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Orthodontic Practice Rescue – Becoming the Pre-eminent Orthodontist By Donald E. Machen, DMD, MSD, MD, JD, MBA, CFA and Hollie A. Machen, Esq.

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In a past article, data was considered from practice reviews that summarized the characteristics of the most successful orthodontists. This article generated many comments and questions from readers, including requests for a follow-up article. Several specific inquiries were from orthodontists who wanted to learn how to recover from a declining practice, especially one with decreasing new patients.

After some thought and a review of many patient surveys, a clear pattern emerged as to what patients are attracted to, and more importantly, what they are not attracted to. As it turns out, a combination of hard and soft factors was deemed significant by patients in 1.) referring friends and acquaintances; and 2.) what those surveyed found significant in choosing an orthodontist for themselves.

On the soft side, doctor-patient/parent interactions were paramount. If negative, this interaction with doctor and/or staff was enough in itself to preclude many practitioners from further consideration. However, it did not always eliminate doctors from consideration. There were two notable exceptions. The first is the doctor who was highly recommended by someone who the patient/parent respected. The second is when the orthodontist's location is particularly convenient (e.g., the only one a particular geographic area or one that has evening or weekend hours that are needed by the patient).

On the hard side, the first consideration of prospective patients/parents was the general appearance of the office and whether they felt comfortable. This applied more so with suboptimal offices than with elaborate and expensively decorated facilities. However, there were a significant number of responses that commented negatively on "over the top" furnishings and amenities. Particular comments focused on the cost of services in a practice that spent so lavishly on non-treatment-related aspects.

The patient responses reveal several key aspects that their orthodontist/orthodontic office needs to demonstrate. Also, because first impressions are so critical, patients need to find these from the first encounter and consistently throughout the relationship. It is no coincidence that these are the components that the EBRM (encounter-based risk management) system, which was also discussed in a prior article and more fully in Managing Risk in Orthodontic Practice, focus attention to and are found in the most successful.

From the surveys, it is clear that patients/parents want a well-decorated, functional, clean, neat office environment. In evaluating and making recommendations for orthodontic practices in need of rescue, a primary goal is viewing the office as a patient/parent would do so. One important protocol involves first calling and then visiting the practice, unannounced. Using a "secret shopper" is a good strategy to really get information about how a caller is treated on the phone, and, after arrival at the office, it is important to see how the normal day looks and feels. Once in the office, a quiet, unhurried first appointment is another important request.

Patients/parents are looking for a clear message from the first contact that the primary goal of the orthodontist and staff (the entire office) is addressing the patients' needs. In other words, the office motto needs to be, "How can I help you?" Many orthodontic practitioners might know this important point, however, frequently lose an appreciation for how important it is to find out what the patients/parents really want or are concerned about when they first present. It is further suggested that it be the mission of the entire staff to place a special focus on learning this information before making any comments about what the orthodontist/practice can do for patients. This aspect is reviewed in detail on several levels in our previously mentioned book including those of improving quality of care, increasing referrals, reducing practice stress and eliminating lawsuits.

Empathic listening is one of the keys that opens the door to a rich relationship which serves as the foundation for being perceived as "the one" for us (e.g., the pre-eminent orthodontist); the one that we trust. In several orthodontic practice "rescues," where practices have been recovered from near extinction, EBRM protocols have been identified as drivers for the turnaround. There is plenty of time to show patients what you can do or relate to them what you think they need or might benefit from. Start by building the relationship, and few aspects build a better relationship than focused listening.

As Stephen Covey wrote in his book, The Seven Habits of Highly Successful People, "first seek to understand, then seek to be understood." It has often been stated, people don't care how much you know, until they know how much you care! Empathic listening to their needs is a significant key to pre-eminence.

With this sound foundation, the following aspects need to be consistently demonstrated, appointment after appointment:
  • focused, warm and caring staff interactions
  • modern systems, equipment and facilities
  • optimal communication, especially concerning patient progress and inter-practice referrals
  • well-trained auxiliaries
  • a great attitude and enthusiasm for what each team member is doing

Rescuing a failing orthodontic practice isn't easy but it is very possible with commitment from the top down. There are reasons that the practice got into the predicament that it finds itself. It didn't happen overnight. Since it took time to get there, it will take time to turn it around. Negative patient comments and loss of referrers and referrals as well as loss of confidence in the practice by even the most loyal supporters can be very problematic. A sincere attitude on the part of everyone involved is the cornerstone. However, the orthodontist needs to objectively evaluate each component mentioned. In some instances, some staff members must be asked to leave, facilities and/or locations changed, equipment and systems upgraded, etc.

These are often difficult decisions. But, whether it is because you want to revitalize and reenergize the practice for an enthusiastic improvement in the quality of your daily practice or you are planning to transition in a few years and want to optimize the value of the practice, here is a calculation to consider. If your practice traditionally initiated treatment on 250 patients per year at an average of $5,000, but now you are starting treatment on only 125-150, the one-year, five-year and 10- year losses can be catastrophic. Using rough calculations for illustration purposes only, it is easy to see that without even including the loss of potential referrals from the lost new patients who would most likely have started treatment themselves, and only counting the hard loss related to the declining treatment initiations, the loss to the practice would range from $625,000 to $750,000 per year.

Without question, there can be a significant value to rescuing the practice. There is also a significant benefit in revitalizing a stagnant practice using similar protocols and procedures suggested for a rescue. As mentioned, this is especially true for practitioners contemplating a practice transition within the next three to five years. All of the metrics used to value a practice (whether for association, partnership or sale) focus to some degree on gross revenue, even if a discounted cash flow method is used. This is so since higher gross revenue generally means or should mean that the cash flow to the firm will also have significantly increased. If not, a careful practice evaluation is suggested.

All in all, the rescue/revitalization of an orthodontic practice can offer rewards to the orthodontist in many ways, including a renewed opportunity for the practitioner to offer improved patient care, experience an increase in referrals, a reduction of practice stress as well as the elimination of negative comments and potential professional negligence lawsuits. The process suggested herein can also be an excellent method for any practice to follow in an effort to reach the next level.

Author Bios
Dr. Donald E. Machen, is the recognized authority on risk management in orthodontic practice, having initiated the discipline in the mid-1980s. He developed, moderated and presented at the AAO's first national risk management telecast to more than 2,600 orthodontists. He has represented orthodontists, dental specialists, general dentists and physicians in malpractice lawsuits and other legal matters as a trial lawyer and is currently a trial court judge in Pennsylvania, having served for more than 14 years. He is a board certified orthodontist maintaining a part-time practice and is on the orthodontic faculty of Case Western University Dental School and The University of Pittsburgh School of Dental Medicine. He is also an adjunct professor of Law at Duquesne University School of Law where he teaches malpractice litigation. Dr. Machen was the editor of the Legal Aspects of Orthodontic Practice column in the AJO, writing amonthly column, and has authored columns in JCO and Ortho Tribune. He lectures extensively to orthodontic groups, both large and small, focusing on developing highly effective systems for eliminating lawsuits, optimizing patient care and increasing practice referrals. Dr. Machen is the author of Managing Risk in Orthodontic Practice and is managing director of Risk Management Consultants, LLC. He can be contacted at: drmachen@orthormc.com.

Hollie A. Bernstein Machen, Esq. - After graduating from the University of Pittsburgh School of Law, Hollie spent the early part of her legal career as a litigation associate and then partner of the Bernstein Law Firm, a multi-office firm specializing in creditors' rights. After leaving that firm to raise her three children, Daniel, Lindsey and Roxanne, she began focusing on legal research and writing as a judicial law clerk in Pennsylvania and has remained active in that endeavor for more than 13 years. Additionally, she spent more than five years counseling clients on financial issues as a wealth management advisor at PNC Bank and National City Bank, earning various designations in the financial services profession including that of Certified Retirement Planning Counselor. Presently, in addition to working with clients at Risk Management Consultants, she spends time teaching online legal research skills to attorneys and judges as a research specialist for Westlaw and acts as practice manager for Dr. Machen's part-time orthodontic practice.
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