I received a call a few days ago from a long time Zuelke & Associates client.  She told me something I have heard 5-6 times in the past year, but that I had never heard even once prior to this past year (and Zuelke & Associates has been consulting with orthodontists for 35+ years!).  This doctor was in the process of hiring a scheduling consultant who apparently had made promises to my client to help with case acceptance and credit and collections as well.  When she told this consultant that she was a Zuelke client and needed no help with financial arrangements, credit and collections, etc., the consultant said that their firm’s ideas were new and modern and “Zuelke’s ideas are dated and passé.”

As I mentioned, I have heard this caca from other consultants, as well as a certain Southern doctor who considers himself to be some sort of guru, but when this comes up I ask my clients to consider the source, to consider the credentials, and to consider the agenda of the person(s) making the “passé” assertion about what we teach.  What is their motive?  Do they gain something by telling prospective clients that what we teach is somehow flawed, behind the times, old?  Does even one of them have formal training and/or experience in the credit management field?

So, in a nutshell, here is what we teach:

Mature, stable people who have integrity and pay their bills make the best patients.  We call these “A” patients and they make up 75%-80% of the population.  These patients/parents tend to have a better dental “IQ” and they say “Yes” to treatment more often.  They are more likely to be clinically cooperative and they are much less likely to no-show, reschedule, and cancel their appointments.  They make their orthodontic payments on time and when they do become delinquent they are cooperative and respond appropriately to your Financial Coordinator’s efforts to fix the delinquency problem.  Most important, the vast majority of new patients referred by existing patients come from those “A” patients and even the youngest doctor or Treatment Coordinator has learned that the very best rates of case acceptance come from patients referred from patients!

Some people are in an unstable (age, residential, marital, or employment) situation or are among those who have a significant and identifiable history of not honoring their financial obligations.  We call these “B” and “C” patients, and these are the patients who cause the vast majority of patient related problems in the orthodontic practice.

We want all of our clients’ patients to start, and we are very pragmatic, so we recognize that “A” patients, while being mature, stable, and with integrity, will not necessarily also be able to afford a big down payment, or any down payment.  They may also not be able to afford a large monthly payment.  So, being pragmatic and recognizing that “A” type people will pay as promised and will contribute greatly to the well-being of the practice, we are extremely liberal and flexible about our credit granting to 75%-80% of patients.  If they need $0 down, they can have $0 down.  If they need long term financing, even longer than treatment time in some cases, we not only allow that but recommend that.

Orthodontists know that 80%+ of all patient related problems (a patient who no-shows once is not a problem.  A patient who no-shows frequently is a big problem) come from a small percentage of their patients and the great majority of those are the “B” and “C” patients.  90% of all serious (60-day) delinquency is caused by “B” and “C” patients and delinquent patients do not refer!  Again, being pragmatic, we teach our clients that the high risk patients can be started and can be kept under good control in the practice with a combination of proper communication policies and verbal skills along with financial arrangements and delinquency control procedures that are proportional to the risk presented by the patient.

Finally, we teach that having a “bigger” practice at the expense of the quality of life within the practice is not a joyful experience and bigger is only better when excellent systems are in place that minimize problems and enhance the quality of the orthodontic experience for the patient, the staff, and the doctor.

That last item, to Zuelke & Associates clients, is paramount!  We teach not to sacrifice quality of life for a bigger practice.  We make no apology for that and we will compare the size of our orthodontic practices, the case acceptance rate of our clients, the net income percentage, and the quality of life within the practice (as measured by missed appointments, health of the recall system, instances of poor oral health, failure to cooperate, the percentage of patients over diagnosed treatment time, etc.), against the clients of any consultant or group in the USA.  We have clients that produce $500k a year and we have clients that produce well over $8M a year.  Our average, single doctor, practice produces and collects $2.1M a year, about $179k per month!  Most important, 98%+ of our clients are non-PPO, non-advertising, non-corporate, fee for service private practice orthodontists and they are located in every single one of our 50 United States.

So, please tell me how what we teach is in any way “passé?”  Granting credit proportional to risk has been done since the moneylenders lent money from the steps of the temple 2000 years ago, and is still done today by every single financial institution, bank, credit card company, and large retail store in the world!  Is this somehow a dated concept all of a sudden?  If, at any time in our 36+ year history I had made the decision to “get with the times,” Zuelke & Associates would have quickly ceased to exist because if you are going to teach credit management you have to teach what works for the overall well-being of the practice and you have to teach what works now and what will continue to work forever!  “Getting with the times,” in this context, means changing what works to something that does not work in order to go with the flow, to be with the “in crowd,” to get on stage more frequently, and to get more clients.  You can count Z&A and Paul D. Zuelke out of that stinkin’ thinkin’!

Unfortunately history has proven that there is plenty of room for the “get rich quick and fail” charlatans that have infected this profession for longer than I have been around.  There are persons who will say, do, and recommend anything in order to get a new client or to get on stage in front of potential clients.  They, for instance, will recommend that their clients sign up for all available PPO/ Managed Care plans because, they believe, volume somehow makes up for poor profitability and poor patient quality.  They recommend that you do retail type advertising, offer discount coupons, and use direct mail, and they either don’t know or don’t care that the quality of new patients coming from these sources is simply horrific.  They recommend things such as not identifying patient risk, allow $500, or less, down payments on all patients while allowing 30-36 month payment plans on 18-24 month treatment plans, etc., all without having the slightest idea of whether or not the patient/responsible party is a solid citizen who will contribute to the practice’s well-being, or a flake that will damage the practice’s well-being in so many ways.

So, is what we teach passé?  Well, if “passé” is to be defined as old-fashioned or maybe something that is just old and has been around a very long time, then yes, I would be quite proud to say that what I teach is passé.  That’s true because in my experience, techniques and recommendations that stick around for a long time, and granting credit according to risk has been around for a very long time, only stick around because those ideas, techniques, etc., continue to get the best results!

-Paul Zuelke