Dr. Marc Ackerman

Enfant Terrible Dr. Marc Ackerman

Q2 2018 TRAVEL & LEISURE SECCIÓN EN ESPAÑOL H.R. INSIGHT KRAKOW: A POLISH JEWEL PROGRESANDO EN ESPAÑOL MY TEAM IS COSTING ME A FORTUNE! – BY DR. ANDREA FONT RYTZNER -BY DR. FRANCISCO GARCIA -DRS. MATT AND COURTNEY DUNN inside this edition... BUSINESS PRACTICE & DEVELOPMENT Enfant Terrible Dr. Marc Ackerman 11 Embracing Innovation: How Becoming PAGE 44 an Early Adopter is the Key to Practice Growth BY DR. GRANT DUNCAN 20 MARKETING/ CLINICAL CORNER Brace Your Practice For Hyper Growth: SOCIAL MEDIA Gain More Patients By Publishing A 57 Book 08 BY ADAM WITTY Aligning Your Brand: Selecting and In Through The Out Door BY DR. DEREK BOCK 34 Securing a Trademark The Cost of Failing to Plan Your Estate: BY NATHAN HARRIS A Reality Check 14 OFFICE LOGISTICS BY CARLA A. DELOACH, ESQUIRE AND Could Convenience Be The Key? JORDAN DELOACH HURLBURT, ESQUIRE BY JEFF BEHAN 06 38 27 Expanding Your Base Through Bond Financing is Best Kept Secret for How to Make Your Next Move The Best Teledentistry Orthodontic Practices Yet BY DR. KEITH DRESSLER BY BRIAN WATSON BY ANGELA WEBER 68 44 36 As Demands in the Orthodontic Enfant Terrible This Critical Data Is Saving Market Continue to Evolve, Innovative DR. MARC ACKERMAN Orthodontists Millions of Dollars Software to Improve Workflow is 65 BY JIMMY NICHOLAS Paramount Why All Dentists Need a Retirement BY URIYAH ROBINSON “Plan B” BY DR. DAVID PHELPS H.R. INSIGHT 72 TRAVEL & LEISURE Design-Build Firm Fast-Tracks New 24 Model of Ortho Practice in Orlando My Team is Costing Me a Fortune! 30 BY RYAN YOUNG BY DRS. MATT AND COURTNEY DUNN Traveling Through Brazil and Peru 74 62 BY DR. BEN & BRIDGET BURRIS Establishing a Captive Insurance Salary versus Hourly: Which Way Is 50 Company Best? Krakow: A Polish Jewel BY PETER STRAUSS BY TIM TWIGG AND REBECCA BOARTFIELD BY DR. ANDREA FONT RYTZNER

ORTHOPUNDIT ANSWERS FROM THE EDGE SECCIÓN EN ESPAÑOL 76 16 42 Technology Will Not Fix What Ails Interviews with Dr. Denny Mauro and Progresando en Español Orthodontists Dr. Ryan Streight BY DR. FRANCISCO GARCIA BY DR. BEN BURRIS

The ideas, views and opinions in each article are the opinion of the named author. They do not necessarily reflect the views Theof Progressive Orthodontist, its publisher, or editors. The Progressive Orthodontist® (“Publication”) DOES NOT provide any legal or accounting advice and the individuals reading this Publication should consult with their own lawyer for legal advice and accountant for accounting advice. The Publication is a general service that provides general information and may contain information of a legal or accounting nature. There is no guarantee or warranty regarding the information contained in the Publication and we are not responsible for any loss, injury, claim, liability, or damage (“damages”) related to your use of the information contained in the Publication or from errors or omissions in the content of the Publication. While we have worked to make our Publication and all the features in the Publication as helpful as possible, the Publication does not endorse any content provided by any feature, nor does it assume any responsibility for the interpretation or application of any information originating from such content. In addition, The Progressive Orthodontist does not endorse any content contained in any advertising on the Publication, nor does it assume any responsibility for the quality or integrity of such work. Content is property of The Progressive Orthodontist and may not be copied or otherwise duplicated without prior written consent from The Progressive Orthodontist. All content contributed to The Progressive Orthodontist magazine becomes the property of SmileMedia. The publisher assumes no responsibility for return of unsolicited manuscripts, art, photos or other content. EDITOR’S NOTE

EXECUTIVE EDITOR It’s that time again. It seems like told as kids, “Knowing is half the & TRAVEL AND only yesterday we were in San battle” and this is why it’s so vital LEISURE EDITOR Diego but the world has changed to pay attention, ask questions and Dr. Ben Burris dramatically in the last year. Change not take anything for granted. We is good and even if you don’t think all have the tools to succeed and CLINICAL EDITOR it is, change is unavoidable and basically all start out the same after Dr. Derek Bock unstoppable (so you may as well residency. What we do from there decide that it’s good!). Practice is dependent on our mindset and sales/consolidation, delivery the actions that spring therefrom. MARKETING/PATIENT systems, industry giants pivoting, The goal is simple in broad strokes ACQUISITION EDITOR miniaturization/cost reduction in but certainly depends on individual Angela Weber 3D printing, decentralization and wants. The goal is to serve as many the race to be the first company consumers as possible, render WOMEN IN other than Align to effectively/ excellent treatment as efficiently ORTHODONTICS EDITOR efficiently print aligners (as as possible, do so with the lowest Dr. Courtney Dunn opposed to printing models) are possible overhead, enjoy life while the crux what is driving change in amassing as much after-tax wealth ORTHODONTIC POP orthodontics today. The face of the as possible and, most importantly, CULTURE EDITOR industry will be determined by how have plenty of time to spend with Dr. Marc Ackerman these things play out. Your success our families and those we love. It’s or failure will be dependent on how simple but not easy. This issue is well you can observe, adapt and full of content from new/different EDITOR EN ESPAÑOL implement. providers who have the information Dr. Francisco Garcia This is a great time to be alive and we need to help us achieve our goal. the opportunity in orthodontics There are many ways to get there has never been greater. But you and you’ll have to decide which to CLEAR ALIGNER EDITOR have to be smart. You have to think take but knowing IS half the battle. Sarah Sharfstein for yourself. You have to do what makes sense instead of what we have See you in DC! always done if you want a shot at -Ben TRADITIONAL OWNER/ OPERATOR PRACTICE long term success. Just like we were MODEL EDITOR Dr. Jennifer Eisenhuth

AAO AFFAIRS EDITOR INTERNATIONAL The Progressive Orthodontist Dr. Anil Idiculla & The ORTHODONTICS EDITOR magazine and study group are AAO Committee on Dr. Grant Duncan your educational resources for new Communications trends, progressive insights and best practices for building a successful WEALTH MANAGEMENT WEALTH MANAGEMENT orthodontic practice in 2018 and AND INVESTMENT EDITOR AND INVESTMENT EDITOR beyond. Dr. Aly Kanani Dr. John McManaman

PUBLISHER - Amy Bradshaw ADVERTISE WITH US! CHECK US OUT ONLINE GRAPHIC DESIGNER - Megan Clark [email protected] WWW.THEPROORTHO.COM

Q2 • 2018 | TheProOrtho.com 1 DR. DEREK CONTRIBUTORS BOCK Dr. Derek DR. BEN BURRIS Bock grew up in DR. MARC Massachusetts, near Cape Cod. Ben Burris ACKERMAN He remained on graduated from The the East Coast Citadel in 1994 with Dr. Marc for his undergraduate studies at Stonehill a BS in biology, spent Ackerman College. After receiving his Bachelor of Science time working in specializes in as a double major in biology and chemistry Washington DC after the orthodontic from Stonehill, Dr. Derek continued his studies at the prestigious Tufts University graduation, received a treatment of Rotary International School of Dental Medicine in Boston. He children with received his Doctorate of Dental Medicine Ambassadorial dentofacial deformity, intellectual and physical from Tufts University in May 2003. Following Scholarship and spent a year in Wellington NZ disabilities and sleep disordered breathing. his dental school graduation, Dr. Derek at Victoria University, graduated dental school He received his DMD from the University of completed his post-graduate training in with a DDS from The University of Tennessee Pennsylvania School of Dental medicine in orthodontics at the University of Illinois at in 2001, and graduated orthodontic residency 1998 and his certificate in Orthodontics from Chicago. He completed a three-year residency in 2004 with an MDS from The University of the University of Rochester-Eastman Dental in orthodontics and obtained his Master of Tennessee. In his short 13 year career Burris' Center in 2000. Dr. Ackerman later completed Science in oral sciences. In addition to his residency, Dr. Derek also completed a one-year practice grew to over 20 locations which his MBA in Executive Leadership at Jacksonville he sold in April 2017. After the sale Burris fellowship in craniofacial orthodontics at the University Davis College of Business in 2009. University of Illinois Craniofacial Center. is effectively retired and living in Orlando, Dr. Ackerman is the Director of Orthodontics at It was during this fellowship that Dr. Derek Florida with his wife and two children. He is Boston Children’s Hospital and teaches residents received additional training in dealing with building what he calls a lifestyle office where in both pediatric dentistry and orthodontics for orthodontic problems as they relate to children he plans to offer braces for 3000 dollars Harvard School of Dental Medicine. with craniofacial syndromes, especially cleft and Invisalign for 2000. Burris (and others) lip/palate. Dr. Derek is an avid golfer, loves expect his new office and unheard of price running, cycling and competes in triathlons, point to revolutionize how orthodontics is JEFF BEHAN and is an accomplished guitar player. He and delivered and engage a significant percentage his wife, Dr. Anokhi, enjoy outdoor activities Jeff Behan is a of the population in orthodontic treatment. with their four children. communications and Burris founded S4L.org, TheProOrtho.com, consumer marketing OrthoPundit.com among other institutions in specialist. He is a fun orthodontics and is a driving force for change CARLA DELOACH & JORDAN and relevant speaker in the orthodontic profession. Burris and Dr. DELOACH whose subject matter Marc Ackerman recently released a book, focuses on internal/ Straighter: The Rules of Orthodontics and do a external communication, connecting with two-day course in Orlando of the same name. Carla existing and prospective patients, referral- Feel free to connect with Dr Burris so you DeLoach building and practice branding. Over his can get a better understanding of who he is and Jordan career, he has worked with a diverse array and what he does. DeLoach of clients including Intel Corp. and Delta Facebook.com/bgburis Hurlburt are Airlines in addition to numerous dental and partners of the orthodontic companies (Align Technology, estate planning law firm DeLoach, P.L. Carla Ormco, Henry Schein and OraMetrix.) is a graduate of Stetson University and holds NATHAN HARRIS He is the principal member of VisionTrust an LL.M. in Taxation from the University of Communications, a company known for Florida. She is certified AV Preeminent with Nathan Harris custom marketing solutions that serves Martindale-Hubbell. Jordan is a graduate of is an intellectual over 1,000 orthodontic practices around the the University of Florida and holds an LL.M. property attorney with world. Jeff is also a founding board member in Taxation from New York University. She is Lando & Anastasi, of VisionTrust International, an international board certified in Wills, Trusts, and Estates. LLP in Cambridge, NGO serving orphaned and neglected children Both Carla and Jordan are graduates of Massachusetts. He in 17 countries around the world, and he is ACTEC's Florida Fellows Institute's inaugural assists individuals, startups, and established currently serving as Vice President of Smiles class. Their practice emphasis includes estate companies with their trademark, patent, for a Lifetime, providing free orthodontic and succession planning, probate, and trust domain name, and copyright issues. Nate can treatment to deserving kids in North America. administration. be reached at [email protected].

2 It’s just BUSINESS ANGELA BRIDGET DR. KEITH DRESSLER WEBER BURRIS Dr. Keith Angela Weber Dressler is an is the Chief Bridget Burris avid entrepreneur Marketing Officer is no stranger to who has over 30 for OrthoSynetics orthodontics. For years’ experience a company over 11 years she which specializes and her husband as a practicing in business have grown and run one of the largest groups orthodontist. In services for the of practices in the country. Having extensive 2000, Dr. Dressler orthodontic and dental industry. She leads a experience in every position in an orthodontic co-founded team of marketing professionals dedicated to office except chair side assisting, Bridget OrthoBanc, LLC a developing and implementing cutting-edge knows how to train employees to maximize cloud-based automated accounts receivable strategies and solutions for their members. their efficacy and how to teach the customer platform, that is currently serving over 4,000 Angela has over 15 years of experience in service delivery that is so essential in the healthcare providers. Dr. Dressler also the advertising industry with a vast knowledge modern practice. Bridget also knows how to co-founded Elite Physician Services, a national of current and past trends, philosophies and grow an orthodontic practice from small to strategies for marketing within the healthcare massive in a logical, stepwise manner because healthcare patient finance company, which industry. Angela has a proven track record of she's DONE IT! Multiple times. grew to over 200 million in sales before it driving new patient volume through innovate Bridget's knowledge and acumen is became the Citi Health Card in 2003. marketing practices. only surpassed by her incredible ability to Angela holds a B.A. in Mass communicate and get others to do the same. Communications from Louisiana State Her unique skill set allows her to enter University and an M.B.A. from the University an office, identify the problems, prioritize PETER STRAUSS of New Orleans. issues and form a logical implementation Peter J. Strauss plan; but, most importantly, she is then able to communicate the plan to the owner is the founder and ADAM WITTY and employees to get consensus and even managing member of enthusiasm for how all parties can get where The Strauss Law Firm, Adam Witty they want to be! No one else in the industry LLC, located on Hilton is the Chief has the experience, wisdom or pragmatic, Head Island, South Executive Officer of solution based approach that Bridget brings to Carolina. He is also the founder and CEO of Advantage|ForbesBooks. your practice. Her results speak for themselves. Hamilton Captive Management, LLC, one of Witty has built the most admired and respected management Advantage|ForbesBooks URIYAH ROBINSON firms in the country, as well as numerous other into one of the largest As product line insurance companies. business book publishers in America, serving manager for CS Peter is a graduate of the New England over 1,000 Members in 40 U.S. states and 13 OrthoTrac, Uriyah School of Law, holds an LL.M. in estate countries. Witty is a sought-after speaker, teacher, Robinson is dedicated planning from the University of Miami, and is and consultant on marketing and business to working with currently enrolled at Harvard Business School. growth techniques for entrepreneurs and authors orthodontic practices to ensure that and has shared the stage with Steve Forbes, Carestream Dental's practice management Gene Simmons of KISS, Peter Guber, and Bobby software meets their unique needs. Uriyah JIMMY NICHOLAS Bowden. Witty has been featured in The Wall has more than 10 years of experience in Street Journal, Investor's Business Daily, USA product management and strategy, and his Jimmy Nicholas is Today, and more. most previous role was as strategic marketing the founder of Jimmy manager at Bard Medical. Marketing who helps orthodontists DRS. MATTHEW & COURTNEY DUNN predictably attract Dr. Matthew Dunn grew up in a small town outside of Saginaw, more new patients Michigan. He attended the University of Michigan for his BS, DDS and into their practice. For more information MS (Orthodontics). Aside from orthodontics, Matt is an avid football about Jimmy Marketing, visit www. fan (he bleeds Maize and Blue), loves to explore new restaurants, go to JimmyMarketing.com. Jimmy will be sharing the movies and spend time cheering his kids on at swim meets. more data and information about how to Dr. Courtney Dunn graduated from the University of Michigan Dental and Orthodontic stop losing patients to your competition on programs in 2001 and 2004. She received the Milo Hellman award for her research and has an upcoming live webinar. For more details presented at many local and national meetings. She is a diplomate of the American Board of on the free webinar and to register visit www. Orthodontics, holds leadership positions in the Arizona Dental Association and is past president MorePatientsIn2018.com. of the Arizona State Orthodontic Association. She spends most of her free time being a proud swim mom. Together, they run a private practice in Phoenix, AZ. They have three children that keep their lives busy and exciting. Q2 • 2018 | TheProOrtho.com 3 BRIAN WATSON RYAN YOUNG DR. DAVID PHELPS Brian Watson Ryan Young is an is a bond attorney architect, visionary Dr. David at Watson Sloane and family man. Phelps owned Johnson PLLC Like many, he is and managed a (Orlando, Fla.), where a transplanted private practice he focuses his practice Floridian by way dental office for on bond finance, and of the northeast – over twenty-one in assisting clients growing up in Jersey and earning his master’s years.While still in dental school, he began his with the formation of corporations and other and undergraduate degrees in architecture investment in real estate by joint-venturing business entities and contract negotiation. He from Northeastern University in Boston. Once with his father on their first rental property in may be reached at (407) 622-6751 or by email he settled in Central FL in 2001, he started 1980. Three years later, they sold the property at [email protected]. a commercial construction company called and David took his $25,000 capital gain share Interstruct Inc., which helped embed him into and leveraged it into thirty-one properties that the cultural fabric of Orlando and contribute to produced $15,000 net cash flow fifteen years DR. FRANCISCO the city’s renaissance over the last decade. later. GARCIA Multiple health crises suffered by his TIM TWIGG & daughter, Jenna (leukemia, epilepsy and a liver transplant at age 12), caused David to leave Dr. Francisco Garcia REBECCA the practice so that his time could be spent has been delivering BOARTFIELD with his daughter. Unfortunately, a divorce outstanding orthodontic and failed practice sale provided additional set care since 2009. Tim Twigg is backs that he had to work through. Dr. Garcia continues the the owner and Today, David is a nationally recognized legacy of almost 40 years of presence in the President of speaker on creating freedom, building real community of Kendall and its surroundings. Bent Ericksen & businesses and investing in real estate. He Being one of the longest established offices Associates, a national Human Resources and authors a monthly newsletter, “Path to in the greater Miami area serving already the Employment Compliance Consulting firm. Freedom” and hosts “The Dentist Freedom third generation of patients that pioneering Rebecca Boartfield is a Human Resources Blueprint” podcast. Freedom Founders Kendall orthodontist Dr. Howard Sacks started and Employment Compliance Consultant Mastermind Community has grown to almost 40 years ago. with Bent Ericksen & Associates with over 15 over fifty members, providing the pathway Dr. Garcia graduated with Honors from years of specialty employment compliance and to freedom for many professional practice Boston University with a DMD degree and human resources management expertise. owners. completed his orthodontic specialty training For over 30 years Bent Ericksen & at the University of Nevada. Dr. Garcia is a Associates has been the “go-to” resource “Specialist in Orthodontics and Dentofacial in Human Resources and Employment Compliance for health care practitioners. The Orthopedics” and completed a 2 year DR. ANDREA Post-Doctoral training from an accredited company provides comprehensive products FONT RYTZNER Orthodontic Program. and ongoing consultative support services that He also has a background in dental help practitioners easily and safely navigate research and has presented multiple times in the tricky HR and Employment Compliance Dr. Andrea Font dental meetings including the International landscape. Rytzner grew up in Association of Dental Research (IADR). For information regarding products, Palma de Mallorca, And the (AAO) American Association of services, opportunities or future seminars call Spain and graduated Orthodontists yearly meeting. (800)679-2760, email: [email protected] dental school in or visit: www.bentericksen.com. Complutense University in Madrid after an exchange year in DR. GRANT DUNCAN Ludwig Maximillians University in Munich, Germany. She continued her education at Case Dr. Grant Duncan (BDS, MSc) is based in Adelaide, Australia. Western Reserve University, completing her Member of RACDS, Pierre Fauchard Academy, International College Masters and a 3-year Orthodontic Specialty of Dentists, ADA, ASO, AAO. Top 1 % Black Diamond Invisalign Residency. She lives and practices in San provider. A number of teaching and membership affiliations, but Antonio, Texas. Currently a director in the probably best known internationally as the co-founder of The Invisible Texas Association of Orthodontists and a Orthodontist (TIO), an international community growing their Board-Certified Orthodontist, music, history practices by claiming the expert Invisalign space in their communities. and travelling are her other greatest passions.

4 It’s just BUSINESS Q2 • 2018 | TheProOrtho.com 5 OFFICE LOGISTICS

Expanding Your Base Through Teledentistry By Dr. Keith Dressler

Teledentistry is still only vaguely More and more adults are looking mostly after traditional business hours. defined, but it has enormous potential to solve smile and orthodontic issues In fact, the most active time I’ve been to widen your base of potential patients, they may have had since childhood or receiving new patients is between 9:30 increase same-day starts, and maximize have become more pronounced as an p.m. and 11 p.m. your profits. That’s what it’s done for my adult. Their challenge more often than practice, anyway. not is scheduling. The traditional work ------environment is changing, but many adults "Many patients who ------still find it difficult to take time away from work unless it is an emergency. may be too embarrassed "The traditional work And it’s not just the nine-to-fiver that has environment is changing, challenges; those working second and to come into your office third shift positions also find it difficult for a physical exam are but many adults still find to connect with healthcare providers. Teledentistry can help solve that issue. very willing to snap a it difficult to take time Smartphones and their high resolution away from work unless it cameras provide excellent pictures few photos and text them suitable for performing cursory to you for evaluation." is an emergency. " exams. Many patients who may be too ------embarrassed to come into your office ------for a physical exam are very willing to In other words, I’m getting potential Two new teledentistry codes released snap a few photos and text them to you patient inquiries at night, while I’m by the ADA went into effect on January 1, for evaluation. The idea of texting, either sleeping. 2018. They are D9995 teledentistry - for through traditional texting or Facebook Thanks to a series of Facebook ads, I synchronous, real-time encounters (think Messenger, is less nerve wracking for can easily educate the patient on the types video chat) and D9996 teledentistry - patients and gives them the freedom to of pictures needed, and direct them to asynchronous; information stored and make inquiries at their convenience. text the images directly to my business forwarded for subsequent review (think In recent months, I have acquired more landline—which is able to receive text, selfies and texts). than 100 new patients, mostly adult and images and Facebook messages—and then

6 It’s just BUSINESS OFFICE LOGISTICS

------store them in Rhinogram, a new, HIPAA- before I can start working with them. But compliant growth tool I helped create and most of them are easy Class I cases that I "Since I’ve started use in my practice. Those ads are linked can take care of in 10 to 12 months. to my Facebook business page, where Because I’ve engaged with patients encouraging patients to patients can send in the images, which I digitally, it’s easy to answer all of their receive through Rhinogram, whether they questions about cost, insurance, duration, send me these images, choose to text them directly from their and number of visits, and then send them I have gained 15 to 20 phone or use Facebook Messenger. the necessary paperwork. All this is done Since I’ve started encouraging patients before they ever visit the office, so a same- new starts per month. to send me these images, I have gained day start on their first visit is the norm. 15 to 20 new starts per month. They are With each new start bringing $3,500 to They are mostly adults mostly adults who would otherwise never $4,500 per case, it’s easy to see how I am who would otherwise have contacted me or anybody else. Of the able to add approximately $80,000 of new people who have contacted me, about 20% patient revenue coming from previously never have contacted me need to be referred to a general dentist unreachable patients. or anybody else." ------

Q2 • 2018 | TheProOrtho.com 7 MARKETING, SOCIAL MEDIA & EVENTS

Aligning Your Brand: Selecting and Securing a Trademark By Nathan Harris

Many practitioners probably don’t give other design elements, such as a logo, ARE THERE PRIOR USERS OF THE a lot of thought to naming their practice. font, or particular color scheme. When MARK? But new patients will encounter that name budget allows, registering a mark in both A mark cannot be registered or used well before they meet you, and current standard character and design forms when it would create a likelihood of patients will refer to your practice name provides the broadest protection. confusion with someone else’s earlier when sending friends and family your trademark rights. In the United States, way. Your practice name, logo, and/or trademark rights can be created by simply motto—your trademarks— play a huge –––––––––––––––––– using the mark in commerce; the owner role in defining your brand, and are likely of an unregistered mark can enforce that some of your most visible and enduring “You will save time mark against later users. For that reason, assets. Selecting and securing a strong and money in the you cannot rely solely on a search of the trademark that distinguishes your practice USPTO trademark database to determine from others is a must. Here are a few registration process by whether the trademark you’ve chosen points to consider: is already taken. A trademark attorney confirming in advance can help you conduct a thorough search SHOULD YOU REGISTER THE MARK? for any prior uses of the mark(s) you are While you do not need to register your that you can adequately considering. trademark in order to use or enforce it, a federal trademark registration through show how you are using ARE YOU CURRENTLY USING THE the United States Patent & Trademark the mark.” MARK? Office (USPTO) offers many advantages. A trademark cannot be fully registered A trademark registration gives its –––––––––––––––––– in the United States unless and until owner the right to stop later users of the it is “in use”—for example, after your mark on similar goods or services. The IS THE MARK DISTINCTIVE? practice opens its doors to patients. But registered-trademark symbol (“®”) itself To be registrable, a trademark must a trademark application can be filed is often a powerful deterrent to would- be distinctive of the covered goods or based on either current use or a bona fide be infringers. A trademark registration services. Distinctive marks, including intent to use the mark within the next increases the monetary damages available “coined” terms (EXXON for oil) and six months. In the latter case, you must to the registrant in an infringement arbitrary terms (APPLE for computers), actually begin using the mark before the lawsuit, and creates a legal presumption are among the strongest types of mark. USPTO will issue a registration. that the registrant is the legitimate owner Suggestive marks, which require some of a valid trademark. thought or imagination to understand HOW WILL YOU PROVE YOU ARE their relation to the goods or services they USING THE MARK? SHOULD YOU PROTECT YOUR cover (NOBURST for liquid antifreeze), Before registering your mark, the MARK IN ALL ITS FORMS, OR IN A are also considered strong. On the other USPTO will require a specimen of use PARTICULAR STYLE? hand, terms that are descriptive (APPLE that shows how you are using the mark in Registering a word or phrase in PIE for scented potpourri) or that are performing or marketing your services. “standard character” form protects that primarily merely a surname (SMITH’S, or Acceptable specimens may include, for wording in any and all fonts, typefaces, GOULD HOTEL) can only be registered example, a photograph of your practice’s colors, and capitalization schemes. Yet after proving that consumers have come signage or other displays of the mark, the mark may also be registrable as part to associate the mark with your services. or a screenshot of your website that of a “design mark” that may include prominently features the mark, identifies

8 It’s just BUSINESS MARKETING, SOCIAL MEDIA & EVENTS

the services you offer, and provides means for contacting the practice or making an appointment. You will save time and money in the registration process by confirming in advance that you can adequately show how you are using the mark.

WHO OWNS THE MARK? A trademark must be used by either the owner/registrant, or the owner’s licensee. A discrepancy between who owns the mark and who is using it may lead to loss of the trademark and cancelation of the registration. Individuals come and go from practices, so giving one or more of them ownership rights in a mark is inviting a future dispute as to who owns the mark. If your practice is organized as a corporate entity, the trademark should generally be filed in the name of that entity.

HOW WILL YOU REFER TO THE MARK? The USPTO often researches how an applicant uses a potentially descriptive mark, so be wary of language on your website or in marketing materials that may give rise to a descriptiveness rejection. For example, if your trademark is “STRAIGHTEST SMILE,” a promise on your website to “give patients the straightest smile around” could be pointed to by the USPTO or third parties as evidence that the mark is descriptive. Also consider using the TM symbol with the mark before it is registered. While it has no legal effect, that designation lets the world (including would-be infringers) know that you consider the mark to be a source identifier.

An experienced trademark attorney can help you pick a mark and guide you through the process, as there are many traps for the unwary in registering and enforcing a mark. Selecting a distinctive, protectable mark will avoid issues down the road, allowing you to focus on your patients while continuing to build goodwill in your brand.

Q2 • 2018 | TheProOrtho.com 9 VISIT US AT BUSINESS & PRACTICE DEVELOPMENT AAO 2018

I DID IT! THE FUTURE IS NOW FOR IN-OFFICE 3D PRINTING

“You can buy a dental 3D printer from just about any dealer, but only 365 clinical approach – backed by unparalleled

Dr. Todd Bovenizer | Bovenizer Orthodontics | Cary, NC

Now is the perfect time to add the power of Ortho 3D printing to your practice. With its consultive clinical approach and proven customer service, 365 Printing can help you get up and running quickly for immediate return on investment.

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Embracing Innovation: How Becoming an Early Adopter is the Key to Practice Growth I DID IT! By Dr. Grant Duncan

THE FUTURE IS NOW Harvard Business professor, Clayton The question becomes, is this in fact Christensen, in his seminal book The what we are witnessing right now in the –––––––––––––––––– Innovator's Dilemma, says: orthodontic profession? Are we at an “All truth passes through FOR IN-OFFICE –––––––––––––––––– historical crossroads where the profession is dividing along lines drawn between three stages. First, it is “Breaking an old business the old and new ways, with the new ways 3D PRINTING being driven by innovations associated ridiculed. Second, it model is always going to with disruptive technology? require leaders to follow With innovation comes risk and is violently opposed. opportunity. Psychologists tell us that their instinct. There will only 10% of the population is ‘hardwired’ Third, it is accepted as always be persuasive to receive, assimilate and act upon new being self-evident.” information. As a general comment, it –––––––––––––––––– reasons not to take a risk. is far easier to do what you have always done in the past. This becomes the great An early adopter of disruptive But if you only do what risk. But, great opportunity can be reaped technologies must accept that they may by those who are early adopters. fall into the early stages of Schopenhauer’s worked in the past, you However, early adopters have their truth. Ridicule and vitriol have been the will wake up one day own dilemmas. With the technology path for many early forward-thinkers. “You can buy a dental 3D printer from just about any dealer, but only 365 revolution, what technologies do you It takes courage to stay the course. And, and find that you’ve been adopt, when, and what should be left on unfortunately, you are never recognized clinical approach – backed by unparalleled the shelf for now. How do you weather via the third stage of truth, as self- passed by.” the reputational storm of being an early evidence implies the ability in all of us to adopter? German philosopher Arthur recognize ourselves as the primary driver Dr. Todd Bovenizer | Bovenizer Orthodontics | Cary, NC –––––––––––––––––– Schopenhauer (1178-1860) wrote about of change. the 3 stages of truth.

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So, is there a roadmap to early ‘yes’ folks, carrying the burden of being –––––––––––––––––– innovation adoption? Can you change constantly inundated with ideas and the way you process and act upon opportunity. The 90% start from a ‘no’ “Failure is the innovators information? Yes, you can, but it is a position. It won’t work; it won’t work in difficult journey for most. my area, my practice, with my patients, companion. ‘I welcome I apply four key tenets when assessing my staff or my referring dentists. When failure’ is a seemingly any new idea or product. you start from a position of ‘no,’ it is very difficult to progress new ideas. asinine comment. But in OPEN YOUR MIND The first hurdle is purely psychological; ENGAGE WITH INNOVATORS truth, it strikes at the very people naturally want to stick with the Talk to those who have tried it. tried and true, and as orthodontists Reach out to developers and other core of the early adopter. we see the value in replicating proven early adopters to better understand the You must be prepared to methods. However, it’s critical to identify innovation landscape, and seek their new technology as an opportunity rather opinions on the product and integration. fail, as failure comes from than a threat. Ask thoughtful questions and collect as much information as you need to feel effort.” –––––––––––––––––– comfortable with taking the risk. –––––––––––––––––– If 10% of people have an ENGAGE WITH KEY BE THE BEST STAKEHOLDERS Become the expert in your community, entrepreneurial mindset, Once you have decided on a course, you as most patients seek out quality. Your hungry to learn and can only move forward with stakeholder patients will find you, your reputation will engagement. You need to be able to tell grow, and with this, so will your business. ready to be the movers your story, parlay your dreams with passion and excitement. Staff, patients TELL YOUR STORY and shakers, my best and referring doctors need to become Develop programs and systems to advice is to cultivate believers too, and excitedly get on your build the 3 pillars of practice referrals; innovation bus. dentists, existing patients and the wider innovation by changing But be warned. Failure is the innovators community. They all need to hear your companion. ‘I welcome failure’ is a expert story. Build a marketing program your belief system” seemingly asinine comment. But in truth, with at least 50 different strategies it strikes at the very core of the early functioning in harmony. Multiplatform, –––––––––––––––––– adopter. You must be prepared to fail, as multimedia, multi-targeted. failure comes from effort. It is easy not to These philosophies are really what Open belief systems are the holy grail fail if you are not trying to change. If you led my son Nick and me to create The of successful business leadership. At The want to adapt to the changing landscape, Invisible Orthodontist (TIO). A little over Invisible Orthodontist (TIO) we talk a not everything you will do will be ten years ago I went to an orthodontic lot about this. This is often the biggest successful. Wear your failure with honor, meeting in Las Vegas where I took a hurdle in helping our doctors grow their as this is where the most learning is done. hard look at my willingness to be an practices. It may come as no surprise, but In summary, early adopting can early adopter. I realized that embracing nearly every orthodontist I have ever met best be described as a skill: the skill a new technology – Invisalign – was a believe he or she is in the 10% innovator of not just adopting but also adapting remarkable opportunity to differentiate group. new technology. It means reviewing myself and gain a real advantage over my technology and implementing it rapidly competitors. BE CURIOUS and thoughtfully. It means challenging At that point, I made the decision to Read journals, be active in forums and your belief systems, welcoming failure, become the Invisalign expert in my area, go to meetings. Visit the trade displays, sometimes wearing a target on your back, and to be an early adopter. Embracing cultivate relationships with key opinion being curious and engaging. It means that technology allowed me to go from leaders and known innovators, set Google being a leader. 10 case starts in the year 2000 to 100, and Alerts for areas of interest, all the while eventually to more than 500 cases per applying the 10% rule. I call it ‘starting So now you’ve adopted a new year. As I shared my story with colleagues, from a position of yes.’ The 10% are the technology. What’s next? I learned that many orthodontists were

12 It’s just BUSINESS BUSINESS & PRACTICE DEVELOPMENT

experiencing the same problems and responsible for starting over 15,000 So, are you an early adopter? Do you looking for new ways to grow. cases in 2017. Our latest market entry is want to not just survive the risks ahead, That’s when the Invisible Orthodontist the United States, where we are looking but actually thrive in this increasingly was born. I wanted to help build forward to growing our international competitive marketplace? Here is a test. a community of entrepreneurial community and building more successful What do YOU know about The Invisible orthodontists who understood and practices. As our U.S. membership grows, Orthodontist (TIO), Dental Monitoring, embraced the expert strategy, a we expect our case volume to multiply to ULab, Spark, inBrace, reputation community willing to share, to leverage upwards of 80,000 patient starts a year. management software, conversion rate the awesome experience and intellect The goal of TIO is a simple one; to optimized digital strategy and patient of its members, and a group supported help orthodontists gain and retain relationship management software? Just by online and offline management expert orthodontic statuses within their to name some of the concepts that TIO is systems. Clinical, marketing, digital, individual communities. partnering with in our quest to grow the web presence, supportive software, live orthodontic expert space. expert consultancy, staff training, and ––––––––––––––––––– To find out what one of the world’s finally innovation leadership. Our team biggest innovators, Google, is doing of developers and consultants are world “Register to join our that is impacting your practice in leading in their respective areas, only free webinar to find out 2018, join our free webinar with David working in the orthodontic space with Nelkin, TIO’s Global Head of Digital runs on the board to prove it. how Google is impacting Strategy by visiting https://doctor. The Invisible Orthodontist (TIO) theinvisibleorthodontist.com. You can has now become a global network your practice in 2018. also email TIO’s US National Manager, of specialist orthodontists who have Visit https://doctor. Brooke Simons-McIntyre, at brooke@ dedicated themselves to innovation and theinvisibleortho.com to learn more about clinical expertise, with a focus on the theinvisibleorthodontist. TIO membership. practice of clear aligner technology. We are the biggest aligner users in the world, com" –––––––––––––––––––

Q2 • 2018 | TheProOrtho.com 13 MARKETING, SOCIAL MEDIA & EVENTS

Could Convenience Be The Key? By Jeff Behan

If you participate in any online groups 1st – Determine what response, or Competition almost always drives for orthodontists, chances are you’ve action, you want your audience to take. prices down. It’s a reality of our consumer participated in, or at least lurked around, 2nd – Ask and answer the question, society. However, virtually every segment a discussion about how the profession “What can we do that will make it easy for of the consumer goods and services world will compete with Smile Direct Club and them to take that action?” striates into segments from high to low. other “do it yourself” options. This latest 3rd – Ask and answer the question, Some find the shortest path to remaining disruption comes at a time when the “How can we make it desirable for them competitive is to lower their price, but traditional collegial relationship between to take that action?” it’s important to not confuse price with GP’s and Orthodontists has already affordability. Those market segments changed the competitive landscape and The above approach applies to any that have figured this out continue to competition between specialists is at an form of marketing and advertising where see their prices rise, while they focus on all time high. All this competition has you want to encourage a direct response, affordability and ease of purchase. many orthodontists feeling like the future like scheduling a consultation, referring I don’t believe SDC and GP’s offering is grim. a friend or a patient, liking or sharing orthodontics automatically translates to You may have noticed that I’m not a post, writing an online review, etc. orthodontists having to lower their fees to as “everywhere” lately as I usually am. Speaking of scheduling a consultation, I remain competitive. Instead, we need to I’ve taken a break from many of my believe that the best way to compete with make sure our message focuses on quality usual speaking engagements and done SDC and other disruptive competition is and affordability. Then you need to make it less writing than normal. I’ve used the to shift the new patient acquisition model easy for the consumer to be your patient… extra time to focus on the future state away from its reliance on the in-person even before they are your patient. That’s of orthodontics, specifically thinking initial consultation. It’s time to reimagine right, convenience. In the traditional about how the profession can position the way people move from prospects to model, consumers have to spend time itself for success against new, disruptive patients. researching options, researching providers, approaches and increased competition researching benefits and, once they’ve like those described above. I don’t believe done all that, they have to schedule the answer is lowering your price, though a consultation (often with multiple many have already taken that step. providers) to find out what their treatment Instead, I believe the answer will require a will entail and what it will cost. Compare shift in the new patient acquisition model that to SDC’s message where consumer’s used by orthodontists for decades. make the purchase decision and start their My favorite definition of effective treatment without ever leaving the couch. marketing is, anything we do that makes That’s convenience. it easy – and desirable – for people to In terms of quality – you’re in charge. take the action we want them to take. Unless you deliver poor results and/or a As simple as this sounds, many small negative patient experience, you should be business owners (orthodontists) have able to associate quality with your practice. a tendency to do what the other guy In terms of affordability, you can stretch is doing without really knowing why. payment plans out long enough to offer a Instead, every marketing initiative, competitive monthly payment. So let’s talk whether it's a Facebook promotion, about convenience, the almost magical website design or a radio ad, should be element that can make or break your developed using the following process: success.

14 It’s just BUSINESS MARKETING, SOCIAL MEDIA & EVENTS

For the 50% of the population that text chat to your website. Maybe you’ve Our uploader isn’t like others that are actually has a dentist, the GP wins king even given out a mobile number so you intended to replace initial records. That’s of the mountain for convenience. After can chat with prospective patients, but a classic example of a strategy designed all, they can provide that service right in have you changed the call to action away to make doctors’ lives easier. There’s their office – no need to see a specialist. from “schedule a consultation”? If not, nothing wrong with that, but it’s not easy Then along comes Smile Direct Club with I think it’s time to embrace a change in or desirable for a consumer to use cheek the powerful one-two marketing punch your approach. retractors and upload 6 complicated of convenience and low cost. Only the If you can engage them early in their photos when all they need to do is send orthodontist has the ability to address online search, creating an opportunity to you a snap of their smile so you can build the magic three elements of quality, connect with them and engage in SMS rapport and trust with them and uncover affordability and convenience if s/he is conversations with them, you win. If that their motivation for seeking treatment. able to unlearn the traditional approach to online conversation includes specific Plus, you’re building a valuable database new patient acquisition. details about their smile and what their for further marketing in the process. At first glance, the “virtual” consults treatment will entail, you can literally skip Xerox, Dr. Pepper, Snapple, Buffalo now being offered by some progressive the new patient consultation, conduct the Wild Wings and dozens of other brand- orthodontists is a move toward entire “sales” interaction via SMS and only name companies have failed to stay convenience, but in reality, it’s more schedule them for a records appointment relevant in our fast-changing world. about convenience for the orthodontist once they’ve decided to start treatment Consequently, they have ceased to than the consumer because the call to with you. survive as independent companies and action remains the same as it’s always For close to a year now, we’ve been are now mere possessions of stronger, been; to schedule and attend an in-office working with our Australian partner more flexible firms. Some of yesterday’s consultation. What I’m suggesting is more (the creators of Dental Ed) to build a superstars like Toys R Us are closing up radical than that. consumer-oriented smile uploader and shop altogether. And the forces that are We all know people born after 1980 are digital marketing platform. We’ve run affecting those big companies are affecting very tech savvy. They’re skilled at online simple ads on Instagram with our “upload your company as well. I think the best way research and highly dependent on online your smile” camera as the primary call to to stay relevant (to remain desirable) is to information in the selection of service action on our landing pages. The results never be a slave to the last seven words of providers. They are also now in the “sweet have been stunning and we’ve found that any business, “That’s the way we’ve always spot” for orthodontic marketing so their the secret to success is NOT to ask the done it.” I’m on a crusade to change the decision-making process should inform inquirer to schedule a consultation, but way orthodontists capture new patients. every facet of orthodontic marketing. rather to do the whole interaction via Hope you’ll keep an open mind. One of the keys to how they prefer to mobile. People love it – and they’re going communicate is that they would much into treatment. rather text than talk. Maybe you’ve added

Q2 • 2018 | TheProOrtho.com 15 ANSWERS FROM THE EDGE

With all the change taking place in orthodontics it’s always interesting to hear from industry leaders and understand their views on where we are now and where they think this thing is going. The Progressive Orthodontist knows it’s vital to understand the challenges facing dental business owners as information and understanding are the keys to making the right decisions going forward. The way we have always done it has never been less likely to be a good plan in the short or long term. This is no time for irrational sentimentality or blind traditionalism! Enjoy. Featuring Dr. Denny Mauro and Dr. Ryan Streight

PROORTHO: WHAT’S BEEN MAURO: Always continue to further THE BIGGEST CHANGE IN your education once you have finished Interview with ORTHODONTICS IN THE LAST residency. Check the ego, find a mentor Dr. Denny Mauro COUPLE YEARS? and really learn from them. I know with the high amount of student loan debt MAURO: The biggest change in that most doctors are incurring now it Ortho in the last couple of years is, in is certainly more difficult to do, but save my opinion, the advent of “at home up to go to meetings, join study groups. orthodontics”. This is something that 99.9% of us come out of school and in our many had talked about as the probable minds, we are ready to take on the world course for aligner therapy to follow, of orthodontics, not fully realizing that we however, I don’t think that most thought don’t know what we don’t know. It takes it would come about this soon. With time, energy, effort and money, but when advancing technology, we may see an even you realize that you can become better bigger shift toward DIY orthodontics. At tomorrow than you are today, it really is the moment, more and more companies an amazing thing. The biggest thing is to are advertising aligner therapy, reaching find what you really believe in and totally Denny Mauro was born and raised more of the population and broader embrace it, from treatment philosophy to in Oakmont, PA. He completed his demographics than ever before. Such the feel of your practice. If you can find undergraduate studies at Penn State a small percentage of the population a mentor that holds those same beliefs, University, his dental training at seek out orthodontic services at the learn as much as you can from them and the University of Pittsburgh and his moment that the increased awareness never be afraid to ask questions! There specialization in Orthodontics at could translate into big things for most are tremendous resources available in the Jacksonville University. He has had offices. Listening to the chatter out there, orthodontic world, some of the greatest the unique opportunity of having it is certainly scary for some, but if you orthodontists in the world are more than practiced as an associate, a sole position yourself correctly things should willing to share successes and failures. owner of a multi-location practice, work out to your advantage. This doesn’t Learn from them! and as a partner in a multi-location necessarily mean you have to change your practice. core beliefs of what orthodontics should PROORTHO: WHAT’S THE BEST be, however, it does mean that you may THING YOU’VE DONE IN YOUR have to adapt to the changing needs and PRACTICE IN THE LAST YEAR AND –––––––––––––––––– wants of those seeking treatment if you WHY? want to grow. The correct positioning is “We constantly evolve. different for everyone. MAURO: Wow, that’s a really tough Never allow yourself question to answer. From a practice PROORTHO: WHAT’S ONE THING philosophy standpoint, we’ve really made or your practice to get YOU’D WARN A RESIDENT ABOUT it a point to focus on our commitment IF YOU COULD REALLY GET THEIR to “give where we live”; supporting stale.” ATTENTION AND HAVE THEM foundations, organizations and causes in –––––––––––––––––– LISTEN? our local and surrounding communities.

16 It’s just BUSINESS ANSWERS FROM THE EDGE

We do this not only in the form of MAURO: I am working a bit less, as far amazing group of people working their monetary donations but by donating as clinical hours compared to last year, hardest to ensure a fantastic experience our personal time as well. The obvious however, the admin time is the same, if for our patients. It makes things a bit and easiest way for an Orthodontist to not a bit more. We have 3 partners and easier when you have a place that people be charitable is by giving away treatment a fantastic associate in the practice. This look forward to going to. Secondly, we and we try to do that as much as we can. certainly made it easier to cut back my constantly evolve. The most certain way to Becoming an integral part of the fabric of clinical schedule while not decreasing decline is to be doing everything the same your community is extremely rewarding. availability for our patients. The big exact way that you were doing it two years Clinically, we have made it an ongoing reason WHY I made the decision to cut ago. Never allow yourself or your practice pursuit to make treatment as convenient back clinical hours was to be able to do to get stale. As a practice, we have added as possible, increasing efficiencies to more fun things with my family more two new offices in the past 5 years, which decrease the number of appointments often! My typical schedule is Mon-Thurs. is certainly a factor in growth. I’m really needed to make it through treatment, Having a 3-day weekend opens up the excited about some new ventures coming decreasing number of “extra care” possibility of some really fun, quick in the future too. Our marketing team appointments, while not compromising getaways. My family is taking advantage has really done a great job of increasing on the finished product. of it and loving it. our brand awareness which is always important, especially in areas where PROORTHO: ARE YOU WORKING PROORTHO: IS YOUR PRACTICE there is increasing competition. Most MORE OR LESS OR THE SAME GROWING, FLAT OR DECLINING? importantly, as I said above, it’s giving NUMBER OF DAYS SEEING PATIENTS WHY? back to the community that I feel has the NOW COMPARED TO LAST YEAR biggest impact. When you take great care AND THE YEAR BEFORE? WHY? We are growing and the reasons of people, when they really know that are definitely multifactorial. First and you care, everything else tends to fall into foremost is the fact that we have an place.

Q2 • 2018 | TheProOrtho.com 17 ANSWERS FROM THE EDGE

patient, educate them on pros and cons is more youer than you”. Be you. Practice and deliver with quality results to the best where there is a need or practice where Interview with ” of our ability. I think the shift to more it is saturated and you want to live. In Dr. Ryan Streight customized, sometimes limited treatment, the end, just make your choices and own has been a major one for our profession. them and don’t focus on negativity. With technology changing quickly we are seeing countless products coming forth PROORTHO: WHAT’S THE BEST each year. Digital customized treatment THING YOU’VE DONE IN YOUR is becoming more important. Esthetic PRACTICE IN THE LAST YEAR AND treatment options are becoming more WHY? important. Adapting our philosophies STREIGHT: It is hard to pinpoint one and our primary goals as clinicians to fit thing in the past year that would stick out these changes and treat the ever growing as the “best” thing we did. So many little population interested in orthodontics is things happen that lead to big positive paramount in order to thrive in a market changes. And it is different if looking at that is seeing more and more at home the business, the clinical, or the personal options, more DSO options, and more aspect of the practice. I think focusing non specialists increasing treatment Ryan Streight grew up in Norman, on clinical efficiency over the past few options for patients. We live in an On- OK. He went to college at years is really starting to have a positive Demand economy and it is different than Washington University in St. Louis, impact on the practice. It seems small the world in which our predecessors in graduated dental school from but buying dental loupes with a headlight the profession were able to practice. Oklahoma in 2008 and finished and really focusing time and energy on his orthodontic residency from bracket placement and the mechanics PROORTHO: WHAT’S ONE THING Tennessee in 2011. He joined a of my bracket system have helped me to YOU’D WARN A RESIDENT ABOUT run more efficiently and finish treatment private practice in his hometown IF YOU COULD REALLY GET THEIR in 2011. They have 3 locations in ATTENTION AND HAVE THEM ahead of time. I have a multi doctor, multi Oklahoma: Norman, Mustang, and LISTEN? location practice, and the focus on bracket South Oklahoma City. He and his placement and treatment mechanics has wife Lara have 3 kids age of 7 and STREIGHT: I don’t tend to follow been beneficial. The average treatment under, Aubrey, Max and Natalie. He all the doom and gloom we see in our time in my office has changed from 22 likes just about everything especially profession. With social media there are months to 18 months and average number having fun! tons of ways to get information from of visits have dropped as well. I think numerous people in the profession and overall that little thing has had the biggest PROORTHO: WHAT’S BEEN sometimes you have to be careful with impact on the practice. THE BIGGEST CHANGE IN that. It's easy to focus on the negativity or ORTHODONTICS IN THE LAST to compare your situation to all others. PROORTHO: ARE YOU WORKING COUPLE YEARS? Be careful that you aren’t falling into two MORE OR LESS OR THE SAME STREIGHT: I think there is an traps I see people fall into: 1) The “it's NUMBER OF DAYS SEEING PATIENTS increased awareness of orthodontic different here” trap. Don’t limit yourself NOW COMPARED TO LAST YEAR treatment in the general population. thinking you can’t do something you AND THE YEAR BEFORE? WHY? We have seen arise in the demand for see others doing because you think your STREIGHT: In 2017 I worked less and treatment amongst all ages and with environment is different than theirs. 2) took more time off. The majority of that is that some of the focus is on the desires The “they are doing it so I should do it” due to having a partner and an associate and needs of the patients themselves. I trap. Also don’t assume because someone doctor to help share the treatment of the think at home orthodontic treatment has else is doing something successfully patients. But also some of that is more brought to light the need to customize (business or clinical) that it will work for efficient scheduling and being properly our treatment to the individual. I think you. As Dr. Seuss says, “Today you are staffed to see the patients. Also part of our job is to listen to each individual you. That is truer than true. No one alive that is due to efficiency in treatment time.

18 It’s just BUSINESS ANSWERS FROM THE EDGE

A lot of things add up to being able to see more patients in a normal day, not having people going overtime in treatment and having other docs there to work when you are off. Scheduling efficiency can lead to a lot more free time for doctors. The answer isn’t always to add an associate. Sometimes you can spend time tweaking your schedule template and being fully staffed can help run efficiently with a full schedule. It all depends on where you are at the time. If you aren’t working as much as you want, focus on patient acquisition and getting exams filled. If you are working more than you want, focus on schedule template and treatment efficiency.

PROORTHO: IS YOUR PRACTICE GROWING, FLAT OR DECLINING? WHY?

STREIGHT: My practice continues to grow. I feel fortunate to be an orthodontist. I think there are many variables at play when an office is growing, flat, or declining. I’ve been fortunate to have a practice that has always grown steadily over my whole career. I think it is important to be aware of why this might be happening. Some might be my practice location. Practicing in Oklahoma isn’t like practicing in LA, New York etc. I think most of it has to do with keeping patients happy. Creating a positive environment and producing quality results goes a long way. More so than marketing, even though I do fair bit of that too. I think any way you can connect with your community and create place people want to be you will see growth happening. The ROI is hard to measure and you may even incorrectly attribute the growth to some thing you did deliberately. I typically tell people, just be kind, be nice to people, keep people happy, be yourself, and make others feel important and valuable. It is more than just moving teeth around.

Q2 • 2018 | TheProOrtho.com 19 BUSINESS & PRACTICE DEVELOPMENT

BRACE YOUR PRACTICE FOR HYPER GROWTH: Gain More Patients By Publishing A Book By Adam Witty, CEO & Founder of Advantage|ForbesBooks

If you Google search “orthodontist” AUTHORITY whomever you receive treatment from.” in your local city, chances are you’ll The power of authority is unrivaled, Dr. Burleson refused to believe that. be presented with over forty different even when you have every professional So, he sought to build up his authority options. How would a potential patient accreditation attached to your name. and gain the trust of his patients so he know that your practice is the best one Take Dr. Dustin Burleson, who is could stand out amongst his saturated, out of the bunch? How would they choose not only board-certified, but is also a competitive market. your name? These are the questions member of the American Association of that every orthodontist ponders when Orthodontists, American Cleft-Palate- TRUST: WHY IT’S NEEDED MORE they’re trying to separate themselves in a Craniofacial Association, American THAN EVER BEFORE crowded marketplace. Dental Association, Missouri Dental When you grow your authority, your Undoubtedly, we all want our name Association, Greater Kansas City Dental patients’ trust grows with it. But before and our practice’s name to show up first, Society, and the Charles H. Tweed you’re seen as the authority in your loaded with hundreds of five-star reviews International Foundation for Orthodontic field, you need to have trust. Trust is the and accreditations. Naturally, you would Research. heartbeat of your business. Without trust, think that these are the attributes required “In the world of medicine, it is really your practice will fail. to garner a quality lead flow for new hard to stand out above the crowd,” says Trust is more essential than ever before patients. However, no matter how many Burleson. “Our government, the media, due to today’s world of rising uncertainty. accolades you have on your résumé, it’s and many others are intent on portraying Between the polarized political landscape not enough to separate you from every orthodontics—and medicine, for that and the breakneck speed of technology other orthodontist in the market. So, what matter—as a commodity where it is and its growing incursions into our lives, do you need to have? largely the same wherever you go and it’s not surprising that, for many of us,

20 It’s just BUSINESS BUSINESS & PRACTICE DEVELOPMENT

our trust in others—from political and Authority marketing is the strategic right, your practice will catapult itself religious leaders all the way down to the process of systematically positioning a to new heights it’s never seen before. folks next door—has hit what feels like person or an organization as the leader By implementing the seven pillars of an all-time low. Nowadays, when people and expert in their industry, community, authority marketing—1. Branding and are first exposed to news, their reaction and marketplace to command outsized Omnipresence, 2. Content Marketing, almost immediately jumps to skepticism. influence over all the competitors. To 3. Events, 4. Lead Generation, 5. PR & In today’s tumultuous world, people are put it more simply, when you create a Media, 6. Referral Marketing, and 7. yearning for trust in every decision that deliberate plan to implement authority Speaking—along with your published they make in their life. Having authority marketing and then perfectly execute it book, your authority status will speed up creates trust, and when a potential patient over time, you’ll command influence over the process of turning prospects to loyal trusts you, there’s no shopping around your competitors and be propelled into patients. or kicking the tires. They make their new business growth. John Cotton, founder of Dental Team decision around the value and service –––––––––––––––––– Performance, spoke on the power that you’re bringing them. Your authority came along with publishing his book and means they can trust you. You’re the “Being a published author utilizing authority marketing. orthodontist to go to. “The book was an accelerator of the What happens when there’s a low level and utilizing authority strategies and tactics we were already of trust or no trust at all? You’re not seen marketing strategies is the using. Certainly, the credibility and as a reliable advisor. You become just visibility of my company and myself another sales person—someone trying to recipe for ultimate success." personally has been a huge impact on put money in their pocket. Your patient enhancing everything that we’ve done,” will make his or her decision based on –––––––––––––––––– Cotton explains. “Every key performance price, because you’re merely a commodity When you’re competing in a crowded indicator that we have measured in years with nothing to differentiate you from marketplace, such as the orthodontic past has improved significantly since the other dozens of orthodontists in your community, it’s all about the influence the publishing of my book. We have community. you and your practice possess over strategically used my book to grow my Think about it, before someone is your competition to magnetically pull business.” willing to spend their hard-earned money prospects to choose you. at your practice, they’ve got to believe that “From the beginning, I understood GETTING STARTED ON YOUR you will do exactly what you say. Patients authority marketing and how it could PATH TOWARD AUTHORITY STATUS have got to trust you. How do you build benefit me and my practice,” says Dr. Published authors use their books that required trust between patients? In a Burleson. “Furthermore, I knew that I to become the authority, celebrity, and word: authority. needed a trusted team to help me with expert in their industry, marketplace, When you and your practice are seen this because I needed to focus on caring and community. When utilizing the as more trustworthy, you speed up the for my patients.” seven pillars of authority marketing, sales cycle and take price completely One of the very first things you can book authorship creates powerful lead out of consideration. You have a value do to be seen as the authority in your generation magnets through advertising, proposition that sets you apart, and marketplace is to publish your own securing favorable media attention people will buy on value rather than book. Patients are looking for the expert and publicity, promoting a cause or making a choice based on price. in orthodontistry, so when you have a philanthropy, and gaining fame and published book laying out on the coffee fortune. THE BUILDING BLOCKS OF tables of the waiting room, it will be easy When you combine the power of AUTHORITY MARKETING for that patient to automatically instill having a published book and authority Authority matters because authority trust in you and think, “Wow, they really marketing, the results are incredibly speeds trust. If you’re looking to have know their stuff!” Having your own book powerful. your practice make an impact in your is one of the best business cards you can Today, Burleson Orthodontics & community, authority and trust are the give out, and it encourages a potentially Pediatric Dentistry is the market leader key ingredients. But, let it be known that untapped patient base to learn more with four locations in the Kansas City authority doesn’t just happen to you. It about you and your practice in an organic metro area. Burleson has authored two doesn’t just creep up on you in the night, way. books that he uses to generate new patient it must be strategically manufactured by Being a published author and utilizing appointments in his offices. He mailed utilizing the building blocks of authority authority marketing strategies is the copies of his books to all the television marketing. recipe for ultimate success. When done and media outlets in Kansas City and

Q2 • 2018 | TheProOrtho.com 21 BUSINESS & PRACTICE DEVELOPMENT

has scored regular guest appearances on Kansas City local stations such as ABC, CBS, NBC, and FOX to discuss braces and children’s health. “If I look at the marketing I do for my practice, the lion’s share falls into the category of authority marketing,” says Dr. Burleson. “Parents make purchase decisions for their children’s healthcare based on credibility and trust. We have built higher levels of credibility and trust which have resulted in growing patients, growing office locations, and growing a practice that I am proud of and enjoy working in.” –––––––––––––––––– “Parents make purchase decisions for their children’s healthcare based on credibility and trust." –––––––––––––––––– Potential patients are looking for an orthodontist they can trust in to care for themselves and their family members and to deliver a beautiful, healthy smile. In today’s competitive marketplace, authority is a necessity to thrive and grow year after year. Don’t get left behind in the hustle and bustle of a saturated marketplace. Stand out amongst the crowd by building your authority status today. Advantage|ForbesBooks has helped over one thousand CEOs, entrepreneurs, and professionals publish their books and implement authority marketing to take their practice to the next level. They do the writing, designing, and marketing for you, so you can focus on the care of your patients. They are the only publisher on the planet that makes marketing, growing your practice, and building your authority with a book its number one priority.

To get started on your path of authority, please visit forbesbooks.com/ortho18 to apply to be the next ForbesBooks author and learn how they can help take your practice to new heights in 2018!

22 It’s just BUSINESS BUSINESS & PRACTICE DEVELOPMENT HOW DO YOU STACK UP AGAINST THE COMPETITION?

TAKE OUR AUTHORITY ASSESSMENT AT FORBESBOOKS.COM/ORTHO

Q2 • 2018 | TheProOrtho.com 23 H.R. INSIGHT

My Team is Costing Me a Fortune! By Drs. Matt & Courtney Dunn

Nobody warned us that some of the extremely painful in the short-term, you performance or you wouldn’t have given biggest stresses in running an orthodontic will be fine in the long-term. In certain them a raise – right? This can lead to a practice would be related to our team situations, you may even be better off in slippery slope with your entire team. If rather than the patients or the clinical the long-run. And don’t worry if patients this person asks for a raise tell them what aspect of orthodontics. This beautiful love this employee. If you replace them they need to do to get one. Once you practice we imagined and subsequently with another friendly person, hardly see a more consistent performance, then built, wouldn’t run properly without anyone will even mention it – we promise. increase their pay. the right people working within its walls. The team we build is essential GOOD EMPLOYEES WITH to running a successful practice. But, –––––––––––––––––– ORTHO EXPERIENCE RARELY HIT once you add people to any equation, “Don’t forget that the THE OPEN MARKET. YOU ARE complications undoubtedly arise. Team GENERALLY SIFTING THROUGH members are humans with emergencies, experienced people need OTHER PEOPLE’S REJECTS AND feelings, immune systems, expectations to be “untrained” from MALCONTENTS. THERE ARE, OF and opinions. On top of that, they have COURSE, EXCEPTIONS. BUT, DON’T families to support and expect to be the way they used to do it BE AFRAID TO HIRE WITHOUT compensated fairly for a job well done. at their previous office in EXPERIENCE. But what is fair? There can be a huge Training someone new is a huge disconnect between what the doctor is addition to the training on pain. Especially if you lose someone willing to pay and what the employee right before a traditionally busy time expects. So, what do you do when this how to do the things in our in the office. It seems so easy to require happens to you? office." experience. We imagine this person seamlessly jumping into our practice and WHILE THERE ARE CERTAIN –––––––––––––––––– start working. Sure, there will be a few EMPLOYEES WHO ARE REALLY tweaks here and there, but it will be easier. GREAT AND WE WOULD HATE DO NOT OVERPAY FOR Now there is the reality. Most of the time TO LOSE THEM, NOBODY IS MEDIOCRITY. with experienced employees, there is a IRREPLACEABLE. So, here’s another common situation. reason they are looking for a job and it It’s one of those nightmare situations You have an assistant ask for a raise. This usually isn’t the reason they stated in the where your highest paid and most critical person is an OK employee, and things interview. Think about the last couple of employee asks for a raise. They are your are running pretty well in the clinic. But, people who left your office – would you right-hand person and patients love them, they aren’t an awesome employee – they hire them again? In our experience, the but their request is unreasonable. This is just kind of clock in and out, never going majority of people who have orthodontic the time when most of us panic because above and beyond. If you lose this person experience need almost as much training we can’t function without them. We feel you will be short-handed for sure. So as someone with no experience so hire like we are being held hostage. “Pay up many of us cave and give this person a for personality and work ethic (if you can or I’m gone.” Do not let your emotions raise, just to make our life easier. You gauge that in the interview). And, don’t take over in these situations. You need don’t want to train someone new and forget that the experienced people need to do what is fiscally responsible for the be shorthanded for a while. But, you are to be “untrained” from the way they used practice. Every person is replaceable. essentially encouraging their mediocrity. to do it at their previous office in addition And while losing this person could be Obviously, you are OK with their job to the training on how to do the things

24 It’s just BUSINESS H.R. INSIGHT

in our office. So, what we’re saying is worth. But, if this ideal candidate wants were going to get. Everything else seemed that the training is going to happen with too much money (especially if you know to get lost. So, one year we decided to almost any new hire regardless of level the norms for the area), it’s probably a red stop tying employee pay with our yearly of experience. So, don’t limit your hiring flag. First of all, because any time we’ve evaluations. If someone felt they deserved pool! ever hired the aforementioned person, a raise, they needed to meet with us they’ve never been worth what we were during the year and explain why they felt DO NOT HIRE PEOPLE paying them. Secondly, they will see this they should earn more. The ball was in WITH UNREALISTIC SALARY as a starting salary and continue to want their court to prove to us why they are EXPECTATIONS NO MATTER HOW more and more and more. And this leads awesome and has proved to be a better GOOD THEY APPEAR TO BE. THEY to our next point. system. WILL NEVER BE SATISFIED. You think you’ve found the perfect DO NOT GIVE AUTOMATIC –––––––––––––––––– candidate for the job. He’s friendly, RAISES JUST BECAUSE SOMEONE competent, confident and the team likes SURVIVED ANOTHER TRIP AROUND “If this ideal candidate him. But, then you ask the final interview THE SUN. question, “What do you expect in terms We think evaluating employee wants too much money, of compensation?” And his answer has performance is essential. We’ve always especially if you know the you floored. It’s not only more than you been a fan of yearly, written evaluations wanted to pay, it’s significantly more than in conjunction with a one on one meeting norms for the area, it’s you feel comfortable paying. Plus, he’s with the doctor for every team member probably a red flag. " already planned a vacation in June, so he (although we’ve recently changed this – will need that week off as well. What do that’s a topic for another day). In the past, –––––––––––––––––– you do? Before dispensing our advice, we’ve also discussed pay at this meeting. we would first like to state that we have Then we started to notice a trend. We We hope this helps and just remember no issue with someone negotiating their would evaluate each employee, but their that you aren’t alone in your day to day salary or stating what they think they are focus was mainly on how much more they stresses. We’re all in this together!

Q2 • 2018 | TheProOrtho.com 25 MARKETING, SOCIAL MEDIA & EVENTS VISIT US AT AAO 2018

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26 It’s just BUSINESS

HOW TO MAKE YOUR NEXT MOVE THE BEST YET By Angela Weber, CMO OrthoSynetics

You’re successful at what you do ◆ A MARKETING PLAN IS MORE efforts are armed with a strong Call to because you’re always thinking ahead. THAN A “NICE TO HAVE” Action (CTA). Don’t leave your audience And when you’re not thinking about how A lot of practices say they do marketing, interested, but unsure of what do next—to to move your practice ahead, you’re doing but a post here or there on social media get results the CTA needs to be easy and it – whether it’s updating your website, won’t do the trick. Neither will a few local clear to understand. sprucing up your office waiting room, or sponsorships. You need to think about buying the latest equipment. After all, you marketing as a long-term investment, just know small changes like these can have like your equipment. Marketing needs to a long-term impact on your practice for be consistent to have any type of impact. years to come. And we know that what The more you get your name out there, you’re looking for isn’t just a quick fix, but the more people will be talking about you. more ways to stay head, and gain even The more they talk about you, the more more ground. you’re top of mind. And the more they’ll Therefore, in the hopes of giving recommend you to their friends. you the advantage you’re looking for, Word of mouth is money in the bank. I’ve polled a few of my colleagues at To get it, you need to increase your OrthoSynetics to create a collection of visibility with a diverse marketing plan. “how tos”. The latest tips and tricks on Consumers are more plugged in and everything from driving new revenue and seeking out service providers in a variety marketing to making smarter business of ways. It’s important not to silo your decisions and investments. marketing efforts. So, let’s get to it. ◆ YOU NEED TO SPEND MONEY QUICK TIPS FOR STAYING AHEAD TO MAKE MONEY Overall you should be spending at least 3% on marketing. If you want your KEEP THOSE PATIENTS practice to grow more, you’ll need to COMING invest in the right marketing mix. To By: Angela Weber, CMO OrthoSynetics know that kind of information, you’ll need to track your success – what’s working – what’s not. Don’t just jump ◆ HEY, I KNOW YOU on the latest marketing bandwagon, get Marketing, put simply, is getting your to know your customers so you can give message in front of the right audience them content they want, and marketing at the right time. You need to be where they’ll pay attention to. they are, talk to them – get out into the community. Get involved. Then give them ◆ ACTION YIELDS RESULTS a reason to take notice of your practice If you’ve spent years driving awareness and choose you over the competition. for your practice, it’s time to turn Basically, they need to care. Give them a awareness into action. Make sure that reason. a sufficient portion of your marketing

Q2 • 2018 | TheProOrtho.com 27 MARKETING, SOCIAL MEDIA & EVENTS

to use it without any problems. Another ◆ IT’S 5 O’CLOCK SOMEWHERE, BUY SMARTER. SAVE MORE. bonus of a good purchasing system: it BUT THE DAY’S NOT OVER YET By: Kim Delle, Procurement Director frees your staff up for other duties, like At the end of every day your team OrthoSynetics giving your patients more attentive care. should be balancing the patient ledger – double checking all cash, check and electronic payments. Unreconciled ◆ REDUCING COSTS WITHOUT 4 AREAS TO PROTECT payments will increase the risk for REDUCING QUALITY AGAINST LOSS OF REVENUE payments posted to the patient’s ledger, While analyzing supply invoices from By: Sandy S. Luparello, Senior Director but not deposited in your respective potential clients interested in reducing Practice Financial Services bank account. This means you could lose supply costs, I noticed most practices pay revenue because the transactions posted a different amount for the same product are not processed successfully - and from the same supplier. Crazy, right? But ◆ TIME IS MONEY; PROCESS YOUR nobody wants that. it’s true! How to fix it: track the product CLAIMS IN A TIMELY MANNER price – do your research and make sure Monitor un-submitted and rejected they charge you fairly for each order you claims reports and process them on time. place. This is important because neglecting these reports, will lead to delays in filing ◆ KEEPING SUPPLY COSTS DOWN and could result in the claims becoming WHERE THEY BELONG denied by the patient’s insurance The best way to do this is to use a company. And you know what that means purchasing system which identifies each – you’ll have to write off those balances item, price and supplier and generates that would have otherwise been paid by purchase orders for you. This will allow insurance. you to see if you were shipped, billed, and received exactly what you ordered against ◆ MISTAKES HAPPEN. LOOK OUT the purchase order you placed. Sadly, FOR THEM suppliers will often send a practice two Do a monthly review of discounts and items instead of one and bill them for two balance adjustments on patient accounts without anyone even realizing it. A good to make sure mistakes don’t happen or rule of thumb: make sure to check your haven’t happened. Why? Employee theft purchase order against your invoice. can be easily hidden through these types of adjustments. It’s important to meet ◆ CHECK THE INVOICE PRICE with your team to determine what the AGAINST THE PURCHASE ORDER appropriate percentage threshold is for PRICE discounts and adjustments. Sometimes the price on your invoice can differ from the price you agreed to ◆ ACCOUNTS SHOULD BE pay on your purchase order. If this is CURRENT & UP-TO-DATE the case, don’t let it slide. Contact the Prior to treatment your staff should company immediately and let them know ensure every patients’ account is current a mistake has been made on pricing. After and up-to-date. If it isn’t, make sure your all, this is business, and mistakes like this staff knows to make it that way before can affect your bottom line. treatment can begin.

◆ WASTE NOT, WANT NOT ◆ MAKING PAYMENTS SHOULD BE By using a purchasing system, you’ll AS EASY AS PIE be able to quickly identify places where Consider extending call center hours, you’re buying too much or buying too offering payment reminders via text, or little of a specific supply. This can help you creating other payment options to make order more efficiently. Just make sure to the collection process easier on everyone. choose a purchasing system that’s easy to Especially, your staff. use and maintain so your staff will be able

28 It’s just BUSINESS MARKETING, SOCIAL MEDIA & EVENTS

different variables within a practice. ◆ IMPROVEMENT IS A PROCESS BUDGET LIKE A BOSS More tools are becoming available that By using a comprehensive actual- By: Don Caputo, SVP of Client Relations can help simplify the forecast-to-actual to-budget plan you can clearly identify comparison for practices. Just make sure missed goals and begin improving your you’re considering them thoroughly process. Contract starts, conversion ◆ WORRY ABOUT THE “WHAT IFS” before making a significant time rates, expense control and monthly year- Times have changed and so should investment. to-year revenue comparisons are key your financial awareness. Forecasting metrics that influence budgetary results. and budgeting tools don’t just measure ◆ PLANNING IS EVERYTHING And to see the real benefit, you need to the success of a practice, they prepare Once you’ve created a proposed forecast review these monthly with your whole for “what if” scenarios. Anticipating based on specific practice trends and team. To maintain financial discretion, your future best prepares you for the historic growth patterns, you can begin present these statistics in a percentage unknown and allows for quick spending to predict possible revenue and expense format. Also, getting buy-in from your adjustments to minimize the impact to outcomes. Once you’ve determined that, whole team during the initial forecasting cash flow. It can also help prepare you the forecast can then become a budget process is important. Not only does it for positive things like an expansion or plan. Just remember to check your budget establish trust, it also promotes personal remodel. and your plan on a quarterly basis to investment, helping your practice achieve make sure you can implement changes as the goals you set together – as a team. ◆ MASTERING THE VARIABLES needed. This will keep your plan nimble It may seem straight forward, but and your finances in check. Have questions you’d like answered? creating accurate forecasts does require Email [email protected] or stop some analytic expertise to master the by AAO Booth #2137.

Q2 • 2018 | TheProOrtho.com 29 TRAVEL & LEISURE

Traveling Through Brazil & Peru By Dr. Ben & Bridget Burris

BRAZIL – MANAUS, BARCELLOS me later in the other boat for some family infamous fish. Plus, they are quite tasty! AND THE JUNGLE! fishing time. In this way I was able to get We did several shore lunches and had a It’s been a lifelong dream of mine to my fishing fix without forcing the family wide array of fish expertly cooked for us go Peacock Bass fishing on the Amazon to be out in the heat and sun all day long. both in the jungle and on the Blackwater River. This year I finally got the chance! It worked extremely well and we all got to Explorer. We flew out of Miami to Manaus on do exactly what we wanted to do. About At the end of the week the Blackwater American Airlines where we were met four days into the trip I had to stop fishing Explorer docked in Barcellos and we took by our guides and taken to a local hotel. for Peacocks. I was bruised from knee to a flight back to Manaus where we spent 24 We took a commuter flight from Manaus shoulder on my right side, my right arm hours before catching the flight to Miami. to Barcellos where we boarded the was numb (when it wasn’t burning) and Since we had time in Manaus we decided Blackwater Explorer – the boat we would I was truly afraid I would hurt myself if I to make the most of it. We got to see and live on for the next week while traveling kept up the 150-200 bass per day pace the feed the pink dolphins, visit a local tribe’s the Rio Negro up towards the equator. The guides had me on for four days straight. If traditional village and checked out the Blackwater Explorer is awesome, holds I go again I’ll do some warmup for several fish market in Manaus. All three were up to 16 fishermen and has an incredible months ahead of time. It doesn’t seem awesome and worth the effort should you crew to take care of everything you could like much but with the amount of casting find yourself in Manaus. need. Though Bridget, the kids and I were and the aggressive reeling/lure action, the I am so happy we decided to go to not their typical clientele, the guides and repetitive motion and the furious strikes Brazil as a family. Though many suggested crew took excellent care of us and spent a can take their toll so preparation is a good this was not a trip appropriate for the good deal of effort making sure the kids idea. family, we had a blast and I’m so glad had a great time. The kids enjoyed catching peacock bass that our kids got the chance to see The fishing was fantastic. Peacock but their favorite activity was spending and experience the Amazon basin for Bass are everything you’ve heard they time on one of the many sand bars in the themselves. Don’t wait. Go see for yourself are – numerous, relentless and beautiful. river, swimming and catching piranha. and take the family with! Typically we would take two small boats We did all three things in the same area P.S. Acute Angling is who we used for for the family each day. I’d leave early to and I was proud of the kids for not buying our trip. It was excellent all around. fish and Bridget and the kids would join into the popular, irrational fear of these Find them at acuteangling.com.

30 It’s just BUSINESS TRAVEL & LEISURE

Q2 • 2018 | TheProOrtho.com 31 TRAVEL & LEISURE

PERU – LIMA, CUZCO AND the town at the foot of the mountain P.S. This is who we used to plan our MACHU PICCHU where Machu Picchu is. There are several trip. He did an excellent job. “Trip of a lifetime” is thrown around ways to get to Machu Picchu and many James Gilmore a great deal. As orthodontists we are choose to hike overland for several days Travel Advisor very fortunate that we have the time and but we really enjoyed the train. Be sure +1 817 210 6443 resources to support our families, support to get the upgraded tickets that put you (Mon-Fri 8:00 a.m. - 7:00 p.m.) great causes AND to travel the world. at a table in a car with huge windows on [email protected] Never take that for granted! If you’re the sides and top as it is certainly worth looking for an awesome trip for the family the extra money to get to see the scenery we can’t recommend Peru highly enough. on the way. Once in Aguas Calientes we Whether you go for a quick trip to Machu boarded a bus that took us up close to Picchu or you take some extra time to see Machu Picchu. After a week-long buildup more of Peru, go! We flew out of Orlando in Peru and a lifetime before that I was through Panama City to Lima on Copa worried that laying eyes on Machu Picchu Airlines. Lima is pretty much like any would be anticlimactic. I am happy to modern city and we didn’t really spend admit that this worry was unfounded. As any time there because of this. After an avid traveler I’ll admit that some places spending the night in a hotel right next live up to the hype and others do not… to the airport we took a Latam Airlines this was much more the former than flight to Cuzco. Now, I have to admit to a the latter! We will let the photos speak serious error on my part and a good bit for themselves though they still don’t do of ignorance at this point in the game. I’d it justice. Suffice it to say that you need heard of the altitude issues and sickness to go see this for yourself and take your from people who visit Machu Picchu but family with you. I’m interested to see what I didn’t get it. I’d looked up the altitude of impact these experiences will have on our Machu Picchu and it was only about 8000 kids as they grow and learn. We can only feet above sea level so I was confused and imagine that having a relatively broad unconcerned since we spent the week experience base and world view will be a before in Beaver Creek, CO. What I failed huge advantage but time will tell. to realize is that the jumping off point for Travel well! just about any trip to Machu Picchu is Cuzco and Cuzco sits at 11,200 feet above sea level and you can certainly feel it! The local tea and pure oxygen are said to help but we didn’t really partake – probably mostly because of my lack of respect and knowledge! I’d certainly plan on doing so for at least the first couple days were I to go again. Sleeping the first night was the biggest issue but after a couple days we acclimated. Cuzco is a great, historic and interesting city. We thoroughly enjoyed our time exploring the central city (where our hotel was located) as well as the field trips we took to surrounding areas such as the local ruins, the Moray salt pans and the sacred valley. After a few days in Cuzco we took the train to Aguas Calientes –

32 It’s just BUSINESS TRAVEL & LEISURE

Q2 • 2018 | TheProOrtho.com 33 BUSINESS & PRACTICE DEVELOPMENT The Cost of Failing to Plan Your Estate: A Reality Check By Carla A. DeLoach, Esquire and Jordan DeLoach Hurlburt, Esquire

We all possess the secret hope of a long of Attorney is a passport to financial bill-paying account. Your children are healthy life, marked by a comfortable, navigation during incapacity and removes upset and lashing out and hire a different worry-free retirement. If we imagine our the need for court intervention. Financial attorney to represent them. passing, it's undoubtedly in our sleep decisions can be managed privately, surrounded by loving family members, eliminating an additional burden of stress, PLAN AHEAD who are independent, productive legal costs, and complexity. Having faced the tough decisions, you members of society. Perhaps these hopes, and your spouse signed wills and trusts. coupled with the unwelcome thought of REALITY CHECK Sticky questions related to children from death, lead many to assume there will Though a model of fitness, you suffer a prior marriages and the division of wealth be time later to address their estate plan, life-snatching heart attack. Overwhelmed have been explored and your intentions putting it off until “tomorrow.” and grief-stricken, your spouse attends are in writing. Though struggling with to funeral decisions sooner than she your loss, your spouse has the necessary REALITY CHECK ever feared. Faced with the reality of documents to access accounts and update Your spouse is leaving the hospital suddenly being alone, your spouse begins titling. Your personal representative and/ after tough discussions with the doctor to assume responsibility for finances only or trustee has clear authority to handle all regarding your impending long and to learn that your name, alone, was listed financial affairs in your absence, and has difficult recovery from the bike accident. on several community bank accounts. a roadmap for the asset division, which The accident affected many of your Your spouse needs to renew the vehicle provides for your spouse and children. functions, and you have extreme difficulty registration for your car but the DMV Court oversight and legal fees are speaking and communicating. Your refuses, demanding paperwork that she minimized. The family is communicating paychecks are deposited directly into a does not have in her possession. In the and is focused on grieving your loss bank account titled in your name alone. midst of this unthinkable circumstance instead of fighting with one another, Although you have online access for she receives an e-mail from your daughter unsure of your intentions. the account, your spouse (being the less (her step-daughter), the one who always “tech-savvy” of the two) does not have liked your spouse, asking for a copy of NEXT STEPS your username and password. In the your Will. Your spouse goes to the safe Estate planning can be a daunting meantime, time is of the essence; money and finds drafts of unsigned documents, task. But, as you can see, procrastination needs to be transferred into the family bill prepared prior to your marriage. The and delay can be costly. The right estate paying account. drafts do not include your spouse as a planning attorney can guide you through beneficiary or personal representative1. the process seamlessly. State law governs PLAN AHEAD Your spouse is overcome by a flood of the law surrounding incapacity and death. A properly executed Durable Power questions. Will I have assets to live on? So, it is important that you contact a local of Attorney grants your spouse access to Will I have to share “our” assets with other attorney who is licensed to practice in accounts titled in your name, providing beneficiaries? Who is in charge? How will your home state. And, as an increasingly authority to deposit funds payable to I pay the mortgage? What happens to all complex area of the law, it is prudent to you, transfer funds from your individual of our household belongings? Your spouse retain an attorney who limits his practice accounts, and establish new accounts, is forced to hire an attorney immediately, to estate planning. among other things. The Durable Power using the limited cash in your family

1 In many jurisdictions, the “personal representative” is referred to as the “executor;” this individual manages the estate of a decedent, administering all court interaction, paying final debts, and distributing assets to the appropriate beneficiaries.

34 It’s just BUSINESS BUSINESS & PRACTICE DEVELOPMENT

It is not uncommon for an estate former spouse as a result of the divorce? Again, the more the estate planner knows, planner to offer a complimentary initial ◆ Did you and your current spouse the better equipped he is to help you solve consultation, which provides you with an enter a pre/postnuptial agreement? your planning problems. opportunity to review your concerns and ◆ Do you have minor children? objectives while communicating crucial ◆ Do you have a child with special As estate planners, we know all too well background information about your needs? the reality many face who do not address family. Do not be surprised if the attorney ◆ Do you have existing estate planning their estate plan. The outcome is trying requests a completed information documents? and inevitably more complex, costly, worksheet in advance of the meeting. ◆ Have you or your spouse made prior and confrontational than necessary. The more information you provide, the gifts to trusts or individuals? Take the first step and contact a local more equipped the attorney will be to give estate planner. Provide the detailed tailored guidance and counsel. Naturally, The question list above is not information requested and sit down to you should expect to provide personal exhaustive. But, it is representative of what discuss your objectives. From there, the data (addresses, dates of birth, social you should anticipate. Finally, you should estate planner can provide his planning security numbers, etc.) But, you should expect to provide the estate planning thoughts focused on your unique facts also be prepared to provide answers to attorney with a complete financial and circumstances. questions such as: statement. Detail is crucial in this regard. The nature, value, and titling of your Be on the lookout for our next article ◆ Are you a United States citizen or assets have a significant effect on the about things you should consider in resident? planning required. A good estate planner crafting your estate plan. We’ll explore ◆ Do you own a business? will review your financial statement with the befuddling questions: Will v. Trust? ◆ Do you own real estate that is not an eye toward tax consequences (income, Beneficiary Designations? Income tax occupied by you? gift, and estate), asset protection, and considerations? Spousal rights? For more ◆ Have you been divorced? spousal protections, among other things. information visit : www.deloachplanning. ◆ If you have been divorced, do you He will review beneficiary designations com have pending obligations to your and ensure your plan is cohesive.

Q2 • 2018 | TheProOrtho.com 35 MARKETING, SOCIAL MEDIA & EVENTS

This Critical Data Is Saving Orthodontists Millions of Dollars By Jimmy Nicholas

Before you can fix any problem in In the last twelve months we have You easily stand out and rise above your your practice, obviously you must first monitored and listened to over 12,000 competition by simply answering the know about the problem. Furthermore, new patient phone calls for orthodontists. phone. you must always monitor and measure The number that always frustrates me the what you expect. Overall, I have found most is seeing the number of missed calls HOW MUCH IS NOT ANSWERING many orthodontists do not monitor their that some orthodontists are experiencing. THE PHONE POTENTIALLY phones and they usually do not know We have seen an average range from 0% COSTING YOU? what percentage of their calls are going to as high as 55% of new patient phone With each orthodontist missing on unanswered. calls going unanswered, with an overall average 50+ calls per month and an –––––––––––––––––– average of 13% of calls going answered in average treatment cost of $5,000 * 12 each practice. months = $3 million of potential lost "Think about the Recent statistics from Forbes magazine production, just by not answering the show that 80 percent of callers sent to phone. Granted, not every missed call is a Mom who is calling voicemail do not leave messages because new patient lead, but let’s just say a mere they don't think they'll ever be heard. 15% of them were, this would still be a orthodontic offices after In today’s marketplace, people want and $450,000 problem in the typical practice. dinner at 7:30 pm and demand instant gratification. If you are looking to attract as many new patients as SOME GOOD NEWS… gets a live person at possible, you must answer the phone live. As orthodontists become more aware You should also strongly consider of the number of missed calls and the your office. Everyone answering the phone before and after your percentage of missed calls, we have seen normal practice hours. Most likely, your as high as a 78% improvement. It is no else she called didn’t competitors won’t be which means more shock that we also see more than double patients for you. When most orthodontic new patient appointments booked when answer. You easily stand offices close around 5 pm, our data shows missed calls decrease more than more out and rise above your calls continue to come in until about 8:30 than 10%. pm. Bottom line, the more phone calls you competition by simply Think about the Mom who is calling answer, the more new patients you will orthodontic offices after dinner at 7:30 have starting treatment with you, instead answering the phone." pm and gets a live person at your office. of losing them to your competitors. –––––––––––––––––– Everyone else she called didn’t answer.

36 It’s just BUSINESS MARKETING, SOCIAL MEDIA & EVENTS

Q2 • 2018 | TheProOrtho.com 37 BUSINESS & PRACTICE DEVELOPMENT

Bond Financing is the Best Kept Secret for Orthodontic Practices By Brian Watson

Many orthodontic practices throughout relationships to access the public capital on conventional financing, and, unlike the United States are often faced with the markets in order to lower their overall conventional construction loans, they need to obtain long-term financing for cost of borrowing. In most cases, the generally do not require subsequent capital projects, including the financing owners may still be able to maintain the conversion to permanent financing. Bond or refinancing of the acquisition and/ relationships with their existing banks financing can also be used to extend the or construction of their office facilities, and lenders, but if structured in the terms and amortization of the debt well as well as the financing or refinancing of correct manner, bond financing can be a beyond the term and amortization of equipment for their facilities. win-win for both borrower and bank or conventional loans. In addition to the What many of the owners of these credit union. costs of acquisition, construction, and orthodontic practices don't realize is that Letter of Credit secured bonds equipping of the facilities, bond proceeds bond financing through the public capital may be used to finance or refinance may also be used to finance interest markets may be an alternative way to the acquisition, construction and/or during construction, and the expenses of finance these projects, saving hundreds equipping of new and expanded locations bond issuance. of thousands of dollars or more for the for orthodontic practices throughout the In order for the orthodontist practice practice. Most owners may simply look United States and may also help those to issue bonds to be purchased by the for traditional bank financing, or in some practices purchase their office facilities public debt markets, those bonds must cases federally assisted programs such that are currently being leased. Some have an investment-grade rating issued as small business loans that are backed advantages of this bond structure include by one of the primary rating agencies by the SBA. Alternatively, orthodontists lower interest rates, resulting in payments (Standard & Poor’s, Moody’s or Fitch). can leverage the credit of their banking substantially less than similar payments An investment grade rating is what allows

38 It’s just BUSINESS BUSINESS & PRACTICE DEVELOPMENT

large institutional buyers, including a larger financial institution by using a requirements would remain between money market funds, to buy and hold letter of credit issued by such a financial the Borrower and its bank or financial the bonds that are issued by the orthotist institution. Even if the orthodontist works institution that is the provider of the letter practice. Most very large companies in with a bank or credit union that doesn’t of credit. the U.S. that already carry an investment- have its own investment-grade rating, The orthodontic practice then pays the grade rating regularly access the public as long as the financial institution is a interest on the bonds at a low interest debt markets for their borrowing needs. member of a Federal Home Loan Bank, rate, which when added to the fees paid to then the financial institution can leverage the bond trustee, remarketing agent and –––––––––––––––––––– the rating of the Federal Home Loan letter of credit issuer, typically results in "The borrower has more Bank to provide credit enhancement for a below-market rate for the orthodontic the bonds. The bonds are then secured practice. In addition to lower rates and ability to tailor the bond solely by the letter of credit issued by fees, a bond issue secured by a letter of structure to provide a the bank or financial institution, and credit also provides the borrower with in some cases, the Federal Home Loan more flexibility than traditional financing. much longer maturity than Bank, and the bondholders would have The borrower has more ability to tailor the no recourse to the orthodontist practice bond structure to provide a much longer traditional financing, and whatsoever. Unlike other securities that maturity than traditional financing, and more flexible repayment of may be issued by private companies, the more flexible repayment of principal. The orthodontist practice would not have bonds can also be repaid in part or whole principal. " any financial disclosure requirements to at any time without penalty. the bondholders, and the orthodontic There are financial and legal –––––––––––––––––––– practice would not be required to provide considerations related to the use of bonds, Assuming that most orthodontic practices any personal guaranties or any other so be sure to check with your accountant do not carry their own investment-grade security or collateral to the bondholders and bond counsel, both of whom can help credit rating, they can nevertheless other than the letter of credit. Just you maximize the effectiveness of these obtain an acceptable rating on their like a traditional loan, any covenants, resources. bonds through leveraging the credit of disclosure, collateral or security

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40 It’s just BUSINESS SECCIÓN EN ESPAÑOL

NEW! SPANISH LANGUAGE CONTENT

The Progressive Orthodontist Magazine has readers from all over the world. Mapping the hits on the free digital version shows the orthodontic hot spots around the globe! As such we are in the process of being more inclusive, and well, progressive. In this issue and all subsequent issues Dr. Garcia will provide Spanish language content – something we should have done long ago! Dr. Garcia speaks 7 languages and we will rely on him to help us more effectively translate and distribute the magazine to our friends worldwide.

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Progresando en Español By Dr. Francisco Garcia

Quiero comenzar esta primera entrega de entrenamiento de personal, así como en el 2008 a 30% en el año 2050, en un agradeciendo al Dr. Benjamin Burris y facilitar el acceso a la salud a través de periodo similar de tiempo los hispanos a su excelente equipo responsables de mecanismos que disminuyan las barreras casi triplicaran su número de habitantes redacción, edición y producción de esta tanto idiomáticas como culturales. de 46.7 millones a 132.8 millones del revista por haberme otorgado el privilegio De la misma manera es un reto y una 2008 al 2050 y la fuerza laboral será en su de colaborar en la misma como editor oportunidad dorada para la población mayoría una representación de todas la en español. Es primera vez que la revista hispana considerar las ciencias de la poblaciones “minoritarias” esto contrasta decide incorporar una sección en español salud como opción profesional a todos con la fuerza laboral anglosajona la cual que esperemos sea de su agrado y abra los niveles. Administrativo, como parece perder porcentualmente presencia las puertas a la discusión de tópicos auxiliares en las clínicas y hospitales, en función del tiempo. relevantes en el área de la ortodoncia. así como en la formación profesional Este comportamiento demográfico No es para nadie un secreto el marcado como dentistas, médicos y profesiones por parte de la población hispana se crecimiento de la población hispana en afines. Esta constituye entonces un debe fundamentalmente a dos razones los Estados Unidos. Este crecimiento área de vital importancia para todos principales; la primera es debido al lamentablemente no ha ido de la mano aquellos profesionales que participamos fuerte movimiento migratorio sostenido con la presencia de suficiente personal activamente como entidades prestatarias desde hace varias décadas desde los hispanoparlante en todas las áreas de servicios a nuestros pacientes y sus países latinoamericanos en búsqueda de del sector salud especialmente en la familiares. mejores condiciones de vida así como a odontología y sus especialidades, por El perfil demográfico de los estados una política migratoria muy receptiva que ello independientemente de la ubicación unidos refleja que aproximadamente para hasta hace pocos años permitía con poco dentro la unión americana es de vital el año 2050 uno de cada 3 personas en los esfuerzo a cualquier inmigrante de las importancia que todas las áreas de Estados Unidos será de origen hispano naciones hispanas radicarse en los EEUU influencia de las ciencias de la salud llevando así el porcentaje de hispanos y optar a trabajos que en poco tiempo continúen el desarrollo de programas en referencia a la población total de 15% le permitían al inmigrante y su familia

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subsistir de manera digna en un país de un producto por demás conocido a los ver directamente con una estrategia una economía pujante. La segunda razón Ortodoncistas, la alineación con termo corporativa de Invisalign donde se no menos tangible es el número de hijos y formados sobre modelos de impresiones escucha que la empresa abrirá más de 1 según los resultados más recientes de los dentales alterados con fines de lograr mil centros para modelar con el scanner censos se refleja que los hispanos tienen movimientos dentales con variaciones “itero” directamente al consumidor la mayor cantidad de hijos en relación con del retenedor “Essix” y es así como surge dejando a un lado por primera vez la los demás grupos étnicos que conforman la compañía Invisalign y su competencia participación del especialista y atendiendo la población americana. ClearCorrect. Avancemos hasta hoy en directamente una demanda directa Sin embargo y como se menciona al día comienzos del 2018 y analicemos solo al servicio por una fracción del costo inicio del artículo. La penetración de un par de variables que nos permitirán de los honorarios que actualmente se población de origen netamente hispano tener una visión más clara de lo que ha de cotiza en las clínicas tradicionales. En dentro de la fuerza de trabajo en el área suceder en el próximo bienio. otro momento conversaremos sobre un de la odontología ha sido escasamente Invisalign posee ya en su poder más de producto piloto que ya se hace conocido representativa y constituye una necesidad 4 millones de casos tratados y a partir de también, el famoso “Smile Direct Club”. imperante y de vital importancia para ellos una innumerable cantidad de puntos Sin embargo no todo es negativo ya que poder responder a la creciente necesidad digitales de movimiento dental que ni el las cifras de atención a la población que de atención “EN ESPANOL”. más prestigioso de los estudios científicos recibe ortodoncia es tan solo una mínima Ahora bien, este no es el único reto o publicados por algún investigador hasta fracción en comparación a un mercado la única transformación que deba sufrir la fecha puedan remotamente ambicionar, que de muchas maneras esta desasistido nuestra especialidad en las próximas es decir existe la posibilidad de enumerar y que aun continua respondiendo de décadas, aprovechamos y abrimos pues la variables en una búsqueda de este forma muy positiva y exitosa para los posibilidad del debate a otros elementos “Big Data” y obtener inmediatamente modelos de atención donde el especialista de vital importancia y que llegaron para resultados obtenidos en modelos va más allá de resultados excelentes transformar de forma indetenible el tridimensionales de casos ya tratados demostrando un compromiso o una panorama de lo que hemos entendido entendiendo nuevamente mejor que presencia comunitaria más fuerte, modelo como la forma tradicional de la prestación ningún otro estudio publicado hasta la este último que es indiscutiblemente un de servicios de ortodoncia en las últimas fecha las características biomecánicas del ingrediente indispensable en el éxito de 40 decadas de la misma. movimiento dental ortodontico de cientos muchísimos colegas en momentos de Menciones algunos de ellos que ya de miles de casos clínicos existentes en esa inevitables cambios como los que vivimos están presentes en la arena del ejercicio de data. ahora. nuestra profesión. Por ejemplo, la llegada Habiendo llegado el “plástico” Sean todos bienvenido a esta nueva del “plástico” en sus diferentes formas, para quedarse afrontamos ahora otro sección en español de la revista comenzó hace más de una década con reto aún más grande y que tiene que Progressive Orthodontics. God Bless

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Enfant Terrible Dr. Marc Ackerman

Dr. Marc Ackerman has a great deal to smile about. His pioneering work on smile has reoriented how orthodontists look at and treat their patients. Over the past two decades, Marc has been committed to questioning the status quo in orthodontics and has produced a catalog of books, book chapters, journal articles and essays that have upended some of the most warmly held beliefs in the specialty. He is the father of enhancement orthodontics and early on in his career he predicted the cultural shift from orthodontic patient to orthodontic consumer. We sat down with Dr. Ackerman in order to gain some insight into his orthodontic journey and what he sees coming in the future.

PROORTHO: YOU’RE A THIRD a glorified past and are monomaniacal in “depression proof.” My grandfather was GENERATION ORTHODONTIST. their attempt to extend the present. The the prototypical neophyte orthodontist. TELL US WHAT THAT MEANS TO mentality of we don’t need to change, it’s He was convinced that he was doing YOU AND HOW IT COLORS YOUR the consumer’s mind that needs to be something wrong clinically and that’s WORLDVIEW. changed is a dangerous groupthink that’s in why his practice was not as busy as he ACKERMAN: The first thing that comes no person’s best interest. would have liked. One day, he decided to to mind is a quotation by the philosopher My orthodontic world view has arrange a visit to the practice of Dr. Allan Samuel Taylor Coleridge. He made the definitely been shaped by lessons that I G. Brodie in Newark, New Jersey. Leon observation that “If men could learn from have learned from the near 100 years that practiced in Elizabeth, New Jersey which history, what lessons it might teach us! my family has practiced orthodontics. I played second fiddle to Newark at that But passion and party blind our eyes, and first want to share a story from the early time. He arrived at Brodie’s office to find the light which experience gives us is a days of my grandfather Leon Ackerman’s none other than Brodie sitting in his small lantern on the stern which shines only on orthodontic career. He graduated from waiting room reading comic books without the waves behind.” Orthodontics’ inability the Dewey School of Orthodontics in a patient in sight. Here was Angle’s protégé to critically evaluate its past and then apply New York City and within several years and someone who would ultimately train meaningful lessons to the present is the of practice he found himself in the height a generation of orthodontic educators, reason why the specialty finds itself out of of the Great Depression. Orthodontic relaxing with the hope that the phone sync with the consumer. Contemporary treatment at the time was reserved for would ring with the prospect of a new orthodontists suffer from the tyranny of the wealthy and relatively speaking was patient. My grandfather suddenly realized

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that his own practice situation didn’t seem Twenty years earlier, my father launched as grim after all and took solace from the the first combined pediatric dentistry- experience. The long-term lesson for him orthodontics residency at the Children’s was that practice success is determined by Hospital of Philadelphia. Coming out of action and hard work versus inaction and the seventies, the fruits of fluoridation were hoping for the best. During his 50-year being realized with caries rates declining career, Leon was an innovator and early and the orthodontic focus was on growth adopter of technology. He was the first to modification. Dad thought that the equip each treatment room with a small clinician most able to meet the needs of the television that patients could watch during child of the future was a super-specialist in DR. LEON ACKERMAN WAS VERY INNOVATIVE IN their appointment. both pediatric dentistry and orthodontics. HIS 50-YEAR ORTHODONTIC CAREER. ON THE SHELF My father, Jim Ackerman, also practiced In hindsight, this was a strong theory that BEHIND HIM IS A FILM PLAYER THAT HE USED AS A for 50 years. There is not enough space in proved weak in practice. However, the COMMUNICATION TOOL FOR PATIENTS IN THE EARLY 1960’S. this article to share the dozens of lessons lesson here is not in the actual innovation that I learned from my father but I would of the combined residency but in how it like to talk about one conversation in was met by the specialty. Orthodontists particular. After graduating (or being frothed at the mouth with rage and paroled) from the orthodontic residency launched a campaign predicting the program at Eastman Dental Center, I decline of the traditional orthodontic returned home to join Dad in practice. practice. When fear mongering is aimed The first year was tumultuous, humiliating, at the wallet it is usually quite effective. and frankly more work than I could have Having gone through a similar experience imagined. At the end of the year Dad, with orthodontic cannibals, I have having been an orthodontic chairman for great respect for my father and am very some time earlier in his career, presented appreciative that he tried to save me me with an orthodontic certificate. It was from my own pragmatic approach to bittersweet. He said something like, “when orthodontics. TO THIS DAY, MANY PAST PATIENTS AND COLLEAGUES you joined the practice I was appalled by IN ELIZABETH, NEW JERSEY REMEMBER DR. ACKERMAN AND HIS SILVER ROLLS-ROYCE. how little they had taught you in residency and I can now say that you are a very proficient modern orthodontist.” The last part emphasized that my residency was a “classical” approach to orthodontics rather than a contemporary one. We enjoyed a good laugh and reflected on the highs and lows of the year, and then Dad dropped the introspective bomb. He said, “Marc, I’ve always thought about how much easier and perhaps more fulfilling my orthodontic career would have been if I had just believed all the orthodontic bullshit! I can see that you don’t believe it either so I want to caution you now about pissing off the DR. JAMES ACKERMAN WAS ALSO FAR AHEAD OF HIS guild because their wrath is like no other.” TIME IN ORTHODONTICS. HE DEVELOPED THE FIRST For those readers who know me, I am not THE JIM ACKERMAN-BILL PROFFIT COLLABORATION PEDO-ORTHO COMBINED RESIDENCY PROGRAM one to shy away from controversy. His HAS LASTED 50 YEARS AND PRODUCED CLASSIC IN THE U.S. AND IS SEEN HERE AT THE DEDICATION thinking was colored by his past experience CONCEPTS LIKE THE ORTHOGONAL ANALYSIS, OF THE PEDO-ORTHO CLINIC AT THE UNIVERSITY OF with controversy. ENVELOPE OF DISCREPANCY AND THE SOFT-TISSUE PENNSYLVANIA WITH PRINCESS GRACE OF MONACO. PARADIGM IN ORTHODONTIC TREATMENT PLANNING.

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PROORTHO: SPEAKING OF dental student, I started to think to myself that smile has nothing to do with success PRAGMATISM, YOU WROTE A BOOK what is he hiding? Why aren’t we seeing the in orthodontic treatment. A DECADE AGO - ENHANCEMENT occlusion in these cases? Well, after going After about five years in full-time ORTHODONTICS - THAT CAUSED home and processing what I had seen, I private orthodontic practice, I had A GREAT DEAL OF UPSET IN THE realized that he was showing how a patient gathered enough clinical material to write INDUSTRY. TELL US ABOUT THAT evaluates success in anterior restorative a book. My good friend and mentor Dr. AND HOW YOU THINK ABOUT treatment. They look at their smile in the Orhan Tuncay opened the door for me to ENHANCEMENT TODAY. ALSO, YOU mirror and not retractor shots! This was make a book pitch to Blackwell Publishing. COINED THE TERM SMILE ARC IN a breakthrough moment for me. Upon The rest is history. Enhancement AN ARTICLE IN 1998 AND IT HAS consultation with my father, we embarked Orthodontics: Theory and Practice came CERTAINLY CAUGHT ON. TELL US on taking a series of digital videos of out in 2007 and it has gone from initially ABOUT HOW YOU CAME UP WITH patients speaking and smiling before and being considered a novelty to becoming a THE TERM AND WHAT YOU THINK after treatment in his practice. My senior cult classic over the past decade. I’m very ABOUT THE PROGRESSION FROM year of dental school, I initiated a research proud that I had the opportunity to write IDEA TO A MANTRA. project to investigate the characteristics that book and am thankful that many of ACKERMAN: Early on in my dental of smile and the result of orthodontics our colleagues finally “get it”. school experience at the University of on the posed smile. We paid a computer I have very ambivalent feelings about Pennsylvania, I learned that the most software company to develop a Mac and what smile arc has evolved into. As you innovative things in dentistry were a PC compatible app to measure smile say, for some it has become a mantra result of the cross pollination of ideas. characteristics called the SmileMesh. Some or even an orthodontic raison d’etre. Penn had always been an avant-garde years later when I published a 2002 JCO Orthodontists cannot operate without an institution and over the years gained a article on smile, the software was available “ideal” in mind and in the case of the smile reputation for clinical innovation and as a free download on the JCO site. arc, many feel smile arc consonance equals the production of super-specialists. I was It was during the time that I was ideal. Well I can tell you from experience, particularly interested in periodontal writing up the manuscript that I coined not all consumers want a consonant smile prosthesis which was the brainchild of the term smile arc. To be fair, the term lip arc and in fact some even have asked for Dr. Morton Amsterdam. In the 1950’s, parallelism had been used in removable a flat smile arc as the goal of treatment. no second thought was ever given to prosthetic dentistry for decades but had It boggles my mind that there is even a extracting periodontally or restoratively not been incorporated in orthodontic bracket system marketed specifically for compromised teeth. Amsterdam came to diagnosis and treatment planning. Smile protection of the smile arc. the conclusion that all available therapies arc seemed like a better term for describing should be employed to save as much this smile characteristic. That 1998 paper PROORTHO: TELL US ABOUT of the natural dentition as possible. He was the first to demonstrate that standard YOUR LATEST BOOK, STRAIGHTER: unified aggressive periodontal therapy and bracket position for the straight-wire THE RULES OF ORTHODONTICS. advanced restorative dentistry, creating a appliance and the associated treatment ACKERMAN: Straighter: The Rules of new paradigm for treating the mutilated mechanics almost always flattened the Orthodontics is a book about attitude and dentition. smile arc as well as intruded the maxillary its effect on your orthodontic practice. It While I was a third-year dental incisors reducing incisor show at smile. is based on both Ben Burris’ and my own student, I had the good fortune of hearing I entered orthodontic residency on a failures over the years and the lessons we the world renowned perio-prosthesis mission to further study smile. Although learned along the way. When I got out of graduate Dr. David Garber speak at a Penn I ultimately was allowed to focus my residency, there was a clear delineation Alumni meeting. He showed magnificent research on occlusal plane rotation in between clinical decision-making and restorative cases and in particular many of orthognathic surgery cases and its effect practice management decision-making. them involved the anterior portion of the on smile characteristics, it had been a I was under the impression that if you dentition. As he went slide through slide 24-month battle with my chairman about treated your cases to exceptional finishes presenting before and after photographs, whether or not the smile was relevant to and demonstrated clinical success, I noticed that all of the images were of orthodontics. I distinctly remember one economic success was assured. Well, let’s the cropped smile. Being a brainwashed conversation in seminar when I was told say that I learned that this wasn’t true

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the hard way. After reading Siddhartha PROORTHO: YOU RECENTLY direct to consumer marketing channel Mukherjee’s The Laws of Medicine: FOUNDED THE AMERICAN was going to destroy the profession. We Field Notes from an Uncertain Science, I TELEDENTISTRY ASSOCIATION all know how that worked out. Today, the decided that after two decades of practice WITH AN IMPRESSIVE ADVISORY uproar against doctor-directed at home it was time to write about lessons learned. BOARD. TELL US ABOUT THAT. clear aligner therapy is just as silly. This The unifying concept was that clinical and ACKERMAN: Outside of clinical mode of orthodontic delivery is safe, practice management decisions are not practice, The American Teledentistry effective, affordable and provides access to mutually exclusive. If you read the book, Association is my main focus right consumers who have heretofore been shut you’ll get a sense for why we chose the now. The mission of the ATDA is to out of traditional in-office orthodontic term rules over laws and how we arrived increase access to dental care through services. at our current philosophy of practice. advocacy for and the implementation of For me, this book is the natural sequel to innovative teledentistry guidelines and PROORTHO: MANY LONG Enhancement Orthodontics. solutions. I have assembled an advisory STANDING INSTITUTIONS IN board composed of experts in telehealth, THE HEALTH PROFESSIONS ARE technology, dental support organizations, STRUGGLING FOR RELEVANCE IN patient advocacy and the legislative branch THE CONTEMPORARY LANDSCAPE. of government. I encourage readers to visit WHAT DO YOU THINK ABOUT our site (www.americantedentistry.org) THE AMERICAN BOARD OF and read about our Board and familiarize ORTHODONTICS’ DECISION TO DO themselves with the facts about AWAY WITH THE TREATED CASE teleorthodontics. What I have found is COMPONENT AS PART OF THEIR that most of the teledentistry “experts” in EXAMINATION? orthodontics don’t know what they are ACKERMAN: You know, that’s a talking about. These ultracrepidarians great question. I published a paper in are more concerned with protecting the the AJODO with my good friends the status quo than truly appreciating the Rinchuse Brothers twelve years ago potential of the current teleorthodontic critically appraising the clinical portion model and how it’s good for orthodontics. of the ABO examination. Not only did I remember when Invisalign launched we present evidence for how the exam just prior to my orthodontic residency was internally and externally invalid THE MARC ACKERMAN-BEN BURRIS COLLABORATION HAS THUS FAR PRODUCED THE BOOK STRAIGHTER AS program. Orthodontists wrote editorials but we proposed a solution that fulfilled WELL AS A NUMBER OF THOUGHT PROVOKING ESSAYS and gave lectures railing against tooth the criteria for being board certified. ON THE ORTHOPUNDIT BLOG. movement with plastic and how the I am thrilled that the ABO has finally accepted our alternative model for board certification. They say imitation is the greatest form of flattery. However, I truly think that board certification is no longer relevant in the consumer driven orthodontic paradigm. My friend Joe Ghafari once quoted an old French/Middle Eastern proverb, “the caravan has passed but the dogs are still barking.” Almost all orthodontic services are elective and an objective measurement of treatment outcome will never be found. That is largely due to the fact that orthodontists and consumers will never DR. MARC ACKERMAN ADVANCED THE PRACTICE OF RECORDING SMILE DYNAMICS WITH DIGITAL VIDEO. AFTER agree on what constitutes success in ANALYZING MANY PATIENT VIDEO CLIPS, HE COINED THE TERM SMILE ARC. orthodontic treatment.

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From a selfish point of view, I am the American Board of Pediatric Dentistry PROORTHO: WHAT DO YOU THINK glad to see that the ABO plaster model qualifying examination. THE PRACTICE OF ORTHODONTICS occlusion measuring stick is going the way WILL LOOK LIKE IN 5 TO 10 YEARS? of the central incisor band. Having one’s ACKERMAN: If I had to make a orthodontic acumen evaluated by a little single prediction, it would be that the mind with a little tool, completely robs one price of orthodontic treatment will go of their dignity. down considerably for the consumer. Long gone are the days of incrementally raising fees year in and year out based PROORTHO: TELL US ABOUT on self-serving and irrational formulae. YOUR DAY TO DAY PRACTICE AT Alternative channels for purchasing BOSTON CHILDREN’S HOSPITAL. orthodontic services will continue to grow ACKERMAN: I practice four days a and the consumer of the future will no week at Boston Children’s Hospital. My longer care if they are seen in a traditional patient demographic is as follows: 25% bricks and mortar office as long as they children with intellectual/developmental have a safe, effective and economical disabilities, 25% medically compromised alternative. children and 50% well-children. My DR. ACKERMAN AND ONE OF HIS MANY SPECIAL clinical concentration and expertise NEEDS PATIENTS. in orthodontics has also been the Selected Bibliography treatment of patients with intellectual and neurodevelopmental disabilities. I am a Research Investigations member of the Down Syndrome Team 1. Ackerman, JL, Ackerman MB, Brensinger CM, Landis JR. A morphometric in Developmental Medicine at Boston analysis of the posed smile. (1998) Clin Children’s Hospital. In light of the fact that Orth Res 1:2-11. sleep disordered breathing is a common 2. Ackerman MB, Brensinger C, Landis JR. comorbidity for the IDND population, I An evaluation of dynamic lip-tooth co-founded the multidisciplinary Program characteristics during speech and smiling for Sleep Apnea and Sleep Surgery (PSASS) in adolescents. (2004) Angle Orthod with colleagues from otorhinolaryngology 74:43-50. and pulmonology at Boston Children’s 3. McNamara LJ, McNamara JA Jr., Ackerman MB, Baccetti T. Hard and soft Hospital. In 2012 I was appointed the tissue contributions to the esthetics of the Editor in Chief of Special Care in Dentistry posed smile in growing children seeking journal, the peer-reviewed publication of orthodontic treatment. (2008) Am J the Special Care Dentistry Association and Orthod Dentofac Orthop 133:491-9. served in this capacity until 2016. Through 4. Ackerman MB, Thornton B. Posttreatment editorial publications in the journal in compliance with removable maxillary 2013 and an editorial in the Journal of retention in a teenage population: A Clinical Pediatric Dentistry in 2014, I short-term randomized clinical trial. (2011) Orthodontics (Chic.) 12(1):22-27. have raised awareness in the professional 5. Sonis A, Ackerman M. E-space community about the access to care DR. ACKERMAN WITH ONE OF HIS BUDDIES preservation. (2011) Angle Orthod crisis for patients with IDND. I direct the FROM THE BOSTON CHILDREN’S HOSPITAL 81:1045-9. orthodontic component of the Boston CRANIOFACIAL PROGRAM. 6. Allareddy V**, Ackerman MB, Children’s Hospital/Harvard School of Venugopalan SR, Yadav S, Nanda Dental Medicine residency in pediatric VS, Nanda R. Longitudinal trends PROORTHO: ANY ADVICE dentistry. I am responsible for the didactic in discharge patterns of orthognathic FOR RESIDENTS AND RECENT seminar series and clinical preceptorship surgeries: Is there a regionalization of GRADUATES? procedures in teaching hospitals? (2013) in orthodontics. The PGY2 residents spend Oral Surg Oral Med Oral Oral Pathol one day per week in my clinic performing ACKERMAN: Find a mentor. Visit as many offices as you can. Try your best Oral Radiol 115:583-8. clinical diagnosis and orthodontic 7. Waldman HB, Ackerman MB, Perlman to avoid the bias of cognitive anchoring treatment of patients. Each spring semester S. Ethics, changing populations, and I teach a board review course (growth and by opening your mind to different the dental profession. (2015) Ethics & development section) in preparation for approaches to orthodontics than what you Behavior 25: 271-8. learned in residency.

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Other Peer-Reviewed Publications Occlusion Became the Philosopher’s Stone 29. Ackerman MB. Specialist envy: Is special 1. Ackerman MB. The Full Coverage of Orthodontics. (2006) Angle Orthod care dentistry a dental specialty or a Restoration in Relation to the Gingival 77:192-4. dental special interest group? (2016) Spec Sulcus. (1997) Compend Cont Educ Dent 14. Ackerman JL, Proffit WR, Sarver DM, Care Dentist 36: 3-6. 18:1131-8; quiz 1142. Ackerman MB, Kean MR. Pitch, Roll, and 30. Ackerman MB, Burris BG. The way it 2. Ackerman MB, Ackerman JL. Smile analysis Yaw: Describing the spatial orientation of was, the way it ought to be, the way it and design in orthodontics: diagnosis and dentofacial traits. (2007) Am J Orthod is, and the way it will be. (2018) Am J treatment planning in the digital Era. Dentofac Orthop 131:305-10. Orthod Dentofac Orthop 153: (2002) J Clin Orthod 36:221-236. 15. Rinchuse DJ, Rinchuse DJ, Kandasamy Selected as a classic article in the 50th S, Ackerman MB. Deconstructing Non-peer reviewed publications/materials in Anniversary issue of the Journal of evidence in orthodontics: Making sense print Clinical Orthodontics. Kravitz, N. of systematic reviews, randomized clinical 1. Ackerman MB. Bigots beware: History will Commentary (2017) J Clin Orthod trials (RCTs) and meta-analyses. (2008) not forgive or forget you. (2017) The 51:602- 605. World J Orthod 9:167-176. Progressive Orthodontist Magazine. 3. Ackerman MB. The myth of janus: 16. Ackerman M, Rucker B, Wells A, Wilson 2. Ackerman MB. Made to measure: The orthodontic history faces orthodontic J, Wittmann R. IT strategic audit plan. dubious relationship between eugenics progress. (2003) Am J Orthod Dentofacial (2008) Journal of Technology Research and orthodontics. (2018) The Progressive Orthop 123:594-6. [Internet]. 1:1-10. Available from: http:// Orthodontist Magazine. 4. Sarver DM, Ackerman MB*. Dynamic aabri.com/manuscripts/09163.pdf smile visualization and quantification. 17. Ackerman MB, McRae MS, Longley WH. Book Chapters Part I: Evolution of the concept and Microsensor technology to help monitor 1. Ackerman MB. Digital video as a clinical dynamic records for smile capture. (2003) removable appliance wear. (2009) Am J tool in orthodontics: dynamic smile Am J Orthod Dentofacial Orthop 124:4- Orthod Dentofac Orthop 135:549-51. design in diagnosis and treatment 12. 18. Ackerman MB. Selling orthodontic need: planning. Chapter in Monograph: 29th Selected for the B.F. Dewel Award Innocent business decision or guilty Annual Moyers Symposium-Information (2004) for the best clinical paper of the pleasure? (2010) J Med Ethics 36:275-78. Technology and Orthodontic Treatment. previous year by the American Journal 19. Ackerman MB. Technology and the art Volume 40: University of Michigan Press, of Orthodontics and Dentofacial and practice of dentofacial enhancement. 2003. Orthopedics. (2011) Orthodontics (Chic.) 12: 89-90. 2. Ackerman MB, Sarver DM. Database 5. Sarver DM, Ackerman MB*. Dynamic smile 20. Ackerman MB. The human capital crisis acquisition and treatment planning. In visualization and quantification. Part II: in orthodontics.(2012) J Am Coll Dent Miloro M, Editor: Peterson’s Principles of Smile analysis and design. (2003) Am J 79: 21-3. Oral and Maxillofacial Surgery, Second Orthod Dentofacial Orthop 124:116-127. 21. Ackerman MB. Technology, evidence and Edition, Vol. 2, Hamilton, Ontario, 2004, Selected for the B.F. Dewel Award the future of Special Care in Dentistry. B.C.Decker Inc. (2004) for the best clinical paper of the (2013) Spec Care Dentist 33: 1. 3. Sarver DM, Ackerman MB. Orthodontic previous year by the American Journal 22. Ackerman MB. First impressions: How to diagnosis and treatment planning of the of Orthodontics and Dentofacial “Wow” students into special care dentists. smile. In Romano R, Editor: The Art of Orthopedics. (2013) Spec Care Dentist 33: 47. the Smile, Berlin, 2005, Quintessence 6. Ackerman MB. Evidence-based orthodontics 23. Ackerman MB. People with intellectual Publishing. for the 21st century. (2004) JADA disabilities must be designated a 4. Ackerman MB, Facial Esthetic Examination 135:162-7. medically underserved population. (2013) and Analysis. In Tuncay OC, Editor: 7. Ackerman MB. Orthodontics and its Spec Care Dentist 33: 207-208. The Invisalign System. Berlin, 2006, discontents. (2004) Orthod Craniofacial 24. Ackerman MB. Dentistry at crossroads: Quintessence Publishing. Res 7:187-8. The access to care crisis for patients with 5. Ackerman MB (Guest Editor). Orthodontic 8. Ackerman JL, Keane ML, Ackerman special needs. (2013) Spec Care Dentist Aligners (Review). Current Practice, MB. (2004) Orthodontics in the age of 33: 261. Volume 17, Number 1, Spring 2010 enhancement. Aust Orthod J 20:3A-5A. 25. Ackerman MB. Calling all special care 6. Ackerman MB, Sarver DM. Orthognathic 9. Ackerman MB. Gatekeepers of scholarship. dentists: scientific article and case reports database acquisition. In Miloro M, (2005) Orthod Craniofacial Res 8:18-20. wanted! (2014) Spec Care Dentist 34: 55. Editor: Peterson’s Principles of Oral and 10. Ackerman MB. Obsequies for an opinion 26. Ackerman MB. What is the difference Maxillofacial Surgery, Third Edition, Vol. masquerading as fact. (2005) Am J between health and disability? (2014) 2, 2012, PMPH-USA. Orthod Dentofacial Orthop 127:531-2. Spec Care Dentist 34: 105. 11. Ackerman JL, Kean MR, Ackerman MB. 27. Ackerman MB, Waldman HB, Perlman Books Evidence-bolstered orthodontics. (2006) S. Indebted to the bank or the profession? 1. Ackerman MB. Enhancement Orthodontics: Aust Orthod J 22:69-70. New doctor debt and its effect on access to Theory and Practice. Ames, IA, 2007, 12. Ackerman MB, Rinchuse DR, Rinchuse care. (2014) Spec Care Dentist 34: 161-3. Blackwell Publishing. DR. ABO certification in the age of 28. Waldman HB, Ackerman MB, Perlman 2. Ackerman MB, Burris B. Straighter: The evidence and enhancement. (2006) Am J S. Increasing use of dental services by Rules of Orthodontics. Orlando, FL, 2017, Orthod Dentofacial Orthop 130:133-40. children, but many are unable to secure Ackerman & Burris Publishing. 13. Ackerman JL, Ackerman MB, Kean needed care. (2014) J Clin Pediatr Dent MR. A Philadelphia Fable: How Ideal 39: 9-11.

Q2 • 2018 | TheProOrtho.com 49 TRAVEL & LEISURE

KRAKOW: A POLISH JEWEL By Dr. Andrea Font Rytzner

When you think of traveling ABOUT THE CITY: around Europe, perhaps other typical Krakow became a city of European stereotype cities come to mind. A city importance in the 14th century, full of life, history, and art. I had the especially after establishing Krakow pleasure of visiting the second largest University, one of the oldest city in Poland in late November with Universities in Central Europe. It a friend. An authentic jewel in the flourished in the 15-17th century. middle of Europe. Now, it has an extremely large In the past years, inter European student population, as well as Erasmus travel has increased. Certain students from all over Europe, OLD TOWN CITY CENTER destinations in Europe have had a therefore creating an international peak in tourism, partly due to low-cost diversity to the city. Erasmus is the airlines such as Ryanair that make it largest educational exchange program affordable to travel. If you are planning in the world, where you can study a trip to Europe, a very cost-effective and learn from a different perspective way to travel around Europe would and integrate culturally, socially and be to investigate low-cost airlines and educationally in another country. explore what countries/cities they fly Historically, the city’s limitations into (Ryanair.com and Wizzair.com) have changed more than once, since I grew up in Europe and have had several towns were once independent the privilege of traveling extensively and have merged over the centuries to SIDE STREETS NEAR THE MAIN SQUARE around several countries. However, become constituents of what we know planning the trip to Krakow was today as Krakow. I will talk about the slightly different than what I was used historical districts of the Medieval to planning. I was going to stay in Old Town, where the Main Square is the same city for a few days, which located, Wawel Hill and Kazimierz would allow me to get to know the city as well as what day trips you can take better. I was ashamed to find out that around the city. I didn’t really know that much about Every time you go to visit a different the country of Poland and decided city/country, the free walking tours or to investigate a little about one of a sightseeing bus tour will probably its main cities and its surroundings offer you the best overview of the city. before heading there. Personally, I enjoy the free walking OLD MEDIEVAL CITY WALL WITH LOCAL tours, usually a 2.5-3h walking tour STREET ART DISPLAY

50 It’s just BUSINESS TRAVEL & LEISURE

with a guide that you tip at the end that do this. Usually they have two recommend you get tickets in advance what you consider appropriate, since different departure times every since these are popular and may get the guide will be paid by the tips of day. Check online, as times change sold out. the group – a good estimate would depending on the language or the day The square is one of the biggest main be around 10 euros a person. I would of the week. market squares in central Europe, also highly suggest finding a tourist bigger than Brussels, Munich, or information center and get some MEDIEVAL OLD TOWN/ Prague. In the center of the square you maps of the city and some useful HISTORICAL CENTER: see gigantic Renaissance building, the information. In this case, the tourist You can easily spend a whole day Cloth Hall declared UNESCO World center is located just outside the main wandering the streets that border Heritage Site since 1978. The building square. the Main Square. Street art vendors used to be a trade center exporting Krakow is an inexpensive city, I surrounding the city walls, little lead, salt, textiles, imported silk, recommend accommodation close to shops and café’s wrapping around spices, leather. the Main Market Square, since a lot of the plaza. In the Square, there are a The building itself now hosts a the walking happens around that area few important buildings that you can couple of museums and you can see or in the Jewish Kazimierz. We stayed go inside and visit. The Gothic St. vendors at the street level under the at an Airbnb in Kazimierz that allowed Mary’s Basilica stands out, where you building arches and shops at the sides us to go walking to the Main Square, a can appreciate the largest wooden of the building which is perfect for beautiful 15-20min walk. altarpiece in the world, designed by souvenirs! You can find the National I did two free walking tours: the Veit Stoss, as well as hourly listening Museum of Krakow filled with great first one covered the Old Town and from the outside to the traditional art and you can probably view the two Wawel Hill and the second one was trumpeter that plays from the top of large rooms in less than 1 hour. Inside exclusively in Kazimierz, the beautiful the tower. Careful if you go in tourist the museum which is on the 2nd floor Jewish historical district. All the season, it gets crowded around mass of the building, so the entrance might Old Town tours start from the Main times. They also have scheduled live be a little tricky to find, there is also Square, there are several companies concerts inside the Basilica, I would a small terrace café, where you can appreciate the view of the square.

STREET ART IN KAZIMIERZ VIEW OF WAWEL CASTLE FROM THE RIVER

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The peculiar thing is that about a 5-10min walk from the main underneath the street level, you will square, the second largest palace in find the Rynek Underground museum, Krakow after Wawel and famous its a hi-tech museum that opened not too “papal window” and for it being the long ago in 2010 after they discovered residence of Cardinal Karol Wojtyla tunnels in an excavation in 2005. before he became Pope John II. There seems to be a maximum number The Wawel Castle is also walking of occupants at a time, so make sure distance from the city center. It is NATIONAL MUSEUM OF KRAKOW ART GALLERY you write your name in the list, and worth the walk up the Wawel Hill they will give you a time slot. We were since the castle represents several running out of time, so I didn’t get architectural styles that are typical in to experience Rynek Underground central Europe: a mesh of medieval, museum, but reviews were pretty renaissance and baroque styles. The good, and it gives an oversight of the once residential castle is now one of history of the city and its culture. the most important art museums in Depending on the season you are Poland. It is also important because thinking of going, the square will have it is a center for the conservation of different activities planned. As the art pieces. Unfortunately for me, you cold approaches central Europe so needed a special ticket on the Sunday CLOTH HALL IN THE MAIN SQUARE does the Christmas spirit. The typical that we went because it was open and AT CHRISTMAS TIME Christmas markets, warm gluhwein - free to the public. The old historic a spiced warm wine, local artisan free walking tour finishes here, which crafts, vendors and street food flood is perfect if you take the early tour, the market square. Music fills the so you can now go inside the church streets and the place is buzzing with located at the top of Hill and enjoy the people wanting to enjoy the Christmas museum. spirit despite the cold. As far as restaurants around the The University is just a few streets historical center, I encourage you to go away from the main square. The free make reservations at the restaurants guided walking tours also take you that are on the main streets that lead WAWEL ROYAL CASTLE AND ROYAL CHURCH there and explain the history of the to the square. You cannot go wrong! Krakow University while walking Food is incredible, inexpensive fancy around some of its premises. Founded food, we were extremely impressed in 1364, the second largest University with the ambiance of the restaurants. in central Europe (after Prague), also I had never had polish food before known as Jagiellonian University, and I was delighted! Try local beers, honors incredible alumni such as pierogis, Zurek, soup in rye bread, Copernicus, two Nobel Prize literature and meats that are well prepared and recipients, and Pope John II. always with a touch of something You can actually walk in front of sweet. the Bishop’s Palace gardens which is FOLKLORE LOCAL STREET MUSICIANS

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KAZIMIERZ: start point for a walking tour if you’re Kazimierz was founded by King going by yourself with no guide on 40 Casimir III, the same king who Szeroka St. The Old Jewish Cemetery founded the University and built the is located right next to it and is Castle, and it is known for its Jewish visible through the gates and walls community, history, and culture. I as you walk around the block. Many believe it is important to know the tombstones were hidden and saved history of such a remarkable district in the basement of the Synagogue, so since it will play an important part in Nazi’s couldn’t sell them or place them World War II. Jewish and Polish lived as paving stones at the entrance of peacefully side by side in Kazimierz death camps. when it was first founded. In the 15th When Krakow was acquired by century, Jewish prosecution began Austria in the 18th century, Kazimierz across Europe, and Krakow was no became a district of Krakow, and was exception. They built walls around the no longer an independent city, many city and was thus known as the Jewish rich families left the overcrowded City. The walls were only surrounding district center and moved to Podgorze, THE OLD SYNAGOGUE, KAZIMIERZ part of the district, but more than half a nearby district across the river. of its inner population lived within During World War II, Podgorze was the walls. Jewish scholars and artists turned into a ghetto, overcrowded. lived here, and it became the center of Unfortunately, most people were either the religious and the cultural Jewish killed when the ghetto was liquidated community. or got sent to the death camps. At one point in time, there were over You can walk across the Vistula 120 synagogues in Kazimierz. Some River towards Podgorze, a beautiful of them are still there and are worth walk across one of the several bridges the visit to appreciate the architecture that connects with the center of both from the exterior and interior. Kazimierz. We crossed with the You can visit the Old Synagogue walking tour and had enough time to which is the oldest synagogue in all of take great pictures from the bridge. Poland and is now part of the Jewish The great St. Joseph’s church is located History Museum, exhibiting Jewish here. You can walk around Podgorze, life and culture. The High Synagogue where the old ghetto was established. which has photographic exhibits of There are touching inscriptions at which some are permanent, some are street level in some buildings that still temporary as well as other exhibits. remain standing. You can also find the There is also quite a large bookstore last fragments of the remaining part of inside where you can find books if what used to be the old ghetto walls at you’re interested in the Jewish culture, 25 Lwowska St. and 62 Limanowskiego ST. JOSEPH'S CHURCH tradition or World War II. There's St. also the Remah Synagogue, located in In 1941, the borders of the Podgorze the center of the district and a good ghetto were closed and over 15,000

Q2 • 2018 | TheProOrtho.com 53 TRAVEL & LEISURE

Jewish were confined to 320 buildings art. Personal recommendation to seduced by the ambiance of the streets, where 3,000 used to live, centered visit Schindler’s Factory, now an the excellent Jewish restaurants, the around the Peace Square. The ghetto interactive museum. Famous for new artsy café’s and lounges, the was exterminated in 1943. The peace Steven Spielberg’s movie Schindler’s bohemian lifestyle, the local stores and square, now named Plac Nohaterow List in 1993, an event that has boosted street art, the respect for the culture Getta, hosts a monument honoring tourism in Kazimierz. The museum and the history of its buildings. A the ghetto victims, giant bronze is pretty extensive, and goes over piano bar, where your tables used to be chairs, yes, you can sit on them and life in Krakow before it became the old sewing machines, or an old Jewish take a picture. In the corner of the Nazi headquarters outside German house, where every room is kept as it square where the chairs are located, territory, where Nazi’s were deployed once was and has lounge style seats you can still see the only Pharmacy to the city, how life was during these in each room making it a unique and run by a Polish man named Tadeusz hard years, what was Oskar Schindler’s cozy bar. Pankiewicz, that provided all kinds of role, what inner battles and struggles Highly recommend traditional help to the people in the ghetto as well were going on during the time and Jewish restaurants, Klezmer Hois as a cover for the Polish resistance that all the political movements around or Starka, at Josepha 14 St. are tried to help Jews in the ghetto. It has important events. Excellent museum excellent options, where they serve now become a tiny museum honoring for World War II lovers. their own flavored Vodka. Ask for the hero and his personnel, but I didn’t There is so much to see, it’s almost recommendations to your server, get to go inside because it had already overwhelming to decide what they will suggest certain vodkas to closed. I recommend checking times museums you want to visit. Most of accompany certain foods. Call in online, as it depends on the day, but it’s the smaller museums we ran into advance to make reservations. Tip: if usually open every day till 5 pm. while we were walking around. I you didn’t make reservations, still go In the eastern side of the district, would suggest doing the walking tours to the restaurant, they only book every you will find Schindler’s Factory and (it’s a must!!) and then you can plan table once a night, so you might still the Museum of Modern Art which to go back and see what you enjoyed. get a table if people are leaving at the in my opinion was not worth the I would recommend to just get lost time you walk in. time since it was extremely arbitrary in the streets of Kazimierz and get

OSKAR SCHINDLER'S DESK, LOCATED IN THE POLISH DINNER AT STARKA RESTAURANT SCHINDLER'S FACTORY MUSEUM

54 It’s just BUSINESS TRAVEL & LEISURE

WIELICZKA SALT MINES : Good for half a day trip. Either plan it in the morning or around lunchtime, otherwise it gets too crowded with tourist buses that get dropped off. You can go by public transport, but its only 20-25 minutes by taxi which is inexpensive, although the tour buses take you there too. Opened in the 13th century, they have stopped producing salt in 2007 but are currently under renovations. It is one of the world oldest salt mines operating still. Underground chambers, lakes, art and a way of life. Part of the UNESCO World heritage. Do not go if you can’t go downstairs. You need to go ONE OF THE LARGEST CHAMBERS IN WIELICKZA SALT MINES DEDICATED TO ST. KINGA down over 300 steps of stairs to get in, don’t worry, the elevator takes you up! Very well organized and the entrance already comes with a tour included.

AUSCHWITZ: Plan for almost a day tour. You will find some tours combine with the salt mines, but it ends up being a 12h day. I preferred to explore the city and go to the Salt Mines on my own, so I wouldn’t be rushed. We didn’t go to Auschwitz because we had already seen a camp when my friend and I lived in Germany, and as we were on a tight schedule, we opted not to go. I would ST. KINGA'S CHAPEL suggest taking a bus tour because it is over an hour and a half away from the city. If you know you are going in advance, check their website to book a guide online. They have limited spaces. It is a shocking and emotionally sad journey. There is a museum included once you get inside. I was impressed by this country, its history, and its culture. I didn’t know about Krakow, it’s well-dressed men, beautiful women, polite society, and impressive food. I will go back.

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In Through The Out Door By Dr. Derek Bock

For those of you reading this with any studio album! This couldn’t be further from age, or admiration for classic rock, you the truth. I would like to discuss how I’ve might be thinking that I’ve gone nuts and used regular record review on my cases to I’m about to talk about Led Zeppelins’ 8th glean insight into mechanical success and failures. For those that have tuned in to one of my Orthodontic Study groups over the last 4 years (The Pragmatic Orthodontist Elite, The Pragmatic Orthodontist Clinical Discussions, The Pragmatic Orthodontist Business Discussions) you’ll recognize the repartee over pristine photography. I’ve successfully leveraged better than average photography to share clinical techniques and outcomes to large groups of orthodontists. I’ve also leveraged the same Long term follow up of these patients photography in progress and final case also allows you see how the face matures presentations to ‘win with a wow’ and grow into the finished result. Sometimes we my business with referrals and directly to miss familial trait queues at presentation the consumer. I will write a future article in that become apparent with time. Seeing the ProOrtho on just this, but for now lets how these traits express in your finished get back to the point. product is a good retrospective treatment I would like to discuss how my planning and mechanical assessment. The own personal review of these records retrospective analysis is the only way you’ll (photographs, radiographs, study models) get ‘in through the out door’. Analyze your at numerous points throughout treatment, finished cases retrospectively and evaluate has allowed me to really improve my the potential alterations to the treatment clinical outcomes and develop a process plan. These ‘out the door’ cases will allow that has not only made me more efficient you to formulate fresh perspective in but has allowed me to scale with growth. your treatment planning process and help I’d like to discuss and show 3 cases that those cases that are about to get ‘in’. This allow me to elaborate on different aspects perpetual learning process should never of record review and how they can help us end if we wish to improve our outcomes. become better clinicians and orthodontic We only get closer to perfection if we make artists. a consistent effort on improvement.

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ROUTINE CASES (PATIENT 1): When I talk about routine cases, I mean INITIAL every day mild to moderate Class I, II, III cases that are treated with braces or invisalign with/without elastics. These cases come in many different sizes/shapes and compromises. I am by no means saying that we should aim to render compromised treatment as a blanket excuse for not treatment planning the ideal. What I mean PROGRESS is that we’re dealing with an imprecise mechanical system applied to a living biological system; perfection DOESN’T exist. You better damn well believe I shoot for perfection on every patient but understand the limitations and the fact that I’ve never gotten there or ever will. I’m ok with that. This first case is an 11 year FINAL old 4 month pubertal female with a mild Class II Skeletal malocclusion due to an asymmetric mandible. She subsequently has a mild maxillary compensated can't with some constriction. The patient was presented with the asymmetry at the new patient exam and the possible solutions. The parents didn’t wish to discuss surgery, TAD’s or fixed functional orthopedics to FINAL RETENTION attempt a large skeletal disharmony. We treatment planned the patient for a Haas Palatal expander and Damon PSL braces with asymmetric elastics. The progress and final photos give the opportunity for me to review my mechanics to make sure that the response is appropriate and we’re going in the right direction. It also allows us to address the progress directly with the parent in a small patient conference along the way to remind them what we are/ aren’t accomplishing. We have a 5 minute progress case presentation the appointment after the records are taken. This allows me time to review the records, study the movements and report on findings to my team. The progress case presentations are given by either the treatment coordinators or the clinical leads in a private consult INITIAL CEPH FINAL CEPH room before their adjustment visit.

58 It’s just BUSINESS CLINICAL CORNER

INITIAL

COMPLEX CASES (PATIENT 2): Modern day progressive orthodontics can get complicated and sometimes go sideways. Sometimes, the patient/parent will dictate treatment recommendations and reject surgery or extractions so we must get creative and work in a different biomechanical envelope. This is one such PROGRESS case (patient 2). A pre-pubertal Class II div 2 collapsed malocclusion with 100% overbite and severe crowding. This is one of those cases where the face screams non- extraction but there are significant hurdles in creating that much arch length to resolve the crowding. These cases are typically longer in treatment time and have the tendency without an organized process of record FINAL review and reporting to get ‘lost’. Lost patients typically end up over treatment time with compromised results. This patient had arch development with the help of a Haas palatal expander and Damon PSL brackets. We expanded skeletally and advanced dentally to create arch length. When you’re creating 16+ mm of arch length in each arch it’s important to FINAL RETENTION map out your incisor torque ideals and a concrete plan on execution. Without progress and final record review to study and demonstrate the movements, it’s impossible to know what you’ve executed. For the first 1,000 cases of my career I used to use a Dolphin VTO to predict my movements (incisors advancement/ retraction and skeletal guesstimates) and then compare them to my executed results. This was labor intensive but extremely valuable in my learning process and day to day 3D conceptualization of orthodontic movements. It breaks down a very subjective artistic interpretation of orthodontic biomechanics into real visual metrics.

INITIAL CEPH FINAL CEPH

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INITIAL CEPH PROGRESS CEPH PROGRESS CEPH FINAL CEPH FINAL RETENTION CEPH

FUNCTIONAL CASES (PATIENT 3): INITIAL Functional Orthopedic Assessment is critical to discern where the correction is coming from; i.e. skeletal vs dental. We often times pontificate about where the AP correction is coming from but we never take the time to go back and review the actual results. Serial records in AP orthopedic cases really lets you see what the outcome was of the appliance that you used, and it allows to you follow the long term maturity of the face that you impacted. This patient was a 12 year 6 month old pubertal female with a hyper-divergent skeletal Class II relationship. I elected to use a fixed MARA appliance from AOA in addition to the Damon PSL system. I decompensate the dentition for 4-7 months before scanning the patient for the appliance. They come back 3 weeks later for insertion and continuation of fixed appliance therapy. As you can see I overcorrect these patients FINAL and often bring them to edge/edge or a reverse overjet situation. It’s important to have the documented cases to show parents the process and steps involved in the treatment. The high quality records allow you and your staff to access this database for education and explanation along the way.

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Q2 • 2018 | TheProOrtho.com 61 816-282-0429 – [email protected] - OrthoChats.com H.R. INSIGHT

SALARY VERSUS HOURLY: Which Way Is Best? By Tim Twigg and Rebecca Boartfield

Questions about whether it is better to EMPLOYEE CLASSIFICATIONS or state laws and thus applies to almost all pay employees hourly versus a salary are Under the Fair Labor Standards Act employees. quite common. There are pros and cons to (FLSA), employees fall into one of two Note: All of the FLSA’s requirements both approaches, as well as advocates on categories: exempt or non-exempt. for exempt status are extensive, specific, both sides of the fence. Some consultants Methods of compensation, such as salary and stringent and cannot be covered here recommend paying staff on an hourly or hourly, do not determine a legal in detail. Suffice to say that at least 95 basis, while other industry consultants classification of employee. percent of all dental staff is non-exempt. advocate for staff to be paid a salary. For specific questions about the criteria or Who is right? Well, that depends upon EXEMPT CLASSIFICATION one of your employees, call our office. your specific circumstances. There is Exempt employees do not receive no one right method for compensating overtime pay; they are exempt from ------employees so long as the rules, when the overtime pay requirements and applicable, are followed. Each employer calculations. Don’t you wish you “It is not as simple as should determine this based on his/her could arbitrarily make every employee “just pay everyone a own business needs and management exempt? Not possible. This classification philosophy. Regardless of which way you applies to executive, managerial, s a l a r y.” choose to compensate your employees, it supervisory, administrative positions, ------is important to make sure that you adhere or governmentally-defined professional to applicable wage and hour requirements. positions that typically require special OVERTIME TRIGGERS Before discussing the relative pros and licensure. To qualify, there are specific On a federal level, the overtime trigger cons of each method, let’s define some rules regarding the amount of time spent is 40 hours in a week. Anything over 40 terms that are important in understanding managing/supervising/administrating, the hours in a week must be compensated the issues. numbers of people managed/supervised/ at time and one half. Some states, administered, and the type of managerial/ like California, have daily overtime HOURLY COMPENSATION supervisory/administrative duties triggers in addition to the federal This is as straightforward as it gets. This and authority that must be met. Most weekly requirement. Be sure you are in method simply pays employees for each employees do not qualify for the exempt compliance with both, if applicable. hour, or portion thereof, worked. This is classification because of the strict rules. Many employers fall prey to the myth easy to understand and administer. that: “if I pay someone a salary, then I NON-EXEMPT CLASSIFICATION don’t have to pay them overtime.” This SALARY COMPENSATION Non-exempt employees receive couldn’t be more false. The method of Payment on a salary basis means that overtime pay at all times, when it is compensation has no bearing on overtime an employee receives a predetermined worked, regardless of their method of requirements. Simply paying an employee amount of compensation on a regular compensation; they are not exempt a salary does not exclude you from having basis, such as weekly, bi-weekly, or from the overtime pay requirements and to pay him/her overtime. “Salaried” is not monthly. This is usually regardless of the calculations. This classification applies, a category for overtime purposes. number of hours worked by the employee by default, to any and all employees who The determining factor for overtime each week, or each pay period. do not meet the guidelines or definition is employee classification as mentioned of exempt, as outlined by the FLSA and/ above. Exempt employees are excluded

62 It’s just BUSINESS H.R. INSIGHT

from having to be paid overtime. While exempt employee fails to work the full what will you do if you define the salary non-exempt employees, regardless of the schedule required, then his/her salary can as 34 hours per week and the employee method of compensation, must be paid be reduced by the appropriate number of only works 28 unexpectedly? Similarly, overtime. non-work hours. Be sure you have clearly if the employee works more than the established policies, in writing, explaining defined schedule, you must increase their EXEMPT EMPLOYEES that you will avail yourself of this right to pay. In other words, a salary based on 34 An important detail for exempt avoid confusion and arguments. hours must be increased if the employee employees is that they generally must works 38 hours. And don’t forget that any receive their compensation in the form of SO…SALARY OR HOURLY? hours over applicable daily and/or weekly salary. There are provisions that dictate As you can see, this question truly overtime triggers must be paid at time what the minimum salary must be, only applies to non-exempt employees. and one half. All of which you should which may be significantly increasing in For this classification of employee, we have in writing to ensure everyone is on the coming months. Generally, exempt do recommend hourly pay because the same page. employees must be paid for the full day it is simple, straightforward, easy to even if they’ve only worked part of a day. understand and administer. CONCLUSION Full day deductions are strictly limited On the other hand, paying a non- As you can see, there are many with rules that must be followed before exempt employee a salary often does have misconceptions and misunderstandings doing so. a psychological value for the employee. about paying employees on a salary basis, And, it can be administratively easy especially as it relates to non-exempt NON-EXEMPT EMPLOYEES if overtime isn’t worked or time-off employees and overtime. It is not as There is no rule that says non-exempt deductions don’t exist. simple as “just pay everyone a salary.” In employees have to be paid a certain way. If you decide to pay your non-exempt fact, when you get right down to it, the They can be paid a salary whether that’s employees a salary, be clear how many cons can outweigh the pros depending a daily, weekly, or monthly. They can also hours per week the salary is based upon. on your circumstances. Be sure you know receive their compensation in the form of It can be any number up to 40 hours. As the rules: 1. Classify your employees a daily rate, an hourly wage, piece rate, or mentioned, you can dock the employees correctly. 2. Follow wage, hour and commission. So long as you are paying a pay. Make clear how you’re going to overtime requirements. 3. Have any and non-exempt employee at least minimum handle this when the employee works less all exceptions clearly defined in writing to wage, you may compensate them at a than the defined schedule. In other words, avoid liability and misunderstandings. rate and method of your choosing. Non- exempt employees must only be paid for time actually worked. This means that when employees are late, have to leave early, or take time off during the day, whether that’s a half or a full day, they are not required to be paid. Unlike exempt employees who all have to be paid the same based on their classification, non-exempt employees need not all be compensated in the same manner. You can have some employees be paid hourly, some daily, and some a salary depending on what you think will be best for your practice. While exempt employees are protected from a variety of salary reductions for work not performed, non-exempt employees are not. If a salaried, non-

Q2 • 2018 | TheProOrtho.com 63 ARE YOU A DENTIST PAST AGE 50... RISKING YOUR RETIREMENT ON WALL STREET?

ORDER YOUR FREE COPY AT www.HighIncomeBook.com

64 It’s just BUSINESS BUSINESS & PRACTICE DEVELOPMENT

Why All Dentists Need a Retirement “Plan B” By Dr. David Phelps

–––––––––––––––––– it with the gift of life—a donor's liver. after day at Texas Children's Hospital in "This was never part of the Away from my busy and stressful Houston, that I made a critical and life- practice, I had a lot of time to think changing decision. original plan..." at that hospital. No cell phone access. A moment of truth. I would no longer Disconnected from the rest of the world, practice dentistry. –––––––––––––––––– nothing else mattered. All of the daily "stuff" that had seemed so paramount CREATING A PLAN B I had laid out my entire life in advance. wasn't even a blip on my radar. All of While a senior in college, I began reading “I’ve got this—the sky’s the limit.” Blessed my education, wisdom, and experience; books about investments (I always had a with good intellect and a work ethic even all of the money I could earn—none knack for planning ahead). I read books to boot. Failure was not an option. A of it mattered. None of it could make a about stock market investing and some perfect family. A perfect life. A perfect difference. about real estate. Comparing the two, real professional practice career. I could only hope. Hope and pray that estate won hands down. It was a tangible But there I was. Sitting on the small, Jenna would recover and I would get a asset that I could control. Investing in the vinyl, padded bench in Jenna’s hospital second chance. A second chance to be stock market made no sense to me. room. The IV machine humming, holding a father—a real father who would be During my first year of dental school several bags of fluids and meds, dripping present, not absent. Not preoccupied with at Baylor College of Dentistry in Dallas into the tubes and through the needles “stuff.” (1980), I talked my dad into being my that ran into her small and bruised hand. Would there be a “someday?” A day in co-venture partner in acquiring a two- Jenna, only twelve years old, is asleep; the future when I could spend quality time story brick rental house (an estate sale) in her body still trying to recover from an with Jenna? a solid Dallas neighborhood. We followed exhaustive six hours of surgery removing It was during Jenna's initial weeks of the fundamental rule of real estate; buy the her cirrhotic and failed liver and replacing transplant recovery while spending day worst house in a good neighborhood.

JENNA FIGHTING CANCER

Q2 • 2018 | TheProOrtho.com 65 BUSINESS & PRACTICE DEVELOPMENT

DAVID GRADUATING FROM DENTAL SCHOOL THE FIRST HOUSE DAVID BOUGHT WITH HIS DAD

I learned how to manage this first asset is essential. Creating relationships is the DAVID… WHY DO YOU DO WHAT for rental income. After graduation from hardest part of making real estate a viable YOU DO? Baylor in 1983, we sold the house and investment and also the reason why so Other dentists ask me, “David, why aren’t split about $50,000.00 in capital gain profit many novice investors fail. They try to do you retired?” (capital gains are taxed at a much lower rate it all themselves. It takes time and work to What they mean is, "If you did so well than ordinary, or active income). establish these critical relationships. Many with real estate and dentistry, why are you The epiphany for me was in realizing that underestimate this crucial piece! still going at it?" I made a capital profit of $25,000.00 from Fair question. It’s true that I don’t need this one real estate asset during the same EVERY DENTIST SHOULD: to do…anything, really. period of time that I worked many, many ◆ Take An Honest Assessment Of Your For me, I do what I do because it’s the hours as a waiter at night and on weekends Life. Are you fully living your mission? most significant way I can invest my time. with much less to show in net income. You have one shot at life… don’t waste your Ever since I sold my dental practice and Why should I work for money all of my life trying to live up to the expectations of replaced my active income with annuity- life when I could acquire good capital assets others. based investments, (my plan B) I've had that would work for me whether I worked ◆ Develop a “Plan B”. What would a burning mission to help other practice or not? happen to your family if you were injured pros escape the hamster wheel and achieve I began to understand that if I could and couldn’t keep trading time for dollars? real freedom to live their purpose. For acquire enough assets, I wouldn’t have to ◆ Consider The Future. Many practice themselves and their families. work as hard…maybe not at all. professionals are realizing that the That's how the Freedom Founders By continuing to purchase and invest traditional model for retirement: “Work Mastermind was born. It's designed for in real estate, I was transitioning from hard, pay taxes, save” isn’t delivering on its people like me, like you - hard working, working for money to investing money in promise. Don’t wait until the sunset of your dedicated, responsible. But who also capital assets that would produce cash flow, career to face your future and get serious want to take a different, more secure and preserve and build wealth. This was my about building the life you want. Time is sustainable path...a path I call "creating a "Plan B." your most precious asset. Plan B" - it's the "opt-out" plan.

HERE’S WHAT I LEARNED… I believe you should take charge of your FREEDOM FOUNDERS IS Network or connections are the most own life, instead of letting others take DEFINITELY NOT FOR THE important factor in orchestrating a charge of it for you. MAJORITY secure financial future. It is also the most ◆ It's not for the rank and file who are underutilized capital asset. Who you know To Your Freedom! afraid and want to keep the status quo.

66 It’s just BUSINESS BUSINESS & PRACTICE DEVELOPMENT

◆ It's for those who are committed to UPDATE ON JENNA chemotherapy as a very young child to transforming their lives and their families. Today, she is in college working towards fight high-risk leukemia and suffered ◆ It's for those who are committed to an associates degree in occupational epileptic seizures from age eight to twelve. going against the grain, knowing that the therapy. A published author, speaker... She missed the first thirteen years of a majority is almost always wrong. she’s got the world by the short hairs. "normal" kid’s life. ◆ It's for those who don't listen to the Pretty good for a kid who, at age sixteen, hype of the mainstream. was reading and writing at a second- Courageous, driven, tenacious, a fighter. ◆ It's for those who listen to their grade level. She suffered through intense My girl. conscience and walk to the beat of a different drummer. ◆ It's for those who want a freedom lifestyle and aren't satisfied waiting for "someday."

That's only going to be about 2% of the entire professional practice population. Truth is, that’s probably not you. If you think differently, find out for sure at: freedomfounders.com/freedom I believe that the greatest risk is taking no action at all.

JENNA HOLDING A PUBLISHED COPY OF HER BOOK “GET UP!” WITH HER PROUD DAD.

JENNA, A HUGE BAYLOR BEARS FAN JENNA, A PUBLISHED AUTHOR AND SPEAKER, SHARES HER STORY TO INSPIRE OTHERS.

Q2 • 2018 | TheProOrtho.com 67 OFFICE LOGISTICS OFFICE LOGISTICS

As Demands in the Orthodontic Market Continue to Evolve, Innovative Software to Improve Workflow is Paramount By Uriyah Robinson

THE ORTHODONTIC MARKET However, it’s never enough to simply ways that practice management CONTINUES TO EXPERIENCE RAPID get patients in the door; to truly software could be used to improve GROWTH, WHICH PRESENTS NEW standout, orthodontic offices need to workflow and thus address some of the CHALLENGES TO PRACTICES offer a streamlined practice experience growing trends in the industry. Increasing pressure on the price of and superior patient care. Providing treatment, a rising number of teen and those things often comes down to TRACKING CLEAR ALIGNER young adult cases and new treatment practice workflow—the behind-the- TREATMENT options, such as clear aligners, to scenes best practices and activities Clear aligner treatment has become name just a few. Competition for that make an office run smoothly. one of the ways for orthodontic prospective patients has only become Practice workflow can’t be enhanced practices to distinguish themselves in more intense as practices seek ways with the flashiest marketing or the a competitive field. Aligners require to rise to the challenge and stand out coolest rewards program, but the shorter appointments and less chair with enhanced marketing strategies most efficient practice management time, which appeals to teens and and elevated patient engagement. software. Fortunately, there are several young adults seeking orthodontic care.

THE ALIGNER TRACKING TAB IN THE NEW TREATMENT CARD ALLOWS CLINICIANS TO SEE AT A GLANCE WHERE ALIGNER PATIENTS ARE IN THEIR TREATMENT.

68 It’s just BUSINESS Q2 • 2018 | TheProOrtho.com 68 OFFICE LOGISTICS

In addition, several manufacturers though some form of inconsistent note To combat this pain point—and market their aligners directly to writing or ad hoc reporting in their to provide orthodontists and their consumers, which means patients practice management software, which patients with flexibility in their come into the practice asking for them can create workflow inefficiencies, treatment options—there is a need by name. However, while offering redundancies and variation across the for clear, consistent aligner tracking. clear aligner treatment can certainly practice. Instead of looking though treatment make a practice more attractive to notes and one-off reports, it’s critical prospective patients, tracking aligner ------that universal aligner tracking is treatment can be cumbersome. "Most important, available directly within the clinical Although some aligner manufacturers chart so doctors and staff can access provide propriety tracking software, simplifying aligner a thorough visual overview of the it often doesn’t integrate with a tracking keeps doctors treatment pathway and progression practice’s management software, so from wasting valuable of aligner patients. By centralizing the clinicians must exit one platform to information most important to aligner track treatment in another. It can be time hunting data and treatment, users can confidently even more of a hassle for offices that gives them more time to identify which tray a patient is treat multiple patients using different currently wearing; how many trays aligner brands, as they must learn focus on the patient and were sent home; the progression of multiple workflows. Whether using their care." treatment; and whether the patient is one brand or many, practices struggle in refinement. Improving the software to track aligner treatment typically ------experience by adding universal aligner tracking eliminates the need to scroll through months of treatment notes or switch between software applications. This quick, high-level overview of which trays are needed for the day could even streamline workflow for multi-office orthodontists, as it’s clear which trays are needed for the day at which location. Most important, simplifying aligner tracking keeps doctors from wasting valuable time hunting data and gives them more time to focus on the patient and their care. Easy-to-access universal aligner tracking also gives other team members more confidence when interacting with patients. For example, A FEATURE OF THE PATIENT INSIGHT PANEL, INFORMATION ABOUT APPOINTMENT COMPLIANCE, if a tray is lost or a patient has BROKEN BRACKETS AND LOST APPLIANCES IS EASILY VIEWABLE SO CLINICIANS CAN HAVE questions about treatment, the front MEANINGFUL CONVERSATIONS WITH PATIENTS ABOUT POSSIBLE TREATMENT DELAYS. desk staff can easily navigate clinical

Q2 • 2018 | TheProOrtho.com 69 OFFICE LOGISTICS

information within the software treatment is taking longer or costing that practices face when tracking they’re already familiar with. Instead more. Most of these extended cases clear aligners, the analysis and design of, “One moment, I need to find come down to compliance, or lack team created and tested a solution your information [closes practice thereof. Therefore, having to ability to see how efficiently staff members management software, opens aligner to view patient compliance is a could get up to speed on a patient’s software, scroll, scroll, scroll]...” the workflow must when interacting with aligner progress at a glance; essentially, conversation becomes, “Ah, yes, you’re patients. When information taken eliminating valuable time combing supposed to be on tray #9.” The latter by the front desk can be collected through inconsistent clinical notes. As scenario is more professional and automatically—such as when an practice management consultant Mary keeps patients from milling around appointment is rescheduled—and Beth Kirkpatrick of impact360 says: the front desk or waiting on the phone. compiled in the treatment card, that “The unique aligner tracking system is Consolidating aligner treatment saves time and valuable practice fresh and new and will be important in tracking in a practice’s management resources. Once documented, clinical tracking trays, revisions and treatment software leads to an improved user staff have the ability to easily check progress.” To help practices address the experience, more efficient treatment patient compliance without navigating issue of compliance, the new treatment and better patient engagement. away from the practice management card of CS OrthoTrac v14 includes an ------software. The ability to quickly enhanced patient compliance section, see a patient’s compliance while which gives users an expanded "With this improvement chairside provides opportunities for real-time snapshot of the patient’s to practice workflow, team members to have meaningful broken appointments, rescheduled conversations with patients and their appointments, damaged wires, office staff can easily guardians on how to streamline broken, etc. With this improvement identify issues and treatment time, such as working to practice workflow, office staff can stress the importance harder to keep appointments. easily identify issues and stress the importance of compliance and its of compliance and its CREATING THE RIGHT RESOURCE impact on case time. impact on case time. " FOR THE RIGHT JOB Evolving patient demographics, Considering all the demands on increased competition and rapidly ------today’s modern orthodontic practice, changing technology will continue KEEPING PATIENTS COMPLIANT Carestream Dental made improving to challenge orthodontic practices. WITH TREATMENT workflow a priority when updating However, improving workflow with Admittedly, clear aligners give the treatment card in CS OrthoTrac practice management software could patients more autonomy, so ensuring v14. The analysis and design team be a simple way for offices to stay patients stay compliant with took a unique “user-centered” ahead of the curve. CS OrthoTrac v14 treatment is more important than approach to the CS OrthoTrac clinical was designed specifically to tackle ever, but compliance is a crucial space, directly engaging orthodontic these challenges to not only enhance issue for every patient. Patients practices for feedback. High-fidelity practice workflow but improve with extended treatment time drain working prototypes of the treatment the quality of care for doctors and practice resources and—with the card were demonstrated and tested patients. increased pressure on the cost of to validate the design intent of the orthodontics—unhappy patients proposed solutions. For example, after *All patient data shown is fictitious and parents want to know why researching the common challenges and for illustrative purposes only.

70 It’s just BUSINESS DENTAL REFERRALS ARE DEAD... ARE YOU PREPARED?

On-Line Training Event Reveals

Listen. Dental and orthodontic competition in your market is getting worse. There are more and more practices jockeying for your new patients. General dentists doing Invisalign. Smile Direct Club going straight to the consumer. Patients who wait or put off treatment. Your own employees who are unwilling or untrained to convert new patients into starts and referrals. This all adds up.

If you’re anxious about where your next new patients will come from, view our online training at

Q2 • 2018 | TheProOrtho.com 71 BUSINESS & PRACTICE DEVELOPMENT

Design-Build Firm Fast-Tracks New Model of Ortho Practice in Orlando By Ryan Young

The Smiley Face Ortho office in Then we started designing the offices, Now living in Orlando, Burris observed southwest Orlando that I designed and too. We have engineered the way that we an opportunity for a new practice on built for Dr. Ben Burris is an expression do our design work based on the wealth the west side of town, which has seen of his longtime commitment to providing of knowledge gained from designing and astronomical growth. Not only would affordable orthodontic care for patients building so many of these projects. it be a new practice but for Burris, it from every socioeconomic background. would be a new model of practice, too. In Burris is nothing if not passionate about ------Arkansas, he provided both orthodontics access to care, a topic he has spoken "This job progressed and general dentistry, and his clinics had a on internationally and written about broader scope of services. extensively on his blog at orthopundit. rapidly. We met last In 2017, Burris conceived of an office com. with a fun, appealing vibe that could Burris found me through a referral fall and soon after that handle a large patient load and provide from another client, an attorney for whom introduction, Burris and affordable orthodontic treatment. “How?” my company Interstruct had just designed you may ask. He determined that no other and built a 6,000 square-foot office. What his staff walked my team dental services would be offered: it was made us a fit for Burris was not only the to be strictly ortho, which would lower personal recommendation, but the fact through the space. He the overhead of carrying a wider range of that orthodontists’ offices are a specialty had a good idea of what equipment and specialized employees. for my architectural firm. We have This job progressed rapidly. We met designed and built more than fifty dental he wanted in terms of last fall and soon after that introduction, and ortho offices in Florida and Texas Burris and his staff walked my team over the past 10 years, moving through the layout and he shared through the space. He had a good idea these projects quickly and easily. his vision for Smiley Face of what he wanted in terms of the layout When I got out of architecture school at and he shared his vision for Smiley Face Northeastern University in Boston, I went Ortho. " Ortho. straight into construction. Everything ------Smiley Face Ortho would have a large, I have learned about construction open concept with modern design, bright and design has been tailored to the Enter Dr. Burris. We connected through colors and cool lighting. It would also be commercial market. I was working as a the referral not long after he moved from loud, with the base bumping and tunes general contractor even as I went back to Arkansas to Orlando in 2017. pumping all day long. The office would grad school and sat for my exams. When he lived in Arkansas, Burris have two recording booths where kids Approaching the design of ortho clinics owned about 20 clinics throughout the could create, edit and share videos for grounded in the experience of creating state. He sold those practices and “retired” social media. If this sounds like Hard built environments was instrumental to Central Florida to enjoy the climate Rock: Ortho Edition, you aren’t far off. in the direction my firm has taken. and time with his family. As it turned out, Universal Studios is a short drive away. We started by building these offices retirement was not in the cards. And that’s At the site, I walked around with and then learning the intricacies and where we intersected. him and he pointed out where he standards of each step of patient care from Arkansas is 29th in the nation for wanted things. I took detailed notes and examination and labs to surgery. population growth, while Florida is third. afterwards we returned to the office and

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massaged those notes, with his solid ideas Interstruct completely understands suppliers. These vendors keep us educated of what he wanted to do in the space, all the little details of designing and on all the advancements in equipment, so into design plans. We were able to draw building an ortho office. We know the our architectural design work factors in from all of our experience and working needs of water, gas and electric and the developments in the industry. knowledge of the technical standards unique back-of-house needs to support On this project, we coordinated with pertaining to this kind of medical office specialized equipment. It can be really Henry Schein Dental, with whom we so that we could fast-track the project. difficult for an architect who is new to often work. Once we get the preliminary Soon after that walk-through, we this kind of project to grasp the details. plan, we look to them to help us lay presented a design and construction There are standards for everything: equipment out and confirm dimensions proposal. He engaged our services and operatory sizes, clearances for chairs, and clearance for the specific pieces. we started design work immediately. x-ray equipment, and even the swing of Steven Symes, the Henry Schein Construction documents were approved lighting arms. equipment and technology rep on this and submitted for permit by mid-January Interstruct comes to the table with all project, was super fast and efficient. 2018 and Smiley Face Ortho is expected of this knowledge that allows us to sit He was able to coordinate with to be complete by April. down with a doctor, get very conceptual us fluidly for fast-paced decision- It’s super important for these doctors to information from them and then translate making, even though almost all the have somebody who is experienced and that into a well defined plan and layout. communication between the team understands the process. Ortho offices We are able to move forward quickly and members on this project took place are very specialized environments with with confidence. electronically. Symes was one part of a particular needs. People want to know We also understand that relationships solid team that started with an idea and that we’ve done this 50 times before and are core to the success of ortho projects. will become fully realized when we hand that they are in good hands from start to Interstruct has tight and lasting Dr. Burris the keys to his office. finish. relationships with all the regional dental

Q2 • 2018 | TheProOrtho.com 73 BUSINESS & PRACTICE DEVELOPMENT

Establishing a Captive Insurance Company By Peter Strauss

Anyone who has founded a business back now, it seems like an easy choice. fully-credentialed underwriter and an appreciates how much time, effort, and Captive insurance changed the course of independent, fully-credentialed, third- expertise is required to make it successful. my career; it changed the lives of so many party actuary. Establishing a captive insurance company of my clients. ------is no different; you might be tempted If you’re like most business owners, you to throw up your hands and forgo it. probably pay an insurance company to "Once that After all, insurance is not your core cover the risk of your business. You may competency. not even know there’s another option. determination is Consider this: what if you could That could be a mistake. substantially improve your risk made, your advisor management program, insure the risk will likely work with ------of your business, reduce your out-of- pocket expenses and create another a captive insurance "I generally recommend source of revenue? You would do that in a service provider or that businesses engage heartbeat, wouldn’t you? The captive insurance industry has insurance actuary to the services of an matured sufficiently to the point that design insurance policies advisor to help launch there are now many capable service providers who can help you analyze your that cover key risks the captive insurance insurance needs, launch and license your captive insurance company, arrange for in your business and company and another to reinsurance, and manage the captive. improve your overall risk manage its operations." When implementing a captive insurance plan, it is critical to focus on management program." ------both its appropriate establishment and A client sent me a message one day its ongoing operation; these are two ------that changed my life. He told me that he distinct areas of expertise. I generally had just heard about captive insurance recommend that businesses engage the The underwriter will evaluate the risk and wanted to see what I thought about services of an advisor to help launch the inherent in your business and identify opening a captive for his business. I had captive insurance company and another areas that should be insured. The actuary never heard of captive insurance but I to manage its operations. will price the risk that will be considered told him I would look into it for him. For example, my law firm focuses on for your captive insurance company to The more I read, the more incredulous the implementation and coordination of provide coverage for your underlying I became. I got back to my client, telling a captive and then works with a captive business. Together, they will identify the him it seemed too good to be true. He manager once the company is licensed. coverage that can be underwritten by your was adamant that this was the future I recommend retaining a lawyer who own captive insurance company and how for his business, he was adamant that I is well-versed in captive insurance to much in premiums you can pay for such should be the one to help him. Looking engage the services of an independent, coverage.

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Armed with that information, your attorney, accountant, or advisors should be able to determine whether it makes sense to proceed with a captive insurance company. Once that determination is made, your advisor will likely work with a captive insurance service provider or insurance actuary to design insurance policies that cover key risks in your business and improve your overall risk management program. An important decision to make is the jurisdiction in which your captive insurance company will be licensed. Jurisdictions vary in their costs, the time it takes to form your captive, and regulatory requirements. The jurisdiction that will ultimately be chosen should be the result of a detailed discussion with your attorney and captive manager. Once the captive is established, you would typically sign a long- term contract with a captive manager to handle its day-to-day operations. As a business owner, you’re aware of the risk involved in any long-term contract and the amount of due diligence necessary before entering into any such arrangement. This is where the services of an experienced professional advisor can be invaluable. Curious? Take my online assessment at our website https://peterjstrauss.com to identify whether or not your company features some of the key qualities that are found in successful captive insurance company owners. Forming a captive insurance company could change your life, it certainly changed mine!

Q2 • 2018 | TheProOrtho.com 75 ORTHOPUNDIT.COM

Technology Will Not Fix What Ails Orthodontists By Dr. Ben Burris

I received this unsolicited email a Honestly, I’m not sure what the phrase intends to try and replicate what Ormco couple days ago. “When evolution means revolution” even does so well in his new position at HSO. means but I do know one thing – the Hopefully by now you’ve figured out “evolution” of “advanced engineering the number one problem facing modern technologies” will not help the vast orthodontists is a lack of new patient flow majority of orthodontists solve the and a lack of case starts. I’ve said it over number one problem facing practices in and over and unless your practice is at the 2018. I also know that this is not the first far right of the Bell Curve then I shouldn’t company to effectively use groupthink and need to remind you of the lack. newspeak to captivate a fanatical fan base Here’s another question I have for the of orthodontists who believe what is “new” true believers who pay 10 bucks a bracket and what is “cool” and what “all their more than you have to or hundreds of friends are doing” (creating community dollars per case for a device that adds a is a big part of the game) is their ticket step and just simulates the Class II elastics to a successful orthodontic business/ that we have done for decades on regular practice. In fact, when I met with the man old brackets/aligners : in charge of Henry Schein Orthodontics‘ How does buying something off the educational programs about a year ago rack that anyone else can buy at any time and tried to explain (unsuccessfully) make you and your practice special? why teaching orthodontists how to run This is the conundrum I just cannot a business was better for orthodontists crack. Does it make sense to build your and for those selling to orthodontists in practice that you spend hundreds of the long-term, I was told in no uncertain thousands of dollars setting up on the terms that he was responsible for the branding and market position you get success of Damon Brackets and that he from a company who will gladly sell the would do it again at HSO. I don’t know exact same brackets, branding and support about the veracity of the first half of his to your nearest orthodontist or general statement but it would appear he fully practitioner competitor?

76 It’s just BUSINESS ORTHOPUNDIT.COM

In my younger days I desperately In an era when new patients are hard to what that is – no one knows better what’s wanted to do what the cool kids did and come by and brackets are available from good for your practice than you do. I followed the crowd when it came to hundreds of vendors and incredibly cheap, self-ligation among other “innovations”. does it make sense to focus on things Just a thought. But as we get older and more experienced rather than people? shouldn’t we become wiser as well? How P.S. To be clear, this is not just about does spending all that extra money on I think not. brackets and intra-oral doohickeys. It’s not something patients do not care about help just about the two companies mentioned your practice? (no, they don’t care about Look, if you have all the new patients here. This piece is about questioning why your brackets no matter what the company you want and you are happy with your you spend time and money on anything says, no matter what you think and no results then, by all means, buy the cool that doesn’t appreciably improve your matter how often you tout said brackets brackets and other doohickeys that ability to render treatment to a broader them). What would happen if you used supposedly finish cases faster (finishing pool of potential customers (which that same money on effective marketing faster doesn’t help you it just makes should be our goal as individuals and as a that appeals to new customers instead financing harder – especially when profession). If you want to solve what ails of brand name tech that appeals to us you have more overhead from buying you then focus on what ails you instead orthodontic nerds? expensive brackets and other stuff) or of what is appealing and familiar to us by gives you more capacity (when you our nature and our training. Most of the –––––––––––––––––– already have excess capacity – look at all best ideas/strategies/techniques for doing "As we get older and more those empty chairs…) while lightening so are freely available, free to implement your wallet. This handful of orthodontic and incredibly effective. Implementation experienced shouldn’t we practices who have all the new patients is the key, however, and this is much more become wiser as well? they want is a very small segment of difficult than just ordering some new orthodontists so if you find yourself in technology that promises revolution. How does spending all that the not so unique position of needing to improve your new patient flow then extra money on something perhaps it’s time to stop listening to the patients do not care about cool kids and start looking out for the best interests of your practice, your patients, help your practice?" your team and your family? If you think –––––––––––––––––– really hard about this you can figure out

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Q2 • 2018 | TheProOrtho.com 77 Brush Up On Your Reading

Drs. Marc Ackerman and Ben Burris are announcing the publication of their book...

Straighter: The Rules of Orthodontics

It is a radical departure from the traditional approach to clinical decision-making and practice management. Drs. Ackerman and Burris reject the warmly held idea that these two areas are mutually exclusive. The book rests on the premise that orthodontics is in large part elective and falls under the category of enhancement healthcare. With that in mind, the authors suggest that orthodontists treat consumers rather than patients and these consumers are seeking an orthodontic intervention that is eective, ecient, fair priced, and easily accessible. Readers will gain insight into the current market trends in orthodontics and learn how to modify their mindset and oce systems to align with the needs of the consumer.

For more information about the book, check out orthopundit.com