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April's Tip: How to Run a Successful Orthodontic Practice - Part III

By: Dr. Mark Paschen

Treatment Coordinator: (I will refer to the TC as "she" even though there may be many very qualified and talented men out there serving in that role). There are five main responsibilities of the TC. They range from meeting the new patient to getting the new patient to accept treatment.

These responsibilities are:
1. Immediately connect with the new patient
2. Take any needed records, while still connecting
3. Go over the treatment plan with the parent and/or patient after the doctor has reviewed the    records and performed the exam
4. Go over the financial options
5. Get the patient to book the treatment

When new patients arrive for their orthodontic evaluations, it is important not to keep them waiting. Nothing is more negative than keeping a patient waiting--especially a new patient. My TC goes out to the reception area and personally greets any new patient. If the patient is a child, my TC gets down to the level of the child (kneels if necessary) and warmly welcomes them. The TC explains to the parent that a series of digital images will be taken first on their child, and then she will escort the parent into the room while photos and the exam by the doctor are performed. You need to schedule enough time for the new patient evaluation appointments so the TC can finish a previous appointment in plenty of time before her next one. We allow 80 minutes for a new patient evaluation in our office, and the time is divided as follows:

First 30 minutes: Gather necessary records, digital images, photos, and connect. Notice I didn't say impressions. We wait on the impressions until the patient commits to treatment. Why subject a six year-old to impressions if we are going to wait another six months for the first molars to erupt before starting? Impressions can also be a negative experience for some patients, and we want to keep this initial visit as positive as possible. For those of you who are novices to orthodontics, the impressions should be taken to better evaluate treatment needs. "Veterans" to orthodontics can usually dictate the treatment plan without models (and prior to a cephalometric tracing) but always caution the parent verbally and in writing on your treatment plan form that the treatment may change depending on growth factors which may be beyond our control. This allows for changes in the treatment plan.

Next 20 minutes: TC goes over records with doctor, gives doctor an idea on patient and parent personality, doctor performs the oral exam and dictates the treatment plan to the TC in front of the patient. It is important that the TC speak with the doctor before he or she examines the patient. (1) A lot of insight can be gained as to the personality of the patient, needs and wants of the patients, and even the personality of the parent(s). For example: Will you be walking into an evaluation where the parents and child are 100% on board and ready to start treatment (recognize the problem), or is there a lot of negativity present and the teenage boy doesn't want braces, and the parents are oblivious as to why they are even at the appointment? It is helpful to know these things before walking into the evaluation. A well-trained TC can give the doctor that insight. We also have specific questionnaires for each age group which help us to connect better with the patients. These will be discussed in an upcoming article on marketing.

Last 30 minutes: TC goes over treatment plan. There are five parts to any treatment plan which should be incorporated, (2) even for general dentistry procedures. They are:
1. Show what is wrong
2. Show what it should look like
3. Tell what would happen if nothing is done
4. Tell them the fee
5. Tell them what the next step would be (schedule the treatment)

Number 3 above, beside the fee, is really what parents want to know. Basically, how will treatment benefit them? You should emphasize some sense of urgency, although you never want a patient to feel pressured into doing treatment or to have "buyer's remorse." Several reasons and scenarios should be given as to the importance of treatment. If this step is done well, the patient (parent) should be asking when they can start--even before getting the fee quoted.

The fourth step of the treatment plan process (#4 above) is often overemphasized. If the first three steps are done well, this step should be seamless. The keys to discussing fees are to give options for payment (3) and to make sure the TC is comfortable discussing fees. I can't emphasize that enough. At one point, I had two TCs who alternated days. I tracked their case acceptance, and one of them had a much higher acceptance than the other. I discussed scripting with them, and we role-played together. I finally discovered that one of the TCs was uncomfortable in discussing fees with patients. Not surprisingly, she was the one who had a much lower case acceptance rate. My current TC is so comfortable in discussing fees that I have empowered her to make any special fee arrangements that she deems necessary. She gives the option of a higher down payment and low monthly payments, or a low down payment and higher monthly payments. We also give a 5% courtesy for payment in full.

Your TC should ask the parent (patient) what option would work best for them. Also, ask if there are any other concerns they may have before starting treatment. If not, the TC then gives options on booking the treatment. For example, it is stated, "We would love to welcome you into our orthodontic family. Let's get your appointment scheduled. Would a morning or afternoon work best for you? Would a 1:00 PM or 4:00 PM fit into your schedule better?" Always make the appointment about THEM. Never state WE have a 1:00 PM or 4:00 PM appointment available. (4)

Having a personable, educated, and well-trained TC will make your life so much easier and will improve your case acceptance immensely. If you are to make any investment in your orthodontic practice, as far as practice management, definitely invest in training one of your auxiliaries properly to become a TC.

The next article will focus on marketing your orthodontic practice. I will discuss internal marketing, which will involve very little financial commitment. You will learn how to connect better with your patients through customized new patient questionnaires, how to "jazz" up your office to get your general dentistry patients interested in orthodontics, some fun contests you can do for your existing patients, and other ideas to keep a steady flow of new patients coming to you for orthodontics.


1. J Swift Consulting, Phoenix, AZ. Office visit

2. Rick Pereira, Practice Management Consultant, Phoenix, AZ. Office visit

3. Chase, L, "Yes to Treatment" 2012, Landy Chase, MBA, CSP

4. Scheduling Institute, Alpharetta, GA. Telephone training module.

Dr. Mark D. Paschen graduated from the Marquette University School of Dentistry in 1983. His 'Passion" has always been practice management, giving his patients extraordinary service. After years of incorporating orthodontics into his general dentistry practice, his practice is now focused solely on orthodontics, TMD, and Sleep. He credits much of the success of his practice to not only furthering his clinical skills, but also to his close attention to practice management implementation. Dr. Paschen has lectured extensively in the United States and also in Sydney, Australia. He is a Senior Certified Orthodontic Instructor for the £40.

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