Orthotown March 2023 - 40

OFFICE VISIT
How'd you get into the profession?
My path to becoming an orthodontist
might be considered straightforward.
I majored in biochemistry during
college, which opened my options
for a graduate degree in life science.
During my senior year of college, I was
exploring medical school as the primary
next step. However, at the time,
I was dating a girl whose dad sent me
an article about dentistry. The article
explored the explosive need for dental
care in the U.S. and the advantages of
owning and running a small business.
I also was heavily influenced by my
childhood pediatric dentist, who had
mastered the art of customer service.
His office was a playground for fun
with a full arcade, fish tanks, trains
mounted to the ceiling that ran the
perimeter of the office and music
blasting all the current hits. The culture
he created would later become an
inspiration for my own offices.
Fast-forward to dental school: I was
fortunate to work in the orthodontic
department on a research paper with
an orthodontic resident exploring the
transverse dimension using periapical
films. This would later become the
foundation of my thesis topic. The
chairman at the time-Dr. Robert
Vanarsdall, aka " Slick " -was perhaps
my biggest influence on becoming an
orthodontist. His passion for our profession
and open-minded approach to
embracing all techniques and clinical
approaches would lay the foundation
for my future orthodontic training.
You've been involved with clear
align therapy since the beginning.
Tell us about the early days.
In 1999, I was certified with Invisalign
while still in my residency. As one of
the first residents/orthodontists to get
trained with the product, I instantly
saw the future would likely include
aligner therapy.
After graduation, I purchased my
first office in San Jose, California, from
an orthodontist who was also certified
and had started about 20 patients.
Inheriting those patients instantly
required a skill set I did not possess.
Those were the early years of product
inconsistencies because of PVS
impressions, unknown force mechanics,
poorly trimmed aligners and no
clear best practices. I had to effectively
learn on the job with each patient.
Signing waivers required from
Invisalign was not uncommon. The
waiver effectively read, " We do not
think this is an Invisalign case and as
a result, you will assume all liability. "
Not exactly a confidence booster.
A few months later I was asked by
the co-founders of Invisalign, Kelsey
Wirth and Zia Chishti, to start training
orthodontists on the Invisalign
system. Align Technology spent
$30 million in a direct-to-consumer
advertising campaign in 2000 that
lifted the awareness of the product
and brand, but had very few doctors
properly trained.
This is where a few of us were
brought in to quickly fill the onboarding
process. Those early years from
2000 to 2005 required me to travel
and give 30 lectures a year to orthodontists
and general dentists, all
while I was practicing full time.
Crazy to think about all those cities,
flight miles and doctors that I was
fortunate to meet!
Then in 2010, I purchased my second
office in Los Altos, California. For
nearly 15 years I was tracking around
40% Invisalign share of chair. This
seemed to work well for a while but
MARCH 2023 | 40 | ORTHOTOWN.COM
over time, seeing 100 patients a day
and trying to make an analog and
digital office work seamlessly proved
too much.
There was a time you almost
walked away. What brought
you to that moment?
I hit a hard wall in 2015 that brought
me to a serious consideration of selling
the offices.
It was a Friday in late February that
I still remember to this day. We had
our typical trouble calls of broken
brackets and poking wires that normally
would not affect me. But that
day, we had five broken brackets and
a few moms who were angry with the
continual breakage of brackets. While
I would have loved to say, " It's your
kid's fault, " I just tried to hear their
frustrations and explain this is part
of the process. After patients left that
evening, I found myself drowning in
anxiety and burnout.
I consulted with my business
partner, Nicole Pruitt, and asked what
could we do to reduce the number of
trouble calls a day. She immediately
suggested we switch to more clear
aligners, which would reduce the
number of office visits, slim down
the trouble calls and allow for more
consultations.
The next Monday, we stopped offering
braces in our office. We knew getting
to 100% would take time. It took
18 months to get to 87% and another
six months to reach 98%.
Our daily number of patients went
from 100 a day to 45 a day, and our
number of consults increased from
four a day to eight a day. We were able
to push patients out from the typical
eight-week intervals to an interval of
12-16 weeks.
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