Office Visit: Dr. Gary Kawata by Kyle Patton, associate editor

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Categories: Orthodontics; Practice Management, HR and Accounting;

by Kyle Patton, associate editor
photography by Christina Gandolfo

Orthodontists spend most of their working hours inside their own practices, so they usually 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 how they practice.

Dr. Gary Kawata has been helping shape the minds that make up the orthodontic world for decades, one class of students at a time. This Townie has won four “teacher of the year” awards serving as a clinical assistant professor at the University of Southern California’s graduate ortho program—where one of his pupils was Orthotown’s own editorial director, Dr. Chad Foster!

Adding to that, Kawata runs a beautiful practice in Corona, California, which we highlight in the pages that follow. Hear his take on the new and upcoming generation of orthodontists, the teaching tips every doctor can bring to their practice, how study clubs can save a career and why sometimes the best source of referrals can come from making a mistake.

Office Highlights

Name:
Dr. Garrett “Gary” Kawata

Graduated from:
University of Southern California

Practice name:
Kawata Orthodontics,
Corona, California

Practice size:
2,400 square feet

Team size:
7

Walk us along the path you took to becoming an orthodontist.

I attended the University of Southern California for my undergraduate studies, and I always knew that I wanted a career in health care. I started as a pre-med student, because I had two uncles who were physicians. But as I thought about the medical field more thoroughly, I started to remember the many times that my uncles were called away with emergency pages and telephone calls during the holidays. My father was a general dentist, and it was quite rare for him to have emergency calls.

After a few talks with my dad, I switched to pre-dent. I had good grades and test scores, and my dad mentioned that I might be able to get accepted into dental school early, so I applied, was accepted, and started dental school after my third year of college. I was fortunate to attend the University of the Pacific School of Dentistry (later renamed after Arthur A. Dugoni). Because I bypassed my final year of college, I was young and looked even younger. My dad advised me that if I didn’t mind a little more schooling, he felt that I would have a better life as a specialist, so while in dental school, I started looking at the different dental specialties.

They had an extracurricular mixed dentition class at UOP that gave us some contact with the orthodontic residents. After shadowing the residents and a couple of private practice orthodontists, and seeing the positive effects of orthodontics, my decision was made: I would pursue the specialty of orthodontics. I attended the University of Southern California for my orthodontic residency, finishing in 1986.

How did you first get involved with teaching, and what has it meant to you?

When I completed my residency, I was asked to stay on and teach in the undergraduate orthodontic department. I accepted and taught part time in the cephalometric course. In 1999, after becoming certified by the American Board of Orthodontics and joining the Edward H. Angle Society of Orthodontists, I was invited to teach in the graduate orthodontic department.

I started teaching in the residency program in 2000. It has been an extremely gratifying experience, and I am humbled that the residents are so appreciative. I’ve told so many people that our residents pay a lot of money to attend our program and that I would understand if they acted entitled or spoiled, but there isn’t a day that passes where they don’t say “thank you” to me. It makes me feel appreciated and makes me want to do my best to help them!

Also, I should add that I felt that it was an honor to be asked to teach in the program that I attended—a program where I had so much respect for the talent, commitment and accomplishments of the faculty. When I attended the program, almost all of the faculty were ABO-certified and most were members of the Angle Society.

As a clinical assistant professor in USC’s graduate orthodontics department, you’ve been voted “teacher of the year” four times. You must be doing something right! What tips do you have for those interested in being better teachers, whether in the classroom or the practice?

Try to put yourself in your students’ position. Depending on their dental background, some of our residents come in with a fairly good understanding of the basics, but others start our program with very little knowledge of orthodontics. I try to start slow and let them know I’m going to be a partner in their education. I think it amounts to having the residents understand you want them to be the very best they can be. I try to take down the barriers that they might have that slow the learning process.

When I meet the first-year residents at our initial meeting, I always tell the story about how intimidated I was as a first-year resident—how I was afraid to ask questions because I didn’t want the instructors to think I was stupid. So I wouldn’t ask my questions and eventually I would get things figured out, but it slowed my learning cycle down. I explain that if they have a question, to not be inhibited about asking, because I can almost guarantee that one of their fellow residents has the same question. I try to be approachable so the residents are comfortable asking me whatever they want. And I believe it has been a good approach, because over the years, I have had many of our past residents call or email me with questions about orthodontics, practice management and life in general.

You’re a mentor to many, but who are the mentors in your life?

I have been fortunate to have had many wonderful mentors. Dr. Arthur Dugoni was the dean at UOP when I attended dental school, and I still believe he was the best ambassador that dentistry has ever had! His list of accomplishments is legendary: CDA president, ADA president, ABO president, etc. He was so positive and motivating, and made you proud of your career choice. Paraphrasing one of my favorite quotes of his: “At UOP we build people, and along the way, they become doctors.” His humanistic approach was very much appreciated and fostered a positive learning environment in the school. I have attempted to emulate his positivity when teaching and in my office.

When I started the orthodontic residency program at USC, the chair was Dr. Harry Dougherty, and he was so smart, skilled, experienced—just a wonderful teacher. On a side note, he was probably the best storyteller I’ve ever met. Sometimes my classmates and I would ask him questions so he would get distracted and end up telling us another story! He was a Renaissance man, and I never tired of listening to him.

Dr. Julian Singer’s influence came several years later. He taught the program’s literature review course, and it was there that we discovered that his daughter had been one of my elementary school friends, so it created a bond between us. During the program we had talked about board certification and the Edward Angle Society, so about 12 years after I finished the orthodontic program, I called and asked for his assistance. At that time, as part of the requirements to become ABO certified, you needed to present 10 cases with before/after patient records in eight specific treatment categories, plus two other miscellaneous cases. In preparation for the case presentation section of the exam, I brought around 25 of my possible ABO cases to Dr. Singer’s office for evaluation, and we spent the weekend together. Dr. Singer helped me see things that I had never previously noticed. It was the turning point in my career as an orthodontist. It reminds me of one of my favorite quotes: “You don’t know what you don’t know.” That weekend session opened my eyes and helped make me a better orthodontist.

And finally, my final mentor was also one of my earliest mentors: my father. I didn’t fully appreciate the excellence of his dentistry until I saw the dentistry that was being performed in the real world. He never bragged about it, but his dentistry was absolutely beautiful.

He once shared with me a story about when he was young in his practice and had prepared a posterior tooth for a crown. His patient came in for the cementation, and it took four appointments before the crown was “just right.” My dad was disappointed with the multiple appointments and assumed he would lose the patient, but to the contrary, that patient told my dad that he was so impressed with how conscientious he was, especially with something the patient couldn’t even see, that he wanted my dad to be his dentist for life because he knew my dad was looking out for the patient’s best interest.

A lot of doctors are afraid to admit mistakes, but you often share stories from your practice that help students see the benefit of doing just that. What’s one that comes to mind?

I was probably four or five years into practice, and this was before I had an in-house X-ray machine. I routinely would ask my patients to go to the X-ray lab for a progress Panorex, but they didn’t always follow through.

So one time, I completed the treatment and when I evaluated the final records, I saw that in one quadrant the upper canine and first premolar had poor root positions. I embarrassingly called the pediatric dentist, apologized for my mistake, and said that I needed to re-treat the patient to get the root positions corrected. I thought that would be the end of the referrals, but it was the opposite. The pediatric dentist said he had seen a lot worse, and the local orthodontists had never mentioned re-treatment. He was so happy that I was so conscientious, and he became a very strong, long-time referrer.

What has it meant to teach your daughter as one of your residents at USC?

It has been so incredibly fun! Because the residency classes are small—she has five co-residents—they get to know each other very well, and they create a lifelong bond. And because I’m one of their teachers, I get to know her co-residents/friends on a completely different level! And it is so fun talking about cases and different treatment modalities with her.

It also gives her a chance to see my treatment mechanics in action, so that when she transitions into my office, she’ll already have a very good idea of how I do things. The one bad thing is that she is somewhat forced to listen to some of my bad jokes. … Hopefully, she’s not too embarrassed!

With the emergence of automated technology in orthodontics, how important are the traditional fundamentals in residency training?

The fundamentals and principles will always be extremely important.

Dr. Dougherty stressed a very solid Edgewise appliance education. We were trained in both 0.018 and 0.022 standard and preadjusted appliances: He used to say that once you finished residency and were out in practice, he wouldn’t be able to control what you used. So you could try any gadget you wanted, but if you got into trouble, you would always know how to get out of trouble.

I do think that some emerging technologies will help orthodontists to get closer to an ideal occlusion, but I also believe that there will be a large number of cases (if not all) that need some tip or torque or in/out bends to get closer to perfection.

Also, I should add that a somewhat common problem that I see when I see second opinions isn’t necessarily the biomechanics but is often a misdiagnosis. What I try to impress on our residents is taking the time to evaluate the records so an accurate diagnosis can be made. If you don’t diagnose the problem properly, you can’t expect to treat it properly.

While we’re on the subject of technology, what clinical advancement or piece of tech would be the most difficult to stop using?

Well, you’re going to date me a bit, because I started practice before computers were mainstream. I used a peg-board system for my accounting, receivables, check writing, etc., and a big spiral-bound appointment book. So, I guess I need to say my computer system with Dolphin Management, Imaging and Aquarium. I have been impressed with Dolphin’s commitment to continually improving its product. I hand-traced cephs for several years, and it is so easy and quick with their imaging program.

My iTero scanner has cleaned up my lab and has helped with model storage deficiencies. I am upgrading from a digital pan/ceph to an iCat CBCT, and changing to a digital treatment card in January, so I’m excited to see how those things change life in our office. My front office team is also excited about the thought of not needing to type up and file charts!

What unique challenges do today’s residents face coming out of school and into the real world?

The biggest obstacle is debt. Some of our residents finish our program with $800,000 of debt. The debt makes it very difficult to qualify for loans to purchase a practice or home. Hopefully, the debt doesn’t affect their treatment recommendations.

When I finished school, I was fortunate because my wife had a career as an occupational therapist. We used her salary to pay all of our living expenses, and my income was used to pay down our loans. In the early years, I would joke that my team members drove nicer cars than me!

My advice to our recent graduates would be to try to live modestly, especially in the early stages of their careers, and to try to minimize their debt load. I was also advised that the best investment is the investment in yourself, because that is the one investment that you can control.

Top Products

Dolphin Management, Imaging and Aquarium. I’ve used Dolphin Imaging since 2003 and Management and Aquarium since 2009, and I couldn’t imagine ever changing to a different system. The programs do everything I need.

InterActive Communication and Training. A customizable patient education software program that I’ve used since the mid-1990s. Great visuals for initial exams.

Reliance Ortho FlexTech for fixed 3-3s. No more worries about braided or twisted wires unraveling and causing unwanted movements.

WildSmiles brackets. Fun, shaped (stars, hearts, Mickey Mouse, etc.) upper anterior brackets for Phase I patients. (Disclosure: I have a financial interest in this company.)

Nikodem or Isoglide springs for impactions. Light NiTi springs for movement of impacted teeth. The light NiTi spring creates more movement with fewer appointments.

How important is continued training after residency?

Extremely important. I am fortunate to be a regular member of the Angle Society, which I believe is the best study club in the world. There are seven components in the country, and each has its own membership requirements; our component, the Southern California component, has a very strong clinical bias. Each year, at our spring meeting, all members are required to present two of their recently treated cases, each with initial and final records. We spend the day evaluating and critiquing each other’s cases, and it is an incredible learning experience. Because all of the case presenters are present at the meeting, we can ask other members why they did it this way instead of that way. It opens up an amazing dialogue.

Also, because all of us present cases, it brings a level of civility to the evaluations. If we’re truly being critical, we all know there’s room for improvement in all of our cases. It’s amazing to see the clinical talent in our membership. But what I like most about the Angle Society is that no one cares about how many patients you see in a day or how much money you make; they only care about the quality of your treatment.

Dr. Dougherty used to say that it is easy to start a case, but it’s very difficult to finish a case well. I am also aware that not everyone wants or can join the Angle Society. A good first step would be to critically evaluate your own cases. Trace the before and after cephs and do an ABO model analysis. Ask an experienced ABO-certified orthodontist for help with your evaluation. It might be enlightening to see if you’re doing what you think you’re doing.

What’s your favorite patient story?

I have two! The first involves a high-profile adult patient who had a very difficult malocclusion. He had a bilateral Brodie bite, with all of his lower teeth occluding with his palate. It was a difficult case to treatment-plan, but we ended up achieving an excellent result with a combination surgical/ orthodontic treatment plan. A few years after he was debanded, he told me that was the first time in his life that people said he had a great smile, and by then he was well into his 30s! He became a wonderful referral source because he was a public figure in a position of authority. I also treated his wife and children.

The second story is about an 8-year-old boy who was extremely afraid of doctors. For the first four or five appointments with us, he cried and cried. His mother, who was a nurse, would apologize to us and try to calm him. We tried our best to be patient and to make him comfortable, and as we eventually gained his trust, his behavior with us improved to a point where he was very comfortable. Unfortunately, he then had a nondental-related accident and needed to go to the emergency room. His mom later told us that when he needed to see the physician at the hospital, he was crying and told her, “I want to go see Dr. Kawata!”

Tell us about your practice. What are you most proud of?

I started my practice from scratch. I initially rented space from a general dentist while my office was being constructed. During the construction and the early days of my practice, I would work 8 a.m. to 5 p.m. as an associate in different offices, eat dinner in the car, then work at my practice until 9 p.m. My wife would work as an occupational therapist during the day and work the evening shift with me. This was before the introduction of cellphones, so we would talk on walkie-talkies on our drive home after work.

I worked six days and two evenings a week. During the early stages of my practice, I signed up for almost all of the insurance plans, because I wanted to be busy enough to drop my associate positions and be available full-time in my office, and eventually that became a reality.

As I got busier, I started dropping the insurance plans: I would prepare to drop one plan, reassess my busyness level after three months, and if I was still busy, drop another. I continued to do this until I had dropped all the plans.

I now see patients about 13 days a month. What I am most proud of is that we treat our patients like they are family members. My treatment recommendations are based on the patient’s needs and wants, not production goals. One of my pet peeves is hearing about overtreatment, where practitioners place an appliance just to get a patient tied into an office or early treatment without a valid reason.

And because I don’t overrecommend treatment, I have gained trust within the community, where patients can come and get an honest assessment without needing to worry about walking out with a mouth full of braces or being “talked into treatment.”

What I have found over time, and what I preach to the residents, is that one of the best things about being an orthodontist is that you can be extremely successful while also being true to yourself. You don’t need to take shortcuts or take advantage of anyone.

What’s your most controversial opinion regarding the profession?

I don’t want to open a can of worms with this, but it is the propagation of orthodontic service organizations.

As orthodontists, we are very fortunate that we can be extremely successful working on our own. We control our own destiny: We work as much or as little as we want; we don’t need to answer to anyone. I love being self-employed!

When you bring a corporate entity into the equation, it’s one more mouth to feed, and it’s a mouth connected to a bottomless stomach. It shouldn’t be a surprise that the reason equity firms are purchasing orthodontic practices is to make money.

Why would I want to give a percentage of my collections for the life of my practice to a company that wants to push me to work harder so they can make more money from me? If I need management help, many terrific consultants will charge a one-time fee to help me, not a percentage of my collections. I work as hard as I want to work. Unfortunately, I believe that if the OSOs keep proliferating, because of their focus on profits and not the quality of care, the two losers will be our profession and our patients.

You’ve had your finger on the pulse of orthodontics for more than 25 years. Where do you think the next big step or evolution will be?

It appears that there is a strong trend toward cosmetic or invisible appliances, so it will be fun to see how far it goes. While I am using InBrace clear aligners and ceramic brackets, I still prefer stainless steel twin brackets because of their predictability and the ability to make quick, precise chairside adjustments.

Give us a snapshot of your life outside of teaching and practice.

I’ve been very happily married to my wife, Dana, for 37 years. We have been blessed to have two wonderful daughters, and we love doing things as a family.

Our favorite family activity is to travel, and a close second is dining out. Fortunately, when you travel, you need to dine out, so the two activities are related. COVID has slowed us down, but we’re itching to get back into the swing of things! Fortunately, Southern California has its share of nice restaurants, but we also love to go to the Napa Valley, which has wonderful restaurants. Our daughters love musicals, so we’ve been to New York many times to see shows and enjoy the restaurant scene. We enjoy international travel, but haven’t taken as many trips as we would like. That’s my fault, because I still have a hang-up about not being away from the office for too long, so I’ve tried to max out our trips at two weeks.

I love to play golf, and generally play once a week with my local friends, and I generally go on a boys golf trip once or twice a year. I’m excited that this year’s trip will be to Nova Scotia!

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May 2023

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Office Visit: Dr. Gary Kawata by Kyle Patton, associate editor

May 2023


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