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Styles of Leadership

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BulbsFind Your Leadership Style

Each team thrives on effective leadership. As we discussed the value of leadership, developing a leadership culture is highly effective in improving the capabilities of your team. Effective management facilitates the processes in an office to achieve success. It is often used interchangeably with leadership, which is a whole different skill. Leadership is a talent that goes beyond job titles and inspires teams to sustain success.

Management is doing things right; leadership is doing the right things.” Peter Drucker

Great teams value a culture of leadership and promote habits that develop leadership. The first step in this development comes from learning who you are as a leader and your favored leadership style. Each style of leadership has its strengths and weaknesses.

Command and Control Leadership

This leadership style is autocratic, and promotes strong team culture. In this style, the leader can be very effective, while at the same time micromanaging the team’s performance. Examples of this type of leader are George Patton and Martha Stewart.

Relational Leadership

This leadership style promotes a “people come first” culture. As opposed to the autocratic nature of the previous style, a relational leader gains employee buy-in by allowing them to be involved in the decisions of the company. They develop a culture where the team follows the leader in a journey together. An example of this leadership style is Tony Hsieh from Zappos.

Expert Leadership

Expert leaders have vast knowledge in their respective field. These visionary leaders use that specialized knowledge to build and guide their teams. Their expert knowledge in the field they are in business motivates those around them to achieve more. An example of this leadership style is Bill Gates, as he led Microsoft.

Charismatic Leadership

This leadership style comes from a leader who inspires greatness in others because of their engaging personality. These leaders use transformational vocabulary that take advantage of their charisma to lead others to success. This style is highly effective in gaining a following and inspiring others. When used by the wrong individual, it can be manipulative and lead to disillusionment. Under the right leader, it can inspire great loyalty and trust. An example of this leadership style was shown by President John F. Kennedy.

Synergistic Leadership

This style of leadership is developed by combining some of the best characteristics of the previous four styles. Those styles have their advantages and disadvantages. By taking the best parts of each style, synergistic leaders have the best chance to achieve great things. The risk to synergistic leaders is that they need to focus to avoid confusion from drawing from too many leadership styles and preventing a consistent message.

Now consider these styles, and get a better sense of what kind of leader you are. What kind of leader do you want to be? Being a synergistic leader can be a great goal, but remember that we are balancing from our own leadership style and the style that our team needs.

Regardless of style, every leader must understand and be willing to implement certain leadership basics. First, they must establish cultures that hold all team members accountable for the outcome of collaborative efforts while also allowing them to participate by providing ideas. Second, they must make sure that there is consistency between their expectations for others and their own actions.” – Don Yaeger, Author, “Great Teams”

Burgers, Braces, and Aligners

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Kitchen CraftsmenshipWhat You Can Learn From a Successful Restaurant

Many of us may have a hard time understanding how running a restaurant is anything like an orthodontic practice. I mean you have burgers and fries to prepare instead of braces or retainers. Technically a huge difference. But from the customer or patient’s standpoint is there a difference?

I know you are thinking of course there is a difference….

Any 16 year old can grill a burger, but certainly is not educated or trained to prep a 3 unit bridge or place brackets and wires or set up a ClinCheck. So how are they the same?

There is a different skill set involved with producing extraordinary orthodontic outcomes. There is the education and training process, the continuing education process, the materials and labs we use and of course our facilities and team members who help us provide the service.

A burger can be different too depending on the meat used, the way it was cooked and seasoned and of course how it is ultimately presented and served.

I think you know may know where I am going with this….

It is not ONLY the orthodontics or the burger, but how the patient or customer perceives the experience of having their braces placed or a burger presented to them. It comes down to how we deliver our services to the patient or customer and this is where we can learn a lot from those restaurants who are continuing to “crush it” and have people lining up each and every night of the week!

Let’s Talk ‘Food’

We need to eat . And certainly there are no shortage of restaurants. Maybe you have noticed some restaurants are busier than others. Even the ones that are considered “high end” seem to be busy and thriving.

Do they have a secret? Is it because the food is amazing? Probably, but there may be more to the story.

Are these restaurants thriving because of their ability to serve their customers in a consistent and caring way that promotes repeat and referral business? Think about the restaurants you tend to frequent.

I will admit I am a bit of a food snob as I really enjoy cooking and often have a hard time finding a place that meets my standards. I am also picky about what type of food I eat and how it is prepared.

However, when I think about the places I like to go to on a regular basis they usually meet these criteria:

  1. They are consistent. I can order the same salad each time and it will be the same size and taste the same and have the same ingredients.
  1. They know me by name or at least recognize that I am a ‘regular.” I like when you are frequent customer at a restaurant they great you by your first name and usually know what you will probably order or even tell you about a special that they know you will love 
  1. The wait staff is friendly and helpful. They don’t seem bothered by your requests for gluten free or an extra plate. They are upbeat and friendly and appear to enjoy their jobs.
  1. If something is wrong, they fix it no questions asked. Being picky, I do sometimes send food back. I once sent a Caesar salad back at Ruth Chris. It was drowned in dressing and absolutely horrible. They took it away no questions asked and of course removed it from my bill along with my main course. 
  1. They are always adding new menu items to choose from. I love to go to my favorite place and have new things to try. Many restaurants will offer seasonal menus to go along with the food available that time of year.

Now think about your practice. Are you providing a similar experience?

We can get caught up in the technical and clinical aspects of what we do in our practices and while this is important, taking care of our patients and providing them an extraordinary experience in our offices is ultimately why practices thrive and continue to grow each and every year.

Is the Future of Orthodontics Human vs. Machine?

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Chess matchAugmented Orthodontics

Technology augmented orthodontics is the future of our practices. Human intelligence, intuition and passion will still remain valuable, despite the expansion of the digital world. But yet there is a sentiment of fear that machines will take over. This rhetoric of humanity vs. technology is becoming more common as technology advances throughout many industries. This perception makes many orthodontists fear for their jobs.

We must face our fears if we want to get the most out of our technology, and we must conquer those fears if we want to get the best out of our humanity.” – Garry Kasparov

Back in 1997, the world champion of chess, Garry Kasparov, was defeated by IBM’s super computer, Deep Blue. The world of chess wanted a human chess champion. And yet a machine won against a human. Despite the machine’s victory, there are more chess players today than ever before. And many of them are playing a collaborative game of chess, where chess players compete each other with a computer by their side. Where the skill of human to computer interaction outplays human skill or machine skill alone.

What will it be like to work with a computer by our side? Human intuition with machine calculation. Human strategy with machine tactics. Human experience with machine’s memory. Human connection facilitated by machine efficiency. The challenge will be in developing the best interfaces for collaborative work that take the strengths of both of the proverbial opponents and turn man vs. machine into man enhanced by machine. Where the value of each practitioner will be amplified by their skill at integrating technology into their treatment.

In the future, effective orthodontic practices will work by the combined effort of a human with an intelligent computer at our side. Combining our strengths will greatly enhance the work we perform. This will allow us to better work on the human relationships with our patients. With current technologies, this future is beginning to be a reality. This holds many more opportunities. Let’s keep in mind that we cannot cease to make progress. We have to speed it up.

Machines have calculations. We have understanding. Machines have instructions. We have purpose. Machines have objectivity. We have passion. We should not worry about what our machines can do today. Instead, we should worry about what they still cannot do today, because we will need the help of the new, intelligent machines to turn our grandest dreams into reality… If we fail it is because we grew complacent and limited our ambitions.” – Garry Kasparov

Trouble with Transparency Under the Sunshine Act

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Sunshine ActTime for Transparency

In order for fellow orthodontists, as well as the general public, to adequately assess for conflicts of interest and general bias, all monetary contributions from companies and organizations made either directly or indirectly to doctors must be publicly disclosed in some fashion. The Physician Payments Sunshine Act, passed in 2010, was an attempt to provide greater transparency; however, the law doesn’t adequately cover all streams of income that can flow from manufacturers and distributors. This means that many doctors are on the honor system to provide this information and it allows for some to keep the origins of their income concealed.

Each year, the previous year’s data for Open Payments is submitted from manufacturers by March 31st, and they allow a 45 day process for dispute and review before the information is published to the Open Payments Database on June 30th. If you are interested, these payments made directly to doctors can be looked up for anyone you are curious about using the Open Payments Data Search Engine. Our concern however are the payments that are going unreported and do not appear on the site.

While the Sunshine Act requires medical product manufacturers to disclose to the Centers for Medicare and Medicaid Services (CMS) any payments or other transfers of value made to physicians or teaching hospitals, transfers of value that are made to a third party that isn’t a doctor or teaching hospital do not need to be disclosed creating the potential for abuse. 

Clever individuals and groups are able to essentially ‘launder’ money provided by companies through educational organizations, industry magazines, educational grants for meetings or forums, vendor fees at the same meetings, internet groups, etc. because these entities do not have reporting requirements under Sunshine regardless of whether or not the entities are owned by a doctor or a group of doctors. In the instances where these entities are doctor-controlled, once the money goes in they are able to reroute the funds to themselves, pay it out to affiliated doctors or speakers, or pass the funds between other organizations and groups that are aligned with their interests and working towards the same end. Furthermore, preferred pricing on products extended to key accounts are not adequately disclosed.

Naturally, we are beginning to see more and more organizations like this popping up with affiliated doctors organizing themselves into what can only be described as “mutual admiration societies” to help establish credibility and coordinate promotional efforts. Since the industry money is being ‘cleaned’ by passing it through or amongst these entities first, these doctors can also technically deny that they receive compensation from these companies, and without them opening their books completely it essentially impossible to distinguish funds that are provided by manufacturers from those that are earned by other means (ticket sales, membership fees, etc.). They are basically on the honor system to disclose any potential conflicts of interest.

There are plenty of other forms of bias out there that can cloud research and recommendations, but financial conflicts are an extremely important disclosure to make. The dilemma we now face as a specialty is that we simply may not be able to get straight answers from the types of entities we have outlined here on the sources and extent industry financing the receive. Therefore, we must consider the information flowing from these organizations, and their affiliated doctors, with increased skepticism and challenge. 

In the interests of greater transparency, we list all disclosures of any financial relationships our doctors have either directly or indirectly with companies or any of the entities in question on our Speakers page under the About tab.

The Value of Leadership

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Leadership

The orthodontic team is a dynamic group of people collaborating towards a common purpose. Highly effective teams can achieve remarkable things and they have a common thread. “Winning” teams sustainably work on building a team culture that allows them to do so.

Organizations that exhibit real greatness combine talent, relationships, and innovation in a variety of ways for the sake of achieving a shared goal.” – Don Yaeger

They have an understanding of who they serve and why. Effective teams bring unique talents that complement those of their other members. These teams also have alignment and understand the direction they are following. Last and certainly not least, great teams have great leadership.

Effective leadership is undoubtedly the key to any organization. The challenge is that most people are placed into positional leadership. Leadership that is given by title does not a great leader make.

It’s not leadership by position that allows people to succeed: it’s the capacity to influence the thoughts, the feelings, the emotions, and the actions of other human beings.” – Tony Robbins

What makes a great leader? Many believe that leaders should be enthusiastic, passionate, genuine and energetic. Besides the hard work and passion, a great leader also has a high degree of emotional intelligence. Great leaders share some common traits that lead to measurable results, where those traits boost a company’s performance. (Daniel Goleman)

Self-awareness – Great leaders see themselves and their businesses clearly. They understand their strengths, weaknesses and those dynamics in their organization.

Self-regulation – Leaders should create an atmosphere of fairness and trust by controlling their feelings. Great leaders think before they act.

Motivation – A great leader should have passion for work and desire to raise the performance bar in those whom they lead.

Empathy – In leadership, it is important to maintain effective group dynamics and teamwork. An empathetic leader does not demoralize those around them by understanding their emotional needs.

Social Skill – Effective leaders work well with a team and are great at persuading others.

These leadership skills are key components to a successful organization. Besides drive, passion and emotional intelligence, I would also add that the most effective leaders create a culture of leadership. This culture is key to sustainable success by nurturing leadership development from within the ranks. This promotes better habits and behaviors for a “winning” team.

True leaders don’t create followers. They create more leaders.” – Tom Peters

Whether we like it or not, each of us is in a leadership position. Leading an orthodontic practice and an orthodontic team is a skill in it of itself. It takes hard work and fortunately, we have great examples that help guide us to understand the value of leadership.

Beware of Habituation in Orthodontics

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Habituation post

Habituation is defined as becoming accustomed or developing tolerance from a repeated action. Because of adaptation, there is a decrease in response to a repeated stimulus where one can no longer sense that stimulus as efficiently as before. Habituation occurs both in people and organizations. When it comes to improving the patient experience in our practices, it is important to beware of habituation.

Think about all of our habits and normal ways of doing things, and consider how we have habituated into doing things in the same way. Sometimes, we have habituated into accepting certain problems. At times, we have habituated into accepting an average patient experience. Or accepted that our role is to achieve the bare minimum necessary. Unfortunately, habituation begins to erode our drive to continually improve and re-evaluate our approach to orthodontic treatment.

Try to see the world as it really is. Not the way we think it is. Why? Because it’s easy to solve a problem that almost everyone sees. But it’s hard to solve a problem that almost no one sees.” – Tony Fadell

There are those methods that our specialty has habituated. Are there areas we can improve, or will we continue to approach it the same way because that is the way we have always done it? What have we accepted as the “average” orthodontic experience? What are the real problems we encounter in treating patients as opposed to the problems we think we have? Breaking those habits can raise the bar for patient care.

As patient expectations evolve, and as the orthodontic marketplace changes, it is imperative that we break out of habituation and design a better experience. Consider the impact of orthodontic emergencies. What about the convenience of scheduling? How about treatment times or patient comfort? Are we delivering technical appointments, or are we building relationships with our patients when they visit our offices? These are the questions we have to consider if we want to become relevant in the future.

Look Out Labs Change is Coming

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Orthodontic Lab TechThe Future of Orthodontic Labs

3D printing and computer aided design (CAD) tools are making orthodontic lab work easier to bring in-house and streamlining manufacturing by reducing the number of physical steps required to make appliances. This technology will significantly change how orthodontic care is delivered and the role orthodontic labs play in the marketplace.

To be able to assess the impact this will have on orthodontic labs themselves, we need to understand first the overall breakdown of the lab work they are currently performing. We were able to compile data from 8 orthodontic labs, ranging in size from one man operations to very large labs consisting of 100+ lab technicians, which gives us a pretty good sampling of the products produced by traditional orthodontic labs across the US.

The average data by appliance category for the labs surveyed is represented below:

Appliance Type AVERAGE
Hawley Retainers 45.4%
Spring Retainers 4.4%
‘Invisible’ Retainers 3.3%
Fixed Lingual Retainers 3.0%
Functionals 2.4%
Occlusal Splints 2.0%
Expanders 11.6%
Habit Appliances 1.0%
Space Maintainers 3.8%
Class II Correctors 6.4%
Clear Aligners 6.6%
Tooth Positioners 4.5%
Indirect Bonding 2.0%
Other (Study models, Mouth guards, etc.) 3.7%

Among the data, there were some other interesting findings:

  • As the size of the lab decreased, the product mix shifted heavily towards Hawley retainers. Large labs would top out at about 20% Hawleys where as some single person labs saw 90%+ in Hawleys.
  • Indirect Bonding and Class II Correctors (Herbst & MARA) were non-existent until you got into the larger commercial labs.  
  • Expanders, both fixed and removable, topped out in the medium size labs before decreasing with the larger labs. This may be due to them being combined with Class II Correctors, rather than being listed separately as an expander.
  • Tooth positioners were also non-existent until you get into the larger labs in the market.  Most of the universities are not utilizing tooth positioners anymore, thus small labs are not getting the demand to carry the product.

The appliances that are least technique sensitive to fabricate and those where significant advantages are gained by shifting work into the digital space are going to be most impacted by 3D printing. This will disproportionately affect the larger labs and primarily concerns ‘invisible’ retainers, study models, clear aligners, occlusal splints, and indirect bonding, which account for 13.9% of lab work performed by orthodontic labs based on the averages in our sample. Spring appliances may also be impacted if they are being done for tooth movement, since may doctors may opt to produce clear aligner in-house as an alternative. The appliances that will be least affected in the short term will be soldered and banded appliances since the advantages from 3D printing that would drive adoption aren’t as significant until such appliances can be directly printed.

How Orthodontic Labs Will Adapt

Given the significant impact that 3D printing technology will have on orthodontics in general, orthodontic labs will be forced to adapt. There are several ways in which we will see them changing their model:

  • Providing supportive digital services so practices can outsource their digital workload and storage. The practice would then have the option of either manufacturing the physical appliance in-house, or having the lab fabricate and ship the appliance as they do now. Some labs have already begun to implement this. Ideally, the global economy would be leveraged to have the digital tasks performed overnight to increase productivity.
  • Manufacturing and marketing direct-to-consumer products, either on their own or in partnership with other companies. Since these labs already have the infrastructure in place to manufacture and distribute products, this may be a natural transition.
  • Offering training services, both on-site and online, for in-house orthodontic lab technicians.
  • Focusing on products less affected by 3D printing. However, this is more of a delay tactic than a solution.

Top Line vs. Bottom Line in Orthodontics

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Cosmos Growth

Growth vs. profitability. These two are not the same. And many times, one challenges the other.

Of course, most of us want both, and we should work on both. The big question is which is more important? Balancing the top line and the bottom line of your business is a critical decision for success…

The rest of this post is available only to orthodontists and orthodontic residents registered with the Ortho Cosmos

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Invisalign Releasing Extended Payment Terms

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Extended PaymentsExtended Payment Terms

It is important for orthodontists to offer flexible financing arrangements to help make great orthodontic care more accessible to patients. Unfortunately, due to the lab fee, many doctors have felt that they can be as flexible with in-house financing terms when using products like Invisalign. We have already shown that orthodontists don’t need to charge more for Invisalign or be less flexible with financing, but the upfront costs of the lab fee are about to become even less of a concern because Invisalign will begin rolling out extended payment terms on their lab fees to doctors.

This will allow doctors to provide even greater flexibility in their financial arrangements with patients, and will help to make treatment more affordable for families. Initially, this program will only be available to Invisalign’s Top 1% and Elite level providers so if you aren’t a Top1% or Elite doctor and you feel excluded, time to treat more patients with Invisalign….

The rest of this post, including details on the extended payment terms, is available only to orthodontists and orthodontic residents registered with the Ortho Cosmos…..

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Print Farm Starter Kit

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3D Printer Shopping3D Printer Shopping

Most of the companies and their reps selling 3D printers have been working in the dental space with restorative dentistry and implant dentistry and have not yet adapted to the substantial differences that exist with orthodontics. Additionally, the margins on the actual 3D printers are razor thin so companies will push items like expensive UV curing boxes (with huge profit margins) when post-curing may not be indicated and when inexpensive UV light boxes for nails salons may suffice.

Orthodontists are in need of greater clarity on what you should or should not buy to begin integrating 3D printing in your practice, so we put together a shopping list.

Print Farm Essential Items

1 x Formlabs Form2 3D Printer (Complete Package is $3499)

  • All the 3D printers we tested for accuracy in printing orthodontic models demonstrated the requisite precision for orthodontic indications; however, the Form2 was the most cost effective and has a wide range of resins available so it makes a good starter 3D printer.
  • With the Form2 you can predictably build 20 dental models vertically per day (two prints of 10 models), which easily translates to 300 models a month on 1 Form2 printer. As your needs grow, you can gradually scale up your capacity by adding printers to your print farm. Having a print farm also provides redundancy so if one printer goes down you have a back up.
  • The complete printer package includes a Resin cartridge, Resin Tank, Build Platform, Finish Kit, and One Year Warrantee

2 x Matte Grey V3 Standard Resin Cartridges (1 included with printer package, $149 for additional)

  • Cartridge system for easy switching between different resins.
  • This resin has highly accurate curing properties and is perfect for dental models.
  • One cartridge will print about 50-70 dental models depending on size, so we recommend getting two.

Additional Resin Tanks (1 included with printer package, $59 for additional)

  • The rule is 1 Resin Tank per Resin Cartridge. These stackable resin tanks (with lids – don’t throw these out) that can be easily removed to switch between resins. The printer will come with one resin tank included.
  • Since the resin tank will be partially filled with resin, you will want to keep the resin tanks with a particular cartridge of resin (you can label the lids). Simply remove and cover with their original lid for storage.
  • The silicone curing window on the bottom of the resin tank wears down with each ‘peel step’ and will eventually cloud and require replacement. The silicone window is tested to withstand 5000 ‘peels,’ which means that you will typically need to replace the resin tank after printing through a whole resin cartridge to keep your prints accurate (2 cartridges is sometimes a stretch). You should evenly utilize the build platform and vary your print position so that the silicone curing windows do not cloud pre-maturely.

Finish Kit (included)

  • The Finish kit includes a finishing tray and accessories to remove parts and perform a thorough alcohol wash while maintaining a clean workspace.

PreForm Print Preparation Software (included)

  • Free software that comes with the Form2 printer. Other printers will have similar prep software for their machine.
  • This software will prepare files for printing and optimize them for printing on the Form2. Simply lay out prints on build platform, use the support generating tool, and push to print via WiFi.
  • You will have to physically present to start a print on the printer (needs manual verification that build platform is in place, etc.), but you can utilize the online Dashboard to monitor print progress remotely.

Optional Print Farm Purchases

CAD software

  • Although STL files for dental models can be downloaded and printed without additional software, if you want to make design modifications to the 3D files themselves you will need additional software. This isn’t necessarily something you’ll need to do right away.
  • This includes movement of teeth to stage clear aligner tooth movement, digital bracket removal, fabrication of direct print indirect bonding trays, fabrication of direct print occlusal splint/retainers, modification of tooth and gum surfaces
  • Some options include Orthoanalyze, Orchestrate, Elemetrix.
  • If you elect not to purchase software, you can outsource these CAD services to labs (to remove brackets, etc.) and have them provide the STL files of the final product for printing and digital storage in-house.

Pro Service Plan ($499)

  • Although the Form2 is dead simple to set up and use, the Pro-Service plan can be helpful for orthodontists new to the 3D world.
  • You will get a customized training session to learn in the ins and outs of desktop 3D printing, priority phone and email support, and the ability to hot swap a broken printer (a good idea if you don’t have a second printer)

Orion Pulse Arc Welder & Argon Tank (~$2500)

  • For welding/soldering parts on printed models.
  • Instead of purchasing an expensive laser welder, pulse arc welders offer an effective means of welding on printed models without melting the print. Welds are sturdier than soldering, but are a different technique so it may take some training for your lab technician.

Siliform Separating Medium (~$260 for 8oz)

  • If you are going to be making Hawley retainers or other acrylic based products on the printed models, you will need a separating medium. However, the surface tension on printed models is different than plaster casts and traditional separating mediums won’t work as well.
  • There are certainly a lot of options that can do the job, but the one that we have found to work best has been Siliform. It is not cheap, but it is effective. You can order from Adell Corporation.
  • 3D printing offers more advantages if you are sticking to thermoplastic retainers or direct printed retainers, so you may want to consider modifying your retention protocols.

Biocompatible Resin Cartridges (price varies depending on material)

  • Bio-compatible resins are only needed for printed final products that will be used in the mouth. You do not need a bio-compatible resin to print a dental model that will be used as a working or diagnostic model.
  • Bio-compatible resins are available for use in direct printed IDB trays, occlusal splints, analogs for autotransplantation, surgical guides, etc.
  • The Dental SG Resin ($399) is already available, but the upcoming Dental LT Clear Resin (~$500) will be a better fit for most orthodontic needs.

Form Wash ($499)

  • While you can perform an alcohol wash with the finish kit that is included, Formlabs has created a little alcohol jacuzzi for your finished prints that accepts a full build platform.
  • This is an optional purchase, but it automates the wash process and takes up less counter space than the alcohol baths in the Finish Kit so it may be useful. The agitation of the alcohol will also get a more thorough clean of the printed items in less time. By purchasing an additional build platform you can start another print immediately while the other build platform is being washed.

UV-Post Curing Box

  • If you are printing objects that are bio-compatible, you will need to do a complete UV post-cure. This can be done either with the Form Cure ($699) or the Kudo Post Curing Lamp ($249). Companies will typically push these whether or not your truly need them because they are high margin.

Additional Build Platform ($99)

  • Build platforms will last nearly indefinitely, but if you are looking to utilize the Form Wash System you will need a second build platform so you can print while your other build platform is being cleaned.

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