The BIGGEST Mistakes Orthodontic Startups Make (And How to Avoid Them!)

[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 Max, and owner and operator of Elevation Orthodontics. Welcome to the show, Dr. Bryce. What's up, my man? How are you doing?

[00:00:29] I'm doing awesome. I'm excited because we're jumping into some startup conversation today, and I'm looking forward to it. I love it. I feel like the last couple of times I've been in casual attire, so now I got the scrubs on, so I feel so official. Well, we're ready for this because today we're talking about our future orthodontic bosses, and we're going to be talking about opening your own clinic.

[00:00:52] It's going to be a wild ride from braces, bites, and big dreams, but don't get blindsided by all the rookie mistakes that can be happening. Dr. Bryce, from your own experience, what are some common traps new orthodontists should avoid? Yeah, I've kind of listed out a couple for today's topic, but the first one I want to start with is underestimating the cash crunch.

[00:01:17] So, basically, whenever you first start a practice, you're thinking, oh, man, I'm going to straighten out these teeth. I'm going to make this money. I'm going to do all these things, but the reality of it is a startup is an expensive endeavor, right? You have costs from the equipment. You have the cost for your x-ray machines and chairs and your inter-oral scanners. All of those things aren't cheap, and so it's very important that you stay in front of mind or at the top of the mind about your cash flow.

[00:01:47] And where I find that most startups fail, and I'm not saying that they fail to work, but what they fail to think about is how they're going to get that cash flow. It doesn't happen magically. And really what I want them to do is I want you to start thinking proactively. We're going to plan for this. We're going to budget. We're going to have a working capital. And so working capital can mean a bunch of different things, but really what we're trying to focus on is you need to have a little bit of a nest egg,

[00:02:13] whether it's through your loan, whether it's through some savings that you can operate, where you can pay bills. Because the worst thing that can happen is you open this beautiful office and you have all of these bills that pile up, whether it's your salary, whether it's when I say your salary, your staff's salary, or just the loan payment, the rent payment. All of these bills pile up. So you need to have cash flow to be able to pay those before your first patients actually get rocking and rolling.

[00:02:44] Yeah. And it's good to be, you know, think about the first 12 months because like high lab fees, like when you're coming into that, that is something that you need to be very, very cautious of. Yeah. So in the first 12 months, what I always tell all my young docs to do is you need to negotiate some type of terms with your, with your loan company or whoever's is, is practicing or giving your, your practice loan. You need to talk to them. You need to say, Hey, I need to have interest only for the first 12 months.

[00:03:13] Um, you can also work with your tenant. If you're renting space, you can say, Hey, can we kind of push some of those, those months of payments until I get open until I start actually rocking and rolling? Sometimes you can negotiate those things, but just like you said, it is really important that we, we look at some of those lab costs for, you know, some clear liners that may cost you $2,000 a case. Well, cashflow is king.

[00:03:38] So you need to make sure that you have enough to, to kind of keep your ball rolling where you can invest in things that matter like training and, um, marketing. It all comes back down to planning those numbers out. And if you need help with that, get with somebody that can help you because I think the next part is almost as important as cashflow. And that's picking a good location. Dr. Bryce, tell us about picking the right location.

[00:04:06] All right. So picture this, you've got a sleek clinic and you have top notch tools, but then it's crickets. Like you don't have any foot traffic. You don't have a good parking lot. You're in a neighborhood that doesn't scream like family friendly. And all of those things are rookie moves. Those are things that make it very challenging for your practice to succeed.

[00:04:27] So really when you're, when you're going through this process, um, you want to pick a location that is close to schools or, um, a booming area or something that is going to have some patient flow in there. And you want to make sure that you do that, uh, in, in a way that helps you make it more convenient for, for the patient. Right.

[00:04:51] And I say that with, with this example, think about all the things that you do routinely. Um, whether it's, you go to a grocery store or you go to a place to eat or whatever. One of the most important things about it is how convenient it is to you, whether that's parking, whether that's just getting to the actual location. And I think one of the things that you have to really take a step back whenever you're planning your location is looking at the actual parking situation.

[00:05:21] Um, my wife is, is she will not go to a place if there's no parking. And I understand the people in New York and, and you guys are never going to have parking for anything, but for the most part, parking is actually a big deal to your practice. So, so remember that key. The parking consideration is huge because there's some restaurants that I love going to. But it is a nightmare to get parking for those places.

[00:05:46] And it's just like, is it worth me, you know, waiting and trying to get in, trying to get that parking space and all of that. And I think another thing to be conscious of when you're picking a location is to see what's the up and coming locations, you know, where in your city is like the next, you know, housing units going to be put in there. Because in Pensacola, Cantolment is like the up and coming part of the city.

[00:06:14] So a lot of things are being built there right now. There's a lot of homes going in there. Pace is another one. So it's like looking at, all right, what is the next place that could be the big boom? Do your research, look into it. And that is something really important because you could, you know, put yourself in a place that is the place right now. But how many competitors in their area? You know, like what is your competition going to be like? Yeah.

[00:06:42] Sometimes it's simple when you're the only person in that area, right? And so if you can get in on the front end of those soon to be or developing areas, that's a really strong staple. I mean, you can be the guy or girl that's in that particular area. And it kind of discourages other people from coming in and getting on your turf. Yeah. You get your foot in the door and it's going to set you up for success. Talk about setting yourself up for success though, Dr. Bryce. Hiring.

[00:07:09] That is one of the hardest things I feel like, you know, dealing with partners, talking to them about hiring. Give me kind of your thoughts on that. Yeah. So I think that a big mistake that young people or startups kind of fall into this pool is they hire friends instead of hiring a pro, right? So you might have your cousin Dave who's really good at computers,

[00:07:33] but that doesn't mean that he knows how to build out a professional looking website that has a strong, consistent brand or that he can maximize SEO or he can fix problems immediately. Right. And so skimping on qualified partners can dramatically slow down your overall growth. You know, don't hear what I'm not saying. I'm not saying that you have to go out and get every single partner that you work with has to be a dental professional,

[00:08:00] but they should know, you know, at least their profession in some capacity. And then if they are in the dental world, then great. That just kind of eliminates some of the other barriers that you'll face at some point. Going just a step further is making sure you get the right people in the right seats. Making, you know, knowing what you need to hire for at the very beginning. We did a whole episode on a marketing coordinator, which you need to go check that out.

[00:08:28] Startups, it's going to be so helpful for you. But knowing which, you know, position. So Dr. Bryce, what is the first position that you would hire for in a practice starting up? Yeah. So I think the first person that you have to hire is you kind of have to hire these two people simultaneously, but you have to hire at least one front desk and then one clinical assistant because you won't be able to scale without either one of those two.

[00:08:51] You can probably go without some of the office managers and those key features pretty for a pretty good amount of time. You know how I feel about the marketing coordinator. So that would be the third hire that I would make would be the marketing coordinator. That way they can drum up business. And then after you make more and more business, you can just add those other pieces. And again, be cognizant of who you're hiring. People are going to give you the best foot forward in your interviews.

[00:09:20] Read their body language. Body language is 93% of what we communicate and only 7% verbal. So make sure that you're paying attention during your interviews. We should do an episode on how to kind of evaluate talent or how to do the interview process because that was one of the things that I struggled with, right? When I first started, I kind of looked at some things online, some guides.

[00:09:44] But what I've done over time is I really refined that to make it where I get the most quality candidates that are efficient uses of time. And then we hire pretty good people. So I think we should do that. I would love to do that episode. I think it would be hugely beneficial for everybody watching. So let's jump into the next section, though, Dr. Bryce, and that's marketing. Marketing can be the greatest thing or it could be the bane of your existence.

[00:10:14] So jump into marketing for us. Yeah, I think one thing that's really, really important is right now is a different time. It is not the days where you could just go out and get your degree and then put up a sign that says orthodontist. And, you know, you had tons of people flocking to you. You have to have a consistent brand on social media, across the digital platforms. And you also want to make sure that you're running some type of targeted ads.

[00:10:43] I like to target, you know, young adults. You guys may want to target the parents, but you have to do that in a way that you're laser focused on who your target audience is. And then you want to show face in the community. I feel like this is one of the things that often goes underappreciated when you first start off. But the more that you show face in the community, the more you will become a staple and people will remember you and know you by name. You have to build a reputation.

[00:11:11] And the only way you can build a good reputation, ads only go so far, especially when you're a startup. People are going to be there's literally one in my town that is a startup dental practice right now. And they're running ads and I know nothing about them. And it's like, it's like, okay, you've got a website, you've got these ads. But I just saw your building for the first time. Your sign went up like three days ago.

[00:11:37] And that right there doesn't, you know, nothing against them, you know, have no ill will or anything. I just don't know who they are. So I'll drive 45 minutes to go to my dentist right now instead of going to them that's like three minutes down the road. That's right. And you hit on it. I mean, when you first start, your early patients are all going to be pretty much somebody that you got direct to consumer where you market it directly to the consumer.

[00:12:02] So what you really have to do is you have to think about, well, one, do I have a good website, which they may or may not. Right. And then two, how Googleable, I'm pretty much sure I made that word up, is the practice. And then you want to build the brand. You want to tell the story of who you are, why you're passionate about what you do. And then that's the that's the other thing that you're talking about.

[00:12:26] And it's really how you get to know the provider and how they get to know you and your patients. And it builds this really a lot of trust and a nice bridge. And so it's the two sides of things. Don't market like it's, you know, 1995 where you're, you know, you just put out your sign. You made sure that your letters are the certain height. You had to get your, you know, measuring stick out. And don't just say, oh, well, I'm running ads right now. That's going to get us patients.

[00:12:55] And you might get some patients, but you could go further faster by actually building a reputation within the community instead of just running a basic ad. So on top of that is I think a lot of people want to razzle dazzle. They want a dog and pony show, Dr. Bryce. And that is kind of over promising what a doctor can do. Yeah, this is this is my clinical bonus that I'm giving everyone.

[00:13:23] This is what I did when I came out of residency, right? So when you come out, you're excited. They're excited. And you're promising that Hollywood smile to every single patient. But the reality of it is some teeth are stubborn and not every case can end up as a board case. So it's really important that you set those expectations properly. And when I did it, it took me a little bit of time to learn this. I mean, you know, I went through some some cases where I had an impacted canine or a tooth that was way crazy. And I was like, oh, don't worry.

[00:13:53] I'll get that. I'll make that look beautiful. The main goal should be that you put the patient in the best smile that their body allows, whether it's from an aesthetics position, a health position or an overall functionality position. That's what you really need to focus on. Perfection is not always the goal.

[00:14:16] So you want to make sure that you do everything that you can to give them the most realistic expectation of their case. The old adage under promise over deliver goes hand in hand with this, because when you're saying, oh, you're going to smile like Brad Pitt or whatever, like you've got this beautiful smile and everything. And it's like, yes, you want to give that to that patient, but you don't know what is going to happen.

[00:14:44] Are they actually going to wear their Invisalign? Are they going to be compliant at all? You know, it's like there's so many different things, variations within each case that if you say, hey, I'm going to help you get you a beautiful smile, that is going to go a lot further. And then you absolutely crush it for them instead of, oh, you're going to be on billboards because your smile is so beautiful. Like that is going to set such a high expectation for the patient. That's right, man.

[00:15:13] And you're spot on in all of the things. This whole entire process about startup is managing expectations. You'll find out that really soon. I mean, it's all about managing expectations with your clients and managing expectations with your team and honestly managing expectations with yourself too. Leveling and being honest. You know, you've got a goal and you're going after it, but know where you're at right now and you can eventually get to that goal the longer you work at it.

[00:15:42] And talking about a little bit overpromising is overpromising some of the patient experience or undervaluing the patient experience. Can you jump into that a little bit for us? Yeah. So in this dental world, you know, that we live in, oftentimes we create these spaces that aren't patient for or meaning like it's not designed for the patient. It's designed for efficiency for us or whatever.

[00:16:08] But nowadays, you really need to kind of make it cozy for the patient. You need to have simple things like a beverage center. You need to have like warm vibes where people feel comfortable. And if you're going to be kid focused, you want to have, you know, kid friendly distractions. So it makes them forget about the dentistry and just kind of have fun with your overall practice. And don't drop the ball here.

[00:16:34] There's so many good resources out there that can help you design an office to help you with your patient flow. All of those things. Actually, we should probably do another video on this to just talk about my secrets for having an amazing patient experience. You would know, Dr. Rice, because you're all about that design aspect of it. And, you know, will, you know, having Dippin' Dots there, you know, crush it for you, you know, conversion wise? Probably not. Probably not.

[00:17:04] But you are making the patient feel like this is such an amazing experience. I can't wait to go back. Now, if you're living like again, back in 1995, you've got like I had an old dentist. His lounge like had magazines from like 12 years ago. He didn't update it. And then it was like, I don't know if I want to keep going here. That's right. And patients notice stuff, man.

[00:17:28] And I mean, you know, they sit in your waiting room and you think that they're not paying attention, but they actually are taking in a lot of things. And they will get turned off really easy if you don't live up to what they value. Yeah. The patient's going to spend more time in your waiting room than you will. That's right. That's a really good point.

[00:17:48] You should always do a walkthrough at some point during your week of your waiting room of the front and remember what the patient experience is like. Because a lot of times what we'll do is we'll come in through the back door. We'll only see the back and we won't think anything about the front. But you should always go through the front at some point during the week to kind of keep an eye on things to make sure you don't need to tidy them up. Make sure you don't need to elevate the experience in some way. Yeah.

[00:18:14] It's kind of like when you're selling a house, you do the front porch test. The time that the realtor is like getting the key out of the box and all of that is the most time that person's ever going to be there. So make sure to get the cobwebs, make sure to clean up and all of that. It's going to go so far for your patients. They're going to feel just welcome and invited into that space.

[00:18:36] Now, talking about just using time wisely within a practice, I think this is something that there's so many plates being spun on trying to get this practice off the ground. Dr. Bryce, can you go a little bit deeper into that for us? Yeah. So when you first open your doors, you don't have any patients. So you fill your time with something. And, you know, a lot of times what you'll do, you'll end up scrolling on Instagram or TikTok looking at other practices that are a little bit more successful maybe.

[00:19:06] But really what I want you to do is I want you to use that time wisely. This is an incredible opportunity that you probably won't ever have again in your entire career. So use the time to either develop your systems, make your new patient intake forms, train your team. It's just really precious time that you want to use it for your long-term benefit. And it's hard to do when you first start off, but I think it's so valuable. Using this time really wisely.

[00:19:36] Hopefully, if your team, you feel good with that, go another step further. Train them more. Yourself, read books. Read business books. The better you understand the side of business, the better your practice is going to run in the long term. Because a lot of times when we're working with orthodontists, our partners, we're having to help them with the business side. We're not helping with the clinical side.

[00:20:02] Yeah, we're helping with the marketing, but it's making sure they understand and how the business should be run and run smoothly. And we've seen exceptional numbers come out of that because they were able to check these few boxes and bam, their practices is running like a well-oiled machine. That's right. As soon as you sign those papers to say that you're going to start your own practice, you're no longer just an orthodontist.

[00:20:28] You're no longer just the person focused on moving those teeth and getting that beautiful smile and that perfect occlusion. You are now a business person, someone that has to know what these metrics are, what these key performance indicators are, all of these things. And so it is very valuable for you to learn at least the basics when you first start off. And then, of course, over time, you will keep on refining and keep on growing as your practice grows out. But it is very important to use this time wisely.

[00:20:57] It's like getting brackets on. It takes a little bit of time, but the longer you do it, the better that smile is going to be, the better your practice is going to be. So soon-to-be ortho trailblazers, dodge these pitfalls, plan smart, hire right, and market like you mean it, and you'll be well on your way to creating a self-sustaining practice quickly. And 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 today.

[00:21:27] This has been Zach. And I'm Dr. Bryce. Thanks for watching the Grow Ortho podcast. Smile big, guys.