WE INTERRUPT YOUR REGULARLY SCHEDULED PROGRAM FOR AN IMPORTANT MESSAGE

Q1 2018 inside this Disrupted: edition... New Rules for a New Type of Customer By Angela Weber, CMO OrthoSynetics Page 34

BUSINESS PRACTICE & DEVELOPMENT TRAVEL & LEISURE CLINICAL CORNER

18 15 37 From the Rear View Mirror Pro Travel Tips High Frequency Vibration Can BY DR. COURTNEY DUNN BY PROORTHO STAFF Reduce or Eliminate Pain During Aligner Treatment 30 20 BY DR. JONATHAN L. NICOZISIS Traveling to the Greek Islands New Gaidge CEO BY DR. DANIELA LOEBL INTERVIEW WITH RYAN MOYNIHAN 32 OFFICE LOGISTICS 34 Traveling to Peru Disrupted: New Rules for a New BY DR. DAVID WALKER 56 Type of Customer Beyond Reminders: BY ANGELA WEBER, CMO ORTHOSYNETICS 40 Tapping the Potential of Texting Traveling to Spain BY DR. KEITH DRESSLER 44 BY DR. DAVID MAJERONI What Would You Do If an Aligner 46 Store Opened Down the Street? ORTHOPUNDIT.COM BY DR. JENNIFER EISENHUTH Traveling to Europe BY DR. BEN BURRIS & BRIDGET BURRIS 09 MARKETING/ H.R. INSIGHT Don't Piss Momma Off! SOCIAL MEDIA BY DR. BEN BURRIS 05 28 24 Go High or Go Low - Just Don't Get Utilize Group Interviews To Made to Measure: Stuck in the Middle Maximize Hiring Success The Dubious Relationship Between BY DR. LEON KLEMPNER AND AMY EPSTEIN, BY BRIDGET BURRIS Eugenics and Orthodontics MBA ANSWERS FROM THE BY DR. MARC ACKERMAN 52 EDGE 59 5 Keys to Capturing the Fastest The Economy Is Booming – Why Growing Referral Source 10 Isn’t Your Practice? BY NICK DUNCAN Interviews with Dr. Jeff Kozlowski BY DR. BEN BURRIS & Dr. Andrew Appel

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 Change is good as we have often perspective of patients. & TRAVEL AND said but few orthodontists seem The good news is that there is LEISURE EDITOR to understand that change is also tremendous opportunity for any Dr. Ben Burris inevitable. If something is going to orthodontist who is willing to adapt happen anyway it is far better to to the new reality and deliver what CLINICAL EDITOR embrace the change and figure out the customer wants on their timeline Dr. Derek Bock how to make it work for you than to and within their budget. The number vainly swim against the current in the of people receiving orthodontic name of quality. treatment will rise at an ever MARKETING/PATIENT Quality is probably the most misused increasing pace of the next decade - ACQUISITION EDITOR and dangerous word in orthodontics the question is who will be rendering Angela Weber these days. We orthodontists say the treatment? Orthodontists are quality when we want to defend what still in the best position to fill that WOMEN IN we do though we cannot reasonably need but only if we can shed our old, ORTHODONTICS EDITOR define quality or accurately assess the arbitrary and detrimental beliefs Dr. Courtney Dunn lack of quality of those with whom about who we are, what we do and we disagree. This age old tradition why. This edition of The Progressive BUSINESS OF of claiming the quality high ground Orthodontist Magazine is dedicated ORTHODONTICS EDITOR will likely be the downfall of many an to looking at some of the sources of so Chris Bentson orthodontist. called disruption that are positioning A lack of new patients and case themselves to harness patient demand starts is the bane of the profession and prosper by delivering what ORTHODONTIC POP now more than ever and this should customers want. Enjoy! CULTURE EDITOR Dr. Marc Ackerman be doubly worrisome given the strength of the economy, lack of PS In an attempt to disrupt our unemployment and high consumer normal operating procedure we have confidence. With all this, dare we ask also included a healthy dose of travel CLEAR ALIGNER EDITOR the question “Why aren’t more people journalism composed and submitted Sarah Sharfstein purchasing orthodontic services from by fellow orthodontists. We hope orthodontists?” The answers are clear these pieces inspire you to put in the TRADITIONAL OWNER/ to those who shed their blinders work so you can enjoy the play! OPERATOR PRACTICE and look at what we do from the MODEL EDITOR Dr. Jennifer Eisenhuth

AAO AFFAIRS EDITOR INTERNATIONAL Dr. Anil Idiculla & The ORTHODONTICS EDITOR The Progressive Orthodontist AAO Committee on Dr. Grant Duncan magazine and study group are Communications your educational resources for new 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

Q1 • 2018 | TheProOrtho.com 1 DR. CONTRIBUTORS JENNIFER EISENHUTH DR. BEN BURRIS Jennifer Eisenhuth Ben Burris DDS, MS is a DR. MARC graduated from The board-certified orthodontist Citadel in 1994 with ACKERMAN who began college intending to be a civil a BS in biology, spent engineer. After her undergraduate studies were Dr. Marc time working in complete, she came to her senses, entering Washington DC after Ackerman dental school at the University of Minnesota graduation, received a specializes in and upon graduation, began her orthodontic Rotary International the orthodontic residency at the University of Minnesota, Ambassadorial treatment earning both a certificate of orthodontics Scholarship and spent a year in Wellington of children with dentofacial deformity, and a Master’s of Oral Biology. After a failed NZ at Victoria University, graduated dental intellectual and physical disabilities and sleep associateship, she borrowed $60,000 from a friend and started her own practice, paying school with a DDS from The University of disordered breathing. He received his DMD from the University of Pennsylvania School this friend back within a few months. Since Tennessee in 2001, and graduated orthodontic then she has started, bought and sold several of Dental medicine in 1998 and his certificate residency in 2004 with an MDS from The practices in the Twin Cities metro area and University of Tennessee. In his short 13 in Orthodontics from the University of will continue to do so as long as the fun year career Burris' practice grew to over 20 Rochester-Eastman Dental Center in 2000. Dr. remains. Her orthodontic practice won the locations which he sold in April 2017. After Ackerman later completed his MBA in Executive “Best workplace 2014” by Minnesota Business the sale Burris is effectively retired and living Leadership at Jacksonville University Davis Monthly Magazine and she was recently in Orlando, Florida with his wife and two College of Business in 2009. Dr. Ackerman acknowledged by the University of Minnesota children but he's actively treating thousands is the Director of Orthodontics at Boston as a top entrepreneur. of cases via teledentistry and building what Children’s Hospital and teaches residents in both he calls a lifestyle office where he plans to pediatric dentistry and orthodontics for Harvard RYAN MOYNIHAN offer braces for 3000 dollars and Invisalign for School of Dental Medicine. 2000. Burris (and others) expect his new office Ryan Moynihan and unheard of price point to revolutionize has a financial/ how orthodontics is delivered and engage a analytical background significant percentage of the population in DR. LEON beginning his career orthodontic treatment. Burris founded S4L. KLEMPNER at Intel and Ernst & Young. He earned org, TheProOrtho.com, OrthoPundit.com & AMY his MBA from among other institutions in orthodontics and EPSTEIN is a driving force for change in the orthodontic Georgetown and has profession. Burris and Dr. Marc Ackerman spent the past 12 recently released a book, Straighter: The Rules Dr. Leon years of his career in the Dental/Orthodontic of Orthodontics and do a two-day course in Klempner, industry with 3M and Ormco. Most recently Orlando of the same name. a board- he was VP of Global Marketing (2 years) and Feel free to connect with Dr Burris so you certified VP of NA Sales (2 1/2 years) for Ormco. He can get a better understanding of who he is orthodontist was in private practice for over joined Gaidge in August 2017 as CEO. and what he does. 38 years. He graduated dental school from Facebook.com/bgburis the University of Maryland and received DR. DAVID WALKER his certification in Orthodontics from Dr. David Tufts University. Dr. Klempner has lectured DR. DAVID MAJERONI Walker completed nationally on the subject of social media undergraduate, marketing and clinical orthodontic treatment. Dr. David Majeroni dental and Amy Epstein has over 15 years of has a private practice orthodontic degrees multinational marketing and branding in Alamo CA and at UNC-Chapel experience. She has an MBA in marketing founder of the Hill. He practices from Baruch College and regularly lectures at non-profit "It takes in his hometown the Zicklin School of Business and Long Island a Village" where he of Morehead City, University School of Business on the subject of provides orthodontic NC as a partner in a digital marketing, entrepreneurship and social treatment to children group practice. He is married to his college media. with a missing or deceased parent. sweetheart, Leeanne, an attorney with UNC School of Medicine. They have one daughter, Madeline, age 2. 2 It’s just BUSINESS DR. JONATHAN NICOZISIS ANGELA DR. KEITH DRESSLER WEBER Dr. Nicozisis is a Faculty member of Invisalign® Dr. Keith Angela Weber Dressler is an National Speaker’s is the Chief avid entrepreneur Marketing Officer Bureau and Clinical who has over 30 for OrthoSynetics Research Networkand years’ experience a company has given over 400 which specializes as a practicing lectures on Invisalign. in business orthodontist. In services for the Dr. Nicozisis is also 2000, Dr. Dressler orthodontic and dental industry. She leads a the founding orthodontist and a scientific co-founded team of marketing professionals dedicated to advisory OrthoBanc, LLC a developing and implementing cutting-edge board member of BAS Medical/Corthera cloud-based automated accounts receivable strategies and solutions for their members. a development stage company founded in platform, that is currently serving over 4000 Angela has over 15 years of experience in 2003 with a mission to develop and market a healthcare providers. Dr. Dressler also co- the advertising industry with a vast knowledge founded Elite Physician Services, a national of current and past trends, philosophies and novel technology to accelerate and improve strategies for marketing within the healthcare the stability of orthodontic treatments. healthcare patient finance company, which industry. Angela has a proven track record of Dr. Nicozisis’ master’s research is the basis grew to over 200 million in sales before it driving new patient volume through innovate for BAS Medical innovative research. In became the Citi Health Card in 2003. marketing practices. February 2010, Corthera was acquired by Angela holds a B.A. in Mass Communications from Louisiana State Novartis. Dr. Nicozisis has been awarded membership to the Edward H. Angle Society University and an M.B.A. from the University BRIDGET of New Orleans. of Orthodontists. He has co-authored a BURRIS textbook chapter on Invisalign with Align’s director of R+D. Since 2010, he is an SAB NICK DUNCAN member of Propel Orthodontics. Bridget Burris is no stranger to Nick Duncan holds DR. DANIELA LOEBL orthodontics. For degrees in accounting over 11 years she and finance. After Dr. Daniela Loebl and her husband have grown and run one of the largest groups starting his career is a second-year of practices in the country. Having extensive as a CPA in Boston, orthodontic resident at the University experience in every position in an orthodontic he returned to his office except chair side assisting, Bridget of Colorado. She native Australia to knows how to train employees to maximize received her Bachelor form The Invisible their efficacy and how to teach the customer Orthodontist (TIO) with his father Dr. Grant of Science degree service delivery that is so essential in the Duncan. Over the past 7 years, TIO has built an at the University of modern practice. Bridget also knows how to international network of more than 100 doctors Michigan in 2012 grow an orthodontic practice from small to and worked with them to significantly increase and completed her formal dental training at massive in a logical, stepwise manner because she's DONE IT! Multiple times. their Invisalign cases. Through his leadership the University of Maryland School of Dentistry Bridget's knowledge and acumen is at TIO, Nick has developed a diverse set of in 2016. She is originally from Miami, Florida and enjoys going to the beach, traveling to new only surpassed by her incredible ability to skills encompassing marketing, technology and communicate and get others to do the same. countries with her husband Steven, hiking, business development. Her unique skill set allows her to enter and skiing. an office, identify the problems, prioritize issues and form a logical implementation DR. COURTNEY DUNN plan; but, most importantly, she is then able to communicate the plan to the owner Dr. Courtney Dunn graduated from the University of Michigan and employees to get consensus and even Dental and Orthodontic programs in 2001 and 2004. She received enthusiasm for how all parties can get where the Milo Hellman award for her research and has presented at many they want to be! No one else in the industry local and national meetings. She is a diplomate of the American has the experience, wisdom or pragmatic, Board of Orthodontics, holds leadership positions in the Arizona solution based approach that Bridget brings to your practice. Her results speak for themselves. Dental Association and is past president of the Arizona State Orthodontic Association. Dr. Dunn is in private practice with her husband, Matt, in Phoenix, AZ. She spends most of her free time being a proud swim mom.

Q1 • 2018 | TheProOrtho.com 3 4 It’s just BUSINESS MARKETING, SOCIAL MEDIA & EVENTS Go High or Go Low Just Don't Get Stuck in the Middle By Dr. Leon Klempner and Amy Epstein

As the orthodontic business model that orthodontists need to carry in order –––––––––––––––––– becomes increasingly competitive, to remain technologically competitive. "Break from the pack prospective patients have many lower Orthodontists are definitely feeling the fee options. Traditional private fee for pressure from every side. with a marketing service practices are finding themselves Unless you are almost at retirement squeezed in the middle, steadily losing age, it’s become clear that staying put is program that market share. Large, corporate, Dental not a realistic option. This is the reality Service Organizations (DSOs) and of the modern orthodontic industry differentiates your insurance companies are pushing down landscape. You can either remain on the fees while overhead costs keep going up. sidelines and hope for a return to the practice and attracts Computer generated tooth straightening good old days, or you can do something more qualified applications in the form of so-called do-it- about it. Today there are two ways to yourself orthodontics are commoditizing remain profitable as an orthodontist: patients." services into a point-and-click shopping go the high volume/low fee option or –––––––––––––––––– experience. Adding to the burden is a differentiate your practice enough to show surplus of competition and mounting debt prospective patients/parents that you are worth paying the difference. There are many ways to stand out from your competition: exceptional patient service, using the latest technology, expertise with multidisciplinary clinical cases or cleft palate management, being the Invisalign or “speed” practice, just to name a few. Each of us are really good at something. But that is not enough, you can’t just walk the walk, you also have to talk the talk. The challenge is that to be competitive, you need to communicate all of this in a matter of minutes when potential new patients can shop around with a quick tap on a mobile screen. Luckily, there are ways to do it. With the right mix of social media marketing, reputation management, and social advertising, a practice can rise above the rest. A strategically designed marketing program will attract patients who have self-qualified for your services and are ready to convert. Potential patients self-qualify when they’ve been exposed to your practice through a variety of online touchpoints, are positively

Q1 • 2018 | TheProOrtho.com 5 MARKETING, SOCIAL MEDIA & EVENTS

influenced by their peers (social proof), like a potential new patient/parent and their searches. At the same time, it’s and feel that your practice stands out your marketing must help solve their important to have a system in place to from the rest. At this point converting problem quickly and confidently so they offer a sounding board for patients in case them becomes a much easier task. don’t have to stress about picking the right their experience wasn’t perfect, giving A report released by Google called orthodontist. Consumers increasingly them a chance to vent before they take to “Micro-moments” revealed that look to online communities to verify the Internet to air their grievances. businesses must capture the attention of their decisions with supporting anecdotal Using a reputation management system potential customers in a matter of minutes evidence, called social proof. like the one we offer to our clients allows or even seconds. Mobile is changing us to capture patient reviews at the point the game in online search. The report –––––––––––––––– of service when they have an immediate instructed businesses to anticipate the visceral reaction to their experience. This micro-moments for users and commit to “A report released by works twofold. It allows orthodontists being there to help decision making when Google called to capitalize on a positive experience, those moments occur. Successful private posting the reviews to all relevant websites fee for service practices pay attention and "Micro-moments" and social networks. It also allows a embrace the pace of today’s busy patient/ practice to vet negative reviews. A parent by being relevant to their needs revealed that businesses practice can review and address a patient’s and connect them to the answers they’re concerns before the bad experience is looking for online. Why? Because more must capture the posted publicly online, where others than half of smartphone users report might read it and become influenced by it. having discovered a new business while attention of potential In case you needed even more conducting a search on their mobile customers in a matter convincing that online reviews devices. matter, consider this: a 2016 survey To do this you must not only of minutes or even by Brightlocal.com found that 91% of communicate the core qualities of your consumers are actively reading online practice but also help your current clients seconds.” business reviews, providing a huge spread the word about their positive ––––––––––––––––– benefit to practices who have a positive experiences on business review sites like online reputation. People truly trust these Google, Yelp and Facebook. Patients who A recent survey conducted by reviews. The same survey reported that have been exposed to your marketing Softwareadvice.com, a medical software 84% of people give as much weight to an campaign walk in the door convinced company, reported that 77 percent of online review as they do to a personal your practice is the right one for their respondents said they used online reviews recommendation. This creates a cycle: family’s future smiles and are willing to as a first step in seeking a doctor. Your the more reviews, the more new patients pay the difference. future patients are doing market research joining your practice, leading to even by reading what is being said about you more reviews, and higher search engine REPUTATION MANAGEMENT: online. Your reputation is arguably your rankings. JUST A MOMENT TO CONVERT most valuable asset, are you leveraging it That person in the coffee shop just A few friends meet at a local coffee effectively? clicked on another practice’s website and shop. The conversation meanders before The web has empowered patients to arranged for a consultation appointment settling on the subject of orthodontists. At share their experiences and opinion about because of the dozens of positive this point, everything stops as someone your practice with friends and neighbors comments and 5-star ratings found on grabs a smartphone and asks Siri, at the push of a button - for better or for Google Reviews, Yelp and Facebook. With Cortana, or some other type of personal worse. In the above scenario, five-star a good online reputation plan, the next assistant app to suggest local practices. ratings on Google Reviews alongside your time, the orthodontic office they choose If your website is properly optimized, business listing with loads of positive will be yours. Google reveals your business listing comments from current patients praising among others. That’s great but what your practice provides the tipping point SOCIAL ENGAGEMENT: compels them to click on your link rather for potential customers researching an FIND NEW PATIENTS WITH than your competitors? Remember, you orthodontist online. SHARABLE CONTENT only have a moment to convince them The key to capturing this busy web The Smiths are a young family who yours is the right choice for their family. traffic is to translate all the good things have been loyal patients of your practice Attention is a commodity and you need you hear around your office into authentic for years. Their family friends, the to stand out online. You need to think online reviews for everyone to find in Greens, are looking for an orthodontist.

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

The Smith and Green families spend off to a friend who asked where their kids production. Like three legs of a stool, a lot of time interacting on Facebook, got their braces, it will be too late. Long reputational management, social commenting on each other’s pictures, before that happens, a potential customer engagement, and Facebook advertising life events and news. It’s the hub of will find out about your competitor on form a solid digital marketing plan their social lives. Because they are so Facebook where mutual friends share unmatched in communicating your close, they also trust each other’s social posts from the office’s page showing off competitive advantages in expertise and recommendations about local businesses their kid’s satisfying smile after their experience to deliver superior customer from doctors to preschools. When the braces came off. service. Smiths needed a dog groomer they asked There are many entry points to your about the business that the Greens used FACEBOOK ADVERTISING: website and ultimately to a page that because they saw an Instagram picture EDUCATION TO ATTRACT directs a new client to contact you. No of the family pet’s latest styling. When PATIENTS matter how they find your practice the Greens needed braces for their kids Mom and Dad have 7-year-old whether it’s an online search, social media they saw a contest the Smiths shared twins. Though their dentist hasn’t yet or a digital advertisement, you should on their Facebook page held by their recommended visiting an orthodontist, be ready to capture attention. Your plan orthodontist. That post sparked an online while they’re surfing Facebook, they’re has to be quick, unique and effective chat in the comments section inspiring a presented with an advertisement about at converting browsers into potential recommendation. the importance of early intervention for patients who clicked on your link from There’s no doubt that having current a healthy smile. They click and they’re any source. With a thoughtful mix of patients share your practice’s content with brought to your website to read a blog marketing, you distinguish yourself from their social media friends adds value. post explaining all the latest technology the average tooth straightener. This will In a report published by Deloitte, the available in early orthodontics. Though help you rise above the low fee, high global professional services firm looked they may not be ready to make a call just volume practices that are squeezing you at how social media influenced decision- yet, you’re now on their radar where you in the middle. making by consumers. Their study found weren’t before. that social media was a factor in the Facebook’s powerful advertising Amy Epstein, MBA and Dr. Leon purchasing decision of almost one in program allows orthodontists to reach Klempner, a retired orthodontist, founded three U.S. consumers. This is especially patients who are in need of services but People & Practice (www.pplpractice.com) true for younger demographics with 47 may not yet be aware of your practice. Ad in 2011. percent of millennials influenced by social targeting can be very specific, reaching media. a demographic defined by a variety of People & Practice is a full-service digital Just having a Facebook page for your categories including geography so your marketing consultancy. We position your business is not enough. Your social ads will be seen by users who live within practice to grow in a new price-competitive advertising must have that “social” driving distance to your practice. These economy by helping you compete on value, element to it. Actively engaging with ads direct back to educational content on not fees. Unlike most digital marketing your patients through social media will your website. As potential patients click companies that measure their success based reap benefits exponentially if done right. around looking for more information they on just getting your phone to ring, our focus A Facebook page must not only have can be presented with forms specifically is different. Our goal is based on attracting a regular stream of updates, it must be designed to capture contact data delivered quality, educated new patients that are interactive, encouraging current fans to right to your inbox. much more likely to accept your treatment like and share your post on their own The blog on your website that Mom recommendation, and pay a little extra pages too. This helps reach their network and Dad spent hours reading, sharing on for a better service. We use digital social of friends, increasing the number of their own social pages, and emailing to platforms to enable your current patients to potential new patients who are aware of one another reinforces your expertise. The advertise for you. your practice. The content needs to be parents feel like they are well informed personalized, informative, or entertaining and will have already built trust your For more information or a free to be good enough to share. A contest that practice. marketing analysis, you can contact them incentivizes patients to like and repost to at 888.866.DOCS, or by email at their own page in order to have a chance GROW BY PUTTING IT ALL [email protected]. to win is just one of many great examples TOGETHER of interactive, shareable content. While these strategies can be By the time your patients get around to used individually, they work best in handing an old-fashioned business card conjunction to boost your practice’s

Q1 • 2018 | TheProOrtho.com 7 ORTHOPUNDIT.COM

8 It’s just BUSINESS ORTHOPUNDIT.COM

DON'T PISS MOMMA OFF! By Dr. Ben Burris

When confronted with a kid who My dad, Dr. Skeet Burris, taught me headed kid too and it took me a long time doesn’t brush or wear elastics, our how to handle this situation not long to realize how smart my momma was first instinct as orthodontists is to say after I finished residency. I’ve used his and I suffered for it!” Then I stand next something like, “Susie, why haven’t you technique for my entire career and have to mom and put my arm on her shoulder been brushing your teeth?!?!” but as soon shared it with thousands of orthodontists and say, “Susie, this is the winning team as those words escape our lips we know and I hope you’ll find it as useful as I (pointing to mom and me) so you should what mom will do. Mom will get upset do. Whenever I see that Susie is not go ahead and get on board or get run and assertively say something like, “Susie brushing properly I say, “Susie, why aren’t over.” Mom smiles and agrees and then brushes her teeth ten times a day and is you listening to your momma?” Mom’s I can do whatever I want with mom’s a perfect angel. I watch her brush and I ears perk up, Susie looks confused and blessing. Brushing instruction, remove the know she is doing what she is supposed I continue, “Susie, I know your momma wires, remove the braces, whatever… and to. How dare you question that?” tells you every morning and every night mom will be fine with it because I’m not We are shocked every time this to brush your teeth, why aren’t you doing attacking her or her child. happens. What is going on here? Why is what she asks?” At this point mom stands mom getting upset with us for trying to up and walks over to the chair – just in Simple. Effective. I wish all of life were help her child and avoid cavities? How time to say, “Doc, I don’t know what to do, this easy! When in doubt just remember dare her question my integrity?!?! I can I tell that child to brush all the time… I “Don’t Piss Momma Off”. tell by looking at this child that she is not guess I’ll have to brush them for her if she brushing properly, much less flossing! I doesn’t straighten up.” And then I say, “I Thanks Dad! know inflammation when I see it! Geez know what you mean mom. I was a hard this is so frustrating.

Perhaps it is time to change tactics to avoid the upsets rather than stubbornly repeating the same behavior and being “shocked” when we get a negative response? What is mom really saying to you?

“I am a good parent and I do the best I can and you have no idea what it is like to try and handle three kids and get them where they need to be and work and do everything else. I don’t need you telling me I’m not a good parent. How dare you judge me?” is what mom is actually saying when you accuse Susie of not brushing. That combined with the lioness protecting her cub creates angst and sends mom over the top almost every time. So what can we do to get the message across and not piss momma off?

Q1 • 2018 | TheProOrtho.com 9 ANSWERS FROM THE EDGE

As we have done for several issues, here again we ask leading orthodontists a few questions about what they do and what they see coming. We love Answers from the Edge because we always learn something. Enjoy!

Featuring Dr. Jeff Kozlowski and Dr. Andrew Appel

PROORTHO: WHAT IS YOUR do as a family (or individually with the Interview with PRIMARY FOCUS FOR 2018? kids). Our biggest summer family hobby is wake surfing. The kids are incredible Dr. Jeff Kozlowski KOZLOWSKI: My primary focus surfers. Unfortunately, Amy can’t surf for 2018 is my family. I know you were because of recent rotator cuff surgery probably expecting me to say something so she has to be content watching the about growing my business – but 2018 three of us. Skiing is our winter family is all about my family. I’ve spent the last hobby even though Jake and I are the 9 years building my practice and we’ve all-day moguls and glades double black grown to 4 locations, 20 team members diamond skiers and Amy and Amelia and are producing at a level I never are half-day green/blue good weather thought possible. I did all this with the skiers who are content to go to lunch or love and support of my wife and kids – the spa or shopping. Other things I do and so this next year is devoted primarily with the family include travel, hunting, to them. My wife Amy and I will celebrate fishing, spearfishing (a combination of our 20th anniversary on August 1st and hunting and fishing!), boating, crabbing, we have two kids. Our daughter Amelia is clamming to name a few. How do we find Dr. Jeff Kozlowski has a unique a junior in high school and our son Jake time to do all this? Clinical efficiency!! perspective on the importance of is in 8th grade. While I’ve always spent Amy works 110 days per year and I work clinical efficiency in the business of lots of time with the kids – this year I’m 131. That means we only see patients orthodontics. With a background in really focused on enjoying their “young about 1/3 of the year which leaves 2/3 Economics and Finance rather than adulthood” – especially with our daughter of our time for everything else we do Biology and Histology, numbers and who is heading off to college soon. together! systems prevail over cytokines and osteoblasts. While his experience PROORTHO: TELL US ABOUT PROORTHO: WHAT DO YOU SEE in orthodontics is varied – from YOUR FAMILY AND ALL THE FUN AS THE GREATEST OPPORTUNITY managing a four doctor 5 location STUFF YOU GUYS DO. HOW DO YOU AND THE GREATEST THREAT TO mega practice – to opening a start- ACHIEVE THE GREAT WORK/LIFE ORTHODONTICS? up – to lecturing around the world BALANCE WE KNOW YOU HAVE? – the one thing that has always KOZLOWSKI: While I am a very been constant is the importance of KOZLOWSKI: I guess I already told positive person, I’ll start with the achieving great clinical results with you about my family! Amy and I met negative first. I know many see direct to the least amount of effort. in dental school and she is a practicing consumer orthodontics as the greatest pediatric dentist. We love to cook and threat but I don’t see it completely that eat and travel together whenever our way. The greatest threat to orthodontics is schedules allow for it. As for hobbies with continuing to do what the profession has the family – well, I am the “Hobby Guy” always done. Our profession continues so I’d love to share some of the things we to sell patients four bicuspid extractions

10 It’s just BUSINESS ANSWERS FROM THE EDGE

and headgear, expanders and lip bumpers, and with better customer service. For in not turning patients away from our bands on posterior teeth, and all of this those of us who are already doing this profession’s traditionally restrictive taking more than two years of treatment we have continued to see great growth financing models. (Yes I’m an investor in (the national average is 27 months of in our practices - even in the face of OrthoFi) treatment). Many orthodontists continue encroachment from PCD’s with short- to do what they have always done; selling term orthodontics, aligners, and DIY PROORTHO: WHAT ADVICE patients the old and tired when there are orthodontics. WOULD YOU GIVE YOUNG so many new and wonderful technologies ORTHODONTISTS AND RESIDENTS? available. These traditionalists yell and PROORTHO: WHAT scream that new technologies are not TECHNOLOGIES OR SERVICES ARE KOZLOWSKI: You can be anything “evidence-based” and they fight against INTERESTING TO YOU LATELY? you want to be in this world if you set the change. It is for all these reasons that your mind to it! Orthodontics is such a options like “short-term orthodontics” KOZLOWSKI: There are a number of wonderful and flexible profession. I tell and direct to consumer aligners are technologies that I have a great interest residents all the time - you can make growing. It may be what some patients in. First is Passive Self-Ligation. I’ve been your practice life and personal life be want - but I believe our traditional way of using the Damon System for over 15 years what you want it to be. Want to work providing orthodontics is driving patients now and I believe it is the key for me to one day a week? Then do it! Set up your there. Who wouldn’t want to straighten continually create great smiles in less systems to do 3-4 starts per day and do their smile in 6 months or do aligners time (averaging less than 17 months of that 50 days per year and you will have from home when the option many in treatment). We’ve also grown in our use an incredible quality of personal life with our profession provide is four bicuspid of aligners for patients who prefer not to the financial means to enjoy it! Want to extraction, expanders and headgear for wear braces. Combining Invisalign with work 5 days per week and crush it, then 2-3 years of treatment. our iTero Element scanners has made retire at 45? Then do it! The other thing I the process of treating with aligners easy tell young orthodontists and residents is ––––––––––––––––––– and streamlined. Aligner therapy is now to never stop learning. Go to meetings; a very relevant and important part of our listen and learn. Visit offices and see what “These traditionalists practice. I’m also a huge fan of CBCT. others do - adopt what you like and make yell and scream that I love my two iCAT FLX machines it your own and see what you don’t like that provide more information for less and don’t repeat it. We can learn from new technologies are radiation than a traditional pan/ceph. every encounter we have with others in Patients and parents can immediately our profession. And finally, I tell people not “evidence-based” see their dental and skeletal issues when - if you are not happy with your current and they fight against viewed in 3D and I believe it helps situation then change it. I was once a communication and ultimately conversion partner in a large group practice. It was the change. It is for of patients to get the treatment they a very good practice with good docs and need and deserve. Finally, I’d be remiss lots of patients. But after nearly 10 years, all these reasons that if I didn’t mention OrthoFi - a company I wasn’t happy. With the support of my options like “short-term that Jamie Reynolds and I started with incredible wife - I decided to retire from our CEO, Dave Ternan, over 4 years ago. the group practice and open my own orthodontics” and direct OrthoFi has been revolutionary in helping office. Starting from scratch 9 years ago practices manage the effects of extended we’ve grown to 4 locations and 20 team to consumer aligners financing that many patients require in members. I’m happier than I’ve ever are growing.” order to do business with our offices. We been and making more money than I built it for ourselves with the help of some ever imagined. If I can reinvent myself ––––––––––––––––––– really smart orthodontists and business - then so can you! And when I’m done So this leads me to the greatest people from outside the orthodontic with orthodontics someday - I might opportunity - the profession could profession. I’m really happy that it’s just become an architect or a chef - who pivot and start providing top quality grown to help over 250 other orthodontic knows? care in less time with fewer extractions practices realize the growth potential

Q1 • 2018 | TheProOrtho.com 11 ANSWERS FROM THE EDGE

PROORTHO: WHAT IS YOUR My dad taught me something early in my PRIMARY FOCUS FOR 2018? career that I try to always keep in mind: Interview with ” as practice owners, it's quite easy to never Dr. Andrew Appel APPEL: My primary focus in 2018 really turn work "off." He always reminds is diversification. I spent the first few me to try my best to lock the door at the years of my career "updating" Appel end of the day, and leave the orthodontics Orthodontics (AO): improving clinical inside for tomorrow! efficiency and scrutinizing everything about the customer service experience PROORTHO: WHAT DO YOU SEE that our patients receive. We have also AS THE GREATEST OPPORTUNITY managed to start and grow a new practice AND THE GREATEST THREAT TO branded differently than our own, which ORTHODONTICS? has been able to help a great number of families with insurance plans not APPEL: I think the greatest opportunity historically accepted by AO. In 2018 I is still having the option to practice a want to continue focusing on building great profession in a manner that is highly that brand and re-creating the same tailored to your personal desire: associate high quality, AO experience in this new with an awesome practice or be your own practice. We are also partnering with boss, open from scratch or buy an existing another orthodontic group to open a practice, work as much as you see fit for your lifestyle, choose the clinical systems Philadelphia orthodontist more boutique style, aligner-only practice, that work best for you. In orthodontics, Dr. Andrew Appel was born and and I'm sure we will commit much of we have a unique opportunity to choose raised in Philly and wanted to be an our time in 2018 to getting that off the our own path and that should never be orthodontist since he was 7 years ground. There are a lot of horses in the taken for granted. old. In July 2013, he joined his father starting gate, as my dad likes to say. As for a threat, there are certain things as co-owner of Appel Orthodontics, putting pressure on the profession which will celebrate its 40th PROORTHO: TELL US ABOUT YOUR FAMILY AND ALL THE FUN like never before: growth in corporate anniversary in 2018. He received STUFF YOU GUYS DO. HOW DO YOU dentistry and direct to consumer aligners, his undergraduate degree from ACHIEVE THE GREAT WORK/LIFE to name a couple. That being said, I try Pennsylvania State University, then BALANCE WE KNOW YOU HAVE? to focus on the notion that traditional graduated summa cum laude from orthodontic treatment will persist in Temple University Kornberg School APPEL: As a practice owner, I am some capacity and with these changes of Dentistry, where he became a always planning on work-related items. come new opportunities. My dad has member of Omicron Kappa Upsilon, Most of us tend to be pretty good at that... been at this for nearly 40 years and can an honor society that recognizes planning for the next big marketing push; recount stories about when he opened his excellence in dental school graduates. which CE events we will attend; what our practice in 1978 and all of the older docs He has a certificate in orthodontics scheduling templates are going to look consistently told him that "the golden days from Tufts University School of like. I basically try to take the exact same of orthodontics are over!" They couldn't Dental Medicine in Boston. Outside approach when it comes to non-work have been more wrong! We just focus our of the office, he is the proud parent of related items. Travel and its associated energy on continuing to move forward. a very handsome long-haired black life experiences have always been pretty cat named Oliver, enjoys hiking in important to me. My friends and I like PROORTHO: WHAT America's national parks, and tries to hike in the summer and snowboard TECHNOLOGIES OR SERVICES ARE to always make the most of Philly's in the winter so like anything else...we INTERESTING TO YOU LATELY? awesome live music and dining plan for it! It's nothing ground-breaking, scenes. just keep your work life and personal life APPEL: I suppose this would fall intertwined enough so that you can see under the tech umbrella...but we spent the whole picture and plan time for both! a lot of time this year doing a complete

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re-development of our website. I think it's easy to overlook the importance of the website in the overall scope of a practice's digital presence because it tends to be more static than, say, ongoing SEO or social media posts and ads. For us, we realized we have put a lot of time and energy into what's happening under our roof, but our previous site did a poor job at conveying that to prospective patients; instead, it provided the same, boring info found on most other sites. We partnered with Clear-PG for our new site, and we literally have new patients coming in saying that they saw our site and our videos. Some have even admitted they were holding back tears while watching this new content! We are finally using our website to show patients what we are all about in an effective and thoughtful way.

PROORTHO: WHAT ADVICE WOULD YOU GIVE YOUNG ORTHODONTISTS AND RESIDENTS?

APPEL: Well, I am a young orthodontist, so it feels a little funny to be asked to dish out advice. Two things that I think could be worth offering are: First, regardless of what career path you choose, write down your short and long-term goals. I have found that I'm much more effective in getting things done when I have put them down on paper. Second, try to enjoy the ride! It's so easy to get caught up in the process of starting and/or growing a practice, the cases that aren't turning out clinically like you would hope, the pressures being applied on our profession by those threats mentioned earlier. We have it so good in orthodontics...try to never lose sight of that and have fun along the way!

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INTRODUCING TRAVEL & LEISURE

We’ve always been big on travel and leisure at ProOrtho but in this edition, we decided to get serious about featuring travel pieces submitted by fellow orthodontists. We hope you enjoy this section and find inspiration to kick it up a notch in your practice so you can take the family on an awesome trip. If you have a great trip you’d like to share then let us know and we will feature it in future issues. Travel well! Ben 14 It’s just BUSINESS TRAVEL & LEISURE

PRO TRAVEL TIPS By ProOrtho Staff

Traveling, especially with family, a great idea. Hand sanitizer is also a process used to be arduous but now it’s can be stressful. But this is an artificial great thing to carry with you but make easy and you can do it on a layover in construct in our minds! Relax and sure it’s a small bottle so you can get any major airport. With global entry remind yourself that it used to take it through security. Make sure your you’ll get TSA pre-check almost every a lifetime to cross the globe or even Kindle, iPad, phones, etc. are charged time and that’s nice! Be sure to add the country. Know that if you travel and ready to go. It’s a great idea to your trusted traveler number to your much at all, delays are inevitable for download shows for everyone – you airline reservation or to your frequent any number of reasons AND airline can do so on Netflix, Amazon and flier account. Clear is a great service employees are there to help you. on most premium cable apps like and very reasonable depending on Getting upset only raises your blood HBOGo. Do not put your medicine in how often you fly and where. When pressure and reduces the chance that your checked luggage. Birth control approaching the security checkpoint you’ll get great service. Reduce stress pills and any daily medication are know that you’ll need a boarding by leaving an hour earlier for the especially important to keep on you in pass for every passenger and an ID airport than you think you should. case your bag gets lost! for everyone but children if flying Avoiding upsets and conflict with domestic and a passport for everyone your family is key to getting your trip Check and see if your local airport if flying international. Have these out off on the right foot. Once through has a valet service. Many do and this and ready so you don’t delay your security enjoy the show. Airports are a is a great way to start your trip off fellow passengers. great place to people watch. Print out stress free. Frequent travelers who are your itinerary and your tickets before loyal to one airline get premier status General rules for passenger you leave the house. Most of the time that allows them to use shorter lines screening on US domestic flights. the app on your phone will work and for check in, check bags for free and Normal screening - you must it’s rare that the airline will make a get upgrades. Or, of course you can remove your shoes and any coats, mistake but when either goes wrong purchase premium/first class seats to scarves, hats. You must take your you’ll be glad you have a hard copy. get these perks instantly. Some credit laptop and tablets out of your carryon Taking photos of everyone's passports cards also offer priority perks and and place each in a separate bin. and your credit cards, front and back, even airline status and are well worth Remove everything from your pockets is a great idea. That way if they are having. Which one depends on what and take off your Bluetooth headset. lost or stolen you have the info you airline you fly. The points guy is a Don’t take any liquids, gels or aerosols need to take action. Remember that good source of info. of more than 3 oz and put the ones airports and airplanes are often cooler you have in a ziplock bag that you than your home so consider adding If you travel much at all take the remove from your luggage. You don’t a jacket or scarf to your carry-on is time to get Global Entry certified. The need your ID or boarding pass out so

Q1 • 2018 | TheProOrtho.com 15 TRAVEL & LEISURE

put those away. Ideally while standing First class passengers and frequent since these lounges generally offer in line or before you’ll get most of this fliers with top-tier status get access to food and drinks included in access to done and be ready to remove shoes airline lounges. These are quite useful the club. and laptops so you don’t delay your and convenient and it’s a good idea to fellow passengers. Wearing shoes that search the airports you’ll be traveling Thoughts about boarding the are easy on off, wearing socks so you through to find out what lounges there plane and general courtesy to fellow don’t have to go barefoot, avoiding are. Lounge buddy is a great app for passengers while flying: belts with large metal buckles and that. If you are flying coach and don’t Remember that backpacks stick generally knowing what is coming and have top airline status don’t worry out behind you so don’t forget that being prepared will make your day as many credit cards will get you when you try to turn in the aisle and easier. into various lounges. Priority pass is smack people in the face. If you can't very useful and comes as a perk with lift your carry on above your head TSA pre-check - If your boarding several American Express cards. There then check it. Checking baggage is pass says TSA pre-check you don’t is a priority pass app that is useful. much easier and more courteous than have to remove your computer or Also, American Express lounges expecting others to do your heavy toiletries from your bag. You don’t are becoming more numerous and lifting. The space under your seat have to remove your shoes. The most cardholders get free admission. is your fellow traveler’s foot space. best bet is to take any jewelry and Finally, you can pay for a day pass and Sometimes passengers want to stuff everything from your pockets and depending on how long you’ll be stuck their belongings below the seat they place them in your carry-on baggage. in an airport this might be worthwhile are sitting on. Don’t be that passenger.

Don’t use headrests as handles - whether walking down the aisle or getting in or out of your seat, remember that grabbing a headrest and using it like a handle disturbs your fellow passenger. Especially on overnight or international trips when they’re trying to sleep. It’s much more courteous to put your hands on your armrests to get in and out of your seat or on the overhead bins when walking down the aisle. Use of your tray table, video monitor and seat back pocket impacts the person in front of you. Every time you tap the screen, raise and lower the tray table, or utilize the seat back pocket you are moving the seat of the passenger in front of you so remember to use appropriate force and limit the number of times you perform these tasks.

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Infants cry. That’s what they do. to get some rest. Keep this in mind Understand that the parents are and be sure to carry those noise likely much more upset about this canceling headsets! Tapping feet to fact when traveling with an infant the music, playing music on headsets than you are. A great way to make loudly and excessive fidgeting the situation better for everyone is impacts your fellow traveler. to travel prepared with ear plugs, noise-canceling headphones and On overnight/red-eye flights a white noise app on your phone and on international flights it’s a AND be sure to smile at the parents good idea to leave your window or even offer to lend a hand if it’s shade down. This gives your fellow obvious they are in need of one. This passengers the best chance to sleep. is especially nice when a parent is Modern planes regulate light during traveling alone with one or more the flight to minimize jet lag but one infants or young children. passenger opening a window will destroy this attempt to make your When in coach remember that journey more pleasant. Also on these there are more arms than armrests. sleep intensive flights, it’s a good idea In a three-seat arrangement, to keep conversation to a minimum traditionally the aisle and window as voices carry a great deal when passengers surrender the middle passengers aren’t moving around or armrests for the person stuck in talking much. the middle seat. In a two-seat configuration, we must share or take Flying commercial means being turns (usually one person ends up in a closed space with others for an predominating). The thing to avoid extended period so avoiding heavy is allowing our elbow to cross over cologne or perfume, foods that are the armrest and into the ribs of our highly aromatic and anything else fellow passenger. This is especially that will negatively impact your common when using a laptop so fellow passengers is always a good remember to be courteous. If you idea. need more room, buy a first class ticket! Parents - especially tall ones - When you arrive at your hotel the can increase their room in coach by first thing you should do is secure taking the middle seat and putting your valuables and travel documents a child on either side. That way in your room safe if you aren’t you paid for all three seats and can going to keep them on your person. encroach on them as you like. Leaving these things lying around your hotel room – even for just a Conversation is great when few hours – can have catastrophic it’s mutual but sometimes fellow consequences. passengers have work to do or want

Q1 • 2018 | TheProOrtho.com 17 BUSINESS & PRACTICE DEVELOPMENT

From the Rear View Mirror By Dr. Courtney Dunn

Today is my first day back at work orthodontic residency, and the AAO –––––––––––––––––– after the 2017 MKS meeting in Dallas. annual session doesn’t provide much The meeting was different for me this useful information in this area. Knowing “But humility reigned. year. Partially due to the fact that I was that, it shouldn’t be a surprise that there Many people put presenting, but mostly due to the content are a lot of people either attending or change that wasn’t intentional by the speaking who have very large practices. themselves out there in organizers. In fact, one of the cool things But this year was a little different. about MKS is that the speakers are not Business was still a great topic and the a very personal way. paid and they are not told what to speak speakers had large and thriving practices. We learned that public about. Really – there is absolutely no But humility reigned. Many people put guidance at all. But, somehow the tone themselves out there in a very personal perception may not reflect of the meeting was consistent. Here is a way. We learned that public perception the true human being summary of my impressions of MKS this may not reflect the true human being and year. that the seemingly infallible were, in fact, and that the seemingly quite human after all. We also learned THE YEAR OF HUMILITY that many of the largest personalities infallible were, in fact, MKS is generally known for being came from humble roots and they were quite human after all." a meeting for “non-traditional” proud of their blue-collar childhoods. orthodontists to talk about their practices. In addition, people were called out –––––––––––––––––– In other words, there is a lot of “meat” on for bragging about their income, their running a business. I’ve always enjoyed number of locations and their large staff. THIS IS WHAT I CAME FOR this because there is a definite lack The overall message – “Nobody cares – I loved the talks coming from of business training in dental school, let’s start focusing on what’s important”. orthodontists I wouldn’t see anywhere

18 It’s just BUSINESS BUSINESS & PRACTICE DEVELOPMENT

else. This is the heart of MKS. Dr. Kervin vendors presenting things that could PERSONAL CONNECTIONS Mack discussed the difficult transition actually be useful, even if we didn’t use Smaller meetings like this give us time from residency to business owner. He was their product. This year, some speakers to talk. There is huge value to these so honest about the bumps in the road, decided to use their time for platform personal connections and discussions. the payroll discrepancies, the outdated selling. Now, I realize that putting on I was so grateful for all the people who office and the need to rebrand. Dr. Mack a meeting is expensive and you need to took the time to make a supportive even discussed his road to healthy living keep the sponsors happy. But, they should comment or ask a great question about – while getting a leg cramp on stage from have been happy without a speaking slot. my presentation. I loved meeting so many an earlier run! These authentic moments The exhibitor’s area was always jumping people I’ve only “met” on Facebook and are special and unique. Another great talk and credit cards were smoking. I found I sincerely hope that you know that any was given by Dr. Kurt Kacer. He shared that most docs were very happy with the and all suggestions I give to you come his experience transitioning from three variety of vendors and services in the from a place of support (sometimes I feel doctors to one and the ramifications of exhibitor’s area. We just don’t want to see like I offend people with my honesty). incorporating general dental services into them on stage presenting a hard sell when These connections remind us that our his practice. For some reason, these types we are there to see docs like Kacer and community is small and that we are not of discussions aren’t seen at traditional Mack. alone. There are great colleagues out there meetings and probably won’t be anytime –––––––––––––––––– willing to help and support you in any soon. I found all of the topics above to way possible. be fascinating and I appreciate their “These connections remind willingness to share so we could learn. In summary, I would consider this us that our community meeting a success. There was great SPONSORED SPEAKERS SUCK is small and that we are attendance, people were sincere, the This year, there were several vendors content was good and there were lots given the opportunity to speak - not alone. There are great of unexpected moments. The biggest significantly more than in the past. I colleagues out there willing negative for me – I was soooooo cold!! was not a fan of this trend, and I can Maybe bring a winter coat next year. report from many grumblings in the to help and support you in halls, that I was not alone. In previous meetings, there might have been a couple any way possible." ––––––––––––––––––

Q1 • 2018 | TheProOrtho.com 19 TRAVEL & LEISURE

TRAVELING TO THE GREEK ISLANDS By Dr. Daniela Loebl

If you’re looking for a vacation with luxury hotel and villa options in Greece, –––––––––––––––––––– countless beaches, cultural immersion, especially on the islands, but having spectacular food, and some ATVing on recently graduated from dental school “Places of interest: the side, look no further than the Greek forced us to stay on a slightly tighter Acropolis, Parthenon, Islands. My husband and I honeymooned budget. there last summer, and are counting down Temple of Zeus, Dionysus until we can return. ATHENS Theater, Filopappos Hill I very much like to plan my own Before heading to the islands, be sure itinerary when I travel, but we did use a to enjoy Athens for at least a day. There (for a great view), Plaka travel company called Key Tours to take is so much history to see and appreciate. care of things like hotel reservations, we stayed at the Fresh Hotel, which had neighborhood ferry tickets, and transport to and from a small rooftop pool and amazing view Restaurants: Dionysus, the ports. In my opinion, it made these of the Acropolis at night! Be sure to parts of the trip (nearly) flawless and walk around the neighborhood of Plaka Ama Laxei, Electra Palace, took a lot of stress away from having at night for great restaurants, bars, and Seychelles, Eat at Milton’s.” to book separate ferry tickets and rides shopping. The next morning it was time and fumbling with a foreign alphabet. In to catch a ferry to stop #2: Mykonos. –––––––––––––––––––– terms of places to stay, there are many

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MYKONOS What a stunning island. We were fortunate enough to spend 3 days in Mykonos and it was perfect. Upon arriving to our hotel (Hotel Lady Anna in Platys Gialos), we worked with reception to rent an ATV for 24 hours. I highly recommend renting either an ATV or scooter (for couples) or a car (for families) to see the entirety of the island. Scooters are harder to rent if your license doesn’t specify you are licensed to operate motorcycles, so we opted for an ATV. We went ATVing to the town of Mykonos which is on the west side of the island, admired the sunset from a bar in Little Venice, and had dinner at a tiny INTIMATE KIKI'S TAVERNA WITH AN AMAZING VIEW traditional restaurant called To Mairero- highly recommend! –––––––––––––––––––––––––––––––––––––––––– Day 2 was adventure day- we went ATVing all over the island and ended up "Places of interest: Dragonisi Island, the windmills, finding beautiful and remote beaches. First was Lia beach (a scuba diver’s Little Venice for sunset drinks, Lia Beach, Panormos paradise) and then Panormos beach, Beach, Paraportiani, Paradise Beach and Scorpios which is well known for its beautiful ocean colors. From there, we headed (if you like to party) to Kiki’s Taverna for lunch, where we Restaurants: M eating, Kiki’s Taverna (lunch), expected to wait in a pretty long line. The restaurant is open from 12-7 and is always To Mairero, Remezzo, Nikola’s Tavern, Funky Kitchen." full- expect a wait- but is extremely worth –––––––––––––––––––––––––––––––––––––––––– it. We stuffed ourselves with the freshest octopus, grilled feta, fresh catch of the day, and Greek salad. Not to mention the location and view are spectacular as well. On Day 3, we decided to stay local and enjoy Platys Gialos beach. At that beach there is a boating company that offers boat tours to Dragonisi Island, an uninhabited island with coves and caves you can swim in. They also take you to a beach on the east side of Mykonos and offer masks so you can appreciate the clear waters, coral, and curious fish and sea creatures. The next day, we enjoyed a quiet morning at the hotel and caught a ferry mid-day to stop #3: Paros.

THE COVES OF DRAGONISI ISLAND

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PAROS Another stunning island. Definitely less busy than Mykonos or Santorini but its popularity is growing fast. We only had 2 days in Paros but wished for more. Upon arriving, we checked in to the beautiful Paros Agnanti Hotel on the west side of the island, close to the main town of –––––––––––––––––––– Parikia. We spent the first day enjoying the town and getting lost in the winding, "Places of interest: Parikia shaded streets. We stopped by the Church of 100 Doors (Panagia Ekatontapiliani) town, Kolymbithres beach, and the Frankish Castle, which was built Kalogeros Beach, Naoussa in the 1200s and definitely stands out among the Cyclades architecture of white Port, Lefkes Village, walls and blue doors. After watching the Panagia Ekatontapiliani, sunset off Parikia’s main road, we headed to Levantis for dinner and enjoyed Lefkes, Marble Quarries delicious fresh seafood. On the second day, we rented an ATV Restaurants: Levantis, to explore the rest of the island. Our first Taverna Glafkos, Aromas, stop was the mountain town of Lefkes. On the way, we stopped by the ancient marble Happy Cows" quarries in Marathi; it is believed that –––––––––––––––––––– the marble of the Venus de Milo marble was extracted from here. Lefkes itself is a quaint and quiet town—we felt like we had it to ourselves. Be sure to take in the amazing mountainous views, including A TYPICAL QUIET STREET IN PAROS views of the neighboring island, Naxos. From Lefkes we headed to Kalogeros beach, known for its abundance of natural spa-like clay. Let the clay dry on your skin and head into the ocean for a quick dip, and emerge feeling extra smooth. Our next stop was Naoussa port, an authentic and traditional village on the northern part of the island. Although seemingly quieter than Parikia, Naoussa boasts a nightlife scene and is dotted with taverns and clubs. We strolled by the myriad fishing boats toward the still- standing Venetian fortress, constructed in the 15th century. Then we enjoyed a nice lunch right on the water at Taverna Glafkos before heading to one of my favorite beaches: Kolymbithres beach. This beach is definitely unique: various rock formations lead directly to the crystal clear waters. It’s a fun place to VIEW FROM KOLYMBITHRES BEACH enjoy the water and watch the various boats go by.

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SANTORINI On the second day, we (once again) When people think of Greece, they rented an ATV to get around the island. usually imagine the picturesque blue The beaches of Santorini aren’t as typical domes of Santorini. Despite being the or popular compared to the other islands most popular (and crowded) island due to its lack of white sand—the sand destination, we decided to make Santorini is actually mostly red or black due to our last stop. Santorini has a unique story, the volcanic origin of the island. Our as it was formed by volcanic activity first stop was the Red Beach, which was centuries ago, which resulted in a flooded a little underwhelming, followed by the caldera formation surrounded by a ring Black Beach in the town of Perissa. Then of islands. One of my biggest regrets is we saddled up for a long ATV drive and not staying in a villa overlooking the headed to Oia, Santorini’s other famed caldera. Still, our hotel was very nice (El village. We headed straight down to Greco Hotel), but a little isolated and Ammoudi Bay and enjoyed fresh octopus you couldn’t appreciate the views. After at Ammoudi Fish Tavern. After a short checking in, we walked to Fira, Santorini’s digestion period, we walked along the main town, and enjoyed the incredible bay to a well-known swimming and cliff caldera views. We hiked out to Skaros jumping spot and got some good GoPro Rock, an ominous-looking rock formation footage in. Afterwards, we went back up that protrudes out into the Aegean Sea, to Oia and wandered the narrow streets from the neighboring town of Imerovigli. until it was time for a final sunset dinner It was a beautiful trek and offered even at Pelekanos. Restaurants with rooftops better views. After that, we set out to find tend to fill up in the high season, so a prime spot in Fira to enjoy the famed reservations are strongly recommended! Santorini sunset, and later enjoyed a nice meal at Argo.

–––––––––––––––––––– –––––––––––––––––––– SKAROS ROCK OFFERS STUNNING VIEWS "Places of interest: Red Restaurants: Argo, OF THE CALDERA beach, Black beach Ammoudi Fish Tavern, (Perissa), Cliff jumping at Pelekanos, 1800, Ginger, Ammoudi, Skaros Rock Da Vinci, Ambrosia " –––––––––––––––––––– ––––––––––––––––––––

VIEW FROM KOLYMBITHRES BEACH

THE SUN SETTING ON THE CALDERA

Q1 • 2018 | TheProOrtho.com 23 ORTHOPUNDIT.COM

Made to Measure: The Dubious Relationship Between Eugenics and Orthodontics By Dr. Marc Ackerman

with the American Breeder’s Association joining its Eugenics Committee. The Eugenics Creed that Davenport later developed read:

“I believe in striving to raise the human race to the highest plane of social organization, of cooperative work and of effective endeavor.” “I believe that I am a trustee of the germ plasm that I carry; that this has been passed on to me through thousands of generations before me; and that I betray the trust if (that germ plasm being good) I so act as to jeopardize it, with its excellent possibilities, or from motives of personal convenience, to unduly limit offspring.” “I believe that, having made our choice in marriage carefully, we, the married pair, should seek to have 4 to 6 children in order that our carefully selected germ plasm shall be reproduced in adequate degree and that this preferred stock shall not be swamped by that less carefully selected.” “I believe in such a selection of "A NEWSPAPER ARTICLE ANNOUNCING THE BRUSH FOUNDATION DONATION OF $500,000." immigrants as shall not tend to adulterate our national germ plasm with socially unfit traits.” Orthodontists by and large have to achieve nature’s intended ideal. “I believe in repressing my instincts a fascination with measuring things As the nineteenth century turned, Sir when to follow them would injure the next and developing normative data Francis Galton’s eugenics movement in generation.” for comparison of individuals. In Britain was promoting the concept of orthodontics, mensuration of just about marriages between eminent families of The American eugenics movement was anything is often mistaken as science good stock in order to improve the human criticized for its racist, classist views and when in fact it is pseudo-science at best. race. Galton coined the phrase, “nature their desire to prove that many groups in When the father of modern orthodontics versus nurture”. Galton and Karl Pearson’s the population were unfit for breeding. Edward H. Angle developed the biometric approach to evolution sparked They used the term “feebleminded” for theoretical basis for and the operational the interest of a Harvard trained zoologist, many of these individuals and many practice of orthodontics, he was heavily Charles Davenport, who is considered States adopted sterilization laws based influenced by the beliefs of the privileged the father of the American eugenics on eugenic research. Davenport was a class during the Victorian age. Man was movement. Davenport became involved founder of the International Federation

24 It’s just BUSINESS ORTHOPUNDIT.COM

of Eugenics Organizations in 1925 with T. Wingate Todd, a physician and physical of obtaining funding from the Brush a Commission on Bastardization and anthropologist at Western Reserve Foundation, Todd proposed to study: Miscegenation (interbreeding). Much University in Cleveland, accepted a young of Davenport’s work was the inspiration orthodontist fresh out of the Angle School “The modes of inception, the types of for the Nazi race laws. He maintained in California to work as a research fellow progress and the final stabilization of adult alliances with Nazi organizations in the Department of Anatomy. That patterns during the second decade, for both before and during World War II. orthodontist was none other than B. Holly the explicit purpose of understanding and Davenport held editorial positions for two Broadbent, Sr. Broadbent Sr. became fostering those traits which determine a German journals and in 1939 he wrote a Todd’s protégé and in 1924 Broadbent proper attitude of family-building ambition contribution to the Festschrift for Otto added a metric scale to Todd’s Western in contrast to careless production of Reche, an important figure in the Nazi Reserve craniometer to more precisely children. The physical and mental patterns plan to “remove” inferior populations. In measure dry skulls which is still used of infancy and early childhood in the light 1935 an investigative committee reviewed today. Todd and Broadbent spent the next of heredity and nurture. To demonstrate Davenport’s work and found that his data several years studying the characteristics the fundamentally scientific purpose of collection was unusable and unjustified. of healthy well-developed children in eugenic education and the indispensability As a result, his office was closed in 1939. the greater Cleveland area. These early of the eugenic method in all efforts designed Davenport’s ideas were widely condemned studies were funded by the Cleveland for population welfare.” by scholars and social scientists at that Health Council and Cleveland Welfare time. He languished in disgrace and died Federation. However, money began to dry The Brush Foundation accepted Todd’s in 1944. up as the country plunged into the great proposal and in 1929 passed a motion to The first mention of eugenics in the depression. Todd had run out of funds fund the project. It read: orthodontic literature was an Editorial by and was desperate to keep his studies Martin Dewey, the Editor-in-Chief of the going. “Motion that the Brush Foundation International Journal of Orthodontia (the Charles Frances Brush, a wealthy undertake an investigation and American Journal of Orthodontics and businessman and strong proponent of interpretation of child development Dentofacial Orthopedics today) in July eugenics created the Brush Foundation with reference to those adult traits and 1918. In the essay titled, “Education and and established a fund for research of patterns which are of importance for race Eugenics”, Dewey argues that the lengthy $500,000 in 1928. Seeing the possibility betterment…” educational process required to become an orthodontist was taking men of good stock away from producing healthy children in their most fertile years of age 21 to 28. He wrote:

“We therefore contend for the benefit of the human race there should be a physiologic side to the question of education, and the human family both men and women should not be so highly educated as to entirely obliterate the possibility of being useful in the production of the human race or in the improvement of the human race. It is indeed a lamentable fact that the people who seem to be the most fitted to rear children as they should be reared are those who have the fewer children and small families.”

This was an interesting take on the role that orthodontists should play in the better breeding movement. "THE HEAD OF A YOUNG POLISH GIRL IS MEASURED USING A CALIPER DURING HER RACIAL Orthodontics became more formally EXAMINATION BY GERMAN AUTHORITIES. (PHOTO COURTESY OF UNITED STATES HOLOCAUST linked with eugenics in the late 1920’s. MEMORIAL MUSEUM PHOTO ARCHIVES)

Q1 • 2018 | TheProOrtho.com 25 ORTHOPUNDIT.COM

In a letter to a colleague from the for 10 years (1922-32) Chester was the former participants of the Bolton-Brush Rockefeller Foundation in New York, President of the Ohio Guernsey Breeder’s Inquiry, in particular brain tumors Todd gives us a sense of how he was Association. Ultimately all finances and skin cancer. Some of these treating willing to make a deal with the devil: related to the Bolton-Brush Inquiry doctors wrote to archivists in the 1980’s were centralized into the Developmental for copies of the x-rays taken years before. “It was a rather hard job to sell the Health Inquiry of the Associated They were provided by Broadbent Jr. who ideas although I must say that when Foundations (Bolton, Brush, Rockefeller, stated that, “There is no direct evidence the Foundation did come across it did etc.) in 1932, with Todd as the Director. linking these cancers to the tests.” In handsomely. It was necessary for me to slur ethics, we call this the doctrine of double over distinctions between the adolescent –––––––––––––––––– effect. If doing something morally good and the infant programs. I had also to color “Now that we know has a morally bad side effect, it's ethically the presentation with eugenics. You will permissible to do it, provided the bad find various other sops but none which give that this historic side-effect wasn't intended. However, away anything important.” there has to be due proportion between data set has little the good effect the proposed act would achieve and its foreseen unintended relevance today, why consequences. The good that is to be achieved must sufficiently outweigh the do we promote it as unintended bad. orthodontics’ great The Bolton study was terminated in 1959. It’s two self-proclaimed legacy? It is also hard major contributions to orthodontics were Broadbent Sr.’s introduction of to invoke the doctrine radiographic cephalometry in 1930 and the Bolton Standards of dentofacial of double effect since developmental growth in 1975. The American Association of Orthodontists there’s no evidence to Foundation provided a sizeable grant support proportionately in the early 2000’s to Broadbent Jr. and colleagues at Case Western Reserve for more good was achieved a project titled, “Digital storage and internet distribution of the records of than unintended bad." the Bolton-Brush growth study center.” –––––––––––––––––– Approximately 20,000 radiographs were digitized. This sample was included in Todd’s study sample eventually the AAOF Craniofacial growth legacy included 5,000 Cleveland children who collection along with 8 other study The initial funding and study sample had been x-rayed repeatedly and a subset collections. for Broadbent’s facial growth study came of 1,000 children who were exposed A 2015 study published in the European from the Brush Inquiry. In 1930, Todd every three months during infancy. In Journal of Orthodontics by Antoun convinced Frances Payne Bolton the total, the study exposed 250,000 x-rays et al. examined the effect of secular widow of Chester Castle Bolton and her over its lifetime. Although there has been trends on craniofacial growth in a series Son Charles Bingham Bolton to set up great debate as to whether or not there of longitudinal birth cohorts that are a fund specifically for the study of the was an increase in cancer in the Brush frequently used in orthodontic research, development of the face of the growing Inquiry population relative to the normal including data from the Bolton-Brush child. Broadbent Sr. and later Broadbent population, one Cleveland physician Inquiry. They pointed out that many of Jr. became the stewards of the Bolton- speculated that less than one-half of the studies which examined the efficacy of Brush Inquiry collection. It is interesting one percent more cancer cases among growth modification used these historical to note that Chester and Frances Bolton Todd’s subjects. So, performing simple controls rather than randomized were actively involved in the American math, 0.005 x 5,000 equals 25 cases more contemporaneous controls. The validity of Breeder’s Association at the time of than the general public. There are other these investigations has been called into Davenport. The Boltons raised pure- Cleveland physicians who claim that question. The study concluded: bred Guernsey cattle on their estate and there have been more cancers amongst

26 It’s just BUSINESS ORTHOPUNDIT.COM

“Our findings suggest that secular trends before his death in 1944. In that essay, are likely to result in modern craniofacial Davenport’s assessment that facial growth traits that are generally larger in size and is largely dependent on heredity is not too exhibit different growth rate patterns far off from what we know today. In fact, than those of historical subjects, thus Davenport was prescient when he made misrepresenting a treatment effect that the assertion: Sources would otherwise not be present if secular AAO Foundation, 2011. Summary of Awards. trends were taken into account.” “Possibly in some cases, the orthopedist Broadbent, Holly Final Report.doc has taken more credit for his technique Retrieved 2017. and given too little to nature when the Antoun JS, Cameron C, Hoy SH et al. Evidence of results of his technique have been especially secular trends in a collection of historical craniofacial successful.” growth studies. European Journal of Orthodontics 2015, –––––––––––––––––– 60-66. Behrents RG, Broadbent BH Jr. A chronological “There is no such account of the Bolton-Brush growth studies. 1984. thing as normal or Bolton CC. Biography. Western Reserve Historical Society. 2017 for that matter ideal. Davenport CB. The development of the head. International Journal of The institution of Orthodontia and Dentistry for Children 1943, 541- 547. philanthropic eugenics Davenport CB. Biography. www.eugenicsarchive.org Retrieved 2017. that orthodontics Dewey M. Education and eugenics. International Journal of Orthodontia 1918, embraced was a double- 388-390. Eugenics Archive. T. Wingate Todd collection of letters. edged sword." www.eugenicsarchive.org –––––––––––––––––– Retrieved 2017. What are we to have learned from Kevin F. Kern, Associate Professor of History, The Hundreds of thousands of dollars were orthodontics’ relationship with eugenics? University of Akron. Author of “T. Wingate Todd: Pioneer of Modern spent on the Bolton-Brush Inquiry since No matter how many humans are American Physical its inception. In the past two decades, a measured by orthodontists in a search Anthropology”. Personal Communication. 2017. significant amount of money and work of what’s “normal”, the answer to this hours have been spent on the digitization kind of question will remain as elusive Kuhl S. The Nazi connection; Eugenics, American Racism, and German National of the Bolton-Brush records. Now that as the Loch Ness monster. There is no Socialism. Oxford University Press 1994. we know that this historic data set has such thing as normal or for that matter little relevance today, why do we promote ideal. The institution of philanthropic Riddle O. Biographical memoir of Charles Benedict it as orthodontics’ great legacy? It is also eugenics that orthodontics embraced was Davenport 1866-1944. National Academy of Sciences 1947. hard to invoke the doctrine of double a double-edged sword. On one hand, it effect since there’s no evidence to support fostered scientific discovery in the hope Schambra WA. Philanthropy’s original sin. Hudson proportionately more good was achieved of alleviating man’s suffering. On the Institute 2013. than unintended bad. other hand, it aided and abetted a dubious Woods JM. Cleveland medicine’s incredible ghosts. The last formal association of philosophy that was far less beneficial Cleveland Magazine 1983, 127-131. orthodontists and eugenics occurred to mankind. I would recommend that in 1943. A disgraced Davenport was we approach the legacy of orthodontic invited to speak to the New York Society childhood growth research with regret of Orthodontists. He gave a paper titled and reflection. Orthodontics today has “The development of the head” which was limitless potential for doing good, I just published in the International Journal of hope somebody out there doesn’t slow Orthodontia and Dentistry for Children progress by trying to measure it along the (AJODO) approximately 6 months way.

Q1 • 2018 | TheProOrtho.com 27 H.R. INSIGHT

Utilize Group Interviews To Maximize Hiring Success By Bridget Burris

The stress of hiring a new employee can time phoning and leaving messages. We complete an application once they arrive. be somewhat overwhelming. Not only is live in the technology age so use it. Also Obviously anyone that arrives late is there an incredible amount of work in the you only have to write the invite once and probably not going to get the job! Since hiring process but the stress of choosing then cut and paste accordingly. We never we do back ground checks and drug the “right” person is tough. Over the years let candidates know they will be attending screening we require their signature and we have used the group interview process a group interview, just that they need consent. to increase efficiency and alleviate stress to show up at 5pm at our office location and this technique has proven invaluable. (include address) and to expect to be there • Once all applications are complete I Let me explain how to do a group for two hours. would normally stand up and introduce interview: the team helping with the process. I also • You will need the help of several team explain the group interview as most • We run our ads on www.indeed.com members for this process. In all honesty, applicants are surprised to see several with a VERY detailed description. We most team members love being part of individuals there for an interview at always use the free service with them, no this process and tend to be a greater help the same time. Collectively introducing need to pay for this. for the new team member when they help everyone and giving them a welcome choose their co-workers. intro is a real time saver as I normally give • Choose the applicants you wish to the full run down on what the company speak with from the resumes received and • Have a team member greet the is all about, what the job requirements are email them an invite for their interview. applicants upon arrival. We always note and what benefits are included – but this We always use email as it cuts down on their arrival time and ask candidates to way I only have to do it once.

28 It’s just BUSINESS H.R. INSIGHT

–––––––––––––––––– important to gauge team interaction vs and may be moving closer to their parents competitiveness; ability to interact with in the next state, we have heard that they "This test is not confining each other, whether they have a desire were fired under suspicious circumstances to improve and general stick-to-it-ness. from their last job, we have heard how but it is a good exercise they used all their vacation and then quit to ensure that all four • Dexterity test: We show the their last job. Amazing revelations that we applicants a paperclip and then give can’t ask about but love to know before personality types are them a wire and ask them to bend it hiring! present in your office to into a functional paperclip within 1 minute. Once again this is more about • Once the applicants are done with ensure a well-rounded how they react than how awesome their interview we let each individual the end product is.I have seen people know that we will contact them via email team culture and to help throw the wire down and quit and have in the next 2-3 days and thank them for get the right people in the seen people giggle when it is actually their time. functional. Truly some great insight. right seats on the bus. An They are given a second chance to • As a wrap up to the process, we get office with only peaceful improve on this too. with our team, ask their opinions and eliminate obvious non-candidates. The personality types would be • Personality test: This is not potential teammates are asked to come normally a timed exercise. We use the in for a working interview (they are very boring and a bunch Colorcode personality test. Basically, paid an hourly rate) and based on their of powerful personalities you are not going to place a social, interaction and performance, we finalize high energy, personality type as your our choice. would kill each other!" financial coordinator as they are more • We are sure to contact each individual –––––––––––––––––– likely to succeed in a TC role. This test via email within the given time to let • Next we split everyone up into groups is not confining but it is a good exercise them know if they did or did not get the of 3-5 candidates with a team member to to ensure that all four personality types job. Also, we ordinarily also send them lead them. The team member will oversee are present in your office to ensure a a hand-written card thanking them for the candidates completing the following: well-rounded team culture and to help their time. We use this as a marketing get the right people in the right seats opportunity! We have had so many • Aptitude test: We ordinarily use the on the bus. An office with only peaceful applicants bring their children to us Wonderlic test. It is incredibly accurate personality types would be very boring for treatment over the years because of and a wonderful tool. After using it and a bunch of powerful personalities their awesome experience during the for several years I believe it really tests would kill each other! group interview and we take this as a the speed at which an individual can compliment to our hiring process. learn. LOVE it! Clinical assistants • In addition to these tests we need to score a minimum of 16 and for ordinarily do a 3-minute interview I encourage you to give the group administration positions candidates with each individual in private. interview process a try. It is great way to need to score at least a 19. I have tested Basically, we are asking if they have any get your team involved and, by doing so, these numbers time and time again questions and what they would like to somehow the dynamic of the interview only to realize that someone that scores see themselves paid in this situation. process changes drastically with the 15 is going to take 6 months to get up Asking what they expect to be paid is applicants – allowing you to learn much to speed, even if they are the sweetest, a very important question as it tells us more about each candidate than you can kindest person! what their expectations are. During the in a traditional, individual interview. I interviews we ordinarily serve snacks and believe you get a greater sense of who the • Memory test: We ordinarily beverages and have our team chatting applicants really are. Yes, it takes a bunch place instruments on a tray, give the to the applicants. This is a great time for of time and effort to do a group interview, applicants 1 minute to memorize it observations as everyone is normally but getting the right fit for your team is and they ask them to duplicate the tray having fun and they tend to be relaxed. worth it! setup. They are given a second chance Yes, this is when we have heard that to improve. Remember these tests are individuals are in the middle of a divorce

Q1 • 2018 | TheProOrtho.com 29 BUSINESS & PRACTICE DEVELOPMENT

NEW GAIDGE CEO Interview with Ryan Moynihan

Gaidge has partnered with orthodontic the beginning of my career in finance metrics and key practice indicators practices across the US, Canada, the working for Intel and then Ernst & Young. through a software interface that delivers Caribbean, and Australia to automatically I earned my MBA at Georgetown, which information automatically from the gather and deliver key performance was a great opportunity to leverage practice management system to cloud- indicators that assist doctors, managers my analytical background and build a based Gaidge. Orthodontists and team and team leaders in assessing needs, strategic marketing skillset. Post-MBA, leaders have an immediately accessible setting goals, and driving practice I worked for 3M in their dental business resource to monitor and address practice performance. Gaidge has the most (now 3M Oral Care) as a Marketing performance, set short-term goals, long- accurate and robust database of Manager (3 1/2 years) and then as a term strategies, and develop a higher level information in the orthodontic industry. Regional Sales Director (2 1/2 years) for of accountability. Gaidge also enables a In addition, it includes the opportunity the west coast in northern California. I method to collaborate with consultants, for clients to compare key practice was recruited to join Ormco as their Vice advisors, accountants, and business performance indicators across practices President of North American Sales (2 1/2 strategists to further enhance information much like their own to benchmark and years) and then was promoted to be the sharing that benefits the practice. Through keep pace with the market. Vice President of Global Marketing (2 the creative development process, Gaidge Since 2010, the company and years) prior to coming to Gaidge. has industry standard benchmarks for its analytics, has been a leader in I met Mary Beth Kirkpatrick, determining practice health, as well as reporting practice performance as well Gaidge Managing Partner, during my an opportunity for practices to compare as industry trends. In 2016, Gaidge tenure at Ormco through a strategic themselves with other similar practices. compiled and reported the activity practice growth initiative. Over time Gaidge continues its development process of client orthodontists in over 1,250 the conversation grew and the Gaidge with a commitment to provide key locations with a combined annual Net opportunity was born. I am very analytics to the orthodontic industry. Production of $1.4B and Net Collection interested in the solutions Gaidge following at $1.3B. This activity included provides its clients and passionate about BENTSON: CAN YOU GIVE US AN 400,000 exams in which 287,000 were helping our clients simplify and grow OVERVIEW OF THE CHALLENGES adolescents and 113,000 were adults. their orthodontic businesses. FACING THE SOLO AND SMALL From these exams, 280,000 combined GROUP PRACTICE OWNER(S) FROM Comprehensive, Phase I, Phase II and BENTSON: FOR THE DOCTORS YOUR PERSPECTIVE? Clear Aligner treatment starts were UNFAMILIAR WITH GAIDGE, CAN MOYNIHAN: Increased competition tracked in Gaidge. Indeed, Gaidge has YOU GIVE US THE COMPANY from many different angles with more become a meaningful product to its user HISTORY AND THE VALUE general dentists doing orthodontics, and to the industry as a whole. PROPOSITION FOR DOCTORS THAT increased pressures from corporate Gaidge recently hired Ryan Moynihan MIGHT CONSIDER GAIDGE AS A groups, consolidation, and a relatively as new CEO and below is an interview TOOL FOR THEIR PRACTICE? new competitor in the direct-to-consumer with Ryan about his vision for Gaidge and MOYNIHAN: Gaidge is a tool or do-it-yourself category of Smile the role it can play for orthodontists going that helps orthodontists simplify Direct Club. There are internal business forward. how they run their business. Gaidge challenges: controlling overhead as was released in 2011 and since then margins tighten, maintaining profitability, BENTSON: PLEASE TELL US A Gaidge has built a robust database and case acceptance with patients who BIT ABOUT YOUR BACKGROUND currently reporting annually over $1.4B are shopping price and seeking payment AND WHAT ATTRACTED YOU TO in production, $1.3B in collections, flexibility. Maintaining market share with BECOME THE CEO OF GAIDGE. 400,000 exams and 270,000 case starts. innovative ways to market their practice MOYNIHAN: It is ironic how a Gaidge was developed by the Impact will also be a challenge. I’m convinced career can have a way of coming full 360 Consulting firm in collaboration that staying on top of practice metrics is circle. I have always had a passion for with the OrthoBanc software engineers. imperative for the solo and small group analytics and numbers and it lead me to Gaidge provides accurate and timely practices.

30 It’s just BUSINESS BUSINESS & PRACTICE DEVELOPMENT

BENTSON: HOW DOES THE visual overview of key practice statistics MOYNIHAN: Implementation can GAIDGE TOOL ARM THE SOLO AND such as starts, production/collection, be accomplished in a couple of weeks SMALL GROUP PRACTICE OWNER case acceptance, and accounts receivable, with great collaboration from the TO MEET THE CHALLENGES along with other daily operations info. practice. Implementation consists of five OF OWNING AND LEADING A The Summary views display a monthly steps: Practice Assessment & Review PRACTICE? or multi-year trending summary of the with doctor/manager, Data Gathering, MOYNIHAN: Solo and small group practice. Within the Summary views, Financial Review and Data Mapping, practice owners need a simple mechanism focus on the production/collection followed by the Gaidge Navigational tour. to quickly analyze their practice and performance sections. Once you Through this process, our team will walk performance and know what critical become a more advanced user, you can the client through all of the necessary indicators are doing to ensure they are set goals in the Leaderboard feature to steps to get Gaidge up and running proactively addressing areas of concern. track your progress toward achievement. in your practice. In addition, we offer Gaidge is a tool that automatically Make sure to use Gaidge as part of three coaching sessions included during provides the doctor the ability to track your daily team huddles to help drive the first year to help you continue to and monitor critical practice data daily, improved communication, goal sharing, understand Gaidge on a deeper level. set and track performance to goals, and engagement across the entire office. Gaidge is integrated with Dolphin, and compare performance to other like Possibly the best tip for guidance is to Cloud9Ortho, OrthoTrac, Ortho2 Edge practices. It is also a great tool to leverage encourage our practices to participate in and ViewPoint. Additionally, we are in as part of the daily team huddle, to engage coaching sessions from our customer care the process of integrating with TopsOrtho and motivate the staff to achieve the and support staff. and Oasys (Crossfire). practice goals. BENTSON: GAIDGE HAS THE BENTSON: AS YOU LOOK BENTSON: WHAT CHANGES DO ABILITY TO PROVIDE THE USER TOWARD THE FUTURE, WHERE YOU HAVE IN MIND FOR GAIDGE AS WITH COMPARATIVE DATA DO YOU SEE GAIDGE GOING? WILL YOU TAKE ON THE ROLE OF CEO OF AGAINST OTHER GROUPS OF YOU ENTER INTO OTHER MARKETS THE COMPANY? GAIDGE USERS; CAN YOU DESCRIBE OR WORK WITH DSOS? ARE THERE MOYNIHAN: Our clients come first THIS CAPABILITY IN MORE DETAIL ANY NEW FEATURES THAT ARE and we want to continually use client AND GIVE US AN EXAMPLE OF BEING CONSIDERED? feedback to create a better Gaidge! With HOW THIS ASPECT CAN BE USEFUL? MOYNIHAN: We have a robust that said, we are focused on enhancing MOYNIHAN: This is an insightful and pipeline of active projects and many other the user experience, reporting more impactful feature within Gaidge. Each ideas on where to take the company. It is a data, and evaluating ways to get Gaidge client is able to compare their specific very exciting time to be at Gaidge and we implemented deeper into practices for practice data to like practices within the look forward to partnering with each of everyday use because our data shows that Gaidge database. The comparison is an you to help accelerate your growth! the practices who use Gaidge tend to grow average and can be compared at the total at a faster rate than the market. Going United States or AAO regional levels and BENTSON: ANY FINAL REMARKS forward, we have many exciting projects even by practice type (single practice, YOU’D LIKE TO LEAVE WITH OUR in the pipeline and will be communicating single practice with associate, or multiple READERS? the details of these new innovations closer owners). For example, if you are a single MOYNIHAN: Gaidge is committed to their commercialization launches. doctor practice in Atlanta, you can side by to our clients and we invite ideas, side compare how your practice measures suggestions, and requests that continue BENTSON: FOR CURRENT up (compares all Gaidge metrics such as to deepen our partnership. We look GAIDGE USERS, IS THERE ANY average case fee, total starts, and aligner forward to collaborating with our clients GUIDANCE ON HOW THEY CAN usage to name a few) to the average single to solve their business challenges and BEST USE THE TOOL DAY-TO-DAY? doctor practice in the SAO region or even provide a more effective Gaidge, to enable MOYNIHAN: We recommend each versus the total USA. practices to maintain market share, user start with bite-size pieces, as they get accelerate growth, and manage day-to-day accustomed to using Gaidge. It is critical BENTSON: FOR DOCTORS THAT operations. to establish a rhythm with Gaidge. The WANT TO IMPLEMENT GAIDGE, best way for doctors and managers to start CAN YOU PLEASE DESCRIBE THE engaging with the tool is to begin with PROCESS AND WHICH PRACTICE the Dashboard and the two Summary MANAGEMENT SYSTEMS YOU views. The Dashboard view provides a INTEGRATE WITH?

Q1 • 2018 | TheProOrtho.com 31 TRAVEL & LEISURE

TRAVELING TO PERU By Dr. David Walker

A short flight from the Peruvian interacting with llamas and native an all-inclusive. Explora focuses on capital of Lima, and a mere 12 miles Quechua speakers, riding ATVs providing what they term “the luxury from the ancient Incan capital of through the Andes, and sleeping in of the essential,” and they promote Cusco, lies the Sacred Valley of the clear pods suspended atop a 1200 foot themselves as a place to disconnect Incas. Formed by the Urubamba cliff, a visit to the Sacred Valley is sure from your day-to-day life and connect River flowing through the Andes, to keep you entertained! with your natural surroundings. the Sacred Valley is most famous for including the ruins of the Incan city Two accommodations in the Sacred Gourmet meals and an open bar of Machu Picchu but also contains an Valley deserve particular mention. satisfy the traditional expectation of array of sites and activities that make The first, Explora Valle Sagrado, is an all-inclusive, but the true value it an eco-tourists dream destination. a Chilean hotel “chain,” specializing of Explora Valle Sagrado is found in From hiking through the backcountry, in challenging what it means to be the daily explorations you design in

MIDWAY THROUGH AN 8 HOUR HIKE TO THE REMAINS OF THE HUCHUY ACCOMMODATIONS AT SKYLODGE ADVENTURE SUITES, SUSPENDED QOSCO PALACES; LED BY OUR EXPLORA VALLE SAGRADO GUIDE, THIS FROM THE SIDE OF A 1200FT MOUNTAIN WITH A 300 DEGREE VIEW OF TREK REACHES OVER 14,000 FEET OF ELEVATION. THE BEAUTIFUL VALLEY BELOW

32 It’s just BUSINESS TRAVEL & LEISURE

conjunction with their knowledgeable the group (limited by there only being guides. These explorations include three sleeping pods) and how often such things as a guided visit to Machu you stop to admire the amazing views Picchu, mountain bike treks, and of the Urubamba river below. Dinner high altitude hiking. All activities is prepared and a bottle of wine are catered to fit the experience and provided for each group when you desires of the guest. A truly amazing reach the top. The pods are relatively hotel and one of the best examples of spacious and beds comfortable; the customer service you will find. views are unbeatable! The following morning breakfast is provided before The Sacred Valley is also home beginning the descent, via a series of to the soon-to-be-famous Skylodge zip lines! Adventure Suites. The Skylodge consists of three clear sleeping pods The Sacred Valley is unique in and one relatively large dining pod that it is remote, but not distant and suspended from the side of a cliff face the major Peruvian cultural hub of overlooking the valley below. Cusco is only a short car ride away To reach the skylodge guests must and makes for a great addition to a first ascend a 400 meter via ferrata, or visit to the valley. For those interested cable assisted rock climb. The climb in outdoor adventure and cultural itself takes around 90 minutes to two immersion this is definitely a trip hours depending on the number in worth taking.

PRIVATE ATV TOUR THROUGH REMOTE ASCENDING TO THE SKYLODGE REQUIRES ANDEAN VILLAGES TO VISIT INCAN RUINS GUESTS TO TRAVERSE A 400M VIA FERRATA, A CABLE ASSISTED ROCK CLIMB

Q1 • 2018 | TheProOrtho.com 33 BUSINESS & PRACTICE DEVELOPMENT Disrupted:

Today, you don’t have to leave your easier to get orthodontic treatment so it’s ------house at all. You can buy clothes, books, expanding the market. But, it would be “When the world beds, TV’s and even cars right from the better if orthodontists in the brick-and- comfort of your couch. Even groceries can mortar practices explored the tools and changes the rules be delivered to your home at a designated technology available and adopted some of time without you even setting foot in the the hassle-free conveniences and lowered change." - Seth Godin store or waiting in line at the checkout. the barrier for patients. For instance, using ------Yet, despite this push towards a video conferencing, text messaging and hassle-free lifestyle, healthcare has made secure email to communicate with patients Now, more than ever, change is upon little progress toward meeting modern in your practice builds a relationship with us. And who’s at the wheel? The modern consumers’ demands. There are a lot of them and fosters trust. After all, trust and consumer. And it’s all based on what they great reasons why healthcare hasn’t caught familiarity between you and your patients want and need. up yet, but that doesn’t mean one should is invaluable and can lead to happier Business, new technology, and customer ignore progress. The want and need still patients and more referrals. preferences are changing faster than ever. exists. And that leaves the market primed Be creative. Come up with interesting And with each invention, and each new for you to make your move and make your ideas and offerings that other practices in platform of communication, reaching practice a trailblazer. your area aren’t offering, then provide it. consumers in a meaningful way gets more Let’s face it, putting our heads in Do a customer survey asking them what complicated. So, the question that comes to the sand, or complaining that we they wish your office provided. Also, look mind is: are we using this new technology wish competition would go away and at other successful practices around the and knowledge of modern consumers to everything would stay the same aren’t country to see what unique ways they’ve our best advantage or are we in denial? options. However, preparing to meet our tackled increasing their revenue stream. This is a pivotal moment. A moment new challenges head-on to create a strong Currently, the average patient draw is where you get to decide what’s next for and vibrant practice is the opportunity. typically a 26-minute drive time around your practice. Do you stay in the driver’s the practice. Why? Well, because patients seat of change or do you fear it and step on 4 BOLD IDEAS TO DRIVE will choose what’s convenient to them. ADDITIONAL REVENUE THROUGH the brakes? But with advancements in technology, DISRUPTION: To feel empowered by change and take we can work to expand that market draw. 1) HYBRID PRACTICE MODELS hold of the opportunities that present Maybe if patients had fewer in-person Aside from your traditional practice themselves takes guts. And because of appointments, they wouldn’t care about approach, thinking about an alternative this desire to succeed and change with the distance so much. Maybe consultation idea that could provide a service to the times, more and more industries appointments can be handled via online your customers that they would pay for have reinvented themselves to meet the questionnaire or video chat. Or, perhaps is key. For example, Smile Direct Club demands of their consumers. Thanks to a second location doesn’t mean a fully- (SDC) provides a hassle free, cheaper multiple apps on smartphones and laptops, staffed office with expensive overhead, but alternative to the traditional orthodontic it’s easier than ever to get things delivered a much cheaper mall kiosk. These are just a model. These are the patients that would right to your door with just the click of a few market expansion opportunities we see have most likely never stepped foot into button. orthodontist exploring around the country. an orthodontic practice. SDC makes it

34 It’s just BUSINESS BUSINESS & PRACTICE DEVELOPMENT

New Rules for a New Type of Customer By Angela Weber, CMO OrthoSynetics

2) APPEAL TO THE DIGITAL them happy. Because if the practices in problems if you didn’t have the constraints GENERATION your area aren’t meeting their consumers’ of your past experiences? We bet you’d In 2013, there were 7 billion devices needs, you can bet another innovative venture out of your comfort zone and worldwide connected to the Internet; that practice will swoop in to give it to them. traditional ways of doing things a lot number is expected reach 75 billion by We think that innovative practice should faster. Yet we know that change can be a 2022—more than 100 times in fewer than be your practice. little intimidating, but there is so much ten years. This rapid growth in the number You can meet the needs of these opportunity (and potential profits) for of people online, means more consumers tech-savvy consumers on many levels: those willing to think “untraditionally.” are using the Internet as a resource for convenience, quality, fun, attractiveness, If you haven’t read the book Blue Ocean everything. This creates an opportunity to connection through social media, Strategies, I highly recommend it. The expand your typical reach to your website improving their health by looking out book focuses on lasting success that comes and social media platforms by becoming for them in a personal way, and self- from creating “Blue Oceans” which are more active on platforms like Instagram, actualization. It’s not realistic to compete untapped market spaces prime for growth. Facebook, and Twitter. Case in point, on all levels, so choose wisely. Think about Companies which focus primarily on the influx of consumer communication how will you own your market, and then beating the competition are not seizing via Facebook messenger is astounding. do it. new growth opportunities. Instead, they’re And every practice should be taking stuck bobbing and weaving, making only advantage of this quick and easy form of 4) MARKET DIRECT TO incremental improvements. The “Blue communication. CONSUMER Ocean” concept is based on opening up Consumers crave ease and order. Why? It’s time to stop dabbling in marketing new market spaces and seizing new growth Just look at their lives. Demanding jobs, and really go for it. Just think, there are so by paying little attention to what the families – life is pulling them this way many more opportunities for orthodontists competition is doing. The focus is more on and that. So, make it easy on them. Start to use when trying to reach prospects offering buyers a leap in value that makes with your online experience and simplify these days. 15 years ago, there were only the competition irrelevant. everything. Make it easy for them by a handful of marketing channels available The traditional orthodontic practice making everything they need: contact to us. And if none of them worked well for won’t be obsolete, but evolution is coming. information, pricing, location, testimonials, your market, then you were out of luck. And we want you to be ahead of it instead results –just a single click away. If it takes Also, the marketing menu was limited to of trying to catch up. Do you have an idea, 3 or 4 clicks for your visitors to get the channels like TV, radio, and newspaper, but in need of a sounding board to work information they need, you run the risk of which can become costly. Today, there out the details? OrthoSynetics can help. losing them. are many channels, and it has become No matter what changes you’re thinking of extremely cost effective to reach millions making, thoughtful planning is important. 3) CREATE VALUE FOR PATIENTS of people in a more personal and organic This ensures the next move you make is the Consumers have always been way. This means orthodontists have more right one. opinionated, but now they have social opportunities to go directly to consumers media channels at their fingertips just allowing them to control their own waiting for them to express every positive destinies. And who doesn’t want that? experience and every aggravation. So, keep Think about this: how would you solve

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High Frequency Vibration Can Reduce or Eliminate Pain During Aligner Treatment By Dr. Jonathan L. Nicozisis

The orthodontic specialist has many and adapt better onto the clinical crowns. study entitled, “Reduction in Pain to considerations when treatment planning As a result of the better fit, the aligners Orthodontic Forces Using a High- orthodontic care such as aesthetics, function and perform better, moving teeth Frequency Pulse Vibration Device: A treatment options, and appliance design. more effectively and efficiently, and even, Clinical Trial” to evaluate the effect of a Additionally, patient comfort, compliance in some cases, reducing the likelihood high-frequency vibration (HFV) device on and how long the planned treatment might of refinements. In most patients that I orthodontic pain. The study investigated take must also be considered. Thankfully, have treated, adding VPro5™ HFV has pain reports of 75 subjects at 4 study technologies help individualize treatment eliminated the need to do additional MOPs centers. Ratings of the treatment were plans to the specific needs of both patients procedures for an average case. separately measured both in-office and and orthodontists. It is in our interest at-home for immediate and extended effect to incorporate ways to add value to our –––––––––––––––––– measures. The results showed that “use of patients’ experience. Applications that HFV in conjunction with aligner treatment make the process a faster and more pleasant “It is in our interest to demonstrated a significant reduction in experience while addressing cosmetic incorporate ways to add recorded pain scores versus control within concerns help towards this endeavor. 5 minutes of exchanging new aligners One patient concern associated with value to our patients’ (p=0.006). Use of HFV demonstrated orthodontic treatment is fear of pain. A experience. Applications a significant reduction in recorded pain study by De Souza, et al., noted that 58.3% scores versus control over a 7-day period of the subjects cited orthodontic pain as that make the process following aligner exchange (p=0.018).2 their primary complaint.1 Fear of pain was a faster and more Managing pain associated with followed by length of treatment time. I pleasant experience while orthodontic treatment with a method find that two technologies address these other than pain relief medications would issues — Propel micro-osteoperforations addressing cosmetic be beneficial on many levels. It has been (MOPs) to accelerate tooth movement, concerns help towards this shown that taking pain relievers can have and the VPro5 high-frequency vibration an adverse effect on tooth movement. (HFV) aligner seating device to alleviate endeavor. ” Studies have shown that using NSAIDS pain. While the HFV device is primarily –––––––––––––––––– to manage pain may negatively impact an aligner seater, it has more recently also tooth movement through decreased demonstrated its capability to reduce pain Because patients also began reporting prostaglandin synthesis, downregulated during orthodontic therapy. This is an a marked decrease (or even elimination) osteoclastic activity and a decrease in the additional advantage of using this device in of pain when switching aligners, I, along inflammatory bone resorption process.3,4 the orthodontic treatment process. with colleagues who were receiving A study by Krukemeyer, et al., reported Invisalign® technology addresses similar patient feedback, decided to begin that patients agreed, or agreed strongly, many patients’ cosmetic concerns about recording our patients feedback to monitor with the statement ‘‘I have pain for days orthodontic treatment, as patients are this phenomenon. Later this data would after an appointment.” With HFV for 5 able to correct their malocclusion without become part of a clinical trial. minutes per day, this clinical trial suggests visible braces. The HFV allows aligners to Dr. Thomas Shipley, Dr. Gary Brigham, reduced pain is possible.5 Therefore, perform better. When the patient uses this Dr. John Sparaga, and I performed a an alternate way of relieving pain, that device 5 minutes per day, the aligners fit retrospective, multi-centered, observational also has a positive effect on treatment,

Q1 • 2018 | TheProOrtho.com 37 CLINICAL CORNER

would be a welcome discovery. Previous articles have demonstrated that high- PATIENT NO.1: DIAGNOSIS: CLASS 1 WITH CROWDING. EXPECTED TREATMENT TIME: 18 MONTHS. ACTUAL TIME: frequency vibration was effective at 5 MONTHS TO REFINEMENT. USED HFV PROACTIVELY. reducing pain originating from teeth.6,7 This study provides evidence that HFV can significantly reduce orthodontic pain and discomfort without supplemental pharmacological analgesia. The reasons why HFV can effectively reduce or eliminate pain stems from several possible theories. The “gate control” theory suggests that pain can be reduced by simultaneous action of nerve fibers that conduct non-noxious stimuli.8 It is also possible that vibration may help relieve compression of the periodontal ligament, promoting normalized circulation.9

For this article, two patients from my practice illustrate effective pain management from VPro5 HFV. The first patient (Figures 1 - 2) wanted clear aligner therapy, however, was worried about discomfort. Her husband is an oral surgeon. Both the patient and her husband were happily surprised by the outcome achieved in just 5 months, changing aligners every 7 days and using VPro5 for 5 minutes each night starting at the beginning of treatment (Stage 1). The patient described the pain-relieving effect as “way beyond [her] expectation.”

Patient No. 2 is an adult male, who was dissatisfied with his smile. (Figures 3 - 5) The treatment plan was to resolve lower crowding and intrude upper anterior teeth to allow cosmetic restoration including four composite veneers. Adding to the complexity of this case was the desire for shorter treatment

Sources 1. De Souza RA, de Oliveira AF, Pinheiro SM, Cardoso JP, 3. Swami V, Swami V. Effect of nonsteriodal anti-inflammatory 6. Lala A. Vibration therapy in orthodontics: realizing the Magnani MB. Expectations of orthodontic treatment in adults: drugs on orthodontic tooth movement – review. IOSR Journal of benefits. Ortho. 2016;1(1):24-27. the conduct in orthodontist/patient relationship. Dental Press J Pharmacy. 2015;5(6):23-29. 7. Ottoson D, Ekblom A, Hansson P. Vibratory stimulation for Orthod. 2013;Mar-Apr;18(2):88-94. 4. Karthi M, Anbuslevan G, Senthilkumar K, et al, NSAIDs in the relief of pain of dental origin. Pain. 1981;Feb;10(1):37-45. 2. Shipley T, Brigham G, Sparaga J, Nicozisis J. Reduction in orthodontic tooth movement. JPharm Bioallied Sci. 2012 Aug; 4 8. Melzack R, Wall P. Pain mechanisms: a new theory. Science Pain to Orthodontic Forces Using a High Frequency Pulse (Suppl 2): S304–S306. 1965;150(3699):971-979. Vibration Device: A Clinical Trial. [Submitted for publication], 5. Krukemeyer AM, Arruda AO, Inglehart MR. Pain and 9. Long H, Wang Y, Jian F, Liao LN, Yang X, Lai WL. Current 2017. orthodontic treatment. Angle Orthod. 2009;79(6):1175-1181. advances in orthodontic pain. Int J Oral Sci. 2016; 8(2):67–75.

38 It’s just BUSINESS CLINICAL CORNER

PATIENT NO. 2: DIAGNOSIS: CLASS 1 WITH CROWDING. EXPECTED TREATMENT TIME:14 MONTHS. ACTUAL TIME: 7.5 MONTHS TO time as he was getting married in ten REFINEMENT. ONE MOP APPLICATION TO UPPER AND LOWER months. Despite movements flagged as 2-2 AND LOWER LEFT QUADRANT AT 2 MONTHS (ALIGNER 4) challenging, particularly the intrusion of FOLLOWED BY HFV the significantly worn upper anterior teeth in a 67 y.o., MOPs was initiated at aligner Number 4 (2 months into treatment) to provide greater predictability and control of tooth movement. VPro5 was given to the patient at the same time to maximize efficiency by ensuring complete dual arch aligner seating and extend the effects of the single MOP treatment. Spontaneous patient feedback was that there was much less discomfort associated with changing aligners after VPro5 as compared to the first two months of treatment without VPro5. Treatment progressed predictably at a significantly accelerated pace. Within 7.5 months all required movements were complete. The patient was very excited to be just one appointment away from a complete cosmetic smile restoration. The study underscored what patients had already been telling me about their use of HFV each night during aligner treatment. In the study, “HFV subjects demonstrated a rapid reduction in pain within 3 minutes, and a continuous decline in pain scores to levels approaching no detectable pain… 30% of HFV patients reported zero detectable discomfort within 5 minutes of use.” It was also interesting to note that 99.6% of patients were compliant with the 5 minutes each day of wearing the HFV device. The clinically meaningful immediate and extended reduction in orthodontic pain associated with HFV has the potential for many beneficial results to the orthodontic practice. Patients who are in less pain are more compliant with treatment regimen and appointments. In addition, happy patients are likely to refer family and friends to the practice, thus perpetuating a positive feedback loop of new patient referrals. The old saying, “No pain, no gain,” can now be edited to “No Pain? No Problem.” with VPro5!

Q1 • 2018 | TheProOrtho.com 39 TRAVEL & LEISURE

TRAVELING TO SPAIN By Dr. David Majeroni

My wife and I are lucky to be around so needed some additional income, so they hidden beaches along the path and you many great lovers of life. The inspiration turned their 600 year-old landowner could walk down these beaches and have for this specific trip started from one of home into a bed and breakfast. We stayed it all to yourself. It was unbelievable. my patients. He's constantly doing these there for 8 nights and used it as our base baller trips like going to Saint-Tropez, camp for day trips and it was amazing. France or sailing the Aegean Sea. So I They had an incredible breakfast with asked him, "Hey, we're going to Spain, fresh-squeezed orange juice and garden where should we go?" He said, "Without a fresh tomatoes that were insanely good. doubt, go to the Costa Brava." They would also have chefs come in and Costa Brava is north of Barcelona cook a gourmet dinner in the evening. up to the France border, and it's on the Dinner in Spain starts between 8:00 and The trail along the water from La Fosca. Mediterranean. We flew into Barcelona 10:00 at night and it's a two-to-three On the upper right and to the left are and rented a car (Sixt). Be sure to come hour event. It's amazing, totally different Roman ruins you can climb on. prepared with an international drivers than the dinners here in the states. The license, you can get one from AAA. first night was filled with laughter and We also went to the Town of Begur, it fun meeting the other couples that were is a very small town 20 minutes away. It's staying. Most places in Spain that are on a hill that overlooks the ocean, and high-end do not allow children but this there's a lookout point with a castle tower place allowed us to bring our daughter. that's 2,000 years old. The streets in Begur She ended up being the little star of the are really small and really narrow. It's a house. medieval town. In Begur, there are a couple beaches. There's one called Sa Tuna. You drive down this canyon for 20 minutes and you arrive at this opening in the canyon with the most incredible beach. You can park on the side, pay 3 dollars and go down the canyon to the beach and snorkel Me and My daughter in front of our and jump off the cliffs. The water is just Spanish home (600 years old). perfectly warm. Going to Spain at the end Fresh fruits and tomatoes picked from their of August is the best time. When we landed, we drove an hour garden every morning. north to a 300-acre winery called Mas Pages that also acts as a Bed and Day two we headed off to a beach 10 Breakfast. There's even a pool on site. Mas minutes away called La Fosca. La Fosca is Pages is run by a Belgium couple. The a white sand beach with Spanish families husband was a CEO of a big company everywhere. There's a two-mile walk and when they both retired, they wanted along the water that is really cliffy and a new project so they started a winery. mountainous. As you follow the trail it goes by some Roman ruins and we were Sa Tuna beach – down a canyon, one of the Once they realized how long the winery coolest beaches I’ve ever been to. It’s about business cycle was they decided they the only one out there. There were these 40 yards wide with large flat round rocks.

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come back around 3 pm for our daughters largest cities on water. It wasn't nearly as hour nap, then go back out around 5 romantic as Venice, but it was nice to see pm, typically to a local beach. There how they do boat life in Spain. are so many beaches. Here are some of The entire Costa Brava is geographically our favorites: Sa Tuna, Cala Aiguablava, divided. There are massive steep Tamariu, Platja d’es Codolar, Playa Les mountains everywhere that divide villages Muscleres (which is in front of an ancient and beaches. Over the furthest North Roman city). These beaches almost never Mountain Range is a charming coastal have lifeguards and little rules unlike village called Cadaques. in America. People are super clean and Cadaques is a beautiful fishing village respectful in Spain so the beach culture is that is isolated. Long ago pirates would outstanding. There is almost always cliff attack and plunder the village so the jumping, snorkeling and ice cream at the town never grew to more than a dozen beach bar. Then we would go to the town people or so. As the government became centers around 9 pm, eat and walk around stronger, the pirates no longer attacked View from castle looking out over the and return home around 11 pm or 12 pm. and over the last 200 years its grown into town of Begur Kids are out everywhere at these hours as a beautiful quaint fishing village with this is the culture. amazing beaches. We'd walk the streets at night and families are everywhere with kids running around. Little kids are selling things on the streets because families are on vacation and in the evening around 10 pm we'd buy little bracelets or whatever from these kids. The people of that area are just wonderful and are so nice. We really got into drinking coffee, overlooking the water, and having great conversations.

Walking at night in Palafrugell – life begins around 8 pm and doesn’t really get going until 10 pm or 11 pm.

Narrow street in Begur

Day four, we went to the medieval town of Pals. In Pals, the whole town is medieval and nothing has really changed. There are other surrounding villages within this entire area another one we enjoyed was Siurana, Alt Empordà. The uniqueness of this area, in contrast to The local kids make and sell their crafts. other more well-known areas, is that there This is their lemonade stands!!! are so few people. You have these villages We spent three nights right next to almost to yourself. You can just arrive in Castle at Tossa De Mar – This town is remote the town and find things to do, it doesn’t and propped up on the side of the mountain. Salvador Dali’s epic house. Salvador Dali have to be overly planned. Each town with was a crazy, ahead-of-his-time artist that its history takes an afternoon to explore We then went further north to a city put large eggs on his roof. He was into fully. We would typically get up around called Empuriabrava. Empuriabrava things that portrayed fertility so his pool 10 am, have breakfast, go out and explore, is the Venice of Spain, it's one of the was designed in the shape of, well, I'll let

Q1 • 2018 | TheProOrtho.com 41 TRAVEL & LEISURE

your imagination go there. He's just crazy, tripped out. He lived in this town called Portlligat and was practically the only one there for a hundred years. We stayed at the same hotel that the friends of Salvador Dali would stay at. It’s literally a hundred feet from Salvador Dali's house.

We found a great beach. The beaches in spain come in two varietys, rock and sand. This was a rock one, we built a “hot tub” for our daughter to play in because the water can get deep. While This is a fountain of a elephant with mosquito we were there a boat came up serving legs. This guy was a genius. fresh mojitos. He would crush the mint. At the pool of Salvador Dali. We talked to him and he was a guy that He was extremely eccentric. converted a boat into a concession stand There's a museum in Figueres that he and he would travel up and down the designed to be one of the craziest places coast going into these coves and serving that you've ever walked into, almost like the people. What a nice life! a Disneyland or Willy Wonka palace. He We went to a town called Pubol, where was so ahead of his time. He was into 3D Salvador Dali's wife had a castle. The art and virtual reality. The guy was just a castle, the history of the castle, and what genius. There's even a room he made of happened there is fascinating. She wanted Mae West. When you're up close it looks an Italian castle. Instead, he bought her like furniture, but when you step 50 yards this castle, and when he bought it, she back you can see how the pieces make a said, "The only way you can buy me this picture of Mae West. This museum is also castle instead of an Italian castle, is if where he was buried.

Taking us into caves. The fisherman’s boat we every time you want to visit me you have Then we drove down to Barcelona chartered knew the coast well. to ask for permission.” It was a really where we remained for the rest of the trip. interesting relationship. We stayed at a hotel called La Praktika We chartered a private boat out to the Bakery Hotel, so it's a bakery on the first furthest point into the Mediterranean floor and up above is the hotel. When called Cross de Cruz. The boat had no you're sleeping, you can smell the bakery life preservers. The guy was a fisherman, and the breakfast was phenomenal. smoking and missing half of his teeth, The best thing to do in Barcelona is and he took us out on his paddling boat. to take a private tour. It's well worth the You go out there and you see the coast money to have a tour guide drive you and the water's just emerald. around, drop you off in front of all the You can have him drop you off at a sites to see then pick you up once the private or hidden beach you see along the sightseeing was over. We spent a couple way, but good luck on getting back. Since days on the beach in Barceloneta, which is our daughter wasn’t even two, we would a new post-Olympic town. Instead of normal fish for the fountain he make her these little play pools from the thought it would be funny if they were rocks or sand. piranhas. Salvador Dali was unique...

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Our return flight got canceled so they rebooked us from first class to coach because One of Dali’s masterpieces. This I had to get back for patients. It was a long 13 hours, we almost lost our minds!!! was built at the turn of the century. He could forsee that the cars being made in America would eventually need a place to Getting away from the practice for park so he built a parking garage in this longer periods of time is centering. We building. Way ahead of his time. This was currently take 16 weeks off a year. We early 1900’s. Look at the curvature to the have reversed engineered our life and building. He was incredible. practice. We start with what we want and then work backwards. My mentor Rael Bernstein taught me to be obsessive about seeing patients, do whatever you can while you are seeing them, same day starts, same day appliance removal, the works. I was lucky enough to do it from day one of opening my practice. I’ve met Walking the Gothic part of the city. Eily was many along the way that say they can’t do mezmorized by it all. this or that for one reason or another. If you keep telling yourself that then you are right. In my mind, one can do whatever they want. Also, thanks to Ben for constantly questioning everything we are all doing and for inspiring all of us to really take La SagradaFamilia is a masterpiece control of our practices and our lives. designed by Antoni Gaudí. He designed the glass to represent nature. You literally feel like you are in a forest when you are in this building. It is an engineering and artistic masterpiece of the world. They have been building this for over 100 years. Park Guell is another Gaudí Our tour guide for the city. masterpiece. He was one of the first to use He was incredible. recycled building materials. Every one of those pieces was collected at night from Overall we were in Spain for 22 days. broken plates, the garbage in the city, and I asked a friend to cover for me in case more. This was also one of the worlds first of any patient emergencies and I have a out-of-city developments overlooking the great team to take care of the practice and city. patients.

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WHAT WOULD YOU DO If an Aligner Store opened down the street? By Dr. Jennifer Eisenhuth

Do you remember the good old channel wants more and they want it is just the beginning. As a small business days, when your competition was the fast. Direct consumer marketing has owner, it feels a bit like David against orthodontist on the other side of town? been phenomenally successful for them, Goliath, although our javelins and spears When you would see the doctor at lunch notwithstanding the limitations of those are no match for this plastic beast. It’s during the local meeting and be friendly fickle doctors who do the prescribing. It the ultimate love-hate relationship and while inwardly rolling your eyes at his only stands to reason that this technology orthodontists need to find a place to style? You quickly forgot him when the would open their own brick-and-mortar survive in this arena because this game- pediatric dentists entered the orthodontic stores, doling out patients to doctors of changer isn’t leaving anytime soon. arena and grabbed up your market their choosing, and nearly eliminating the Social media has buzzed with the share, putting braces on their own pedo need for doctors altogether. Of course, opening of this store, and the predicted patients like they were shooting fish in we did this to ourselves. We had to effect on the small business orthodontist a barrel. Corporate dentistry has been realize that encouraging technology that are varied, although they all seem to agree an annoyance for many of us, as their reduces the need for direct doctor services on one particular thing: it isn’t good. Many patients are funneled into specialists would turn our talents into more of a expect a reduction in their production, on site. Color us flabbergasted when commodity than a service, and eventually plus a reduction in profitability as fees the primary care dentists jumped in as make orthodontists nearly irrelevant. tend to reduce with increased competition orthodontic suppliers holding weekend This aligner company is the beast that we for the consumer. For some, it will be courses crammed in the tooth-movement created and it is hungry. an annoyance. For others, it will be basics while hawking their brackets. As we all know, in November, it was devastating. Perhaps a few can turn it And now? An aligner technology that announced that an aligner-manufacturing into a time of growth? Regardless, plastic orthodontists welcomed and helped evolve company has opened a store in San aligners have already changed how many barreled into our arena with blazing Francisco. Is there a doctor in this of us practice today and with the opening guns, exploding traditional referral store? No, no of course not. That doctor of an aligner brand retail store, it is clear patterns while far too many of us stood by nonsense can be handled off-site or even that more change is on the way. So how do watching with our mouths hanging open. remotely, eventually by the lowest bidder. we compete? And now this new technology/delivery Patients? Oh, you bet there are and this

44 It’s just BUSINESS BUSINESS & PRACTICE DEVELOPMENT

ALIGNERS ARE NOT FOR INCREASE YOUR INTERNET –––––––––––––––––– EVERYBODY (GASP!) PRESENCE IN THE COMMUNITY Not all parents like their kids chewing The patients who visit an aligner store “I can’t see into the future on plastic. Not all patients are compliant. are on the internet. If you don’t have a any more than the next Not all parents trust their kids, in the long great SEO guy or a pay-per-click manager, run, to keep track of their aligners. We it’s time to find one. Google algorithms orthodontist. However, I all have patients that would struggle with don’t care which orthodontist comes up removable appliances, and luckily there are on the first page. Google wants the best acknowledge that the tide excellent alternatives that we’ve been using SEO or the highest pay-per-click address... is rapidly changing. We for decades. Aligners are tools, just like they have no bias regarding specialty, as braces, functional appliances, retainers, we are all on an equal playing field on the need to stay on top of our headgears, etc. We have a toolbox and internet. game and evolve to keep the ability to select the best one for each individual case. INVEST IN YOUR NEW EXAM pace with technology along EXPERIENCE with the new demands of –––––––––––––––––– If you believe fixed appliances are better, be sure you educate patients on our customers.” "The dilemma that all your reasoning. Do you have before and –––––––––––––––––– health practitioners have after photos that support your work? Real cases are better at building customer KEEP THE FAITH at one time or another is confidence over manufacturer’s photos. Have faith in the average consumer. Is your TC trained well? You don’t have How many of us have been online managing patients who much time to build rapport, educate, searching for a service provider, landing have their own ideas on handle objections and close so you better on a broker site where they recommend be good at it when you get the chance – a a certain business based on our location? the type of treatment they great TC is essential to do so. Your job is I tap that back-arrow immediately insist we use." to evaluate the patient for treatment and when it happens. Most of us don’t need make the best recommendations. A great a company rep telling us where to go. –––––––––––––––––– TC will support your treatment. Improve Word of mouth, Google reviews, and your conversion ratio for those that come social media have a hand on who we do to your door and you’re automatically business with. Keep your brand strong. We GET YOUR HEAD OUT OF THE increasing your production. are not commodities, although these big SAND box aligner manufacturers will sell more If you prefer fixed appliances, that’s ok. product if consumers think we are. Both But if you aren’t offering an aligner option TECHNOLOGY IS A DOUBLE aligners and fixed appliances are tools and in the first place, you’re automatically EDGED SWORD should be understood as such. sending patients out your door to your Yes, we can thank advancements in competitor who does. Why lose market technology for this increased threat of I can’t see into the future any more share? If you believe that the aligner aligner stores which may increase our than the next orthodontist. However, options are not ideal for the patient, tell competition. A tool has been created for I acknowledge that the tide is rapidly them the pros and cons just like any other non-specialists to move teeth and we changing. We need to stay on top of treatment option. The dilemma that all even have manufacturers servicing the our game and evolve to keep pace with health practitioners have at one time or public directly. However, this explosive technology along with the new demands another is managing patients who have technology has given us more options to of our customers. This evolution is their own ideas on the type of treatment choose from and can offer better control of necessary for the continued success of they insist we use. I can and will improve both production and cost. 3-D printers are your practice and those who resist will a malocclusion with tools that are not only getting better and costs a fraction of find themselves behind the pack. Play to my first choice after educating patients typical lab fees of corporate manufactured win, rather than planning to lose. on my limitations using that system. I’m aligners. This allows us an in-house not saying you need to use aligners on solution to compete for the more price- In the words of Thomas Edison, “There sensitive consumer. everyone or even anyone, but you should is a way to do it better. Find it.” have them available as a treatment option for those who desire them.

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TRAVELING TO EUROPE By Dr. Ben Burris and Bridget Burris

In late September and early October, we but they have group classes as well. The chef took the family for a week in Florence and was incredibly good at engaging the family, the surrounding area. We flew Norwegian teaching as well as being an excellent cook. Air from Orlando to London Gatwick and We learned a great deal that we use at home can’t say enough good things about the and we made a family memory that will last flight. The first-class cabin is much like an a lifetime. In Tavola Cooking courses is who upgraded domestic first class cabin and we worked with. for the price, we were blown away by the SAN GIMIGNANO - This little town value. We plan on using Norwegian often was one of our favorite parts of the entire in the future when going to Europe. We had European trip. Picturesque, clean, not a fantastic time and highly recommend a overrun with people and tons to see and do. European trip for travelers of all ages. Here We spent a half day here but we should have are the highlights: spent the day or even spent the night. There are some great little hotels there and next FLORENCE HIGHLIGHTS time we go we will SFSU one night in San We stayed at the Palazzo Vecchietti Gimignano. This little city is fantastic and Suites and the location was perfect. The embodies the image we had in our heads of Piazza della Republica is less than a block a quaint Italian town set among vineyards. from the hotel offered a convenient place There is a good deal to do and next time we for the kids to run around at any time day travel to Florence I bet we spend one night or night - they loved the carousel and the in San Gimignano. The kids had a blast street performers. Everything we wanted walking around town. There is a world- to do in Florence was a short walk from famous gelato shop, some great local artists the hotel and our trip was built around that selling original watercolors and oil and fact. We used Italy Luxury Tours to plan some excellent photo opportunities. our activities, transport us and provide local From San Gimignano, we went to a guides. winery where we learned about wine and PISA - We did a day trip to Pisa on our vinegar making in the region. This was not first day in Florence. The hour and a half car our favorite part of the trip and we wouldn’t ride gave an opportunity for napping since do it again but the food was good and the we were all jet lagged so that was nice but experience pleasant. we had no problem staying awake once we WINE - Local wines are plentiful, cheap arrived. Unlike many famous places we have and fantastic (except at the winery tour). visited the tower lives up to expectations VINEGAR - the vinegar is an experience and we had a blast taking the kids up to the in itself and worth investigating. There are a top. Be sure to reserve your time ahead and myriad of options. Try them all. show up at your appointed time as they are SIENA – Worth the trip for sure to see serious about who gets to go up. the site of the horse racing in the central COOKING CLASS - This was a big hit square as well as walking the streets. We with everyone. The kids especially enjoyed enjoyed our half day there. “getting to do stuff” instead of just watching. FOOD TOUR - We has a guide for a There were 6 of us so we did a private course food tour of Florence and it was another

46 It’s just BUSINESS TRAVEL & LEISURE

highlight. Truffles, pastries, coffee, wine, The richness of the history and culture cheese and a wide array of pastas along with in Florence are incredible and reminds some insight into local history made for a us of how young a country the US is. great half day. The Mercato Centrale was Whatever your interest you can find fanatic and the kids had a blast exploring. what you’re looking for. We particularly We gave them a handful of euros and sent enjoyed learning about the Medici in their them off to buy chocolate. They had to hometown. figure it out or do without chocolate so The cathedrals are fantastic and guess what happened? Great life lessons... numerous but honestly after you’ve seen a LEATHER GOODS - next to the Mercato few hundred you’ve seen them all... We hit Centrale is a labyrinth of vendors selling the major ones but left the others alone. leather goods among other things. Beware We try hard not to do the obligatory just the famous “double-sided leather” which is because everyone else does – especially with how local vendors embellish unlined leather the kids along. goods. Of course everyone has their own Not far from our hotel is the famous Il taste but the best leather goods we found by Porcellino. Be sure to stop by and touch the far (and we looked at every stall and store) snout for luck and put a coin in the pig’s was Adriano Firenze. We bought bags for mouth to see how it falls. The kids loved it. ourselves and our friends and ordered our Ponte Vecchio is the world-famous bridge Christmas gifts from Adriano as well. in Florence lined with jewelry stores and Letting the kids range and engage was a surrounded by all other forms of shops. big part of having them in Europe. They are The views are great, the people watching 8 and 9 and though our tendency is to limit entertaining and we even picked up a few them, every time we give them latitude we things we couldn’t live without. are shocked by how capable they are. Mark Pay attention to the traffic signs in Twain once said “Never let school get in the Florence and you’re in for a treat. There’s a way of a good education” and we couldn’t Banksy style graffiti artist who defaces signs agree more. The experience and confidence in interesting ways. they gained is invaluable and will serve DAVID - No trip to Florence is complete them well. without seeing David. It’s as impressive as you can imagine and mind-blowing to ------think that one man carved this masterpiece without modern tools or much planning. It “The richness of the was interesting to see the statue in person, history and culture in note the strangeness of proportions and wonder if it was intentional (and why). Florence are incredible Another memory the kids won’t soon forget. and reminds us of how UFFIZI MUSEUM - A must and you can spend a great deal do time here if art young a country the US is your thing. Know that David is in a is. ” different museum and you’ll want to see both. Having our 8 and 9-year-olds with ------us was challenging but we solved this by taking them to see Botticelli’s works and We picked up several original pieces of then I took them out for gelato and carousel art in Florence and love having these little rides while Bridget and her mom explored reminders of our trip displayed in our the museum more thoroughly. The kids home. There are styles to fit all tastes and were impressed seeing the Birth of Venus budgets. and they were delighted to inform me that

Q1 • 2018 | TheProOrtho.com 47 TRAVEL & LEISURE

Venus came from Uranus... They thought square was when we sat at an outside table much more. Both are heavily regulated, this part of mythology was particularly fun with a view of the Grand Canal, listened protected and very expensive. A short water to tell me and I don’t care as long as they are to the bands playing on the square and taxi or gondola ride cost us more than taking an interest! watched the people go by. We particularly the flight from Venice to Paris but when At the end of the week, we sent Bridget’s enjoyed watching one of the many rose in Rome... or in this case Venice, both are parents and our kids home and boarded the salesman ply his trade by “giving” a flower worth doing. high-speed train from Florence to Venice. to a lady passing by and then demanding payment from her companion. We watched ------VENICE HIGHLIGHTS for a couple hours and never got tired of it. “Three days is plenty TRAIN TO VENICE - We enjoyed the Venice’s commerce area is Mercati de train ride and thought the extra cost for Rialto and like just about everything else, it of time to stay in Venice business class well worth it though we hear is in easy walking distance of the hotel. We coach is more than acceptable. enjoyed just walking around and people in our opinion as long The grand canal was bigger, more watching. The fish market was particularly impressive and much busier than we enjoyable but know that it’s not open on as you stay in the heart imagined. We got a solid eyeful on the water Sunday or Monday so plan accordingly of the city so you can taxi ride from the train station to our hotel. (and eat steak instead of seafood on We stayed at the Baglioni Luna Hotel and Monday!) explore by waking. ” were very happy with the accommodations While walking the narrow streets of but the location was the best part of this Venice it’s easy to follow the crowd and ------hotel. The entrance to St Mark’s Square was take the same routes over and over but we’d MURANO - This little island is a must a few paces away and we spent a good deal encourage you to intentionally explore the see. We did a day of island hopping via of time there. It wasn’t what we expected less traveled streets. You never know what water taxi and started with the glassmaker's exactly but the square and all its flourishes you’ll find. shops on Murano. The island is beautiful, exceeded expectations. The cathedral was GONDOLAS AND WATER TAXIS - We the shops lining the canal picturesque and interesting in the way that all of them are. did a gondola ride because that’s what you Bridget found a few things that she just Probably our favorite time on St Mark’s do but honestly we enjoyed the water taxis couldn’t live without. It’s fun having some

48 It’s just BUSINESS TRAVEL & LEISURE

glass pieces to remind us of our time in there are two restaurants to choose from if ICELAND HIGHLIGHTS Italy. you plan ahead. This time we chose Victor Upon landing at KEF airport, we BURANO - We’d never heard of this Hugo’s - a Michelin starred eatery with great were met by a driver and taken to the island until we visited but we really enjoyed service and an unmatched view. Blue Lagoon hot spring spas. It was an our time there. Burano is known for cookies Notre Dame and Sainte-Chapelle are interesting experience and worth the trip and lace and we tried a bit of both. Great not too far from the Eiffel Tower and we’d but a few hours is plenty of time there. After photo opportunities so come prepared. recommend both despite my lack of affinity hitting the springs (and running into an RESTAURANTS – We tried several and cathedrals. orthodontist and his family) we had dinner they were all great. It’s hard to go wrong but We decided to take a bicycle rickshaw at the onsite restaurant which was very you’ll want to make reservations ahead of at one point during our trip and learned good. It’s hard to go wrong with seafood or time. a valuable lesson - be sure to read the fine lamb in Iceland! We took a day trip to see Padua and print on the price list (prices are for one From the Blue Lagoon, our driver took Treviso and we wouldn’t visit either town passenger) and agree upon a total fee before us 2.5 hours along the coast to Skalakot again or recommend that others take the sitting down. Small stuff but annoying. Oh Country Lodge. This hotel is a working time to do so. well, education is expensive. sheep and horse farm and the owner/ Three days is plenty of time to stay in The Louvre and Il Jaconde (Mona Lisa) operator is a true craftsman. He built the Venice in our opinion as long as you stay are something we never tire of and worth hotel and you can see the work of a master in the heart of the city so you can explore the trip downtown. You could spend weeks in every stick of wood and every tile. The by waking. It’s worth the cost to stay in a in The Louvre so pick your strategy of what food and service are first class and they have great location as transportation costs will to see and plan on coming back again. a nice selection of wines. kill you otherwise. We took a water taxi We took the high-speed train from Paris We were amazed at the number of sheep to the airport and caught an EasyJet flight to London and again it was a very pleasant in Iceland and how much sheep influence to Paris. We were surprised by how easy experience. The accommodations and the people and the economy. Again the and inexpensive our trip was. In Paris, we food in business class were worth every lamb is fantastic. The next day we went for used Uber to get to the hotel and around in dime and we plan on utilizing the train a horseback ride to a local waterfall and did general. We love Uber because there is no system much more on our next European some hiking. The views are fantastic and language barrier, the transaction happens excursion. Uber in London was as expected the landscape was unlike anything we’d seen automatically and it’s highly unlikely that and we spent the next couple days at The before. your driver will take you the long way to Luton Hoo with our friends from The pad his fare. Taxis in Paris not so much... Invisible Orthodontist. Bridget and I talked to a fantastic group of orthodontist and PARIS HIGHLIGHTS team members about how to improve our We stayed in the Shangri-La hotel just customer service and patient experience in across the Seine from the Eiffel Tower. an ever-changing world. Can’t say enough We’ve stayed in Shangri-La hotels all over good things about our British colleagues. the world and they never disappoint. As you may have guessed this entire Having a view of the Tower from our room European trip was created around the made the two days we spent in Paris seem speaking engagement in the U.K. Honestly like much more. we had no intention of going to Iceland Montmartre, the hill upon which but while searching for return flight from Sacre Coeur sits, is a must and we spent London we discovered that Iceland Air’s a morning there mostly looking at all the first class cabin (again it’s like a domestic original art by local artists. As is our custom first class, not a lie flat) was very reasonably we took a bit of Paris home with us! priced and they allow up to a tend day Arc de Triomphe is another icon of the stopover in Iceland for no additional charge. city or lights and a walk down Champs This made visiting Iceland a no-brainer! Elysees is never disappointing with all the We hired Nine Worlds to plan our Iceland people watching and chic shops. adventure and were well satisfied with the No trip to Paris is complete without results. visiting the Eiffel Tower and, in addition,

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Waterfalls are a dime a dozen in Iceland Reykjavik anyway. and each more beautify than the next. The next day we drove to the airport and The following day a local guide picked us took a 4 hour, private helicopter tour. It up in a massive customized 4WD vehicle was certainly expensive but we could have and took us to hike a glacier. This was a cut our Iceland trip to 3 days total if we’d new experience, to say the least and it was known what we are doing and how good interesting to learn how the glaciers are the helicopter tour was going to be. As an receding a good deal in the last couple aside, we are taking the kids to Iceland this decades. The glaciers grow and shrink summer on the way to Europe and have an as they have for millennia but they are awesome itinerary planned now that we definitely getting smaller of late so you have some context. The helicopter covered a might want to go sooner than later to check tremendous amount of ground and landed them out! three times for us to get out and have a look. From the glacier, we took the short drive The landscape was literally unbelievable - to the black sand beach. The beach is black photos and even video don’t come close to and more pebbles than sand because Iceland doing it justice. It would take weeks if not is a relatively young piece of real estate and months to do what we did in 4 hours if you there has not been time yet for water and tried to do it via car and hiking. I cannot waves to do their work on the land. The recommend the helicopter tour strongly rock formations of the beach are stunning enough - hotels and food and everything and represent all the different crystalline else in Iceland is very expensive so cut down patterns basalt takes on due to varying rates on your days then spend that money on a of cooling. If geology is not your thing I’d helicopter tour. recommend reading up or watching a few ------YouTube videos on how volcanic eruptions form land, the Mid Atlantic Rift and basic “The landscape was types of rock because you’ll get way more out of your trip if you have some basic literally unbelievable - knowledge. The next day we drove I overland in the photos and even video guide’s vehicle to visit Thor’s Garden - a don’t come close to favorite camping and hiking spot among locals. You need a serious vehicle to get doing it justice. It would here and it takes some time to cross all the rugged terrain and rivers but we highly take weeks if not months recommend the effort. After a great day in the wild, our guide drove us back to to do what we did in 4 Reykjavík where we stayed at the Canopy hours if you tried to do by Hilton hotel in the heart of downtown. We wouldn’t recommend staying there it via car and hiking. I unless you plan to party into the wee hours and not get much sleep because it’s LOUD. cannot recommend the We are prepared travelers and we had our white noise app and foam earplugs but it’s helicopter tour strongly still incredibly loud. The service and the enough ” room and the food and the wine selection at the hotel were excellent though. The ------noise wasn’t the end of the world but I’d We did the Inside the Volcano tour and have done it differently if I’d known better. it was interesting. The wind was blowing Honestly, there’s not much to downtown 30 knots, it was cold and raining and the

50 It’s just BUSINESS TRAVEL & LEISURE

“45-minute walk” was more like an hour us from the US but we are in the habit of rained we were glad we had our gear for and a half hike each way but it was worth buying a multi-port USB charger in the Iceland with us. Same goes for the U.K. I the effort to go into a volcano. I wouldn’t country we are visiting for our phones, thought it was very pleasant but Bridget recommend this for young kids or older iPads, and kindles. needed a jacket most of the time. Something folks as it is not an easy excursion. CONNECTIVITY - Italy, France, and to keep in mind when taking advantage of Greenhouses are plentiful in Iceland - the U.K. have high-speed internet and WiFi the colder season to visit when things aren’t flowers, tomatoes, and other vegetables do just about everywhere. Iceland not so much so crowded. very well because of the cheap, renewable outside of Reykjavik. Google translate is a great app to use electricity and abundance of fresh water. PHOTO APPS - We use a couple and you can download a language for use Most greenhouses utilize geothermal heat different apps to get our photos from our offline. Cell phone coverage was great - another big advantage. We did lunch at phones to our walls at home. We like both everywhere we went and it was 10 dollars a a tomato greenhouse and it was awesome of these. If you have better ones please day extra (for days we used our phones) on to see the details of planting, the use of educate us. Mixtiles and Keepsake are the AT&T to access our normal data plan in any bumblebee colonies, upkeep of the vines apps we use. of these countries. and all that. A massive undertaking run like CURRENCY - Before leaving home get Booking tickets for major attractions a Swiss watch and well worth the time it your local bank to exchange money for you in Europe like The Louvre and the Eiffel takes to see. if you want some cash (and you will). While Tower are best done ahead of time and easy in country, use your ATM card or credit to do on sites like Viator. As mentioned GENERAL COMMENTS card to draw the local currency at any of the TripAdvisor is indispensable for things TRIPADVISOR – If you don’t use it, plentiful ATMs. You’ll get the best exchange to do and ratings. Download the app and start. This app has “things to do” in every rate this way - much better than currency do your homework before going. Photos city and is a great source of items for your exchange places. If this is not possible then posted by visitors are much more telling itinerary. in Italy the local post office is your best bet than the official photos. POWER CONVERTERS - It’s vital to for currency exchange. make sure you have them - many converters The weather at the end of September in Get out there and have fun! have multiple plugs that will work in just Florence and Venice was not overly warm about any country. We take them with in the evening and a couple days when it

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5 Keys to Capturing the Fastest Growing Referral Source By Nick Duncan

The orthodontic community QUESTION 2: WHAT IS YOUR the same way you currently look at your understands the value of referral streams. WEBSITE’S CONVERSION RATE? website. Whether these referrals come by word of To put it in perspective, let’s say you mouth from your patients or through a Few orthodontists know the answer have a conversion rate of one percent; successful advertising strategy, knowing to this question, and with eCommerce more specifically, one out of every who arrived at your practice and how growing by 23% annually, orthodontists 100 visitors to your site requests an they got there is the foundation to an can no longer ignore the importance appointment. This is actually higher than expanding patient base. of their digital footprint – the secret the average number we tend to see before Digital marketing is one of the ways a to success is forming a calculated and The Invisible Orthodontist reworks a practice can capture online referrals and targeted effort online.1 Your website’s website. You could throw hundreds or make the most of its marketing budget. conversion rate is the number of visitors thousands of dollars into advertising to Additionally, understanding referral who request an appointment (or complete get more people to your site to develop sources and conversion rates can allow another call-to-action determined by your more leads. However, a more cost- you to differentiate your practice to attract marketing objectives). effective way to achieve practice growth is more patients who understand the value through converting more of your existing you provide. ------visitors. Let’s say that conversion rate Below we have outlined common is increased to 3% - THAT’S A 300% questions we ask our partners and the 5 "It is just as important INCREASE IN THE PERFORMANCE key elements of maximizing your website to track your website OF YOUR WEBSITE, and all future to be a conversion tool. advertising campaigns will benefit from conversion rate as it is greater returns. QUESTION 1: WHAT IS YOUR TREATMENT COORDINATOR’S to track the conversion QUESTION 3: HOW ARE QUALITY CONVERSION RATE? rate of your Treatment LEADS CAPTURED? Most orthodontists know this answer Coordinator. " How exactly can you as an evolving and keep a watchful eye on the metrics practice owner create a high performing of new patients that come in the door. In ------digital strategy that delivers measurable fact, you probably invest a lot in keeping Many websites are designed to look results? At The Invisible Orthodontist, our your TCs well-paid, well-trained and pretty, but do we hold them responsible process starts by building a website with ensuring they have the tools they need to for producing results the same way we the goal of maximizing the conversion be successful in new patient conversions. do a TC? Imagine measuring your TC rate; we do this in the following ways:

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

USER EXPERIENCE (UX) that you are catering for people visiting driving them to complete your call to PRINCIPLES: these principles focus on your site at any stage of the buying cycle, action is critical. the utility, ease of use and efficiency of a and once they know about you, not letting People looking to straighten their teeth website them go. Two ways to achieve this are may not even know what an orthodontist CONVERSION METRICS: a wealth of outlined below. is or how to search for the right data behind us that provides insight into LOCAL SEO: ensuring that someone information. They look for guidance from how users behave at different stages of the who is searching locally or on the go is experts and knowing where and what new patient journey, enabling us to tailor provided with your practice's information phrases to use to capture their attention the site to get more appointment requests. based on geographical data ensures a successful marketing strategy. However, ongoing assessments are ONLINE REVIEWS: developing Web analytics software such as Google crucial to the success of a website. On a a review strategy that enhances your Analytics will allow you to see how users regular basis, we monitor and optimize reputation in search engines, review sites, navigate and click through your website. the website through tools such as web etc. You may ask: analytics, heatmapping, and A/B tests to Where did users who convert come improve the conversion rate. A website ------from? is never a finished product - it should Which pages on my site did they visit? constantly evolve and adapt to the needs "It’s not the customer's Do returning visitors convert at a of your users; if it’s just passed to you by job to know what they higher rate than first-time visitors? your web design company and left as is, it will never increase the conversion rate. want. – Steve Jobs " You should be using such data to plan Would you hire a TC and never expect marketing campaigns and tailor your them to improve their closing rates? ------products. For example, if you find that This process of on-going optimization is 2. TRACKING DATA people who visit your site for a third time known as conversion rate optimization The beauty of digital marketing is that are much more likely to convert, then (CRO). user data is readily available and can why not run retargeting ad campaigns to An efficient and high converting come in many forms, ranging from web people who have visited your site twice website is a crucial step to growing your analytics to heatmaps. Reviewing and but not converted? practice. It’s also important to look at how analyzing this data is the first step to Heatmap software (such as CrazyEgg) prospective patients can find you, and optimizing your website. Then, tailoring will allow you to analyze user’s behavior what you do with their data once you have your website to quickly provide the user on the page and show you which elements it. Below, we’ve included five elements with what they are looking for while and content they interact with. that create a simple formula to generate and nurture quality new patient leads. We define a quality new patient lead as a new patient requesting an appointment through your website with the intention of starting orthodontic treatment.

5 CORE ELEMENTS OF WEBSITE CONVERSION

1. ATTRACTING CONSUMERS WITH BUYING INTENT Many orthodontists focus on how many visitors they have had to their website, or how many times they appear in the search engine results pages (SERPs). The reality is, that this information alone is not going to grow your business. You need to ensure

Q1 • 2018 | TheProOrtho.com 53 MARKETING, SOCIAL MEDIA & EVENTS

Data analysis will allow you to see how site. We use our industry insights and Providing guidance for taking the next your digital investment converts website run split test campaigns, where two step allows visitors to convert to leads. visitors into active orthodontic patients. concurrent versions of a page are run – each to 50% of your audience – and ------assess which performs best. These insights and techniques will ensure your website "If a website is conceived enhances the growth of your practice. as a ‘sales pitch’, it has

4. OPTIMIZED CONTENT a much lower chance of If a website is conceived as a ‘sales pitch’, it has a much lower chance of conversion. conversion. You should You should have a ‘tone of voice’ which have a ‘tone of voice’ starts to build your relationship with the user the first time they interact with your which starts to build site. your relationship with 43% of online consumers reject “blatantly self-promotional” content.2 the user the first time Websites that balance production of original content that is entertaining, they interact with your educational and persuasive have a higher site." probability of converting visitors. Your content should also be written ------semantically for the search engines, as well as to drive conversions. Without TURNING NEW PATIENT LEADS all these components to your content INTO TREATMENT STARTS strategy, you won’t be found and your users won’t convert. The challenge that orthodontists and their staffs face is managing the leads that are converted from online traffic, and understanding what the protocols are to treat a website lead versus a general dentist referral or internal patient referral. At The Invisible Orthodontist, we provide our members with a continuing, 360 degree digital growth strategy that not only generates new patient leads, but also converts those leads into active patients. 3. SUPERIOR USER EXPERIENCE The user experience (UX) of your For more information about The website is a digital reflection of your Invisible Orthodontist, visit www. business – people are less likely to seek 5. CALL-TO-ACTION theinvisibleorthodontist.com out your services if the user experience The last step is to clearly indicate how is poor. Building a professional and visitors can react to the information Sources functional website is necessary here – they have gathered from your website – 1. Tracey Wallace. Ecommerce Trends: 147 Stats Revealing How invest in a company who specializes in providing a clear, effective call-to-action Modern Customers Shop in 2017. https://www.bigcommerce. com/blog/ecommerce-trends/. [Last accessed: 08.11.17]. orthodontics and CRO. We work with (CTA). Understanding what patients users to understand how they use and need and using language that resonates 2. Michael Brenner. B2B Content Marketing Report – Need to focus on the basics. https://marketinginsidergroup.com/content- read orthodontic websites and utilize with them most in CTAs is a significant marketing/b2b-content-marketing-roi-need-to-focus-on-the- these findings to translate this to your element to consider in this instance. basics-report/. [Last accessed: 08.11.17].

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

Q1 • 2018 | TheProOrtho.com 55

Untitled-1 1 11/13/2017 3:02:43 PM OFFICE LOGISTICS

Beyond Reminders: Tapping the Potential of Texting By Dr. Keith Dressler

Have you ever wished you could always do; he started asking questions. verticals, Dr. Dressler was the first to perform a cursory exam while the What if patients could initiate real text bring it into his office. patient is at work, home, or on conversations with their orthodontist? The results have been remarkable. vacation? Thanks to a new, cutting- What if the same number patients call In addition to reducing call volume edge app, that's not just possible—it's was also textable? What if they could by more than 30% and generating an easy. text selfies of their teeth, leading to influx of positive patient feedback, Sending texts to patients is nothing remote cursory exams? What if care Dr. Dressler has seen his new patient new. Automatic appointment teams could field those messages from starts incrementally increase by an reminders have been around for years anywhere, on any device? And what average of 20 new patients a month and are widely used in orthodontics. if all that was fully confidential and since allowing patients the ability to Dr. Keith Dressler, an orthodontist of HIPAA-compliant? text three selfies of their teeth along 32 years and founder of Orthobanc A product making all that possible with any questions into his practice. and Rhinogram, once used traditional did not exist, so Dr. Dressler Dr. Dressler categorizes the vast automatic reminders in his practice. assembled a team to create it. The majority of these starts as very easy He quickly saw they failed to capitalize result is Rhinogram, a HIPAA- Class I cases that can be treated in 12 on the untapped potential of texting compliant texting and messaging app months or less, priced between $3500- with, not at patients. that specializes in patient-initiated $4500 per case. His only marketing Dr. Dressler did what forward texting. While the product now has effort is a $200-per-week Facebook thinkers and industry disruptors clients across the US and multiple spend. $80,000 from $800. ------"What if patients could initiate real text conversations with their orthodontist? What if the same number patients call was also textable? What if they could text selfies of their teeth, leading to remote cursory exams?" ------

56 It’s just BUSINESS OFFICE LOGISTICS

want to think of. These new text- initiated patients keep appointments, have more “same day starts” and are easier to monitor because all of their questions have been answered before they ever walk in the door.” Dr. Dressler also notes that the vast majority of patients’ perceived emergencies can be resolved with a patient taking a “selfie” of the problem and a quick resolution text, not an appointment. While patient-initiated texting is the feature that’s changing the industry, Rhinogram has also brought automatic messages forward into the 21st century. Traditional appointment reminders appear to come from strange, five-digit numbers. The Not a bad ROI. many retainer and clear aligner checks patient can’t call that number, and As much as he believed in through Rhinogram, without those the only response they can send Rhinogram from the beginning, Dr. checks taking up space in his team’s is canceling or confirming their Dressler has been surprised by the schedule. volume of new incoming patient------appointment. If they have a question, initiated texts and the estimated a concern, or just need directions, they 15-20% expansion of the potential "No more spending have to find the actual phone number patient base by capturing people who exam time only to find and call. Simple reminder systems can would have never sought treatment reduce call volume, but does nothing because of the sheer inconvenience out the patient can’t to create lasting patient connections. of traditional phone communication. afford it, doesn’t really With Rhinogram, clients can still send automatic messages, from Recent examples include a school want it, or is going for teacher who wasn’t allowed to make reminders and reactivations to post- calls during class but could easily text three other opinions." procedure followups and birthday while her students were working and messages. The key difference is these ------messages can be easily personalized, an assembly line worker who only had “Rhinogram clients across the and they come from the office’s own five-minute breaks every two hours. country in numerous healthcare business number. With just a tap, Both had wanted straight teeth for verticals say they can’t imagine patients can call or text back with any years but never pursued it because of practicing without being able to use questions. the inconvenience of phone tag. Rhinogram,” says Dr. Dressler. “No “I wanted a solution that grew my Dr. Dressler says Rhinogram has more spending exam time only to find practice while also making life better made his office the most efficient it has out the patient can’t afford it, doesn’t for my patients and my team,” said Dr. been in his 32 years of practice, largely really want it, is going for three other Dressler. It seems he has that, now. because it allows him to perform opinions, or whatever excuse you

Q1 • 2018 | TheProOrtho.com 57 OF104_DischAd_MKS_Rd1.pdf 1 11/21/17 9:18 AM

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The Economy Is Booming Why Isn’t Your Practice? By Dr. Ben Burris

The biggest problem facing orthodontic 1.) There will be a significant downturn I’m talking to people who are dissatisfied practices in the United States is a lack of in the economy/stock market with all the with their results but refuse to change. new patients. Though there are outliers associated sequelae. who have more work than they can handle 2.) Doctor directed, remote treatment –––––––––––––––––– and despite other concerns, orthodontists with clear aligners via teledentistry will are obsessed with how they can get more become mainstream. "One of the semi-legitimate new patients and more case starts. And 3.) There will be serious, like really reasons orthodontists give they should be. Orthodontists who own a serious, downward price pressure on in practice are running a business that will person orthodontic treatment. for not changing from the cease to function without a regular influx traditional delivery model of new customers starting treatment. So what is one to do? What’s the solution? Simple. Figure out how to to a more relevant one is SO HERE’S THE RUB. deliver the services consumers want The US economy is on fire, the within the price and time constraints that they own or are vested stock market has never been higher they have and do so before any of these in their physical plant (aka and unemployment is effectively zero three things happen. The easiest ways to BUT STILL the biggest problem facing accomplish this are to modulate service/ office building or buildout/ orthodontists is a lack of new customers. lower price and incorporate teledentistry leased space)." The implications are obvious and beg a into the modern orthodontic practice. Of few questions: course whenever I suggest such things –––––––––––––––––– there are howls of disagreement and Having an established physical plant • What will happen when the next declarations like: that is antiquated in time, space, location downturn in the economy comes along? and function certainly is a millstone • Why aren’t more people buying • I have too much overhead already, I to drag around and limits flexibility orthodontic treatment from orthodontists can’t lower my fees. but even this can be overcome. The now when things are good and consumer • I have too much student debt, I can’t smart doctor should consider selling confidence is high? lower my fees. their practice while the market is hot. • What’s the biggest impediment • Low fees mean low quality, I won’t The prices being paid for orthodontic to customers seeking and purchasing lower my fees. practices are unprecedented, the buyers orthodontic treatment? • My time is valuable and I’m a plentiful and the terms favorable. Even • What will happen when the already professional, I won’t lower my fees. if you’re relatively young I’d still urge small number of available customers • My patients pay for the best, I have no you to consider this path. I have several becomes significantly smaller? need to lower my fees. friends who have sold recently and they are ecstatic about the results – they The answers to these questions are And if you believe these are good cashed out at the top of the market, put obvious, or they should be, but we reasons to keep doing what you’ve always away big bucks, agreed to work 2-5 years orthodontists refuse to even consider done even though you lack new patients running the practice they sold, are paid changing “the way we have always done in one of the hottest economic periods well for doing so, enjoy the practice i t ”. ever, then that’s up to you. Let me know of orthodontics without the hassle of Let me take this one step further. I’ll go how that works out for you. If you have running a business AND if they decide on the record right now and say that in plenty of new patients and are happy to do so in the future they can relocate the next 5 years one (or probably all) of with how your business is doing then and construct an ideal office in an ideal these things will happen in the US: keep doing what you’ve always done! location to deliver orthodontics in the

Q1 • 2018 | TheProOrtho.com 59 ORTHOPUNDIT.COM

manner patients want instead of the way Still think it’s crazy to sell at your age? group. OR you can do any combination we have always done it. These doctors get Well consider one more thing. For what of these things in any order you choose! to keep all their knowledge, shed all their it’s worth, I’m not convinced that the Of course most of us will choose to do baggage and get paid well for doing so. If prices that are being paid for practices nothing and hope “it won’t happen to me” you decide to have a look at your options are sustainable. If the purchase price of as we orthodontists have collectively done feel free to contact me and I’ll connect practices keeps going up and the price of for decades. If our past is any predictor you directly with several buyers – no need orthodontic treatment keeps going down, of what will actually happen, those to get some broker between you and the at some point those lines must intersect orthodontists who are currently doing buyer to cut into your nest egg! You can and that will be the end of the sweet well will continue to do so and those who get several offers and choose from among deals that are currently available. For that are not will bemoan all the external forces them. When practice buyers compete, you matter if any of the three things above I’m they blame for their lack of success but win!* predicting actually happen, that will be never realize that if they refuse to change –––––––––––––––––– the end of high practice purchase prices their mindset they will never change their as well. Something to think about. circumstances. "For what it’s worth, The choice is yours. You have options. I’m not convinced that You can open your mind, adjust to the *I have helped facilitate several of new reality, provide great service, grow these deals and I have always refused to the prices that are being your practice, have a great attitude, enjoy take a finder’s fee or any other kind of your success and keep rolling along remuneration for doing so. I don’t want or paid for practices are in solo practice. OR you can cash out, need a cut of your money! sustainable." put away a bunch of money, be “just a –––––––––––––––––– doctor” and enjoy being part of a bigger

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Q1 • 2018 | TheProOrtho.com 61 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 eective, ecient, fair priced, and easily accessible. Readers will gain insight into the current market trends in orthodontics and learn how to modify their mindset and oce systems to align with the needs of the consumer.

Drs. Marc Ackerman and Ben Burris will be giving a 2 day intensive, interactive course for implementing the Straighter philosophy into your new or existing practice. Topics such as oce systems, market positioning, realistic outcome planning and mechanics, managing consumer expectations, and marketing will be discussed. Bridget Burris and Amy Bradshaw will be giving a concurrent operations team course that is appropriate for oce managers, TC's, financial coordinators, front desk personnel and even chairside assistants.

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