This Bay Area Townie, already a proponent of a high-tech office, leapt into action to treat patients during the COVID-19 pandemic
by Kyle Patton, associate editor
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. Howard Chu’s scratch practice that sits in the foothills of California’s San Gabriel Mountains. Chu and his wife, a pediatric dentist, partnered up professionally to run a multispecialty office that combines fresh aesthetics in a great design.
Read on to learn how the the couple went about the process of building an office from the ground up, Chu’s advice for docs who want to do the same, his outlook on the future of the profession, and more.
Name and credentials:
Dr. Howard Chu
DMD: Harvard School of Dental Medicine
MS in orthodontics: UCLA
Fresh Orthodontics & Pediatric Dentistry
2,600 square feet
4 open bay chairs
2 private operatories
Let’s hear your origin story.
My parents always pushed me to become a medical doctor. As the obedient child, I volunteered at the hospital and began my college career at Arizona State University majoring in molecular biosciences and biotechnology. Very quickly, I discovered that I did not have the passion for molecular biology and changed my majors to philosophy and Spanish. Nevertheless, I continued the path of being a premed student.
During a medical volunteer trip my junior year, I unexpectedly rotated through a dental hygiene station. This was my first exposure to dentistry and I absolutely fell in love. I realized that while I did not like being in a hospital setting, I very much enjoyed the patient interaction and lightheartedness of dentistry.
I returned from this trip and focused my efforts on learning the field of dentistry. I began to shadow different dentists and eventually became an assistant for a general dentist, Dr. Daniel Kang, working part time assisting in both the front and back office. That time solidified my desire to go into the field of dentistry. With Dr. Kang’s guidance, I applied to dental school and was accepted at Harvard School of Dental Medicine.
During dental school, I explored all the different specialties and found my true passion in orthodontics. Because my mother lived in Los Angeles at the time, I accepted a position and graduated from the orthodontics program at the University of California Los Angeles.
You started a scratch practice with your wife, a pediatric dentist. How does her side of the office benefit your side, and vice versa?
We call Christine’s pediatric dental side the “farm system” for our orthodontic side. Most of her new patients are much younger, in the up-to-age-7 range, and don’t require any orthodontic treatment at the moment. As these patients become older, we can expect some of them to become orthodontic patients. On the flip side, some orthodontic patients I see transfer their general/pediatric dental care to our office due to the simplicity of being under the same roof.
Walk us through an average pre-pandemic day, then explain what you’re doing differently now.
Before COVID-19, I would see about 10–15?patients a day. Luckily, our schedule hasn’t really changed much since the outbreak. We do have new social distancing policies in place to protect everyone, such as having the patients wait in their cars until we take their temperature. We perform all aerosolizing procedures in the private treatment rooms now, and we also separate the patients in the open bay by seating them in every other chair.
The biggest change for me is the new personal protection equipment (PPE) required for these procedures. It can definitely make me sweat after a long appointment!
Give us a summary of the past few months—specifically how COVID-19 affected your practice.
Our office closed March 16 and reopened June 1. It was stressful and chaotic in the beginning, because we didn’t know the extent of the pandemic or how long we’d be closed. We used the 10-week break to apply for different federal loans and to ensure that we obtained the proper personal protective equipment for once things reopened.
Returning to normal—the “new normal”—what changes have you already implemented in the office?
Before their appointments, patients are required to fill out a coronavirus-related health questionnaire and informed consent to treatment. We ask all our patients to text the office once they’ve arrived in the parking lot. A staff member will meet them at their car and take the temperature of anyone who’s entering the office. Once in the office, we maintain social distancing and will only perform aerosolizing procedure in the private operatories with the appropriate PPE.
How do you feel this pandemic will change the future of dentistry?
It has increased the amount of personal protection equipment required for aerosolizing dental procedures. We are currently using N95 or p100 respirators and a face shield for these procedures. Without a proper vaccine for COVID-19, I don’t believe that these recommended protocols will be eased any time soon.
You built your practice from scratch. The finished product is amazing, but it was a challenge to get there. Walk us through the journey.
With the help of a family real estate agent, we were able to locate an old office building that operated formerly as a call center for vehicle donations. We stretched our resources and applied for a Small Business Administration loan so we could purchase the building and began our project.
The next step was to demolish the existing office. During the demolition, asbestos was discovered, which required further abatement and testing from a third party.
We hired Joe Architect and Velocity Design Builders for our project and began the design of the floor plan and office. Because of the old nature of the building, many parts of the office were not up to ADA code. We had to move the front door of the office and redesign and add concrete to the parking lot to become ADA-compliant.
The city of Monrovia, where our office is, also started to outsource its plan checking. The third-party reviewer took forever with revisions and required multiple rounds of back-and forth-talks to obtain all the approvals. Overall, the project took more than nine months to complete.
What are your Top 3 design-related elements of your practice and why?
Open waiting area. We wanted to create something that felt inviting for the patients—a place where kids would not feel like they’ve just arrived at a dental office.
Private entrance for doctors and staff. This allows for discreet movement of the staff and doctors.
Our floor plan has a circular path across the entire office that allows easy access to and from any direction.
How did you get past the fear of starting this massive project, and what advice would you give to dentists looking to build, remodel or move?
There is always fear in doing something that you’ve never done before. However, someone once told me that no one has ever regretted starting their own office too soon.
My best piece of advice for dentists looking to build, remodel or move: Bet on yourself. You know what type of doctor you are. You know the type of environment you want to create. So why not take the risk to create something that is completely yours?
You admit to being a bit of a control freak. Your office gives you the opportunity to exercise that control. What are you doing in your new practice that you love?
The control is probably the main reason why we started our own office. To be honest, I love sculpting the entire patient experience, from the moment they’re greeted by our front office team to the music that’s being played to the scent of the air to how we interact with them. Making sure that their “experience” is of the highest quality is what we focus on.
ODL Orthodontic Lab
Along those lines, you love the ability to pick your starts. What sort of cases get you the most excited, and which kinds do you postpone or turn down?
The cases that get me the most excited are the ones where the patients are the most excited and passionate about their treatment. It is such a cool energy when a patient trusts you completely with their care and is excited and dedicated to move forward with the process.
Cases that I tend to postpone or turn down are cases where the patients are not motivated or do not have trust in my care. Infrequently, I will have consults with parents who are “dictating” what is required for their child. These are definitely cases I avoid.
Where do you see your practice 10 years from now?
My goal is to realize our office vision: to create a “brand” of orthodontics and pediatric dentistry where thousands of patients have been treated and still appreciate the experience and care that they’ve received so much that it becomes second nature for them to refer their friends and family to our practice. My goals as an owner are to treat my work family as my second family, and to take care of them and grow together.
How do you market your practice and how is it going?
Our main marketing dollars go to Yelp and Google Ads. As a new startup, we find that most of our patients are searching for us online. We are slowly growing, and our internal referrals are also increasing.
Tell us your favorite patient story.
It happened when I was doing a consultation for a 19-year-old Hispanic male at a different multispecialty office in which I was working. After I reviewed the treatment findings and started to discuss the treatment options, he very quickly stops me and says with the straightest face, “Doctor, if I buy my own set of braces off eBay, can you install them for me?”
I looked at him and responded, “I’m sorry, my man, but braces are not tires. There is much more to it than that!”
He then responded, “I know, I know, but I’m not trying to buy the ones from China; I’m only looking into the German ones!” Let’s just say he did not end up starting treatment with me.
What’s your approach to educating patients? What advice would you give to orthodontists who’d like to improve this area of their practice?
My approach is to explain things in layman’s terms. When speaking to patients and parents, instead of using “overjet” I will use the more colloquial “overbite,” because they understand this concept more easily.
Another example: When explaining “impacted” third molars, I will simply say that there just is not enough room for them to fit. My goal is to make sure that the patient and parent understand the point that I’m trying to make and to not overwhelm them with jargon. My advice: At the end of an appointment, always ask if they have any questions or concerns.
Outside of practice, you’re big into fitness. What’s the most intense workout you’ve ever done? If you had to win a bar bet, what would you challenge someone to try?
I love CrossFit and Olympic weight lifting, and I have been doing both since 2011. The most intense workout I’ve done was when I first started CrossFit and did the workout called “Fight Gone Bad.” The workout consists of a mess of movements, stations and an unrelenting clock. You spend a full minute at each station doing as many reps as possible, then switch to the next station. The workout got its name from professional MMA fighter B.J. Penn, who performed the workout, which is timed similarly to an MMA fight. When asked how the workout compared to a fight, he responded that it was like a “fight gone bad.”
If I had to win a bar bet, I’d challenge someone to either a clean-and-jerk or snatch competition. My personal best for each is 320 pounds and 260 pounds.
Tell us about your family and how you balance work and life.
We have two beautiful boys that just adore each other. Blake, the oldest, is 3½ and our youngest, James, is 9 months.
We are so fortunate because both boys go to a small, family-run day care that’s just two doors down from our home. Morning drop offs and afternoon pickups are a breeze! Our routine is to drop off the kids by 8:30 a.m. and pick them up at 5 p.m. after work. Our office is closed on Fridays, and we use this day for errands and personal time. The weekends are for the kids.