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First, I want to tell the doctors who read my newsletter how overwhelmed I was by the positive comments I received as a result of my “Passé” article from last week.  Within three days of the newsletter being sent, I had already received more comments than all I have received over the last few years of newsletters.  I am profoundly grateful to my clients and especially grateful to the many non-clients who took the time to write incredibly supportive emails to me.  Clearly there are many orthodontists who believe in the fee for service, non-managed care, non-advertising, non-discount model of the orthodontic practice.  It is true that this model of orthodontics is alive, well, and thriving, even as many of the young doctors go directly into the corporate world and others fall under the spell of those who promote the managed care and discounted dentistry model.

Our 7-10 year forecast for the profession is that there will be far more corporate orthodontic practices, triple or more than exist today, even as the less well managed corporates will continue to fail.  As physicians who went into corporate medicine 10 years ago are learning today, when the corporate practices need increased profitability for the investors, doctors get laid off, “production” quotas increase, and quality of life in some cases disappears entirely.

In 7-10 years there will be fewer pure fee for service orthodontists simply because of the number of orthodontists choosing the corporate path.  However those practices will thrive and prosper at a level far greater than today!  As I have written before, there is a very large percentage of parents and patients out there who will never set foot in a retail advertising corporate or corporate style orthodontic practice, and the future of the fee for services model is entirely secure.  The corporate practices will thrive as well because there is now and will always be a strong market for whatever is quickest and the cheapest.

We believe that the orthodontists, corporate or not, that choose to focus on Managed Care/PPO plans as a significant source of their new patients are going to suffer.  The ACA (ObamaCare), having essentially excluded orthodontics from coverage and included children’s dental care as an essential health benefit, has caused many parents to choose Exchange based ACA type policies that do not cover orthodontics and many employers are choosing those same policies, many and perhaps most of which are or will become medical PPO policies, for their employees.

The choice is simply to choose what model you want to have.  Choice #1 is to enjoy an excellent net income by seeing vast quantities of discount fee patients.  Choice #2 is to net the same, but with high quality patients in a high quality non-discount environment.  Both choices will likely provide equivalent financial security so new doctors should choose the model that fits their picture of quality of life.

Again, I am most grateful and encouraged for the support I have received in recent days.  I have included a few of the abbreviated comments I have just received.

“Bravo!  You nailed it.  The “hip” doctors are already blasting the article online.  But what I’ve noticed is that the one’s criticizing the article the loudest are the proverbial hamsters on the hamster wheel.  Under the guise of “access to care” (for elective orthodontic treatment, I might add), they advise younger graduates to sign up for every discounted plan and PPO that exists.  Truth be told, it’s not access that they’re most interested in; it’s ego, fame, and money.  Unfortunately, many of the more gullible, naive doctors, infatuated by the allure of a seemingly gazillion-dollar practice, bite on the advice like trout to live shrimp.”

“After more than 30 years in practice, and 13 years as your client, I can still say that hiring Zuelke and Associates was, and still is, the best business decision I have ever made.  Hands down!  No other consultant has even come close.  When a process works it can usually stand up to the test of time and your system is no exception.”

“I am proud to be on your side of the conversation.  I suspect that consultant who made the passé comment also supports sub-prime mortgages and Colin Kaepernick’s right to sit on his ass.”

“LOVED IT, esp. the bit about the Southern doctor.”

“Thank you, Paul. I and many others appreciate the path that you have always recommended. Keep up the great work.”

“I loved the newsletter!  The Zuelke system has worked in our $195k per month, single doctor practice for 16+ years.  Your smart clients are shaking their heads, and not going anywhere…they know better.”  

“Outstanding !  Really enjoyed that incredibly well written letter!”

To demonstrate that some good orthodontists have an opposite point of view, a few doctors sent me the following.  It was just posted to Facebook by Dr. Neal Kravitz.

“To All Young Orthodontists,
In a recent newsletter by our profession’s most recognized financial advisor, he advocated orthodontists to not accept PPOs or HMOs, and not accept minimum down payments.  This is terrible advice.   Remember, be generous, be affordable, be understanding of your patient’s life expenses that are often far more important than braces.  Participate with all insurances, so if your patient changes plans, or if their employer changes plans, you can simply pick up their next insurance at no out of pocket expense to the patient.  Do not focus on money. Focus on people, kindness, empathy, and the quality of your work. Your patients will forever appreciate that you went the extra mile to make their treatment easy and affordable for them.  As orthodontists, we shouldn’t look for advice from “financial” advisors. Establishing sound core values such as integrity and kindness and empathy are much more important.”

I underlined part of what Dr. Kravitz wrote because it is a gross misrepresentation of what we teach.  Dr. Kravitz, once again, we teach our clients to be financially liberal and flexible, including $0 down payment and long term payment plans when necessary, with the 75% to 80% of patients/parents who are mature and stable people with a history of paying their bills on time.  We also recommend to our clients to require down payments and payment plans proportional to the risk for the remaining 20%-25%.  You may not subscribe to such “radical” thinking, and that is your prerogative.  However if you are going to refer to me or to what I teach, please try to be accurate!

— Paul Zuelke

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