Office Visit: Dr. David Richter by Kyle Patton, associate editor

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Categories: Office Design; Practice Management, HR and Accounting;

by Kyle Patton, associate editor
photography by Caleb Alvarado

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.

Before he was an orthodontist, Dr. David Richter was just a guy flipping through the phone book trying to decide what he’d do with his life. His finger landed on dentistry, which eventually led him down the road to the world of orthodontics.

But after several years of running himself ragged trying to run the office, Richter almost hung up the white coat for good. Then he looked inward, and decided he’d need to be the one to change before he could change his career.

Now, with a new and bustling practice that’s still looking to add a pediatric dentist and a med spa, Richter has told his wife he doesn’t plan to ever retire! This Townie’s new 6,700-square-foot practice in Greeley, Colorado, is, as he puts it, “the nicest dental facility I’ve ever been in.”

In our exclusive Q&A, Richter tells us how he went from burned out to burning with a renewed passion for the profession when other doctors his age are considering retirement. Plus, hear his hard-learned lessons on how to be a better manager and team leader, and look at some of the impressive tech inside an impressive build.

Office Highlights

Name:
Dr. David Richter

Graduated from:
University of Oklahoma College of Dentistry orthodontics program

Practice name:
Richter Orthodontics
Greeley, Colorado

Practice size:
6,700 square feet;
12 operatories

Team size:
20

Seven years ago, you were ready to get out of orthodontics entirely. What led to that feeling?

Dealing with staff. I could not figure out how to manage them; it seemed like I would put out one fire and the next thing I knew, I was putting out another. There was so much drama between team members, and instead of resolving things, they would just quit! The crazy part was, I was oblivious to it: I would tune in only when it was too late and people were looking for the exit. I became frustrated by their lack of work ethic and the sense they were feeling entitled. I began losing interest in educating my team because I knew they wouldn’t be around for long, so I would hire experienced employees whenever I could and try not to hire anyone who needed training.

How did things get so bad you wanted to quit?

I felt like I was maxed out: In my mind, I had tried everything regarding my employees and treatment options. I wasn’t making the headway I wanted in creating a “great team,” and everything I tried didn’t seem to have a lasting effect. When I brought in consultants, the great results would only be temporary. This was, in part, because there was little follow-up ... and if there was, it wasn’t hands-on. I believed my team would “ride it out” until things got back to normal.

I think the hardest part, and where the real burnout came from, was in trying to treat my patients with the level of care that I felt they deserved. I love my patients! I know we all do—well, most of them, at least.

I was using a self-ligating system in a 0.022-inch slot. My finishing wire was a 0.019-by-0.025-inch titanium molybdenum alloy. Because of the amount of slop (30 degrees), I had little control of the third order, and because it was a one-size-fits-all, I had little control over the first order. (Teeth have varied sizes and shapes.)

So even after many repositioning appointments, I’d still have many detail appointments. I was struggling to finish cases, and they usually went over the estimated treatment time.

What was the turning point?

A dentist friend of mine suggested I check out Jay Geier’s Scheduling Institute, and it was a great fit for me. I still wanted to grow my practice and fix the internal staffing issues I had, and I needed real solutions.

It was expensive to join, but ended up being a great decision. We doubled our practice in three years and have developed an amazing culture.

I also learned a lot about myself—I learned I was the problem in the practice! I expected team members to be successful without giving them the tools to be successful. I’d tell them to do something and would get mad if they didn’t do it the way I expected. It’s very different now—I’m more engaged in my team and giving them the tools they need.

Another thing that was a turning point was that I embraced aligners. I wasn’t crazy about aligner therapy, but we must embrace it to remain competitive.

The biggest point from a clinical perspective was switching to the Stride bracket system by KLOwen.

To me, this was like finding the Holy Grail. It’s like the technological change of going from horse-drawn carriages to motorized vehicles. Now, for the first time, I have control over the first-, second- and third-order positioning. The indirect bonding trays are incredibly easy to use, which significantly reduces the possibility of human error. The vertical height of the slot is 0.0195 inches, so there are only 3 or 4 degrees of play.

Let’s go back to the beginning. How did you get into the profession?

I was in college in the business management program. One day in my third year, I decided I wanted to be in my own business and not work for a corporation. I got a phone book out and looked at all occupations. Dentistry seemed like a good match: I liked interacting with people and really enjoyed working with my hands. I wanted a profession that was lucrative and allowed for a lot of autonomy.

Over the years, my purpose in my practice has morphed into something much more intentional. We are very community oriented and hold charitable fundraising events to give back to our community. We also provide events to help our team members learn life skills they wouldn’t otherwise have been exposed to.

Now, here you are, with a beautiful new practice and a revitalized drive. Let’s get into it. Introduce us to your office!

As you walk in the front door, there’s the atrium and a showcase where people can see all our awards. We’ve been voted “Best in Greeley” as well as “Top Dentist” in Denver’s 5280 magazine for the past nine years.

As you enter the reception area, our core values and mission statement are posted. On one side of our reception area, we have floor-to-ceiling windows. We also have a beverage and snack bar and our movie theater. The theater ceiling displays twinkling stars to add to the ambiance.

As you approach the front desk, you’ll notice there are no phones. This ensures when patients check in, the process won’t be interrupted by any outside phone calls. Opposite the checkout area is one of three new-patient suites, where digital scans, pano, ceph and pics are taken and displayed on a wall-mounted monitor.

There are no dental chairs in these suites; instead, we have reclining chairs for us to examine patients. These rooms were designed with a patient’s comfort in mind while reducing the clinical appearance.

Walking into the clinic, you’ll see pictures of me and my associate, Dr. Emily Malihi, and our credentials. As new patients walk past them, our treatment coordinators “credentialize” us and explain how orthodontists are different from general dentists because of the additional specialized education.

Straight ahead is another new-patient suite, and to the right and left are eight operatories. Each of them has partial separation from the others, which our patients love. All operatories have carts with everything an assistant may need, which provides greater efficiency in assisting. On the north side of the building, there are four more operatories and another new-patient suite.

We have a sterilization area, an ordering computer and an in-house lab where we print aligners. Farther down the hall is a wellness room. One year we had nine pregnancies among our team members, who didn’t have anywhere they could pump.

There’s also a break room we also use for training monthly and quarterly. (The Zoom host can be seen on the TV and the camera will follow whoever is speaking. We love this room!)

The doctor’s office can be shared by four doctors, with a bathroom and lockers for each one. I wanted to share the space with my associate doctors so we could easily collaborate on treatment.

What are a few things you learned during the build process?

The process went well; I strongly advise using a builder with experience in the dental field. Mine said it would take nine months going through the dead of winter, and it went half a month over that estimate only because of a severe cold freeze.

Don’t go with the cheapest bid—go with the best. If you don’t, you’re going to pay for it and have a frustrating experience. This was a ground-up build for me, but I’ve had three previous tenant finishes.

Also, with virtual monitoring and efficiencies with custom braces and aligners, you just don’t need that big of a space. My space is 6,700 square feet and it’s too big for just ortho, so we are going to add a pediatric dentist on the north side of the building and a med spa.

I can’t tell you how much I love my space! I don’t mean to brag, but it is honestly the nicest dental facility I’ve ever been in. I love the tall ceilings and huge windows. The finishes are amazing! I love all the sconces and the industrial feel, with lots of windows and lofty ceilings. The architectural firm is VFLA out of Fort Collins, Colorado, and the team is brilliant.

It’s not just about form, though—you’ve built in just as much function. What are some practical details that make the office run smoothly?

One of the main focuses was really on function. Clinically, the idea was that the technicians would not have to get up for anything except possibly microetching, so all the carts are stocked for this purpose.

Also, as I mentioned, there are no phones at the front desk, so patients won’t be interrupted by phone calls while they check in. Patients also can be checked out directly from the operatories because every operatory has a printer and can print appointment cards, which saves time if patients are leaving straight from the operatory and heading out the front door.

All our supplies are stored on the clean side of our sterilization room and on shelves that can be pulled down instead of having to stand on footstools. Everything is easily visible and a computer is right there so things can be ordered with efficiency.

You’ve come out the other side of things for the better. You’re more profitable than ever, too. What tips do you have for struggling docs?

Even when you’re growing your practice, you must keep an eye on your profit-and-loss (P&L) statements. There are industry standards that you should follow.

Labor is the easiest expense that can get away from you. You do need to be staffed adequately to maintain quality customer service, but often it’s a tough balance to maintain. Always look at your P&L statement and you’ll know where you stand.

Also, when ordering supplies, it’s super important to get the best deals out there. We use Mari’s List—we know there are some other options out there, but we’re happy with this one.

Top Products

Stride Custom Braces by KLOwen. Custom braces allow me to finish my patients with a 30%– 40% reduction in treatment time over a one-size-fits-all bracket system. Fewer appointments and better finishes.

Invisalign clear aligners. If you don’t like providing aligner treatment, you’d better get over it, because aligners are here to stay. If you don’t adapt to this treatment option, you’re missing a huge financial opportunity. I’ve used multiple aligner systems but I think Invisalign’s is the best.

Grin Remote Monitoring. Virtual monitoring has been a godsend in our practice. Aligner patients take scans before changing to the next aligner; if we see any teeth not tracking, we tell patients to wear the same aligners and focus their chewies on the culprit teeth, then send another scan next week. It lets us address problems early and fix them, with much fewer office appointments.

InBrace lingual braces. If patients don’t want the look of braces but admit they won’t wear their aligners, a lingual option can be a good choice. InBrace has just come out with its next-gen bracket, which looks promising. With a smoother profile and full slot engagement, it’s been a great option in my practice.

A patient-centric team. This is important! It takes a lot of work, but it’s worth it—and patients expect it these days. The truth is, it really starts with the practice owner. I read several books on leadership and discovered a lot about my leadership. A few titles I highly recommend include:

Good to Great: Why Some Companies Make the Leap and Others Don’t by Jim Collins.
The Five Dysfunctions of a Team by Patrick Lencioni.
It’s Your Ship: Management Techniques from the Best Damn Ship in the Navy, by D. Michael Abrashoff.

Let’s get clinical. What advancements over the years impress you the most? How have these advancements affected your patient care?

I think the most important treatment option for fixed appliances is the custom bracket system by KLOwen. It has revolutionized my practice. We’ve started more than 700 cases with these brackets. We’re going from 20-plus appointments down to 10 or less. I believe it’s the greatest technological change that’s happened in our profession since the introduction of straight-wire appliances.

I believe another must-have technology is virtual monitoring. I love the simplicity of Grin Scope, but whichever virtual monitoring you use helps you bring patients in only when they need to be—not every four, six or eight weeks, as we’ve done historically. It streamlines your treatment and makes it so much more efficient. It frees up your schedule significantly. As a result, you don’t need as big of a space as you think, which saves money while letting you keep track of your patients’ care more closely.

As if you weren’t busy enough, you’ve also got a unique passion: inventing. Tell us about your invention and your patents. How did it all get started and what are your next steps?

Creating new things is a passion for me. It didn’t start until about 15 years ago. After I completed the Dawson Academy, it occurred to me that dentistry was headed in a digital direction, so I hired a physicist and we created a virtual/digital articulator that I’m currently negotiating with some large companies.

I also have a patent on a retainer that’s a hybrid between a Hawley and an Essex. The Dawson philosophy believes we shouldn’t be covering the occlusion at all when cases are finished, but Hawley retainers don’t prevent rotational relapse of the incisors.

I also have a patent pending for a cheek retractor design, and I have six other things lined up once I get these rolling. I think the thing that gets me most excited is that I’m creating things that help people’s lives to be easier. I’m a huge fan of Thomas Edison. Did you know that he had 1,098 patents? And hundreds of other things that weren’t patented. Pretty cool!

As someone who spent most of his career practicing solo, what’s it like now having two other doctors under the roof with you?

I love having associate doctors in my practice! Looking back at when I was a solo practitioner, I was isolated from my peers. Now I can treatment-plan with someone who may see things a little differently or pick up on things that I didn’t. I think it’s been a benefit to Dr. Malihi’s patients, and it’s been very stimulating for me because I can bounce ideas off somebody else. (It’s also great because I can be on vacation and our doors are still open for business.)

Practice management used to be a stress point for you. Compare where you were as a business owner at your lowest moment to where you are now. What turned it all around?

I think the lowest time in my career was when I felt like I couldn’t manage my team. Once I started learning from other experts about how to manage people, it became a real passion for me. It’s not easy, and I believe it’s the most challenging part of what we do as practice owners, but it can be very gratifying once you learn the techniques to connect with people and give them the tools to be successful.

Who or what are the big players in your practice when it comes to helping you run your business and grow?

The Scheduling Institute had a huge impact on our growth and culture and was instrumental in me becoming a better leader for my team. We’re no longer with SI, but we still implement the things that we learned from them. We’re now with Adapt, which is owned by Align. They look at every aspect of the practice, from marketing to expenses to workflow, and are experts at that part. So if you want to grow your practice, I highly recommend SI, but for us in our current stage, Adapt made a difference in managing our costs in workflows.

Give us a snapshot of your life outside of orthodontics.

Life outside of practice for me is time with my wife and boys and immediate family. We love to ski in the winter and wakeboard in the summer. I don’t see myself retiring anytime soon, so I told my wife that I want to go on a vacation every quarter and that’s what we’ve been doing. Our last trip was scuba diving in Belize.

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September 2023

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Office Visit: Dr. David Richter by Kyle Patton, associate editor

September 2023


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