Orthotown September 2023 - 50

OFFICE VISIT
Consulting can be hit-or-miss. For
you, it was a hit. Run us through
your experience and what kind of
changes it led to in your office.
Our consulting experience was more
than just a hit-it was a home run!
Our schedule template was a mess,
so I called Mary Beth to ask her to
revamp it, and I ended up getting a
whole lot more than just that. Not
only did she help make our schedule
much more efficient and add places for
starts-which facilitated the growth
we are experiencing despite shrinking
to a single-doctor practice-she also
helped us use our practice management
system more effectively, streamlined
our new patient process and
helped distribute some of the workload
among our administrative team.
You're an advocate for digital
scanning, 3D printing and having
an in-office lab. What are some
things other docs might be missing
out on by not leaning into these
advancements?
Our in-office lab is more of a throwback
than an advancement. We have
kept that fairly traditional with the
in-house fabrication of space maintainers
and expanders. The huge
advantages are quality control and
turnaround time: I can fit bands on
a patient on Monday and deliver his
appliance on Tuesday.
We have modernized our in-office
lab with the addition of 3D printing,
but I tried to do it in a cost-conscious
manner. I've always been tech-savvy
and willing to tinker, so I decided
several years ago that I would dip
my toe into 3D printing with a hobby
printer from Amazon. Today, we
have three Anycubic Photon Mono X
My dad asked his longtime
receptionist to make sure
she greeted each patient
as they walked through the
door. She replied, 'Dr. Trotter,
I don't think patients expect
that.' To which my dad
responded, 'Exactly. They
don't expect it, so that's why
we're going to do it.'
printers, which print six models
horizontally in about 45 minutes.
We have loved scanning for retainers
before debonding. We provide patients
with two vacuum-formed retainers
and their model. Rather than a
subscription-based retainer program,
we will replace their retainer for one
fee if the patient brings the model back
and another (higher) fee if we have to
rescan and print a new model. If you
don't have this capability in your office
and have to outsource this, it would
be difficult not to have to make a program
subscription-based to cover the
additional costs.
What are the biggest obstacles
that corporate dentistry and
orthodontics pose to new grads
and new docs? What are some
potential solutions?
The biggest obstacle comes in the
valuation of practices. Because corporations
are willing to pay such large
multiples of earnings before interest,
SEPTEMBER 2023 | 50 | ORTHOTOWN.COM
taxes, depreciation and amortization
(EBITDA), it makes it difficult for a
new graduate to compete to buy that
same practice.
I recently read an article by Roger
Hill in the McGill Advisory in which
he proposed a potential solution. He
has proposed an EBITDA+ valuation
for private sales, in which the value of
a practice is not valued based on traditional
metrics of production or collections;
rather, he values it on a modified
version of EBITDA that makes more
sense for a private buyer. This values
the practice higher for the seller, but
also still cash-flows for the buyer.
What's the next piece of tech
you think you'll adopt?
I have been intrigued by the robotic
lingual retainer bender, but I'm
waiting for it to be able to bend beta
titanium (TMA) wires. We use 0.027inch
TMA for our lower 3-3 retainers
and the last time I looked, the bender
machine was not able to bend TMA.
What kind of cases
excite you the most?
Because we are working on efficiency,
right now I'm most excited about
cases that are finishing months ahead
of their estimated treatment time.
No matter the initial difficulty of the
case, it's always fun to make a patient's
day brighter by telling them they'll be
getting their braces off much sooner
than they expected. This has been
happening more and more lately with
KLOwen, and it never gets old.
What's a trend in the
profession you love?
I like that digital custom treatment
seems to be catching on more and
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Orthotown September 2023

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