Office Visit: Dr. Brice Gilliam by Kyle Patton, associate editor

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Categories: Practice Management, HR and Accounting;

by Kyle Patton, associate editor
photography by Joseph Patrick, except where indicated

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.

This Nashville Townie is redefining what it means to have a side gig. When Dr. Brice Gilliam isn’t running his practice for adult patients in the heart of Tennessee, he and his wife are filming Making Modern With Brooke and Brice, a home-renovation show that recently broadcast its second season on the Magnolia Network. As if that weren’t enough, he also works as an associate!

In this month’s Office Visit, we learn how Gilliam juggles practice ownership, associateship and being a television star; which construction and renovation tips he has for doctors; why direct-toconsumer orthodontics can be a good thing; and more.

Office Highlights

Name:
Dr. Brice Gilliam

Graduated from:
Meharry Medical College (dental school); Howard University (orthodontics)

Practice name:
Elevation Orthodontics, Nashville, Tennessee

Practice size:
2,444 square feet:
3 open-bay chairs,
1 consult room,
1 private treatment room

Team size:
5

How’d you get into the profession of orthodontics?

I always knew I wanted to do something in health care, but medicine never really interested me. I was naturally good at drawing and working with my hands, which led me to the conclusion dentistry would best blend those two worlds.

Before dental school, I didn’t know much about dentistry. During training, I quickly realized I didn’t enjoy doing general dentistry. It was hard for me to understand how any person could be great at all things. And as dental school continued, other aspects of dentistry became more apparent: I despised endo, prostho was too slow, pedo too fast, oral surgery too messy and perio was perio. I was running out of specialties quickly.

At some point, I assured myself that I was going to be the first dentist in my family and I needed to set the bar high. While I always felt like orthodontics was the pinnacle of the profession, I didn’t realize it was going to be the path for me—but it was.

On top of practicing full-time, you and your wife, Brooke, found a remarkable side hustle. Tell us about Making Modern with Brooke and Brice.

The show came into existence in the most organic way possible. After my residency, we moved back to Nashville and started building our house, but during the process we were less than happy with our builder—our expectations were not being met—so we decided to part ways. Once we did so, we took the build on ourselves. (Let me remind you that neither of us had any design or construction training!) Brooke would hire subcontractors and oversee their work throughout the day, while simultaneously learning their respective trades.

At the time, I was a full-time associate orthodontist. After work, I would meet Brooke at the house and we would continue to build our house into the late hours of the night, just the two of us. This went on for months and months.

We noticed our neighbors started rooting for us, cheering us on, bringing food and just being amazing, supportive people. One of those neighbors had a friend who was new to Nashville and insisted we meet her.

As it turned out, the friend, Sarah, was a three-time Emmy-winning producer. Sarah came over and hung out, asking questions about our build and a little about us, and said, “Y’all need your own show.” We replied to what we thought was a joke with “Sure.” She then asked if she could bring a camera crew to film a “sizzle.” We had no idea what a sizzle was, but we didn’t want to be rude, so we responded with another “Sure.”

Then she showed up with people holding cameras and microphones! Turns out, a “sizzle reel” is a short promotional video designed to entice network interest in a potential series. Talk about being awkward! We were so uncomfortable, I think I introduced myself as Brooke a couple of times. Five hours later, the crew said, “Y’all did great. We’ll pitch this to some people.”

A few months went by and we had forgotten about the sizzle. I was fully consumed trying to keep my brand-new practice open during a pandemic. We got a call from Sarah saying a couple of people wanted to meet with us. We hopped on some Zoom calls with these huge television networks and the next thing we knew, we were a part of Chip and Joanna Gaines’ Magnolia Network family.

Give us a peek behind the scenes. How do you balance all the responsibilities of being a practice owner, a full-time orthodontist and a TV star?

Balance … what’s that? We joke by saying we both have four full-time jobs—practice owner, orthodontist, designer and TV personality. (That last one is always going to seem so strange.) The behind-the-scenes of it is that there are late nights and lots of work on the weekends.

We compartmentalize a lot. We start our mornings early and discuss construction updates and meetings for the day, who is going to be able to facilitate those meetings, etc., then move into what’s going on that day with orthodontics and pharma work.

Assuming we can get on the same lunch schedules, we switch to design/build mode, where I tell her about the ideas or designs I’ve created for our projects, and at dinner we normally talk production/filming discussions. We don’t film during our “work hours,” unless the crew is coming to my office. Filming is reserved for nights and weekends.

I think it’s worth noting that we sacrifice a ton: We miss birthdays, get-togethers, vacations, anniversaries (we still haven’t opened our cards to each other from months ago) and more. Luckily, we’ve been married for 10-plus years and are pretty good at communicating with one another, which is tremendously helpful with all of the moving parts and huge decisions that are made daily. It’s been tough at times, but extremely rewarding overall. I’m lucky to be in a marriage where we pick each other up when the other is down, celebrate wins together, and push one another to be the best version of ourselves.

Making Modern With Brooke and Brice
Photo courtesy of Magnolia Network

But wait … there’s more?! You also work as an associate. Why?

I guess there is more! I’m also an associate. Does that count as job No. 5? I work at my office three days a week, use one day for administrative things, and one day a week I work in a rural practice as an associate.

The office is two hours from my home, and that extra-long distance was intentional. It makes me sit for two hours to and from work, which creates time for me to call family, catch up with friends, schedule phone meetings or listen to audiobooks. Once I’m at the practice, I have the freedom to simply be an orthodontist.

At my practice, I’m the boss, CEO, COO, marketing department, customer service ambassador, lead TikToker, janitor and orthodontist. It’s a relief to literally walk into an office and just treat patients.

Is it safe to say that you and your wife teamed up to build and design your current practice?

We did! In 2019, we set out to create a unique space for a new dental experience. We hired a great commercial construction team to help with building my dream office. At the time, Brooke didn’t have her general contractor license, so the team built out my designs. Once the walls and larger construction items were completed, we were able to put in those personal touches. Because Brooke welds, tiles, sews, does woodworking and generally brings my visions to life, this was our time to shine.

Looking back on it, I think we customized every single aspect of the office, down to painting the screws on the dental chairs black. We were trying to do something big, something different, so we thought it was important to lock into the details to build the foundation of our brand. We were creating the first adult-only orthodontic office. I remember the sense of validation I felt when we won best specialty office design in Incisal Edge magazine. So now I tell people this is an award-winning office.

When it comes to building, designing and renovating, what are some mistakes doctors should avoid?

The first thing to figure out is the why. Why are you renovating? What is the goal? How is the space going to be used? How should it feel the moment you walk into the space? Once these foundational questions are answered, everything can be designed with the end in mind.

Pro tip: If you can touch or feel it, spend a little extra to ensure its quality. If you can’t touch it or feel it, spend less money and find something that will achieve the same look—lighting, for example. You don’t have to spend $2,000 per chandelier that no one can ever touch; therefore, find a less expensive choice that looks similar.

There are a couple of things that came up as I was building out my office. I found everything that was labeled for “dental” or “dentist” was three times the normal cost. I would ask, “Why is this so much more?” The response was that it “will last 30 years.”

So, I don’t know how most orthodontists feel about this, but keeping the same chair or couch or screen for 30 years is something I don’t value. I don’t see myself as the type of doctor who only updates the office once every three decades. So I didn’t see the value in that. I think you should focus on things you or your patients will value, including comfortable seats, homelike finishes, live plants, etc.

Another avoidable mistake is setting clear expectations! This is by far one of the biggest problems in the building world, and it can also relate to orthodontics. Set clear expectations of what you want the results to be. Whether you’re working as an interior designer, directly with the general contractor or with an adult with less-than-straight teeth, it’s super important to communicate each party’s roles and responsibilities, as well as each person’s deliverables.

Let’s take ortho, for example. Sometimes patients will come into your office and want a Julia Roberts smile but have teeth shaped like the Grinch. There’s no amount of “alignment” that will make that happen, so you must be clear about the outcome before you start. If done correctly, both the patient’s and your expectations are met.

Same with design and build: You don’t want to think you’re building your dream house while the contractor thinks he or she is building a shed.

Which design aspects of your practice are you most proud of? What do patients comment on the most?

I love when patients come in for a new patient consult and we’re clicking on all cylinders and the patient is just in awe. They typically comment on how beautiful the office is and how we’re so different from their previous orthodontist. They’re so thankful we’ve created another option for safe, doctor-led treatment.

Elevation Orthodontics is Nashville’s first adult-only practice. What made you buck the trend of having a patient core of children and adolescents?

“Adult-only orthodontics—wait, what?!” That’s the typical response when I describe my office. When you think of orthodontics, most people associate it directly with kids—and to be fair, they should, because kids make up a huge portion of the profession. I wanted to focus on the smaller (but still significant) piece of the pie, which is one of the fastest-growing sections of orthodontics.

Here’s how I concluded that I wanted to treat adults only: I saw a huge need, which was increasingly more evident by the number of people willing to participate in DIY or direct-to-consumer aligners. To me, this was a desperate, maybe subconscious, cry that they wanted other options than the traditional “family” orthodontist model. I felt like adults wanted a way that aligned with their idea of how the treatment should go: They want an easier way to begin treatment, they want aesthetic options, they aren’t interested in multiple years of treatment and they don’t want to come to monthly appointments.

I also believe that they wanted value. Don’t hear what I’m not saying—the majority didn’t necessarily want “cheap,” they just wanted the price point to reflect what they were paying for.

Another thing I noticed was how much money these direct-to-consumer companies were spending on marketing to adults. I figured that instead of a place that appeared to meet most of their wants but was mostly smoke and mirrors that would quickly be seen through, patients would prefer to be treated by an actual orthodontic specialist who specializes in adults.

What’s it like working with adult patients?

How many of your readers like working with adults? (I’ll wait!) Very few orthodontists want to work with adults because they can be challenging patients, but I think working with adults is easier, for a few reasons:

Compliance. Because adults are typically paying for their own treatment, they’re more motivated to comply with my instructions.

Communication. Adults can easily tell you what they’re looking for and what they expect to get out of the treatment. When you ask how they feel about their progress, they’ll respond with a better answer than “I don’t know.”

No growth. You don’t have to anticipate future growth.

Gratitude. They’re extremely grateful once they finish treatment because it was their decision to begin it: They paid for it, so they see the value.

For these reasons and many more, I truly believe adults are great!

Your community had an especially hard time a few years back: On top of the pandemic, a tornado ripped through your area. Thinking back on that, what comes to mind?

It was a lonely time, but I’m proud of our resilience. When I was first entertaining the concept of adult-only treatment, all of my colleagues and dental representatives were like, “That’s too hard” or, “That won’t work.” I clearly didn’t see it that way, so we pushed onward.

The grand opening was great and patients started flowing in instantly. Then, just two months later, we had a devastating tornado rip through our community.

The day after, the unaffected parts of Nashville moved on with their lives, but we were stuck trying to piece our places back together. Loneliness set in. The destruction was extreme: We were without utilities for 28 days. After nearly a month of being away from the office, we finally made it back!

Then, two days later, mandatory pandemic legislation forced us to leave work for weeks. I’m so proud of thriving in the craziest of situations! I consider it a miracle we’re still here and a blessing that we’re thriving.

How do you like to run things in your office?

Because I have so many things pulling my attention away from my practice, I surround myself with people who I can trust have my best interests in mind.

It’s good to know your strengths, but much more important to know your weaknesses. Once you identify your weaknesses, find someone who has those attributes as strengths. For example, I’m not a numbers guy. It’s not my strength, so I really lean into my CPA to talk numbers and break down the health of the business.

As far as my office team, I empower them by giving them high levels of autonomy. This is something you must be careful with until you believe they’ve been trained in the culture and pillars of the practice. Once you have them thinking as you would think, you can provide them with tasks and they take ownership to see the pillars completed.

You have a unique perspective on direct-to-consumer teeth straightening services.

I’m a pretty optimistic guy; I can typically find something good in less-than-perfect situations. Direct-to-consumer aligner companies are a thing—we all feel however we feel about them, but they’re here to stay, so now what?

I asked myself what these companies are doing that we orthodontists haven’t been. Why have these companies been able to successfully convince so many people that orthodontists aren’t needed?

Suddenly, it became clear: As a profession, we didn’t take the time to hear what the world was telling us. They were telling us they wanted a different option other than brackets and wires. They didn’t want to come into the office 100 times. They wanted minimum interaction and wanted “straighter” teeth (not necessarily ABO-standard smiles).

We have been trained to notice if the bite is off and how to fix it. We have been trained to get the proper buccal overjet in the posterior, but if their values and ours don’t align, that’s where we run into problems.

Let me put it like this: If you took your car to get your front end aligned but the mechanic came back and said, “One of your taillights is slightly dimmer than the other and it’s going to take two weeks to fix,” you’d be like, “No, that isn’t even what I came in here for!” I think we’re trained to see too much, and often we don’t give the patient what they actually want.

Which cases or patients excite you the most?

I enjoy working with multispecialty cases—ones that might need surgery or implants and finish with some crowns or veneers. The reason I love this is because the patient gets the exact smile they want. They aren’t held back by limitations of the shape of the natural teeth or jaw position. It’s truly transformative.

Which pieces of technology or service could you not practice without?

I believe an intraoral scanner has the highest ROI of anything in my office. We use it for everything—scans, intraoral pictures, patient education—and as a tool to help case acceptance.

Cosmetic treatment options. My patient population isn’t a traditional brackets-and-wires treatment group. Knowing this, we have built our treatment modalities with “in-treatment” aesthetics at the front of our minds. Leading our consultation appointment with clear aligners and lingual braces as the most “invisible” treatment options has a direct correlation to our increased case acceptance.

Virtual consultations/appointments add another level of convenience to our patients’ experience. We’ve found it allows patients peace of mind—they can communicate with our team without interfering with their own busy schedules. We’ve also noticed it weeds out the “price-shopper” patients, which frees up space in our schedule for more exams.

Convenient hours. We work abnormal “orthodontic” hours: Our patient population typically works until 3 or 4 p.m., so we’re open until 7.

A mature and comfortable office design makes for a warm and welcoming space that kicks the stereotypical dental office feel. It looks much more like a high-end living space.

A sense of gratitude. I think this is one of the most overlooked “must-haves.” Potential patients don’t owe us anything: There is a slew of other amazing providers out there, so the fact our patients have taken time out of their day to trust us and our team with overseeing their treatment is a big deal. Be grateful for that.

Where do you see the profession headed in the next 10 years?

I think the profession is fine and will be fine. Maybe it’s not as easy as it once was, maybe profitability is less than it once was, and maybe there’s more competition. But, I ask, which desirable industries aren’t facing these issues? We will always have the Chicken Littles of the world, but if you cut through the noise, you’ll see that each year, more and more potential patients are coming to the market.

Consumers are more aware of malocclusion and want to change it. As orthodontists, it’s our job to continue to educate them as to why they should be visiting an orthodontist for their treatment. The future looks great. Do your part to continue that.

What advice do you have for other orthodontists?

I was told at a very young age that there are enough patients for everybody, so I implore others to think this way too. For you to succeed doesn’t mean someone else has to fail, and when someone else is succeeding, it doesn’t mean you’re failing. Rather, support your “competitor” orthodontists— y’all should be rooting for one another and building up the profession and the community in a mutualistic manner.

One of the most memorable moments of opening my office was when an orthodontist down the street brought me a congratulatory gift with a note telling me it was going to be hard but to stay focused, and if there was any light or insight he could share, he’d be happy to help. This is what a healthy orthodontic community should be like.

Also, treat your team right. Yes, they technically work for you, but they also work with you. Build them up, challenge them to be better and correct them when they are wrong, but ultimately respect them as humans. Because no matter how you look at it, they are giving you 40% of the awake hours each day they’ll never be able to get back. Value that.

Give us a snapshot of your life outside orthodontics.

My life outside the practice is hectic but very low-key. Brooke and I are either building and creating or we’re asleep. We don’t have any kiddos or dogs, so that helps us be able to work a little more freely. We do have a lot of plants, though, and many of them are very needy.

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