When do orthodontists retire

Ryan Isaac: How much life insurance? If someone comes up to me at a party and asks if I have considered premature death lately, how much life insurance do I buy? Reese Harper: Think about the number of policies that you have. You have your life insurance, you have life insurance to consider for your associate, you have life insurance to consider on a spouse. You also have disability insurance for your higher than normal income, you have business overhead disability, you have business reducing term.

Reese Harper: Yes, on person and operation. You have got your higher than average liability on vehicles and home. You have to think about whether you have any of the appropriate level of malpractice as you grow. Ryan Isaac: They change every year too! Every time net worth, or spending, debts, or assets it should change. Reese Harper: But you know, the overhead itself and practice growth and practice evaluation is a big question.

How do you protect that huge investment? That is not an easy decision. Combine all of that with the fact that you have zero background in financial training. The advisor you are depending on for a lot of these choices, in most cases, will be a CPA. That guy has some ability to handle some of these questions.

He has an extremely good ability to handle several of these, but no idea how to answer half of them well. Ryan Isaac: Or even a strong opinion on them. He is just not in the business of giving advice around these areas. The alternative is the life insurance guy by the pool.

So you have that guy or your CPA. I feel like his name was probably Larry, for some reason. This is one you have coined a term on. The fourth reasons that they retire later is because they are not only the entrepreneur but because they are also the professional working in the business that they have built. You would call that an entre-professional. Ryan Isaac: I coined it, ya right I did. That is tough though. It is tough to be on both sides of that spectrum. All of the time and energy and resources that can be put into building a good business are different skill sets.

It is a different amount of time and money than doing the work. Reese Harper: You have observed that within our own practice here. Which is a lot like a dental practice. You have seen me be the doer of the work and struggle to balance that with being an entrepreneur. What have you noticed in our own evolution that has been insightful? Ryan Isaac: One of the biggest problems that people face in that situation is that you in order to pay attention to one, you have to sacrifice the other.

At some point, if you are going to spend a lot of time building a good business and maybe learning how to do marketing really well, that means that you have less time for patients and clients. In our case, you can have less clients if you want to learn how to build a podcast, or do online marketing, or spend time hiring the right team.

Ryan Isaac: The dentist is the same way. He wants to learn what marketing is going to work in his area. Ya know, spending time and money that will take away from his ability to spend time with patients.

Or analyzing out of all the insurance companies you can accept in this practice which one should I take and not take? That just takes away form other things. That is the first take away. It is hard, man. It is hard to be in that position. Reese Harper: There are some financial tradeoffs too that people struggle with.

They are different. The rewards for each of those. Ryan Isaac: What are the tradeoffs? What are the tradeoffs that a professional that focuses on that faces? What happens? Reese Harper: You can have income today. You can have higher, steadier, more predictable income today. You can just get more clients, in our case, or more patients.

Reese Harper: Or you can delay income, take any that you might earn and hire people, build a business, pay for marketing and a nicer location plus equipment, and then build an asset that will build your net worth and balance sheet higher.

Ryan Isaac: It is just an important tradeoff to articulate. They want to have their cake and eat it too. Ryan Isaac: I want high current income, plus a business that is worth a lot of money!

Reese Harper: I think this is an interesting parallel. Big, big, big, big companies work this same way. There are two types of businesses out there. One is called a growth stock and one is called a value stock. In a value stock there is actually a high amount of current income generally. There is cash left over in the operations and those typically pay what we call dividends. Some are high growth. Apple stock, ya know, has never really paid a dividend until the last few years.

They finally declared a very, very, very small dividend because they said we are just going to grow this thing as big and fast as we can. They try to take all of the profits, reinvest them, and grow the company. Our goal at that point would be to make that thing be really profitable. Take all of the money out that you can, lower expenses as much as possible, and make profits. We can sit on this thing and enjoy the income.

As a dentist, I think those are your choices as well. Both choices have really, really good tradeoffs. Ryan Isaac: They will pay you at different times and in different ways. A lot of that choice just needs to be based on what your natural temperament is. What is your natural temperament for what kind of level of stress you want to have in your life?

What do you want to have your lifestyle feel like and be like? Someone who is tilting towards the entrepreneurial route has to be living on a shoestring budget and cutting back on lifestyle expenses.

If you are going to hire an associate you are going to have to take some of your profits and give them to that associate. That is just the way it looks, or at least some of your production. Your current income will have to go down. That is a short term tradeoff that you will have to make. I think it is important to say which hat do I feel most comfortable with? Do I like the entrepreneurial hat? Do I like the professional hat? Or like many of us, do you like a little bit of both? Can you make concessions as you try to do both?

Just know that they are different and when you start moving towards that entrepreneurial road of expansion and adding an associate you have to be ok with the fact that you are still going to make money, but the money you are going to make will come in the form of growing the business not in the form of current income, as much. Ryan Isaac: A bigger business. I am glad that you bring that up. I get that question a lot. People are asking in context of what is the right way and the wrong way.

Ryan Isaac: I am getting started and it seems like three locations is the right way to do dentistry. Ryan Isaac: They have one or two hygienists and a small business. Then we have a lot of clients who have practices, partners, and locations. What do you value?

It is personality driven. How much stress can you handle at night before you break? Reese Harper: Part of it is just figuring out what you naturally find yourself doing throughout the course of your career.

Ryan Isaac: What are you drawn to when you have free time to work on something? Are you going to see more patients or are you going to the back office and working on marketing, or designing a different process for patients?

Reese Harper: Totally fine! Our financial philosophy and perspective is that there is not a right or wrong way to achieve some level of financial security, everyone can do it. There is just a right path for each person based on their temperament. Maybe the right way to qualify that is that people can only make slight adjustments. Minor, slight adjustments work but major adjustments do not. Reese Harper: People just revert back. I tend to do it when I go on my diets, ya know? I think you can make minor adjustments and you can move towards the right outcome.

One day maybe I really will be able to give up all dairy and wheat. Reese Harper: Yes, I have cut back. But I am still going to have my dairy here and there. It was stolen from me at the ripe age of It is a sense of urgency around organization, financial planning, and having a good plan with your personal finances.

There is not enough urgency. It is not an exciting thing to go pay for. You brought up Apple, we are not Apple. Everyone is excited to go throw three grand at apple whenever they launch a product. Paying an advisor to keep stuff organized on a spreadsheet and talk to you about it every once in a while to help you from self destructing is just not very exciting or urgent.

It feels like something you can definitely do later. Reese Harper: It is definitely something that can wait until you are like Then pick it up. Ryan Isaac: We love the people who call us in their early thirties, all of you young bucks.

Reese Harper: It is cool to see! Yes, keep calling in. You are doing great, but we will probably tell you to keep going back to school and focus on that for awhile. It is ok, go ahead and graduate first. Ryan Isaac: But it is good to know! It is good to ask the questions early on. Reese Harper: Ryan is saying it the way that we put it in a lot of the conversations. With a higher income there is just is not a lot of urgency to do important things.

There is just urgency to do fun stuff, and stuff that is urgent. Stephen Covey has got the box of urgency. The general concept is that there are ideas that are urgent, and non urgent versus important and non important. Reese Harper: Ultimately, if you think about four boxes, then in the top left hand corner are things that are both urgent and important.

For Ryan that is like his gains are going down at Crossfit. Ryan Isaac: Yes, I have not squared in three days and I can feel my thighs getting smaller. Reese Harper: Top right hand corner are things that are not urgent but they are important.

Those are things that for most of you are things like financial planning. Reese Harper: It is really, really important, but it is not urgent. The bottom is not important stuff. There is not important stuff that is urgent. That is like someone walking into your office when you are on a phone call and they ask you about whether they can take the next thirty minutes off because they have got to go and they want to do it right now. During the period while this new order is taking place the orthodontic department could be augmented by imported academic personnel from abroad.

Unfortunately, there is no such mechanism. At best in some states, the imported faculty member can teach in the clinic and have an intramural practice one day per week. The State Board of Dentistry must be lobbied to allow these faculty to practice on a daily basis as long as they stay in academia full-time. Additionally, AAOF could provide matching funds for their retirement plans as well as portfolio management advice and services.

There is ample expertise among the AAO to provide such support to the young academic, citizen or permanent resident. Investment of funds in these areas is what will ensure our survival as specialists. Not as a criticism, but rather as a statement of fact, it can be said the AAO has been preoccupied to address the needs of the current membership at the expense of investments for the future of the specialty.

Similarly, the Council on Scientific Affairs while trying to decide whom to award among the candidates oftentimes finds itself trying to choose between advancement of science and practical issues of today.

Meanwhile, the Council on Informatics spends more time trying to help the current membership, rather than planning for the future, and there are identical stories told for the Council on Communications or Education, or the rest. Obviously, the needs and interests of the current membership can never and must never be overlooked.

Yet at the same time, room must be made for the future of the specialty. Extinction is not an exciting practice alternative. The following article, written by Dr.

Larry White, is reprinted with permission from the Orthodontic Cyberjournal, and was first published as a guest editorial in Orthodontic Cyberjournal, June edition. Though some may find this essay controversial, it is intended to make us think about the current state of education in our profession and of the pending problems of supply and demand for orthodontists.

Editor, Orthodontic Cyberjournal. The April issue of the American Journal of Orthodontics carried an historical time line that highlighted some of the notable achievements of the American Association of Orthodontists over the past century.

Another development that occurred in was the dissolution of the orthodontic preceptorship program, which the AAO formally endorsed in s. This orthodontic training program allowed dentists to apprentice with an established AAO member for three years and then establish their own specialty credentials by passing an examination. By , pressure from the AAO to consolidate and balance orthodontic training placed all sanctioned training in university programs.

On the surface, this change seemed as innocuous as it was well meaning, but nothing altered orthodontics quite like this one change because it essentially turned over the future of orthodontics to the universities of the United States. From this point on, they would essentially determine the direction of the profession. Universities and their faculties would decide who was admitted, how many were admitted, the curricula taught, the hours devoted to research, the amount of clinical experience, the time spent in the programs and so forth.

The AAO, through its House of Delegates, has some input, but it is minimal at best so as not to interfere with the autonomy and discretion of the individual institutions that manage these programs. How has this assignment of duty worked? For the most part reasonably well, but recently the custodians of this charge have been telling the AAO that a crisis in orthodontic education now exists. Currently, at least 10 chairs of orthodontic programs lie vacant. Approximately full-time positions remain unfilled in orthodontic departments.

Were it not for the unselfishness of part-time faculty in our universities, many of the orthodontic programs would undoubtedly have to close. With this much dilution of faculty, it is hard to see how the current orthodontic education scheme can remain healthy and viable. The crisis as I briefly experienced it has three aspects: personnel, purses, and product. Most universities complain that they cannot compete for personnel because of low salaries, which their institutions dictate; but this is only partly true.

The schools do have salary caps that cannot be easily violated. Yet many of the schools severely limit what their faculties are able to earn outside of their university employment. Some insist that the faculty engage in an inefficient and highly limited intramural practice as the only supplement to their salary.

They forbid any independent outside practice. Also more and more schools are insisting that Chairs come with Ph. And not just the degrees but also the obligatory NIH research grants that they are supposed to collect with those degrees. In fact, the pursuit of federal grants has become such a priority for full-time faculty that it has relegated the teaching of orthodontics to a secondary status.

Another barrier that has arisen even for people who do get their advanced doctorates has been the recent tendency of schools to give tenure only to those who publish in highly ranked journals.

Not one of the orthodontic journals worldwide is ranked in the upper 1st or 2nd tiers of publications, which universities recognize. This means that orthodontic Ph. I have a friend who is a first-rate orthodontic researcher, teacher, clinician and frequent publisher whose tenure was denied in this senseless way.

But deans of dental schools increasingly endorse this personnel approach. In some instances, we now have the scandal of even non-dentists being made chairs of orthodontic departments, which de-emphasizes clinical features even more. While the ABO is not necessarily the sine qua non of orthodontics, it does indicate at least a minimum of interest in clinical skills and knowledge.

Such decisions are almost always left up to the deans of the institutions, so if there is a personnel crisis in orthodontic education, it is self-inflicted, and we have to look no further than to the leadership of our schools. Deans who have taken a pragmatic approach to this problem have little or no problem in faculty recruitment. The University of Pacific comes to mind as an institution that allows faculty to have independent practices, so their teachers are able to do about as well financially with their part-time practices and full-time professorships as they would do in a full-time orthodontic practice.

Those who wish to teach full-time should not be financially punished because of their appetite for academia. Yet, that is exactly what happens for the most part in many orthodontic departments right now.

Who can blame them? Nevertheless, if these people could supplement inadequate organizational salaries with outside work, many more would be willing to make that tradeoff and the so-called personnel crisis in orthodontic education would abate. A second feature of this crisis in orthodontic education that is closely related to the personnel issue concerns the purse or the economics of running orthodontic departments.

Traditionally, orthodontic departments have been substantial profit-centers for dental schools — so much so that incomes from their enterprises are often diverted to shore up the less profitable departments. Whatever the merits of such administrative decisions, and they are often compelling, the net effect has been to dilute and limit the resources of orthodontic faculties and to place their programs in jeopardy. I am not sure how all of this school-wide dependence on orthodontic departments developed, but right now it is almost universal.

My suspicion is that as the sponsors of schools such as state legislatures continued to squeeze budgets, deans began to scramble to find funds wherever they existed.

We are not only doctors but we are people as well. We understand tough situations, life changes, and when things are just not working out. Ask the office manager if they have recommendations for other offices in the area and ask how much it will cost for copies of your orthodontic records including your orthodontic pre-treatment photos, pre treatment and progress treatment x-rays, intra-oral scans, orthodontic models and all applicable treatment notes.

You may also want to request your financial ledger to confirm what you need to do financially to settle your accounts. The American Association of Orthodontists recommends a standardized transfer form that orthodontist use for patients in active treatment and you will most likely need this as well to begin the transfer process with the office that you intend to transfer to.

ProSmiles Tip : A thank you goes a long way! Leave on the best terms possible by saying thank you to your doctor, favorite orthodontic assistant and the Office Manager. Finding a select few offices where you would like to transfer your active orthodontic treatment is the next step.

Start by researching offices near where you may be relocating or close to your current residence. There are many great resources to look for orthodontists in your local area. Here are a few of the most popular:. Some chambers even provide businesses with their own mini-website that can provide quick access to some basic information about the practice to get you started on the right path. Dental Insurance Carrier Your dental Insurance carrier is a great resource for multiple reasons.

The first and foremost being that you have a vested financial interest in utilizing your insurance benefits towards your orthodontic treatment. This will decrease the out of pocket expense of transferring your orthodontic services. You will find business advertisements that are curated specifically for you and your search query.

Some well designed ads will feature clickable promotions, discounts for treatment and contact information. This will make it very easy for you to contact the business that you are searching for. Clicking the ad will take you to our website where you can learn more about our office and even book a free consultation. Many offices will have similar ads for their businesses. Facebook Groups Facebook groups have become an incredible resource for families with regard to orthodontic treatment.

There are multiple groups where you can ask for recommendations on what orthodontist to choose to transfer your orthodontic care. These groups are filled with past and current patients that will be willing to offer strong recommendations.

As Facebook Groups continue to grow and thrive they will be a great way to engage with your local community. Facebook is a great place to find the information that you are looking for in real time.

Dental Office A local dentist or pediatric dental office is a great place to start to ask for a referral to the orthodontist they prefer. Most offices will offer a few referral options, allowing you to shop around.

If you are moving to a new state, finding a new dental home should be high on your to-do list. Once a relationship with a new dental home has been established, you will want to ask your dentist and their staff for their strongest recommendation to continue your orthodontic care.

The Financial Aspect of Transferring Out Financially transferring your orthodontic treatment to a new provider may be the most stressful aspects of the transfer process. You will need to settle your accounts with the office that you are leaving prior to transferring your treatment.

Most offices will only charge patients for the amount of treatment that has been completed up to the time they transfer. This will include the cost of your initial treatment records, x-rays, bonding your braces and all adjustments up to the date of your transfer. You will need to fulfill your contractual obligation by settling your account. You must do this even if you are transferring because you are unhappy. Orthodontic offices may utilize any and all legal means to collect payments due if you do not settle your account.

After initiating your transfer of services, settling your accounts and creating a short list of potential new providers, you are ready to book a consultation! When booking your appointment you should immediately make it clear that you are in active treatment and interested in transferring your services.

Confirm that the office accepts transfer cases. Ask if you need to bring your current records with you or have them emailed over prior to your consultation. Be prepared to show up to your consultation enthusiastic about getting your treatment on track with your new doctor! Meeting your new orthodontist face to face, may be both terrifying and exciting. The consultation should be thorough and include a review of your medical and dental history. Your current orthodontic situation should be discussed at length.