Orthotown November 2023 - 8

A VOICE IN THE ARENA
CHAD FOSTER,
DDS, MS
Editorial Director
'Do Not Go to That Offi ce!'
O
ne of many fond memories of my residency
at the University of Southern California is
of the quality of people on the faculty. Residents
quickly came to realize how diff erent
the orthodontic instructors' treatment philosophies
were, from Tweed to Damon and everything
around and between. An important lesson
was learned: Th ere's plenty of room for healthy
disagreement between colleagues, but one should
be restrained when criticizing the work of a
colleague-especially when communicating with
a patient. It was a lesson well learned, and to this
day is one I still greatly respect.
I practice in Arizona, statistically one of (if not
the) corporate-dental epicenters in the United
States. I spent my fi rst fi ve years out of residency
bouncing around corporate/chain practices and
at each new offi ce, I was eff ectively obligated
to accept a huge number of transfer
patients already in treatment. I was
the recipient of all kinds of cases-
some were very well controlled
and the previous doctor
" behind the wheel " was
intentional with some
kind of plan. (Th at doesn't
mean I always agreed fully
with the plan, but at least someone
was behind the wheel.)
In others, there was no clear direction,
or treatment was puzzlingly long, with little
progress made in regard to the main issues.
Whether I was the second or fi fth orthodontist
taking over that case, my priority was just to
safely land the plane in a compromised but hopefully
acceptable destination-not likely the ideal
one. Th at was the best many patients could hope
for within the circumstances of that practice.
In Arizona, given the dominance of corporate
clinics, this is the reality for a huge number of
patients in orthodontic treatment.
I don't expect this statement to be met with
universal agreement, but I believe it's much more
diffi cult to control the quality of the outcome
when multiple orthodontists are involved
throughout the course of a single treatment.
(Th at's not to say it's not possible for two or three
very conscientious orthodontists to collaborate
in a well-executed treatment-but it is defi nitely
more diffi cult, absolutely not the norm and,
practically speaking, very rare.) Th is is not the
only variable that aff ects treatment outcome, but
it's diffi cult to argue about the signifi cance of
this one.
For most corporate (or even doctor-owned)
practices with a large number of offi ces,
employee orthodontist staffi ng is a challenging
variable to deal with. Unless they're uniquely
structured (again, that would be the rare exception
and defi nitely not the norm), most of these
practices can't maintain consistency in the doctor
behind the wheel of the active patients.
So, the question is: Does that matter? What
happens when the orthodontic position is
commoditized and reduced to a carousel where
there's a new person behind the wheel every year
or two?
The carousel effect
Actually, a few important things happen that
directly aff ect treatment outcomes.
Most often, the employee orthodontists in
this type of practice understand they likely
won't be there for the long haul. I can speak from
experience that the orthodontist's mentality is
completely diff erent in that scenario than if they
believed they'd be there for the next 10 years. I'm
not arguing that it should or shouldn't be that
way-that's just the straight-up reality. Mentally,
the ownership and accountability of the cases
are diff erent, and the eff ect this has on treatment
in these offi ces is real.
NOVEMBER 2023 | 8 | ORTHOTOWN.COM
http://www.ORTHOTOWN.COM
Orthotown November 2023

Table of Contents for the Digital Edition of Orthotown November 2023
