This Townie’s 5 years of practice ownership have left him positively focused on success
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, we visit Dr.? Matthew Schofield, who was selected in a drawing from all the Townies who completed their ballot in the 2019 Townie Choice Awards. (In addition to appearing on the cover of this issue, he also received a $1,000 prize from Orthotown!)
A young orthodontist who bought his practice shortly after graduating, Schofield has navigated the twists and turns of practice ownership while maintaining a unique connection with his teenage clientele. Read on to see how he overcame some of his biggest struggles and what he’s learned along the way.
You were surrounded by a lot of people who worked in the dental field when you were growing up. Your best friend’s father was a dentist, another good friend’s father was your orthodontist and your pastor was an oral surgeon. Is it safe to say pursuing a career in orthodontics was inevitable?
Many dentists are lucky to have family members in the field who influenced them in their career choice. I don’t have any health care providers in my family, but I benefited from the amazing examples of friends and their families I grew up with. It’s rare to call your family dentist, orthodontist and oral surgeon “close family friends.” I also did have orthodontics twice as a kid, which definitely familiarized myself with the profession.
In the end, my best friend, who always knew he wanted to go into dentistry, was the biggest influence in my ultimate decision. I even went as far as to move to Kentucky to attend dental school with him at the University of Louisville before I was accepted at New York University and moved to New York City. (I was probably better off not attending with him, honestly, because we would have joked around too much.)
Your path to orthodontics wasn’t exactly smooth sailing: You started out as an English major, and didn’t get into dental school the first time around. How did you move past that and ultimately become an orthodontist?
My issue in high school and the university was that I simply wasn’t working hard academically! I was focused on being “well-rounded,” which basically meant not stressing about grades and having a good time. Definitely not the best strategy for getting into professional school. I did well on the DAT and my overall GPA was fine, but my science GPA was mediocre and my extracurriculars weak.
After I got my act together at the very end of college, retook a particularly difficult class—Organic Chemistry II, anyone?—and added a few extra science classes to my course load, I significantly improved my acceptance chances.
The second time around, I got a few more interviews, and the one at NYU went particularly well. While on the tour at my NYU interview, I was lucky enough to run into two old friends whom I hadn’t been expecting to see. One was from my high school in Sacramento and another was a college friend from Denver. The faculty on the tour noticed how well I “fit in,” and said that did play a factor in my acceptance. After I got into dental school, I put my head down and worked, worked, worked in classes as I’d never worked before. I wanted to specialize, I was sure, but didn’t decide on orthodontics until I got into the clinic.
I came across this quote recently by President Calvin Coolidge:
Nothing in this world will take the place of persistence. Talent will not. … Genius will not. … Education will not.?… Persistence and determination alone are omnipotent. The slogan “press on” has solved and always will solve the problems of the human race.
I sincerely believe in this principle of simply working your tail off to victory.
1. G&H miniPrevail buccal tubes. I finally found a tube I really love: microetched pad, no crushing issues, ID’d center of resistance for easy placement. We bond most all 6s and 7s, so it’s nice to have a tube that is very reliable and easy to use.
2. TP Mini NuEdge brackets. Love the quality. Very few debonds, and great control for finishing. I’ve used only this bracket since I’ve graduated, and really can’t think of a reason to change.
3. 3Shape Trios scanner. I’m so glad we have one. It’s a balanced combination of scan speed, head size, upkeep costs, versatility and quality.
4. Ixion instruments by DB Orthodontics. I’ve been very happy with all the instruments we’ve purchased from DB?Orthodontics. They cut well, are slim and ergonomic, and hold up very well after autoclaving.
5. SureSmile DIY Aligners. I don’t always use clear aligners, but when I do, I use SureSmile aligners with the DIY option. I’ve been very happy with the software, turnaround time and quality of the product. It’s the level of customization and control that excites me. Without using a technician, you’re able to detail the movement, the number of aligners and attachments. It’s great for relapse, finishing and hybrid options where one arch is done with fixed and the other in aligners.
You bought your practice in 2015, shortly after graduating. What led you to make that decision and what obstacles did you face? How has your practice grown since then?
Ownership was always something that attracted me to dentistry. Of course, the reality is that startups take a while to get off life support and finding a practice to purchase can be very difficult. Of the practices available, many seem like risky investments, with either collection numbers that are too low or burdensome overhead costs.
I was wildly fortunate to connect with a Columbia alumnus, Dr. Cecil E. Alumbaugh, who was looking to sell his practice before I started my last year of residency. You sometimes hear horror stories about transitions after buying a practice, but we honestly had an incredibly smooth transition. He was gracious and respectful to me, and I was blown away by the connection he had with his patients and the quality of his work. His patients truly loved him!
For the first three months, we worked on the same days while he continued to see all the recall patients and I focused on meeting current patients, consults and new starts. After three months, we split the patients into those who were finishing and everyone else. For the next six months, we practiced together on different days before he rode off into the sunset. We still go out to lunch a few times per year, and I count him as a dear friend and mentor.
Fortunately, the office has grown over the past four years and I can maintain everything on this location alone. The growth has come through reaching out to new referral sources, moving to a more visible and better location, and increasing the convenience of the practice.
When you first started out, in addition to working at your own practice, you worked at four other practices. Why did you decide to do this, and what led you to ultimately quitting your “side jobs” to focus on your own practice?
For the first three years, I worked two days a week in the practice I’d purchased, without pay, as it grew. I lived off a three-days-a-week corporate gig and also saw patients out of a friend’s general dentistry practice once a month. I honestly enjoyed all of the patient care, but as my office grew, it made the most practical sense to go “all in” even if it was an initial financial risk.
I know there are orthodontists who work both corporate and private long term (like Townie “UCLA98”), but the upside to growing your own office is so much greater than per-diem corporate gigs. I enjoy more work–life balance now because the schedule flexibility and control have allowed me to spend more time with my family. The amount of clinical control you have at your own office typically isn’t as robust at DSOs. Corporate outfits are typically not run by orthodontists, and most can’t appreciate low-ROI investments such as software, TADs and scanners, or even TMA wires.
Still, it seems like single-office orthodontists are becoming fewer and farther in between, because putting together three busy days a week at a stand-alone office can be very difficult. Working multiple gigs is the reality for most young grads, and I think the key is doing the very best orthodontics you can, wherever you are. I’m hopeful the employment landscape will continue to allow for private practice ownership, because I think a good argument can be made that it has the potential to offer a good quality of life for the doctor and very good patient care.
You’ve taken humanitarian service trips to Grenada and lived in the Dominican Republican for two years. How did those experiences help you connect with your patients?
I’m really proud to say that even though Irving is principally Hispanic, it’s the most diverse city in Texas! My entire team and I are bilingual, speaking both English and Spanish, which I know is of great benefit to our Hispanic patient population. We treat patients from nearly every Latin American country, most states and territories of India, Nepal, Bangladesh, Sri Lanka, Vietnam, Cambodia, Korea, China, Taiwan, Japan, Philippines, Ghana, Nigeria, Gambia, Senegal, Egypt, Sudan, Iraq, Iran, Syria, Pakistan ... and I probably have forgotten many more.
Living in New York City for seven years, taking service trips to Grenada and living in the Dominican Republic has given me a profound appreciation of other cultures and diversity. Through the difference, there is so much that unites us. Everyone values family, education, health, fairness, integrity and, thankfully, aesthetics.
What advice do you have for someone who wants to own their own practice straight out of school?
Good luck! It will be worth it, but don’t underestimate the number of things outside of teeth you need to understand well to succeed.
I think I benefited initially from not biting off more than I could chew. It’s nice to start small for a few years and work up to a dream office.
Definitely watch your fixed overhead costs, such as rent and staff. You can do a lot of orthodontics with two chairs and two staff members. Check out the industry recommended percentages for each overhead category and monitor those closely. Try not to deviate too much from those numbers, though it is hard with lower collection numbers.
Learn as much as you can about organizational behavior and keep your team filled with people you trust. Commit yourself to provide the very best orthodontic treatment.
Unfortunately, I’m not sure that just working hard, being honest and providing good results guarantee success anymore. But I still believe those values offer a solid foundation on which to build any success. You can have all the marketing and sales skills you want, but integrity still goes a long way in orthodontics.
What’s an average day like at your practice? What does your patient population look like?
After I’ve met with the treatment and financial coordinators about consults and financial issues, our team huddle begins promptly 15 minutes before the first patient. Days before, I review each chart, check the records, and confirm the treatment plan we created for the visit. We then go over each patient’s treatment as a team, adding any details or corrections. We see just 35–40 patients per day, with the whole gamut of procedures being scheduled.
Debonds and long treatment procedures such as laser or TADs are scheduled in the morning, while bondings and recalls are scheduled throughout the day. I “glove up” for every patient and prefer a hands-on style, notwithstanding the confidence and trust I have in my team. We stagger lunch and breaks, and don’t stop seeing patients all day.
Once a week, we have a three-hour block for meetings or training where we go over anything and everything we need to do to get better as a team. The morning huddle and weekly training have been invaluable in creating the kind of environment that’s easy to work in day-in and day-out.
As far as patient population, we have a 70/30 split for adolescents and adults. We do very little Phase I treatment, so 95% of our active cases are “comprehensive” plans. Our number of lingual cases is growing rapidly and now make up 5% of our total cases.We’re doing less and less “full” clear aligner therapy, though I am doing many hybrid treatments with the upper arch SureSmile DIY aligners and the lower arch fixed labial.
What do you enjoy most about working with teenage patients?
Teasing teenagers is my favorite social part of being an orthodontist. Many of these young patients are in the most difficult emotional period of their lives, and I try to make it clear they can count on me for unlimited amounts of cheerleading. I’m passionate about connecting with them because they need as much support as possible—not to mention I know it produces better compliance and, therefore, better results.
Luckily, I have lots of life experience being a teen with braces. My first time in treatment, I was a knucklehead 11-year-old who didn’t brush his teeth or wear his rubber bands. The three things I remember about that 18-month treatment was the Donkey Kong Jr. arcade game in the waiting room, my unmasked and goateed orthodontist and having to take my braces off early for noncompliance. What a disaster!
I got treatment again at 17 years old when I was just starting my senior year of high school. I went through senior pictures, prom and graduation, and started my freshman year of college, all with braces on. Oh, the humanity!
Fortunately, none of this life experience has gone to waste. I hope I’m much better at motivating 11-year-olds because I can definitely understand when they’ve had a bad hygiene or elastics appointment. It’s also super easy to empathize with older teenagers who are worried about braces getting in the way of some important life moments. Kids need to know you’re on their side, you’re in their corner, and together you can do something very hard and very rewarding.
•?SmartJet by DynaFlex
•?Memoria Leaf expander by Leone
•?Reliance Assure Plus
•?Monobond Etch and Prime
•?Groman Dental Microetcher
Brackets and wires
•?GC Orthodontics Chic ceramic brackets
•?3M Transbond Plus
•?Ultradent Opal Band cement
Class II and III appliances
•?Dentaurum Tomas TADs
•?Opal Gishy Goo
•?TP E-link modules
•?Orascoptic loupes with Spark light
You have a lot of experience in lingual orthodontics. What do you like most about this treatment, and how often do you provide this treatment?
Providing lingual orthodontics is difficult, which is probably why I’m drawn to it. Though I was always interested in it, my exposure to lingual orthodontics in residency was minimal. That’s pretty common in the United States.
When I saw a first-of-its-kind lingual fellowship offered at the University of Texas Health Science Center at San Antonio, I decided to take advantage of the opportunity—and it was an absolutely great decision! Getting to learn from some of the best lingual orthodontists in the world gave me the confidence to treat difficult cases and to navigate problems and issues that arrive in nearly all treatments, lingual or otherwise.
Clear aligner therapy is amazing, and has proven it can provide excellent results even in difficult cases. In my experience, however, it takes longer than I would like to arrive at those results (to nearly everyone’s exasperation). When patients ask for clear aligners in a consult, I simply find out if there’s something specific about plastic they like or if they’re just looking for aesthetic treatment. Lingual is so much more predictable for me in terms of time in treatment and result.
One thing that burned me right out of residency is underestimating patient expectations. Patients want the very best result, period. If it can be or look better, they want it. I’m able to provide an excellent result more predictably with a fixed appliance, and a lingual appliance satisfies the aesthetic demands of patients who can’t or won’t consider a traditional labial appliance.
Orthodontics can be a pretty taxing profession, both mentally and physically. As a result, you’ve developed some back pain, which led to you going to physical therapy. How has this helped you, and what would you recommend for other orthodontists to help combat it?
From the stress of graduating residency, finding a job, moving halfway across the country and learning how to run a practice (most definitely the last one), I found myself getting steroid shots for excruciating back pain. It took about two years to get the pain under control and have it not be a daily issue.
I’ve developed an exercise and stretching routine I do once or twice a week that has helped tremendously. It’s an amalgamation of physical therapy, yoga, and flexibility or resilience training. I found, too, after analyzing my movements at the gym, that I tend to really strain my cervical spine, so I watch that very closely when I’m exercising now. Sleeping on my stomach also had to stop.
Still, when I feel a flare-up, I pop 800 milligrams of ibuprofen and a proton pump inhibitor to immediately reduce the inflammation, and I stay on that for two or three days. Between the inflammation reduction and DIY physical therapy and stretching routines, it’s not a daily distraction. I also really love my loupes and light, which help me have better posture during extended procedures. My hope is that everything will stay under control so I can avoid surgery and continue practicing for a long time.
Tell us about some of your hobbies. What do you like to do in your free time?
Free time is 99% dedicated to family, fitness and music. Probably 1% to fantasy basketball. I have four kids and an amazing wife, with whom I love spending time playing games, doing family yoga, reading, going to the park and swimming. Through the influence of one of my orthodontic co-residents, I really got into high-intensity interval training, and I have tracked every one of my workouts since the middle of residency. It’s always a good day when I can set a personal record on an exercise or routine.
Besides exercise, I love unwinding with my Reverend BC1 Billy Corgan signature guitar, Fender Blues Junior IV amp and Big Muff Pi fuzz pedal. My kids think I’m crazy, but rocking out is really good for my chi!
Fantasy basketball is nothing but social media for crotchety old dudes. Growing up in Sacramento, the NBA is the only professional game in town, and you grow up a huge basketball fan. Fantasy basketball lets busy, old basketball friends stay in touch.
What’s something you’d like to see orthodontics do differently, as a profession, within the next 10–15? years?
Orthodontists are amazing! Count me in the “colleagues, not competitors” camp. We need to support and back each other up in providing the best orthodontic care possible.
The two slippery slopes of orthodontics are elitism and quality of care. The two ideas are so intertwined because the better care we provide, the more we feel entitled to get what we deserve. On the other hand, when we offer convenience and affordability, we may feel inclined to cut corners on the clinical side by justifying that patients are “getting what they paid for.” The best orthodontists are ones who eschew elitism, obviously, charging a fair fee and running a profitable business while offering the very best orthodontic care they can. We are doing that, and I hope we continue to do it.
Technology, of course, will continue to improve and it will likely increase our quality of life and quality of care. If I had to look into the crystal ball of orthodontic technology, apart from ubiquitous 3D printing, we’ll likely get to a point with imaging that quality and dosage can balance, and 3D imaging becomes the standard of care.
I don’t know how far down the road that is, but it might be realistic for the next generation of orthodontists to be trained in planning not only aesthetic crown placement but also healthy root placement in the alveolus based on enhanced imaging. The software is basically already there, and now we just need the capturing to improve in order to justify the radiation. It could be really exciting!