An interesting fact about orthodontists, is that we are driven people. Top of the class, best grades, and a competitive nature are all common denominators in our specialty. I have noted that in school, competitiveness becomes an important part of advancement since scholastic achievement is often measured by your ranking. Fast forward to professional, and business life, and you realize the rules of the world are just a bit different. We are misguided at times because teachers favored the best student. In real life, patients don’t regard your grades and class rank as valuable. There is no study, that I am aware of, where your academic ability was in any way related to your success in the business of orthodontic practice. And yet our competitive spirit continues.

It can be a never ending battle of frustration if our goal is to beat the rest. Ultimately, there is going to be someone better, faster, cheaper, more popular than you. This sense of competition is not unique to the orthodontic profession. Not at all. There are competitive business strategies all across industries. This leads to the concept of finite players vs. infinite players:

The joy comes, not from comparison, but from advancement” – Simon Sinek

I, like many of you, have a competitive spirit. And yet I find the most fulfillment in outdoing myself, than beating someone else. Constant and never ending improvement is one of our mottos. For the team, for myself, for our practice.

Orthodontic practice can feel like a circus some days. A series of patients are late to their appointments, one of your clinical assistants called in sick, and your phones are off the hook calling in for emergency appointments. We have all been there, but the circus I’m really talking about is the circus industry. Specifically, about the changes to the circus business that led to the closing of Ringling Bros. and Barnum & Bailey Circus.

At its prime, the Ringling Bros. and Barnum & Bailey Circus was a popular family outing. Over time, expenses grew, ticket prices did not, and concerns over the use of animal acts led to public concerns over the industry.  This year, after 146 years of performances, this American icon has hung up its big tent.

The competitor in many ways is time. It’s a different model that we can’t see how it works in today’s world to justify and maintain an affordable ticket price. So you’ve got all these things working against it.” Kenneth Feld – CEO

As market trends continue to change and other players enter into the orthodontic space, is the private practice of orthodontics headed in the path of the traditional circus?

Where most circuses were competing with each other over market share of a decreasing demand of traditional acts, a lack of change in the circus experience was leading to a downward spiral of the industry. By contrast, the circus has been reinvented and successfully invigorated by Cirque du Soleil. Their focus was on changing the experience: taking the popular and cost effective strategies of a circus act, and raising the experience to the level of theater. This tapped into a client base that saw the circus act from Cirque du Soleil more as a broadway show, than a sideshow act.

In less than twenty years since its creation, Cirque du Soleil achieved a level of revenues that took Ringling Bros. and Barnum & Bailey (the once global champions of the circus industry) more than one hundred years to attain.

What can we learn from Cirque’s success?

The key factor in their success is differentiation. Create an uncontested space where competition is irrelevant. Cirque du Soleil has learned to generate and capture new demand. They also broke the value and cost trade off that plagues many business models. In many ways, we can still create great value to patients and decrease practice costs with the efficiencies patients expect.

It’s generally believed that the way to beat your rival is to outperform or outpace them. But in business, the better way to win is to create uncontested new market space where no competition exists…Cirque du Soleil designed the classic symbol of the circus with a glorious external finish and a higher level of comfort, making its tent reminiscent of the grand old circuses. Gone were the sawdust and hard benches. Acrobats and other thrilling acts retained, but their roles were reduced and made more elegant by the addition of artistic flair and intellectual wonder to the acts.” – Mauborgne & Kim – This is how Cirque du Soleil reinvented the circus

We are at a crossroad, where we are moving from an industrial economy to a service economy. Patient experience is king, and straight teeth and quality outcomes are no longer a differentiator, but the price of entry. Through technology and economies of scale, delivering the product of straight teeth will reach a large scale where orthodontists can no longer compete by cost and sustain a viable business. The key differentiator is delivering unparalleled patient experience by offering those aspects that are difficult to replicate by achieving an incredible office experience, unrivaled customer service, shorter treatment times, greater comfort, and better convenience. Ultimately, take the best aspects of orthodontic treatment and reinvent the experience.  Seems tough? If it was easy, everybody would be doing it… and that’s the whole point.

Want to learn more about Cirque du Soleil’s philosophy for success?  Check out: The Spark

By definition, a catalyst is a substance added to another substance, to accelerate the rate of a reaction. The catalyst is not consumed in this process and may be used many times before it loses its effectiveness. The issue with a catalyst, is that it does not cause a reaction by itself.

Consider practice growth as the result of a reaction.  Technology is a catalyst that will not lead to a result unless a base reaction is present.  Simply using scanners, 3D printers, cone beam, or Invisalign will not guarantee success.  Toys are just that, unless they add value to patients, and lead to return on investment to the practice.

By itself, technology will not grow your practice.  There are many toys and applications to chose from these days.  In most circumstances, there is a sales team that will show you how that new device, application, appliance, or equipment will lead to practice growth. There are key things that must be in place to maximize the benefit of a technology add.

The base reaction to practice growth is the right type of practice culture. Your team culture, outstanding service, and the right practice model for your demographics are key steps that need to be in place to facilitate growth.  Once the base reaction is in action, it is important to have processes that are congruent with technology.

If you integrate a piece of technology in your practice, consider ways to enhance how the technology adds value to patients and make that message a standard script in your office.

• Have a team culture that promotes the benefits of technology.
• Use technology to improve the patient experience.
• Highlight your team’s special experience with the technology.
• Emphasize how your skills with the technology benefited the patient’s treatment.

For many of us, we invest in technology to improve our practices. It becomes more important what you do with that technology, than simply buying it. The key to grow is taking that digital tool and use it to enhance what already makes your practice unique.

Data is critical to make the right decisions. “What gets measured gets done” is a key business principle. Across industries and professions, decisions evolve from limited observations, to shared evidence that improves outcomes. Businesses who use data and analytics to drive decision-making continue to outperform their peers.

Orthodontic treatment has improved and will continue to evolve because of shared data and evidence that pushes the specialty and the dental profession forward. The way data is being collected and distributed has changed significantly over the last few years. The power of data was often limited to academics, consultants and industry “insiders” who had the opportunity to review multiple practices, data sets, and research projects. With new digital tools and the development of big data, information that was limited to a few, is now much more accessible.

As Orthodontists, it is important to realize that the digital tools, services, and appliances we are using are contributing to a powerful data set never seen before. Whether you realize it or not, these data sets are growing the value of many leading companies.

Cognitive Data

The decisions made by people are valuable pieces of information. As an example, anyone who has used Facebook boosts to market their practice can realize that your personal Facebook account does not make you their customer.  You are actually their product.  The content we freely upload to their servers offers invaluable data on buying decisions, items of interest, and very specific demographics that can be purchased for targeted ads. Sharing data is making a huge impact in our personal lives and the most valuable assets of companies such as Facebook, Google and others.  Although playing with a smaller subset of data, there are several players in the orthodontic industry who are gaining ground with the power of data.

Business Analytics

Business consultants use metrics from their clients to evaluate market trends and use this data to make best practice recommendations.  Each consultant was limited to how many clients they had, and the diversity of the data collected.  Third party financial services are now gathering a tremendous amount of data that dwarfs what consultant surveys could do in the past. Currently, two large contributors to business data are OrthoFi and Gaidge.

OrthoFi offers a set of tools for managing financial systems in an orthodontic practice. As this company grows in managing hundreds of thousands of patient contracts, we are starting to see results of their data analytics. Their data will continue to show consumer trends and insight into the orthodontic financial systems.

Gaidge has been collecting data metrics from orthodontic practices for several years. Practice data is well organized to tap into daily updates from orthodontic practice management software. Bar graphs and graphics display the data for review of what is happening in the orthodontic practices enrolled in their service. As this data grows, Gaidge offers comparison groups based on regional groups and practice models. Since they collect data directly from practices on a daily basis, these trends offer many opportunities to evaluate the orthodontic business model and areas of improvement.

Data Mining and Machine Learning

One of the biggest players in this area is Align Technology. The innovations in attachment optimization, SmartForce, SmartStage and outcome simulation are products of the data their Invisalign product has been gathering.  Align Technology’s biggest asset is the data it has been collecting from the millions of patients who have been treated with Invisalign.  With digital scanners, clincheck, and iOSim, the amount of data gathered is growing exponentially and will continue to grow their product development and commitment to augmenting orthodontic treatment.

Treatment Data Pipelines

The digital age of orthodontics now offers an easier collection channel of treatment data.  Intraoral scanners, CBCT data and even smartphone photos offer the opportunity to collect treatment images that can be superimposed and evaluated to reveal the results of treatment decisions.

Dental Monitoring uses the smartphone camera to capture tooth movements and allow orthodontists to monitor patient progress remotely. As this data is collected with their proprietary app and tracking system, a large amount of treatment progress data will also become available to review the effects of compliance and different treatment modalities. As the data is collected, the potential for correlations and treatment data will be revealed.

Orthoscience is a new forum that promises to gather treatment data from CBCT technology for the potential of better treatment decisions. By collecting data from the digital treatment card and 3D data from full head CBCT, much can be gained in learning the impact of treatment decisions. A data set of diagnoses, various treatment plans, and superimposed pre to post treatment data certainly aims to grow objective treatment data.

The Risks of Data Sets

The growth of big data sets will continue to offer many opportunities for us. The future will hold many business models that will grow the influence and power of data. It will be important for all of us to remember that although data sets can help up make solid business and treatment decisions, the source of data and the conclusions from that data are not always crystal clear.

The right approach to data is skeptical, not cynical––it understands that, while powerful, data science tools often fail. Data is nuanced, and “a really excellent skeptic puts the term ‘science’ into ‘data science.'” The big data revolution shouldn’t be dismissed as hype, but current data science tools and models shouldn’t be hailed as the end-all-be-all, either.” – Cathy O’Neil

As doctors, we will have to weigh the data trends and remember that we are ultimately responsible for patient care and treatment results.

There is increasing alarm that the complexity of machine learning may reduce the justification for consequential decisions to “the algorithm made me do it.”  Fairness, Accountability, and Transparency in Machine Learning.

When a digital treatment plan suggests a modality that does not make biologic sense, consider that our ultimate role in the treatment of patients will still depend on our ability to discern between data sets and experience to make the final decision.