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Ready, Set, Start by Dr. Mike DePascale

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Ready, Set, Start   

Master the culture of now to boost your orthodontic practice’s success

by Dr. Mike DePascale

We live in a culture of now. Just about every person you know is busy, or thinks so, and all of us want things right away. Waiting is the hardest part (Tom Petty, anyone?). Sometimes it seems like people want things yesterday! If they have to wait for whatever they want, they are likely to move on. Now, you may disagree with the reasoning behind that phenomenon, and rightfully so, but you can’t hide from it. It’s the reality of the world we live in. There are many reasons for this. In my opinion, the biggest one is the induction of and exponential advancement of all things digital, the internet in general, Google searches displaying instantaneous information, and immediate unwavering access to seemingly endless information at our fingertips (read: smartphones).


Understand today’s consumer
What does this have to do with us? Well, it has a lot to do with orthodontic treatment, even as it relates to moving teeth and scheduling, but for the purposes of this piece, let’s stay in the context of whether or not a prospective patient decides to even begin their orthodontic journey with you. The truth is, they have another option (or three or four or even six other options) that their friends or the internet has told them would be just as good as you, and perception is reality. Even if they aren’t as good as you (because let’s face it, you’re the best in your area, right?), you’ve got to find a way to grab onto that patient and not let go.

They say it takes seven touch points for messaging to really stick with consumers. We use that philosophy when we talk about same-day starts. It’s usually not seven times, but we try to lay the groundwork for this decision several times before the decision time comes and we are actually ready to offer a same-day start. Importantly, a same-day start in this context means a person came in for a consult, a financial agreement is signed and they got braces or got a scan for aligners that same day. This process begins with the first time they ever call the office.


First conversation
Our first touch point is the initial phone call, when we are asking what the patient’s concerns are, who referred them, if there is anyone else in the family they would like us to see, etc. Whoever answers the phone will explain what the initial exam will entail, inform them that the doctors will review their situation in detail using our 3D X-ray to come up with a plan, and that we reserve the time in our schedule to get started that day if it makes sense to do so. Once informed, we will ask, “Is that something you’re interested in?” This is a critical initial touch point because not only have you told them what to expect and prepared them for the appointment, you’ve also given them an opportunity to tell you whether or not they are interested. If they give you a hesitant “Okay,” you will navigate that conversation differently than if they say, “Oh my gosh, amazing!”


Follow-up
The second touch point is when the patient gets a confirmation call from one of the treatment coordinators. This call will typically be one or two days before their scheduled appointment. We will remind them of the location and time, review the flow once again, remind them to have a financially responsible party present and reiterate that we can start that day (if the doctor believes they are ready. Important note: treatment should only be recommended when absolutely appropriate).


The soft close
This will all be reviewed again at the initial exam. Once the treatment coordinator has explained everything and gotten the patient’s concerns and goals, they will leave the room and say, “I’m going to review this with the doctor(s) to come up with a detailed treatment plan. I’ll come back and review it with you. If they think you’re ready, is that something that you would like to get started on today?”

This is a soft close. You haven’t told them they need to start, but you’ve guided the possibility. It’s important to pay attention to all details of the communication because at any point in any of these conversations the answer could change or the demeanor could change. They could’ve sounded excited on the phone and they’re now skeptical. They might have been unenthused on the phone, but now love the office and the communication and are ready to get started. Either way, as a treatment coordinator, you’ve got a responsibility to tell the doctor which bucket they fit into.

Are they excited? Are they reserved? Or are they defensive? The doctor then has a responsibility to appropriately address that patient. No one should ever be forced into treatment. We want all of our patients to feel excited about their decision and comfortable with the choice.


The stats
You might be thinking, “Well, you could do all of that and not have to start the same day.” That is true. However, if we think back to what I said about all of their options and people looking for second, third, fourth and fifth opinions on things, it’s important to consider if they leave your office without signing a contract, there is already an increased likelihood they are not going to start treatment with you. Data from OrthoFi proves that to be unequivocally true. As soon as they leave the office without a signed contract, your conversion goes down from 100% and steadily declines until the 45-day mark, where it’s about 60%, then drops off a cliff.

So, you could be the best doctor in the world, but if a patient leaves your office without braces or an aligner scan, there is a significant chance they are not coming back for one reason or another. Additionally, as I mentioned prior, people are busy. Their kids need to get back to school. Susie simply can’t miss another class! They’ve got to get back to work or their lives. Whatever the case is, they’ve already set time aside for that appointment and changed their schedules. They’re already there. You already have a treatment plan. The only obstacle you have now is yourself.


Culture
How do you get these people started in the clinic? We get this question all the time and the answer is simple—challenging but simple. Your culture has to support this and it has to be set that way now.

Let me give you a different example. If a patient comes in for an adjustment at 4:45 p.m. and you see four brackets that need to be repositioned but the team is packing up and you want to leave, what do you do? Do you tell them to come back another day and schedule it when you have time? Or do you just do it there? If a patient comes in for final adjustments but there is nothing to adjust and they have senior pictures coming up, do you schedule them to come back because it’s hard to fit that in and your schedule says you don’t have time, or do you take the braces off so they can smile for those pictures and you avoid an extra appointment?

We would reposition the brackets in scenario one and get the braces off in scenario two. Not only would we do it, but the team would suggest it. That’s a culture of now.

This may surprise you, but we don’t have appointments built into our schedule for same-day starts. We just do it. How do we do that? Culture and training. The team members all know how we operate and they are all helping each other to allow this to happen. The expectation is set and the follow-through is managed accordingly. We don’t have team members who are standing around waiting for the doctor and not doing anything else. If they are waiting for a doctor and there’s something else that can be done, it gets done. Whether it’s helping another assistant, grabbing something for another person, cleaning, turning another chair or writing notes, they are always doing something. That both frees up time and promotes the camaraderie and dedication necessary to find ways to put braces on in the middle of the schedule. As the doctor, you’ve also got a responsibility not to waste time at appointments to allow for this possibility.

The truth is, when the culture is primed and the patient is ready, it’s like Nike for orthodontics. You just do it. You are going to have a team member or members that have to do a little bit more for part of the day to stay on time (we almost always run on time, by the way). It’s helpful if you’ve got an extra assistant to handle that, which might mean one or two more chairs in the clinic, but we often don’t. It’s a result of everybody working together with a common goal of making sure you are delivering the best care, the best service and the best customer experience for your patients.

In summary, this whole process starts from the first phone call and it ends with a well-oiled machine making it happen in the clinic. None of this is possible without strong leadership and a strong team, so start there. Everybody has to know that you are all going to do everything you can to help a patient get the treatment they need with no wasted time. Because everybody knows that, they will talk about it on the new patient call, when the patient calls back, when we confirm their appointment, when they meet the treatment coordinator, and then maybe once again when the doctor says it as well.

When patients ask if they can start today, be excited, be honored and be proud, because you’re the best place for them to be, and you know that if they walk out that door, there is a chance they are going to see someone else. If you’re reading this and you don’t believe that you are in fact the best orthodontist for them to ever see, I would encourage you to look in the mirror and do some work to make sure you feel your office should be the home for their journey.


Final thoughts
Finally, if you love the idea but you are truly unsure how you would make this cultural or procedural change to your office, please reach out to me. I do recognize that it’s helpful to see this happen in real time and we live in this world all day, every day. I’d be happy to help guide you to a more productive, more convenient office! Do more. Be more. Smile more. OT
Author Bio
Dr. Mike Depascale A New Jersey native, Dr. Mike DePascale received his orthodontic master’s degree at the University of Maryland in Baltimore. In 2017, he joined the team at Kozlowski Orthodontics, a practice that matched his dedication to high-quality treatment, innovation, efficiency and education. When DePascale is not in the office, you can find him in his garage gym or coaching CrossFit at a local gym, where he puts to use his passion for personal growth, leadership and commitment to others (You may see him there throwing weights around, too). He believes in pushing boundaries, doing what you love and sharing that with the world.



Orthotown Magazine
September 2025
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