Staffing is one of the most common topics in orthodontics right now. But in a recent conversation with Dr. Jeremy Lustig, orthodontist and co-founder of Lustig and Young Orthodontics, a multi-location practice in Texas, the discussion shifted to something deeper.
The conversation quickly moved past hiring and into something more revealing: how work is actually designed inside the practice, and how that design shapes everything from team performance to the patient experience.
Staffing challenges in orthodontics are real. The model has changed.
There is no question that staffing feels harder today. Orthodontists are navigating longer training cycles, fewer experienced hires, and more turnover than in the past. More than half report significant staffing challenges, with concerns ranging from recruiting to retention .
At the same time, orthodontic practices are busier. Production has increased, while the average number of staff per doctor has declined . That means teams are being asked to do more, across more complex workflows, with fewer people.
Technology has added another layer. Digital workflows, new tools, and evolving patient expectations have expanded what teams are responsible for every day. Training is no longer about learning one role. It is about learning a system.
This is where the conversation shifts.
Because what many practices are feeling is not just a staffing shortage. It is a system that has not kept pace with how orthodontics has evolved.
Why a fully staffed orthodontic practice can still feel inefficient
One of the most important insights is this. An orthodontic practice can be fully staffed and still feel inefficient.
The schedule is packed . The chairs are full . The team is working hard. And yet:
- Follow-ups are inconsistent
- Tasks fall through the cracks
- Patients slip out of the funnel
- Questions constantly route back to the doctor
This is not a people issue. It is what happens when systems are unclear. When there is no defined way for work to flow through the practice, teams fill in the gaps. They rely on memory. They make decisions in the moment. They ask each other what to do.
Over time, that creates variability. And variability shows up as inefficiency, stress, and inconsistency in both performance and patient experience.
“You know, in many cases, what looks like a people problem, is actually our problem. It’s a design problem. The good news, there, is that there’s something that we can do about it.” – Dr. Jeremy Lustig, Lustig Orthodontics, Texas
The hidden problem inside orthodontic team roles
Most orthodontic practices are structured around job titles. Front desk. Treatment coordinator. Clinical assistant. But those titles often hide how much is being asked of each role.
A front desk team member may be responsible for scheduling, patient communication, insurance verification, financial questions, and follow-up. Each of those requires a different type of focus.
A treatment coordinator may be responsible for presenting treatment, explaining financing, navigating insurance, scheduling starts, and following up with patients who do not start.
These are not single roles. They are multiple functions grouped together. When one person is responsible for too many unrelated functions, unpredictable things happen.
Tasks slip. Accountability becomes unclear. Stress builds. Burnout follows. Not because the team is not capable. Because the role is not designed for consistency.
How high-performing orthodontic practices structure work differently
The practices that are performing at a high level are not necessarily better staffed. They are better structured. They focus on how work flows through the practice, not just who holds a title.
That starts with breaking work into functions.
- What happens from the first phone call to the consult
- How patients move through financial conversations
- How insurance is verified and tracked
- Who owns follow-up on pending treatment
When those functions are clearly defined, they can be structured in a way that supports consistency.
Some responsibilities may stay together. Others may be separated. Some may be supported by technology or automation. The goal is not to add complexity. It is to remove ambiguity.
Why systems matter more than ever in orthodontics
In many orthodontic practices, systems still live in people’s heads. It shows up in small ways.
“Just ask her.”
“That’s not how we usually do it.”
“It depends.”
These moments signal that the practice is relying on memory instead of process. That creates friction everywhere.
Training takes longer because there is no consistent way to teach. Turnover becomes more disruptive because knowledge leaves with the person. Patient experience varies because execution is inconsistent.
When systems are documented and clear, the opposite happens. Training becomes faster. Expectations are easier to understand. Teams gain confidence because they know what success looks like. And the practice becomes more stable as it grows.
A better way to approach staffing in orthodontics
When staffing is treated as the core problem, the solution often becomes hiring faster or finding more experienced people.
That can help. But it does not solve the underlying issue. When staffing is viewed as part of a larger system, the focus shifts. It becomes about:
- Designing roles that are sustainable
- Creating workflows that are repeatable
- Building systems that support the team
In that environment, staffing improves naturally. Hiring becomes easier. Training becomes more effective. Retention improves because the day-to-day experience improves.
The same team can deliver very different results depending on how the practice is designed.
The opportunity for orthodontic practices
Staffing challenges are real, and they are not going away, but they are also not the only lever.
The practices that are navigating this moment well are not just trying to solve for people. They are redesigning how work happens inside the practice. They are building systems that create clarity, consistency, and confidence across the team.
And when that happens, staffing starts to feel less like a constant challenge and more like a foundation for growth.
