Office Visit: Toothbar by Arselia Gales, assistant editor

Drs. Kimberley Barclay and Lauren Jacobsen earned top honors in an ADA design competition for their downtown Austin “dental spa”

by Arselia Gales, assistant editor

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 Drs. Kimberley Barclay (at left above) and Lauren Jacobsen, whose practice in downtown Austin, Texas, won the inaugural ADA Design Innovation Award in the “New Build” category in 2019. The award recognizes dental providers for excellence in facilities that combine function, design and aesthetic appeal.

When designing their sleek, modern practice, Barclay and Jacobsen wanted to remove the traditional dread often associated with a trip to the dentist. From the first step inside, Toothbar feels more like a luxury lounge or spa, with touches like tech and refreshment bars in the lobby and lounge area for teeth whitening parties and “detox” mini-cleaning treatments between six-month appointments.

“Opening a practice is not an inexpensive endeavor,” the doctors express, but “you need to trust that what you’re doing will pay off not only monetarily but also in witnessing lives being changed as you care for your patients.”

What led you to choose a career in dentistry?

Dr. Lauren Jacobsen: Growing up, I was lucky to have a neighbor who was a dentist, Dr. Stacey Zittel. She opened her own practice at the same time I was looking for my first job. I helped her that summer, and for several summers thereafter. She exposed me to all aspects of dentistry and taught me what it meant to be a business owner. Dr. Zittel proved to me that it’s possible to be a caring health professional, a business owner and an amazing mother. I’m very thankful for her insight and encouragement.

Dr. Kimberley Barclay: In high school, I did a summer internship at Tufts Medical Center and was supposed to shadow the surgical unit. At the last minute, I was switched to the dental clinic—which at the time I was not very happy about, but it ended up serving as the catalyst that sparked my passion for dentistry.

I always knew I wanted to be in medicine, but it wasn’t until I got the opportunity to shadow a dentist that I realized that with dentistry, you are able to see every aspect of care with the patient: You get to be the diagnostician, the surgeon, the radiologist and the postoperative manager. With general medicine, you typically only get to be a part of a single aspect of patient care, whereas with dentistry you get to be involved in the entire process.

I love continuing relationships with the patients I treat years down the line and seeing how my work has directly changed them. I’m glad I can be a part of their lives for years to come. I’ve always enjoyed business and branding, and loved that dentistry serves as an avenue for me to build my own path and combine multiple passions into a limitless trajectory.

Where did dentistry take you after dental school, and when and why did you both decide that you wanted to go a different route and open a practice together?

At Midwestern University College of Dental Medicine, we were fortunate that the curriculum emphasized providing students with the tools required to be successful in private practice. After graduation, we were hired as associates in a new and innovative dental chain in Austin, Texas. Although it was a corporation with more than 20 practices, the company allowed us the autonomy to build the practice the way we wanted and provide personalized care to patients in a corporate setting.

The thought of corporate dentistry is often clouded with skepticism, but we saw which aspects of corporate dentistry worked well while identifying what didn’t work and what’s missing. For four years, we were the only two doctors in the practice, and we grew the practice into one of the most productive ones under the corporate umbrella. Our initial intent was to buy the practice and turn it into our own private practice, but things don’t always work out as planned. Having spent four years building that specific practice, we knew what would work in downtown Austin. We searched for several months but couldn’t find an existing practice that worked for our vision, so we decided to build one instead.

Toothbar won the ADA’s 2019 Design Innovation Award for a new building. Tell us about how you came up with a concept that earned this award.

“No offense, but I hate going to the dentist.” We would hear this from friends and strangers when they asked what we did for a living. As a result, we decided that when we built our practice, we would create an experience that would change the stigma behind what going to the dentist should feel like.

We’ve been downtown Austinites for years, so it’s not unusual for us to run into our patients in a yoga class or a grocery store. We wanted to get rid of the “white coat syndrome” stereotype often associated with medicine and create an office that gave you the same enjoyment you’d have relaxing in the lobby of an upscale hotel bar, for example—which was how we came up with the name “Toothbar.” We wanted to change the mentality and dread associating with being at the dentist and instead make it something you look forward to—a chance to escape from day-to-day life while also receiving the most expert care.

In today’s society, trust in medical practitioners has decreased with the advent of upselling, so ensuring clarity and transparency with our patients was an important component to building our dream practice. Overall we wanted to create an experience that patients would enjoy, and also convey that they were receiving the best care that dentistry has to offer in an environment that transports them beyond the traditional mindset of what a dentist office is supposed to feel like.

What steps did you take to design your practice?

We took inspiration from other industries and tied them into a dental environment. We have some amazing dental reps who helped us make sure the bones of the practice would work for dentistry but also allow us the freedom to draw from nondental environments to elevate the traditional dental experience.

Our Henry Schein rep guided us to our construction team, and our A-dec rep helped us ensure we would have the best dental equipment to guarantee our dental providers would have the proper armamentarium to provide premium care to our patients. We ended up not using a designer and instead pulled from places and experiences we enjoyed, then relayed that to our construction team to see if it was possible. Whether that be a beautiful hotel lobby or the bench in the waiting area of a spa, we combined these elements in building the practice.

From the moment the patient walks through the door, we want them to know that Toothbar is something different. Our lobby is set up to resemble a hotel lounge, complete with a tech bar with free Wi-Fi and a refreshment bar. With 15-foot floor-to-ceiling windows, our patients have a 360-degree view of different parts of the city.

We wanted to take out the mystery and help alleviate some of the fear patients have when sitting in an operatory, so we created an open floor plan. With 20-foot tall ceilings, we designed our dental suites to not have individual roofs and instead allow patients to have a full panoramic view of the outdoors. No operatory has a door, just 12-foot-tall soundproof wall partitions, and a Sonos speaker system installed in every wall for privacy when speaking.

We created an all-white sterilization hallway to show patients on our new-patient tour and allow them to feel confident that everything is sterile and clean. Patient comfort and technology were key in ensuring that patients were receiving the best care in a warm, comfortable environment. We installed A-dec 500 chairs in each operatory, along with an overhead TV and nitrous attached to each one. Upon exiting we have a gold “brush bar,” complete with all our favorite products and a large vanity mirror so patients can refresh themselves before or after their dental appointment.

You aren’t Austin natives—why did the city, specifically downtown, seem like the ideal place to open your practice?

Both of us live downtown and connect well with our downtown clients and their lifestyles. Austin is also experiencing massive growth, attracting talent and companies from across the United States, resulting in a net inflow of about 100 new residents per day. We saw a growing demand for personalized care in an upscale, convenient, downtown setting. While we embrace the ever-changing skyline, we also recognize the importance of maintaining what made Austin so great to begin with, which is why we felt that our local private practice only enhanced the city’s offerings. Keep Austin weird! Or perhaps keep Austin smiling is a better motto.

Tell us about some of Toothbar’s unique offerings.

To elevate the dental experience, we wanted to pull from many aspects that people love about going to the dentist, so we created the Toothbar Lounge. The lounge is an area where we have reclining chairs and a bar. It’s a fast, relaxing way for patients to brighten their smile for special occasions or between their biannual dental appointments. We offer express services such as the “detox,” which is a mini-cleaning for patients who love the way their teeth feel after a cleaning but don’t want to wait for their six-month appointment. The detox is a polish, floss and a shot of mouthwash, so patients can have that fresh-from-the-dentist smooth teeth feeling anytime they want.

We also offer teeth whitening services from Glo to Boost to Zoom, as well as a “happy hour,” which is a unique way for patients to celebrate a bachelorette party or a birthday. They can reserve the lounge and enjoy a beverage while getting their teeth whitened. We also host seasonal smile enhancement options. For example, last year for the South by Southwest festival, we offered teeth gems, where we placed mini gems on patients’ canines or lateral incisors using flowable composite. Patients are inundated with so many at-home options that we wanted to ensure that the patient experience they get by going to a dentist provides more incentive and value for them to seek out professionals rather than do-it-yourself things at home.

Two young dentists opening an untraditional practice seems like fun, but there must have been some difficulties along the way. What obstacles did you face when trying to bring your vision to life?

Because starting a practice from scratch is such a large investment, we wanted to ensure we would have a patient base from day one. Part of that meant making sure that we had a full schedule when we opened. Of course, as is true with any new build, there were construction delays and it was hard to tell our patients when we would be open. We had originally booked patients for our proposed start date and ended up having to move them back several months, but fortunately for us, they were willing to wait.

There are so many components to starting a practice from the ground up, and we wanted everything to be the best while still being cost-effective. We had so many different opinions that at the end of the day we had to trust our gut and not shy away from trying things that were unfamiliar to us. We decided to use an array of new software that none of us had any experience with, including Open Dental, Weave and Zen Supplies for ordering. The first few weeks of being open were definitely a learning curve for all of us and there was not a lack of frustration, but it’s amazing how quickly you adapt to something new.

What advice do you have for dentists who might be thinking about opening a practice? What do you wish you’d known starting out, and what have you learned since opening in April 2018?

1. Stay true to yourself, go with your gut and trust your strengths. Your practice will be your second home and something that you share with your patients every day. Make it something you’re proud of.
2.  Surround yourself with a group of experts. We have great relationships with our dental reps and look to them for advice. Make sure you communicate clearly and directly, and have a good working relationship with your team.
3.  Be willing to invest. We knew that some of our equipment and products would put a strain on our budget, but we purchased them anyway because we knew that these investments would allow us to provide the highest quality of care for our clients, which would later result in a return on our investment. Opening a practice is not an inexpensive endeavor. You need to trust that what you’re doing will pay off not only monetarily but in witnessing lives being changed as you care for your patients.
4.  Lastly, on a more practical matter, always install more outlets than you think you’ll need! Whatever your contractor says, make sure you put in twice the number of outlets than listed in the design specs.

What does your patient population look like?

Roughly ages 25–65, and professionals who either live or work downtown. They value convenience and timeliness, are very well-informed and do their research. Most of our patients have PPO policies or do not have dental insurance and pay cash. In downtown Austin there are a lot of tech startups that don’t provide dental insurance, so we created a Toothbar VIP plan, which is essentially an in-house discount plan for patients with no dental insurance.

Our patients value efficiency, excellent bedside manner, expertise and honesty, which are all the qualities that Toothbar embodies. In building Toothbar, taking note of our patient demographic was a huge component to how we built the practice. For example, we use Weave software to text our patients as they often prefer that to calling. When going over a treatment plan with a patient we make sure to go over all the intraoral photos and iTero scan to build an environment of transparency and convenience.

Because your patient pool is very specific/smaller, do you find it difficult to market to new patients?

The old adage rings true: Location has been one of the key factors driving our growth. We’re situated in the heart of downtown Austin, in an area with high foot traffic. A majority of our patients walk to our office, because we’re surrounded by new high-rise residences and office buildings that contain employers such as Google and Facebook. Our new patients are primarily “walk-bys” or referrals, and we’ve been fortunate to have a constant flow of new patients.

Our best type of marketing is the customer service we provide. When our patients have great experiences, they tell their friends, family and colleagues about Toothbar, which drives additional traffic. Also, a number of companies have an internal database of preferred providers, where you’ll typically find Toothbar listed. We also work with the concierges of the surrounding high-rises to generate awareness for the residents.

What’s an average day like? How do you work together?

Our day starts at 7:40 a.m. with a team morning huddle, in which we highlight any key items needed to ensure a great day for patients and staff alike.

We are fortunate to have known each other since dental school, and we complement each other in a way that allows us to work really well together. Dr.?Barclay really enjoys the marketing and branding portion of Toothbar, while Dr. Jacobsen is incredible at the numbers and operations of the practice.

Between the two of us, a typical day has us seeing 40 to 60 patients, so balancing the dentistry and business portion is imperative. We use a software called Asana to track our progress with tasks and projects, so it’s clearly outlined who’s doing what and what the status is. We use Slack for messaging updates to the staff as needed. Over the almost 10?years of working together, we discovered we truly are yin and yang—we are best when our strengths are combined, and we complement each other’s weaknesses and appropriate tasks accordingly.

How’d you like to see your practice grow in the next five years?

In just a year and a half, we’ve been able to grow our practice from an empty concrete shell to a bustling business with more than 3,400 active patients. And we’re only getting started. In five years, we’d like to continue to be the go-to dental office in downtown Austin, providing our patients with an incredible experience every visit. There are so many unknowns when opening a practice that having each other to lean on was the biggest comfort. Along those lines, we’d love to be able to license Toothbar to other dentists who align with our values and have a desire to start their own private practice, but who might be unsure about taking the plunge on their own. We envision creating a concept for dentists that allows them to maintain their autonomy while still providing them the support of the Toothbar brand and de-risking their initial startup.

What’s your favorite case/patient story?

Dr. Barclay: During one of our first weeks being open, I had a patient come in in tears; she was still shaking while getting her blood pressure taken and was one of the worst dental anxiety patients I’d ever seen. I asked her what exactly made her nervous and she let me know that it was her fear of drowning. From that point on, we took baby steps with everything and ensured the hygienist had an assistant with her at all times to aid with suctioning. The slightest attention to detail completely transformed her from a terrified patient to having six upper veneers placed. When we sat her veneers, she started shaking again! I was terrified that I must have unknowingly sprayed water on her, but instead she explained that she was shaking because she was so happy—for her entire adult life, she had never wanted to smile and didn’t think she’d be able to sit through a dental visit to get her front teeth fixed. To see her transform was pretty remarkable.

Dr. Jacobsen: One particularly memorable patient was a woman in her early 30s who for years had been told that she needed jaw surgery to correct her open bite. With the help of Invisalign aligners and local orthodontists, we reviewed the patient’s scan and diagnostics, and determined that an Invisalign treatment could fix her open bite. In less than a year, she was biting into sandwiches and was fully functional. She recently got married and came into the office to show me the photos. I love being able to provide treatment options that are less invasive but equally as life-changing.

What do you enjoy most about dentistry? What would you like to see the profession do in the next decade?

We love that dentistry means so much more than treating teeth: We are businesswomen, medical providers, consultants and, in many ways, artists! Dentistry has so many aspects to it that you’re able to take on a variety of roles and expand your knowledge of many different fields.

The two main concepts we’d like to see dentistry put more emphasis on in the next decade are comprehensive care and technology. We’d like to see this profession embrace the mentality of treating the person, not just the teeth. We collaborate with incredible specialists and other medical and dental providers to ensure that our patients receive the best comprehensive care possible. Because we work together as a team and every provider has something different to offer, the patient benefits tremendously.

Second, we hope dentistry continues to embrace new technological advances and increases the speed at which practices incorporate these new tools. Immediately after the iTero scanner came out, we invested in this technology and it has been a game changer for our practice. Dental professionals need to continue to provide feedback to their suppliers and help them understand the clinical demands, so they can continue to make improvements to the technology. It’s the patients who ultimately benefit from this.

When you aren’t working, what are you doing?

Dr. Barclay: I’m originally from London but grew up in Spain, so traveling has always been an important part of my life. I also enjoy painting and actually made some of the art we have in our office, which is probably why I enjoy the cosmetic aspects of dentistry so much. Recently, I’ve gotten back into horseback riding. I enjoy having a hobby that has nothing to do with dentistry, and have made it a 2020 goal to enter a show-jumping competition. It has been a humbling experience to feel like such a novice and to be able to grow and train in a sport I’ve loved since childhood.

Dr Jacobsen: One of my passions is running. I ran cross country in high school and it’s always been a part of my family and my life. It gives me the opportunity to enjoy the outdoors as I run around Lady Bird Lake and catch up on the latest How I Built This podcast. Also, I’ve been so fortunate to have developed so many unique amazing groups of friends here, one group in particular being my book club group. I’m an avid reader and this group has broadened my love for different genres and subjects because of their diverse backgrounds and how they bring new and exciting perspectives that continue to challenge me.

On the weekends, you’ll find me in rural Texas enjoying the peaceful countryside, horseback riding, simply reading on the porch or hosting dinners that end with all of us sitting around a campfire telling stories and catching up. It’s the perfect escape from the vibrant city life, although I’m still getting used to all the critters out there!

 

 

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