Coupling Up by Dr. Brion Long

Categories: Orthodontics;
[Coupling Up

Orthodontic/pediatric dentistry partner practices are becoming more popular. Here’s what to know about these relationships, from a doc who’s thriving

by Dr. Brion Long

Editor’s note: As orthodontists battle to stand apart in an increasingly competitive market, some doctors have added a pediatric dentist to their practices as a way to offer more to patients under one roof, as well as to increase the number of internal referrals. When the partnership is approached smartly, it can be a win-win situation—but it’s not a decision that should be rushed, because there are some possible negative ramifications, as well.

When Dr. Brion Long opened his first standalone practice in Tallahassee, Florida, in 2014, the orthodontist brought aboard two pediatric dentists. Seven years later, the concept has been so productive that Long is opening a second location of SmileWorks Children’s Dentistry and Orthodontics, and offered to share some details of what a successful partnership looks like.

How did you get involved in a pediatric/orthodontic practice?

My interest arose just from an amalgamation of my experiences after graduating from dental school. Upon graduating from Oregon Health Science University School of Dentistry, I went into practice at a public health dental clinic, where I got a heavy exposure in the world of pediatric dentistry. In dental school, I never really had any desire to work in pediatrics, but after my exposure in public health, I discovered I enjoyed many aspects of that specialty. After I graduated from orthodontic residency, I worked in some corporate practices that had incorporated a dual orthodontic/pediatric dental model, and I was able to see what worked and what didn’t in those offices.

When I had the opportunity to buy an existing pediatric dental practice, I was excited to incorporate and improve on the knowledge I had learned. When I opened the practice in 2014, I wanted it to focus on providing excellent patient care, utilizing the latest technology, and have a stellar team to help deliver the best care possible.

The pediatric/orthodontic office is one of the fastest-growing trends in the dental industry. What are some of the advantages you have seen in moving towards this model?

One area that patients as consumers are paying attention to is the rising value of convenience. It’s very convenient for parents if their kids can have a cleaning and orthodontic adjustment at the same appointment, for example. And patients increasingly are looking to receive care under one entity because of established familiarity within a particular practice. If a child has been seen at a very early age in the practice, it’s a very comfortable transition for them to stay and receive orthodontic care at the same facility.

Another advantage is collaboration between the pediatric and orthodontic specialists in the office. More complex problems can be identified at an earlier age, and facilitated communication between the specialties flows naturally to help provide an exceptional service for the patient.

It’s also very convenient to have scalability in staffing based on patient demand for scheduling. All of our team members have been, or are in the process of being, cross-trained in both specialties, which makes us much more efficient. For example, if there is a cancellation with the pediatric schedule, we can easily fill that time with an orthodontic procedure if needed. Cross-referrals between the specialties is also very easily accomplished.

Economies of scale can be more easily accomplished in a pediatric/orthodontic practice, too. Technology is playing an increasing role in both specialties, and overhead costs can be greatly reduced with shared resources. For example, the Solea hard- and soft-tissue laser in our practice can be used for anesthesia-free restorations in pediatric dentistry, and also to expose covered teeth for orthodontic bonding. So although it may be an expensive cost outlay, that can be mitigated to some extent by utilizing the same equipment by both specialties in one facility.

What are some of the disadvantages of this model? What are some of the challenges that you have come across?

Unfortunately, some of the strengths of the model are also its biggest weaknesses. Cross-training staff in both specialties greatly increases the amount of training time. Each specialty’s billing, insurance and scheduling are very different from the other’s, which adds a layer of complexity for team members.

To fully maximize the benefits of simultaneously running both specialties, it’s smart to have a larger facility. One of the challenges we face right now is that during high-volume times of the day, we tend to have a shortage of dental chairs. But depending on where a practice is located geographically, having a larger practice footprint may or may not be a viable option.

Another downside for the orthodontist is potential loss of referrals from other pediatric dental offices. Most pediatric dentists won’t refer patients for orthodontics if they believe the patient might want to transfer to the pediatric side of the practice as well. (This is understandable, but should be more than compensated for by internal referrals.) That being said, many practice management coaches say a pediatric dental provider could refer 30%–50% of its pediatric patients for orthodontics at some point in time. Internal referrals from just two pediatric dentists would be enough to sustain a healthy orthodontic practice.

Adult patients, depending on whether they have children in treatment, may not feel as comfortable being in an office environment with a lot of children present. Our office design and interior layout is set to appeal to a wide age range of patients. If you’re looking to wade into the pediatric/orthodontic model, it would be wise to not make the atmosphere too focused on very young children at the expense of teenagers and adults, especially if you intended to create an adult-oriented orthodontic practice.

Combining practices also can present a challenge in the practice management software for both specialties. With the rapid growth in pediatric/orthodontic practices, a number of practice management software packages can process both specialties—Dolphin, Cloud 9 and DOX, to name a few. In my experience, each of the practice management options is great for the specialty it originated in but is lacking for the secondary specialty. (For instance, Dolphin is great for orthodontics but is missing features offered by a pediatric dental management system.) As the trend toward combining pediatric and orthodontic practices continues, I expect to see a greater refinement in the operating systems available to support an orthodontic/pediatric dental practice.

What are some of the challenges that you see facing orthodontics in the future? How do you see the shared practice of orthodontics and pediatric dentistry fitting into that future?

I think the traditional referral model to orthodontists from general or pediatric dentists has been in decline. We’ve also seen the corporate dental model moving into both orthodontics and pediatric dentistry. The convenience to patients, economies of scale in purchasing, shared staff and advertising, all advantages that can be brought by the orthodontic/pediatric dentistry model, can enable private practitioners to stay economically competitive in the changing environment of tomorrow.

What are your plans for the future?

We’re in the process of building a second building from the ground up. Ground-up construction is always more complicated than a build-out, but it also provides the opportunity to design and build what you really want. I’m very excited to be able to incorporate some of the available new technology into the new building.


Author Bio
Brion Long Dr. Brion Long graduated with honors from Oregon Health and Science University. After graduation, he served as the dental director of La Clinica del Valle in southern Oregon, where he managed multiple clinics that provided care to the underserved population. Long completed more 6,000 procedures on pediatric patients there. He also held many leadership positions, including serving as co-president of the Northwest Regional Primary Care Association and as a member of the steering committee that developed policies for the California Primary Care Association.

While completing his orthodontic residency at the University of Florida, Long conducted benchmark mixed-dentition research for Align Technology. He is a member of numerous dental organizations, and served as adjunct faculty at Oregon Health and Science University and Oregon Institute of Technology. He also is an adjunct clinical professor at the University of Florida’s College of Dentistry.

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