Office Visit: Bracing for Impact by Kyle Patton, associate editor Orthotown magazine

Orthodontists spend most of their working hours in their practices, so they usually don't get many opportunities to see what it's like inside another doctor's office. Orthotown's recurring Office Visit profile offers a chance for Townies to meet their peers, hear their stories and get a sense of their practice protocols.

In this issue, we introduce Drs. Dustin and Tyler Coles, brothers who manage five locations and 24 staff members around the Phoenix metro area. Turn the page to learn more about Premier Orthodontics.

What was the path each of you took to becoming an orthodontist?
Dustin: You could say that dentistry runs in the family—our dad is a dentist, we also have a sister who's a dentist, and a brother who's an oral surgeon. (One brother is not a dentist, he's a salesman—we like to call him the black sheep of the family.) I was a dental assistant for my father for years; I always knew that I wanted to be in dentistry, and when I was introduced to orthodontics, I knew it was for me.

Tyler: When my career in music didn't work out, I thought that dentistry would be a great backup plan. In reality, though, my dad told me that I needed a "real job."

Dustin was growing this great practice and needed some help, so we joined forces and grew Premier Orthodontics. (Something kind of funny: Dustin mentioned that dentistry runs in the family, but running also "runs" in the family! Two years ago, all of my brothers, Dustin's wife and my dad all ran a marathon together. Marathons, like dentistry, are sort of a family tradition.)

How are your practices laid out? What's the workflow like?
Dustin: All our offices have open floor plans; we love light and we love open space. We're available for parents to speak to us; they're welcome to see what we are doing. We work hard, but also love to have fun while at work.

What's your practice philosophy?
Tyler: Our practice philosophy is to make others smile. We achieve this through the way we talk to people and how we interact with them. We want the experience in our office to not just be "expected" but to serve them with the unexpected. You wow patients and create raving fans by doing things that don't just meet expectations but exceed them.

What do you do to help set the practice apart from others?
Dustin: We like that our offices are so different from the competition, and we like it when we hear things such as "I can't believe that this is a doctor's office!" We offer lifetime guarantees, extended hours and Invisalign. Our competition doesn't always do the same. Honestly, some offices probably think that we're a little crazy because of what we do, but we wouldn't have it any other way!

You're also heavily involved with Smiles Change Lives (SCL).
Tyler: SCL has been one of the best things we've done. It allows us, as a practice, to give to the community and help where it's really needed. When we first heard about the opportunity and were encouraged to join, we asked how many kids were on the waiting list in the Phoenix area. They said, "Around 27. How many would you be willing to take?" We told them to send them all.

Most providers of SCL will treat somewhere around two to five patients a year. We thought, "If we're going to do this, we might as well go all-in." Kind of a "go big or go home" mentality. The director was in tears; there had been kids on the Phoenix waiting list who'd been waiting more than three years to get treatment. We were so excited that we could help. This year we've pledged to treat 100 kids. The only drawback is that there aren't any kids. We recently hosted an event to find more kids in Phoenix to help, and we found the 100 kids that we're going to help this year!

Dustin: SCL honored us last year by giving us a Gini Award, which goes to those who support the organization's mission. They act like we're doing a lot for them but, frankly, this has done so much for our team. The children are the most grateful, humble patients, and it's the most rewarding experience to treat them. We feel blessed to be able to help those in need. SCL patients always love to hug us after we finish their treatment. I'm not a "hugger," but it is a pleasure to receive their thanks through a hug.

You also received an Invisalign award. How did that happen?
Dustin: As a practice, we've worked hard to learn to treat difficult cases with Invisalign. I came to a crossroads where I thought, "I need to either learn to do Invisalign and do it all the way, or stop treating with Invisalign." I started treating difficult cases and found that we were getting fabulous results. I submitted a case to the Invisalign case shootout competition, where they showcase well-treated Invisalign cases. We were lucky enough to have two cases chosen to be Top 20 semifinalists in the competition, and one of the two was chosen to be a Top 4 finalist. I presented this case at the Invisalign Summit and was voted the winner for the case shootout for the hardest-treated Invisalign case in North America. We were so excited to be recognized for our work trying to push the limits of what's possible with Invisalign.

How do you get the word out about your practice?
Tyler: We've concluded that we need to have a marketing system, not just random acts of marketing. We've been clients of Burleson Seminars for a couple of years and have learned what it means to have a true marketing system. In our system, we now do things for patients, for referring doctors, and directly to consumers. These efforts consist of reports and books for patients, monthly gifting to referring doctors, and monthly contests and events for existing patients to encourage their referrals. We also do direct-to-consumer marketing through Google AdWords and through Facebook. These systems are automated through the use of Infusionsoft, a marketing software.

We have no lack of places or methods to tell others about our practice. If it sounds complicated, it's because it is! We've found that to be successful and grow five practice locations, this marketing system is the only way to make our goals attainable and achievable.

What's the biggest challenge orthodontists face today?
Dustin: I saw a blog on Orthotown.com recently about buying an existing practice, and the doc posting to the message boards was asking about referring doctors (GPs) not referring anymore once the selling doc left and retired. There were some differing views on what to do, but one of the biggest problems that we face is that the business of orthodontics has changed drastically, even in the 10 years that I've been practicing.

We used to rely heavily on doctor referrals in our own practice; in fact, close to 60 percent of our practice was coming from doctor referrals. These days, that's down closer to 30 percent. That sounds alarming, but our practice is up almost 40 percent this year. We're relying much more on sophisticated marketing techniques to generate patient leads. Gone are the days of a solely referral-based practice, and they're not coming back anytime soon, either.

It's been a little depressing to realize that what I used to think was important really doesn't matter all that much to patients or referring docs. I was told, just do great work and they will come. Kind of like Field of Dreams: "If you build it, they will come." That couldn't be further from the truth. Most patients only know how to judge you and your practice on how you make them feel. Much more important to patients are things like: Was I seen on time? Did the doc do something for me that was pleasantly unexpected?

Tyler: Marketing is now the most important thing to growing a practice. We still try to do great work in our practice and to treat people well, but we know that isn't quite enough if you want to have a successful practice in a competitive area. There really is no magic bullet to having a successful practice—you must do everything, and you must do it well, to grow a practice in today's economy.

What's your patient philosophy?
Tyler: We want to treat them like they're a part of our family. We look at them as if they were our family! All of our treatment decisions are based on that philosophy. We also try to have a steady balance of fun and hard work, and we find that this makes for a dedicated, loyal and hard-working team. Our success lies on the health and happiness of our entire team. Without them, we wouldn't have happy patients.

What's the greatest advancement of change you've seen during your tenure?
Dustin: The biggest changes I've seen in my short 10 years are the advancements in technology. I like to say that technology usually makes things better, easier, quicker and more fun. I liken it to my golf game, or snowboarding on the slopes. New technology makes for the ability to hope for a better golf game and a truly enjoyable day on the slopes! The digital age has been revolutionary in how we treat patients and in the patient experience. We no longer take impressions in our practice, and the patients truly love that! I think that's the most important thing in looking at technology: How does it benefit my patients?

What are your hopes for the profession?
Tyler: I think that the referral-based model of orthodontics is on its way out. The profession has changed and will continue to do so. How a practice generates patients is going to continue to change to a more consumer-based/marketing-based approach. Patient experience is also a super important factor that should not be overlooked.

What can you not live (practice) without?
Dustin: Our team! I've had many different employees through the years, and not all of them have caught the vision. The Premier Ortho team now in place has seen the vision of what we want to create; they understand that what we do is bigger than ourselves. Our partnership with SCL has helped our team to understand the importance of giving and serving others. It's amazing to work with such talented people.

Outside of practicing, you also have an orthodontic marketing company. Give us the rundown.
Tyler: We started Orthomarketing DFY (Done for You)—our brainchild conceived during a flight back from a visit with our marketing and practice coach, Burleson Seminars. We meet with a group that shares many great ideas, and marketing helps, but most of the ideas in the group seemed to stay just that—ideas! The implementation part of doing marketing was lacking because the doctor didn't have enough time to do it, or there wasn't anyone in the practice to delegate the task to, or nobody on the team knew how to do that specific project. Through trial and hard work, we've successfully implemented many great marketing ideas, and from there developed a marketing system that offers these same "done for you" marketing services to others. If someone has a marketing idea and wants it to get beyond just an idea, they can call us and we can help get it done for them!

What's been the most rewarding part of your career?
Dustin: The most rewarding thing that I've done in my practice life is to treat kids through SCL. I'd gone many years looking for a way to serve the less fortunate but didn't know how or where to even begin. One of the things that I struggled with was how to choose who was deserving of the treatment. With SCL I don't have to make that decision; I just treat the patients. As orthodontists, we truly have one of the best professions ever—take the amazing feeling of giving someone a new smile, and multiply it by 10! It's so gratifying to hear their stories and to see their smiles. Often the patients and parents are in tears, and the rewarding feeling you get can be greater than anything monetary you could have received.