Many years ago, back in the golden age, orthodontists enjoyed a legalized monopoly. (Some say we still do.) All you needed was a state-mandated education to get a state-issued license and practice in an area with a relative shortage of providers. But, with Smile Direct Club and other disruptors getting in our faces—and, more importantly, our wallets—life is not so simple anymore.
At one point, we enjoyed the respect of most everyone. Our profession was easily in the top 10 earning and regarded vocations in countless polls published in national magazines. All the parents of children who played sports and danced with mine wanted their kids to become orthodontists. (I know it was only because I showed up on time for practice and was rarely called away because of a beeper going off during an event or big game.) How did we get to that vaunted position?
I'll be the first to admit that one of the first hires an orthodontic practice makes—or if it doesn't, it should be—is in sales and marketing. Just like a Supreme Court justice (the most celebrated profession when I was in middle school), being recognized as a respected professional requires a certain type of behavior.
What behavior allowed for a profession or trade to become respected or placed above others? Integrity comes to mind—integrity being defined as the quality of being honest and having strong moral principles; moral uprightness.
Are we practicing like this today? Just as I railed against being a product pusher rather than a principled provider in a previous column, certain things come to mind, like second opinions and transfer patients, that can strengthen our position in our communities and in the eyes of our patients.
Look at orthodontists' websites, including my own, and you'll see that the view of transfer and second-opinion patients has changed. After all, we are in the business of treating patients. I cast a big net for all patients and have a small referral base that reaches across virtually all income and educational levels. I don't wish to steal or poach from others, but I truly enjoy fixing as many crooked teeth as possible for the challenge and mental and financial reward.
So, how can we adjust to the new normal of welcoming transfer cases and second opinions? How do we avoid saying things that may stir the pot or, worse yet, lead to litigation or complaints?
Some concerns include:
- Big down payments required for transfer patients to continue care.
Patients saying the wrong braces were applied by the previous orthodontist.
Poor bracket placement by the previous doctor.
The wrong treatment plan was adopted.
Time estimate is way off.
Fortunately, typical patients don't care or want to know about most of those issues. What they want is to be respected, managed well, treated fairly and move on for a reasonable fee. If you feel like it's tough to take on a transfer patient, put yourself in the patient's position!
My attitude has been to just suck it up and, hopefully, start the next kid in the family! I've always tried to avoid a negative presentation. Whenever possible I try to compliment the previous orthodontist, validate his or her treatment and put the best spin on the situation. Complimenting the patient goes a long way as well, whether it be on tooth brushing, elastic wear or handling the transfer.
On the flip side, when I know my patients are transferring out, I remind them to brush their teeth well. It's amazing how this little task can totally influence the transfer patient exam.
It's also important to remember that these patients selected the previous orthodontist, so they think he or she is the greatest. Who are you to try to alter that opinion?
Some might worry about malpractice. Malpractice involves damages, and unless you are confident that the patient has been damaged, the chances of you being involved in a case are quite small. A differing method or variation in a treatment plan is hardly reason to claim malpractice. Covering your bases with time leaves the door open for possible tooth removals and bracket changing.
What about second opinions? I've voiced my thoughts on those in previous columns as well. Namely, assume every patient is getting one or that you are the one. Have scripts prepared for your area that take the competition's educational background and appliances into account. Try to address each one of those issues in your exam and explain to the family why you believe in what you are proposing.
When parents are in attendance, I almost always start my discussion with, "As it says in my practice brochure, orthodontics is, for the most part, an elective procedure." This sends the elephant out of the room and allows you to speak to what the concern is or what you feel is most important. You won't find yourself pitching or selling orthodontic care. Rather, you will offer up all the benefits of care and assure the parents that if treatment is not in their plans right now, they are still loving and caring parents.
The benefits of being careful, considerate and thoughtful are innumerous. Consider one of my recent patients, whom I wrote about in a column several months ago. This 60-something-year-old male felt ripped off after two years of going nowhere with aligner therapy for a cross-bite, narrow smile and an entire arch of worn restorations.
After I proposed widening of the arch and a full reconstruction by my dentist, who's a member of the American Academy of Cosmetic Dentistry, the patient left disappointed and somewhat angry at his previous dentist. I recently bumped into him at a Starbucks, where he grinned with his new, porcelain, narrow smile and offered to buy me a cup of coffee. I ordered a venti.
"How do you like them? They are A-1!" he proudly proclaimed. "Great," I said.
Some patients will never learn or listen. On to the next one!