Emily Howell, DMD, knew early on that she would wear two hats: business owner and clinician. She found a way to weave the two into an orthodontic practice that successfully prioritizes family and community.

By Alison Werner | Photography by Emily Lauren Photography

Emily Howell, DMD, knew before she even started dental school that she wanted to own her own practice. The daughter of small business owners, she knew what it would take to make it a go. And she knew early on that even in a male-dominated profession she could succeed as a solo female practitioner from the start. She’d already seen it done.

Howell underwent orthodontic treatment at 14. She experienced the impact it had on her self-confidence and she saw firsthand how much her orthodontist enjoyed his job. She expressed her interest in the profession and he offered her the opportunity to shadow him before hiring her to work in his office during the summers. He wanted her to be sure of her decision before committing to a decade plus of school. There, she learned how to develop x-rays and take impressions. But 2 years later, he sold the practice to a young female orthodontist who had just graduated. The transition was eye opening. She got to see a woman in the job, and a woman who was a business owner.

“For me to see a woman that had come out [of residency], who was single and headstrong, and had goals, it was amazing,” she recalls. Howell worked for that doctor for an additional two summers. “That sealed the deal for me.”

At the beginning of college, Howell made a crucial decision, rebelling against the advice of her pre-dental advisor who insisted she follow the typical pre-dental curriculum, majoring in a science, if she wanted him to be her advisor. She knew she needed a business degree and was determined to follow a path that would serve her long term.

Working for those two orthodontists during high school, Howell saw how they wore two hats: clinician and small business owner. Having grown up in a family that ran its own lumber business, she saw first hand the skills her family needed to make the business successful and to keep it afloat during the hard times. A business degree would set her up to succeed as a business owner; just as dental school would prepare her to succeed as a clinician. She completed her business degree, with a specialization in Management Information Systems, at the University of Georgia and completed her pre-dental requirements in time to graduate, taking classes year round.

“Everyone I’ve talked to in dental and ortho has said, ‘You just don’t get much business in your education.’ Yet you manage your practice. You have to market, you manage employees and finances. You have to do accounting. And if you’re starting your practice from scratch, there is so much of it,” she says.

Howell knows what she’s talking about. On a Friday night she graduated from the Medical College of Georgia, where she completed both her dental degree and her certificate in orthodontics and dentofacial orthopedics. On Monday morning, she opened the doors to her own practice in Jefferson, Ga.

“When you have been working on this goal for 10½ years in school, you’re just itching to get out and do what you’ve been taught how to do,” she says. In fact, she’d spent the last 6 months of her residency, every long weekend, making sure her office buildout was proceeding and hiring and training her one staff member—a front desk receptionist to answer the phone and book appointments.

Howell did her homework before settling on the small, rural town of Jefferson. While still in residency, she and her husband set up an Excel spreadsheet analyzing a number of towns within a reasonable driving distance from Atlanta, where her husband would be working at the time. The spreadsheet would include per capita income growth in the preceding decade, as well as the number of dentists and orthodontists.

Jefferson was on the shortlist when a dentist from the town brought his daughter to tour the Medical College of Georgia. Howell overheard him mention he was from Jefferson and struck up a conversation. That doctor and his wife hosted Howell and her husband for a visit, where he made the pitch: The town desperately needed an orthodontist. While he had taken orthodontic courses over the years to meet the needs of his patients, he was still referring patients to one 20 miles away. She should start her practice here.

When Howell opened her first office in 2007, she hired one employee, a front desk receptionist to answer the phones and make appointments, while she did everything else. Today, she has 12 staff members.

The dentist and his wife took them around the town of just under 10,000, showing them the local schools, the church, and introducing them to the community. “He just sold us on it,” she recalls.

Howell started small with that first practice in 2007. She credits family with helping her find her legs. Her mother, who is an accountant, helped her file her quarterly taxes and taught her how to do payroll, tasks that she otherwise would have had to pay for, but instead learned how to do. In addition, her husband supported her, allowing her to not pay herself a penny for a few years, instead putting that money back into the practice and paying off student and business loans.

In those early days, while her front desk person took care of checking in patients, answering the phone, and making appointments, Howell was responsible for everything from sterilization to insurance. She was her own orthodontic assistant and treatment coordinator. And from that she gained invaluable knowledge. “I learned to appreciate every single person who works in my office because I’ve done their job,” she says.

Howell found ways to save money when starting out. First: used equipment. A local oral surgeon donated three chairs that he was going to throw out. Instead of paying close to $25,000 for new chairs, she spent $1,500 to re-cover them. Second, Atlanta Dental, her main product and equipment supplier at the time, offered to design her office at no charge as long as she was buying x-amount of equipment from them. “I needed that equipment anyway, so that was good,” she says.

Howell also saved money on her buildout by negotiating with the owner. Half the building was leased by Jefferson Pediatrics, putting her front of mind with her target patient population. Because she was doing some leasehold improvements to the overall building as part of her office buildout—for example, adding to the back parking lot and adding a side lobby—her landlord paid a portion of the cost per square foot.

The main advantage of starting a practice from scratch, for Howell, is the fact that she could lead from day one with a specific culture and goal. “That is just a culture of love and faith in God,” she says. “Every single morning, before we see patients, [my staff and I] pray together and repeat our motto: Sharing God’s love through exceptional orthodontics.” And while faith is a large part of the practice’s culture, Howell adds that this isn’t about coming across as preachy, but rather letting the community know that the practice is there for them in times of need. One example, a prayer box set up in the corner of the lobby. If someone happens to see it, they can slip in a request for a prayer for a sick grandmother or mother who has lost a job. The staff includes those prayer requests as part of their morning huddle.

A native Georgian, Howell says her connection to community engagement started as a child and reached another level when she served as Miss Georgia during college. Howell never considered herself a pageant person per se; she was drawn to it because of the scholarship opportunities. But the role exposed her to a level of community involvement and support that she’d never experienced. Today, that translates into involvement in her local Chamber of Commerce and its Women in Business component, the Rotary Club, and local school council. And her practice supports the community through its Give a Grin essay program which gives a deserving middle school student orthodontic treatment. Another program, Serve Save Smile, gives adolescent patients an opportunity to volunteer in the community to earn $10 for every hour served at a local non-profit. Volunteers can earn up to $500 off their orthodontic treatment. To date, the practice has given away well over $100,000 in treatment fees to kids who serve the community.

Howell, seen here in her office’s 3D printing lab, has always followed the advice of the chairman of her orthodontic program when it comes to integrating new technology: Never be the first to jump on the bandwagon, but don’t be the last.

“A lot of the kids who started will do more than 50 hours because they realize they have a passion for [volunteering],” says Howell.

In 2016, Howell knew it was time to expand, but she also knew she wanted to remain a solo practitioner and cut back on her time in the office, not add to it. Currently, she works 3-4 days a week, alternating weeks, plus the practice closes for Spring Break, Christmas, and a summer break. Howell, a mother of two daughters, is proud of the fact that her 12 person staff, many of those working moms, has a culture that prioritizes work-life balance. She admits she’s a little overstaffed, but she wants to make sure that if a member of her team needs to take time off for a sick child or school field trip, they can.

“We’re a tight knit group,” she says. “I tell them, family is everything and I want them to value their families more than their job. So if we have enough staff to cover and we’re not canceling or changing appointments, I want them to take that time off. We’re holding to our culture and putting family first.”

The key to making growth and work-life balance possible: Technology and clinical efficiencies.

Howell has always followed the advice of the chairman of her orthodontic program: Never be the first to jump on the bandwagon, but don’t be the last. Over the years, she’s incorporated intraoral scanners and 3D printing. Currently, she is onboarding an indirect bonding workflow, which will free her up to see more patients and make those appointments more efficient. In a practice that primarily treats adolescent patients (adults only make up about 10-15% of her patient population), Howell primarily treats with brackets (3M Clarity Ceramic Brackets), with an average treatment time of 20 months. She’s proud of that treatment time as she treats a number of surgical cases and sees a lot of Herbst patients.

As she was building out this new larger office, now with six chairs in the bay and one TC exam room, Howell had a new appreciation for her first practice and her decision to start small. It’s a lesson she wants to pass on to other doctors just getting started.

“I’m so glad I did not build this big building from scratch on day one because I wouldn’t have known what I wanted.” With the expansion she not only knew what she wanted but what she needed.

This time around she hired Joyce Matlack, of the orthodontic and dental office design firm Matlack/Van Every Design. While the cost of hiring a professional designer can feel daunting, Howell is quick to point out how the decision allowed her to adapt her space as world events took hold and new technologies changed her needs. Howell praises Matlack’s forethought in planning out the space, such that when the pandemic hit and she readied to reopen her office after closures, she already had dividers and a pre-lobby that allowed staff to conduct temperature checks before patients entered the reception area. And when she did call Matlack for advice ahead of reopening, Matlack redesigned a closet space to accommodate a washer and dryer. More recently, she redesigned space to allow for a 3D printing lab.

Howell, who expanded her practice in 2016, says, “I’m so glad I did not build this big building from scratch on day one because I wouldn’t have known what I wanted.”

While it might feel out of reach when building a practice from scratch, Howell recommends spending the money on specialized experts to advise you—for example, not just an accountant, but a dental accountant, or a consultant like Jackie Dorst to set up the sterilization space.

Howell knows she is a rarity these days as a solo practice owner who wants to remain a solo practitioner, unless her daughter decides to follow in her footsteps. The fact that she chose a small, rural town to make her career in also makes her a bit of a rarity. Howell grew up in a small town and knew she wanted to stay in one; but more often than not, new orthodontists seek out medium to large markets to start their career, leaving many rural areas in desperate need of an orthodontist as was the case when Howell first heard about Jefferson. But small towns offer a wealth of opportunities, especially if you are willing to become part of the community. And that is key to finding success there.

“Community matters,” says Howell. “People appreciate that I’m going to be there if they need me.”

Howell also recommends that orthodontists setting up in small towns make a point of building relationships with local dentists. “No matter where you go that’s important, but especially so in a small rural town like this,” she says. “I know in Atlanta it’s so saturated and it’s hard to get your name out there and people don’t seem to have the time to meet with you. But [in a small town] people really do appreciate [you making the effort].” Howell considers it a point of pride that local dentists entrust their children’s orthodontic treatment to her. It tells her that she has built a strong relationship with them. And it’s just another sign that she has succeeded in building the business and culture she envisioned.OP