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Office Visit: Dr. Christos Papadopoulos by Kyle Patton

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Categories: Practice Management, HR and Accounting;
Office Visit: Dr. Christos Papadopoulos 

This Townie’s scratch practice success, which he makes look easy, is the result of years of refined observations and purposeful implementations

by Kyle Patton, associate editor
photography by Kelly Lawson

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.
For years, Dr. Christos Papadopoulos worked as an associate in what would grow to be Canada’s largest OSO. During that time, Papadopoulos watched and learned, amassing knowledge until it was time to launch his own practice in New Brunswick. “I do not think that anyone considering a startup will truly feel ready,” he explains. “There are always aspects of practice ownership that you can only learn through experience.” Now, as a startup expert, this Townie will present at this year’s AAO Annual Session, where he’ll do a deep dive into today’s startup landscape, covering action plans, building timelines and exploring the viability of “starting from scratch.”

In our exclusive Q&A, Papadopoulos recaps his first year as a new practice owner. Learn which corporate traits best translate to private practice, his tips for docs looking to venture into ownership, what areas a startup should focus on most and much more.
 
OFFICE HIGHLIGHTS
NAME:
Dr. Christos Papadopoulos

GRADUATED FROM:
Western University, London, Ontario

PRACTICE NAME:
Papadopsmiles Orthodontics,
Quispamsis, New Brunswick

PRACTICE SIZE:
2,700 square feet; 2 consult rooms, 5 ops

TEAM SIZE:
7
What was it like working for Canada’s first OSO?
I had many options after my residency. I was considering Ontario or the East Coast, where I was born and raised, but having been away from my family and home province for eight years, it was an easy decision to return to New Brunswick once I met the OSO’s founding orthodontist.

The opportunity was not presented as “working for an OSO”; rather, this doctor had a huge clinic plus four other locations, all under the same practice brand and logo, in a few other cities in Atlantic Canada, all within 250 miles.

I practiced mainly at his founding clinic and one other moderately sized location. Within a couple of months, the OSO had acquired other practices across Canada, and by the time I left 4½ years later, the organization had grown to include more than 55 clinics across the country.

Being able to witness the growth of an OSO from the inside was a unique and eye-opening experience. In residency, we rarely talked about “corporate” because there wasn’t a strong presence in Canada at that time, even though I knew the model existed in the United States. By watching this corporate entity grow as I worked in the founding clinic as the solo orthodontist, I had a unique vantage in that I was viewed as “the orthodontist” to the practice’s patients without being the practice owner.

I began observing every little thing and evaluating it as if I owned the practice, but without the responsibility of being the decision-maker. All of this helped me understand the importance that everything (big and small) has—from office systems and protocols to team culture and so on.

Lay out your startup journey.
Starting a practice from scratch is certainly not an easy task. That said, I believe that the startup journey for anyone should always begin the same—with a vision.

I know all too well the circumstances and thoughts that residents and recent graduates face: skyrocketing student debt, the lack of a realworld private practice experience and the heavy decisions that can weigh on one’s mind when navigating a career path after graduation. It’s not easy to figure out those details, but you must take time alone for self-reflection and continuously ask yourself, “What kind of orthodontic career do I want to have?”

During my final year of residency, I knew I didn’t want to step into practice ownership immediately, but I also knew I wanted to be a practice owner at some point. That’s why my startup journey began in residency. I visited several orthodontic practices to learn about their office cultures, ergonomic office design and systems. Crafting a vision takes time and persistent effort, but it is the most critical starting point and will lay the foundation for when you decide to leap.

After gaining experience as an associate for a few years, I grew eager to bet on myself and go for it—to start my practice. I simply felt it was time for me to make a change.

How’d you know it was time?
I don’t think anyone considering a startup will truly feel “ready,” because there are always aspects of practice ownership you can learn only through experience.

The opportunity arose when I made a phone call to an oral surgeon friend and colleague regarding a mutual patient’s third molars. We chatted briefly and when I asked him what was new, he told me that a group of his colleagues (three oral surgeons) were looking to open another oral surgery clinic in the Saint John area.

When I told him I was from Saint John and asked how he felt about an orthodontist joining them for their new endeavor, that was all it took. We got together as a group, planned, and before I knew it, we had a location in my hometown to build a new professional center. What were the most valuable tools you learned from the OSO model?
Aside from the numerous practice metrics I learned about when evaluating a practice’s growth and success, working at a fast-paced clinic where I’d see close to 100 patients per day prompted me to evaluate my clinic efficiency, develop and refine my orthodontic protocols and armamentarium, and continuously evaluate my clinical skills and treatment planning.

Reflecting, I can’t pinpoint one “most valuable” trick, tip or tool. Rather, it was the culmination of many aspects that helped me become the orthodontist I strived to be.

Learning how I wanted to practice and not necessarily what I wanted to practice with was the critical aspect of my associateship and development. It allowed me to steer my startup in the right direction from the outset.

Give us a snapshot of your practice.
The practice was designed and built with the idea it would be an inviting, relaxing and welcoming clinic for all ages. I want patients to feel at home the moment they step foot in our clinic.

We have a lot of natural light; a long stretch of tall windows runs across the front and side of the clinic, making it feel more spacious. I also knew I wanted to have a family-based orthodontic practice where people of all ages would feel comfortable, so there are many design elements integrated into the practice that lend themselves to a simplistic, clean look. Lots of wood, white and blue.

However, the aspect I’m most proud of is that we’ve developed a clinic that’s built on a foundation of positive office culture, exceptional patient service, orthodontic excellence and involvement in our community. Having the opportunity to return to my hometown and relate to our patients with firsthand experience has made my startup journey immensely rewarding. I used to play in the same gyms, act on the same stages and, at times, had the same teachers as some of my current patients.

You believe the biggest challenge often comes down to time. How do you manage yours?
Starting a practice is the biggest marathon of your life, but it will feel like a never-ending sprint, especially if you don’t have good time management.

In high school, I heard the quote “Failing to plan is planning to fail,” and it has stuck with me all these years. Organization, planning and time management are critical for many aspects of our lives, and this is no exception when it comes to starting a practice. Think back to when you wanted to be an orthodontist: It required numerous small steps of success, but before you knew it, you were accepted into your orthodontic residency.

It is common to feel overwhelmed when one considers all of the decisions and actionable steps required for a startup to succeed. However, it’s imperative that when you decide to move forward, you do it one small step at a time. With a startup, each decision, big or small, will require your attention, deliberation and decisiveness. This takes energy and can be daunting at times.

You must be prepared to keep the big picture in mind while concentrating on the smaller tasks at hand. Be efficient with your time solving those tasks. Once one task is done, it’s on to the next. Keep moving forward with your foot on the gas, and be keenly aware of the approaching decisions ahead.

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What are the most important first steps for doctors embarking on their startup journeys?
Crafting a vision for the orthodontic practice you desire is the singular most critically important first step. Once you ground yourself in your vision, many of the decisions you need to make will be much easier.

For example, if you know you want to have a family-based orthodontic practice that will provide services to many children and teenagers, it will be very easy to determine the kind of location you should look for when setting up your practice—rural and near many schools.

Think of your orthodontic vision as a guiding light. Take your time developing this proverbial light through introspection and being honest with yourself. Without doing this, you’ll feel lost in the dark.

Once you’ve developed the concept of your ideal orthodontic practice, you need to make a list of all of the things you’ll need to address. Start with general and overarching categories first and then develop those.

For me, any aspect of consideration for a startup can be allocated into one of five areas: organizational structure, physical aspects of the clinic, clinical and practice requirements, administration and human resources, and branding and office culture.

Relatedly, each person is their brand. Authenticity is something that is not only more comfortable and comes easier to a person, but it’s also more genuine and builds real connections with people. My brand is based on who I am and who I strive to be.

I learned many valuable lessons while working as an associate, but perhaps the biggest general piece of advice I can share is to pay attention to the day-to-day operation of the practice. There are so many things you can learn about running a practice simply by being in one and watching the roles of each team member.

Secondly, you need to determine your orthodontic style and pace of practicing orthodontics and develop your routines. What kind of orthodontist do you want to be? Develop your consultation routines, refine your clinical efficiency and protocols, advance your technical skills and don’t be afraid to try a new orthodontic product or technique. Always be learning!

While a lot of success can be found in unquantifiable aspects like branding and culture, what are some tangible numbers that new practice owners should be mindful of?
When I first discussed opening a practice from scratch with some of my colleagues, their initial excitement for me was quickly followed up with the comment that the biggest challenge early on would be cash flow. That, along with the number of patients starting treatment, is probably the only true tangible number a new practice owner is going to be looking at for the first few months.

Opening a brand-new practice from scratch with no existing patients is very expensive and can be very stressful, especially during the first year. Practice owners certainly need to be aware of several more numbers and I was not naive to that reality, but I believed it was too early for me to focus on dozens of metrics, so initially I judged the practice’s success on just cash flow and new patients.

My real focus was on developing excellent office systems and team protocols early on, being involved with our local community, collaborating with my dental colleagues, and providing a welcoming and educational experience for all our new-patient consultations.

I evaluated the initial growth of my startup from a completely different lens: qualitative advances, not quantitative measures. Doing that allowed our team to focus on the important things patients consider and value when selecting a clinic. I believe that cultivating this value as seen from the patient’s perspective has contributed greatly to our early success and has grown our practice in those tangible numbers as well.

Some might suggest that starting from scratch isn’t a viable option in today’s ortho landscape. What’s your take?
It’s certainly not an easy task, but nothing worth having ever comes without its challenges. Yes, it is much harder today given the changes in the orthodontic landscape—growing OSOs, student debt, upfront costs, etc.—but it’s not impossible. I graduated with six figures of debt (which I’m still paying down), had little private practice experience and had no experience operating a business.

However, starting a practice from scratch is still a very viable option for those who want to do it and are willing to put in the work.

The critical piece of that sentence is willing to put in the work. Opening a practice requires a tremendous amount of constant effort: Your motivation may come in waves, but your discipline will always be more reliable to get you through difficult times.

Believe in yourself and what you’re capable of. If you want this, then go for it! Find good mentors, develop your vision, make a strategic plan, be flexible in how you execute it, and enjoy the ride.

What are some practical attributes of a solid action plan and timeline when it comes to a startup practice?
At an early point in the planning stages of my startup, I realized that my to-do list kept growing despite completing multiple tasks and feeling very productive. I would complete three tasks, but by the time they were complete, I had six new ones. That’s when I realized you must figure out the details of the details.

For example, writing “create a website” on your checklist isn’t enough— what features do you need to consider and address regarding your website? You need to write down and figure out each aspect of your site and ensure you have a plan to address them. Will the site integrate with your practice management software and integrate online scheduling? What written content do you want to appear on all the pages throughout your website? What options should you consider for who will build your site? These are all aspects that need to be thought of, explored and decided upon, and all will take time.

The only way you can create a realistic action plan and reasonable timeline is if you properly account for all of the things you’ll need to spend actual time on.

You’ve said that “nice is the default” when it comes to creating the patient experience in your office. What are some differences between a “nice” experience and an exceptional one?
You’ll know you’ve created an exceptional experience for a patient because you’ll see it in their eyes. Creating “Wow!” moments for your patients and seeing a spark resonate in them requires the doctor and the team to continuously reflect and ask each other, “What could make this even better?”

The doctor should always lead by example here. For example, during new-patient exams for children, I always try to remember their pet’s name if they have one. More often than not, the patient will be placed on an observation appointment for a follow-up anywhere from six to 12 months later. You can imagine their surprise when they come back a year later after only meeting me once and I say, “So, how’s Peanut doing these days?”

It’s creating little moments like that that are not only fun for the patient but also fun for me as well.

How did you teach yourself the business side of the profession?
Unfortunately, during orthodontic residency, there isn’t much formal education on the business side of things. Fortunately, I was a notorious notetaker and realized how lucky I was to be taught by many practice owners.

The reality is that much of the business side needs to be learned on the fly, and the onus is on the resident to figure it out. This ongoing yearning for learning while in residency—and in the early years after graduation—is critical if you want to start a practice.

I have a great group of mentors, friends and colleagues I can go to if I’m seeking advice or a different perspective on something. Also, the Wharton–AAO “Mastering the Business of Orthodontics” program was a great course to take before I began my startup, and Orthotown magazine has been a staple for me ever since I discovered it as a resident.

What mistake turned out to be the best teachable moment?
There were many teachable moments during the build-out and the first few months of opening, and I continue to experience teachable moments each day, because I think it’s important to be self-aware. One of these moments occurred before it could become a permanent mistake, when I was struggling to design my clinic layout.

Because the shell building was not yet designed, initial drawings of my clinic had the front door centered on the exterior of my space. I kept struggling to design my office layout the certain way I wanted it, but I just couldn’t seem to get it right.

This went on for weeks. That’s when one of my former orthodontic instructors from residency evaluated my plan and told me, “You need to move your front door.” Instead of having the main door centered, we moved it to the far left of the space and everything fell into place perfectly. (Thank you, Dr. Anthony Mair!)

This highlights the importance of having colleagues and mentors. Don’t put so much pressure on yourself that you feel you have to figure everything out on your own. We’re blessed to be part of an orthodontic community where many of our colleagues not only want to see us succeed but also are willing to help us get there.

As an advisory board member for Align Technology, you’re in a unique position to discuss the future of the profession. What are you excited about?
I’m pleased to serve not only on the University and Early Career Advisory Board of Align Technology but also on various councils and boards for the AAO, the Northeastern Society of Orthodontists and the Canadian Association of Orthodontists. This allows me to be very involved and aware of our profession as I move forward through my career.

I’m optimistic that we as a profession can continue to incorporate and leverage digital technology for our practices and our patients. But I’m also aware of the potential negative aspects digital technology can introduce.

The way digital technology has affected orthodontics (mostly positive and some negative) in such a short time, from when I was a resident to today, is mesmerizing. For example, we have a very digital practice and utilize 3D printing, but during residency we hardly discussed 3D printing in private practice.

I think it’s up to us as orthodontists to remain rooted in evidence-based research, educate the public and continue to look for ways to improve orthodontic efficiency without compromising orthodontic quality and optimal patient care. With technology, we must be keenly aware that just because something can be done does not necessarily mean that it should be done, unless there is strong evidence to support its use.

That’s also one of the many reasons I encourage all residents and orthodontists to become members of their respective professional organizations and get involved with organized orthodontics. Giving back to our profession, contributing to its advancement, educating the public and being part of a group of colleagues who truly care about the direction of our specialty has been especially rewarding.

What’s your life like outside of orthodontics?
Right now, my life is very much involved with my startup each and every day. Owning and operating a new practice as a solo owner requires work around the clock, but I knew this going into it and I am embracing the challenge. Even when I’m not actively working on something for the practice, I often catch myself thinking about it and what I need to do next. (It’s a bad habit!)

Outside of the office, I enjoy traveling, sports, music and standup comedy. I always try to prioritize spending time with loved ones, too— I didn’t become an orthodontist so I could build the biggest, busiest practice possible and judge my success based on that. The measuring stick of my professional success will always be compared to and balanced by my ability to be present and support the people who matter most in my personal life.

This profession affords us a unique opportunity to have an excellent work-life balance, but only if we are conscious of it and design a practice modality to fit our lifestyle needs. That balance certainly gets thrown off when you start a practice from scratch—ask me how I know!—but the long-term goal is to get to a point where you look back and can say, “It was absolutely worth it.”
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