Topics of the day:
1. Re: Where Can I find this measuring gauge
To Dr. John McDonald:
I've one, it says "ZURCHER MODELL DENTAURUM 042-751". I think you can try the "Dentaurum company".
Retention between phase I and phase one phase II is a problem that in most cases cannot be resolved efficiently - and this is one of the many reasons to avoid II-phase treatment. Others are prolongued total treatment time and higher cost in relation to standard I-phase treatment, while better results cannot be expected.
The very few exceptions to these rules today are the same as they were defined 50-60 years ago: class III, cross bites, extreme overjets with air-cooled incisors and some other rare diagnoses. It is very rewarding to read the old articles by Nance and Strang on this issue. Although they were not based on extensive research, but rather on clinical experience and intuition, most of what they wrote on treatment timing stood the test of time and was confirmed by research in recent years.
Thus, the rising popularity of II-phase treatment in our days cannot be justified by scientific data. On the contrary, it seems to be based mostly on practice management decisions, because young patients can be branded early and kept in the offices for a longer time. Good for us, but bad for them.
It is not my intention to attack anyone asking a question on II-phase treatment, but I think if treatment efficiency is a matter of concern, such problems will rarely occur in daily practice.
Dr. Henning Madsen
Re: Phase 1 retention
What is it that you are trying to hold?
My feeling is that if a first phase of treatment is necessary (I find only about 20% in my practice, not counting serial extraction/lower lingual arch) then it is the orthodontists responsibility to insure that the correction is held until phase II. In my practice that means soldered TPA's after expansion, upper lingual arches with spurs distal to the laterals and in some cases, a bonded lingual 1 to 1 to hold a diastima closed if that is what I corrected.
I often wonder if people really think that the average 9 year old can keep track of a retainer for 2 1/2 years waiting for teeth to erupt. I mean, most adults loose their car keys at least once a month. Permanent retention is the only responsible solution, or ask yourself, why you are doing the treatment. Is it really something that cannot be achieved in a final, definitive phase of treatment? If not, fix it and hold it without any patient cooperation. Parents are happier and your life is easier.
Dear Todd Walkow,
Total staff compensation including salaries and benefits ordinarily should be from 20% to 25% of your gross practice receipts. Any less than then 20% and you are most likely underpaying staff. Any more than 25% and you are probably overpaying. If you live in the northeast the high range can go to 27% due to some state laws.
Jerry Clark, DDS, MS
My comments are in response to the question raised by Dr. Walkow's regarding whether staff salaries should be in the 21-24% range.
It was implied that staff (“team”) growth is predicated on maintaining a certain percentage of income to the staff. Why effectively give the staff a fixed percentage of the practice's income. The staff certainly does not receive a portion of its liabilities? The comments also suggested that staff is motivated by income. Parents don't make a decision to begin treatment principally on the fee, so why think that staff does a good job based on salary, regardless of what they say. I submit that we doctors too often use our analytical bias to solve this “touchy feely” problem of how to keep staff motivated. Who knows, it may be that when staff is paid too much, they become lethargic.
Also, to strive to be in the “range” of staffs salaries found in other practices is to be like other practices, which is “average” by definition. Lastly, as one's practice grows, there is an economy of scale, i. e. the percentage that is for salaries should lower.
The amount of money that “should” go to staff is the amount necessary, along with other perks, to get the job done in the manner desired.
I feel bad that your time at Harvard didn't more completely overlap my time. You would have been so much better prepared :-)
You are exactly right on what you are doing, the only suggestion I might make is to separate raises from reviews. It tends to muddy a lot of issues. Due to reviews one week and then give raises by letter or text a week or two later.
Salary overhead is what matter and 19 to 21% works unless you do a lot of lab work in house and then you might raises the percentages about 2 or 3 %
We have been using the "tag" system for our inventory of our orthodontic supplies. It gets pretty laborious but has worked for many years. I would like to know if anyone is utilizing a computerized inventory system. Are there any companies that provide a software program to get us started?
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