This Tennessee doc’s tech-centered practice redefines general dentistry inside a renovated former distribution center turned arts and culture collab.
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 Dr. Daniel Bird, a general dentist who has found purchase in one of the most unique environments we’ve featured. Housed in a 12-acre parcel, Bird’s 4,000-square-foot practice is among hundreds of local businesses and residential offerings that have turned a once-derelict Sears distribution center (circa 1927) into a hub of eateries, art, culture and local business.
After spending the first part of his career working in an office he couldn’t customize and getting a firsthand look at the world of DSOs, Bird went all-in on creating a scratch practice in an up-and-coming section of Memphis. Check out his office, including how he eliminated his waiting room, turned same-day dentistry into an everyday occurrence, brought the best tech all under his roof, and more.
Name and credentials:
Dr. Daniel Bird
University of Tennessee
College of Dentistry
Crosstown Dental Group
4,000 square feet; 7 operatories
Tell us about yourself and the path you took to becoming a dentist.
I grew up in Paragould, a town in northeast Arkansas 90 miles from Memphis. My dad was one of two radiologists in the area who worked seven days a week and eventually developed a bad taste for medicine. Our next-door neighbor, “Dr.?C,” was a dentist who fished a lot and one Sunday as my dad was going to the hospital to read films, Dr. C was coming back from fishing. My dad told me that day that I should consider dentistry.
I attended the University of Arkansas in Fayetteville and started out as a biology major. A couple years into college, my grades were not at the dental school acceptance level, so I switched to agronomy. I ended up with an agronomy degree and went to work as a crop consultant and salesman for a farm chemical company. I did that long enough to realize that I really needed to be a dentist. I worked hard and finally got myself accepted into dental school. Better late than never.
Before moving into your new practice, you dealt with some less-than-desirable circumstances at your previous office. What was going on there, and what finally led you to starting fresh?
I graduated from dental school in 2003 and was approached by a local dentist who wanted to sell her practice.
It was great for the first month or so, but then she decided to move to California. So I was a new grad, in an old office, without a mentor around. It was tough, but I learned a lot. However, the demographics of that area were not the greatest. I saw a low-income population and although I got good at extracting teeth and making dentures, I wasn’t getting the sexy, cool work that I really wanted to be doing.
I watched that area of town and that part of the state start to dry up. People were moving out, but no young people were moving back in. I needed to relocate, but the opportunity just wasn’t there. So, I kept plugging along, learning endo and implants to expand my options. I hung in there long enough for a group starting a DSO to find me and offer to buy my practice. I ended up selling it to them, working for them for about a year, then realizing that I wasn’t happy working as an associate.
I had never worked for anyone but myself and I knew it was time for a change. I knew there was a better way to run my practice, but it needed it to be laid out differently and I needed fresh new faces to help me fulfill my vision. I worked on the vision and mission statement for several months. Once I figured out what I wanted, I just needed the perfect location; any old space wouldn’t do. It was great coincidence that my new practice and the Concourse were starting to take shape around the same time.
1. Cerec. Getting a crown on your lunch break is fantastic.
2. KaVo electric handpieces. Part of not sounding like a dental office is quiet handpieces.
3. Picasso Lite Laser. I use it every day for something. It’s a great tool.
4. Designs for Vision loupes and headlight. We don’t use overhead lights. These help create the look and feel we’re going for in the office.
5. Gendex digital sensors. Digital X-rays are a must. I wouldn’t practice without them.
Your new space is a unique location for a dental practice. Tell us about the area.
The Crosstown Concourse was originally a Sears distribution center. Back in the days before Amazon, people looked in the Sears catalog and ordered things by phone and through the mail. Our building was one of eight nationwide built by Sears; ours was built in 1927 and was a hub for retail and distribution, and even some office workers. It operated until it was abandoned in 1993. The building sat derelict for 20 years until a group of artists decided it was an eyesore and should be repurposed instead of torn down. That started a four-year journey that took a lot of architecture, a lot of money and a lot of faith to make it happen. The building focused on the arts, health care and education, and evolved into an amazing place with about 3,000 people working there, 265 apartments, several restaurants, and more than 40 not-for-profit businesses occupying the space. It’s a melting pot of people, politics and culture that’s not traditional in Memphis. The theme of the building is “Better Together.”
You made the decision to invest heavily in technology. What do you have under the hood?
I use multiple wavelengths of lasers, CBCT, digital impressions and 3D printers.
I knew I needed help to pull off my vision, so we partnered with brothers Darin and Josh Throndson, owners of Innovative Dental Technologies, and built our own on-site digital lab. They are growing with us and taking on new digital clients rapidly. The Throndsons are in the lab every day designing restorations for practices all over the world, as well as doing all of our implant planning, surgical guide fabricating, 3D-printed splints, digital removables and daily lab work.
This allows patients to come in on their lunch break and we can prep and make a crown within the hour. Often, they come down from an office upstairs, I prep the tooth for a crown, the lab starts making it and the patient goes back to work. When the crown is done, we send them a text, they come back and we put it on. We have gotten it consistently down to under an hour. That’s huge. People don’t have to take half a day off work anymore. For our patients who live or work in the building, they never have to move their car!
It’s not all just technology, though. You’ve completely restructured how a dental office “normally” operates in terms of customer service, environment and flow. Talk about what you’re doing differently and the patient response.
I knew when I decided to start over from scratch that I did not want the status quo. I’d been a dentist for 12 years and knew that I could improve my efficiency. I hated having people waiting on me in the lobby. I knew I wanted to eliminate that, along with any need for filling out paperwork in the office. We put all our paperwork on our website, so it’s finished before patients ever step foot inside the office.
I knew that if we scheduled properly and paid attention to the time, we could have patients arrive at a set time and, because the forms were already done, they could go straight to the chair at their appointment time. Every chair is set up the same and we use carts to help us be more efficient.
I also wanted a different feel: People always complained about the overhead lights and the X-ray heads, so we got rid of those—we use headlamps and Nomad handheld X-ray devices instead.
I wanted an office that didn’t feel like a dentist’s office. For that, we needed it to not have the sounds and smells of a traditional office. We have air diffusers throughout the office and a Sonos system for great music all day long.
All the toys and features aside, customer service is still key. There are lots of great dental clinicians out there. However, the majority of patients are not aware of the quality of the dentistry. What’s important to them is how they feel in your office.
Six Month Smiles
What were some of the qualities you looked for when hiring? What does your team do well?
My team members are rock stars. When we started this practice, we didn’t have an office. We didn’t even have a design; we had only a location and a vision. I hired the majority of my team before we started construction, so they were able to watch alongside me as our space was created, and they set it up, organized it and made it their own. They’re as proud of it as I am, and that’s huge. They make people feel loved and appreciated.
Their clinical skills are important, but not as important as their people skills. Experience in the dental industry is not a requirement for hire with us; it’s all about your personality. I love the saying “iron sharpens iron.” For my team of professionals, it’s true—they make each other better.
Same-day services are a focus in your practice. What’s something you’re able to do for patients who might not expect such a fast turnaround?
Most people are used to traditional dentistry. If they need a root canal, they’re referred to an endodontist. They take a half-day off their job to visit a dental office, arrive at 9 a.m., sit in the waiting room until 9:30, are eventually brought back while an assistant takes an X-ray. They wait for the doctor, who says, “You need a root canal,” so the patient is referred to get that done. Hopefully it gets done that week, but often it takes longer. Then they’re sent back to the original dentist to get a crown. Same sit-and-wait scenario, another day off work. The dentist puts on a temp crown and tells them to take another day off in two weeks to come back to get the real crown. Same sit-and-wait yet again. The patient has taken off work three times, and three weeks later they’re still sitting in a waiting room.
In my practice, patients make an appointment online for 9 a.m. They arrive and immediately are greeted, checked in on an iPad and taken back to a chair. An assistant sees them and takes an X-ray. If they need a root canal, I can do that for them. I can also do the crown. We immediately prep the crown and send it to my in-house lab. While the crown is being made, I will do the root canal. Generally, by the time I’m finished with the root canal, the lab is bringing me the crown. I seat a final crown—no temporary—right then. They get a root canal and a final crown in about an hour. No leaving the office and taking off work multiple times.
It just makes sense and the patients absolutely love it. We have essentially turned a three-week procedure into one completed in an hour. To many people, that is life-changing.
You have a diverse range of services. What has the experience been like having it all under one roof instead of sending out?
Being a small-town general dentist has its advantages, for sure. In my early years of practice, we didn’t have many specialists near us. I’d refer people to have a root canal and a few weeks later they were back in my chair, telling me they never went. Eventually, I decided I could handle these cases myself, especially if they weren’t going to go have it done elsewhere.
There are certain procedures that no matter how nice you are, they’re still uncomfortable if they are awake. These people get referred to the appropriate person to preserve my relationship with them.
Having the lab in house is one of the greatest things we did. We are able to do same-day procedures using Cerec and other technology. We bring the lab techs over to the clinic to interact with patients, too. I think that strengthens the relationship we create. We even take patients into the lab and involve them with the design and shade of crowns and things. Making them part of the process is cool and they really appreciate having input on their teeth.
No one likes PPOs, but you’ve managed to do something a lot of docs didn’t know they could: negotiate. How’d you manage patient insurance and coverage without tearing your hair out?
I’ve always been interested about how insurance companies work. Their UCR fees are based on location, not on your skill. I had friends in other parts of the country who got paid way more than I did for the same crown made by the same lab. After some research, I realized that if I moved my practice just 7 miles to the east, I could get almost double the fee for a crown.
I contacted Five Lakes dental consultants, which helped me establish a fee schedule, negotiate with carriers, and select the plans to accept and the plans to avoid. We did some demographics and found out the main employers in our building and in the general area. We signed up to be providers for those first, because the first question people ask is always, “Do you take my insurance?”
I had another important realization, too: People with jobs generally have dental insurance. Some pay for it themselves, the employer pays for it for others, but most have some type of coverage. And it didn’t matter what their job was or how much money they made—if they had that benefit, they wanted to use it. So why would I not accept the plans of the people near me who have jobs and pay for insurance? So what if I have to write some off? Some is better than none, and with a startup there’s plenty of “none” at first.
About the 1.5-million-square-foot Crosstown Concourse: With all those businesses and shoppers, have you tailored your marketing and advertising tactics to leverage the locals?
We’ve taken a multitiered approach. We offer a Crosstown discount for anyone who lives or works in the building, and we’ve made appreciation cards that we give to patients to take downstairs and use at the coffee shop, ice cream shop or juice bar—we bought gift cards from the vendors and when the patients present our card, they just swipe our gift card and the patient gets a free coffee, etc. For bigger cases, like same-day smile makeovers, we’ve teamed up with the nail bar and we send our patients down for free manicures and pedicures while they wait for the lab to make their crowns.
We also polled the employers in the building and helped them pick dental insurance for their people. We’re very active in and around the building, and we volunteer at all the functions and set up tables at the various things going on in the building, such as trunk-or-treat at Halloween, or we pass out free waters with our logo at the Crosstown 10K.
We put a ping-pong table and cornhole boards outside our office for the people of the building to use. Lots of people have become new patients because they spent their lunch hour playing on our ping-pong table—they stare at our office long enough that eventually they decide to give us a try.
We also encourage our employees to get out and mingle around the building if they aren’t busy. We are a startup and early on there was lots of downtime—a great opportunity to meet a friend and create a relationship outside of our space.
You took the plunge into tech and it’s paid off. Is that success something skeptical colleagues could achieve if they wanted?
I’m lucky in this regard: Younger dentists just graduating from dental school have enough to worry about, much less trying to learn and incorporate new technology. Couple that with the fact that most have huge student loan debt and can’t afford to invest in the technology, and the majority of them can’t take the risk. Older dentists, meanwhile, are finally comfortable in their practices, but most of them don’t want to spend the time training or money.
The investment is substantial and there is no way to tiptoe—I went all-in. I figured that because I’d worked my entire career so far with old equipment, old cabinets, air-driven handpieces, etc., that when I decided to start over, I’d do it with every cool piece of equipment that I’d always dreamed of having. It’s awesome to sit down to stuff that works! The older docs who have acquired an older practice know exactly what I’m talking about.
How has this pandemic
changed things for you?
COVID-19 initially shut us down. We were closed for seven weeks. In our area, there were not a lot of cases and very few deaths, but we were shut down like we were in the epicenter of the pandemic.
My practice operates on an appointment- only, no-waiting concept. Because we don’t have a waiting room, our normal flow was not changed because of the virus. It was not chaotic at all. There was an eerie feel in the air for a few days, but once we got back to seeing patients, things started to feel normal again.
I don’t love the term “new normal.” In other industries, they’re learning a new normal; in dentistry, viruses are normal. We deal with all types of viruses and bacteria—some we’re aware of, others we aren’t told about. That’s why dentistry adopted universal precautions; we treat everyone like they have everything. We’ve started taking temperatures and asking screening questions, but we don’t clean any more or less because this virus is famous. We clean between all patients for safety. We treat every patient as if they have every disease.
We’ve been back at work for a month now, and this week it seems like old times. Our no-waiting-room and no-waiting policy came in handy during this time for sure. We have added the screening questions and we take temperatures now, but the dentistry hasn’t changed. We produced almost the same amount of dentistry in May 2020 as we did in May 2019, so that’s certainly a positive.