One continuing challenge for all orthodontists is to maintain the balance between the quantity of patients in active treatment and the quality of the treatment results. How do you achieve this balance? The balance between quantity and quality differs during the various stages of an orthodontist’s practice career. Let me use a metaphor to explain how this balance changes with time. Imagine in your mind the shapes of a cone, a funnel, and a cylinder.
When a young orthodontist begins his or her practice career, new patients flow into the practice, have appliances placed, and begin a 2-year treatment process. During that time, the flow of an orthodontic practice resembles a cone. Patients flow in at the top, and none exit at the bottom. For a new practitioner, this patient flow works nicely. As the number of new patients increases, the cone fills. If the increase in new starts is gradual, the orthodontist can usually maintain the quality of the treatment results. After about 2 years, the cone (orthodontic practice) is nearly full of patients, and the practice flow gradually changes to the shape of a funnel, with a small opening at the bottom.
The funnel shape allows completed orthodontic patients to exit the practice so that the number of active patients does not become excessive. However, as long as the hole at the bottom of the funnel is smaller than the hole at the top, the practice is out of balance. If the flow of new patients entering the practice significantly outpaces the flow of completed patients leaving, the number of active patients will continue to increase.
Eventually, a well-balanced practice develops the shape of a cylinder, with the hole at the top (patients entering the practice) identical to the hole at the bottom (patients completing active orthodontic treatment). So, if the inflow numbers match the outflow numbers, can you assume that your practice is in balance? Technically, yes, but realistically, perhaps not. This is where the assessment of quality must be included. For the well-balanced, quality-oriented orthodontic practice, the number of patients who finish treatment should not be determined by the number of patients who begin treatment. On the other hand, the number of patients who start orthodontic treatment should be determined by the number of patients who complete treatment. And let me add an important caveat: patients who complete treatment must be finished at a high level of excellence.
The size of an orthodontic practice or the size of the openings at the ends of the cylinder can vary. Some orthodontic practices are large, and others are small. Some practitioners have 6 or more treatment chairs and others have 3 or 4. Both of these practice models could be in balance; ie, the numbers of patients entering the practice could be equal to the numbers completing treatment. But the most important part of balancing your practice is to also maintain a high level of quality.
I track the numbers of patients beginning and finishing treatment in my practice. I adjust the number of patient starts to equal the number of patient completions. And to determine whether the finished treatment results are at a high level of excellence, I use the ABO Objective Grading system to monitor the quality. Twice each year, in January and July, I score the posttreatment dental casts and radiographs of 10 consecutively finished patients. I expect that 9 of 10 completed patients will score at a level that would pass the ABO examination. If I achieve this level of excellence, and my practice flow resembles a cylinder (equal numbers of starts and finishes), then my practice is well balanced with a high level of quality. If, during this biannual assessment, I ever find that the quality of my treatment results is not at a high level, then perhaps the size of my cylinder or the quantity of my patient load will need to be adjusted.
How do you determine whether your practice is well balanced? Does your practice flow resemble a funnel or a cylinder? Do you maintain quality and monitor quantity? Or does your orthodontic practice represent a conflict between quantity vs quality?