If there’s one question weighing on small private practices, it’s how do we compete with the large multi-office practice in town, or the corporate behemoth with multiple locations throughout the metro area?
The question is certainly one Maria Castano-Rendon, DDS, MSD, and Juan Rendon, DDS, MSD—the husband-and-wife team behind Texas-based Rendon Orthodontics—have asked themselves as they’ve built their practice. But it’s a question they have been in a unique position to answer for themselves. Having started their careers in a large group practice, they have learned the specifics of what it takes to be competitive as the small practice in town.
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Practice Profile: Rendon Orthodontics
Locations: Frisco and Allen, Tex
Number of chairs: Frisco–6; Allen–4
Years in practice: Maria–14; Juan–13
Education: St Louis University–Master’s degree in Orthodontics for both. Universidad CES, Medellin, Colombia–dental school for both; Master’s degree in Orthodontics for Maria; Master’s degree in Pediatric Dentistry for Juan.
Average patients per day: 35-40
Starts per year: 240
Days worked per week: Maria–3; Juan–2 at Rendon Orthodontics and 3 as an associate in a large group practice
Staff size: 8
Top products used: In-Ovation® C and R Self-Ligating Brackets (Dentsply Sirona); Carriere® Motion Appliance (Henry Schein Orthodontics); i-Tero® (Align Technology Inc); LED Pro Seal (Reliance Orthodontic Products Inc); NeoBond Light Cure Adhesive (Dentsply Sirona)
Practice website: rendonorthodontics.com
Maria and Juan’s story starts in Colombia. While Maria comes from a long line of dental professionals—her father at 82 still works part-time as a periodontist—Juan was the first in his family to go to dental school. However, a cousin soon followed him. While Maria and Juan attended the same dental school—Universidad CES in Medellin, Colombia—Maria started a year after Juan graduated. So, it was that cousin who brought the two together.
Colombia is also where they initially started working professionally—Maria as an orthodontist and Juan, who is dual trained in pediatric dentistry and interceptive orthodontics, as a pediatric dentist. Once he completed his Master’s degree, Juan was offered a position as a professor at the dental school, focusing on pediatric dentistry as well as trauma. He was responsible for running the school’s trauma clinic, which received emergency patients from the hospital.
In 2000, a year after Maria finished her Master’s degree in Orthodontics at Universidad CES, the two made the decision to leave their young careers behind and start over in the United States. The decades-long conflict between government forces and paramilitary and guerrilla groups meant instability and violence in the country, which by the early 2000s had reached a crescendo. Maria, who was educated in a bilingual school, was fluent in English and had family already living in Texas. The two decided that she would apply to orthodontic programs in the United States, as Juan did not yet speak English, and, if she was accepted, they would leave.
The orthodontic program at St Louis University offered her a spot.
Once in St Louis, Juan spent his days learning English at a program geared to refugees. Within a year, he was ready to apply to St Louis University, and joined Maria there the following year. Once in the program, Juan decided to put the 8 years he’d spent in pediatric dentistry in Colombia behind him and focus on orthodontics.
While one might balk at having to repeat their orthodontic education, Maria and Juan found joy in the experience.
“It was a lot of work. We still had to do everything everybody else did, but we were able to enjoy it more. We were able to be exposed to much more technique, to a lot of technology [that had emerged since] we started,” says Maria, who received the Marshal Award while at St Louis University.
“The first time, some things didn’t make sense,” Juan says of orthodontic training in Colombia. “And then the second time, you see things and you have a better background.”
“We were able to just get extra knowledge and understanding, and to take advantage of that,” Maria adds. That extra knowledge included Cleft Lip and Palate Fellowships for both, a challenge they welcomed.
From Colombia to Missouri to Texas
While the two enjoyed their time in St Louis, they ultimately had to leave if they wanted to start their careers immediately. Every state has its own laws and requirements with regard to licensing international dentists. In Missouri, the two would have been required to return to dental school for 2 years, despite the fact that they had already completed dental school in Colombia and been trained in a US-based specialty program. However, in Texas, where Maria’s sister and brother already lived, the two could take the boards and be licensed as long as they had completed a US-based specialty program, which they had at St Louis University.
Moreover, the two wanted to start working on gaining residency as they couldn’t open a practice of their own until they did. To do that, they had to find a sponsor. They found one when they both were offered positions at a large group practice with over 15 offices that is owned by an orthodontist and specializes in orthodontics.
Both Maria and Juan are thankful for the experience. “We have just great things to say about them,” says Maria who worked for the practice for 4½ years and Juan for 5½ years. She credits the experience with preparing her and Juan for opening their own private practice.
“It’s one thing to be in school and see patients. It’s another thing to go out into the real world and start treating people. We saw a good number of patients every day and that totally prepared us to know what we wanted to do and what we did not want to do,” she says. And while the couple had worked in private practice in Colombia, they admit that while clinically things are similar, there are differences in terms of management.
In 2008, the couple opened their private practice in Frisco, Tex—right as the recession hit. Fortunately, the two had decided that one of them would continue working for a group practice to provide financial stability while the other worked to build the private practice.
“[Juan] gave me the opportunity to be in the practice. It gave me a little more flexibility since we have two daughters. They are now 13 and 10, but they were very, very little at the time,” Maria says.
Juan moved to another large group practice with the opening of the Frisco office and has stayed on part-time as an associate even after the couple opened a second office in Allen, Tex, in 2013.
Despite jointly owning the practice’s two offices, Maria and Juan have never worked in the same office. Maria sees patients in the Frisco location Mondays, Wednesdays, and Thursdays; while Juan sees patients in the Allen location Tuesdays and Fridays, and works as an associate the other days. And while the two don’t overlap, some of their staff does, splitting its time between the two offices which are 20 minutes apart.
According to Maria, the offices are very different. The couple considers Frisco the practice’s main office and Allen a satellite. Frisco is a growing city, while Allen is a much more established community. That translates into population differences. While adolescents make up the majority of Maria’s Frisco patients, Juan’s Allen office sees a higher percentage of adults. The latter is also a result of the fact that Juan specializes in multidisciplinary cases, working hand-in-hand with a local oral surgeon who refers many cases.
As Maria and Juan are native Spanish speakers, the practice also sees many Spanish speaking patients, or their parents. “While the kids are bilingual, the parents are not,” says Maria. In addition, Juan points out, these patients may just feel more comfortable speaking in their native tongue.
‘They’re always very grateful and happy that we can explain things to them in their own language,” Maria says.
Having started in a large group practice, and with Juan still having a toe in the water, the couple has unique understanding of how to differentiate a small private practice like Rendon Orthodontics from local large-scale practices. The goal, Maria says, is to be “patient-centered.” And while that descriptor can often sound trite, Maria and Juan have a very specific notion of what it actually means.
“We want people to know that we’re not a corporation; that these are our offices; and that you’re going to see the same doctor every single time. We’re not going anywhere. We’re going to be here treating your case,” Maria says. “In a big corporation, people see their doctors come and go. There’s not a lot of continuity in their treatment.
“Every patient that comes through our doors, we call them by name. We want to know about their hobbies. We want to be able to talk to them. So, we never want to be too busy that we can’t even talk to our patients. That’s very important to us.”
On the days when Juan is working in the large group practice, he makes a point of carrying these values with him.
“We have a higher volume [at the group practice], but I try to communicate more with the patients, with the parents, and to know what is going on with them. I’m trying to do what I’m doing with quality,” he says.
The couple’s experience also means they have a unique understanding of why patients may choose a corporate or large group practice over a smaller private practice. A lot of it, Juan says, comes down to the perception that treatment at a small private practice will be more expensive than treatment at a large multi-office one. Potential patients wrongly assume that the economy of scale will benefit their pocketbook.
“[Patients] don’t understand that private practices are going to [offer them] a payment plan,” Juan points out. “They think that’s only going to happen in the corporate world.” What’s more, they fail to consider the cost of traveling further, and hours of school or work missed because of that greater distance to the less expensive corporate practice.
But beyond cost, there’s also an intimidation factor at play, says Maria. “Sometimes people are too intimidated, if you will, to go into a practice that looks nicer or is in a nicer area.” So, as Maria puts it, “It’s a matter of educating the patient”—a responsibility the two take seriously.
A Select Group of Specialists
For Rendon Orthodontics, patients, current and former, are their best referral source. The Dallas-Fort Worth area where they practice is saturated with orthodontists and a good number of general dentists doing orthodontics. But the two have decided to be proactive in addressing the problem—by educating potential patients on why they should choose a specialist for their orthodontic treatment.
Less than a year ago, they teamed with four other area orthodontists—John Wise, DDS, and Jessica Lee, DDS, MS, of Wise Orthodontics and Stonebridge Orthodontics; Greg Greenberg, DDS, of RxSmile Orthodontics; and Brandon D. Price, DMD, of Price Family Orthodontics—to create OrthodontistSELECT. The group is dedicated to educating area residents on the importance of seeking an orthodontist for their orthodontic care and what it means to be an orthodontic specialist. As Maria puts it, the group wants to build on the efforts of both the American Association of Orthodontists (AAO) and the Texas Association of Orthodontists to educate consumers about why they should seek out a specialist for their orthodontic treatment.
“The AAO spends money trying to educate people. We just want to do a little bit locally that will have more impact for us,” she says. “People get offered braces by their general dentist and they just don’t know any better.”
“They just want to follow instructions,” Juan adds.
The group’s first effort was to create a website—orthodontistselect.com—and invest in SEO to target potential patients in the Frisco, Allen, and McKinney areas the five private practices serve. The site explains why a patient should seek out a specialist and then provides information about each of the doctors and their practices. The goal is get patients into an orthodontic specialist’s office, whether that be Rendon Orthodontics or one of the other four practices. Rather than see each other as competitors, Maria and Juan choose to see the other local orthodontists as partners.
Moreover, they hope that by educating patients on the importance of choosing a specialist for their orthodontic care they can help the orthodontic community as a whole and create more opportunities for young orthodontists just starting their careers.
Maria and Juan are well aware of the complaints within the orthodontic community about the growth of corporate orthodontic practices, and the choice of many young orthodontists to go work for one. In strengthening and building the businesses of existing private practices like those taking part in OrthodontistSELECT, the couple hopes there will one day be more associate positions available to give new orthodontists more job opportunities.
Giving Back Locally
Even as the couple juggles the work of building their private practice and Juan’s work in the group practice, the two make a point of giving back to their local community. They have actively worked with Give Kids a Smile for the last 5 years; Maria currently serves as the co-chair of the local program through the North Texas Dental Society. When Maria and Juan initially got involved, the local program focused on dental screening, but now an orthodontic screening program has been established. Each year, one to two patients with the most challenging malocclusion are chosen to receive orthodontic treatment for free from a local orthodontist. In the last 5 years, Rendon Orthodontics has taken on some of these patients.
Whether it be ensuring that patients in need get the treatment they need, or helping the orthodontic community counter the threat of general dentists doing orthodontics, Maria and Juan know that even a small, local act can make a difference. OP
Alison Werner is the editor of Orthodontic Products. She can be reached at [email protected].