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Fuel Practice Growth by Dr. Alex Culberson

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Categories: Practice Management, HR and Accounting;
Fuel Practice Growth 

How the right digital tools can streamline workflows, boost efficiency and transform your practice

by Dr. Alex Culberson

Let’s be honest. Orthodontists don’t invest in digital tools just to feel tech-savvy. We’re looking for results—more efficiency, better outcomes and, ideally, a path to growth that doesn’t come at the expense of our time or sanity.

But what most people don’t talk about is what happens after you go digital. The time you get back. The mental space to lead. The unexpected shift in team culture. In our practice, digital orthodontics wasn’t just a systems upgrade; it was the catalyst for a total transformation.

We didn’t hire more people. We didn’t pour more money into marketing. We restructured how we work, and we grew. Today, we run three locations, we work fewer patient days and we’re outpacing our previous growth trajectory in a competitive market.

The hidden cracks and the wake-up call
When I joined the practice in 2019, it looked buttoned-up from the outside. But under the surface, things felt off. Communication was disjointed and there was no consistent vision guiding the team. As the old proverb goes, “If you want to go fast, go alone. If you want to go far, go together.” That wisdom hit hard. We had ambition but without alignment, we were running fast in different directions.

It wasn’t any one person’s fault; we just didn’t have a cultural system. Sure, we had plenty of orthodontic practice systems: scheduling protocols, clinical workflows, financial processes. But we lacked the systems that actually shape how a team works together: how people lead, communicate and grow. And as long as the schedule stayed packed, there was no chance to reflect or restructure. Then COVID-19 hit.

From analog survival to digital transformation
When I purchased half the practice, uncertainty was high. We actually pulled back from digital orthodontics, relying on analog systems—traditional braces—for more than a year. It felt like survival.

Eventually, we realized pulling back was slowing us down. So we doubled down. We adopted LightForce Braces and reintroduced remote monitoring with DentalMonitoring while ramping back up our use of SureSmile wires for metal braces, all at once. Going all-in with digital gave us something priceless: time.

Our practice had used custom wires and aligners for years, but now we were going fully back into digital. And with these tools, something shifted. Yes, they saved time. But more importantly, they changed how we viewed time. Instead of simply filling our schedule up with more appointments or busywork, we stopped and asked: What would it look like to use this space to lead better?

Leading on purpose
We knew we needed a leadership team, but in the beginning, we didn’t have the time or structure to make it effective. So, we did what we could: we met on Fridays—rushed, tired and unfocused. These early meetings were well-intentioned but chaotic.

Once we had time back in our schedules, we stopped managing by gut. We started running on vision, structure and clarity. We adopted the Entrepreneurial Operating System (EOS) to define roles, set goals and make sure everyone was aligned.

These five EOS-driven tools made an immediate impact:
  • The Accountability Chart. Not an org chart. It shows who owns what. This alone changed the way we delegate.
  • Level 10 Meetings. Meetings with the same structure, every time. This keeps us focused and solving real issues.
  • Scorecards. Simple metrics for every leader to track their area. If the numbers are off, we know where to dig in.
  • Rocks. Quarterly goals tied to each leader. No fluff, just traction.
  • Core Values + People Analyzer. A brutally effective way to evaluate team fit and cultural alignment.
These weren’t abstract ideas. They were practical tools that gave us structure. And structure gave us freedom.

But alignment came with a cost. As we began shifting our culture and leaning into leadership development, not everyone was on board. In fact, more than 50% of our original team ended up leaving. That wasn’t easy, but it was necessary. The team that stayed, and the new talent we brought in, fully embraced our core values, took ownership and aligned with the vision we were building.

Losing that many people could have derailed us. But instead, it refined us. It reinforced that culture isn’t just about pizza parties and posters on the wall; it’s about clarity, buy-in and the willingness to grow together.

No more scrambling on Fridays. We carved out real space during the week for team development, training and intentional leadership.

At first, it was a scary concept: closing down time that could be used to generate revenue to work on something other than treating patients. But in hindsight, that decision was the unlock. It signaled that leadership, culture and team growth weren’t just side projects—they were part of the business strategy.

Growth without more days
For years, our practice hovered at a plateau. Then, with the right tools and team leadership in place, something wild happened:

Before:
• Two locations, two doctors, 21 team members
• 14–16 patient days per month per doctor

After:
• Three locations, two doctors, 20 team members
• 12–13 patient days per month per doctor
• 10% production growth in the first year of full digital integration
• Surpassing that halfway through 2025

This wasn’t a startup boom. Our practice had been around for 20+ years. What changed wasn’t the opportunity—it was how we operated.

Flip the focus: Team first
Walk into most orthodontic offices and you’ll hear a familiar mantra: “We put the patient first.” And while that’s a worthy goal, I started to wonder, what if we flipped it?

What if we put our team first, really poured into their growth and fulfillment, and trusted the patient experience would reflect that investment?

We began asking a different kind of question: not just “How will this benefit our patients?” but “How will this benefit our team, and by extension, our patients?” That shift led us to lighten the clinical load, adjust our schedule to reflect reality, and create a work environment where people could thrive.

The turning point
We dipped our toes back into digital orthodontics. We limited remote monitoring to a few cases. We hesitated to commit. It didn’t work.

The real shift happened when we went all in. When we said: This is how we operate now. That clarity created buy-in.

It wasn’t just about scaling a system. It was about signaling to our team, “We believe in this, and we believe in you.” Most team members want to grow. They want ownership and they want autonomy. That’s why we embrace a decentralized command model. We equip people with the skills to lead and then give them the space to actually do it.

People who feel stuck or stagnant eventually seek new opportunities. And in the early stages of our cultural shift, we saw that firsthand. But now, because we’ve built a structure for growth and accountability, our turnover is dramatically lower. People don’t just work here—they’re invested. They feel it’s their practice too.

Inversion thinking: Avoiding the worst to build the best
One of the most powerful mindset shifts we adopted came from Charlie Munger’s concept of inversion thinking. Instead of asking, “What would make us a better practice?,” we flipped the question: “What would make us a terrible orthodontic practice?”

The answers came quickly:
• Disorganized communication
• Overworked doctors with no time to lead
• No clear accountability
• Confused patients
• Burned-out teams

So we did the opposite.

This mindset became a compass. It pushed us toward clarity, structure and consistent leadership. Every time we faced a decision, we inverted the question and avoided the behaviors we knew would sink us.

Pearl: Turning ‘film’ into feedback
One of the hardest things to do in any business is bring awareness to a problem without making someone feel personally criticized. This is easier with athletes because they can watch film and see the issue themselves. The awareness comes from within. There’s a difference between criticism and feedback. Criticism is telling someone they did something wrong. Feedback is identifying the error and offering a path to correct it. That’s the culture we’re building, one where clarity doesn’t come at the cost of dignity.

I had a football coach growing up who always said, “Film don’t lie.” Now that we have DentalMonitoring, we have plenty of film, enough for the doctor and team to analyze mistakes, learn from them and grow.

Instead of walking through basic procedures like how to bond a Motion appliance (which 99% of assistants and doctors already know), we focus on recurring issues that we see in our digital records. We identify patterns, pull up real examples and talk through them as a team. In our busy practice, it’s not realistic to take intraoral photos of every patient. So we put the patients to work; remote monitoring helps us capture those photos without disrupting chair flow.

This isn’t theoretical leadership. This is tactical, hands-on development using data your practice is already collecting.

Orthodontists struggle with letting go. I get it. We’re trained to control every detail. But holding on too tightly creates a ceiling.

Digital orthodontics lowered that ceiling and gave our team the room to rise.

The real win
Everyone’s chasing a magic solution, a silver bullet. We didn’t find one. What we did find were 100 small wins. Remote tools. Leadership meetings. A culture of accountability. Team autonomy. Real feedback. Personal ownership.

Call them golden BBs. And culture? Culture is the bucket that holds them all.

We didn’t start out trying to build a better leadership structure. We started out trying to make things run more smoothly. But once we did, it became obvious: Digital orthodontics didn’t just improve our margins. It gave us the bandwidth to build the practice we actually wanted.

Our team is happier. Our patients are more engaged. And we’re not stuck in the chair five days a week trying to grow by sheer effort alone. There’s no substitute for consistently showing up and putting in the work. But effort alone isn’t enough; you need the space to lead and the clarity to make sure that effort is actually moving you forward.

This isn’t about tools. It’s about what you do with them.

And that’s where the magic happens.
Author Bio
Dr. Alex Culberson Dr. Alex Culberson is the co-owner of Classic City Orthodontics, a private, multi-location orthodontic practice in Georgia. He earned his undergraduate degree from the University of Georgia and completed dental and orthodontic training at the Dental College of Georgia and The Ohio State University. Culberson focuses on digital orthodontics, team leadership and building practice systems that support long-term growth.
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