Todor Stavrev, DDS, MS, of Todorthodontics Smile Studio explains how collaborative relationship building and digital technology allow his practice to outperform the market.

By Alison Werner | Photography by Rudy Meyers

What’s the key to growth when the industry as a whole is down? For Todor Stavrev, DDS, MS, of the San Francisco-based Todorthodontics Smile Studio, it’s a referral marketing strategy centered on building collaborative relationships. But how do you effectively build those relationships when you are a solo practitioner with a young, busy practice? Well, you effectively use the technologies available to you.

Collaborative-focused referral marketing

At just 4 years old, Todorthodontics has experienced 35% growth in production year to date, amid a down market. Stavrev credits a mixture of digital marketing with The Invisible Orthodontist (TIO) and referral marketing for his recent success, but when it comes down to it, those patient leads are only good if the practice’s follow-up is consistent and systematic. This is where training is key, says Stavrev. Staff need to be trained on effective patient relationship management, down to knowing how the lead prefers to be communicated with—whether phone call, text, or email—to get them into a chair for a complimentary consult.

Stavrev favors referrals—whether from patients or other dental specialists—to leads from digital marketing who are more price-sensitive and more likely to shop around. Most recently, he has worked with Levin Group to grow his referral marketing program; but the foundation was already in place.

From the start, Stavrev has focused on building strong relationships—whether with vendors or referring doctors. Some of those referring-doctor relationships go back to colleagues he met in dental school at the University of California at San Francisco School of Dentistry. But as more general dentists do orthodontics, especially adult orthodontics with clear aligners, Stavrev has sought to build relationships with other specialists as well, including periodontists and maxillofacial and oral surgeons, working with them on comprehensive or restorative cases.

Cultivating these relationships requires more than the occasional lunch. Stavrev’s approach is consistent and systematic—the same approach he instills in his staff when it comes following up on patient leads. And he makes a point of not only engaging the referring doctor, but also the team. In fact, one of his best referrers is front desk staff for a referring general dentistry practice who was once a patient.

Stavrev does games, including raffles, as well as lunch and learns with the staff, presenting different cases his practice has treated and asking the referring practice staff to keep an eye out for similar cases and refer those to his practice. And when it comes to the easier orthodontic cases, Stavrev isn’t afraid to tell a referring general dentist to keep the case and instead wait to send him a more difficult case. He even has plans to have a few general dentists from the area into his practice for an educational session aimed at helping them triage orthodontic cases and identify which they should keep and treat with aligners and those they should send to an orthodontist for treatment.

“Educating and helping them, to me, that’s a true relationship and partnership,” he says.

And once a patient is under his care, Stavrev makes a point of proactively and consistently communicating with the referring doctor. He sends the referring doctor the initial report along with all imaging. And now that he has added a CBCT to his practice, he plans to invite his top referring doctors to send their patients for imaging, especially their restorative cases. “Instead of sending [patients] to a lab, I can help [these referring doctors] like a true partner,” he says.

Given that adults make up 90% of Stavrev’s patients, and many adult cases require comprehensive or restorative treatment to achieve optimal oral health and aesthetics, building collaborative relationships across specialties has gone a long way. As Stavrev describes it, successful patient care “is a joint effort between me, the general dentist, and sometimes the periodontist or the oral surgeon. It’s not us versus [them]. Being open minded and willing to help, it pays off.”

At Todorthodontics, the entire patient experience is digital – from intake forms to remote monitoring during treatment. Stavrev credits his digital workflow with both giving him the time to cultivate a strong referral network and creating efficiencies that allow his production to skyrocket.

Finding the time to build a referral network

Cultivating these collaborative referral relationships requires time—time that a busy orthodontic practice often doesn’t have. But Stavrev has both—a busy (and growing) practice and the time; and he credits his digital workflow for allowing him both as a solo practitioner.

At Todorthodontics, the entire patient experience is digital, including intake forms (which the patient fills out online at home before they arrive for their appointment), records, and financial presentation. When it comes to treatment, Stavrev uses Invisalign for aligner patients and LightForce for his brackets patients, and relies on DentalMonitoring to track all his patients, including his surgical cases. While he sees patients for initial delivery, IPR, extra attachments, and refinement scans, the majority of the practice’s appointments are as needed.

As Stavrev puts it, the success of his digital workflow is easy to see: “My chairs are empty. My production has skyrocketed, and I work only 3 days a week.”

Stavrev currently works 4 days a week—opting for a 4-10 workweek, with 3 patient days and 1 admin day. And even with this reduced schedule and no associate, he still exceeded the production goal he set for himself and still has room to take on more new patients without compromising the treatment of existing patients.

“With the digital workflow, I actually can produce way more and still have time to do other things, like establish and bring in more referrals,” he says.

Todorthodontics
Stavrev takes a proactive approach to managing his practice, a skill he developed during his previous career as a consultant.

Making a career change

As a small business owner, Stavrev takes a proactive approach to managing his practice. He tracks everything and looks at his numbers daily to ensure he’s meeting his goals—a practice he developed as a consultant in his previous career.

Before attending dental school, Stavrev studied economics and mathematics in his native Bulgaria before immigrating to the United States and going on to complete a master’s in economics at Boston College. He went on to work for 8 years as a consultant, focusing on litigation support for price fixing and monopolization cases. In fact, he was in an economics PhD program when a friend in the program first introduced him to orthodontics.

Like his friend, Stavrev didn’t find the economics path personally fulfilling. He couldn’t imagine spending the rest of his life sitting behind a computer crunching numbers making corporations more money. A people person who wanted to be of service, he had an interest in both medicine and dentistry, but ruled out medical school because he knew he was already 10 years older than all the other students and wanted to be working sooner rather than later. Living in Boston at the time, he enrolled at the Harvard Extension School to complete the required courses to apply to dental school. When he eventually applied and was accepted to UCSF School of Dentistry, he still wanted to make sure this was the right choice, so he sat down with a career coach. She helped him see that you don’t have to be just one thing. An example she cited, someone who was a lawyer 2 days a week and an actor the other days. Stavrev saw how his career change from economics to dentistry wasn’t a stretch. Moreover, she helped him see that the field offered him the trifecta of something he could be good at, something he enjoyed doing, and something he could make a good living from. After completing his dental degree at UCSF, he went on to complete his residency at Columbia University.

Stavrev chose to return to San Francisco to start his orthodontic career, working as an associate for 3 years before starting his own practice in 2020, when the pandemic hit. With the dental industry shut down, Stavrev had time to think about what’s next and seized the opportunity to start his own practice. A general dentist friend and mentor offered some of his chairs, and with the help of his partner and a friend, the practice thrived. Growing from zero patients to over 100 his startup quickly needed more space; that’s when a doctor who was selling her practice to relocate out of the country offered him the opportunity to combine his startup with an established practice.

Todorthodontics has continued to grow year over year. With his office situated near San Francisco’s Union Square, adults make up 90% of his patient pool. They are busy young professionals working for local tech companies who are largely driven by aesthetics. Stavrev, who is gay, has also built a strong relationship with the local LGBTQIA+ community. He has prioritized creating a boutique practice where patients and staff are treated like friends and family. And recognizing that his patients are adults, he’s opted against an open bay layout, enclosing each of his five chairs into separate rooms to give his patients privacy.

And while Stavrev remains focused on his KPIs, he knows that there are slow months or economic trends that he can’t control. To counter, he focuses on training his team and cultivating those referral relationships and building new ones. And he continues to work with a career coach on the business side, recognizing that “there’s always room for improvement,” he says.

In the end, Stavrev has made a career change that suits him.

“I’m super happy where I am. I can’t imagine doing anything else. To work with a smile and live with a smile, if I had to do it again, I’d do it all again, even though it was a lot of work,” he says. “Imagine: You have one lifestyle and then all of a sudden you have no money again and go back to the books, and everyone is 10 years younger than you. It was challenging, but totally worth it.”