Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 52

Practice Management

Practice Management Diary

Striving Toward Mastery

Dr. Jeffrey A. Nichelini
American Canyon, CA
PCSO Bulletin Section Editor

52	

Do you feel like you have mastered the art of
orthodontics? Many seasoned clinicians believe
that managing their practice is more difficult
than treating their patients. And, even though
I am guilty of holding this belief, I do not think
practicing orthodontics is easy. In fact, I feel like
I am in a constant push to try to better my work.
This is not to say I lament the quality of my care.
To the contrary, I think I provide an outstanding
service to patients, but I recognize it could be
better. Jamie Reynolds commented in his 2020
PCSO Annual Session lecture that he viewed
" mastery " as an asymptote that we strive
to reach, meaning that even though we can
continually push closer to this level, it is never
quite reachable. I agree with this perspective. In
the 8 years since I have graduated residency, I
have taken several dramatic steps to improve my
skill: sought employment with an established
practice of great repute (thank you, Jasmine),
joined forces with a great orthodontist to run a
satellite practice with the expectation of learning from him (thank you, Ken), brought a partner
into my own practice to double the eyes on each
case (thank you, Matt), joined a Spear Study
Club (thank you, Kuni), became a SureSmile
provider (thank you, Ken), and recently became
a volunteer clinical professor at the University
of California, San Francisco (thank you, Sunil).
All of these steps have ultimately benefited my
patients by bringing greater confidence to treatment plans, more efficient treatment execution,
more solid bites, more esthetic smile arcs, and
more stable results when braces are removed.

Despite the improvements, however, there is
still room for professional growth.
As I push toward the asymptote of mastery, I dwell
on the question, " How good is good enough? " If
the best orthodontists in the world do not treat
every case to the American Board of Orthodontics
(ABO) standard, then what success rate separates
good from mediocre clinicians? Considering that
some cases should not be treated to the ABO
standard, how do we differentiate successful treatment from unsuccessful outcomes? As a specialty,
we have not yet answered these questions, and
maybe we never will. In the absence of an objective
grading mechanism to know the level of care we
provide, I find peace reflecting on how far I have
come. Occasionally, I will look back at finished cases I have been proud of; with more seasoned eyes
I observe details that I previously overlooked and
recognize that the caliber of a finished case that
gives me pride has gone up. Also, I have a memory
from my residency in which my co-resident was
impressed with a faculty member because after
several attempts at trying to improve a patient's
midline, the faculty observed with a quick glance
that one lateral incisor was 0.4 mm smaller than
the other. He was so impressed that he said, " One
day I want to be as good as Arndt Klocke; I want to
see my cases that clearly. " The week before writing
this edition of the Practice Management Diary, I
reviewed a mildly asymmetric lateral incisor case
with a resident and thought about that interaction
with Dr. Klocke. I may not be at his level yet, but I
am on the right track.

PCSO Bulletin    Spring 2021



Pacific Coast Society of Orthodontists Bulletin Spring 2021

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Spring 2021

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