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First a definition of “mature.”  Solely for the purpose of this article, I am defining mature as meaning a practice owned and operated by doctors in their 60’s or older.  In today’s world that also, of course, includes quite a few practices run by doctors in their 70’s and even a few that I know of in their 80’s.

As with almost all of my articles, I am writing this as a result of observing some of the statistics from these mature practices, statistics that were changing in an unhealthy way.  Consider the following situation which describes a rough approximation of what I am seeing all too often among these practices.  See if you can tell me what is happening.

I am on a routine statistical review call with a client, an orthodontist in his late sixties who has been in practice for just over 40 years.  His new patient flow is stable – not growing but not declining either.  He practices in an upper middle class suburb of a city with a population of about 1.2M.  He has a skilled and loyal team working with him in a modern and beautifully designed and decorated office.  In the past 4-5 years or so he has lost a couple of professional referral sources, but has gained some others.  That’s a tiny hint!  During that same period his Production Per Patient (gross production divided by the number of first-time case starts) has risen sharply and by a much greater amount than his fee increases could have generated.  That’s a more significant hint!  His rate of case acceptance during the period has declined from a well above average 73% to a slightly above average 64%, causing a substantial decline in production and income, even with that increase in production per patient.  A huge hint!!

So, without reading ahead, what’s going on here??

Initially, I thought that perhaps he had become conservative in his diagnoses of the younger kids and instead of recommending Phase I or other forms of early treatment he may have instead been putting the same kids into recall who he would have put into early treatment 5 years ago.  Since case acceptance rates on early treatment cases tend to be 85% and better, yet typically have fees that are well below a full case fee, a decline in such cases would result in an instant decline in case acceptance as well as the increase in the production per patient (fewer low fee cases cause a temporary increase in production per patient!) I was seeing.  Both he and his team insisted that while doctor’s diagnostic style had not changed, they had in fact noticed a decline in early treatment age new patients.

Hmmm, total new patient exam count is the same, but less early treatment aged kids.  No consulting skills needed!  They had to have seen an increase in teens or an increase in adults!  Just then, the Treatment Coordinator, who has been feeling a lot of pressure about this decline in case acceptance says, “Dentists who used to send us lots of kids are mostly still referring to us but are sending adults instead of kids.  We also had a pediatric dentist who sent us lots of kids in the past but now sends all of his patients to Dr. X.  We also see more and more TMJ patients and we don’t like them!”

By now you all know what has happened in this office but you need to know the rest of the story.  This doctor had made up a story in his mind that once he turned 65 he would “naturally” start to lose young kids as new patients.  He enjoyed practicing orthodontics and had no desire to quit anytime soon and he wanted to maintain his practice size.  He had been hearing, from every direction, of the need for good marketing to build a practice so he had the brilliant idea that he would visit each of his referral sources and solicit them for TMJ and other adult patients who could replace the adolescents he was convinced he was destined to lose.  He even spoke with these doctors about the “natural transition” that happens as an orthodontist grows older!

By his actions and by his “speaking” this doctor hastened the demise of his practice and simultaneously made his practice extremely unattractive to a potential buyer.  After all, what young doctor would be interested in purchasing a practice with declining kids, increasing adults, and lousy case acceptance?

It is possible, I suppose, that the “natural transition” that this doctor spoke of could exist.  However, over my now 34+ years as a consultant I have seen far too many orthodontists in their late 60’s and early 70’s, whose active and vibrant practices are filled with kids, to believe that such a transition is inevitable and besides, ending your years as an active orthodontist treating adults and TMJ patients doesn’t sound like much fun at all!

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