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August's Tip: How to Run a Successful Practice Part VI


This is the sixth in a series of articles outlining How to Run a Successful Orthodontic Practice. In the previous five articles, I emphasized the importance of the receptionist, hygienist, treatment coordinator, and the orthodontic team, plus I presented some simple and cost-effective internal marketing tips. In this edition, I will discuss the importance of communication. Too often, we think the product will "sell itself" or that our patients will accept our orthodontic treatment based on their past history at our office. Without pushing our patients into treatment that they may not want (buyer's remorse), we need to be able to convince them of the need for treatment and gently persuade them to want the treatment.

You need to keep in mind three things when it comes to orthodontic treatment: (I)

1.          Most patients (parents) feel that orthodontic treatment is elective.

2.          There is usually a large out-of-pocket expense, even with insurance coverage.

3.          Our orthodontic customer base is turning over about every 24 months.

Due to the above three factors, we need to have proper scripting in place to address the concerns of our patients and to ensure our patients do their orthodontic treatment with us. You all have seen the statistics floating around on brochures promoting orthodontic courses: "...add $250,000 to your bottom line by incorporating orthodontics into your practice." The converse is also true. By having one orthodontic patient per week not agree to treatment (based on a $5,000 per case fee), you will have roughly $250,000 per year walking out your door. Of course this doesn't take into consideration the typical orthodontic treatment plan that is spread out over 24 months. Let's discuss the three points above. In the case of #1, we all know orthodontics is not performed primarily for esthetics. Our patients do not realize that. Before going into the merits of why having a functional occlusion is important, we need to find out why they chose to come to you for an orthodontic evaluation in the first place. This can be addressed on your patient questionnaire (along with breathing issues, speech problems, hyperactivity, etc.). If a patient is in the chair because he or she recognizes that a problem exists, the approach is definitely different than if they are there because a problem was pointed out to them, and they were totally unaware of the problem. In the first circumstance where the problem is obvious, you simply address the problem and explain how treatment would benefit them. Albert Einstein once said, "Make everything as simple as possible, but not simpler." (2) In other words, don't over-explain (which we dentists are notorious for). Use simple terms your patients will understand, while still getting your point across. Be succinct. This takes a lot of practice, and you need to rehearse words and scripting with your treatment coordinator to make it happen. It is also important to let your patients do some talking. People like to hear themselves talk, and the number one reason patients accept treatment is that they feel like they have been  heard. (3)

In the second scenario where the patient (parent) does not understand why they are at the appointment, the approach is definitely different. Remember the Einstein quote and still keep your explanation simple. From the patient's perspective, doing treatment due to a skeletal deep bite, anterior open bite, or posterior cross bite is not really that important to them. This is especially true if there is not a current esthetic problem associated with the above. In these cases, you need to illustrate what could happen if treatment is not performed (there is orthodontic software that can do this for you). For example, show photos of worn-down teeth due to a deep skeletal bite, canted smiles with elongated faces due to open bites, or asymmetrical smiles with chins way off-center due to posterior cross bites. No parents want their child to grow up with a "distorted" face, and it is often difficult to explain the benefits of treatment to parents without using concrete examples. Photos are the best way to communicate this to them. Ideally, you would show them examples of treatment done on your own patients. This not only helps to explain the problem, but it also is a great testimonial as to what type of treatment you do. Keep an album handy in your consultation room with before and after photos of every imaginable scenario of orthodontic problems that you have treated. This has proven to be of tremendous benefit in my practice.

For case #2 above, orthodontic insurance seldom covers a large amount of the treatment. Patients are accustomed to dental insurance covering 50-80% of treatment, whereas orthodontic insurance usually covers about 25% or less of a typical case. (4) In cases where cost is a factor (perceived to be a factor in most cases, but I have not found that to be true), you need to relay to the patient (parent) the value of performing treatment. Your treatment coordinator needs to have several scripted lines which reinforce your expertise in delivering orthodontic treatment. "Dr. Paschen has treated many cases similar to John's with tremendous results," or "Dr. Paschen attends many continuing education courses and is at the cutting edge of orthodontic treatment." Hardly anything speaks to people more than testimonials. We all have certain patients that are over-the-top in giving compliments and who also have terrific personalities. Ask those patients for permission to have prospective patients e-mail them as to the treatment they received at your office. Keep those e-mails in a file and present them to any prospective patients who appear hesitant to do orthodontic treatment with you. It is also becoming very common for people to look at Google reviews before eating or shopping at a particular place. (5) The same is true about orthodontic treatment. I will elaborate on Google reviews in my next article. People's opinions are important to other people, and they value what others say about how they will be treated at your office.

Patients will also use finances as an excuse not to do treatment when, in fact, they may not trust your ability or feel confident with your treatment plan. Most of you, being general dentists, will be drawing patients from your own patient pool so this will not be an issue. However, the longer you are in the orthodontic business, the better chance you have of seeing patients from other offices. These are the ones you need to convince that you offer the best value for their money. You need to concentrate on the expertise of the doctor, the expertise of the team, and give options for treatment but clearly state why you feel a certain treatment plan will work best for them. By showing your patients documentation of your clinical results (as mentioned above), you create a positive image of your office. This will decrease their fear of risk and increase their chances of doing business with you. Patients won't buy until their fear of risk is removed. (6) You will find that the better your treatment coordinator becomes at explaining the benefits of treatment and reinforcing your expertise, the less that money will factor into the decision making process. (7)

The third item (#3) above was addressed in my marketing article (Volume 27, Number 4, Winter 2016) of the TAO Journal. You need to connect to all of your patients who are not yet ready to begin treatment, and you need to show patients who are ready to get started that your office is a fun environment where they would want to go for orthodontic treatment. Don't take it for granted that your patients of record will do treatment with you, and definitely don't take it for granted that if you treated one family member that you will automatically treat the rest of the family. Siblings talk, parents talk to other parents, and schoolmates talk about their treatment amongst themselves. You need to be constantly coming up with new and innovative ways to make your office "the place to be." I compare my recruitment of new patients to being on a treadmill. You need to constantly keep moving and keep pace if you want to stay in shape (and be productive). Once you stop, you will fall off the end of the treadmill, and your case starts will drop. There is no such thing as not accepting new patients for orthodontic treatment. Once you do that, your case starts will drop, and your orthodontic practice will cease to exist. New patients are the lifeblood of your orthodontic practice, and you will eventually run out of your existing patient pool from which to draw. Never stop marketing for new patients, whether it's internally or externally.

Communication doesn't stop with the patient-to-doctor or patient-to-assistant interactions. How well do you communicate with your own dental team? Dentists need to realize that many team members do not have the same level of motivation (invested interest) in the practice that they do. It is your practice, and you have the right to expect your team to function at a certain level, but scolding and talking down to a team member never works. Even giving constructive criticism in a relaxed non-threatening environment (and in private) doesn't always work. You definitely can't address the entire team about an issue when it pertains to only one team member. I had a full-on revolt one day when I pointed out and generalized a problem to my team, when in fact it was an issue that only involved one team member. My team was insulted that I accused them of something that they were not involved with (and they knew who was), and the rest of the day was not very pleasant. You need to confront the team member who is involved, show him or her what the problem was, tell them how you would have handled the situation and why—this may prompt some discussion from your team members which you should listen to, but ultimately you are the boss, and your decision is final; compliment them for something positive they did, and then move on. (8) Keep these discussions short, productive, and one-on- one with the team member involved. My mantra is to "always pick your battles wisely."

If a problem persists with a certain team member, you need to continue going through the steps outlined above, always documenting every discussion that you have with that team member. When it is obvious that the situation is hopeless, it is time to cut ties with that team member. I once had an assistant who was always late. I tried many things to get her to come to work on time, since other than her tardiness, she was a very good people-person assistant. I finally said that I would give her three chances and after the third time of coming to work late, that she would be dismissed. After the second time she was tardy, I warned her that she only had one more chance. I made it crystal clear to her that this was not a threat, but reality. The very next day, she was late again and was promptly escorted out of the building. To my amazement, she was very surprised. I did not dispute her collecting unemployment, but when the unemployment office saw my documentation, they thought she wanted to be fired, so they denied unemployment compensation to her. By letting her go, I gained the respect of my team members for not giving her special treatment, and the "fired" team member kept bringing her daughter in for orthodontic treatment. She knew deep down that she was wrong and did not ultimately hold any grudge against me for letting her go. All of you can experience this if you handle these situations in a calm way and document everything. I feel it is best not to share any information concerning the problem team member with the other members of your team. That can only be construed as gossip and may come back to haunt you. Even when you hear things such as "why do you always favor her?" or "why can she do anything she wants?, "you need to keep quiet and let the situation play out. (9) In cases where a team member is terminated, in the long run you will have a more cohesive team and the avenues for communication will be opened more readily. Your other team members will also realize that their jobs are not completely secure, which is always a good thing.

Hopefully, you won't have to deal very often with letting a team member go, but it is bound to happen. I have always found that when a situation goes from bad to worse with a team member, their happiness is ultimately what should be reviewed and discussed. If a team member is not happy at work, they have no business working for you, and that unhappiness will only filter down to your patients. (10) Patients choose to do treatment if they are happy. If they sense unhappiness in your office, it is likely that they will choose to do their treatment elsewhere.

In summary, never take anything for granted when communicating with your patients. It's not always what you say that's important, but HOW you say it. Always keep the communication simple and short. Listen to what your patients are saying and, more importantly, to what they want. If patients feel that you are listening to them and are addressing their concerns, they will likely choose to do treatment with you. Be honest in all of your communications, never promise what you may not be able to deliver, and have fun with your patients and with your team. Communication, when used properly, can be the greatest asset to any orthodontic office.

In my next article, I will delve into the world of social media and tell you some of the things I am doing in my practice to keep me from falling off my treadmill by attracting new patients. I will also include some external marketing tips that are cost-effective and have worked well for me in my orthodontic practice.


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

2.      From "On the Method of Theoretical Physics," the Herbert Spencer Lecture, Oxford, June 10, 1933, paraphrasing a quote from Albert Einstein.

3.      Rosemary Bray, IA0 Annual Meeting, Scottsdale 2010.

4.      A typical comprehensive case is approximately $6,000. Insurance will usually cover a higher percentage for early treatment cases and/or when coordination of benefits is involved.

5.      Jack Hadley, My Social Practice, seminar Lake Geneva, WI 2016.

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

7.      Refer to my article concerning the Treatment Coordinator in the Volume 27, Number 3, Fall issue of the LAO Journal.

8.      J Swift Consulting, Phoenix, AZ. Office visit, April 2014.

9.      Personal experience in dealing with team members. I once had to let two team members_go within a 6 month period. The other team members were in agreement with my decision and were motivated to work harder until new hires were made. I did not share information with them during the entire process which led up to the dismissals.

10.   I had the "not happy at this office" discussion with one of my team members, and she was ultimately let go. Due to the way the situation was handled, she even asked me if I would be a reference for her when searching for another job.

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 IAO.

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