellman award from the AAO for distinguished research in orthodontics. He has written numerous articles and lectures nationally and internationally on a variety of topics. He is on the Clinical Advisory Board for Align Technology and is a Fellow of the American College of Dentists.

Dr. Clark Colville has been in private practice since 1993. He earned his DDS degree from the University of Texas Health Science Center, San Antonio. He earned a Certificate of General Practice Residency from the Saint Francis Hospital & Medical Center in Hartford, Connecticut. Dr. Colville obtained both his Certificate in Orthodontics and Master of Science degree from the University of Texas Dental Branch in Houston. Dr. Colville is a member of the Pierre Fauchard Academy. He is a past president of the Texas Association of Orthodontists and is the current AAO Chair (currently serves) on the AAO Council of Membership, Ethics, and Judicial Concerns. Dr. Colville lectures nationally and internationally for Align Technology and serves on the Clinical Advisory Board. In addition, Dr. Colville is an assistant clinical professor with the graduate orthodontic department at UTHSC Houston Dental Branch.
Orthotown Magazine
October 2025
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