Office Visit: What's Up, Doc? by Kyle Patton, associate editor, Orthotown magazine

Orthodontists spend most of their waking hours in their practices, so they usually don't get many opportunities to see what it's like inside another doc's office. Orthotown magazine'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 Dr. David Harnick, an award-winning Albuquerque doc who has spent the past 42 years in dentistry, 30 of those years as an orthodontist. Harnick is a frequent contributor to the Orthotown.com message boards (3,000+ posts), and has served as a wealth of experience and information for his peers. It's no wonder why he's won multiple awards in his community and why his daughter is finishing up her residency to follow in her father's footsteps to become a third-generation dentist.

Tell us the story of how you became an orthodontist.
I developed temporomandibular joint disorder (TMJD) in?1979, with a clicking and pain of the left joint. I went to the orthodontist I always referred to, and he suggested removing the UL4 to make my left side Class I and give me canine rise. (That was the treatment back then.) But my upper midline was already to my left, and this would have left the UR1 in the center.
So I started taking classes wherever I could find them to learn more about TMJD and orthodontics. This led me to learn alternative techniques in orthodontics, such as Crozats, functional appliances and even Frankels. I learned how to place brackets and use straight wire from the American Orthodontic Society, an organization for teaching general dentists orthodontics. I treated myself with Crozats and have been pain/click-free now for more than 37 years.
I got so obsessed with orthodontics that I applied to the University of the Pacific and was lucky enough to be accepted. Pacific was a very thorough progressive program and met my needs perfectly. The hard part was going back to school with a family in Albuquerque. I flew home 94 weekends during those two years. I worked on Saturdays to make ends meet.

You have a varied background: You were a general dentist for years before you decided to go into ortho. Now you're an American Board of Orthodontics-certified orthodontist who's earned many distinctions and awards in your career. What's been your driving force in all your endeavors?
I've always found that taking courses and learning new techniques has made me not only a better practitioner but also more excited about dentistry and a more successful businessman. I was in a partnership that didn't work out, and at age 59 started all over again in a part of town where I knew nobody. I forgot how hard it is to start an ortho practice!
I used the time to advance my knowledge base. I took a miniresidency at UCLA in sleep breathing disorders, and I attended the McLaughlin two-year course. Both made me a better practitioner and helped grow my practice. I also spent as much time as I could in learning the Invisalign system. I was one of the original doctors certified in 1999 and was part of its alpha group.
However, I found the system to be too difficult to achieve quality results. I was determined to master the appliance and have taken every single course available on the website, attended every regional meeting I could and have not missed a summit. I now find it to be the workhorse in my office.

Walk us through your average day in the office.
I really enjoy going to work each day. My first patient arrives around 8 a.m. (varies slightly by location). I see between 35 and 60?patients each day. I am never rushed; we schedule ample time for each procedure and all my staff is cross-trained, so if I do need some extra help I can get it. With Invisalign, most appointments are less than 10 minutes (and some take less than five). I generally see the Invisalign patients myself, and the assistants see the fixed patients. I have plenty of time to go on Orthotown!
I do not believe in seeing the after-school rush. I have very few after-school appointments and leave the office about 4:30 each afternoon, Monday through Thursday. My daughter, Kari, who will join the practice after she graduates from the ortho program at Oregon Health & Science University (OHSU), shadowed me one morning, and we had lunch. I asked her how she thought the day went, and she looked at me and told me I'm a goofball. What a great compliment! Doing a great job, having fun with your staff and patients is what it's all about.

Has your practice philosophy changed over the years?
I think my practice philosophy has changed in the 42 years I've been in dentistry. For the first 11 years, it was as a general practitioner; for the past three decades, I've been an orthodontist. At first I was more focused on the business's growth and doing fast-paced work.
I didn't want to burn out, so I've chosen a completely different way of practicing: Outsourcing is my new approach. I hired OrthoSynetics, and now have about two fewer employees on-site. A team of five is easily manageable, but as you add on team members, issues can multiply exponentially. So I outsource all billing and insurance. I outsource all retainers (easy to do when you have a scanner). No noise or mess from pouring models. No extra people to do lab work. No running around to make a retainer on time.
I choose strategies to reduce stress. Now, this comes with a cost—my overhead is higher than most—but I could never go back to the old way. My net is higher than most, too! My way is just a different way of doing things.

One of the local magazines in Albuquerque has voted you"Best Orthodontist" several times in recent years. What does your practice do that sets you apart?
I do anything for my patients—I can't remember any complaint where I didn't do my best for a patient. For example, with Invisalign, I'll do as many aligners and refinements it takes. I literally outlast the picky patients until they say "no more." Someone breaks a retainer, even a few years out of treatment, I'll replace it—sometimes at no charge.

What's an aspect of ortho that never ceases to amaze you?
I think technology is changing orthodontics forever, just as it is in many other fields. There probably have been more advances in the past 15 years than there were in the first 100.

Seems like orthodontics runs in the family. Your daughter will join your practice in January. What does that mean to you?
Well, in one word, everything. My dad was a dentist, so Kari will be the third generation in the profession. She surprised me at the age of 16 and asked me if she could become my partner. I really thought she'd be a certified public accountant, like her mom.
Kari has a great attitude and worked very hard in college (got her degree in dental hygiene) and dental school. OHSU has really trained her in traditional orthodontics, and I've been able to supplement it with the aid of texting and emailing. I can't wait to see what kind of orthodontist she becomes.

What do you find is the best to market your practice? Were you always successful, or was it trial-and-error?
Up until recently, it had always been easy for me. My general practice grew to be very large, so starting my ortho practice out of school went seamlessly. This new one that I started eight years ago was slightly more of a challenge—it's hard to go from being very busy to seeing only a few patients a day. A lot of internal marketing. Now I have two locations and a very successful practice. The practice is exactly how I want it, and I've also been positioning it for future growth with my daughter.

What have Orthotown.com and Orthotown magazine done for your professional life? For your social life? What's your favorite feature?
I started posting on Dentaltown.com's orthodontic category about 18 years ago. I'd bought one of the first Windows-based practice-management systems and didn't know how to type! I needed to practice, and Dentaltown needed an orthodontist to answer questions. I was in on the start of Orthotown.com, but drifted—then, after I'd started my new practice, one day I checked in on the website and since then I've been hooked and can't imagine practicing without it. My knowledge base has expanded dramatically because of the great posts. I've met several docs who recognized me at the AAO convention!

Give us a snapshot of your life outside of work.
I love tennis and play three or four times per week. I play in several leagues at the 4.5 level. In addition, I work out every night for at least a half-hour, even if I've played tennis. I'm hooked on the University of New Mexico Lobos basketball team. I keep my life simple. On weekends, my wife and I go on 3-mile hikes.

What advice do you have for ortho students still in residency?
In most likelihood, your residency is barely enough to get you started. Learn, learn and then learn some more. It has been so long for me and a different era; I'm not sure I can give any more advice. To me, there's always room for one more good one. I got a taste of starting from scratch again, and you really need a positive attitude. Do not buck current trends. Be a leader.

Coming soon: Tips to maximize clear-aligner business
Dr. David Harnick calls clear aligners the "workhorse" of his practice—and he's agreed to share some advice based on his years of expertise. Look for his article in the October 2017 issue of Orthotown.