Office Visit: Dr. Barry Glaser by Kyle Patton, associate editor

This renowned clear aligner expert shares his take on adapting in a world of competition, taking on complex cases, remote patient monitoring, and more

by Kyle Patton, associate editor
Photography by Sean Micah Creative

Orthodontists spend most of their working hours in their practices, so they don’t usually 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 visit Dr. Barry Glaser, a Harley-riding, award-winning New York orthodontist who runs one of the best Invisalign practices in the country. As a clinician, he’s set himself apart in his community and among his peers, becoming a lecturer, author, teacher and consultant for clear aligner treatments all around the world. Check out Glaser’s take on the future of aligner therapy, competition and how to stay sharp in an ever-changing industry.

Let’s talk clear aligners: You’ve not only been using them in your practice for a long time but are also recognized as one of the top Invisalign providers in the country. What have you seen change in clear aligner treatments and options? What do you expect to see 5–10 years from now?

The progress in Invisalign treatment over the past decade has been remarkable. From a clinical perspective, the “G” series of innovations has taken treatment from a displacement-driven system to a force-based system, meaning that the aligners no longer simply push teeth from one position to another. The combination of SmartTrack aligner material, optimized attachments and SmartForce features places sophisticated forces at the level of the crown that resolve to the level of the PDL, leading to more predictable movements. This is something I think many doctors don’t fully appreciate.

I still see many ClinCheck treatment plans with large rectangular conventional attachments on most teeth. This tells me that these doctors still think that the aligner simply “grabs” the attachment and displaces the tooth in space, which is not at all how the system works.

Over the next 5–10 years, I believe we will see clear aligner companies continue to mine the large volume of data they have to refine the process even more. In addition, new options like the mandibular advancement feature and Invisalign First mixed dentition treatment will continue to expand the applicability of clear aligner treatment, as will the development of 3D printing and in-house aligner manufacture. Certainly, as new players enter the clear aligner space, I believe the competition will only quicken the pace of innovation.

What’s a case that some orthodontists might not even realize is a clear aligner case? What’s your advice on getting doctors comfortable with offering it as an option in those types of situations?

The first thing that comes to mind is teen treatment. It surprises me that after a decade, only 10% of teens receive clear aligner treatment in North America. In my practice, that percentage is 80%. I find the notion that teens won’t wear their aligners or will lose them to be a myth. For the most part, teens are more compliant than adults. I routinely treat all types of teen malocclusions—including Class II, Class III, deep bite and open bite—with clear aligners.

The advice I would give to doctors is to open their minds to the possibilities and give it a try. I am now teaching live classes almost every week and have several online Master Class platforms to provide 24/7/365 education online to help doctors gain the clinical and practice management confidence they need to treat their child, teen and adult cases to excellent results. I will let others judge my clinical outcomes, but I will say that I am proud to show my finished cases.

You’re a believer in keeping the profession relevant. What do you see in the near future for orthodontics as a profession?

There’s a rising tide of fear and trepidation from some in the orthodontic specialty surrounding the rapid emergence of direct-to-consumer orthodontics. I have no doubt that orthodontic treatment is best delivered by trained specialists, and I believe that the orthodontic profession can compete on several fronts.

First, it’s incumbent upon each of us to drive the message that our years of unique training and experience make us the most qualified to deliver orthodontic care. Second, we need to listen to our patients and deliver flexible, sometimes limited treatment options that address their chief concerns in a safe and affordable fashion. Along with this, it’s most important that clear aligner manufacturers partner with doctors and offer more affordable appliances to address these limited treatment options in a way that allows the average orthodontist to deliver great care and still make a fair profit.

At this point, I don’t see a product on the market that can allow us to compete with direct-to-consumer systems on a level playing field. Along with this, we need our state dental societies to rapidly open up opportunities for orthodontic auxiliaries to provide services such as digital scanning with less doctor supervision.

On top of turning your office into primarily a teen clear aligner practice, you’ve also let your workflow evolve all around. Tell us what your practice is like now, compared with where you were when you started.

Digital workflows allow for incredible efficiency. Over the past 10 years, I’ve reduced my days in the office from four and a half to three, with fewer staff members while seeing a 30% increase in revenue. We have halved the number of patient visits per day over the same time period. These are truly incredible times. As the great baseball general manager Billy Beane once said, you must “adapt or die.”

 

 

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One of the cool features your practice offers is remote monitoring of clear aligner patients. How does that work? It seems like something that patients would love, but how does it affect your bottom line?

These days, we are pushing the efficiency curve even further by using Dental Monitoring, which is an artificial intelligence application that allows us to monitor our patients’ treatment remotely using their smartphones. Patients install an app on their phone and are trained to use Dental Monitoring’s ScanBox to take a series of photos of their teeth every week.

We monitor their progress on a cloud-based dashboard and can communicate with them at any time. While there is an additional cost for the service, we still wind up increasing profitability with far fewer office visits, which allows for decreased staffing costs and less time spent physically in the office. In addition, because patients are held accountable for their aligner wear, we are completing treatment faster with fewer refinements.

Cortlandt Manor is a relatively small town, especially when you compare it to some of the most densely populated areas in New York. How’s the competition among other orthodontists and dentists who offer ortho treatments? What’s been your key to thriving?

There are many more orthodontists and GPs in my area providing orthodontic services than in the past, and these days many of the pediatric dentists who used to refer to me now have orthodontists in their practices. As a result, the pie is being sliced up into smaller and smaller pieces.

To keep my practice thriving, I have tripled my marketing budget over the past 10 years, with a strong focus on SEO and social media marketing. We have also strengthened our ties to the community, giving generously to many programs that support youth activities and scholarships, as well as nonprofit organizations that support patients and families suffering from breast and ovarian cancer. These charitable endeavors are a true win–win, because we can support our local community while at the same time raising awareness of the services we offer in our practice.

What made you get into orthodontics?

The movie Marathon Man, of course! Actually, I’ve wanted to be a dentist since the age of 5. My brain has always been equally divided between the scientific and the artistic, so orthodontics always seemed to be a natural fit for me. I am forever grateful to the late Dr. Anthony A. Gianelly for the opportunity to learn my craft under his supervision at Boston University. Without Dr. G’s guidance and friendship, I would not be the person I am today.

When it comes to running the business side of your practice, what has your philosophy been? How has it changed since you started? What tips would you give new docs?

From the beginning, my philosophy has been to hire for personality, not experience. I can train staff members to do their jobs, but I can’t train them to be nice, honest, loyal or dedicated. Some of my worst hires, in fact, have been staff members who had years of experience at other offices and were difficult to train because “that’s not how we did it in my other office.”

The second part of my business philosophy is to not micromanage. I have a great staff and my job is to train, lead and get out of their way. Lastly, it’s critically important to keep up with continuing education and to keep adapting to the rapidly changing world.

There are three very important tips I would give to a new doc:

Don’t undervalue the worth of your services. Charge fees that are both fair to your patients but also reflective of your skill and training.

Develop solid office systems from the beginning and stick to them.

Start saving for retirement from Day? One. The best way to do this is to try to live below your means. Simple changes like skipping the store-bought lattes can add up to hundreds of thousands of dollars more at retirement!

Tell us about the educational website you created to share information about clear aligner treatment.

I founded AlignerInsider.com as an educational resource for all aspects of a clear aligner practice, featuring online master classes on clinical aligner orthodontics, as well as practice management and marketing to help doctors take their aligner practices to the next level. It’s a resource that’s available 24/7/365.

There’s some nice country around you for riding. You cycle and you’ve got a Harley. Tell us about your bikes! What are your favorite rides, respectively?

The Hudson Valley is a beautiful place to ride! When I’m in pedaling mode, I enjoy riding my Specialized Roubaix Comp on Seven Lakes Drive in nearby Harriman State Park, or on the North County Trailway that winds through Westchester and Putnam counties. We also have world-class mountain biking trails in the Blue Mountain Reservation, which is less than a mile from my home. If you come to this neck of the woods to cycle, be forewarned that it is very picturesque, but also very hilly!

As far as my 2012 Harley-Davidson Fatboy motorcycle, many of the same winding country roads make for a great place to take a relaxing cruise. I’ve also done some incredible riding out in the Las Vegas and Phoenix deserts. You get a completely different perspective when you’re on two wheels.

Other than hanging out on two wheels, what’s your life outside of the practice all about?

My wife, Tracy, and I have just officially become empty nesters, and we’re taking advantage of that opportunity to take some amazing active vacations! Over the past several years, we’ve cycled with the fantastic company Backroads through Quebec, Provence and Tuscany and hiked our way through Iceland. I also have the unique opportunity to travel the world teaching as an Align Master Faculty member and have given hundreds of lectures to thousands of doctors on five continents. These days, I’m on a plane going somewhere to teach almost every week. It’s an incredibly rewarding, sometimes exhausting gig.

If you could go back and give yourself advice when you first started practicing, what would you say?

The first piece of advice I would give my younger self would be, “Don’t be afraid of change.” The orthodontic landscape is rapidly changing, and it’s imperative to keep up with the changing trends in orthodontics. The second piece of advice is to try to live life to the fullest every day. Time goes by so quickly, and for sure I would tell my younger self to try to worry less and enjoy life more!