It is time someone actually put the M.D.S. orthodontics program to an audit. Is it really worth the time and money ? Is there an alternative ? Let’s analyse.

The M.D.S. program is basically meant to train teachers and researchers. Of course it is a fact that there is very little teaching and the research is almost zero.

Students pay exorbitant capitation fees for an entry in the MDS Ortho program with an eye on returns from a private practice. I have still to come across a student who joined the program with the intent of being a good teacher or researcher. Or let’s put it straight. The students are there because of the practitioner and not because of the teacher.

The quality of education in the MDS programs is already at the bottom of the hill. There is no place to go except in a hole. This is mainly because the programs run by private institutions are by and large only meant for the purpose of earning huge sums of money for the Management.

Most teachers are there for the name sake and have become Professors and HODs by merely lending their names for the purpose of certification by the Govt agency. Eight years is all it takes to become a Prof. There are dozens of them around incapable of making any sound contribution to the teaching program.

Some time back the scene changed to high gear for Orthodontics in India. The advent of the Pre adjusted edgewise appliance was manna from heaven. The entire Begg’s community changed sides to Pre adjusted Edgewise without knowing a word of Edgewise. Most of the teachers are trained in Begg’s appliance and after having taken a two day course become experts in Pre adjusted edgewise. Sadly enough the course conductors themselves were similarly trained. (check this out )There is no control on who teaches what.

The entire Indian Orthodontic establishment is in a state of instability as everyone who has some clout advocates a new system at the first opportunity. Thus, claiming superiority over the others. And the general lot, who lack confidence, chase the new introduction in the hope of finding solutions to their problems in patient management.

It is the general impression that everything happens automatically in the pre adjusted appliance. Therefore, bite is never corrected in the majority of cases and the wire never moves up from a 016 NiTi in the treatment. This is because the operators who have changed from the Begg’s philosophy are content with the feel of the 016 wire and the opening of the bite in the Begg’s treatment plan is a foregone conclusion. It is also all right to have a Begg tube sitting on a molar. A sure atrocity, at best. After all what is being sold is the bracket system and not the treatment.

Also there is no concept of the anchorage. Sadly enough no one realizes that the pre adjustment is limited to tip and torque only. Is Orthodontic treatment only tip and torque ? What of anchorage, bite control and space closure, surely these are not pre adjusted.

The poor quality of work is masked by the offer of fancy gizmos. The result takes a back seat and salesmanship takes over with the offer of self ligating brackets, thermal wires and any other nomenclature that can impress the patient. Have you heard of robotic braces or dissolving braces? These are methods adopted to cover up on the incompetence.


Yes !! there is. If your intent is to practice, then a certificate course is the best way of learning orthodontics. You save time and money and learn from the best of orthodontic practitioner in India trained in Edgewise capable of delivering the very best education.

Put the suggestion to a test, consider the money involved, the poor quality of teachers in college, the return on investment which is at best dismal today and the scope of the job market as compared to the returns in practice and you will opt for a certificate course in Orthodontics.

The courses offered by the INDIAN INSTITUTE OF ORTHODONTICS are worthy of your attention. The Residency Program is the best suited for fresh dental graduates. Check it out.


It's that time of year again. The e-mails, the letters, and the cold call voicemails are beginning to arrive. They all pretty much sound the same. "Dear Dr : I am the best thing ever, so hire me. PS: I need to be paid $1,500 per day to start, and you need to finance my ultimate purchase of your practice because I am dead broke. PPS: I am coming to your town regardless of whether you hire me, and I will be happy to work as an itinerant orthodontist for multiple general dental practices as long as they pay me what I want."

Beautiful. These annual missives don't give you a whole lot of warm and fuzzy feelings about the future of the orthodontic specialty. The first two questions that come to mind when I read one of these letters are 1) who advised this person to study orthodontics in the first place; and 2) how much has this person borrowed to become a university-trained orthodontist? Well, after a few years of thinking about it, spending 3 years teaching in one of the most expensive orthodontic residency programs in the United States, reading some 2011 survey data,1 and doing some elementary-school math, I think some answers to these questions are self-evident.

The current orthodontic resident population (in the US, Puerto Rico, and Canada) is 1,035. After they complete residency, their plans include the following :

  • purchase a practice (54%)
  • work as an employee (25%)
  • launch a startup (11%)
  • go into academics (4%)
  • enter the military (3%)
  • other (3%)

Among this same population, first-year income expectations are as follows :
  • 8% expect less than $100,000
  • 37% expect $100,000 to $150,000
  • 41% expect $150,000 to $200,000
  • 14% expect more than $200,000

Meanwhile, orthodontic resident debt at graduation is well into six figures :
  • 26% owe less than $100,000
  • 15% owe $100,000 to $200,000
  • 22% owe $200,000 to $300,000
  • 19% owe $300,000 to $400,000
  • 18% owe more than $400,000

Right now, the AAO Practice Opportunities Services listings include 457 orthodontists seeking a practice and 153 practices offered, for a shortfall of 304.

Reality Check Let's look at two possible scenarios. Orthodontic Graduate A has $250,000 debt at 7% interest with a 10-year repayment.

  • Gross income: $150,000
  • Net income per month: $8,250
  • Debt repayment per month: $3,000
  • Money for living per month: $5,250

Ability to borrow for a practice or home purchase: marginal. Orthodontic Graduate B has $500,000 debt at 7% interest with a 10-year repayment.
  • Gross income: $150,000
  • Net income per month: $8,250
  • Debt repayment per month: $6,000
  • Money for living per month: $2,250

Ability to borrow for a practice or home purchase: unlikely.
The Facts
There are more orthodontic graduates per year than jobs available.
The mean debt of graduates is very high and rising.
Compared to the traditional 10-year loan payback, new graduates are looking at loan repayment over 20 years or longer. Tuition at public and private universities has increased at a greater rate than the consumer price index. There are approximately 65 accredited orthodontic residency programs in the United States, with more 3-year programs than 2-year programs.

The number of residency positions has significantly increased in the past decade.
There are two tiers of orthodontic residency programs. First-tier programs pay residents a stipend or charge a lower tuition, while second-tier programs charge up to $80,000 per year for tuition.
Individuals are not the only buyers of orthodontic residency positions. Some schools have initiated programs with foreign governments to reserve positions for international dentists at a "premium" tuition.

Some fiscally mismanaged dental schools and universities are dependent on orthodontic tuition revenue to keep their doors open. So who can afford to be a university-trained orthodontist in 2012? I would argue that, conservatively speaking, about two out of three current orthodontic residents could actually afford it. In fact, if an expert in finance were to sit down and calculate a 30-year net present value (present value of future cash flows) of an orthodontic education for each of the current residents in the United States, he would probably come up with a neutral or negative net present value for at least a third of them.

Why? In simple terms, you cannot rack up enormous debt that causes large year-over-year future cash outflows, have a modest amount of future cash inflows for the first 5 to 7 years of practice, and at the same time want to live a lifestyle that includes early practice ownership, home ownership, and hobbies requiring disposable income. So essentially, if the prospective orthodontic resident borrowed the same amount of cash but invested it in something that gave a return of 7% rather than investing in a dental/orthodontic education, he or she would have a better chance of reaching the desired lifestyle and financial targets for retirement.

An orthodontic resident who recently attended the AAO lobbying junket in Washington, DC, related the following encounter. In one of the breakfasts with senior leadership, he confided in a well-known orthodontic politician that he was deeply concerned about his impending $600,000 debt at graduation. The senior leader responded, "I have never met a poor orthodontist, so don't worry!"

As they say in Alcoholics Anonymous, the first step in recovery is to admit that you have a problem. I suggest we start discussing student debt transparently and in large public forums that include organized orthodontic leadership, academic dental leadership, and the lending industry. If not, you can rest assured that in a short time, annual missives from soon-to-be graduates will stop coming to orthodontist's inboxes and start arriving in from more sinister places.

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