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The Seven Characteristics of the Most Successful Orthodontists Donald E. Machen, DMD, MSD, MD, JD, MBA, CFA

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By Donald E. Machen, DMD, MSD, MD,
JD, MBA, CFA

Having had the opportunity over the past 25 years to consult with more than 200 orthodontic practices, some successful and others that strive but struggle to become more successful, several attributes continually appear to be present among the most successful of those client practices. The definition of success or successful as used in this article is not one of scientific certainty, but realistic simplicity.

Several of the criteria of success considered include: a significant number of annual case starts (more than 300); an upward pattern of increasing case starts, both in good and less optimal economic times; optimal patient care; a stress-free practice environment; and, few, if any adverse incidents, such as negative patient and/or professional comments, requests for records to be transferred to other local orthodontists or malpractice claims.

One very important aspect was a general evaluation by the orthodontist and staff that the practice was a great place to work and that they looked forward to each day. Interestingly, on a consistent basis, the practices and/or the orthodontists who have not had the level of success that they desire are missing at least several of these attributes.

The most successful orthodontic practices and their orthodontists are from different geographical and socioeconomic locations. Also, these orthodontists were trained at almost every residency program in the country, and had widely diverse undergraduate educational experiences and formative backgrounds. This information is offered for the purpose of giving a glimpse into the factors that are empirically correlated with success in orthodontic practice, especially since so many practices are experiencing difficulty during these challenging economic times, while a small group of orthodontists are continuing to thrive and grow.

The Characteristics

1. Successful Orthodontists Have Humility.
Each of the most successful practices, without exception, have both orthodontist(s) and staff who demonstrate a complete lack of self-importance or arrogance. They are humble and modest in demeanor and presentation. They work hard at making their patients feel that each are the most important person at all times. Their attention is focused solely on each patient when they are with them. No interruptions for telephone calls, unless a true, rare emergency. No discussions about personal matters of the orthodontist or staff member. This was also the case when dealing with parents or guardians.

This undistracted, single-minded patient focus permits optimal patient care and reinforces the notion that the service performed at each visit was very important and that the patient's cooperation in this most important endeavor was a critical aspect of successful care. As a result, patient cooperation is significantly higher with less appliance breakage and more compliance with auxiliary treatment aspects.

At this time, there were no practices with lavish furnishings, expensive artwork or other trappings of opulence. Rather, the practices were clean and neat, well-maintained, stylish yet functional, and most importantly, focused on the needs of the patients and parents with games, computers, quiet study areas and easy-access restrooms. Additionally, an important theme was on-time appointments that demonstrated respect for the patients and parents and their time. In the rare instance when a delay was unavoidable, a full and complete explanation and apology was promptly given and if needed some accommodation was offered.

2. Successful Orthodontists are Strategic.
The most successful orthodontic practices and their orthodontists have a deep-seated vision. They have fully formalized and articulated their dreams and desires for their practice, as well as their personal and financial lives.

These orthodontists don't just show up at their offices each day ready to treat patients and assume that the patient flow and referrals will continue to appear forever. Rather, they are like championship chess players, always thinking multiple moves in advance. They stress test their ideas, potential decisions and proposed strategies via risk management, considering all of the various permutations and combinations that might have an effect on their strategy.

These highly successful orthodontists are constantly receiving feedback in a 360-degree fashion and monitoring their practice, personal and financial environments for potential opportunities and potential problems or concerns. They have systems in place that permit them to do so with very little effort and they have advisors and consultants with whom to discuss any issue in real-time and without delay. Their working premise is that the time to look for expert advice is not when the problem arises, but long before.

The successful orthodontist and his or her advisors develop a long-term strategic plan, often extending out more than 20 years but with intermediate milestones at three, five, 10 and 15 years. Each milestone has multiple components upon which the ultimate goals are built. This long-term plan is periodically reviewed and modified as needed to ensure the success of the overall mission. All aspects of the successful orthodontist's professional, personal and financial life are included since they are intimately intertwined and to overlook one or give it less than equal status in the long-term strategic plan could lead to not achieving all the goals desired.

For example, regarding the professional practice of the most successful orthodontist, the review prior to creating the strategic plan includes all systems, all interpersonal relationships (staff, referrers, patients, parents, other treating health-care practitioners, etc.), internal and external image, branding, marketing and advertising, correspondence, surveying, retention and so many more. These aspects integrate into what becomes a smoothly functioning, stress-free environment that continues to grow without regard to economic or societal changes that might occur.

Of utmost importance, the most successful orthodontists do not merely accept the notion that "since we have done it this way in the past and it has worked, we can do it the same way now." Rather they are continually asking how can the systems communications, processes, etc. be improved… how can they be made better.

3. Successful Orthodontists are Risk Managers.
It is important to understand that risk management is not about not taking risks. To the contrary, risk management is about achieving your goals while understanding your environment from the inside out, including having considered in great depth the potential benefits and hazards that lie in the path of achieving those goals. To use the sports metaphor stated by writer Fred Wilcox, "progress always involves (taking) risks. You can't steal second base and keep your foot on first." That pretty much sums it up.

On the other side, the majority of orthodontists are risk averse. That is fine but ironically it might entail more risk since the failure to adapt could lead to extinction, or a low- or no-growth practice. This is not to infer that in order to be very successful, orthodontists need to leap into whatever new comes along. It does mean being open to new ideas, ways of doing things and technology. It also means being willing to take a risk after careful analysis suggests that course is optimal.

One of the most significant traits noted among successful orthodontists with regard to taking well-considered risks is that they have overcome their fear of failure as well as their fear of success. Either or both of these fears have prevented orthodontists from moving at all and taking the first necessary steps toward becoming successful. But, as mentioned, taking no action might be the biggest risk of all. It is often difficult to do so alone, especially while trying to cope with a busy, less-than-optimized orthodontic practice. That's why the most successful orthodontists work in close association with their consultant and advisors.

4. Successful Orthodontists are Socially Networked.
In the not too distant past, it was possible to have a highly successful orthodontic practice with several good referring dentists and a reasonably active patient/parent referral system. However, with competition increased, especially with multiple office practices, and the changing dynamics of referrals, which includes many general dentists practicing some orthodontics, it doesn't appear to be possible any longer.

Orthodontists must be on the forefront of social networking in all aspects of social media. Note: In a prior column, social media was discussed including the potential downside and what one might do should negative comments become viral. However, because networking has become such an important component of the overall practice marketing/advertising program, orthodontists are encouraged to carefully prepare a strategic and tactical social networking plan that includes regular updates and responses to keep interest and focus on the practice, the staff, the orthodontist(s) and the patients.

Many orthodontists are uncomfortable with this relatively new aspect that is needed for the highest levels of success. Several have inquired as to how they should work this into their practices, especially when they feel some discomfort about the prospect. It is suggested that they consider working with one of several excellent social media consultants who would establish and manage the various modalities and add new ones as they become available.

Because of the potential problems associated with using staff members to supervise this most important endeavor, it is also suggested that the orthodontist be the contact person working with the consultant. Notwithstanding the dedication, longevity and experience of any given staff member, be advised that for this type of program, outsourcing might be just what the doctor ordered.

Even though it goes without saying, I will say it anyway – redoubling your efforts with referring dentists, especially with the Encounter-Based Risk Management correspondence system, implementing and revitalizing an active and professional patient referral system, community involvement integrated with the social media/networking program should be key components in the strategic and tactical marketing/advertising plans.

5. Successful Orthodontists are Planners and are Well-prepared.
From the very beginning of dental school through orthodontic residency, careful diagnosis and treatment planning were the hallmarks of the highly successful orthodontic practitioners. It's the same for any actions, whether related to patient treatment, business or investments. While preparation and proper planning are not everything, they are almost everything. It certainly doesn't hurt to have some good fortune and good timing along the way. Bear Bryant, the famous football coach from Alabama stated: "It's not the will to win, but the will to prepare to win that makes the difference."

The successful orthodontist takes that extra measure, regularly holds training sessions for staff, reviews the office systems and protocols over and over again and spends the extra time to reposition that bracket when it's probably "good enough." The successful orthodontist takes the extra time (even when very busy with the after-school rush) to speak with a concerned parent, makes the time to call the patient after a long procedure, critically reviews the literature and updates the office treatment systems and technology.

Planning and preparation are an ongoing and continually rolling series of events. By rolling it is meant that these reviews and plans occur monthly, quarterly, semi-annually, annually, every two, three, five, 10 years or more. The process just continues ad infinitum. Also, successful orthodontists are never satisfied with any measure of success that they achieve. They realize that success is a relative and fleeting notion. Tomorrow new orthodontists might move into the community. They understand that similarly their best referring dentists might begin to incorporate orthodontics into their own practices or that they might begin to refer to one or more orthodontic practices. Nothing is taken for granted by these highly successful practitioners.

6. Successful Orthodontists Plan and Execute.
It is not uncommon to receive an e-mail or call from an orthodontist who states that he or she waited a little too long before implementing an excellent idea for marketing their practice only to learn that someone else has just done so. They feel awful and somewhat angry with themselves for procrastinating and for missing an opportunity that could have made a significant difference.

Whether it is too late to still incorporate the idea depends on many aspects. But, no matter if it is, the main takeaway is that so many of us have great ideas that have the potential to make big differences but we just don't act. Years ago, Andrew Carnegie stated: "The first man gets the oyster, the second man gets the shell."

This is true both in our orthodontic practices and in our personal lives. A perfect example is the stock market. How many times have you thought that you should either buy or sell only to not do so and later regret not acting? Another old saying is: "Plan your work, and work your plan." The old sayings are often very true.

Many of us develop excellent plans, even set time schedules but begin to either second guess or list the reasons that something won't work and then become afraid to commit the time and effort or become concerned about embarrassment if the effort should fail. So what? Look at legions of really successful men and women who failed so many times before their shining moment. They took action on their plans.

There will never be a perfect time, or the perfect circumstances or the perfect people, etc. The famous writer Mark Twain wrote: "Twenty years from now, you will be more disappointed by the things you didn't do than by the ones you did…"

As a final note on this aspect, one comment offered to orthodontist clients is in the nature of economic encouragement. It is suggested that they evaluate the impact on their practice from adding five, 10, 20, 40 or more new patients per year. It is suggested that the orthodontist consider both annual and long-term value especially sale value. Taking action will make a huge difference. It is like the farmer planting a crop, it takes time but nothing will happen if no seeds are planted.

7. Successful Orthodontists are Perseverant.
As was mentioned above, the most successful orthodontists take action. They take a lot of action. Many of their actions might not prove to be successful but the successful orthodontist is never discouraged even in the face of a failed plan. They try and they persevere. Beverly Sills aptly stated: "You may be disappointed if you fail, but you are doomed if you don't try."

Few, if any, are naturals at creating a successful practice. It takes a lot of analysis, planning, practice and execution. Vince Lombardi, the famous and highly successful football coach of the great Green Bay Packers football organization was known to practice blocking and tackling over and over again until these seemingly elementary football skills were deeply ingrained into his players. His belief was that since the vast majority of plays involved these basic skill sets, executing them flawlessly would make all the difference. As it turns out, he was right. It is no different with the most successful orthodontists.

Highly successful orthodontists achieve a sustainable competitive advantage by persevering in each of the areas mentioned in this article.
Author’s Bio
Donald E. Machen, DMD, MSD, MD, JD, MBA, CFA, is the recognized authority on risk management in orthodontic practice having initiated the discipline in the mid-1980s. He developed, moderated and presented at the AAO's first national risk management telecast to more than 2,600 orthodontists. He has represented orthodontists, dental specialists, general dentists and physicians in malpractice lawsuits and other legal matters as a trial lawyer and currently is a trial court judge in Pennsylvania, having served for more than 14 years. He is a board certified orthodontist maintaining a part-time practice and is on the orthodontic faculty of Case Western University Dental School and The University of Pittsburgh School of Dental Medicine. He is also an adjunct professor of Law at Duquesne University School of Law where he teaches malpractice litigation. Dr. Machen was the editor of the Legal Aspects of Orthodontic Practice column in the AJO, writing a monthly column and has authored columns in JCO and Ortho Tribune. He lectures extensively to orthodontic groups, both large and small, focusing on developing highly effective systems for eliminating lawsuits, optimizing patient care and increasing practice referrals. Dr. Machen is the author of Managing Risk in Orthodontic Practice and is managing director of Risk Management Consultants, LLC. He can be contacted at: drmachen@orthormc.com.
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October 2025
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