Ed Rabinowitz

"What keeps them coming back...is the practice culture"

How oversaturated is the dental practice marketplace? Maureen Uy, managing partner of 

 says that in some more densely populated regions, “you can’t toss a nickel without hitting a dentist.”

The question then for patients is, why go to one dentist over another? And that’s why it’s so important for dentists to distinguish themselves from their peers, and their competition.

Uy, whose company specializes in developing marketing plans for medical, dental and legal practices, says that dentists often look to distinguish themselves by adding new services, such as sleep apnea screenings. But the best approach, she says, is going back to the basics of marketing.

“We ask them, if there’s only one procedure you could do, and it’s highly profitable, and you could do it with your hands tied behind your back and eyes shut, which is it? “she explains. “And from there, we prioritize down.”

Why ask the question? Uy says that 9 out of 10 times there’s a dichotomy between what service is most profitable for the practice, versus what the dentists want to be known for, versus what they want to add to their repertoire. That’s why she recommends dentists first focus on what they’re good at.

“We don’t want them tainted by looking at their competition and saying, ‘Oh, we want to do that too,’” Uy explains, “because sometimes it just doesn’t match their practice culture.”

It’s all part of the strategy, Uy says, of having dentists look inward at themselves, but also compare that desire of what they want to be with the reality of what their practice is bringing in. Does that socio-demographic support the goals of where they want to go with the practice?

“And then in terms of where they want to go, can their socio-demographic client base support it?” Uy asks, rhetorically. “It comes down to the psychological versus the factual. That’s the discovery and analysis that has to happen before you can say, let’s add on veneers and flippers and sleep apnea and everything else to our practice.”

What about the amenities a practice might add to differentiate itself? What about the practice décor, or the way patients are greeted, or headsets that pump in relaxing music during treatment? Uy says those elements, what she calls the practice culture, but they’re not why patients schedule an initial visit.

For example, if a patient has a young family and has received a couple of recommendations on dental practices that specialize in pediatrics or family dentistry, the patient will look first at the practice’s capabilities. Does the practice do teeth whitening?

What keeps them coming back, however, is the practice culture. Does the patient feel valued? Does the dentist and staff truly care about their oral health. Is the practice willing to work with the patient even if they’re having financial trouble affording basic dental care?

“That’s where the employer brand comes in,” Uy says. “Is this a doctor who will champion my oral health? Does the whole practice team work together like a well-oiled machine? What’s the patient’s experience within the practice culture? You can’t fake that.”

That’s the alignment that needs to occur for a dentist to stand out. Do the technical capabilities align with the practice culture. If those two elements are not in alignment, Uy says, then “anything we do from digital marketing to traditional advertising and public relations to bring in more patients is only going to throw gasoline on the fire.”

If you really want to set your practice apart, remember that patients often get their referrals from word-of-mouth recommendations given by friends and family. So, for every patient—new or current—who visits the practice, make certain to gather empirical evidence that reviews your practice’s performance. And not just the dentist, but the practice as a whole.

“We work with the practice to make sure they have a review measurement system that is HIPAA compliant, that ties in with their practice management system, texts or emails, and in some cases a phone call, that brings it all together,” Uy says.

And the time to gather patient feedback, Uy adds, is not when they’re sitting in the exam chair, but rather after they’ve gone home and time to reflect on their experience.

“It’s a nice way to let them have time to think, but still close enough to the visit without putting them on the spot,” Uy says.

Articles

How many dental practices are within a 5- or 10-mile radius of your own? Probably too many, if you're being honest. So how do you differentiate yourself from the competition? Before you start setting grandiose goals, take a closer look at who you are and your practice culture. Aligning those two are key if you're to become the go-to dentist in your area.

Want to Be the Go-To Dentist? Start By Understanding Who You Are

"...if we can prevent losing teeth, we can prevent then having to fix things," LaQuia Vinson, DDS, MPH

Mother to small children. Foodie. Sports fan. Reality TV enthusiast. Advocate for parents and children.

LaQuia Vinson, DDS, MPH, a pediatric dental surgeon at 

 in Indianapolis, is all of those—and more.

And yet, Vinson says her career in dentistry came about through a bit of happenstance—even though her father is a dentist, so it’s in her blood.

“I worked in [my father’s] office all through high school, but I went to college believing I was going to be a pediatric orthopedic surgeon,” Vinson says. “That’s all I ever talked about. I was going to be the person to fix little children’s bones.”

And then came the lead up to taking her MCAT (medical college admission test), and the light bulb came on. The years working in her father’s office, even serving as his patient during his pediatric rotation while in dental school, had stayed with her. So over Christmas dinner during her junior year in college, she made the announcement.

“My father almost choked,” Vinson recalls. “It was pretty shocking to everyone, especially him, because his daughter was now going to follow in his footsteps.”

If junior year in college was the turning point toward a career in dentistry, it was junior year in dental school where Vinson turned her focus toward pediatrics. To that point she had worked with many geriatric patients and was becoming frustrated. Too often she found herself fixing things.

“At that moment, I thought, ‘Well, let me focus on prevention so if we can prevent losing teeth, we can prevent then having to fix things,’” Vinson says.

She turned her attention toward children. Focusing on prevention in children, Vinson reasoned, could spearhead healthy habits early on. The goal would be to get to the point where people are not losing teeth. Because teeth, she says, are just like any other bone in the body. And in her mind, it’s no different than going to a medical practitioner for an annual physical.

“[Teeth are] supposed to last a lifetime,” Vinson says. “If you take care of them. That’s not necessarily expensive. It’s when you find out everything that’s wrong that it can become expensive.”

Becoming a mom took Vinson’s advocacy and focus on prevention to another level. She says it helped her become more understanding of the frustration parents may have when it comes to brushing their children’s teeth. Vinson even shows a video to her graduate students from the time she tried brushing her 18-month-old daughter’s teeth.

“I’m literally holding her down,” she laughs at recalling the image. “But now my 3-year-old daughter is happy to brush her teeth without a fight.”

Vinson sees more than her share of 2-year olds who have decay because their parents don’t want to force them to brush.

“They always say pick and choose your battles,” she says. “Well, this is a battle we really need to choose, because the alternative is not fun.”

Vinson explains that if she had to choose a career other than pediatric dentistry, it would be a fairly easy choice: become a chef, or a fashion stylist.

The former comes from a time prior to having children, when she and her husband would frequent restaurants several times during a two-week period. And not necessarily the same restaurants over and over again. Vinson believes her love for a wide range of food comes from having lived in very different parts of the country.

“I went to college in New Orleans,” she says. “I did dental school in San Francisco, and my residency in Chicago. All of those have different flavor profiles and different cuisines that are sort of native to that area. I think that’s sort of where my love of food started.”

As for being a fashion stylist, Vinson recalls being “a 12-year-old kid” who was fascinated with watching “Style with Elsa Klensch”, a CNN program that ran from 1980 to 2001 and focused on fashion and design from around the world. There was something about those fashion runways that drew her in.

“I was always fascinated by runway shows,” she recalls.

But that wasn’t her only obsession. Vinson says her husband is fascinated how she can sit for hours and watch reality TV shows, in particular, people looking for houses.

“It’s nice to look at some of the architectural styles,” she explains. “The house we live in is 100 years old. So it’s nice to look at things from an architectural standpoint, trying to modernize or restore things but keep some of the original character. That’s a fun part of my life.”

Vinson’s affinity for sports comes from her mother’s love of basketball. And for a family growing up in suburban Chicago in the 1980s, that meant Michael Jordan and the Bulls. Vinson caught the bug.

“That’s how I got into it,” she says. “And in college I got more into college basketball. Very big on North Carolina, and Michigan and the Fab Five. I just grew up around a basketball-loving mother.”

She still follows the sport, completing numerous brackets for the recent NCAA playoffs. How did she do?

“Some came out good, and some not so good,” she laughs.

What’s always good, however, is seeing the smiles on the faces of children Vinson has helped. When children who used to scream and cry and be afraid of visiting the dentist turn those frowns into high fives at the end of an appointment, that’s an exhilarating experience.

“That’s the most rewarding part,” she says. “That I get to go to work every day and do something that I absolutely love. It’s a small thing, but it can have such a big impact.”

Click here to sign up for more Dentist's Money Digest content and updates.

Prosthodontist Unleashes the Artist Within

Classical Musician Transitions to a Career in Dentistry

General Dentist Makes Inroads Treating Sleep Apnea

As an advocate for parents and small children, LaQuia Vinson uses her own experiences as a mother to show empathy and compassion to her patients. But she also finds time to clear her mind by watching hours of real estate-oriented reality TV.

Pediatric Dental Surgeon Brings Smiles to Tiny Faces

"We in dentistry can help our patients overcome their fear of the dentist,"

Most people know at least one person who has a fear of going to the dentist. That’s because it’s 

 that as much as 15 percent of Americans, or approximately 40 million people, avoid seeing the dentist due to anxiety and fear.

As an oral health practitioner, chances are you’ve seen your share of these patients. Helping them to overcome their fears is a priority for every dental practice. And according to 

, DDS, MSD, Associate Professor of Periodontics and director of the undergraduate DMD program in periodontics at Case Western Reserve University, there is reason for optimism.

“Research shows that fears, even phobias, can be overcome,” Palomo says. “Incredible fears—fear of snakes, of heights, or speaking in public&mdash;all of these can be overcome. We in dentistry can help our patients overcome their fear of the dentist.”

Doing so benefits both the patient as well as the practice.

Palomo says that easing patient fears is “so much a part of dentistry” that it is woven into the fabric of Case Western’s curriculum. And the most reliable way to make patients comfortable is to slowly acclimate them to the different treatments they will require.

“Initial visits are just about getting to know the patient; getting to know their health history,” Palomo says. “We need that health history. But it also gets the patient more relaxed and acclimated to that environment with the caregivers.”

Part of that initial conversation is broaching the topic of possible bad experiences the patient may have previously had, which could be at the core of their nervousness. For example, if the patient’s blood pressure is taken during the initial visit and it’s elevated, ask them, “Is your blood pressure always elevated?” That opens a conversation not only about hypertension history, but also about their history of sitting in a dentist’s chair.

“Very often, if that initial blood pressure reading is high, we may take it two or three more times during the same visit and see if their blood pressure actually drops during the same visit as the patient becomes more acclimated to the environment,” Palomo says. “And, as the level of trust between the caregiver and the patient starts to become a foundation.”

Then you’re able to build on that foundation.

Palomo says that because fear often develops from the unknown, it is important to help patients understand the ‘why’ and ‘how’ elements of their treatment plan. Some dental offices have a treatment coordinator who engages the patient in that conversation. As such, staff plays an enormous role in helping allay patient fears.

For example, after becoming acclimated to the dental environment, the patient may need complicated therapy. Palomo recommends beginning with a less complicated therapy — maybe staging a visit with the hygienist before jumping into a more invasive treatment.

But when it comes to easing patient fears, everyone plays a part including the front desk receptionist.

“There’s a level of trust between the first face in the dental office that the patient sees, and the patient,” Palomo says. “And over time that first face gets to know the patient and a lot about their family.”

Imagine a patient has been coming to the practice for 20 years. It’s likely the front desk receptionist, through conversations with the patient, has ‘watched’ the patient’s children grow up. And now the eldest is heading off to college, leaving the patient feeling stressed. That information could be conveyed to the dentist.

“Research more and more clearly elucidates the oral and systemic link,” Palomo says. “If you see signs of stress, look for poor self-care. This person, in going through a stressful time, might be neglecting themselves to care for an elderly parent.”

Fearful patients can be notorious for cancelling appointments. But Palomo says patients don’t usually announce that they are cancelling an appointment because they are scared. More likely, in a phone conversation with a staff member, they will explain that they’re scared, but they do intend to keep their appointment this time.

“That opens the door for the staff member who makes phone calls scheduling patients to have that conversation about the steps we take to overcome their phobia, and ease the patient into treatment,” Palomo says. “How the first visit will just be talking. And the second might just be x-rays, or might just be hygiene. Then we wade deeper and deeper into facing that phobia.”

Which not only benefits patients, but a practice’s bottom line as well.

“Huge,” says Palomo when asked if easing patient fears can impact a practice financially. “The better the clinician’s chair side manner, the better that center’s overall performance.”

New Guide May Help Your Young Patients Conquer Dental Fear

Genes Might Be to Blame for Fear of the Dentist

Women Expect, Tolerate More Pain at the Dentist

Easing patient fears of dental visits is of primary importance for all practices. If patients are fearful and those fears lead to canceled appointments, that results in a loss of revenue - not to mention a disruption to the practice schedule. But by slowly acclimating patients to the practice environment, dentists and their staff can ease fears and build a solid level of trust with their clientele.

The Multiple Benefits of Easing Patient Fears

Uninsured patient accepts about four procedures a year whereas a membership plan or insured patient will accept about seven procedures.

Dentists are always looking for ways to make dental care more affordable for their patients, while keeping them compliant in their dental care.

Similarly, patients are tired of paying sizeable insurance premiums that often don't provide the critical coverage they and their families need.

What’s the answer? Maureen Uy, managing partner at 

National Society of Certified Healthcare Business Consultants

 recommends a dental membership program with tiered coverage that meets patients’ specific dental needs.

“[A dental membership program] helps the dentist aid his patients in preventing dental emergencies or planning out long-term dental care objectives,” Uy says.

And these plans are increasing in popularity. According to Dave Monahan, 

, a cloud-based platform that enables dentists to design and manage their own membership plan, approximately 80 percent of all dental practices are currently considering membership plans.

Monahan says one of the driving factors in the adoption of dental membership plans has been the desire to deal as little as possible with insurance.

“[Insurance is] less and less profitable, there are more restrictions, and reimbursements are not getting any better,” Monahan says.

Then there’s the uninsured patient factor. Monahan says that roughly 40 percent of all consumers in the U.S. do not have dental insurance. On average, those uninsured patients visit the dentist about once every two years compared with the insured patient who comes in approximately 1.3 times each year.

“And when you look at the data, what you see in the uninsured patient base is that they accept about one-third of the treatment plans compared to insured patients,” he explains. “But if you talk to the uninsured patient you learn they want more treatment. They want to buy a dental plan, but they’ve looked at insurance and decided it’s too complicated and too expensive. They don’t think there’s a solution available for them.”

That’s where dental membership plans come in.

According to Uy, “For a varying but modest amount of $125-$300 per year, dentists can offer these programs and show the savings in time and money while demonstrating an increase in better outcomes.”

Monahan has compared the numbers from various dental practices, looking at uninsured patients versus insured versus membership plan patients—what treatment do they accept, and what value are they to the dental practice. He found that an uninsured patient accepts about four procedures a year whereas a membership plan or insured patient will accept about seven procedures.

“It’s roughly 50 percent higher treatment acceptance if you’re an insured or membership plan patient,” he says.

Consider the perspective of the patient who buys into a membership plan. He or she pays a monthly subscription fee of approximately $25. For that, he receives cleanings, exams and x-rays, plus a discount on other procedures. There’s no deductible, no annual maximum and no pre-approval.

“That’s a much better deal for the uninsured patient than insurance,” Monahan says.

It’s also a much better deal for the practice. If a patient purchased insurance, the premium goes to the insurer. The subscription paid by patients goes directly to the practice, whether the patient visits the practice or not. But Monahan says it’s a shortsighted gain to take the subscription money and hope patients don’t come in.

“Get them in, get them in the chair, and when they’re in the chair, if they have a membership plan, they accept 50 percent more treatment than without the plan,” Monahan says. “And with a membership plan, you set the fee schedule, not the insurance company. So, the membership plan patient is worth about 30 to 40 percent more than an insured patient.”

In the past, setting up and maintaining a membership program was challenging because it was typically paper-based. Today, with platforms such as the one created by Kleer, dentists can easily set their subscription options and in about 15 minutes launch a membership plan. A portal makes it easy to manage patients, and a 12-month auto-renewal feature enables staff to function more efficiently.

“They can focus on the practice and on the patients versus the membership plan,” Monahan says.

In addition, Uy says, membership plans enable the practice to identify and create loyal patients.

“I encourage all dental practices to consider implementing this type of program,” she says, “because it truly helps grow your patient base and attract the large market of patients who do not have dental insurance.”

Adhering to New Dental Codes Brings Financial Benefits

Dentist Fueled by Creating Experiences for His Patients

Dental Accounting Tips To Make the Numbers Work For You

Dental membership programs are not concierge medicine. With the latter, primary care physicians limit their practice to focusing on a few hundred up to perhaps 1,000 patients. Dentists, however, can offer membership programs to all their patients in addition to, or in place of costly dental insurance that might not afford patients proper coverage. These programs can help dentists grow their practice while increasing revenue.

Dental Membership Programs Benefit Practices, Patients

Dentistry or art, Wu is exceptionally adept at both.

He’s an artist. Whether holding a pencil or a drill, the goal is still the same: Perfection.

 who puts an artistic touch to every tooth he crafts. It’s an approach he has taken ever since working toward his doctor of dental surgery degree from New York University College of Dentistry in 2008.

“My colleagues would say, ‘Let’s hang out,’” Wu recalls. “But I would say, ‘No, I have to get this right. I ended up spending more time in the lab than my colleagues trying to figure out how to make the perfect denture, or make this smile work for my patient. It’s like art. It’s like sculpting.”

Wu admits that in his youth he never thought of becoming a dentist. Instead, he envisioned archeology, or perhaps becoming a comic book artist. His mother was an artist, and it rubbed off. Wu would often be found with pencil and paper in hand, drawing. And by the time he attended Occidental College in Los Angeles, he began to see how he could blend his two passions—art, along with biology and the health sciences—into one.

“I was able to draw and transition from dragons and comic book characters to hyper-realism, which is like portraits and anatomy,” Wu says. “I was thinking about how I could see myself in a career that merges those two passions together. And that was dentistry—a perfect amalgam of those two passions.”

But Wu’s creative side doesn’t start and end with drawing. Even before he began his dental career he taught himself HTML, web design and web building. His older brother who obtained a degree in computer science was always building computers, spending time coding in Java or HTML.

“I didn’t understand it at the time,” Wu recalls, “but he brought me to computer stores to pick up parts, and I was able to learn how to build a computer and dabble in things like HTML. Having that background in software was good because today, I can show my team and the patient the computers and technology we have.”

When it comes to drawing, Wu talks about the “weird sensation” he gets when he starts to work on a blank canvas. He describes it as his brain shutting out the rest of the world while he focuses on the tip of his pencil and the paper—at times for four or six hours straight without eating, which he acknowledges is strange because he does get hungry.

But the drawing, he says, is incredibly relaxing.

“If I’m stressed and end up drawing, it does help me filter things out,” he says. “And I’ve been doing that for a while now.”

That ability to focus, to block out things around him, contributes in no small way to the artistic nature of his dentistry. Wu refers to himself as “the architect of the mouth,” explaining that he utilizes the same type of focus he has with art and translates it into his dentistry. For example, he begins envisioning a procedure even while looking at a patient’s CT scan.

“Even when I see a patient for the first time, and they smile, and the first thing they say is, ‘I don’t like my smile,’ but it helps me to see and envision where we want to be,” Wu explains. “I’m already closing my eyes and envisioning a beautiful smile that will match the patient’s face. And I feel my artistic talent really helps with that.”

Wu, who has been a prosthodontist in private practice since 2012, recently opened a ClearChoice office in 

 He explains that for his dental specialists, staying in one location is not an option.

“They are usually travelers, or work in multiple locations,” he says. “No one location will offer a full-time job for prosthodontics, because they don’t need it.”

ClearChoice, he says, offered not only the opportunity for a full-time job but the ability to work on specialty and complicated cases like full mouth reconstructions with every resource under one roof.

“It’s not only convenient for me as a practitioner, but also for the patient because they’re able to save time,” he says. “Since we’re all under one roof, they don’t need to visit multiple offices. There’s always an oral surgeon on site full time. I always have full-time lab technicians on site. This is the perfect place for me to be.”

Somewhere else Wu has been is outreach trips to Jamaica. He describes the experience as life-changing—visiting destitute areas, and together with a team of about 15 dentists, providing care for people who had never seen a dentist.

“They’re in pain, and they don’t know what to do,” he says. “When we’re able to help people like that, it’s very rewarding.”

Ever grateful, the locals would feel as though a weight had been lifted from their shoulders. That type of work, Wu says, is what he’d like to do more of.

“I like being able to bond with other dentists, and share the passion.”

It’s what drives Wu, being able to see and transform a patient’s life. Talking with them first, and being able to visualize the changes he can create for them.

“Now they look like they did when they were younger, and they start crying,” Wu says. “It makes the hairs on my skin stand up thinking about it. Being able to do that on a daily basis is what keeps me coming back. Because you can see the immediate results of how it changes patients both emotionally and physically.”

George Wu always loved drawing with a pencil and paper, but he never thought that would translate into crafting the reconstruction of a patient's mouth. Blending his two passions, Wu sculpted his career into a newly opened ClearChoice office in greater Los Angeles. And he uses his artistic insight to benefit every patient he meets.

 Staff members will treat patients the way doctors treat their staff members.

 as “an obligation or willingness to accept responsibility or to account for one’s actions.”

Sounds simple enough. But according to a 

 conducted by AMA Enterprise, a division of the American Management Association, one out of every five business leaders (21 percent) believes the percentage of unaccountable employees ranges from 30 to 50 percent.

That’s a lot of people who don’t take ownership of their on-the-job responsibilities. And dental practices are not immune.

However, by developing a culture of accountability within the practice, that percentage of responsibility shirkers could be dramatically reduced.

Dianne Watterson, RDH, MBA, a Lexington, North Carolina-based 

, says that if a dentist hires competent people, and makes sure they have the proper training to do their job, he or she won’t have to stand over them holding their feet to the fire to ensure accountability.

But that doesn’t mean dentists should maintain a complete hands-off policy.

“The dentist is accountable for the success of the practice, and has to have systems in place to at least check for accountability, and know when people are doing their job well,” Watterson says.

Doctors also need to be aware of, and take seriously, complaints from patients about a particular staff member. It may not always be legitimate and could be a result of bias on the patient’s part, but it could also be substantial.

“Doctors need to have their staff members’ backs too,” Watterson says. “But if one patient complains about something, and the doctor then receives a second complaint along the same line, he or she needs to take that very seriously.”

Many doctors, she says, glaze over at the thought of having staff meetings — but such meetings have a way of bringing problems to light. And in a group practice, even better than a general staff meeting is holding department meetings. For example, hold one meeting with hygienists, and a separate meeting with the assisting staff.

“With department-type meetings you can focus on specific things,” Watterson says. “And you can do that with a number. If you’re looking at the efficiency of a particular schedule coordinator, then you can examine the downtime percentage, and there’s a number for that.”

One way to improve accountability is to offer incentives in the form of setting goals that staff has to work toward, and then rewards for achieving that goal. However, Watterson cautions that if the practice is experiencing significant problems with downtime, improvement needs to be shown before bonuses can be distributed.

“Sometimes the system is broken in a practice and you’ve either got to come up with a new system, or train people to do what they’re supposed to be doing,” she says. “And then if you don’t see improvement, it might be time to replace that person.”

Incentives, of course, need to be realistic. If, for example, a practice is experiencing 25 percent downtime, a good initial goal would be to reduce that to 20 percent over the next several months.

“It’s better to incrementally make improvement than to say we’re going to drop this to 10 percent in three months,” Watterson says. “That’s just not easy to do.”

Fostering a team concept is important, Watterson says. In dental offices where staff function like a team, peer-to-peer accountability becomes a natural outcropping of the team concept.

“Among healthy teams, accountability is a natural thing that occurs,” she explains. “They want to help each other. And if there’s a goal to work toward with a reward, most of the time people will get on board with that.”

Watterson believes that when dental practices foster a culture of accountability, good things happen —  morale goes up, productivity improves and the practice bottom line reaps the benefits.

“Most staff members want to do a good job,” she says. “Most want to know that their doctor approves of their performance. So it can definitely affect the bottom line in a healthy way when there’s good peer-to-peer communication and oversight.”

The benefits trickle down to patients, who can sense when staff members are happy doing their job versus fussing and competing with each other.

“One of my mentors used to have this expression: Staff members will treat patients the way doctors treat their staff members,” Watterson says. “There’s probably some truth in that statement.”

Mistakes happen but when mistakes occur or there's an oversight, are employees owning responsibility? Are they accountable? Developing a culture of accountability within a dental practice can improve productivity and employee morale, and have a healthy impact on the practice's bottom line.


Practices Benefit From a Culture of Accountability

It felt great to be able to help so many people. I just fell in love with the Aspen model.

	Monica Garnache did not take the traditional route on her way to a career in dentistry. Quite the opposite.

Garnache, DMD, who today is the owner of 

 in Eugene and Springfield, Oregon, attended and graduated from the San Francisco Conservatory of Music, and had a 10-year orchestral career.

“I started studying music at a pretty young age, around 6-years old,” Garnache recalls.

The early studying blossomed into a potential music career while she was in high school. Garnache, who is a classically trained French horn player, won several scholarships, which helped pay for college, so music naturally seemed like the best path forward. She even spent a year living in South Africa to get her principal experience — the principal musician in an orchestra is the lead player for each respective section of instruments.

“You can’t get that experience in this country right off the bat,” Garnache explains. “You have to go abroad, get training as a principal, and then you can come back. It’s something a lot of classical musicians will do.”

When she returned, Garnache spent time “driving around a lot” playing with virtually every orchestra in the Bay Area other than the San Francisco Symphony. She also taught music privately, but eventually tired of the lifestyle.

“It just wasn’t the long-term life that I wanted for myself.”

When Garnache was around 5-years old she had a tooth knocked from the front of her mouth, and as a result, spent a good amount of time visiting the dentist. While most might look back on the experience as a negative, Garnache enjoyed the visits.

“It probably had to do with the fact that I also got little treats and prizes when I went to the dentist,” she recalls, laughing. “But I always felt good when I was at the dental office, and I had a good rapport with him.”

She even thought about changing her major to pre-med at one point in college, but the lure of a career in music was still too strong. Later, however, when Garnache tired of life on the road and returned to her original dream of a career in dentistry, a dentist friend of the family encouraged her to apply to Tufts University in Massachusetts. That set in motion a transition that lasted several years.

“I had to give up my (music) jobs to go back and do my pre-reqs, because I had to do four years of pre-reqs before I even got into dental school,” Garnache says. “And when you turn down a job once, they’re not going to call you again. So it was like, okay, I guess I’m making my decision.”

Along the way, Garnache admits there were moments when she wanted to second-guess herself a bit, but “I’m pretty determined when I make up my mind.”

“My degree is in French horn. I’m a classically trained French horn player.”

Garnache opened her initial practice in New Hampshire, and says she had the ability to do so thanks at least in part to the backing of Aspen Dental. Having an organization there to back her up when she needed assistance boosted her confidence.

“I really liked the way they operated, and their support,” she says. “They were just way more supportive than I would have imagined. From the very beginning, it always seemed they were looking out for us in a way I had never thought was possible.”

Garnache eventually relocated to San Francisco for family reasons and opened a practice locally, but soon realized the market was oversaturated. She eventually moved to Oregon and rejoined Aspen, becoming a practice owner in 2014.

“It was their model and their mission of access to care,” Garnache explains about her affinity for Aspen Dental. “It felt great to be able to help so many people. I just fell in love with the Aspen model.”

Along the way, Garnache’s daughter, Michelle, fell in love with the field of dentistry. Perhaps not surprising, given that her mother was a dentist and her father, Garnache’s husband, a hygienist. But Garnache says while she encouraged, she didn’t egg her daughter on to follow in her footsteps.

“She saw us both change our careers to go into [the field of dentistry],” she explains. “I think she saw the whole process and liked what she saw.”

Michelle practiced with her mother in Oregon for about eight months, then moved back east where she now practices with 

“I’m very proud of her,” Garnache says. “It’s not an easy path. But she really set her sights on it, and decided that was what she wanted to go for.”

Once a musician, always a musician — at least at heart, and Garnache is no exception. She still plays from time to time, picking up the trumpet — “It’s hard to not play the French horn for a year and then pull it out and play well. It’s a pretty demanding instrument” — and jumping in to play or help record with her husband’s band, but says it’s mostly for fun and relaxation.

“I love supporting the symphony here,” she says. “You don’t always have to be performing [music] to love it, to gain therapeutic benefit. It’s just always with me.”

Professionally, Garnache loves the work she does, saying it has provided her with some of the most rewarding moments of her career. And while she’d love to have her daughter return and practice with her, absent that, Garnache still feels like she’s “at the top of the rainbow.”

“I’m really pleased with what I have, and feel so fortunate,” she says. “I don’t think, career-wise, I could ask for anything better.”

Monica Garnache, DMD is a well-respected dentist and mentor to other dentists, but her career in oral health almost never happened due to her love for classical music. It was a challenging transition that was years in the making, but today she looks back and acknowledges she couldn't have asked for anything better.


Classical Musician Transitions to Career in Dentistry

Patel believes building a relationship of trust is a key factor leading to increased case acceptance. 

When it comes to measuring case acceptance, or being consciously aware of it, for that matter, many dental practices come up short.

More often than not, the focus of a dental practice, says Shalin Patel, DDS, chief clinical officer and co-owner of 

, is on the clinical side of the equation. Which, he agrees, should always be the primary focus.

“The only way they’re going to be able to get more clinical procedures is by studying their case acceptance,” Patel says. “It’s about what can they do to provide more dentistry to more people, and get more efficient at what they’re doing.”

Patel says that, in his conversations with dental school graduates, the two most requested points of assistance are mentorship, and help with non-clinical aspects of dentistry — two areas they feel they received little or no exposure to while in school. They want to better understand insurance —the business component of dentistry. And they want to know more about case acceptance.

What's the rate of case acceptance at your practice? Most dentists won't know the answer to that question. But understanding case acceptance and what it takes to move a patient from presentation to accepted treatment plan can have a major financial impact on your practice.