Orthodontists spend most of their working hours in their practices, so they 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 you’ll meet Dr. Dameon Fisher, a Townie who owns three practices in the metro Atlanta area, each with its own business model created with knowledge gleaned from previous experiences. (His main office is a single-doctor practice, the second shares space with a general dentist, and the third is run in partnership with a group of pediatric dentists.)
Meanwhile, Fisher’s also growing a program that makes it easier for some clear-aligner patients to be treated without visiting a physical office.
“It’s all about offering patients options that fit their lifestyles,” he says. “Adapting, evolving and delivering.”
Dr. Dameon Fisher
• Bachelor’s degree:
Morehouse College, Atlanta
• Doctor of Dental Surgery degree: Meharry Medical College School of Dentistry,
• Orthodontic residency:
• Fisher Orthodontics
3 locations: Smyrna, Marietta and Lithia Springs, Georgia
• Atlanta Clear
2 locations: Alpharetta and Midtown Atlanta
5 shared staff
2 office managers
3 call center employees
8 clinical assistants
1 digital technician
1 laboratory technician
Tell us how you decided to get into orthodontics.
I first became interested in dentistry when a college buddy told me he had just returned from taking the dental admissions test. He tossed me the study guide and, to my surprise, I was really good with the perceptual ability section. I had entered college wanting to pursue a career in medicine; however, after discovering this unique ability, I thought I might consider a career in dentistry. Shortly thereafter, Meharry Medical College’s dental admissions recruiter paid a visit to our campus and asked, “Who’s interested in dental school?” I raised my hand, and my journey began.
I was accepted early but wasn’t allowed to go because my mother wanted me to have my undergraduate degree first. After deferring my admittance and receiving my undergraduate diploma, fortunately I was admitted in the next dental class.
Once in dental school, I did work–study in the orthodontic department for my entire tenure there and also worked with local orthodontists in the city. While shadowing, I was able to learn valuable insight into the specialty and also develop invaluable relationships with my preceptors.
After completing dental school, I applied to orthodontic residency, but I wasn’t accepted. I completed a general practice residency instead, and reapplied. Fortunately, I was accepted the very next year.
After you completed your residency at Howard University, you were fortunate in that a group practice in Atlanta reached out to offer you a position. What were those first few years of practice like in such an environment?
I joined a large multidisciplinary, multioffice and high-volume group practice with a mature orthodontic department. The senior orthodontist had built a fantastic ortho department with very efficient protocols and procedures. I believe it was a perfect situation for a new graduate.
I was soon given two locations with my own staff. I began developing my own treatment plans and managing day-to-day patient flow. The seasoned staff directed me at all times on where I should be in the office, and trained me on how to see patients in a high-volume setting. I saw 100-plus patients per day and was able to instantly increase my treatment planning and diagnostic skills. Most importantly, I learned how to properly staff, manage and efficiently treat patients while maintaining high-treatment outcomes. In addition, I worked closely with GPs and various specialists and was able to develop valuable referral relationships.
For the next five years, I practiced in various group settings. In each capacity, I paid close attention to each practice’s protocols and procedures—some I liked, some I didn’t. This was the most valuable takeaway during my early years as an associate doctor.
1. Dental Monitoring. Using artificial intelligence, this device can identify multiple oral conditions. I use it to monitor my aligner patients, who take weekly scans of their teeth during treatment. DM provides me with valuable diagnostic information that helps me identify when it’s time for aligner changes or noncompliance. DM improves patient engagement and leads to better treatment results.
2. Medit i500 intraoral scanner. The compact design of this fast, video-based capture color scanner makes it completely portable, and plug-and-play operability allows my team to transport the handpiece between chairs or from office to office and simply plug it in. It’s extremely accurate and
has an affordable price.
3. Formlabs Form 2 3D printer. This high-resolution stereolithography printer is a workhorse and extremely reliable. Formlabs offers a variety of resins for many different applications. The models are accurate and functional. Its affordable cost allows you the option of having several printers for redundancy, which is crucial for our in-house laboratory.
4. Spectralase 980 Ultra Pulse laser. I use this soft-tissue laser to expose canines and teeth that are slow to erupt. It’s probably the most important tool I use in my practice. I’m real big on how gum tissue frames out my ortho cases, so I always take the opportunity to sculpt the tissue before removing the braces. This always ensures that “wow!” moment that my patients and parents have been waiting for!
In 2005, you opened your first practice and what’s still your main location, a stand-alone office in Smyrna. Describe the layout and style of the office—and have you made many changes during the almost 15 years it’s been open? What were your biggest challenges?
It had been a dream for quite a while. I’m a big fan of architecture and design; I took cues from many of the offices I saw along my journey and ultimately decided on a midcentury modern design. I chose a location in a live/work/play development, which at the time was a new concept. Coincidentally, the developer’s father was an orthodontist and saw my vision, and together we sketched the layout in about 15 minutes.
The office design consists of many elements that are interesting to the eye and timeless—angular and curved walls, lots of windows providing natural light. The lobby has a midcentury-inspired rug design made with Flor carpet tiles and an imaginative and playful wall elevation with images of smiling faces peeking through. In the center of the treatment area, which is an open-bay design, is a light by Artemide that changes color for chromotherapy. I’m literally in heaven every time I’m there.
I’m an art collector, and the office is filled with works from various artists. I believe it’s very important for my patients to see art because it stimulates their imagination. Also, I often liken their ortho experience to the paintings to show how much orthodontics is a creative process, filled with imagination, much like the art on the walls. Currently hanging are pieces from folk artist “Missionary Mary” Proctor. When I met her at an art fair and told her what I did, she insisted that her work be in my office. She created an incredible bench, which happens to be from her church: When she passed it one day and saw pews stacked at the curb for trash collection, she asked her pastor if she could have them and paint on them. My bench has images of children and encouraging phrases, such as “Stay in School” and “Don’t Do Drugs.”
Of course, having a stand-alone facility presents many challenges. Along with having the luxury of being surrounded by the things that make your space unique and yours comes the responsibility of maintenance and upkeep of the facility. A significant amount of time and cost is invested in maintaining the facility and equipment. Fortunately, because of the timeless design of my space, I haven’t had to make many aesthetic changes, but I have had to replace office furniture and treatment chairs over the years.
The biggest challenge has been room for expansion—or lack thereof. At times when more space was needed, unfortunately space next door wasn’t available, so expansion had to be put on hold.
Obviously, your initial investment is an important consideration, especially now with increased construction costs. I believe it’s important to make your office as nice as possible and make it a place you are proud of. My patients often compliment us on how much they like our office, tell us how relaxed it is and ask how long we’ve been there.
Because of that, when you were looking to open a second location, you opted not to build another stand-alone practice; instead, you entered into an association with a general dentist who had an office in Marietta. What were the biggest advantages of this setup—and what were the biggest hurdles or trip-ups to be worked through?
When I decided to open a second location in 2008, I didn’t want the same responsibility of time and commitment it took to run my main location, so I decided to seek a partnership with a GP who had an existing office in another part of town. The office consisted of several doctors and afforded a multidisciplinary approach to treatment.
I entered into an agreement where I subleased the office a few days a month. I added my practice signage and created a web presence in the area.
The biggest advantage of acquiring a second location this way was that I had instant presence in another part of the city, where there happened to be a need for an orthodontist, with little to no upfront cost. And, of course, I gained an internal referral source.
The biggest hurdle with this scenario was maintaining a constant flow of referrals. As staff and doctors changed in the practice, so did my referrals. To grow, I used the same internal marketing ideas I used in my main location and worked to develop a good reputation in the area. To maintain continuity, my staff travels with me and we employ the same business procedures and treatment protocols as if we were in our main office.
Speaking of partnerships, in 2012 you started working with Kool Smiles, a national pediatric DSO that’s headquartered in Marietta, to develop a pilot program for orthodontics.
I was charged with creating the first ortho treatment locations. Using my years of experience, I was able to implement valuable clinical standard operating procedures to introduce orthodontics in a high-volume environment. By now, my schedule had grown to managing my two private practice locations and the new pilot with Kool Smiles. Logistically, fitting all within a five-day workweek was tough, but I made it work.
This was the beginning of one of your “Seven-Year Rule” projects. Explain more about that setup.
It’s a plan that requires you to think creatively, objectively and realistically all with purpose and an overall goal in mind.
Years 1–3 are Create and Develop: I come up with an idea and implement.
Years 4 and 5 are Evaluate, Adapt and Adjust: Objectively look at the project and make adjustments.
Years 6 and 7 are Embrace or Create: Continue the project, or come up with another idea.
•VPro5+ aligner seating device from Propel Orthodontics
•GoTo light-cure adhesive paste from Reliance Orthodontic Products
•Assure Plus bonding resin from Reliance Ortho
•Maestro Low-Profile Bracket System by Ortho Organizers
•Clear Sapphire Ceramic Brackets by MISO
•Unitek Multi-Cure Glass Ionomer Band Cement from 3M
•Carriere Motion 3D Class II/III Corrector
•Ministar thermal forming material from Great Lakes Dental Technologies
• Clear aligner material from Taglus
•Phos-Flur Ortho Defense rinse from Colgate
•CS Orthotrac Cloud from Carestream Dental
This was a project where you opted to end the effort early. What led to that decision?
In 2015, while working with the large DSO, we started experiencing operational problems and management issues—patient scheduling, staffing issues and collections. Because orthodontics was a new business model for the company, I offered my input, but quickly realized that the provider’s business opinion wasn’t really welcome. After coming to the realization that in major companies like this one, executives make the decisions, not dentists, I decided to leave after three years and regain focus on my own private offices.
For your third location, you partnered with a group of pediatric dentists.
During the time that I spent working with DSOs, I learned valuable operational knowledge, so when it came time for me to search for my next venture, I believed I was well prepared. I still wanted to maintain and develop a relationship with a group practice, so in 2015 I created my third location and partnered with a pediatric dental group—two pediatric dentists and one GP who treated only teens. In this relationship, I wanted to ensure that my management team was in full control, so we would be able to implement our own standard operating procedures. We agreed to sublease space from the pediatric group and operate independently. In this way, our ortho-trained staff takes care of everything as we would do in our own office.
We created a call center to receive all incoming calls and centralized our lab in our main location. To ensure that the office is run efficiently and productively, we’re very keen to the concept of space utilization. To maximize chair profitability, we pay close attention to the number of days that each provider uses the space.
Although the ortho and pedo offices operate as two separate entities, we share limited number of staff and also share cost on several things, including advertising and community outreach efforts.
The pedo/ortho symbiotic relationship has been very productive. Our model offers our patients convenience, and all our patients’ needs are met in a unique way under one roof.
You’ve got a unique plan when it comes to walking the floor at AAO meetings!
To ensure that my practice stays ahead of the curve and delivers to our patients the very best and most efficient treatment options, I’m always looking for new ideas centered around technology. So when I attend conference meetings, I usually avoid the big companies in the middle of the exhibition hall and instead explore the perimeter of the room to find the smaller companies that are bringing new and exciting things to market.
A few years ago, I started to notice that several companies had begun to offer 3D printers. I instantly recognized that there was a tremendous shift happening in the clear aligner market. As I did my research and asked questions, I learned that some of Align Technology’s patents were expiring soon and several companies were now ready to fill the gap in this new frontier. These new companies started offering all the tools necessary to allow doctors to begin offering digital orthodontics directly to their patients.
I began to search for affordable 3D printer options and found one by Formlabs with a price that rendered a tremendous ROI. The cost was so low, the purchase was a no-brainer. I already owned an intraoral scanner, and now all I needed was tooth movement software to complete the suite. I demo’ed with several tooth movement software companies and eventually chose SureSmile Ortho. I then had all the tools necessary to begin offering my patients my very own “white label” clear aligner system.
Taking things further, at the end of last year, you rolled out a program that provides clear aligner patients the opportunity to choose virtual treatment instead of making the trek to an office.
Our in-house custom aligners have been received very well. I designed a clear aligner system that is both efficient and effective. However, what our patients like the most about our in-house clear aligners is their ease, convenience and affordability. After I had seen a young teen patient, his mother mentioned that she’d thought if her son was wearing aligners, he wouldn’t have to be in as frequently for in-office visits. I quickly replied, “You’re right. His next visit will be a video visit!” She was delighted with the idea and expressed how much this would help with her busy schedule.
The introduction of the video visits freed up valuable chair time and increased tons of space in our schedule. For HIPAA compliance, we partnered with a telemedicine company and began to provide routine monthly video visits for most of our aligner patients. The parents love this unique treatment option so much, we’re now getting lots of referrals asking specifically for our clear aligners.
It’s my belief that in the modern age of 3D orthodontics, it’s all about offering patients options that fit their lifestyles. Adapting, evolving, delivering. Today, orthodontists have many tools available that leverage this new technology. The question is, what are we going to do with them?
What logistics come into play with video visits? What if patient compliance becomes an issue?
We use video visits to monitor patients who are wearing aligners and some observation patients. Using a company called NextPatient, patients make a video appointment request, choosing from the available times, and our office joins the video chat through a secure website portal. Using diagnostic information provided by Dental Monitoring, our doctors can advise aligner patients to go to their next aligner or continue wearing the existing trays until proper fit. These tools give our team an advantage when it comes to managing patient compliance.
We’re always able to spot those patients who may benefit from in-office visits, or those who may be better served with a fixed appliance because of noncompliance.
How has your marketing evolved to reach this demographic?
As landscape in the dental market rapidly changes, I believe the traditional days of an orthodontist waiting for GP referrals are over. We are in the millennial age and we need to be able to deliver for this new demographic. Today, I primarily use social media to reach new patients. Through Facebook and Instagram, I work with a company that uses geofencing, which targets a desired location with an exact demographic such as age and income. Using this method, we can reach people who are interested in clear aligners or braces and show them ads that target their specific interests.
The 2005 opening of your Smyrna practice was the beginning of one seven-year plan; the second, in 2012, involved giving DSOs a go. It’s 2019 now, so what’s the next plan about?
I dreamed of taking the concept of my in-house aligner system a step further and earlier this year launched Atlanta Clear, a virtual clear-aligner company.
I’d noticed that more adults were seeking orthodontic treatment while demanding treatment options that afforded ease and convenience without wearing a mouth full of braces. Our clear aligner system addresses this concern. Atlanta Clear leverages cutting-edge materials and tech-savvy diagnostic tools to save patients time and money.
With several scan centers located around the city, patients come in for an initial scan and meet in person with one of our partnering doctors. If their case fits the mild to moderate criteria, they’re offered our virtual clear-aligner treatment option.
To ensure that patients’ virtual treatment is going as planned, Atlanta Clear partnered with Dental Monitoring. Patients take weekly scans of their teeth using Dental Monitoring’s ScanBox and a cellphone, and the company uses artificial intelligence to track tooth movement and supplies the doctor with precise clinical data. With this diagnostic tool, our orthodontists are able to remotely guide patient treatment. For complex cases that may require IPR or elastics, a patient can have a traditional in-office visit as needed at one of our partnering Atlanta Clear full-service orthodontic offices.
You’ve seen a lot of changes and gone through a lot of growth since you began practicing back in 1999. If you could go back in time, Groundhog Day-style, but with the mindset and memories you’ve developed over your decades of practice, what one thing would you definitely choose to do differently?
I wouldn’t change a thing! Fortunately, my experiences along the way all have allowed me to be able to objectively make the career transitions that I have made thus far.
What do you think is the most challenging problem for orthodontists today?
I believe it’s important for orthodontists to realize that there is a change happening in our profession. With new and creative models being introduced daily, our practices are going to have to evolve to meet the needs of our patients. These changes will be centered around efficiency and convenience. With internal and external competition from GPs and DIY companies, the future of traditional orthodontics is in jeopardy.
However, I believe that orthodontists can meet the need—we’re going to have to rise to the challenge. As technology has a greater impact on our profession, we should embrace this change and begin to monitor the narrative, while ensuring that technology never takes the place of humanity.
If you could send one note back to yourself before you began practicing, what would it say?
“Continue to be student of your trade, evolve with time, and be fearless.”
Give us a glimpse of your life outside the office.
My wife, Kimberly, and I have a beautiful daughter, Mackenzie. I’m an avid art collector and supporter of the local arts scene, and I also support the March of Dimes and advocate for differently abled individuals. To stay active, I enjoy golfing and exercising, particularly CrossFit.