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A Voice in the Arena: David vs. Goliath by Dr. Chad Foster

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Categories: Practice Management, HR and Accounting;
A Voice in the Arena: David vs. Goliath   

by Chad Foster, DDS, MS, editorial director

My dad, David Foster, fought in the Vietnam War. One thing I always find interesting when I ask him about his experiences there is the high regard with which he speaks of the opposing side; I think the blessing of having years after and outside of the experience have gifted him that perspective.

On paper, American troops were by far the superior side in almost every measure. In spite of that, and with strategic acknowledgement and concession of those inadequacies, the Viet Cong chose to limit military engagement, as much as possible, to their own selective areas of relative strength. Completely outmatched, they very conscientiously and persistently fought the war on their terms and effectively mitigated the significant American advantage.

During my official presentation at this year’s AAO Annual Session, I will discuss my experience on both sides of corporate orthodontics—most notably my work history at 14 different offices over my first five years of practice before purchasing my current private office. The overarching theme of “David vs. Goliath: Success in a Single-Doctor, Single-Location Practice” is my strategy operating a very traditional (aka “outdated”) practice model in Phoenix, arguably the most mature and saturated corporate dental environment in the United States.

Fortunately, my competition with corporate orthodontics is not on the terms of the Vietnam War. It’s not a life-or-death scenario, or even a zero-sum game—I don’t believe that me “winning” in terms of my practice’s success requires the other side to lose. I seriously doubt any continued success in my single-location practice will leave a dent in the big picture of corporate orthodontics. Likewise, further growth of corporate orthodontics is not at all a death knell to my practice, even in the long term.

The paradigm I hope to share for the benefit of others in similar practice situations stems from two agreements. First, accept reality; don’t waste your energy in “impotent rage” or overinvested in areas of relative weakness. Second, carve your success from your areas of strength.

Take the emotion out of it
When a corporate group decides to jump into the orthodontic game, it is not a personal or vindictive decision. The intention is not to defile the specialty or to make private practice owners lose, but to make money. It’s a dispassionate business decision, and frankly, as a capitalist, I can respect that. They look at areas in which they have strategic advantages (most often related to their power of scale) and look to leverage those to outcompete the market.

I view my competition with them through the same lens. Rather than spending my energy in impotent rage wishing them away or debating philosophical rights and wrongs, I try to keep my thoughts equally as realistic and practical. In which areas of practice management am I obviously outmatched? In which areas am I at an advantage? After a cold appraisal and acceptance of the participants and the playing field, the strategy can be developed.

Orthodontics’ unique position in corporatized health care
My main area of strategy comes from one specific position. An innate burden—and, ultimately, weakness—of the corporate health care model is the inevitable “employee” doctor/provider turnover that is significantly more frequent than that in practices owned and operated by doctors. By way of its nature—one treatment, many appointments/ stages/decisions, an extended duration— orthodontics is unique among the myriad health care procedures managed by corporate ownership groups. Because of this, few health care procedures are as negatively impacted by doctor turnover as orthodontic treatment.

The following two statements are as powerful or inconvenient (depending on what side of the fence you are on) as they are true:
  • There is a significant benefit to the quality and consistency of orthodontic treatment when it is rendered by the same orthodontist from beginning to end.
  • Likewise, a turnover of the orthodontist during a given orthodontic treatment poses significant and practical challenges to the quality and consistency of that treatment.
While it is impressive to hear those with opposing views (often in corporate orthodontics) attempt the logical gymnastics required to diminish these self-evident and very inconvenient truths, anyone who has practiced extensively in both scenarios is not confused in regard to their validity. The challenge of employee orthodontist turnover and the resulting compromises in patient treatment are the glaring weaknesses of the corporate model—again, more consequential in orthodontics than in almost any other field in corporate health care.

A simple and powerful strategy
So, my advice to those in a doctor-owned, doctor-operated orthodontic practice surrounded by corporate growth is simple: If you aren’t already doing so, allocate effort, resources and messaging to that very important, accurate and easily defensible position I mentioned above. Without a doubt, that position will only become stronger and more self-evident in the future as corporate orthodontics grows and more consumers have more “experiences” in corporate health care in general. That position also immediately resonates with our patients more easily than any orthodontic jargon we would spend our efforts on in an attempt to differentiate ourselves.
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