By Nona Naghavi 

I am always inspired by Ben’s thought provoking posts and laser sharp view into the future. He is constantly paving a tunnel to clear the path ahead and I’m grateful that I don’t have to do the hard work researching the future myself. His recent blog “Emotional Orthodontists” was especially interesting to me because I am living proof that great changes can bring great opportunities. While most of us loath the fact that GP’s do orthodontics, some of us have realized that therein lies an opportunity for us. The GP’s desire to offer orthodontic services is so bad he will flip backwards for you to come in and do what you love to do. What is this called? A job guys! What so many of us complain we CAN NOT find…Doctor, it’s not rocket science. Here are 14 observations and tips I’ve learned through my own mistakes: (please know these are my own experiences and opinions. I understand these won’t apply to everyone)

When you set out to work with a GP:

1. Don’t ask for per diem. It’s such a mood killer. Work hard, grow the practice, reap the benefits. Rinse and repeat. It’s that simple. Why would you literally pick up a block and place it right on the table between you and the owner? Can anyone move forward now? There’s nothing more motivating to me to go into work one day with a full schedule of “free” consults knowing I won’t get paid until we close some or all of these. Hustle and run. The thrill is worth it. I’d be mindlessly on my phone all day if I was on a per diem, honestly, which would lead to less starts and therefore less production down the road when you’re on percentage. I know some of you disagree with me. That’s ok. I decided to remove the block from the table and reach and shake the guy’s hand on the other side.
2. Spend more time talking about how you would split “responsibilities”, and less time solidifying your percentage or per diem.
3. Remember: They don’t interview you, you interview the office to see if it’s a fit for you. There are a list of things I ask the owner and a list of things I ‘eye’ the office for to quickly know if there’s a need and potential for ortho. Is the office truly ready? Will the owner be MY team player? Not the other way around.
4. We’ve all read many posts on all forums about how the owners spend so much time and effort and techniques trying to motivate their staff to believe in the office vision, be a team player, have self-initiative, instead of being solely focused on clocking in and out and their hourly rate. Doctor, when you walk in that GP office, you ARE the owner for that day. This is the BEST advice I can give you to succeed in ANY collaboration with a GP. Don’t preach your own staff about looking beyond their salary and then walk into the GP office on your phone the whole time. Don’t have an employee mentality. Tell, show, do: verbally tell the owner you have your eye on EVERYTHING as if it was your own office. Show the owner that you are fully engaged and present. Do it. Pick up the trash on the floor because those consults that walk into his office might not know that you are not the owner. If the water is running, turn it off to save on water bill. Turn off the compressor at the end of day. If staff are just ‘hanging around’ while clocked in, give them something to do. I do this EVEN if it’s the owner paying them and not me. Do you really think the owner who sees all of us will be anything but in love with you? Do you think he sees this and still schemes to nickel and dime you? Maybe. I choose to believe that he won’t. Just like I don’t nickel and dime a staff who I can see is going above and beyond.
5. When you go to interview an office, shower the owner with all the benefits you’re about to bring into his office. Tell him you have done this successfully and this is how, or you know of someone who is doing this and this is how. Talks about a contract shouldn’t even come up after this. Only if YOU want one, you should bring it up. I have never had a GP office push a contract on me after they hear me explain to them what I’m going to do and what they can expect from this amazing venture. I think they’re so thrilled to get started that they feel a little ashamed to even insist upon a contract.
6. Two things can make a contract become the center of attention: greed and dishonesty. Not only the owner’s but also YOURS. Don’t be greedy and dishonest and most people in their right mind won’t get in a tangle with you.
7. Best job referrals for me these days is through hygienists and assistants. Once they work with you they start talking about you to their other coworkers who work in other offices who might want to start offering ortho. Job ads to me signal a possible revolving door like a home that’s been on the market for too long.
8. Many grads say “I want autonomy, I can’t work for someone else, I’m not sure ownership is for me but I’m going to do a startup anyway because there’s nothing else”. Stop. There are other options so you can have the best of both worlds.
9. What if the GP office gets sold? One of my productive GP offices was sold 2 months ago. I started ortho there pretty much from scratch and it grew pretty well. The owner and I were getting along famously and I finally understood that sky can really be the limit once the doc and the manager (in this case the owner’s wife) see eye to eye and have goals that are aligned. It was a beautiful and fruitful relationship. Fast forward about a year and a half and the wife tells me they’ve decided for personal reasons they want to sell and move. The first lesson I learned from her talk was, ownership is NOT for everyone. Here was this GP who opened up an expensive office right after graduation thinking he was going to ride into the sunset but with ownership comes the need for a thousand other capabilities that if you haven’t got it you can’t just go to a store and buy it. The wife was one of the best mangers I’ve seen, yet lesson two was that if one wheel of the bus isn’t running the whole bus stops. Lesson three was no rash decisions needed, calm down and observe the change. I did worry. Mostly about things most of which did not materialize. Moral of the story is even if an office changes directions on you, be fluid enough and flexible enough to make it work.
10. Don’t get too dependent on your TC. Likewise, the world doesn’t end if you find yourself without one, especially if all your eggs aren’t in one basket. I wrote in “Doctor, please stop assuming” about my busiest office having a treatment coordinator that I incentivized for same day starts and the results were nothing but amazing. Well, about 5 months ago she experienced a miscarriage and with it went all same day starts. Of course this was a very traumatic chapter of her life. We all grieved with her. There’s nothing more tragic than a life being lost and I gave her as much time as she needed to get through this. First lesson I learned was don’t get too dependent on your TC. Second lesson was everyone is replaceable. As if one office wasn’t enough, 3 months ago another TC in another awesome office was diagnosed with cancer. This is very heartbreaking as this guy is only 28 and the best male TC I’ve seen. Nearly closes every case because he is the embodiment of confidence. Good news is both individuals are back to work full force and all is fine again but the hiatus taught me many lessons, perhaps the best of which was that I have become resilient and flexible enough to ride through these changes. Stay flexible, stay calm and re-strategize. You can do this.
11. Put your eggs in different baskets. Pick up as many offices as you can handle. There’s nothing more stressful than if your ONE office has an issue you have to solve to make it more productive. We hear about it all the time on all the forums. First of all, working in other people’s offices leaves the hard work for the owner, not you. So that’s great already. But second of all, if you have multiple sources of income and all of a sudden one office is hitting a road block you can have peace of mind that income is coming in from other offices that are doing well and you can maintain a clear head through the raod block and find a solution quicker. This happens to me all the time. In an almost synchronized fashion, production in one office dips but others soar. In total the income is roughly the same so my stress is low. I can focus on that one office until the issue is resolved and so on.
12. Having orthobanc or any automatic withdrawal set up is nice but not always practical in a GP office. I have learned to come to terms with that. I used to ask the TC to try and collect for all the missing appointments so accounts would stay current. Then I realized it can quickly become difficult for a mom to come up with 3 or even 2 monthly payments at one go. Not impossible but it left a not so happy taste. Money talk is always unpleasant and there is no quicker way to piss off a parent. Best way I taught the TC’s to explain this is: If you go on a vacation for a month you still have to pay your mortgage for that month. If your car is at the shop you still have to pay your monthly lease. I thought it would be a no brainer explanation. It’s not. Parents still fight you on this. Finally I gave up. Being behind on payment for a few months doesn’t scare me as it did before. I’m fully aware of what the balance is. We will keep on treating until the balance is paid. And then we will debond. Sometimes I think it’s much less headache to just continue collecting monthly payments as they come and bypass the whole ugly money talk with mom. If they ever ask why isn’t the treatment done yet, kindly remind mom that the teeth are looking great and debond can be done as soon as balance is zero. Most will run to the front desk.
13. You know the moms that walk in with their arms crossed and face as stiff as a brick? When I see that I think about my past few days. Did I walk into Starbucks and not smile at the barista because I was thinking about my student loan? Did I not give a big hello to my assistant this morning because I was thinking about my daughter home with the flu? Catch my drift? I’m not saying it’s ok to be rude to others. I’m just saying we don’t know what’s on mom’s mind. Maybe it’s not you. If it is you, try and address it. If you can’t, try something like this: well thank you Johnny for not breaking any brackets today! I really love that! Most moms will give you at least a half nod because you complemented the joy of their life: their child. If there are broken brackets AND mom looks pissed, offer Cuban coffee! In South Florida EVERYONE is drinking them ALL THE TIME! I know most offices have coffee makers now. But the difference here is this: Cuban coffee is served in tiny cups on an actual tray with an assistant walking around the office like a waiter and serving everyone from moms to doc to pts to front desk… it’s magical. It’s such a personal, homey, and friendly service you forget you’re in an office…and pissed. I know I do! I’ve even been interrupted in the middle of a consult by a staff entering the room with a tray. Oh, it sooo breaks the ice..
14. The list of insecurities in “Emotional Orthdontists” were: SDC, Invisalign taking over, number of ortho programs, DSO, GP doing ortho. I will add one more for the newbies.: Hearing and reading about the amazing and successful practices. This can be very intimidating. Of course it made me doubt myself too. Where did I fit into that spectrum I thought to myself many times. I had an epiphany one day when I realized THAT WAS NOT ME. Doctor, don’t be ashamed of yourself. Some of us are thin, some fat, some tall, some short, some light, some dark but by God we are all beautiful and human and we all bleed red. A huge part of me believes that there actually are patients out there who are intimidated to seek treatment in super elite offices. They might consider it unattainable (wrongfully). So there will forever be need for all tiers of providers. Bottom line: Successful offices can not get the better of you. Be you. Just as there are many lessons hidden in each of the listed insecurities, there are lessons in intimidation too. Just as you should think for yourself how you can leverage these changes to your advantage, you can channel intimidation in a productive and positive direction to benefit you, not to hurt you.

We keep hearing these days that “change is good!” I wasn’t sure I believed that until I wrote this article and realized how much I have changed and grown through these trials and tribulations. Change really WAS good!