Orthodontists' perceptions of and adaptations to nonspecialist and direct-to-consumer orthodontic service providers

To evaluate orthodontists' perceived impacts on their practices as a result of general practitioners (GPs) and direct-to-consumer (DTC) orthodontic care providers and the adaptational changes implemented in the past 10 years. An electronic survey was administered to 270 orthodontists in Canada and the United States to determine demographic background, perception of perceived impact, and specific changes implemented to improve practice competitiveness. More experienced orthodontists (P = .0001) and males (P = .027) were more likely to indicate a perceived impact from GP orthodontics. American orthodontists were significantly more likely than Canadian orthodontists to perceive an impact from DTC providers (P = .017). There was a positive association with orthodontists' years of experience and having implemented adaptational changes to their practice for a period greater than 10 years across multiple categories. Female orthodontists were more likely to have implemented adaptational changes for a period of less than 10 years across multiple categories. The perceived impact of GPs providing orthodontic care was greater than that of DTC providers. American orthodontists were significantly more likely to perceive an impact from DTC providers. Orthodontists have experienced a reduction in referrals from GPs and an increase in referred case difficulty. Less experienced and female orthodontists have made the most adaptive changes to their practices in the past 10 years.