Latest / Orthodontic Products Podcast / Future-Proofing Your Practice in a Shifting Economy: Key Takeaways from the 2024 Practice Performance Survey
Transcript
- Alison Werner (00:05) Hello and welcome to the Orthodontic Products podcast. I'm your host, Alison Werner. Today we have back with us Dr. Roger Levin from the practice manager consulting firm Levin Group. He's here to help break down the findings of our fourth annual orthodontic practice survey. Dr. Levin, great to have you back with us. Roger Levin (00:21) Alison, I'm very excited to be with you. These surveys are really interesting. It's great to see where the orthodontic specialty is. And hopefully we get to help people improve their practices and their situations. Alison Werner (00:34) Yeah, so we're going to do this a little bit differently than we've done these podcasts in the past when we've looked at the results. So I want our audience to know that the survey was taken in February. So we asked all our readers, you asked your your clients to fill out this survey in February. The article itself and the survey results were analyzed in early March. So a lot has happened since then in terms of the economy from tariffs to economic policy. So before we kind of dig deep, because the two 2024 results now have to be taken within the frame of mind of the economy changing. So before we kind of dive into those results and what they could mean, which is not necessarily what they meant in March, I want to ask you, where are we? What should doctors keep in mind as we go forward with this conversation? Roger Levin (01:31) Right. Well, Alison, as you know, I love data. Our firm loves data. We try to support all of our consulting systems and policies and recommendations with data. And you're right, we are in at the moment uncharted waters. So I think the three major points. Number one, this survey was done for the year 2024 and all in all, and I know we'll come back to it. It was a pretty good year for orthodontics because there are other headwinds we'll talk about that Alison Werner (01:53) Mm-hmm. Yeah. Yeah. Roger Levin (02:01) that may have made the results not as excellent as we might like, but they were still overall pretty good. Number two, everything has changed and I'd say about the last eight to 10 weeks. We have all kinds of not clearly defined tariff policies coming out affecting the economy. We act, other countries react. So from an economic standpoint, Alison Werner (02:09) Mm-hmm. Roger Levin (02:29) Nobody knows what's going to happen. We only know what's happened so far until today. I will make a prediction. I'm not a gloom and doom person. I'm an upbeat person, but I think our economy is going to have a fairly rough time for a while based on everything I'm seeing. Hope I'm wrong, but I have to help prepare our audience. What do we do if the economy does slow down as orthodontic practices? And then number three, Alison Werner (02:32) Yeah. You Mm-hmm. Roger Levin (02:58) We don't know how long anything is going to go on or what else will be added to it. We're, playing a little bit of a act react type of game right now. So, you know, as I always say to people, the only thing you can control is your practice. So let's do the very best job we can with the orthodontic practice today. Alison Werner (03:08) Yeah. Yeah. Okay. So you noted in the article that you wrote up on the survey results that practice performance improved across several metrics in 2024. So let's talk about what those improvements were and what you view as the most actionable going forward with this new economic reality. Roger Levin (03:44) Yeah, yeah, oddly enough, and this may sound surprising. The first question I asked myself, I always go into everything by asking what's the big question here. And to me, the big question is how much unused potential does an orthodontic practice have? Now that may sound funny when we're talking about economics, but I was trying to evaluate as we have for many years. If most orthodontic practices fall into a certain range, and the average seemed to be around 1.5 million per year, exactly $1,588,744 to the other data nerds like me out there. What is the unused potential? Because at a million five, you're making a great living, especially if you're falling at a 50 % annual overhead. So you don't have to worry about it. But if that million five becomes a million two or a million one, Alison Werner (04:35) Mm-hmm. Roger Levin (04:42) And somebody might say, wait a minute, Roger, nothing's going to fall that fast. And my cute, funny, clever answer would be, have you seen the stock market lately? So, which is a barometer. Yeah, it's not, it's not the economy, but it's a barometer of the economy. So, I looked at the unused potential. We believe most practices, most orthodontists could do 2.2 million. We have many that do, some that do more, some that do less. Alison Werner (04:52) Yeah. Yeah, right. Okay. Roger Levin (05:11) but we know it can be done and anybody listening, your first reaction might be, well, no, that can't be right, except I can show you tons of practices doing it, which is just my proof point that yes, you can do it and you should be optimistic. So the answer to the question was probably a half a million to $700,000 in increased production. I'm gonna give you a key reason in a moment it can be done. But at the same time, my answer to your question is, Alison Werner (05:35) Yeah. Roger Levin (05:40) you need to start accessing that potential now. Because if you're at one five and you can grow to two, but your one five drops, you might still be at one five. So you always want to do two things as a CEO. You want to grow your business and you want to protect your business. And accessing the unused potential is what most orthodontic practices need to do now. The truth is most offices don't know how to do it. They've never had to do it. They've never worried about it. Alison Werner (05:42) Mm. Right. Roger Levin (06:09) But I'll add one example here. I know it's early for examples, but just look at remote monitoring. Anybody who reads me knows I'm very big and I think it's gonna be a very big shift in orthodontics. If you can open up 10, 15, 20 % share time, and by the way, you can still grow without doing this. This is not the only way to do it. And fill it in with new patients, you'll have that increased growth that we need because Alison Werner (06:13) Yeah. Yeah. Mm-hmm. Mm-hmm. Roger Levin (06:38) a slower economy is going to have some negative effects on orthodontic practices. Alison Werner (06:43) Right. What would you say to smaller markets that maybe think I can't be a $2.2 million practice? My community, my market doesn't allow for that. Roger Levin (06:58) That's a really good point. this is the, you again, I love surveys and I love other people's surveys and I love talking to people, but this, have the only survey where I've ever seen a measurement of the major metropolitan area versus the, you know, city versus small, medium town to small town. And the big drop off takes place at small town. That's a very valid point. It's a huge drop off of almost three to $400,000. Alison Werner (07:18) Mm-hmm. Yeah. Roger Levin (07:28) in average production. But it's the same ratio. If you're doing 1.1 in a small town, which is the average, or 1.18, call it 1.2 million, then you could probably do 1.5 to 1.6. You won't do as well as the major metropolitan areas, but the ratio of growth will be the same if you access the unused potential. Alison Werner (07:38) Mm-hmm. Roger Levin (07:56) And that means having all of your management systems properly in place, having a TC who's trained for modern sales, not the sales of yesterday, a customer service profile for all mothers, fathers, and new patients, and referrals. And when you put those together, most practices can be 20 to 30 % larger in production than they are today. Alison Werner (08:12) Hmm. Okay, so 93 % of the orthodontists we've we surveyed were confident about the next five years. Again, the survey was done in February. So I'm going to caveat this every time. What what let's look at the 2024 though in isolation, what were the factors driving that optus optimism? And how can that optimism maybe help with the uncertainty that's coming? Roger Levin (08:34) Yeah. Right. And, you know, the analogy is there's also a Fortune 500 CEO survey on consumer, economic and consumer confidence. Unfortunately, whatever we knew, two to three months ago is no longer valid and we don't know what valid is going to mean. So the reality is that we came out of COVID 2020, kind of a rough year for a lot of practices. Although there are practices that caught it up and ortho did well because unlike the rest of dentistry, they still had to see their patients. Even if they did it remotely, you know, people are embraces. They've got aligners they needed to get started. And then 2021 came and that was actually a record year for many practices. You know, the pent up demand factor was huge. It was a record year for many, many of our clients. I think we're really good at what we do, but we weren't as good as the growth that we got in 21. We had some help from pent up demand. 2022 was the worst year since 2008 for two reasons. Now production actually went up, which was surprising to me. I thought production would be down a little bit. It was up a little bit, but overhead skyrocketed. Alison Werner (09:46) Yeah. Mm-hmm. Roger Levin (10:06) And there were two reasons for that. Staff compensation went up on average 10 to 12 percent. And then supply chain inflation on other products and services went up. So because of that, the rise in production was less than the rise in overhead. So in 2022, if you looked at production, it was OK. If you looked at overhead, it was bad. And if you looked at profit, it was bad because the overhead overtook the profit. Alison Werner (10:13) Mm-hmm. Yeah. Mm-hmm. Right. Roger Levin (10:35) 2023 overhead did not go up that much. Production went up a little bit again, so that was good. And 24 was the best year since 21. So I think in people's minds, they looked at 24 and said, hey, I'm up three or 4%. The average was up around 3.5%. I feel good. The headwinds are good. The next five years should look good. All of that before we started discussing tariffs and other Alison Werner (10:47) care. Mm-hmm. Roger Levin (11:05) issues that are impinging upon the economy and slowing us down at the moment. Alison Werner (11:07) Yeah. Yeah. Okay, so you mentioned there that overhead kind of remains stable in this year survey compared year over year. And but compensation costs have increased. With those two factors in mind, how can practices kind of balance that rising staff pay and long term profitability, if those costs are likely to increase over the coming years or the next year? Roger Levin (11:33) Yeah. Well, I can actually answer that one because fortunately our number one focus at Levine Group is increasing practice production. And as I tell every doctor, your goal is to increase production every year. You may have a down year, but you should not have too many. And the answer is, the only answer is production. And here's why. If we had a new client, we might be at a lower their overhead. Alison Werner (11:37) Okay. Roger Levin (12:02) 3 or 4 percent, maybe in a minority of cases 5 or 6 percent. But really, most practices, if we really scrutinize it, we really eliminate waste and we put in efficiency, overhead is going to go down about 3 to 4 percent. Now that's $3,000 $4,000 of profit, theoretically, on every $100,000 of production. That's not bad. But the fact is, you can only lower overhead by a finite amount. If it, and once you've lowered it, you're done. There's nowhere else to go. As I like to say, you can't fire the same assistant twice. So, you know, and I'm joking when I say that, but production is theoretically infinite. can go up 5%, 10, 15. I mean, you know, very unusual, but we've had clients over the years that doubled. mean, in a year, very unusual. don't want to misrepresent what we do, but I'm just making the point that per so whatever overhead has done. Alison Werner (12:33) Yeah. Yeah. you Yeah. Yeah. Roger Levin (13:00) it's more important to focus on increasing production because if production outpaces overhead by enough, you have more profit. And if profit goes up every year, then you're going to go from a good practice to a great practice eventually, because you have a compounding effect. It'll just keep growing every year. So the number one recommendation I have for orthodontists is production, which means new patients, new patients starts, referrals, Alison Werner (13:17) Yeah. Yeah. Roger Levin (13:29) new patients, new patients starts. That's a huge area we focus on to get production up. Everything else after that is management logistics. Alison Werner (13:39) Okay. Well, speaking of that management logistics, we talked a little bit about this before, but remote monitoring. So 30 % of practices reported this year that they're using it with some reporting 24 to 40 week intervals between appointments. So you've talked a little bit about why practices should really consider adopting remote monitoring. What's the risk of waiting too long to adopt this model? Roger Levin (13:49) Yes. Well, I'll give you my view of remote monitoring. I like to look at the future and try to come up with data-driven predictions, but there's still predictions. And I'm always fascinated when I have something wrong that I find out later because it's fun to look back and say, where did I miss on that? Now, let me warn the audience that if I'm wrong, you're only going to be better off. One of the principles I hold myself to is Like for example, I said, hey, the economy looks like it's going to be rugged, get your production up, you go get your production up and we have a great economy, you're only better, then you only have higher production. I, so I hold, I hold myself to not hurting anybody with bad predictions. Um, having said that, uh, the bracket and wire interval was seven weeks in office, eight weeks with remote monitoring. Keep in mind how close those two are. Alison Werner (14:42) True. Yeah. Yeah. Roger Levin (14:59) And then with aligners, it was 10 weeks in office and 16 weeks on average remote monitoring. Now, I've been, I'm not just looking at remote monitoring. We've been studying it. We've been talking to companies. We're looking at the AI. We're looking at the FDA approvals. And here's what I think is going to happen. I think we're in the infancy of remote monitoring. Artificial intelligence is a huge part of it. I think the analogy would be the introduction of aligners. I think that was 2004. Alison Werner (15:23) Mm-hmm. Roger Levin (15:28) Huge resistance. Nobody liked it, nobody wanted it, it couldn't be as good until they found out it was and it's growing every year in orthodontics. And so we have some resistance, but I think remote monitoring is in the early stages and then it's going to just take off. There's going to be an inflection point where it's going to take off. My warning is that the challenge is you can't just do a little bit of it. Alison Werner (15:30) Yeah. Mm-hmm. Roger Levin (15:58) You really need to change your systems to make it work. But what I love about remote monitoring, because I'm a believer in the quality, and you have to learn how to build relationships remotely. we know how to do this. This can be done. And you have to know how to collect your money remotely. Well, we're pretty good at that now. Remember, it used to be religion that a patient had to come in every four weeks. And that was orthodontic religion until it wasn't. Alison Werner (16:14) Yeah. Right. Yeah. Roger Levin (16:28) I think as it takes off, what we're going to see, and we're doing a huge research study, we're adding it into our consulting because it's going to open up chair time. And literally there are practices that we'll be able to double or triple because of remote monitoring by opening chair time. And that's just a function of getting more new patients into the practice. And these are, it's typically, I'll tell you who's going to go first at that. The high end practices are going to figure this out fastest. They're going to open up chair time. Alison Werner (16:55) Yeah. Roger Levin (16:56) We have clients today, I'm not an orthodontist, but as far as I'm aware, their referrals are great, so I assume the quality is good, that are seeing a liner of patients every 28 to 32 weeks. In Europe, we have clients, because we have a European part of our company, that deliver the trays and never see the patient again. It's all remote till the end. And I'm not promoting the idea, I know that's a stretch for some people. Alison Werner (17:05) Mm-hmm. Hmm. Yeah. okay. Yeah. Yeah. Roger Levin (17:25) But you and I have been around long enough, a lot of things that are resisted today become normal tomorrow. So remote monitoring is going to allow for huge production increases, but you have to operate with different systems and that's why we're building them now. Your TC process is different. You need a remote monitoring manager is the name we've come up with. They have to know, what do I do when they're not getting back to me with their scans? Alison Werner (17:45) Mm-hmm. Yeah. Roger Levin (17:52) But this is going to become normal. And then for parents, it's going to be a godsend. You know, somebody said to me, well, how are you going to build relationships? I'm like, the mother cares a lot more about not coming in than having a relationship with you. So for the next few years, remote monitoring will also be a huge marketing benefit to a practice until it goes mainstream, like a liner. you can market aligners, but everybody has them now. Remote monitoring is going to become a, we're teaching RTCs how to make a Alison Werner (18:02) Yeah. Yeah. Roger Levin (18:22) huge benefit out of longer intervals between visits. Alison Werner (18:26) Okay, so it becomes that practice differentiator. Yeah, yeah. Well, another one of the results showed that there's been an increase in adult referrals and a liner use now presents new opportunities. How can practices better kind of capitalize on the adult orthodontic market in 2025 given the uncertainty? Roger Levin (18:29) For now, yes, absolutely. Yeah. Well, right. Well, let's start with the reality. Here we go again with things that can't be done. So 80s, 1980s, 1990s, orthodontist after orthodontist said to me and to our consultants, well, I don't want to treat adults. I don't like treating adults. Yeah, because they actually have an opinion and they ask questions and they don't come in and headphones zoomed out. So. Alison Werner (18:57) Mm-hmm. Mm-hmm. Yeah. Roger Levin (19:15) I have said for years and even today, the adult market is a huge pioneering territory for us to go after. It's massive. If the AAO, which is a great organization, but if they had unlimited resources, I would call them and say, you need a massive adult orthodontic campaign on all social media sites. That's the place to be. Alison Werner (19:36) Hmm. Yeah. Roger Levin (19:43) I think we're going to see a couple things with uncertain economy. First of all, a lot of parents are going to hold off on their children's orthodontics. They always believe they'll get back to it, but they don't. And some adults are going to say, well, wait a minute. You know what? I don't like what's happening before I spend five or $6,000 on ortho. Maybe I won't do it. Except, and here's the exception, even in down economies, cosmetics sell well. Alison Werner (19:53) Mm-hmm. Mm-hmm. Roger Levin (20:11) I Alison, I've known you a long time. You always look great. Do you foresee with this economy you're going to change your shampoo, buy $3 glasses, no makeup and get rid of your ego? Alison Werner (20:20) I'm not gonna lie, I just did a big purchase this weekend because I was worried about tariffs on certain products. Roger Levin (20:25) Right, right, right. And if you use those up, I've got a feeling you're gonna find a way. So we need to think of teeth as cosmetic and we need to market adult cosmetics. Most adults only want one thing, a prettier smile. And aligners were the huge breakthrough because they didn't want metal and wire in their mouth. It wasn't convenience, it was strictly they didn't want to look like that. So aligners are growing in orthodontic practices consistently. Alison Werner (20:31) Yes. Roger Levin (20:54) and you are gonna see more and more adults for cosmetic reasons having a liner therapy. Now, what I haven't figured out yet is what should you be doing with your fees because the aligners have higher lab fees in many cases, but you also have one DSO for example that has their own aligners. They've given it a branded name and they're $1999 versus an average of $5,800 in orthodontic practices. Alison Werner (21:09) Mm-hmm. her. Roger Levin (21:24) You may remember early on when orthodontists felt like they were being shoved into aligners. They took their fee and said, well, I'm just going to add $1,800 to it. I'll just add the lab fee. So they were really expensive. One of the things I've been writing about, and you've seen it because I love writing for you, you're the editor, so I work for you, and is fee wars. Fee wars. We're going to start to see. Alison Werner (21:34) Mmm. Yeah. Yeah. Hahaha Roger Levin (21:52) They've been here. I've seen the billboards in Florida. I'm seeing the aligners for under $2,000. When I was at, I spoke at an orthodontic conference about a month ago. And when I finished a, you know, young woman came up to me, orthodontist, and she said, can you help me? I said, sure, what do want to talk about? You know, cause when I'm, when I'm doing that, I love to help and I love to make a difference. She said, you know, my fee is $6,200 for an ortho case. And a new young orthodontist, not General Dennis, but orthodontist has moved into town and he's giving out flyers to all the GPs saying he'll do the cases for 3,500. And she's losing cases. People are coming in, hearing her fee and leaving. So we're going to see fee wars and I'm going to make a prediction. I'm not promoting it. I don't necessarily like it. I'm just telling the orthodontic community. I think we're going to see Alison Werner (22:34) Yeah. Roger Levin (22:50) practices that might have more than one set of fees to address this. It's not here yet, but I'm seeing some of it in response to competition. Competition's growing in ortho. 24 was a good year, but even a bad economy creates opportunities to compete differently and more effectively. Alison Werner (22:57) Uh-huh. Mm-hmm. So what would your advice be then to practices that need to bring down that aligner fee? What should they be doing to offset that? Roger Levin (23:25) Sure, and let me say again, I'm not recommending to our audience to lower your fees. That's not my message. I'm giving you, but you when you talk about strategy, everything should be considered. It's remote monitoring because what you need to do is see patients less, open up chair time, have better referral marketing and community marketing, attract more patients, have excellent fee options. For example, patient financing. Alison Werner (23:29) Yeah, right. Yeah. Mm-hmm. Mm-hmm. Roger Levin (23:54) A lot of orthodontists most resist it because their view is, well, wait a minute, Roger, I have an interest-free payment plan. You can pay us over 18 months, two years, whatever the case may be. What they're missing is that there are more and more people that can't afford the deposit or the monthly fees. You and I are talking about tariffs and the economy and the stock market. There are a lot of people in this country that live paycheck to paycheck. Alison Werner (24:15) Mm-hmm. Roger Levin (24:23) but they do want ortho for their kid and they sometimes want it for themselves. So patient financing is just access to debt is another great opportunity. But too many orthodontic practices have patient financing and go out of their way not to tell anybody. So you don't have to say lower your fee if you have better options for payment at the same time. But the answer would be efficiency and technology. Alison Werner (24:32) Mm-hmm. okay. Mm-hmm. Okay. Okay. Roger Levin (24:52) Both of those are critically important in being highly efficient, a smooth running office that can see more patients, higher volume. Orthodontics is a volume based business. We have orthodontists who easily do a million a day or more annualized. And if they're doing it, others can do it. Assuming the market, like a small town, you might not do three million in three days, but you can do better than you're doing today. Alison Werner (25:03) Mm-hmm. Mm-hmm. Yeah. With so the the twenty twenty four results showed that there's still a little bit of volatility on the labor side. So terms of staffing with that in mind, what's your kind of advice given the uncertainty of the next, you know, ten months, eight months? Roger Levin (25:38) Yeah, I have written extensively about this and it keeps changing. But here's the bottom line. We have, my words, a staffing crisis. You know, a few years ago I might have said staffing challenge. We have a staffing crisis. Orthodontics is getting more complex, more digital. We need better trained people and when we hire we're getting lesser trained people for more money. It's just the way things are. And that's not gonna change. So first of all, the best way to not have to train new people is to keep the team you have. So one body of science I've worked on is how do we increase staff longevity? I don't know if you and I have ever talked about this, but we have a 31 year ongoing study of top 10 % producing practices, including in ortho. And when I started the study, Alison Werner (26:08) Yeah. Roger Levin (26:33) My first question was, and I hope this is kind of interesting real quickly. When I started the study, my first question was, are these just superstars in the top 10 % that are non-reproducible? Because if that was the case, I wouldn't have done the study, but we did it to start learning what are the best practices in the country doing. And we found over time, and this is both objective and subjective data, we found over time 17 principles that they generally have in common. Alison Werner (26:57) Mm-hmm. Okay. Yeah, definitely. Roger Levin (27:02) So that might be a podcast for us one day, Alison. But one of the principles was higher staff longevity. The average staff longevity in the top 10 % is 11 years. So imagine if your average is 11 years of staff. And by the way, you may be saying to yourself, to our listeners, well, I've got people been here 20 years. Yeah, but you also have people been there for six months. So that brings the average down. Okay, so. Alison Werner (27:15) Okay. Mm-hmm. Right, Yeah. Roger Levin (27:30) We found that they have higher staff longevity. And by the way, it's not that they're any better early in their careers at staff management or leadership. They actually had the same turnover rates as the average orthodontic practice, but they were people who could not tolerate poor performance and they would go through the pain and suffering until they just kept hiring until they either got lucky or figured it out or got the right person. Alison Werner (27:40) Mm-hmm. Roger Levin (27:59) Okay, so given that, the first step is excellent leadership. We need brand new models of leadership today because today's worker is not yesterday's worker. I'll tell you this story. We have a client hired a brand new assistant about a year ago and the second day at the end of the morning she looked at the dentist. This was a general practice but it's equivalent to ortho. Alison Werner (28:25) Mm-hmm. Yeah. Roger Levin (28:27) And she said, I'm going home. And the dentist said, what do you mean you're going home? I'm going to go home for the rest of the day. He said, well, why are you going home? I'm sad. That's a real story. So she went home and he said, you can stay home. But the point was that, yeah, that's an extreme example, but you know, it's a different worker set of values today and you might not like them. It doesn't matter. It's what it is. Alison Werner (28:38) Mm-hmm. Yeah. Mm-hmm. Yeah. Yeah. Roger Levin (28:57) Number one, we need new leadership. Number two, we've got to get much better at recruiting. You want to be recruiting on a regular basis. You want to make sure you've got up-to-date job descriptions, great ads. The ad can't be orthodontic assistant one. It has got to talk about the culture, the practice, the fun, the enjoyment. Give me those soft values and skills where I say to myself, whoa, I'd like to work there. I'm very flattered. I got a call the other day from someone. Alison Werner (29:16) Mm-hmm. Yeah. Roger Levin (29:25) asking if we had any openings for consulting. She said, you know, from what I've heard, I really want to work for your consulting firm. like, that makes me feel good because it means that we treat our people well. That's that makes me feel good. Number three, get good at interviewing and plan to hire in one interview. Now that's 180 from what I used to teach. Never hire in one interview. Three interviews, two with the doctor and one with the staff. Not anymore. We get the resume in advance. Alison Werner (29:34) Mm-hmm. Mm-hmm. Hmm. Okay. Yeah. Really? Mm-hmm. Roger Levin (29:54) We get the references in advance. If they look good, we make an offer the first interview, because by the time you bring them back, they'll have taken a job somewhere else. Yeah, you gotta be smart. Assigning bonuses, longevity bonuses. I've got a whole list of things you can do. And then finally, make your office fun. I'll give a quick list of things to our listeners. Somebody said, well, what do you mean by fun? What can I do? Alison Werner (30:03) okay, okay, okay. Hmm. Roger Levin (30:21) Okay, number one, give out lunch gift certificates. Two, as surprises out of nowhere. Two, bring in lunch. Three, give your staff restaurant gift certificates to take their family for dinner. Fill the staff room refrigerator. Don't do these all at once. Surprise them. Fill the staff room refrigerator with food that they can, snacks they can eat. Put snacks in the staff room. Snacks are a permanent benefit. Get a basket. Some people might not like this. It's okay. This is just one of the ideas. Alison Werner (30:26) Mm-hmm. Yeah. Mm-hmm. Roger Levin (30:50) But we have clients who do it too. Nothing's 100%. Get a big basket for the staff room, fill it up with miniature liquors. Tell it, put a sign, please take two or three home. And then a joke, please do not drink these during the workday. Staff meetings, put a Post-it note under one or two chairs. Make sure if your staff all sits in the same place, after they sit down, make them get up and change around. Whoever's sitting on the Post-it note chair gets a $100 bill. There are endless ideas. Alison Werner (30:59) huh. Roger Levin (31:19) your practice fun. People want to enjoy it. But having said that, the staffing crisis, in my opinion, will continue for five to 10 years. So training is now critically important. You need technology trainers, systems, management systems trainers, people who build you new schedules, referral marketing expertise. And by the way, to the orthodontist, you are very smart people. I went to school with you. got it. You're a specialist because you're smart, but you can't know it all. And in today's world, you've got to access experts, whether it's a CPA, an attorney, an estate planner, a consultant, a marketer, or whatever it may be, you need experts to train and retrain your team regularly. You do not want this. If you keep the exact same people, you want a different team two years or three years from now, same people, new skills. Alison Werner (31:50) Yeah. Okay, okay. So kind of for my last question, it's gonna be a three-parter. I wanna take a look at or get your advice for orthodontists at the three stages of a career. So let's start with the orthodontist, the new orthodontist entering private practice today or in the next couple of months. What would be your advice for the year to come? What should they prioritize in this first year? Roger Levin (32:39) Well, without question, referral marketing. The bottom line is, if you have enough referrals, you're fine. If you've got a lot of referrals, you're more than fine. So if I'm a young orth, if I'm a, well, what you're describing for the most part, not 100%, are younger orthodontists. Often married, often have children, get out in the community, go to everything, join everything, be it the sporting events, be it the PTA. And because you're young and have a lot of energy, Alison Werner (32:49) Mm-hmm. Mm-hmm, yeah. Roger Levin (33:09) Go spend time with your referring doctors. If you don't have referring doctors, go meet them. If you're inhibited about it, they love to meet you. They're more than willing to meet new specialists, build relationships. This is what we do. We've worked with almost 13,000 specialists in 41 years, and a good half of those are referral marketing. We wouldn't be effective if we couldn't get General Dentists to start referring to our clients. We do it every single day. Alison Werner (33:25) Mm-hmm. Right. Yeah. Roger Levin (33:37) Don't be inhibited and don't be put off by somebody who doesn't engage in a relationship with you. It's a numbers game. You chase 10 or 20 to get five to 10. It's okay. As I like to say once an older client, everybody's not gonna love you and that's okay. As long as we get enough people loving you. So in the early stages, and the other thing is when you're younger, you got a lot of energy, work lean. You don't need every staff member on the planet because they're really expensive today. Alison Werner (33:47) Mm-hmm. You Roger Levin (34:07) You can have people doing multiple jobs. Living group used to be opposed to cross training. We like specialization. Now we like cross training because you, if somebody leaves, somebody else has to know how to do it. But when you're younger, you got great energy. You can have a great time working really hard and not even being tired at the end of the day. don't get a mentality of I shouldn't have to market. Yes, you should. And by the way, that will make you incredibly successful. Yeah. Alison Werner (34:15) Hmm. Yeah. Right. Okay, all right, so now for the mid-career. Roger Levin (34:40) Yeah, mid-career, I would describe as you are busy, you are successful, you got referrals coming in, because we're not talking about practices falling off the cliff here. Your staff is competent. Again, most staff need new skills. I don't want say they can be better, because that's like a judgment word. They can improve. They can improve performance, which I come in every day in my career to improve performance. So have no problem asking others to think that way. Alison Werner (35:07) Mm-hmm. Yeah. Roger Levin (35:10) Things are good, but there's another term we use for that called level three. You're maxed out in many cases, partly because you've got a bad schedule. Now, when I say that, your first thought is, have a really good schedule. No, you don't. We build schedules based on mathematics and data. Your schedule is typically 30 % below capacity, and that's before remote monitoring. So you might actually be 150 % below capacity. Alison Werner (35:24) Mm-hmm. Okay. Roger Levin (35:40) Having said that, things are okay and you're making a living assuming this economy doesn't go where it could, there's a possibility it might go into recession. So the key there is working on upgrading your systems because the better your systems and then having your team absolutely follow the systems. Right now you're running your practice by habit, it's okay. Alison Werner (35:52) Yeah. Yeah. Roger Levin (36:09) Because the supply and demand has worked. There's enough demand for orthodontics. Well, that demand slows down in a couple of ways. One, if the economy slows down. Two, for example, that DSO I mentioned, and this is just fact. I'm not, you know, I'm not pro or con, so to speak, but I don't have the luxury of being pro or con. I have to deal with what's happening. But that DSO I mentioned, these are general dentists doing the ortho. Now the orthodontists hearing this are probably tearing their hair out. Alison Werner (36:25) Yeah. Yeah. You're right. Mm-hmm. Roger Levin (36:39) and I've had these discussions many, many times, but the fact is they're still doing it and they're still selling it and it's competition. And they're one third the fee of most orthodontists. So you really want to be as efficient and well-systemized as you can. You need your referral marketing firing on all cylinders. Even if you don't think you need more new patients, you need to protect your future. And then, Alison Werner (36:44) Yeah. Yeah. Roger Levin (37:05) critically important at this stage is work on your customer service because this is where it starts to break down. This is where the staff gets a little more immune to the patients. I was talking in another webinar about customer service and my philosophy is every parent and patient is a VIP and needs to be literally looked at and treated that way. customer service is not an accident. It is a Alison Werner (37:29) Mm-hmm. Roger Levin (37:33) system, it requires training, but that would be my huge focus, efficiency and service in the mid-career. And then the other thing, Alison, is saving for retirement because I know that's not our topic today, but I've given lectures on wealth accumulation for orthodontists, not because I'm an investment advisor, although actually I am a registered investment advisor, but I don't use that at all. It's general concepts. Alison Werner (37:42) Okay. Hmm. Yeah. Mm-hmm. Mm-hmm. Yeah. Roger Levin (38:02) But if you're not saving well in mid-career, you're gonna be working a long time. Alison Werner (38:07) Okay, all right. So now for those orthodontists who are nearing the end of their career and are looking at retirement, what's your advice with this uncertainty in mind if they're planning to get out in the next year or two? Roger Levin (38:22) Yeah, well, uncertainties are definite. just, we just, I don't see anything that's going to make our investments better in the near future. We might be, you know, it might come back. you know, nobody really knows what's going to happen because we don't have any data for this. know, we know what a real estate recession looks like. We know what a technology recession looks like. So, you know, by the time people are hearing this, it could be better. could be worse. My guess is it's. Alison Werner (38:25) Yeah. Right. Yeah. Yeah. Roger Levin (38:50) it's gonna be worse, I'm hoping it's not a lot worse. That's my optimism. But not optimism based on anything other than I wanna be optimistic, because I like to be. So reality is for between mid-career, late-career and late-career, I would offer the following points. Get a financial plan, and I don't mean one that's spit out by one of the brokerage firms off a computer. Get a real financial plan done. Alison Werner (38:54) Yeah. Mm-hmm. Okay. Roger Levin (39:20) Number two, when you calculate how much you need to retire, calculate it without the sale of your practice. These are Roger Levin's recommendations. They're not right. They're not wrong. But anybody doing what I say will be in good shape. If you don't have to sell your practice to retire, the sale becomes a bonus. So I've counseled forever. Don't depend on the sale because, you know, depending on economies, even a good practice might not be saleable. Alison Werner (39:35) Okay. Hmm. Okay. Right. Right. Roger Levin (39:50) And I've been through lots of sales and I've seen just about everything and it can get, it can be good or it can get pretty ugly. Number three, no matter what your financial planner tells you you're going to need, they are wrong. A hundred percent of the time they are wrong. Now, how can I say, I said that to get everybody's attention like Roger, what do you know that they don't know? Nothing. Here's what I know. They can only base your financial plan on what we know today. Alison Werner (39:58) Yeah. Yeah. Roger Levin (40:18) So if you had a financial plan done four months ago, it just became, and you have it done again today, it's a totally different look as to how much you have to put away. know, 5 % growth is great, except when the market's going down or the bond values are going down. And my last suggestion is, and the younger you hear this, the better, whatever they tell you in financial planning, you need to go for 20 % more. Tell your financial planner, redo my plan. Alison Werner (40:24) Right. Mm-hmm. Roger Levin (40:46) Assuming I need, let's say they say to you, need five million or four million to retire, add 20 % to whatever they tell you. Once again, if I'm wrong, you're only better off, give it to charity, give it to your kids. But if I'm right and you don't do it, you're going to be working more years. And the average age of an orthodontist retiring is near 70 today. And yeah, and I'm certain it's going to go higher. Alison Werner (40:52) Mm-hmm. Hmm. Really? Roger Levin (41:15) in the next few years. I said that before the whole tariff discussion, that taxes are going up, cost of living is going up. Right now, the only thing everybody talks about are eggs. They've gone up. But the fact is, it's going to cost more to live in the world. And therefore, by the time you get there, you may not be in a position to retire. And don't say to yourself, well, I'll work till I'm 75. Alison Werner (41:15) Huh. okay. Mm-hmm. Yeah. Roger Levin (41:43) You might, that's great. I'm a third generation dentist. My grandfather, general dentist, but he retired at 79, not because he had to, he loved dentistry. But ortho is different than any other part of dentistry, and you and I have never talked about this before either. A 70 year old surgeon, no problem. Endodontist, busy as can be. General dentist with a great patient base, no problem. When you cross that 60, 65 year old, Alison Werner (41:44) Yeah. Mm hmm. Yeah. Mm-hmm. Hmm. Mm-hmm. Roger Levin (42:11) age bracket in ortho, your referrals naturally begin to decline. They don't have to, but you're older, you're out of touch, you're definitely far away from kids. don't have, younger orthodontists in the community are taking away referrals because they're in those natural positions. So when we get a call from a 55, 60, 65 year old orthodontist who's down 30%, they're in big trouble. That's a hard turnaround. So Alison Werner (42:17) Hmm. I know. Mm-hmm. Mm. Okay. Roger Levin (42:41) Again, save early, compound interest is great, even in a bad economy, it will come back. Know how much you have to save, add 20%, put yourself in a great position and don't need the sale of your practice. Because if you're 70, your practice could be good or it could be half of what it used to be. And we get these calls every month here from different orthodontists looking for some formula for help. Alison Werner (42:44) Mm-hmm. Mm-hmm. Mm-hmm. Yeah. Yeah. Well, Dr. Levin, thank you again for breaking this down for us and for keep bringing in what is currently going on so we can make this practical for orthodontists for the next for the year to come. So thank you again so much. Roger Levin (43:24) I've loved doing this with you and I hope next year when we do this and complete the survey, I've got really good news. I want to say to everybody, I was so wrong. That would be great. Alison Werner (43:34) Yeah. Well, you have plenty of caveats and you said like if you just follow the advice, you could be if you're wrong, you're still ahead. So yes. Yeah, yeah. So we'll see you for the results of 2025 a year from now and we'll see where where it all stands. So thank you again. Roger Levin (43:37) Yeah. I hope to always do that, you Great, thank you, Alison.