[00:00:06] Welcome to the GrowOrtho Podcast. I am one of your hosts, Zach Dykes, joined by Dr. Bryce Gilliam, 2024's 40 Under 40, America's top young dentist, co-host of the TV show Making Modern, available on Macs, and owner and operator of Elevation Orthodontics. Welcome to the show, Dr. Bryce. Thank you for having me, man. I'm excited about today.

[00:00:30] I am looking forward to this because we have already done part one of this talking to our startup orthodontists, the pitfalls that they have to kind of navigate and avoid. But today we're talking to our seasoned orthodontics, the titans, if you will. They've already built their empires on aligners and archwires, all of those things.

[00:00:52] But a lot of orthodontists have to know that there can still be stumbles, there still can be traps that are out there that threaten to lose just tons of crazy stuff into their practice. So let's talk about some of the common pitfalls tailored for our veteran orthodontic practices. One of the main things is letting cash flow complacency creep in. So all that means is over time, you've built up this steady flow of patience and you should feel really good about that.

[00:01:22] And you're used to a certain amount of money coming in. But what we do is a lot of times we get blind by the expenses just kind of creeping up slowly. Some of those things are rent rising, new tech coming into the market, the shiny thing syndrome is what I like to call it. And then the staff, their pay scale just kind of rising over time. And so what that ends up doing is it starts to kind of erode those margins.

[00:01:52] So your margins of profitability become smaller. So you have to stay on top of it and proactive whenever you're talking about your budgeting and you're talking about your plan with vendors. You want to make sure that you're going to be aware that at some point they're going to increase their pricing. So you have to plan on that to make sure that you keep your margins the same. And as good business stewards, knowing your margins and anticipating where your margins are going to be year to year is going to be really important.

[00:02:22] The better you understand that, the further you're going to be able to go. Because, you know, Harrison always says that small hinges swing big doors because lifestyle creep is real for everybody. You know, you get comfortable, you want a little bit more of this, you want a little bit more of that. And your practice is the same. So you have to be conscious. Well, how many subscriptions are we paying for?

[00:02:45] You know, like I'm looking at business stuff and it's like, oh, I'm paying, you know, for ChatGPT. And then I'm paying for a thing that's pretty much ChatGPT, but just a different name. And like you see how much you're putting out and you're like, man, I could, you know, bring that a little bit back. And I have a little bit more overhead. I can invest in the business in a different way.

[00:03:06] So keeping your eye on cash flow, I think, is going to be huge for any practice, whether you're crushing it or if you are needing a little bit of help. I think thinking about that, understanding it, and if you don't understand it, go talk to a professional, someone that knows how things should be, you know, percentages and all of that. And, you know, I think that's a big thing that people just, you know, get out of your comfort zone a little bit, be honest, level with yourself.

[00:03:35] And you're going to see your practice grow exponentially because you're not strangling it to death with your cash flow problems. That's right. And one of the tips that I'm going to give everybody is kind of what we do. We find a slow month each year, which is typically December for us. And we go through all of the subscriptions, all of the partnerships that we kind of partake in, and we go through and evaluate them. We say, is it worth the amount that we're paying them? Have they showed us value?

[00:04:05] Have we increased based on this? Have they made it easier for us? And if the answer is no, then we cancel that subscription or we cancel that partnership. And we do it every year. And you can pick whatever slow month that you have and do the same thing. That is such great actionable items to do because you just need to keep aware. You need to keep aware. Just like with your staff, you need to keep aware of, are you letting people cling on because they're loyal to you?

[00:04:33] Yeah, so this is a tough one, but it's something that as a seasoned doctor and a seasoned business owner, you have to really kind of watch out for. And it's the loyalty trap, right? They've been with you for a long time or they've been with you through tough times. But what you want to know and what you want to look for is their performance. Are they fumbling through online booking? Are they really slow with scans?

[00:05:01] The pitfall is really to keeping those underperformers out of habit. Really, you want to make sure that you train, replace, or reassign them to meet your practice's demands. And you want to make sure that you're giving every patient a top-notch experience no matter how long your team has been around. It's also different seasons of life.

[00:05:26] You know, they might have started as a front desk and now they want a little bit more of a challenge. They don't feel like they're growing. So, you know, you've got to keep an eye on that because not everybody is going to come to you and be like, Hey, Dr. Bryce, I, you know, I'm not really enjoying my position right now. Can I get something more, you know, challenging? Not a lot of people are going to do that. That's like a diamond in the rough kind of situation because people don't want to rock the boat.

[00:05:56] They don't want to seem ungrateful. And just keeping your eyes on that. And then there's the flip side of there's some people that don't need to be in those roles and they're not going to say anything either. That's right. You want to kind of develop a culture. And I'm sure most of you seasoned orthodontists have kind of developed at least some culture. But you want to develop one that is there's transparency and there's approachability, right? You want to be able for, you know, either your office manager or yourself be approachable.

[00:06:26] So if there are issues and things like that in people's mind, then they can openly talk about it. And they don't feel like they have to hold it in and do something that they hate. Don't let it turn into a J-O-B. You don't want that. You want that to be ownership in your practice. That's well put.

[00:06:43] On top of the loyalty trap, we've also got the old school marketing trap where we're still doing the same thing that 25 years ago worked, but we're doing it in 2025. Yeah. So this is a tough one too because you've had success, right? You've built this reputation. It's solid. Your word of mouth is still bringing in a steady flow of referrals.

[00:07:11] But you haven't really invested into your social and digital marketing. And I think that this is where you can start to lose a little ground. You have the person down the street who's also building a good reputation, but they're also in the social media world. They're also in the digital marketing world. And so they're starting to take some of your share of chair, I guess.

[00:07:34] And you have to always remember that a patient wants more than just results. They want to be part of the hype. They want to be part of the buzz. So you have to continue to create a hype type of atmosphere for your practice so you can either modernize it or you end up fading away. Yeah. Yeah.

[00:07:57] And it's that thing that's innate within humans is we want to belong to something that's successful. That is the doctor that you go see for a general practitioner. That is your orthodontist or dentist. You don't want to be like, oh, yeah, I go to this orthodontist and it's so like, oh, my God, I feel so bad for him. That's the only reason I want to keep going. But, you know, it's like people don't do that. They want to be part of something successful. Yeah.

[00:08:27] And you're spot on. I mean, think about just how just trends happen. People sometimes don't even believe in the trend, but they want to be part of the cool, the hype, the buzz. And so they end up doing it anyways. So if you can create an atmosphere that captures that and captures that energy, dude, you can get the whole entire community involved. And you'd be so successful.

[00:08:52] Stop trying to, you know, use like a flip phone, like get with the smartphone age, like jump on SEO. Stop neglecting Google reviews. Even if you have a you might not even have a Google My Business profile at this point. And definitely go dust off that website. Don't let it just sit there. You designed it in the 90s. Don't let that be the thing that people see when they look up your practice.

[00:09:17] And you brought up like talking about cases a little bit, but let's jump into over committing to every case. Why is that a problem, Dr. Bryce? Yeah, I think this is one of those things that when you first start as a young doctor, you over commit to cases and think that you can do stuff heroically. Like you can do stuff that is, you know, I'm going to bring this impact at K9. I'm going to do all this stuff and great, great, great.

[00:09:44] Well, as you start to get a little older, you kind of get away from that. But what you end up doing is you end up still trying to chase perfection. And so you keep these patients in treatment for longer than they actually need to be in treatment. And so if you don't get those patients out of treatment or if you have a bunch of patients over treatment time, you end up treating them essentially for free. So you want to make sure that whenever you have a 24-month treatment plan or a 12-month treatment plan that you get those patients out on time.

[00:10:12] You don't have to get everything perfect. I know I'm not telling you anything new, but just remember that you've got to get those patients out of treatment where you can kind of move on and let them have a happy life and you as well. At the end of the day, all they really want to do is get off the braces, get off the Invisalign and be able to see their smile and not worry about it.

[00:10:36] And when you do that, you're opening up chair time for a new patient, which, again, you don't want to be treating somebody for free because you've kept them on the schedule for too long. Yep. And we all do it. As doctors, we all do it. I mean, we all see a little rotation that we want to fix. And it's like, you know, now it's like 24 months goes to 28 months. And next thing you know, you know, there's some little thing that you're trying to tweak and it's not really working. And it's 36 months.

[00:11:04] And it's like, you know, at what point do we just say, OK, the patient is very, very happy with the results. Let's meet them where they're at and take these braces off. I love it because if you just keep going, eventually they're going to get tired of coming. That's right. And then that's when you start seeing you start hearing these horror stories of like people being in braces for four or five, six years.

[00:11:29] And what ends up happening is you kind of tinker with it here a little bit. And at year two, they're starting to get burned out. At year three, they're definitely getting burned out. So they may not even come for the next whole entire year. And then now they're in braces for five years because they've skipped out because they've got burned out. And so, you know, you kind of got to juggle that. But it's that is definitely something that if you can avoid going over treatment time, you should try. So let's jump into the patient vibe.

[00:11:58] You know, a lot of established practices like they kind of hold on to their look. Why is letting that kind of slip going to affect the overall like practice? Yeah. So many of you guys may know that I am the designer on our TV show where Brooke is the builder. But really, I am I am hypersensitive to the design of a practice.

[00:12:25] And there's nothing worse than you having a practice that's still stuck in the 90s, even though in the 90s it was awesome. But we're now past that. Right. So what I like to tell people is every five to seven years, you should look at doing some type of refresher. That doesn't mean that you have to do a total office overhaul. That doesn't mean that you have to change chairs and all that kind of stuff. Maybe that means we just put a little paint on the wall. Maybe we change the artwork. Right. That's pretty simple.

[00:12:54] Maybe we add some plants or take some plants away. Maybe we just clean off the front desk a little bit. Maybe declutter some stuff. It's simple things like that that will keep you right up to the current aesthetic and make it feel like your practice is still modern. The vibe is still there. But you can stay true to who you are as well. Yeah. You don't want to be the sad beige office that everyone's like, oh, yeah, the sad beige orthodontist.

[00:13:24] You want to bring in somebody that you trust, but that hasn't been in your practice. They might see stuff that you've never seen before. I was talking to a realtor a few weeks ago and she was like, yeah, I was selling a realtor friend's house and she knows all the tricks of the trade to get everything looking good. And then she looked on her kitchen counter and there was just these stack of papers. And she's like, what is this? And she's like, oh, I didn't even realize that was there.

[00:13:54] It's just been there. Like she totally just glossed over it because it's a fixture essentially in her house. But that's the same way with your practice. If you're not, you're just kind of got blinders on. You're doing your day to day job. So you have to be cognizant of that. Yeah. It's kind of like being nose blind, right? So you get used to smelling something and you don't even notice that it smells bad. It's the same thing with what you see every day.

[00:14:19] Like you don't even notice that it's accumulating these pieces of paper in the corner or whatever it may be. But you can hire a designer. Don't feel like you have to take this on yourself. Hire a designer. Hire someone that knows what they're doing and just say, hey, make my office a little bit better. We don't have to do an overhaul, but just make it nicer or make it where it's a little bit more up to date. That's all I'm asking. So shifting focus a little bit, let's talk about sticking to the still location strategy.

[00:14:49] What does that mean, Dr. Bryce? Yeah. So this one is a little bit tougher, right? This is me saying that maybe your location is not the location it once was, right? So what happens over time is parts of town change, right? So it may have been the booming thing 20 or 30 years ago, but maybe it has kind of devolved instead of getting better.

[00:15:16] And so really what we're looking at is make sure that you're cognizant of your community and the trends and the trendy districts and things like that. Maybe you need to look at putting a remote office in one of the more trendy places or one of the up and coming places, more like a satellite office. I think that it's just one of those things that you don't want to get so stale and so stuck in what you do on a day-to-day basis that you forget that things change around you.

[00:15:46] So, you know, good practices is you look at a demographic study every five years to make sure that everything is kind of still what it was once you were, you know, you open the practice. And I think that that's a good habit. You know, pay a couple hundred dollars and have someone do a study for you. And it kind of gives you an idea of, heck yeah, I made the right decision or I might need to look for a satellite option. Going back to cash flow and all that, all these different points kind of go into this one.

[00:16:15] And it's like, once you know that, oh, this is the up and coming area, I want to keep growing. Then, you know, oh, I can go to this place and, you know, ask, you know, trusted advisors in the, you know, real estate sphere. You know, when you get your data back, like, hey, is this matching what you're seeing in the market? You know, are you seeing, you know, this part of town on the up and up, you know, are they're building new houses?

[00:16:42] Like there's a lot of key indicators that you're going to see, you know, oh, they're putting in a new strip mall. They're putting in a Publix or whatever it is. Oh, another Starbucks is going up there. You know that there are people there and that is going on. And, you know, it's funny because I can already hear my colleagues saying, yeah, right, Dr. Bryce. I've built this office for the last 10, 15, 20 years. I'm not going to move. I'm not asking you to move.

[00:17:07] I'm asking you to take that reputation that you have and use it in another area. You've already got the hard part. It's the reputation, right? So you use that in another area. You've doubled your practice size. You've doubled the scope. And some of you guys are going to fight me on that. You're going to say, hey, I don't want to be any bigger. Well, great. Get you an associate. That's the only way that you can scale. And what that means for you is you get more time back. You get more of the quality of life that you want back.

[00:17:34] So, you know, there's always a reason why you shouldn't do it. But I think that this is one of the things that if you do it correctly, you will be very happy with what you've accomplished. I love all of these points, Dr. Bryce. And when you really think about it, these orthodontists, they've conquered the game once and they can do it again. You know, looking at these pitfalls, they're not, you know, it's got me. I can't get out. There's, you know, nothing that cannot be fixed.

[00:18:04] So sharpen your strategy. Rethink that playbook you've been looking at and keep your practice as flawless as the smiles that you craft. What's your next power move? That's what I want you to be asking. What's my next power move? Because Mark Twain said it best. The secret of getting ahead is getting started. So get out there and get started making the changes you want to see in your practice. Now, this has been Zach. And I'm Dr. Bryce. Thanks for watching the Grow Ortho podcast. Smile big, guys.

cash flow complacency

This Is Why Your Orthodontic Practice Isn’t Growing Anymore