Hard Eight Coming Out

On the heels of my Vegas trip for the Invisalign Summit, I figured that this gambling reference would help drive home a point about a vital part of our practice’s future success.

What does a dice combination in craps have to do with our practices? Watch this short video and find out.

All the best,

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Want to be a part of a geographically exclusive Facebook group like none other? With monthly webinars and CE courses with top speakers in the industry, there are only two prerequisites: You’re an orthodontist (yes, you can be an associate) and you want to contribute to a group of like-minded peers who have come together to share our practice ideas and solve our common business, leadership and management issues. Email me at Glenn@OrthoPreneursRD.com to learn more and to see if you’re region is available.

A Nasty Trend in Orthodontics

I had a really nice new family in my office on Friday. Their story was a common one. They started orthodontic therapy in Houston about 4 months ago, but the flood and a job relocation has caused them to move to Dallas.  Their 15 year old young son, a star football player, was in my chair with a full set of brackets and a desire for me to continue his care. They were a “yes, sir” and “yes, ma’am” family; Kind, sweet and very respectful. They weren’t looking for anything more than for me to continue care for their child and they didn’t have a negative thing to say about their previous Houston orthodontist, who was fine with the transfer.

So, why am I writing about this?

When I asked how they found us, she replied that we were he 6th office they called, but the first who would accept them. I asked her what that meant. She said that the first 5 offices either said that they “didn’t accept in-state transfers” or, without having seen her, they told her that they would “need to remove all of his braces to start”. This was all based on telephone conversations.  She was so incredibly thankful that we would even see her son for an exam, and this just seemed so wrong and unnecessary.

Before everyone throws the front desk “under the bus”, I have heard those exact two aforementioned statements from the mouths of my colleagues, so I know it happens a lot. I don’t understand it. Why would anyone summarily not “accept in state transfers”? I understand if a prospective patient has a story that includes an orthodontist from down the block, but why would you summarily not accept a transfer from 300 miles away without having examined them or hearing their story? Again, I know that everyone will say that they’ve never heard of such things before, but I’ll repeat that I’ve seen it. A lot.

Remember, her first statement was that they were coming from Houston because of the recent flood. I’d think that might help override some practice policies.

I have no problem meeting any patient. Yeah, my time is valuable, but even if they are in braces from the next town over, or just started, I’ll still see them. It doesn’t obligate me to do a thing, but there are always two sides to a story and a little investigation never hurt anyone. I’ve seen some awful people try to blame a colleague for issues that were clearly their making and I’ve seen cases where a friend orthodontist told me he’d be happy for me to take over the case.

I’ve seen braces placement that made me envious of the skill of the previous orthodontist and I’ve seen brackets placed in such a way that removal and replacement was the most expeditious way to finish. But, if placed properly, are we not able to finish a case with someone else’s brackets?

I rarely take off existing brackets if they look good and I always take new patients from anywhere, if (note the “if“) I get the current orthodontist’s blessing. So, why are scheduling coordinators telling patients that they need to take off all brackets and that they won’t accept in-state transfers? It’s coming from somebody in the office. If that’s not your policy, double check to see if your front desk is saying the wrong thing to prospective patients.

I see tons of posts on social media from orthodontists claiming that they take great care of their patients and others asking how to increase new patient flow. Well, here’s your chance. Policies of inclusion rather than exclusion and a willingness to observe, investigate and help others might just be the thing you’r looking for.

There are a lot of patients out there who are looking for orthodontists for a variety of reasons. I would NEVER recommend “poaching” a patient from another practice or interfering in a relationship in which we don’t belong. However, there are many offices (I know because I’m told by colleagues) that do not accept transfers from within their states, even considering the recent catastrophe in Houston. This leaves a lot of folks (like the ones I met on Friday) in a huge bind.

Most of us love our patients. But what about other office’s patients? That’s up to you.

Wishing you an amazing day,

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If you want to come to learn more about an amazing business meeting for orthodontists, simply visit OP2018.com . We’ve got a world-class lineup of speakers, amazing food and an ambiance that will make you want to come back year after year. You can always email me at Glenn@OrthopreneursRD.com or message me on Facebook. I’m here to help.

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Is Your Advertising Working For You?

Both my dad and my grandfather were dentists, so I remember what dental practices were like 45 years ago. It was truly a different world. I remember my father telling me how one could actually be “in the black” (making a profit) in as little as a few months, and there was literally ZERO advertising (it was actually not allowed). In case you didn’t think you read that right, he spent no money whatsoever on advertising. In his words, and the words of many of his colleagues from that period, you could “throw a dart at a map”, get an interest free loan from an equipment company, set up shop where the dart landed and  make a living rather quickly.

Crazy, huh? Could you imagine zero advertising today? No Facebook ad, no school sponsorship, no mailers, no gift baskets and no patient reward system. Seriously, can you imagine that?!?! Nowadays, unless you have a very unusual practice, you do need to advertise in some way, even if it’s just subtle. But the real question is: “How much does one need to spend on a marketing budget?”

I have an oral surgeon friend who is extremely successful. He has a huge practice and sort of owns the area where he practices with nobody a close second to him. Every year he invests almost 9% of his gross income to marketing. The more he makes, the more he puts back. If he’s grossing $2million/year, it means that he’s reinvesting $180,000/year into just marketing his practice. One could say that he’s spending too much, but others would argue that’s what is helping keep his practice so successful.

Other specialists I know have chosen to spend a lot of money (up to 10%) in the early years to get name recognition and then have eased back when they’ve become more successful, kind of like an airplane reaching cruising altitude.

Yet other friends have taken the exact opposite approach, borne mostly out of fiscal responsibility. They spend very little early on (1-2%) allowing their practice to grow simply through word of mouth, then growing the percentage lightly every year until it hits a comfortable level and just leaving it there.

The point is that every successful orthodontist I know has a certain amount they spend on their marketing, but it’s done using a plan they’ve developed. They set aside a certain amount with the idea that they will use it in a specific way. Whether you’re a young startup with a tiny budget or an established practice with a marketing team, you need to be judicious in the way you spend every penny and it all starts with a plan.

Forbes magazine had a great article in May 2017 where they offered the following advice for businesses developing a marketing budget:

“Determine your business goals by asking yourself the following questions:

  • What are your business objectives for the quarter?
  • What are your business objectives for the year? How about three years out?
  • How many of those contacts need to be delivered to your sales team, based on their close rates, to impact revenue enough to achieve those objectives?

It’s common for small businesses with revenues less than $5 million to allocate 7-8% of their revenues to marketing, splitting that between brand development costs such as websites, blogs, sales collateral, and promotion costs, as well as campaigns, advertising, and events. Never base your marketing budget simply on what’s left over after covering all other expenses.”

Did you read the last line of that quote? Unfortunately, that’s how many clinicians develop their marketing budget.

The end of the year is coming and it’s a great time to sit down and develop your marketing plan for the coming year. Whether you spend a lot or virtually nothing, it’s up to you, but have a plan, stick to it, then reevaluate it again next year.

Unlike my father and grandfather’s eras, advertising and marketing is simply a part of our lives and we need to embrace that. Nobody is saying that you need to spend $100,000/year to market your practice, but while making my budget I often remember the  advertisement the local movie theatre used to display to get people to buy advertising space there. It flashed across the screen before the feature presentation and read:

“A funny thing happens when you don’t advertise…


So, go out there and do something.

Wishing you an amazing day,

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If you want to come to learn more about an amazing business meeting for orthodontists, simply visit OP2018.com . We’ve got a world-class lineup of speakers, amazing food and an ambiance that will make you want to come back year after year. 

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What Our Teams Say About Us

As clinicians and business owners, we rely on our team members to serve specific needs for our practices and patients. After all, how can we perform our best orthodontics without someone to help us? We rely on our team members from the moment the phone is answered until the final recall visit.  But, do you view your team members as integral parts of your practice or as replaceable cogs in a wheel that will spin no matter who is there?

I remember hearing someone once say: “If my team member can’t show up for work on a regular basis, I have no use for them.”  I can understand the sentiment, but it has to be looked at from different angles.

On one hand, every member of our team needs time and energy invested into their training. We simply can’t hire someone (or shouldn’t) and tell them to go do the job. It takes time to hire and train the right person and if we view them as expendable, we’re in for a lot of work, while we constantly hire, train and fire workers. Sure, there are a lot of practices out there who view their team members as expendable parts of a bigger machine, but I’ve never looked at it that way.

I’ve always considered my employees to be much more than folks who just show up, work and get a paycheck. They’ve been invited to my family celebrations, they know my kids and wife and I care about them as people, first and foremost. And when the work relationship ends (usually because they’ve moved on to bigger and better things in their lives) we’ve stayed in touch. I invest in them well beyond their job responsibilities. Note the word “invest”. I’m not talking about parties and going drinking with them, but rather, spending the time and energy to help their lives outside of the walls of our practices.

YOU have to make the decision of how the employer/employee relationship will play out, but I couldn’t imagine working with my team and not helping them grow and become better in their daily life struggles because it makes ME a better person along the way.

It starts with finding the right employees and if you spend the time hiring people you know you can count on (more on the hiring process in another post) and let them know that you care about them beyond what they can do for your practice, you’ll create a culture where people feel taken care of. But, you need to “walk the walk”, which means that if you tell your team that you want them to feel like family, but fire someone the second they make a mistake, you’ll be seen as a charlatan and you’ll get back what you put in.

I recently visited the practice of Dr. Jim Stork in Iowa. It’s an example of a successful, fun and team-oriented practice. I watched his team work like a really well-oiled machine. It was evident that a lot of time had been put into training. During lunch I and had a chance to sit with his team and ask them about their jobs. Each and every one of them said that they loved the fact that Dr. Stork showed how much he cared about them and that they knew he wanted to see them succeed. It showed and they were successful because of it. They would do anything for him and his practice was successful because they would go that “extra mile” without being asked. Sure, he could have hired less capable and less positive people and treated them like employees, but he chose to treat them as a part of his family and their work ethic showed his investment in human capital.

Your attitude will show beyond those fun team building bowling nights or holiday parties. I’ve seen teams go through money management courses together and do book clubs as well as having speakers come in to help the team learn skills to help them succeed in life. I remember my dad paying to get a phone installed for an employee who didn’t have one, just because he knew how it would help her in her day to day life.

The less experienced and corporate bosses tend to talk about team members like they’re pawns on a chessboard with no lives outside the office, with no realization that those who have committed to us rely on our practices to pay their bills, take care of their kids and meet financial responsibilities. I’ve always felt a personal responsibility to my team members and while a mean or dishonest employee loses my emotional investment, I often realize that it was my missing something during the hiring process and it was generally my fault. So, I live and learn and keep taking care of those around me, not letting that previous failure ruin it for the rest of my team.

As Herb Kelleher, founder of Southwest Airlines used to say: “Your employees come first. And if you treat your employees right, guess what? Your customers come back, and that makes your shareholders happy. Start with employees and the rest follows from that.”

In this age of instant gratification, it’s important to remember that we’re put on this planet to make an impact and leave the world a better place than when we got here. If your goal is to take and take and take and not help those around you, I’m sure you can do that, but I couldn’t imagine living like that. For me, the value of my team members goes way beyond anything I’ll see on a P & L and making sure that those who care about me and my success get tenfold in return.

Wishing you an amazing day,

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If you’re not a member of our geographically exclusive OrthoPreneursRD Facebook page there are only two prerequisites: You’re an orthodontist (yes, you can be an associate) and you want to contribute to a group of like-minded peers who have come together to share our practice ideas and solve our common business, leadership and management issues. Email me at Glenn@OrthoPreneursRD.com or fill out the form below to learn more and to see if you’re region is available.ORTHO22final spot

Contact me for anything you want to discuss related to your practice life


Let’s Play a Little Game…

Every time I go to a physician’s office, I like to play a little game. I call it: “If I did this, I’d lose patients”. I try to count all of the things they do (or don’t do) that would cost me patients if I did them in my office. I’m sure you’ve done the same.

We could start with the huge glass window found in every medical office. The one that separates the patients from the front desk and make that horrible noise when moved. George Orwell couldn’t have done a better job of separating the bourgeois and proletariat. It makes it clear that we shouldn’t bother the front desk, who incidentally couldn’t care less about the patients except when they ask for the insurance card, ID and copay without even looking us in the eye. What would we tell our team members if they acted that way?

The waiting room (there is no way I’m calling it a reception area) is spartan with no TV (or worse yet, like my wife’s doctor, 2 TV’s with “dueling programming”), no games, not even a magazine. Where is the highlights magazine of my youth. I’d kill for that part where 10 things are wrong in the picture while waiting in this borings of places. Maybe there’s a dusty plastic plant in the corner, and the interior decorator looks like they worked for IBM in the 70’s with their creativity. The hum of the fluorescent lights has drawn my attention. I’ve decided I’m keeping their pen even if I’m not supposed to.

The assistant stands at the door, calling your name like an executioner coming for a condemned man, without ever looking at you and never saying “hi”, while telling you where to go. Maybe you got lucky with a “how’s your day going” comment, but it comes out like someone trying to get through a bad speed dating session or an IRS auditor starting the examination. She tells you where to sit and what to do and generally treats you with the compassion and kindness of a McDonalds employee taking your order.

If you’re lucky, you’re not forced to sit on the paper strip and allowed a chair. I always go for the chair if she doesn’t say anything, but like my dog trying to get away through the open door, my dreams are dashed as they often corral me back onto the crinkly paper that I’m sure they buy in bulk from the butcher. Can’t we just sit eye to eye and just chat? Oh, and could you at least look at me when you ask me about any recent weight gain instead of looking at your computer only? I mean, I worked hard for those pounds and you should see the joy on my face as I tell you about it.

The room is usually adorned not with anything a normal person would want to see but rather with posters or models that allow me to reacquaint myself with the anatomy of the ear, eye, knee or shoulder. I’m sure that with the amount of time I’ve often been left alone, I could pass a specialty board exam about the anatomy of the inner ear.

It goes on and on and I keep asking “how can all doctors get away with this level of customer service?” If I were to do this, I’d be out of business. I’m sure that the doctor is a nice person and cares about the patients, but the bigger question is how did the dental and medical models get so far apart? And it doesn’t stop with just the customer service or decorations.

Look at how differently we practice? Let’s take outcomes as a simple example. Let’s say you go to the orthopedist for an ACL repair. You sit with the doctor and he explains the surgery, what you should expect and what your recovery will be like. You go through the surgery, and as you’re recovering, the doctor tells you how well the surgery went. Everything went exactly as planned. You go through the rehab and do everything you’re supposed to. 6 months later, your knee still hurts a bit while you walk and there’s limited flexibility and you can’t play basketball anymore. You return to the doctor and he says:”Everything looks fine. The surgery was a success. The ACL looks great and it’s just that you’ve developed some stiffness. It’s just something you may have to live with.”

You see, the medical model has done something that we, in the dental community have never been able to pull off; They’re able to separate the outcome from “success”. The biologic outcome is different than the treatment outcome. Can you imagine if you told a patient:”Your bite looks awesome and the smile is perfect. I know that the clicking in the jaw has increased and you can only open half way, but it’s just something you’re going o have to get used to.” Medicine has gotten really good at having physicians not take things too personal and owning the problem. “Sorry, but there’s nothing else I can do for you” and here we are as orthodontists searching our Facebook groups for 3 days looking for an answer for our 9 year old patient who has canker sores that bothers him or how to give post operative instructions in a way that our patients will really care.

Could you imagine getting a special gift or goodie bag when you leave your physician? Or a follow up note thanking you for choosing the practice? Yes, I’m sure it happens somewhere, but it’s generally the exception, not the rule.

The point is that we’ve chosen to raise the bar in our profession and give our patients exceptional experiences. We market and try to stand out based on the “patient experience”. I know that going the way of the medical model is not the right thing to do and I’m proud of the way we all treat our patients like human beings deserved of kindness, respect and a little entertainment from time time. Yes, I think we often make our patients’ problems our problems, but I’d much rather belong to a profession that has people talking (and writing) about how well we treat them rather than the comical aspects of the poor customer service.

So, the next time you go to the doctor, take a look around and note the things you see and go back and make your practice and patient experiences better. Let’s be proud of the way we’ve chosen to treat our patients and drive ourselves a little bananas in the process.

Wishing you an amazing day,

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If you’re not a member of our geographically exclusive OrthoPreneursRD Facebook page there are only two prerequisites: You’re an orthodontist (yes, you can be an associate) and you want to contribute to a group of like-minded peers who have come together to share our practice ideas and solve our common business, leadership and management issues. Email me at Glenn@OrthoPreneursRD.com or fill out the form below to learn more and to see if you’re region is available.ORTHO22final spot

Contact me for anything you want to discuss related to your practice life


You’ll Shoot Your Eye Out…Or Not…

If you’ve ever seen the movie “A Christmas Story” you’ll remember that all the lead character “Ralphie” wants for Christmas is a Red Rider BB gun. He envisioned the fun he’d have with it, but all he heard from everyone (including Santa) is “you’ll shoot your eye out”. Was he overconfident? Were those around him just too worried? What does this have to do with our practices? It’s all about dreams and fear.

When I graduated, I was worried about every possible contingency that could occur in clinical practice. I guessed that everyone felt the same way.  I don’t care how cool you are, or how excited you are to finally be working, when you sit down in front of that first patient who needs your help, it’s got to be natural to be at least slightly nervous. Eventually, experience teaches you lots of lessons and you learn to trust your training, or you go out and get more education to increase your confidence. Some outgrow their fears and others cling to them, but if you’ve ever owned a practice, you understand how many decisions you need to make every single day and the role that fear can play.

When it comes to decision making, we’re all wired differently. Some are “emotional” leaders, while others are “technical”. Some leaders jump into decisions without thinking things through and other never “pull the trigger” because they’re too scared. But most interesting to me is the difference between leaders who see the glass as half full, versus those who see it as half empty.

You probably already know what I’m talking about. How often have you seen a post about an idea and the immediate response is how it can’t be done, or worse, all the reasons why you shouldn’t do it? Someone says they want multiple offices, the respondent says that it’s too much trouble running more than one. Someone asks about giving free retainers and the answers are all about how patients will try to take advantage of you. Mention providing free sports mouthguards for teams and many will talk about the liability you’ll incur or the cost of making them. Negativity seems to hover over the discussions and often squash the dreams of those asking for help. If you’re of a cheerful and optimistic mind, don’t let them get you down.

I was once fortunate enough to attend a remarkable lecture by Dennis Finch, one of the pilots of flight 232 which crashed into the cornfields of Sioux City, Iowa in 1989. It is an unbelievable story of heroism, problem solving and optimism. (The story can be found here.) While the flight did lose all navigation control, they were able to successfully find their way to an airport using thrusters alone, saving 185 of the 279 on board. It was a miracle of an outcome and Dennis Finch repeated, over and over again, that “attitude affected attitude”. Optimism helped land that plane.

Every day we’re faced with decisions about our practices and how we want to treat our teams, patients and communities. We can choose to face it with optimism and hope and make the decisions that we know will help our practices. Or, we can be pessimistic and look for all the ways that others can take advantage of us and never do the things we want. The truth probably lies somewhere in between, but I suggest that when in doubt, let the voice of optimism take over.

You went into business because you had a vision of what you wanted for your life. You had dreams and goals and probably lots of debt. It’s scary. I get that. But, when the spark of entrepreneurship strikes and a new idea takes hold in your mind, think first of all of the possibilities and don’t let others talk you out of what you see as a potentially exciting idea or opportunity. While you should always do your due diligence and speak with your advisors for any legal issues, don’t let the naysayers drag you down. People will tell you why you can’t do something and like the overplayed song says: “Haters gonna hate.”

Sure, Ralphie almost shoots his eye out but the final scene is of him fast asleep with his trusty Red Rider gun by his side and a look of absolute peace and joy on his face. The reward is often worth the risk.

Sometimes you just gotta dream big and go for it!

All the best,

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If you’re not a member of our geographically exclusive OrthoPreneursRD Facebook page there are only two prerequisites: You’re an orthodontist (yes, you can be an associate) and you want to contribute to a group of like-minded peers who have come together to share our practice ideas and solve our common business, leadership and management issues. Email me at Glenn@OrthoPreneursRD.com or fill out the form below to learn more and to see if you’re region is available.ORTHO22final spot

Contact me for anything you want to discuss related to your practice life

Are you the socket or the plug?

It’s hard to understand now, but people were calling Aaron Feuerstein crazy. They said he was nuts. What kind of CEO does the sorts of things he was doing? “That’s no way to run a business!” Of course, the haters were few and far between, but to many of us it was impossible to believe that anyone could hate this guy. What did he do?

It was 1995 and Feuerstein’s company, Malden Mills, was doing great. 1n 1979, they had invented a new lightweight replacement for wool referred to as “polar fleece” and their personal brand “Polartec” was selling very well. It’s important to note that instead of patenting the concept of polar fleece, Feuerstein decided to let it be produced cheaply and widely by many vendors. That’s the kind of guy Feuerstein was. People thought he was crazy, but he did was he felt was right. Then came the fire.

It ruined his production facility and there was nothing left.  He could have taken the check and moved his company to another city with better tax advantages or to another country altogether, which was something that many of his competitors were doing. But Feurstein realized that his company was a huge fixture in the small production town of Lawrence, Massachusetts and with no factory came no jobs. He cared about his employees and the town and couldn’t imagine taking the money and leaving.

What he did next is still being discussed in graduate business programs today.

Not only did Feuerstein announce that Malden Mills would be rebuilding in Lawrence, but moreover, he would personally make sure that every employee received their pay while the factory was being rebuilt. He had no production facility and no new sales of any kind, but he cared about his employees so much that he was willing to ensure their financial viability at a time when they didn’t know what the future held. THAT’S commitment to employees.

Or, you could look at the story of Hamdi Ulukaya, Chobani’s amazingly philanthropic owner (whose story of success is so amazing that I will feature it in another post) who believed BEFORE building his billion dollar empire that “…for the sake of our communities and our people, we need to give companies the ability to create a better life for more people.”

So, let’s come back and focus on orthodontics. I know there are a million reasons why we could argue that we’re different, that our smaller practices can’t be compared to these large companies. How we have such tight margins that we can’t just give to our employees. That if someone doesn’t help us, well, we don’t need them around. But is that really a fair way to look at it?

I’m not saying that we need to keep incompetent or overpaid employees on our payrolls. But, how many times has an employee asked for a day off for personal reasons such as  closing on a house or to attend a child’s event and you’ve given them grief before begrudgingly letting them go (or not even letting them go altogether)? How many employees had to beg you for a raise or fight with you over amounts of money that wouldn’t impact you in any way? How many practices get rid of older, more experienced employees to get younger, cheaper labor at the advice of a consultant, throwing away years of honor,  loyalty and relationship with the former employee?

I remember a time, 30 years ago, when I saw my dad (a dentist) pay to have a home phone installed for an assistant because she couldn’t afford one. It was at that moment  that I realized how blessed we are to be in our profession and his example of philanthropy has remained with me ever since. We have the opportunity to help make better lives for those around us who may not have had the same financial, educational or familial opportunities that we did. To our employees, we may be the most successful people they have ever met and we need to help raise them up at every opportunity instead of ignoring or keeping them down so we can better afford them.

I’m not saying (or suggesting) that we be our employee’s best friends, but I am saying that if you treat your team like they were family and give them the respect, credit and yes, love, that they deserve, not only will your practice succeed and have a line of employees waiting to work for you, but you’ll go to bed at night knowing that you’re making an even bigger difference in this world. It’s not about having a drink with them or having a huge bonus system or a big holiday party, but rather them knowing that you care about them as people and that you’re willing to be there for them no matter what.

As my friend and iconic orthodontist, Dr. Anil Idiculla taught me, we can choose to be the socket or the plug. Are we going to be the one giving or the one draining power? Every day I try to create a positive vibe to help those around me and I come home with more energy than I left the house with that morning.

So, which are you: The socket or the plug?

All the best,

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Work/Life Balance?

I was having a great conversation with one of my most respected and beloved orthodontic friends last night. She’s an amazing “emotional” balance to my “driver” style and the conversation of moms in orthodontics came up.
I am genuinely amazed at how working moms are able to hold it all together irrespective of the age of their kids and their stage in practice. The challenges they must face have to be enormous and as the son of a woman who went back to school when I was 10, my “hat is off” to every person, male or female who pushes through their daily personal struggles, be it emotional, physical, financial or otherwise to go to work and put patients first.
I also want to clarify any misconceptions about previous posts I’ve made regarding “work harder”. I’m a sole breadwinner for my family of 5 and like many of you, if I don’t earn it, my school and don’t get paid, my mortgage could be late and food on the table could be an issue. So, please don’t misconstrue, my former remarks to mean anything but the following: If you want more, you need to work to get it. Practice ownership is an amazing meritocracy. The more you work on your practice/life/business/skill, etc., the better it will be. It’s a linear relationship and it doesn’t care about any excuses or personal limitations. It’s not emotions, just fact, and we can’t change the rules.
I remember the stories of Jerry Rice, arguably the greatest wide receiver of his generation who had a workout that was named after him and a hill so hard to run that most others gave up. He worked when his teammates went out drinking or worked out less. His hard work allowed him to be the best of his generation and he focused ON his game and not the other distractions. Most just saw his grace on the field and assumed he was just “gifted”. Those in the league knew otherwise.
I have a wife who understands that there are many nights we aren’t going out to the movies or we’re not going on a trip because I need to work on the practice. “Work/life” balance is a choice, not a requirement, and I’ve found that my work/life balance comes from security knowing that my practice is solvent, not being home at 5pm. I know that’s not how many people feel but my wife and I have been happily married for 23 years and it works for us because we talked about what it would take years ago and she was on-board, the same way that being home at 5pm and going out and having fun every weekend night may work for you. No matter your situation, everyone has some free time at some point and how we choose to spend it is up to us, right? I just like working on my practice.
Before you get all in an uproar, I’m active in my faith and things like boy scouts and camping and dinners with the family and yes, I do have friends I spend time with, but like the kid in school who wants to be valedictorian, I consciously make an effort to be actively engaged in my practice over my social life 9 times out of 10. Yes, it’s a personal choice that I don’t force on anyone else and when my kids go to bed and I’m tired, I go to work on my practice until I can’t keep my eyes open anymore. I also LOVE every second of working on my practice and I genuinely hope that everyone out there experiences the kind of joy I get when I come up with plans and systems to make my practice stronger and more efficient.

I used to listen to a motivational tape on my way to work (yes, a cassette tape) and it was “10 steps to success” by a famous basketball coach. These were the podcasts of the 1990’s. Step 10 was “Stay Successful” and his point was that when we’ve done everything right, we need to work as hard as we did to get there or it will all go downhill, just like the practice of that 75 year old that was driven into the ground with neglect.

If your practice life is exactly where you want it to be and you don’t need it to be any bigger or more successful, that’s awesome. If my comments have made you question your effort and work harder and get more, I’m thrilled. If I’ve made you angry, good. But if I’ve hurt you in any way, or made you feel as if I’ve belittled your struggles in any way, please accept this apology and know that I am there for you in any way you need me. Please reach out, no strings attached, and I will help you in any way I can.

All the best,

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What to do about Smile Club Direct?

Recently, I’ve seen some great Facebook threads related to public perception of orthodontics and how we can help people understand the value of orthodontists. Simply by virtue of the rise of Smile Direct Club (SDC) there’s a pretty clear indication that the public views “teeth straightening” as a commodity. If you’re not sure what a commodity is, I wrote about it in a previous post, “Don’t Make Your Practice Like Coca Cola!!!”, but basically it means that much of the public doesn’t view aligners from SDC as being inherently any different or less valuable than aligners from an orthodontist. So, can we help reverse that trend? Is there anything that we can do?

Back in the 70’s I used to watch a TV show called “Happy Days”. It was a throwback to life in the 50’s complete with a “greaser” named Fonzie who, to a 10 year old boy, was the embodiment of cool itself. But, in later years, when the ratings began to decline, the writers of the show felt (for reasons that I simply cannot fathom even to this day) that it was a good idea to have Fonzie jump a shark on water skis-while still wearing his trademark leather motorcycle jacket. While trying to draw attention to a fading TV show, they produced what was arguably one of the dumbest things ever to appear on television, and it was an absolute flop. So much so, that whenever one attempts to draw attention to, or create publicity for something that is perceived as not warranting the attention, we refer to it as “jumping the shark”. Where does orthodontics come in, you ask?

I believe that we’ve “jumped the shark” with regard to public perception of aligner therapy. The public couldn’t care less what we have to say on a broader scale, and like the plot of every outer space alien movie ever written, I believe that organized dentistry had a chance to contain this “threat” when it was small and now it’s gotten large enough that the future is out of their control. Don’t believe me? Think it can still be “contained” or reversed?

We used to think that the only people who wanted an at-home aligner was an “uneducated” person from a demographic who would never consider us anyway, but by now, most of us already know of a sane, educated person who has decided that at-home aligners was the thing for them. I recently heard of a dentist’s son who was getting aligners through the mail. A dentist’s son!!!

SDC is now a $20 million/month company and shows no signs of slowing and we’ve all seen the huge amount of advertising they’ve done. It’s clear that the public is at the very least interested, and at the most excited, about the possibility of not having an orthodontist involved with aligners. So, again, back to the question: How do we make orthodontists great again? (Sorry, I couldn’t help it.)

Some have ardently supported the idea of getting involved in organized dentistry. They suggest that we should band together at the highest level and spend our resources through the AAO, competing to sway public perception against a war chest of advertising that Smile Direct Club spends. Is this really the right approach? Is the job of our parent organization to advertise and change public perception, or is it to protect us and the public through legislation efforts with local and national politics? If both are true, is it too late to make a dent?

Here’s a question for you: What is the American Medical Association’s message? Ok, not sure? How about the American Bar association’s message? Maybe the American Association of Meat Processors’ message? (By the way, if you want to see an organization that is REALLY involved in protecting its’ member’s rights in Washington, follow what they do.) Do you know the message of any organization outside of dentistry? Have they ever made a dent in your thinking or perception of any industry? Of course they haven’t. The only people who care about the national message of our industry are those in our industry. Let’s not be haughty enough too believe that a 28 year old executive in Anytown, USA is going to see a PSA for the value of orthodontists and say “hmmm, I didn’t realize that where I got my braces mattered. I’m going to cancel that appointment with my general dentist for Invisalign and go see a certified orthodontist.”

What we CAN do is spend our time and resources on becoming educated about social media and flooding our areas with information about our practices, helping the public understand what we should have been telling them for the last 30 years; “We’re here, we care about you, we have special training” and most importantly “go ask the thousands of your friends whom I have treated”. Our practices have turned out a ton of local missionaries for orthodontics, and our results can be seen in every elementary, middle and high school in our towns. We’ve made a local impact that no national campaign can. But, are you, John Q. Orthodontist, willing to learn and do what it takes or do you just want to complain that the AAO isn’t meeting your needs? I’m all for taking new directions, but I won’t listen to complainers who do nothing.

While I genuinely believe that no amount of education or marketing can turn the tide of the wave that is SDC, it doesn’t mean that we should just give up. I hope that our governing bodies legislate prudently to protect the public where it is necessary because that’s what they do well. I believe that we should work on turning out exceptional orthodontic outcome and making our practices such a vital part of the community that people begin to  question why anyone would choose to see a non-orthodontist for teeth straightening of any kind. Let SDC follow whatever path it’s going to take and do your best to compete in this ever changing market.

Richard Branson once said: “From a young age, I learned to focus on the things I was good at and delegate to others what I was not good at.” We’re good at changing lives, one smile at a time and getting people to trust and value what we do. I don’t think this can or should be delegated.

All the best,

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If you’re not a member of our geographically exclusive OrthoPreneursRD Facebook page there are only two prerequisites: You’re an orthodontist (yes, you can be an associate) and you want to contribute to a group of like-minded peers who have come together to share our practice ideas and solve our common business, leadership and management issues. Email me at Glenn@OrthoPreneursRD.com or fill out the form below to learn more and to see if you’re region is available.ORTHO22final spot

Contact me for anything you want to discuss related to your practice life


You think that braces are the future? Everyone’s laughing.

If you’re a regular reader of my blog, then you know how much I stress the importance of clinicians understanding that while the clinical outcome is important (and is what lets us sleep at night), the public generally could care less. Nonetheless, every single day I see orthodontists trying to convince peers (and themselves) that if we just do a great job, and educate the public (about what, I’m not sure) that everything will be OK. We’re orthodontists, they say, and braces are a better alternative. If the public could only understand the difference between braces and Invisalign….

Enter Joe Hogan, stage left…

CNBC bills their show, Squawk Box, as “the ultimate ‘pre-market’ morning news and talk program, where the biggest names in business and politics tell their most important stories.” In short, the biggest business influencers go there to discuss the biggest news stories. On June 1st, Joe Hogan, Invisalign’s CEO, was asked to discuss Invisalign, its future and its impact on the global orthodontic community. If you’re an orthodontist who’s hanging on to the idea that braces are still the future, please listen to the exchanges on that show. (The link is at the bottom of the page and you should watch it after reading this post.)

“We see this as an analog to digital movement” Hogan explained to the hosts. “It replaces an old analog system where metal is glued to your teeth.”

Ok, so you’re not convinced yet. I get it. You were taught metal, you like metal and you think that it still gives the finest clinical outcome. Listen on…

Andrew Ross Sorkin, one of the hosts and a very typical example of your potential patients said: “It’s effectively opened up the kind of people who are selling the system. It used to be just an orthodontist would give you Invisalign and now dentists do it and I believe others will do it too.” Hogan agreed and explained that even Smile Direct Club can do it and he explained how Invisalign has a 17% share in SDC.

Then Sorkin asked the biggie:”Does this take over the traditional orthodontistry [sic] business?”Without hesitating and mid way through Sorkin’s sentence, Hogan said “Absolutely. It’s just a matter of time.”

Invisalign, love it or hate it, is growing by over 20%/year in the US, it’s posting 100% growth/year in China, 50%/year in Spain, and 40% in other areas around the world, yet Hogan explained that it still has only a 10% penetration rate in the US and less overseas. Hogan even acknowledged that Unitek and Ormco are developing their own systems and are expected to be big players which should only “legitimize the space” and help it grow even further.

We can agree to disagree that the future is plastic. But remember, those who know it well will tell you that Invisalign doesn’t change the way teeth move, but is simply a different way to move them. The same concepts of tooth movement still apply and the outcome relies on the know how of the clinician. I’ve seen clinicians get exceptional results in difficult cases using Invisalign. It’s not the method, but rather the clinician overseeing the outcome that makes the difference. Obsess on the clinical outcome and you can get it with Invisalign, and that’s what distinguishes us from general dentists and SDC. Our expertise allows plastic to be another tool in our toolbox.

Sure there are limitations for certain cases, but if there are truly 3,000,000 orthodontic case starts/year in the US and Invisalign accounts for less than 10%, I see that as a HUGE opportunity for orthodontists to accept it and be a part of a movement that certainly isn’t new, but is growing.

So, you can push your chest out and explain proudly to the world that you’re an orthodontist and shun plastic and Invisalign (and other aligner companies and options) and continue only doing brackets and you have every right to do that. However, don’t sit there and try to convince me, yourself and others that if you just educate the public about how braces give a better outcome they’ll all flock to you and shun plastic. Not only do I believe that statement to be misleading, but the market share numbers for plastic aligner starts per year would also disagree. The public wants plastic and they’re not going to put up with you if you push braces on them.

If you’re not knowledgable on how to get remarkable outcomes using plastic and genuinely believe that you can get a better result with brackets, for the sake of your business and your professional AND technical growth, you must make an investment in your education and learn how to be a better plastic orthodontist. I started with invisalign as a GP in 2004 and yes, back then, it was tough and I got very frustrated with the system.  I walked away from aligners as a viable alternative. Today, it’s an altogether different ballgame and I’ve happily embraced (or un-braced) it. (Sorry, but that pun was just too easy.)

Oh, and please don’t say how sad you are for the profession. Not only does it make you sound bitter, and it helps nobody, but you’re showing your pessimistic side. Stop and take a look round at the rest of the world and then look at what we do. We are blessed in every single sense of the word. We get to decide what we want to do and if we market ourselves well and take care of those in our charge, we have an amazingly bright future.

Remember, speaking about outcomes and educating the public is your technical side venting out loud. If you want to be successful, you better let the entrepreneur have a say every now and then.

All the best,

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If you’re not a member of our geographically exclusive OrthoPreneursRD Facebook page there are only two prerequisites: You’re an orthodontist (yes, you can be an associate) and you want to contribute to a group of like-minded peers who have come together to share our practice ideas and solve our common business, leadership and management issues. Email me at Glenn@OrthoPreneursRD.com or fill out the form below to learn more and to see if you’re region is available.ORTHO22final spot

Contact me for anything you want to discuss related to your practice life

Click Here the link for the Squawk Box episode with Joe Hogan, CEO of Invisalign.