Where have all of the Family Orthodontists
gone?
If you are a parent of pre-teens or teens you may have
noticed its getting tougher to locate a single doctor Orthodontic Office these
days in larger urban locations. Even in
the suburbs there seems to be a trend toward corporate dentistry as companies
seek to place satellite offices in strip centers of every Randall’s Grocery
store or HEB on the block. In fact,
there are more corporate offices employing dentists and dental specialists due
to high student debt, inability to finance new offices and over-burden from the
fatigue of running a business (staffing, taxes, billing, insurance, HIPPA,
OSHA, etc., etc.). Companies used to
pulling in 10% to 15% annual return on their investment see this as a perfect
opportunity to profit from dentists and Orthodontists who don’t want to run
their own practice or don’t want long-term ownership/anchorage to a
practice. In other words you have a new
population of employee dentists and Orthodontists that drift around and compete
against the old-fashioned family dentist your parents used to know and appreciate.
Is this bad? Can companies
reduce overhead and simplify life for the practitioner? Absolutely. Does this always help the patient? Certainly it
can but in reality this model inserts a new middleman that must be paid to
manage the office. Also, the doctor will
no longer have the same feeling of ownership with patients; if he or she is
using the company to just practice as an employee without responsibility or
effort then it is a problem for the patients. If you are fortunate and your doctor has
chosen to work with a company to manage the practice so they can focus on the
patients (without interference from cost-cutting management, etc.) then you can
receive good care.
“companies reduce overhead and
simplify life for the practitioner ... but
in reality this model inserts a new middleman that must be paid to manage the
office.”
So how can you tell if you are getting the best
treatment and service; what should you expect?
First, you should
be well informed of any treatment BEFORE any fees and BEFORE any
procedure. In the case of children, you
must give consent for the treatment at the beginning and be asked for
permission to do anything that changes during the course of treatment.
“you should be well informed of
any treatment BEFORE any fees and BEFORE any procedure.”
Second, you
should expect to speak with the Orthodontist anytime you have a question. Privacy laws and efficiency generally lead
Orthodontists to have parents wait in the waiting room during adjustments however
they should be available for questions after the appointment at your request
(and if they are with another patient, the assistant should be giving you an
update as the front office schedules your next visit.
“expect to speak with the
Orthodontist anytime you have a question.”
Third, and probably
most important, the Orthodontist should see the patient EVERY visit. You are paying for very specialized
knowledge, experience and skill.
Assistants are great auxiliaries and a good doctor will have
exceptionally trained assistants but they are no substitute for the experience
and skill of the doctor. You should be
asking questions if the doctor is not seeing you or your child during treatment
adjustments or if the assistant is bending the wires.
“the Orthodontist should see the
patient EVERY visit.”
Fourth, you
should have an estimate for treatment completion and you should know when
treatment is being delayed by poor compliance or poor oral hygiene.
“have an estimate for treatment
completion and you should know when treatment is being delayed by poor
compliance.”
Other things to look for are after hour care/availability,
payment options without interest, cheerful staff that recognize you and your
family and you should see positive results in your child’s or your smile as
treatment progresses. The doctor should
help keep your expectations realistic so that if there is an issue that arises,
there is a reason not just an excuse after the fact. Look also for referrals from friends. Online reviews are helpful but can be a
breeding ground for abuse by disgruntled patients (many with balances or non-treatment
related issues); doctors cannot respond online to complaints so these can
certainly not reflect an office if it is a single or infrequent complaint. Friends and neighbors are a much better
source.
To summarize, you should expect to feel comfortable and
confident in the doctor you choose. If
this is a company office, you should still have this relationship with your
doctor; the company should be thought of as a management group only there to
assist you and the doctor with the non-dental needs.
When should you look for another opinion
or office?
What you should avoid:
Multiple doctor offices that have a different doctor seeing you or your child
at every visit. Avoid offices where the
doctor isn’t chairside at every visit or allows his/her assistants to bend
wires (and therefore dictate treatment).
Avoid offices that don’t give access to the doctor when you ask (you may
have to wait a few minutes but they should come to answer questions as they get
free). Avoid offices where they have new
doctors altogether every 6 to 12mo; orthodontic treatment is an art and very
difficult to control and finish accurately when there are multiple doctors
throughout treatment. Avoid offices that
push less accurate treatment because it is “more esthetic” or “less noticeable”;
in particular avoid all-Invisalign offices, especially for kids with poor compliance
on average due to loss of trays and lack of wear time. Aligner trays have been shown to be only 18%
to 47% accurate in moving teeth (j.ajodo.2007.05.018;
ajodo.org) and adolescent teeth/jaws
are still growing; they are ill-suited for adolescent and teen corrections for
these reasons alone. Also, these aligner
offices generally involve a doctor of group of doctors running 3 to 5 (or more)
locations, they are normally understaffed and tend to treat every patient the
same in spite of their unique malocclusions.
Many are no better than an online or mail-order treatment.
“Aligner trays have been shown to
be 18% to 47% as accurate as braces and adolescent teeth/jaws are still growing”
Are all company-run dental offices bad or lower
quality?
There are practices
run by quality companies that realize they must maintain quality to
maintain their pool of patients and prospective patients. They are usually companies that only join
specialist practices and they work closely not to change the patient-doctor
relationships on the front end but use their size to negotiate supplies and reduce
expenses to streamline treatments without costing the patient more or taking
too much from the doctor(s). They also have good business experience that many
of us doctors simply do not learn on our own.
A good company-doctor relationship can benefit all parties but both you
as the patient and the doctor must receive good service and fair compensation for
a lasting relationship and successful treatment.
“A good company-doctor
relationship can benefit all parties but both you as the patient and the doctor
must receive good service and fair compensation for a lasting relationship and
successful treatment.”
Above all else remember that you are paying for excellence
and experience, for compassion and skill.
There is absolutely no reason to settle for anything less in today’s
medical environment as long as you are willing to look around a little for the
right fit!
If you have questions or comments concerning this or any
orthodontic question, please feel free to make a complimentary new-patient
appointment at either my Steiner Ranch location or my North-central Austin
location on West 35th street and MoPac.
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