Ep 59 - The Past, Present, and Future of Orthodontics

May 20, 2024

We always look forward to conversations with Chris Bentson, Partner of Bentson Copple & Associates and President of the American Association of Orthodontists Foundation. In this episode, Chris delves into his past predictions while casting a visionary gaze into the future of the field. Throughout the episode, he illuminates the transformative impact of technology on orthodontic practices, stressing the paramount importance of embracing digital braces in today's landscape. Chris advocates for a forward-thinking approach, asserting that the future belongs to those willing to adapt. He confronts the reluctance of some older practitioners to embrace digital innovations, debunking notions of expense and investment hesitancy. 

Chris also underscores the significance of crafting tailored treatment plans and leveraging communication and technology to meet the diverse needs of adult patients. The conversation extends to strategies for reconnecting with former patients and speculates on the future trajectory of OSOs and DSOs. Remember: There’s never been a better time to be an Orthodontist.

IN THIS EPISODE:

  • (4:52) Chris looks back on his predictions and looks forward to the future
  • (9:44) Chris talks about the way technology has changed the ortho space and how critical it is for offices to embrace digital braces 
  • (12:55) Chris discusses aligners digital and remote monitoring, stating that is the future and that it is the older doctors who are not willing to change
  • (15:52) Chris speaks to the doctors who feel digital is too expensive and they don’t want to invest
  • (21:15) Discussion of birth rates being down and, therefore, there are fewer kids and appealing to adults
  • (23:02) Chris talks about making a plan, considering limited treatment, and meeting the adult patient where they are through communication and technology
  • (26:58) Discussion of reaching out to former patients and the future of OSOs and DSOs

KEY TAKEAWAYS: 

  • If you haven’t raised your rates in the last two years, raise them tomorrow. You need to take steps to overcome the rising interest rate situation.
  • To make a digital practice work, you must trade staff costs for lab costs. Digital improves the doctor’s quality of life inside the practice, allowing them to use the extra time for patients, practice, or lifestyle. 
  • The consumer wants digital braces. Orthodontic doctors who are slow to change are the older ones who have mastered analog braces. The younger doctors, 35 - 45 years of age, want to start with digital to get ahead of the shift we are bound to see.

EPISODE TRANSCRIPT

What follows is an AI-generated transcript. The transcript may contain errors and is not a substitute for watching the video.

(00:00:00) Dr. Leon Klempner: How's your ortho practice going? Are you up? Are you down? Are you flat? What's the forecast for 2024? Is it worth investing money in marketing and technology? Or could you just keep doing what you've done before? Want the answers? Who are you going to call? Not Ghostbusters. Chris Benson, our Golden Age of Orthodontics podcast sponsors, make it possible for us to bring you new episodes.

Dental monitoring is making orthodontic treatment smarter. DM Insights provides clear analytics on clinical operations and practice workflow. You can measure and enhance the effectiveness of your protocols, all while creating a new standard in patient experience and practice efficiency. Lightforce Orthodontics is revolutionizing orthodontic care with cutting edge Custom bracket technology that offers personalized digital treatment plans that are fast, precise, and uniquely tailored to your patient's needs.

Take advantage of (00:01:00) the new standard of care with 3D printed, fully customized brackets combined with indirect bonding and digital planning. You can learn a lot more and take advantage of some special offers by visiting our partner page at pplpractice. com 

(00:01:15) Narrator: The future of orthodontics is evolving and changing every day.

But And although the way to achieve practice growth has changed, there's never been a better time to be an orthodontist. Let's get into the minds of industry leaders, forward thinking orthodontists, and technology insiders to learn how they see the future of the orthodontic specialty. How will digital orthodontics, artificial intelligence, clear aligner therapy, remote monitoring, in house printing, and other innovations change the way you practice?

Join your hosts Dr. Leon Klempner and Amy Epstein each month as they bring you insights, tips, and more.

And now, welcome to the Golden Age of Orthodontics, with the co (00:02:00) founders of People and Practice, Dr. Leon Klempner and Amy Epstein.

(00:02:07) Dr. Leon Klempner: Welcome to the Golden Age of Orthodontics. I'm Leon Klempner, retired board certified orthodontist, uh, grandfather of four. Welcome to Right now, uh, director of ortho at Mount Sinai hospital, part time faculty at Harvard, CEO at people in practice, and I am joined by my. Lovely daughter, Amy. 

(00:02:30) Amy Epstein: Uh, four grandchildren and I'm gonna go ahead and speak for all of us that we're done.

That's it. It's four right now, and that's the cap. The Max shops closed. Um, I'm Amy Epstein. I am the COO of people in practice. I've spent the last 20 years helping businesses grow, uh, with strategic marketing in the last, let's say, 15, helping orthodontic practices grow. Today, we are thrilled to have Chris Benson back on the podcast.

If you don't (00:03:00) know Chris, I do not know too many people who do not know Chris. He is a partner at Benson Koppel and Associates in Greensboro, North Carolina. They do ortho practice valuations, provide recruiting services, negotiate transactions with both buyers and sellers. Aside from his work at Benson Koppel.

Chris serves as the president of the AAO foundation and he guest lectures. You will see him around whether it's to the Wharton students through the mastering the business of orthodontics program, or at AAO meetings, regional ortho society, residence programs, study clubs, you name it. Chris is our trusted advisor in the ortho industry.

And Chris was recently awarded the AAO's prestigious award for outstanding contribution to the specialty by a non orthodontist. Congrats on that. And welcome to the podcast, Chris. 

(00:03:53) Chris Bentson: Amy, thanks so much. Great to be with you and Leon. Um, I've got, I've got one getting (00:04:00) married of my threes and no grandkids yet, Leon, but I can't wait for that.

So, um, I hear it's a thrill. Um, but, uh, we won't get the cart before the horse, but it's always great to be with you guys and, uh, I appreciate the 

(00:04:13) Dr. Leon Klempner: opportunity. Well, we appreciate it, Chris, um, and I've been looking forward to having you on because there are so many questions that come up. So, um, let's start big picture.

So, since covid, um, ortho's have been trying to figure out what is normal. Are we getting back to normal? We had a big bounce and then we've been flat. Um, I know you've had an opportunity to take a look at the Q1 numbers for 2024. So I'm curious what your thoughts are and what your predictions are for the balance of the year.

(00:04:52) Chris Bentson: Yeah, you know, it's been a roller coaster for sure. Uh, you know, 19 was a great year. And then we had the COVID year, we're off (00:05:00) 8%, but heck of a positive bounce back. 21 was that upside once in a hundred year flood year that everybody was double digit, you know, bounce back. Then we hit 22. Down 5 to 7%, depending on where you were then last year, we were down 1 to 3, depending on where you were.

And now here we are in 24. as I thought about 24 at the end of last year, I called it. I think it's going to be Groundhog Day. I think we'll experience 23 again in 24. Then I saw the January numbers, which are pretty darn good. Um, but a lot of that is HSA reloading. We typically have good Januaries, but it was an upside surprise to me.

Um, I saw February and it was a further upside surprise. So I'm gone. Um, maybe I'm getting old and not very smart, um, but March just was in the tank. Um, when you really looked at it though, um, for the first quarter, we had (00:06:00) an extra production day in January of 24 that we didn't have in 23. We had an extra, you know, leap year production day in February that we didn't have.

Those account really for, you know, quite a bit. And then we had two fewer work days in March. So when you look at an average number of days, they were the same the first quarter this year, as they were in 23 and for the quarter, we ended up minus a percent in production compared to last year. Uh, minus almost 2 percent in collections and unfortunately, minus 3.

4 percent in starts. So I think the way I was thinking about 24 at the end of last year is actually coming, you know, it looks pretty on target. I think there's a lot going on in this country. Um, there's a lot of angst, I think, after the election, regardless of which side wins, um, the consumer is going to feel better.

And I think as soon as we get. Uh, a couple of interest rate cuts under our belt, we're going to feel (00:07:00) better. And so if you heard me lecture a year ago, I was thinking 24 would be a pretty good year, 12 months ago. Things have kind of taken longer than I thought, uh, most economists thought. And I think this will be the first time I saw some data recently in 30 years that we've had three, uh, Down years in a row in ortho.

The good news is we always bounce out of these things in a really positive way. And so while it's lagging and taking a little bit longer than any of us would like, 25, six and seven are going to be killer good ortho years. What do you do between now and then? I think we'll talk about some of that, but it's, it's time to invest.

It's time to get ready for those 25, six, seven good years. If you're not already, the consumer is going to want certain things differently, I'd take an ortho and. Uh, you know, we'll touch on some of those things, but not a bad start. You know, I guess my, my charge to the industry is when, when you've got (00:08:00) inflation, even though it's coming down, we're at, I think we ended up at 3.

8 percent last year, we were 7 percent the year before. If you haven't raised your fees in the last couple of years, do that tomorrow. Because if we're going to be down a percent or two this year, if you raise your fees, two or 3%, you're going to be flat and that's, I think flat is the new up in 24, thinking of that way.

(00:08:22) Amy Epstein: So, uh, what you, what, it's amazing what you say and what we hear and how it's just perfectly parallel, um, it's, um, in some ways, reassuring, um, you know, and, but I'm glad to see that there's a light at the end of the tunnel that we're looking forward to some good years. I want to talk a little bit about your comment about investing and, uh, at the moment ahead of that.

I hear your lectures and a lot of what you talk about is the technology that's available to orthodontists, whether it's custom digital braces or the different options for aligners, (00:09:00) remote monitoring technologies from a marketing perspective. We love this. This is great. It gives us the opportunity to differentiate practices to promote things that we've not been able to before to get in front of people we hadn't been able to get in front of before the patients that maybe live farther away or are looking for different things.

Can you tell us about the trajectory of that uptake of different technologies, uh, in the ortho industry and how you're seeing it, um, you know, maybe prepare orthos for the coming years or hedge against what's happening right now? Like, how is this technology paralleling what we're experiencing industry wide?

(00:09:44) Chris Bentson: Yeah, you know, I have talked, um, really, I guess, for the last, a little bit less than a decade about, you know, digital in your practices where you got to be. Um, and a lot of my work has been centered (00:10:00) around. You know, how do you trade 100, 200, 300 fistful of brackets for a lab fee? That's a thousand dollars or more.

And how do you do that profitably? We spent a lot of time on that. We understand revenue per full time equivalent and all these kinds of things that we've been talking about. However, we've just had aligners really in that digital space and they're now 27 years old and this align is, and there's 100 aligner companies in the globe.

If you can believe that, um, you and I could name six pretty easily, but a hundred. Um, and the last two or three years in North America, a lot of starts have fallen drastically lower. So adult starts, um, since 21. But that's only 30 percent of our starts, so 70 percent of our practices were still analog with braces.

Now we have the advent with a growing cohort of digital braces (00:11:00) providers, where we, for the first time in the history of the specialty, can have a new patient come in, scan that patient, and have a discussion about, would you like custom aligners or would you like custom braces? Um, and, you know, the, the players in that digital braces space are growing.

And, you know, the obvious company is Lightforce. That's going to, you know, just tremendous growth. That's, that's going to be in this line 2. 0 on the braces world. But you have some other players in there, uh, KLO some others. And then you have just about every bracket company that has an aligner. Offering some kind of use our software to do a setup and we'll do an, uh, indirect bonding, you know, uh, you know, braces case for you.

And that's how they're playing in that field. And that's growing like crazy. So I, you know, what's clear to me is the data and the data says that an average aligner case is getting in and out of full treatment for an adolescent in 11 visits, an average (00:12:00) analog case is getting in and out of treatment and braces in 18 visits, and when you think of yourself as a.

Consumer of orthodontics of which of those two options, which you have, uh, the consumer today has a clear choice and that's fewer visits. Um, and now you can do that custom with 11 appointments for the digital braces cases in 11 appointments for the aligner cases. So they're equivalent. So we're going to see a huge uptake in the future.

It's happening now, um, in, in the digital braces side of the business, because that's what the consumer wants. And you can do a fantastic job as an orthodontist with it. Um, you know, you don't take any arrows in the chest right now, as far as being early, because even the digital braces company, I think the light force has been out five years, these other ones, two, three, four years, those products will continue to improve just as aligners did, but that's what people want to do.

And when you overlay that. With kind of the third leg of digital, which I would (00:13:00) say aligners is one leg digital braces, another leg or indirect bond. You want to look at it that way. And then some kind of remote monitoring system. Um, and I've, you know, I know the most about dental monitoring, but there's other there's a grand there's virtual assistant within this line.

There's a lot of those out there. But when you, when you use those 3, that's the future of the specialty. Um. In the 35 to 45 year old orthodontists, you know, get that when you query the residents, they want to start that way. It's my age group that's the problem because we're expert in, you know, we've got an, uh, we've mastered analog braces, um, and to change that is difficult.

And so it'll take a while, but the double digit growth going forward is going to be in the digital braces companies. Um, you know, I think Align will continue to grow at 67 percent year over year. But, you know, I look at those numbers in North America and I say, how do they keep hitting their quarters?

It's because, you know, Orthodox across the world have (00:14:00) expanded in 75 percent of their businesses outside of the boundaries of North America now. So they're growing there. Uh, the future is digital. It's clear to me, and you can make money doing it. And we've, we've cracked that code, but you can now really lever The efficiencies that come with digital on the number of people you need, um, which we haven't had when we were just in the line or space.

(00:14:22) Dr. Leon Klempner: Yeah. So, I mean, we've been, we've been saying similar things to our clients for a, for a long time. Uh, but I think that we're, we're coming to a point where, um, it sounds from, from the way that, that, that you see it, at least that, um, it'll soon not be. An option for orthodontists. I know a lot of orthodontists kind of sitting on the fence.

Some of them believing that, well, I could kind of just do my traditional thing and not invest because, you know, the, the other piece of it has to do with the rising lab costs and the costs of (00:15:00) doing this. So, you know, when you add up dental monitoring, life force, some marketing, I mean, that, that, you know, you're, you're putting a hefty, um, Price that most or most orthos aren't used to spending.

And, you know, they, what I hear from discussions with them is that they can't afford it. Uh, because their practices aren't growing, so, but, you know, how are you going to get your practice to grow unless you invest? So with, you know, what do you say to those orthodontists that say, well, you know, this seems like maybe it's just going to pass and it's a lot of money.

I think I'll just kind of stay and do what I'm doing. 

(00:15:43) Chris Bentson: Yeah. I mean, it's a discussion that you have every day. I do too. You know, data is friendly and when you have data that you can share and show improve your thesis that you can do digital (00:16:00) profitably. Um, I think that's the best argument. And that's what I tell him.

You know, I tell them your, your practice will go digital, maybe not while you're in it, but your successor, I mean, in the future, you know, high pull headgear disappeared. It did a great job, but it's not around anymore. And analog braces will become less relevant every year going forward embrace in in orthodontics.

And so, you know. What the real magic for me, and the reason that I'm so enthused about digital braces is because that's where 70 percent of your business is. And I talked for years on how to be profitable with these, you know, aligner case fees, lab fees. But only 30 percent of our business was, was with aligners and 70 percent was with analog.

So you still had to act and staff like an analog office because that's primarily what you were. And that's where the market is still today. Now with, with digital braces, you, you have both and the future orthodontic practitioner is (00:17:00) going to produce more, work less, have as good or better outcomes and just.

You know, have fewer people in there, fewer staff people. Um, and, and that's very clear to me. And so there's so many examples that I could share just serially practice after practice, after practice. That is either all in digital or it's 70 to 80 percent combination braces and aligners. And their overhead is 50, 55 percent because they don't have all the people.

Um, and that's, that's the only way you can titrate this. You have to trade people costs for lab costs. And that's the only way it works, but it does work. And your quality of life inside the practice is better. You can trade that extra time that you get back for more time with the patient. If that's what you want.

Or less time at the practice, if that's what you want, or delaying adding that associate or partner, if that's what you want, I mean, it's got all kinds of (00:18:00) positives and I see that the younger generation wraps their arms around this, they understand that. It, um, you know, it will take a while because I think the clients that are spending, you Money with me on transition.

That's, that's the argument they have. Hey, Chris, I don't want to go to digital because I don't want my overhead to go up. And it does for a short time. It's it's there's a, there's a value of about six to eight months, depending on how you do it, where you actually probably do make a little bit less money.

And so growth takes care of a lot of that. Right. And we've not been in a group high growth period. So there's been some hesitancy to go there. But we're going to grow, and this takes a minute to understand and get on board. So if I'm spending money as a practitioner in 24, I think I got to dip my toe into the digital bracing space with.

Whatever option that you want to choose. And if you're like me, I'm a small business owner. I hadn't updated my website in 10 years and I'm just doing a new website. I (00:19:00) mean, you got to be able to tell your message in a relevant way to the consumer. Those are two good places to be. And as I've always said, the practices that outperform on every operational and financial metrics that we value, have somebody like you in their life.

And so, you know, you have to have. A sensei and part of the attractiveness of these OSO and group practices is we've got some smart MBA type people that know how to make the phone ring that know how to do systems that know how to do websites that know how to implement and buy things cheaper. Um, and that's part of the attractiveness of that.

But even those, those companies have had a hard time growing, but now's the time to invest. It's clear to me that you can. You know, raise your fees. You'll be flat on cash. Make a investment. It's not, we're not talking about anything that will break the bank this year, but be ready for this growth so you can speak to the consumer.

Anecdotally, I'm, I'm also seeing, um, I can't prove it, but I (00:20:00) believe it is that the digital practices are outperforming the non digital practices when it comes to growth. And so, you know, you always hear the unicorns and things like that. But if you, if you just look at the whole body. Of, of work in the orthodontic independent practice space, the ones that are digital are actually growing in this environment and the ones that are not are not.

So, um, you know, I think facts are friendly. Let's look at the data. And if you want to go there. You know, the later you get there, the later you get the results. 

(00:20:32) Dr. Leon Klempner: Yeah. And you know, we're always looking as marketers through the lens of the patients and the parents and certainly the convenience factor, but there's another element that, um, I, I heard you.

Speak about recently, and that has to do with the, uh, the birth rate and the number of kids and the, the necessity for orthodontist to, to appeal to (00:21:00) adults and, and, you know, to supplement that is, you know, during a period of time where we might see a decrease in the number of kids, what, what is the forecast in terms of the next 5 or 10 years in terms of, of kids in our practice?

(00:21:16) Chris Bentson: The business of orthodontics is unique in many ways, but 1 way it's unique is, you know, that 70 percent of your case starts on average today are 11 or 12 year olds, give or take. So you rewind the tape to birth rates 11 or 12 years ago, and you can kind of see what's coming into the. The market as a whole, and when we had that hundred year flood year in 21, and you, and you go back, we were at the peak.

We had 4. 3 million births that year. And then we went to 4. 2 and 4. 1 and we're now in the 4 million and we leveled off at 4 million for about 4 years. So what we see coming into the market right now. Is going to be steady for the next three years, but then it goes down to three, nine, three, seven, three, six, three, four.

(00:22:00) And so if I know that, um, and I know that competitiveness is not decreasing, it's increasing for lots of reasons. I know that orthodontists are actually with digital technology, for one reason, working longer, um. And so I better have a strategy that I'm starting to think about on how to speak to the adult marketplace, because they're going to be super important.

And we saw them in spades and COVID, um, they had time, they were, they had money. They were working from home. They, we had the zoom effect, all those things were true. But then in 22 and 23, they fell off the map. They'll come back. It's not linear, but they're, they're there. How are you speaking to them? And we've seen Spondra at club go bankrupt.

That's a great thing because 2 million people said yes to that idea. And when you, you know, a lot of orthodontists tell me, Chris, I don't want that patient in my practice. I said, really, you don't want firemen. You don't want teachers. You don't want government workers. You don't want shift workers. These, (00:23:00) all these people can afford.

Whatever option you have, whether it's full treatment or limited treatment. And so I think we've talked in the past about limited treatment. I'm a huge fan of it. I think he can make great money doing it. Um, you know, there's direct print options and things like that now that really bring the cost of that idea down.

And so I would be thinking if I'm a. With our business owner that's starting now, he's got another 30 year plan. I want to do a great job with my supervision patients. That's you guys. I want to do a great, great job. Um, You know, speaking the language that the adult patient needs to hear, which is flexibility.

And when I can come in flexibility and payments, um, you don't have to get the perfect occlusion. You can get a, you know, small group club, like experience, um, and price, you know, be higher, but not that much higher. And I'm going to start speaking to those folks on. My digital media sites, because that's how that's where they go.

(00:24:00) And, um, you know, I think that is very important for, especially if I'm, if I'm under 40 and I know I got 20 years left, I know what's coming, so I got to get good at this and it takes a while to get good at this. 

(00:24:13) Amy Epstein: Yeah, just to go a little, you know, full circle to the technology, the implementation of technology and the targeting of adults.

I mean, the benefits of a digital workflow really speak to adults. You know, fewer appointments and being able to, with remote monitoring, be treated from. You know, the comfort of your home and all that stuff is those, those messages speak, uh, exactly to what works for many adult patients who are trying to squeeze in orthodontic treatment.

And if they can't, they won't do it. But if they can, if you make it easy for them and you tell them. Um, and that's the key, I think, is like you said, telling them messages, making sure that you're reaching them and then providing the ability. It's part of the digital (00:25:00) workflow is the communication workflow, providing the ways in which you can connect with them easily and making it easy for them.

Make them call you and wait on hold or leave a message, or like, some of the times we just can't do that. Uh, but we can in between pickups and drop offs and all that thing, send a text message or, you know, reply to something. Uh, so it's just like meeting, meeting these adult patients where they are, um, through the technology, the digital technology itself, the, you know, appliances, but also through the communication, uh, that you offer them.

I agree. I mean, 

(00:25:32) Chris Bentson: it amazes me still to see clipboards and paper to onboard a patient. There's not a mom on the planet that wants to do that. There's not an adult on the planet. I hate it when I have to do that in the, in the, on the medical side and I still have to do it, you know, and I'm seeing the doctor a lot more than I used to, but it's just insane.

And, and I would say too, I mean, what you just said about the convenience for the adult (00:26:00) patient, I mean, I'm 62 and I had braces for about 15 months, started two years ago. And, you know, I chose David Sarver who lives in Birmingham and, you know, I'm in North Carolina, but, and I did a hybrid really, I wore a liners for 10 And I wore them great at the beginning and terrible at the end.

And my teeth stopped moving. And I said, I'm kind of cooked. Let's get this finished. And he said, what do you want to do? And I said, put me in Lightforce. And so I finished up with Lightforce for four months, but I only saw David five times and I got a brand new smile. That's what the adult patient wants.

And. It's possible all day long, however you want to do it. You can see it more than that. You can't see much fewer times than that, but you know, we did, we did dental monitoring on top of that. So we got to, to see that, but that, that was my own experience and I loved it. But you've got to start talking to these people.

They have to know that that's an option. I think the other thing, and (00:27:00) I don't know what you guys think about this, but we have always been trained really by the consultants, get these patients out of your practice when they're done. You know, do one. Uh, retainer check, um, and then dismiss them from your computer system.

I think the bigger practices at least that have 10, 000 smiles walking around town need to stay in a cadence of communication that you can do digitally now with those patients and educate them that we're here for you. Um, You know, you may or may not wear your retainer, you know, age happens, you may or may not be as satisfied with your smile 10 years from now that you aren't.

We're here from you. And this is a no guilt place. You know, we're fine. There's a lot of patients out there that have been seen by an orthodontist in their town that won't go back to that person because they think they're going to let that person down. But if I'm in communication with them digitally, it doesn't take a staff person.

I think that's a huge idea that we need to adopt. Okay. 

(00:27:59) Amy Epstein: (00:28:00) Definitely. I mean, it's a, it's not a project anymore. It's not a, you know, one and done, but it's a relationship like you have with literally almost every other doctor that you go to, uh, an ongoing relationship where you see them beyond just whatever it is.

It's the, uh, concentrated time you spend with them on a particular, uh, issue that you're facing. But yeah, that's a, that's a big communication. Effort because it really is trying to reposition in the eyes of the patient, who you are to them and what the relationship can be, but it's not that difficult to do because the deterrent is really, you know, feeling like I'm letting you down because I didn't wear my retainer.

Take that away. Just take it away and tell them. It's just communication. 

(00:28:48) Chris Bentson: And, and, you know, you got to touch those people every year, one time at least. And, you know, do you want to check up, send us a picture? I mean, we can do all kinds of things now that we couldn't do not so long ago. So 

(00:28:58) Amy Epstein: absolutely. (00:29:00) Yeah.

Oh, that's a whole other, you know, internal training exercise too, is, is keeping in touch. And like you said earlier, uh, not dismissing them, but, you know, keeping them on the, uh, recall in some way. To be able to establish long term relationships where it doesn't feel like it's out of the blue to come back and it doesn't feel like a failure.

It's just, you're inviting them to come back, but that's a whole other initiative that isn't currently being done. It's a 

(00:29:24) Chris Bentson: big idea. Yeah. We need to do that. 

(00:29:27) Amy Epstein: Absolutely. I want to, uh, squeeze in a question here. Um, you mentioned a little bit. Earlier, we're talking about transitions and so is D. S. O. S. Let's talk a little bit about that phenomenon.

So for a while we were feeling like that O. S. O. Discussion was happening a lot. Practices are selling. My observation is that that may be leveling off from our viewpoint. Is that true? And what's your outlook on, um, you know, the continuation of OSOs, (00:30:00) um, buying a practices? The piece 

(00:30:01) Chris Bentson: of acquisitions by the OSOs and DSOs is drastically down for the last 2 years.

Largely for the same reason that some practices are down, which is the cost of capital, um, IE, money, you know, interest rates have gone up a lot. So, you know, again, facts are friendly. The facts are that about 10 to 11 percent of the orthodontists in the United States have sold to an OSO or DSO. So 90 percent ish have not.

Another 8 percent of our younger doctors are working in one of those environments. So if you look at. The population of roughly 10, 000 active licensed orthodontists, 1800 of them are somehow attached to that idea. Um, the, the 8 percent that are working are not staying there. They're bouncing out and they want to be Leon someday.

Um, and they want to run their own shop and run their own deal, but we have this kind of delay. You have a job or (00:31:00) two, and then you, then you bounce out and buy your practice, partner with a practice. You know, and so forth, you know, so the, the question really is, is, you know, we were down acquisition wise. 21 was a huge acquisition year, but, um, after COVID, um, and then 22 was down.

25 to 30 percent from there last year was down another 15 to 20 percent most of that is because the cost of money, it just is more expensive for the OSS to do that. Once you see the interest rates come back down into this year. 1st, part of next year, you're going to see that ramp up again. Where does it go?

I really do think it'll go to 30 percent because if I have a 3Million dollar practice, it financially is likely the best option for me. Um, if I have a practice underneath that, which is pretty much. 80 percent of the practices in the country, um, you know, I, I may not want to go that route, but I think it, I think it grows to 30 percent of the, of the orthodontists in the country.

(00:32:00) And I might think the other 70 percent for as long as I can see are going to be independent, you know, cottage industry folks. And so if you have a kid that wants to be an orthodontist, You know, this isn't going to be like pharmacy. This isn't going to be like, you know, and that's the, the antidote I always hear.

Um, it's not going to be like that and it's going to be whatever you want it to be. Um, and so I think orthodontics long term very bullish on it. Uh, but I do think these guys will grow. There's some distressed orthodontic. Assets out there right now in the corporate world, but they'll get refinanced. Um, there's a lot of money in ortho as we all know, and, um, it's not going to go away.

(00:32:42) Amy Epstein: Well, Chris, thank you. Uh, it's refreshing to talk with you because, um, I, I really enjoy facts. I think facts are friendly too. I love data and you're the data guy in ortho. So it's always great to talk with you because you have good observations, but they're always data. Forward and data based. So (00:33:00) appreciate your time as always.

Um, if there are questions from our listeners and they'd like to be able to connect with you, um, what's the best way to, to reach you? 

(00:33:10) Chris Bentson: Yeah, we've been around for a while. Um, our website is, um, Benson, coppel. com. My name's spelled weird. It's got a T in it. So, um, to get that right, you'll find us. Um, and of course, um, you can just Google us and.

Google Chris Benson and you'll find us or whatever. Um, we'd like to take the opportunity to say that, um, Shannon Patterson has been a partner here for a long time, and we are changing the name of our company to Benson Coppell Patterson and Associates, um, to add, add her and recognize that, and we're making that debut at the AO in New Orleans.

So, um, it's not like she's a new partner, but she's been with us for a while and just hasn't gotten the recognition we decided to do that when we were changing our website. 

(00:33:52) Amy Epstein: Very good. All right. Well, congrats. And, uh, that's wonderful. We look forward to seeing you at the AAO. We're going to be exhibiting there and speaking (00:34:00) there.

And I'm sure you are too. And so we look forward to reconnecting there. 

(00:34:05) Chris Bentson: Well, you guys do great work for your clients. I mean, the results speak for themselves and, you know, it's just nice to have this relationship now for a long, long time. I don't know how many of these we've done over the years, but. You know, four or five of them.

And it's nice to, to have a chance to reconnect every year or so. So I appreciate you having us on and listening to what we're kind of seeing, and any, anytime we can be of help to you, we're there. And if you're an orthodontist out there listening to this, um, do not be discouraged, be encouraged. It's gonna A, get better.

And b, you're in one of the best professions on the planet. 

(00:34:38) Amy Epstein: Absolutely. Those are our sentiments and we, we close out the show with a similar sentiment. Every time we'll do it today as well. Uh, Chris, thanks again. Looking forward to seeing you soon. Thanks, Amy. Thanks, Leon. You can subscribe or download other episodes on Apple podcasts, Spotify, SoundCloud.

YouTube, if you want to see our faces or wherever you get your podcasts, and if you (00:35:00) enjoyed it, we'd appreciate you telling a colleague for more information about people in practice. You can visit our website at pplpractice. com. You can even chat it, you know, text directly with my dad, if you want in that little chat box, he's on the other side of it.

And, uh, he'll get back to you. 

(00:35:16) Dr. Leon Klempner: You heard it from Chris. Um, For forward thinking orthos that are not afraid to adapt, to invest in marketing and new technologies, it really has never been a better time to be. And orthodontists, we're in a golden age right now. Take advantage of it. So bye for 

(00:35:34) Narrator: now.

Thank you for tuning in to the golden age of orthodontics. Subscribe now on Apple podcasts, Spotify, or visit our website at the golden age of orthodontics. com for direct links to both the audio and video versions of this episode.


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