Dentists spend most of their working hours in their practices, so they usually don’t get many opportunities to see what it’s like inside another doctor’s office. Dentaltown magazine’s recurring Office Visit profile offers a chance for Townies to meet their peers, hear their stories and get a sense of their practice protocols.
In this issue, we introduce you to Dr. Kelley Fisher, a restorative and cosmetic dentistry dentist who practices just outside Seattle. Some days, Fisher might see just one patient; others, she might see five. Here, she shares her philosophy on “conscious dentistry” and explains how she schedules appointments—with 80% of collections met before noon, and one day a week dedicated to planning.
You’ve been practicing and specializing in cosmetic and restorative dentistry for about 15 years. What inspired you to become a dentist, and what led you specifically to cosmetic dentistry?
I accepted a part-time position in a dental office during high school, and the dentist I worked with was a very positive individual—he enjoyed dentistry, and he enjoyed life to the fullest. In a twist of fate, I met up with this doctor later, after I went away to college: I was working for a hospital in California and his bill came across my desk. He was a patient participating in a clinical trial for cancer at this same hospital, which was in another state, and it was four years after I had worked for him. The odds of his bill landing on my desk were nearly improbable, so to reconnect this way seemed like destiny.
I’d never realized it, but he had been fighting the cancer when I worked for him: He would go to chemotherapy at lunch and come back like he had just gone out for a stroll. He never complained and never mentioned his treatment. He loved what he did every day and it showed. I was inspired—I wanted that fulfillment in my career and in my life.
The cosmetic component of dentistry came later. I’d always been interested in cosmetic dentistry, but my training started with a focus on temporomandibular disorder (TMD) because I had experienced TMD pain in my own mouth. I’d been looking for treatment options and realized how difficult TMD treatment was to find. My local orthodontist, Dr. Joseph Yousefian, successfully treated my case. Working with him led me to the Dawson Academy in Florida, where I learned how form and function are intimately related. That led me to learn more about occlusal reconstruction and, ultimately, replacing what was damaged with something beautiful and natural.
So, the teachings evolved in a stepwise manner when I was ready for the next piece of information. In order to rebuild the smile, I first had to learn the foundation, the joint, bite and function, and then the aesthetics came naturally. The American Academy of Cosmetic Dentistry (AACD) was the icing on the cake. After working with the academy, I learned the finesse of the cosmetic components. I believe we meet everyone in our life at the right time and when I was ready, my teachers appeared.
You recently moved practices in hopes of creating a more efficient way to deliver care to your patients. How is your new practice laid out to help you achieve this goal?
My previous practice originally belonged to my mentor, the dentist that I worked for in high school. It was laid out for a left-handed dentist and designed for the way dentistry was practiced decades ago, and the equipment and technology were antiquated. Dentistry can be challenging enough without having to maneuver left-handed and be a plumber and mechanic. The final straw was when one of my orange 1970s treatment chairs began to smoke. I wanted to be able to focus on complex care of my patients, not complex care of my equipment and space!
With so many components to complex restorative and cosmetic dentistry, I needed everything within arm’s reach, no matter what type of procedures were needed for each patient. More importantly, I wanted my patients to have a seamless flow of treatment in a clean, comfortable environment. Most design experts were recommending the traditional open, two-entry operatories, but these rooms were filled with dental cabinets and opportunities for inefficiency and clutter, which didn’t represent my goals for seamless, complex treatment. This meant thinking of nontraditional ways to lay out the practice—essentially, fewer operatories, with closable doors and single entries, and multifunctional rooms. It was challenging to find someone who would listen to what I was looking for and have an open mind about the possibility of having clean, private efficiency. I had to listen to my inner self-knowing and not accept what was being offered as the “right way.”
Your practice is very modern and technologically advanced. Tell us more about the operatories and how they help you maintain a seamless workflow.
While I was exploring design options, I was fortunate to meet Matt Ehrenstrom from Sirona, who showed me an office design that was congruent with my vision. Much of it revolved around the treatment centers—instead of putting in dental “chairs,” I was able to put in “treatment centers” that had everything I’d need to treat a patient incorporated into the chair. For example, I have a built-in piezo scaler, apex locator and nitrous system all coming off the chair, which eliminates the need for carts, cords and excessive cabinetry. It also allows for an efficient single-entry operatory, with room for the dental assistant to move freely behind the patient chair.
If I’m preparing some crowns for my patient and need to do a root canal, additional equipment doesn’t need to be brought into the room; I can simply scan my crowns, perform the root canal and seamlessly move to the next treatment need. Simply by changing settings on my chair and picking up instruments off the actual chair itself, everything can flow from one procedure to another with ease.
Matt also helped me organize the sterilization area as a central hub with Kappler cabinets. This hub allows us to have minimal supplies in the treatment rooms and use bins and cassettes for procedures in any room. The central hub allows us to see what supplies are available at a glance.
Your peers have voted you among Seattle’s top dentists for 10 consecutive years (2009–2019) in Seattle Met magazine. What sets you apart?
I believe the reason that we get nominated every year is because we’ve taken a step back from the norm, the rush and the pressure to produce now, in this moment. I learned to practice from my heart. Getting to know my patients and their desires is deeply important to me; I call it “conscious dentistry.” The entire team takes the time to establish meaningful relationships, hear our patients’ stories and co-diagnose to find each patient’s unique story and unique plan. I believe everyone, both regular patients and dentists who are patients, desires this kind of care.
As a cosmetic dentist, you might not see as many patients because your treatments are more specific. How do you market yourself within the community? Do you receive many referrals, or do potential patients seek you out?
Like any office, we’re not unique in needing new patients to keep our practice growing and thriving. To market our services, we rely on word of mouth and patient referrals. Over the years, we’ve tried different strategies to obtain new referrals and the best strategy has often been to just ask. At the end of every treatment plan, we present the patient with a thank-you card and use this happy moment to ask for referrals. We thank our patients for entrusting us with their care and ask if they know of any friends or family who might be interested in getting the same level of care.
We also give new patients a tour of our beautiful office and the technology that awaits them. We show them how we can clean the dental lines between each patient with our built-in chair system. We show them our Cerec crown scanner and built-in patient entertainment systems—our “Netflix and drill.” Patients are so excited about what they see that they tell their friends and family. We currently spend about 2% of our collections budget on external marketing, mainly web- and social media-focused. We can keep this number low because we are using things that we already have: our trusted patients and our brand-new office.
What’s an average day like at your practice? How many patients do you typically see in a week?
An “average day”—is there really such a thing in dentistry?! There are some days when I may see one patient, and other days when I may see more. A good schedule is no accident, and my team works tirelessly to maintain parameters that we’ve agreed upon. No matter how many patients are in the schedule, it’s my goal to see one patient at a time. Although we’re mindful of our bottom-line collection needs, I never feel pressured to “stuff” the schedule or rush procedures. In the long run, overloading the schedule leads to more lost production time, deteriorating relationships between my patients and me, and overall lower quality of work.
We schedule all of our high-production dentistry in the morning; this ensures that the most intense work is done while we are fresh. Before lunch, 80% of our collection goals should be met. We always schedule our new patients first thing in the morning or first thing after lunch, so we’re never late seeing them for their first visit.
A sample schedule might look like this: From 7 a.m. to noon, I’m scheduled for five crowns on one patient and a crown and a filling on another. While I’m seeing these two patients, a team member is performing a whitening procedure and another team member is doing a consult for a prospective patient. We have a two-hour team meeting over lunch, and then the afternoon has three crown seats, a new patient and a patient who’s coming in for bite analysis. That’s a total of seven patients in the schedule, but my team is able to handle two without me, so I have five patients to see. On this sample, more than 90% of our production will be finished before lunch Then again, last Friday, I saw one patient the entire day—we prepared an upper arch of crown work, and no other patients were seen.
I see patients in my clinic three days per week and use the fourth day for treatment planning and thinking. One of the most overlooked aspects in dentistry is being mindful that quality work takes planning. Treatment-planning time must be built into the schedule during a nonstressful time when the doctor can relax and let ideas flow freely. Most bigger cases succeed or fail based on the blueprint or the plan—the dentistry part is easy.
About one-third of the dentists practicing today are women. Have you experienced any obstacles being a woman in a field that’s predominantly male? Have things improved in the field since you started practicing?
Although I have experienced some difficulties being a female in a male-dominated profession—which is rapidly changing, by the way—I’ve also seen the tremendous opportunity that being a woman can offer. As many times as I’ve run into gender roadblocks, I’ve run into 10 times as many compassionate and helpful male colleagues. One advantage to being female is that I learned that many patients actively seek a female dentist, expecting a high level of compassion and gentleness. Some of my patients bring their family to me because they want their daughters to see that being a professional woman is an option.
My team members have also tended to be female, which provides me with an opportunity to lead, mentor and teach other women. I believe that the best way to change our collective consciousness is to change oneself and lead by example. Compassion, mentorship and being a role model mesh perfectly with my “lead with a heart” philosophy and allow a wonderful integration of my practice and life goals. That integration takes the “work” out of work and has turned my job into my life in a beautiful symphony of teaching, leading and caring. If we’re separated from our work, we can see it as stressful or overwhelming; if we can connect it with our life’s purpose, it’s suddenly transformed into something smooth and natural.
You’re affiliated with a number of organizations, such as the AACD, and describe Dr. Pete Dawson of the Dawson Academy, where you studied advanced occlusion and smile restoration, as one of your heroes in dentistry. What are some philosophies and techniques that you learned at the academy that you utilize today?
The Dawson Academy and Dr. Pete Dawson were an influential part of my early education. The most important things that I learned from Dr. Dawson were to slow down and look at the big picture—develop a relationship of trust and curiosity, and look at the whole puzzle before you try to solve it. Hearing him speak is exciting because he breaks complexity into simplicity and presents it with passion and heart.
l’ve also been involved with the AACD to enhance the principles of smile design and spent a great deal of time with the Schuster Center for practice management. The Schuster Center was critical for learning how to integrate the type of dentistry that I want to do, the lifestyle that I want to have and the financials of running a small business.
I’ve gathered many other philosophies and techniques over the years. Some of my best techniques were taught to me by my lab technicians, Doug Kinnear and Dene LeBeau. I’ve found that the more you can remove your ego and be open to ideas and listen to others, the more you can provide your patients.
All this knowledge is only powerful if you can incorporate the knowledge into your practice. I firmly believe that the entire team should be taken to all meetings, dental labs and mentorship opportunities. My team travels every year to learn together. We’ve been to the Schuster Center for practice management, we learned to write practice policies together, and the entire team learned how to budget for a successful practice. My dental hygienist of 10 years, Jennifer Lekness, attended the Dawson classes, came to all the Schuster programs, and went to every AACD and ADA dental meeting with me. I never dreamed that one day she would become my office manager, but the years that she spent training with me have been invaluable as she transitioned from hygienist to manager. A powerful team knows all aspects of your philosophy, goals and systems.
As someone who helps give patients their smile back through veneers, full-mouth reconstructions and other procedures, you’re bound to see a lot of happy patients once the work is completed. What’s one of your most memorable patient stories?
I get tears thinking of the way we have helped patients! One of my most memorable patients was a 60-year-old retired schoolteacher who had chronic TMD her entire life. Her teeth were worn and broken, and she was in chronic pain. Looking at her facial photos, her profile looked sunken and she had aged before her time. We reconstructed her bite and restored the lost height in her face. Even years later when she returns to the office for her cleanings, she bursts into the office and exclaims, “I am still smiling! Still pain-free!” She remembers the change in how she felt, and her beautiful smile is radiant and energetic. She is traveling and enjoying her family, pain-free, and is feeling and looking fantastic. What a gift to assist in that process! What is more precious than the gift of a healthy and enjoyable retirement?
Your practice is in Sammamish, 30 minutes outside of Seattle. What led you to open your practice there?
I moved to Sammamish because I wanted to bring big-city dentistry to the suburbs. Seattle is a beautiful city, but the traffic problems can be a hindrance to patients if they need to travel to the city for appointments. I saw no reason why I couldn’t bring that care to them. Many of my patients live within 10 minutes of my office, which allows them to get high-quality, elegant care without the hassles of big-city parking and commuting.
It was also a lifestyle choice for me: I didn’t want to spend my time in traffic commuting, and I wanted to be there for my growing children. My kids are teenagers now and I recognize that they’ll soon be going to college and starting their own lives. My new office and my children’s school are across the street from each other. This was no accident; it allows me to drive them to school every day and be close by so that I don’t miss events and sports. It integrates my practice with the rest of our life and makes the practice a natural extension of my family. When looking for a location, look for a space that meets all of your needs—clinical, financial and personal. Do not compromise on any area and you’ll have success.
What are some challenges that you face today?
How do you try to overcome them?
Some of my biggest challenges have been in learning to slow down, be patient and see everything that happens in the daily practice as an opportunity for personal growth. As a young dentist, I always wanted change to happen immediately. I wanted a fully trained team, complete clinical knowledge and satisfied patients immediately. It has taken practice to see that the joy is in the process. To be able to see everything that happens in my office as an opportunity for personal development takes growth and a willingness to do things differently from the outside world. Looking at my life from 10,000 feet helps me not get bogged down in minutiae and lets me trust in the big picture. I’ve found that this takes away the traditional stress associated with dentistry.
What are some of your hobbies outside of dentistry?
I’m a firm believer in integrating a healthy body and a healthy mind. I love to cook and grow food and herbs in my garden and share recipes with patients and my team. As a dentist, it’s easy to get sedentary and easy to get injured. I keep strong by competing in Olympic weightlifting, and I love to ski and hike. My focus this year has been on fun and play. Dentists are so serious, so tight and so stressed!
What’s something you’d like to see dentistry do differently, as a profession, within the next 10–15 years?
I’d love to see dentistry become even more engaged with direct reimbursement options for patients. How cool would it be if patients and doctors made important health decisions together? We could really simplify dental insurance for patients, employers and dentists if we were able to find more room in our system for this kind of care. Our current system is too complicated and doesn’t provide enough flexibility for quality care. Patients would get the treatment they need and desire without waiting periods or restrictions. Decisions could be made by patients and qualified dentists, and employers could be sure that the dollars they spend are going to the care that their employees need. As professionals, it’s our duty to preserve the integrity of our treatment decisions and protect our patients.