I'm an Orthodontist-not a Car Salesman

When I went through dental school and residency the focus was on the treatment of your patients to the best of your abilities. We received very little in the way of business courses or the running of an orthodontic office. Our professors told us that if you were warm and caring to your patients and treated them well, the money side of things would take care of itself.

Obviously they had no idea that the economy would look like it does now and that the idea of payment for services rendered would fall to the wayside for many people. While I don’t want to get into the debate that everyone in the world is entitled to health care, I will affirm that providers do need to be reimbursed for their services. While we are health care professionals, we are also business owners. Our hard work and talents provide income for employees, dental suppliers and their reps, utilities, insurance companies, office suppliers and a myriad of other people that are support services. If I don’t get paid, they don’t get paid.

It amazes me how the mindset has changed in the years that I have been in practice. I have seen a progression in the number of patients that feel that they must bargain with you over your fees. They will go to three or four orthodontists to compare fees and then try to convince you to charge whatever is the lowest fee. They are not comparing treatment modalities, your reputation and knowledge, professionalism of the staff, or office appearance; they are comparing fees.

Just yesterday I had a woman come in with her daughter for a consult. I had treated both the woman and her older son with great results, had an excellent relationship and we even went to the same church. They are financially very comfortable and send their children to a private school where the tuition is higher than a lot of colleges. After we had done the exam and I had left the room, my treatment coordinator went over financials, took 10 percent off as a family courtesy and was told that they had seen another orthodontist who quoted them $225 less. That is the price that she felt she should have to pay. She was told that we felt our fee was a fair one and that was the price. They left without scheduling an appointment. They are going to travel an extra twenty miles to a practitioner that they have no experience with for the sake of $225.

Maybe you can argue her side, but I think that is insane. I also felt quite betrayed......

Invisalign-Care for Patients or Profits??

I recently received an email from Align Technology letting me know that they now have proficiency requirements for the use of their appliance. Align Technology are the makers of Invisalign. I am sure you have seen their commercials on television and how they are the clear alternative to braces. Wear their clear retainers; change them once every two weeks and soon you will have a wonderful looking smile without having to wear unsightly braces. As an orthodontist, I wish it was that simple and worked that well. I would imagine that Align wishes it worked that well too. If it did, they would be inundated with cases from orthodontists rather than having to peddle their product to general dentists with little or no training in orthodontics (oops, I forgot that they get certified in a special one day course! Heavy training, huh?) or run TV ads targeted to the uneducated public.

Sorry, I digress. Back to the initial “proficiency requirements” email. It seems that Align has created a monster in “certifying” more than “40,000 Invisalign-trained doctors in North America” and now they want to make sure that visitors to their web site are referred to doctors with enough product knowledge and experience to treat them correctly. I guess the one day certification course did not do that. Now they are requiring a doctor to complete at least 10 cases by the end of the year or their special Invisalign provider designation will be lost and they will not be able to use the product. (Darn, I’m not going to be able to use a product that I viewed as inferior when compared to traditional braces. AJO-DO Volume 127, Issue 2, Pages 268-269 (February 2005).

I have a problem with a company deciding if I am qualified enough to use their orthodontic product. That is a responsibility of a state or federal licensing bureau, dental board or state certification board or the ABO. This is not the responsibility of a company that has given “certifications” to under-qualified individuals in order to boost its bottom line.

On the surface, I would applaud the effort of a company to make sure that its users are competent and educated in the use of their appliance. But that cynical part of me keeps looking toward the bottom line part of the equation. It seems that by making it mandatory that doctors do at least ten cases by the end of the year, they are boosting their profits quite a bit in the wake of a very slow economy. It will be interesting to see how this plays out.

A Giant Has Been Lost.

Word has been received that Dr. Anthony A. Gianelly passed away on May 28, 2009 (http://www.neso.org/). If you are an orthodontist you know how much this man meant to the orthodontic community. If you are a patient, please read his obituary. This man was a giant in his field and a wonderful, caring human being.

My only regret in knowing Dr. Gianelly is that I did not train under him. He was absolutely brilliant with an incredible command of the orthodontic literature. His common sense, realistic approach to orthodontic treatment and his honest assessments of what worked and didn't made going to his lectures an absolute enjoyment and enlightening educational experience. I patterned so much of my orthodontic treatment after his teachings.
My personal experience with Dr. Gianelly was limited seeing him briefly at meetings and saying hello or asking a question after one of his lectures. I did have the opportunity to bring him to our state meeting to lecture our group and found him to be so unpretentious and friendly (unlike some of the prima donna lecturers that I have dealt with) that there was an immediate desire to do whatever it took to make his stay with us a great one. From the email I received from him later I like to think he was being more than just gracious in his thanks. He was that type of man.

Dr. Gianelly is gone but I assure you that this orthodontist will never forget him and will keep his memory alive through the smiles that he has helped me create.

Self-ligating vs Ligating Revisited

To be brief and concise, coming from the AAO meeting in which I listened to a number of lectures and networked with my fellow orthodontists, the evidence and literature are pointing to the fact that there is no significant difference in treatment time, comfort, quality of treatment or any other parameter between self-ligated and ligated brackets. In the words of one lecturer, "...the answer is in the wire, not the bracket".
I will editorialize at this point. Some orthodontic manufacturers are now targeting the patient, rather than the clinician, in order to sell their products. This is similar to the drug companies and their heavy TV commercials targeting the consumer with a vast array of pharmaceuticals. My comment on this is "let the buyer beware and be aware".