Our editor-in-chief, Damon Adams, DDS, interviews Steven Barrett, DDS, a founding partner and the chief clinical officer at Greenberg Dental & Orthodontics, part of one of the largest privately owned group practices in the country with 92 offices in Florida, about his unique approach to doctor development for recent graduates as well as for doctors with many years of experience. With more than 30% of graduating students now choosing to start their career with a DSO—and many believe this will only increase—this in an important topic within our profession.
Dr. Barrett, you have been working with and training dentists for the past 25 years. Has working with young dentists today become easier or more complex?
Dr. Barrett: Twenty-five years ago, working with young doctors was much easier. I say that for many reasons. Today, a young graduating dentist is introduced to a broader range of dental topics during his or her 4 years. Twenty years ago, discussions on intraoral scanning, in-office milling, aligner therapy, and restoring or placing implants were not part of our training. Just as digital technology has influenced the way we practice, so has the ever-evolving choice in materials available. Also, there are now countless ways for doctors to get access to dental education. This is wonderful, and yet it can also be confusing to a new graduate. In addition to the clinical side of dentistry, today’s graduating dentists must navigate through the many different business models that make up the current dental landscape. Therefore, any training program must not only address current clinical issues but also highlight the strengths of its business model. I would say what has not changed and must remain constant is that any mentorship program needs to focus on clinical excellence above all else.
What are the current challenges you see as you work with this next generation of dentists?
Dr. Barrett: A big challenge is trying to distill current information and trends and then weave them into the information that our group has amassed over the last 42 years. The information needs to address the challenges that dentists face in their day-to-day practices and provide solutions to those challenges. Our goal is to reduce the learning curve for all our dentists and to help them achieve their desired levels of success sooner. School debt is a big issue, and doctors are looking for programs that can help them decrease that burden as quickly as possible. With that in mind, our focus is to help doctors strengthen the fundamental aspects of dentistry and to also help them predictably work through relatively complex dental diagnoses. Helping young dentists get up to speed faster not only helps them overcome the huge debt burden but, more importantly, also helps more patients experience the full potential of clinically excellent dentistry. This occurs not just from my own efforts but also in combination of working with other mentoring doctors and our in-house specialists.
I must also add that today’s dentists want answers quickly. It may be a chairside decision that needs to be addressed or a case planning discussion. In either situation, I truly believe that because we are a privately owned group that’s owned and operated by dentists, we understand this better than most. With no middle management layers, our doctors can communicate directly with one of the partners (who are all dentists) at any time.
|Figure 1. Dr. Quyen Pham designs a crown using the glidewell.io system (Glidewell).||Figure 2. Periodontist Dr. Shalia Santana, working with Dr. Richard Collier, does surgery in the lower anterior while 2 other interested colleagues also observe (Altamonte Springs, Fla).|
|Figure 3. Dr. Barrett, working on an anterior case with periodontist Dr. Victor Yeung,
Dr. Stephanie B. Chavez, and Dr. Ava Lee in Jacksonville, Fla.
|Figure 4. Dr. Barrett, demonstrating photography skills while taking preoperative lateral photographs with studio lighting.|
|Figure 5. Hands-on photography course for the Pre-Dental ASDA (American Student Dental Association) Chapter at the University of South Florida in Tampa.||Figure 6. Dr. Barrett teaches an impression program at the University of South Florida for the Pre-Dental ASDA Chapter.|
How would you describe the training program that you have created at Greenberg Dental?
Dr. Barrett: I have personally visited dental schools for the past 20 years, and each time I ask students what is most important to them after graduation. Is it location? Is it pay? Is it mentoring? Mentoring is always the No. 1 thing students are looking for. Based on that feedback, our Vision First program was developed. It is built around the philosophy that a dentist must first develop his or her mind’s eye, expand his or her vision, and learn to see what is possible. Taken one step further, the dentist must now create a shared vision for patients and for his or her practice and dental laboratory teams. And, most importantly, the dentist must learn how to communicate the vision. The Vision First process can help doctors at any point in their careers to learn how to achieve a predictable outcome by following an established set of protocols. Over the years, I have seen a decrease in the number of aesthetic procedures that dentists have an opportunity to do in schools before graduation. Prior to graduating, most students have done very few, if any, porcelain veneers, multi-unit ceramic crown cases, or implant restorations. In addition, many students are using cell phones as the standard for dental photography.
It sounds like aesthetics is a major part of your Vision First program, correct?
Dr. Barrett: We do focus a large portion of the program on aesthetics. The reality is that looking good never goes out of style, and more patients are looking for aesthetic dentistry, which is most often elective dentistry not covered by insurance, at an affordable fee. The Vision First program is first introduced to our doctors during a very intense 2-day orientation. Following the orientation, there are bi-monthly, 3-hour in-person doctor meetings in each region of Florida. During the meetings, we introduce the “Barrett Esthetic Protocols.” These protocols are geared to teaching how to diagnose, sequence, and treat aesthetic cases with better outcomes, less remakes, and a high degree of patient satisfaction. The protocols include learning how to incorporate motivational mock-ups, photography, video, and custom BioTemps Provisionals (Glidewell) into the daily practice. As doctors develop their minds’ eyes, their vision for how they see teeth and how teeth fit into the face becomes second nature. They then become more comfortable planning aesthetic and elective dental treatments.
In all of our meetings, we present case studies from patients we have treated within our group. Topics within our treatment planning discussion include the sequencing of treatment, restorative material options, insurance implications, and how to discuss patient financing. In addition, we have developed a diagnostic and treatment template that helps to guide doctors through these decisions.
What is the next step after you help doctors create a vision?
Dr. Barrett: Let me answer that in 2 parts. First off, after creating one’s vision, a dentist needs to learn how to influence patients to make good decisions for their own dental health. It is important to develop case presentation skills that address not only need-based concerns but also elective dental concerns. The case presentation must be non-confrontational, caring, and compassionate. It must always take into account the patient’s dental budget. This is something I learned a long time ago from one of my mentors, Dr. Paul Homoly, and it is still true today. We continually focus on being able to meet or exceed our patient’s expectations. Some patients just require routine dental treatment, but others require and expect a much higher level of care. We need to be able to deliver both types of experiences to our patients, especially the multidisciplinary cases that require coordinated care between a general dentist and specialist. We are uniquely able to take care of those patients with our integrated specialty care model.
|Figure 7. (Figure 7a) Pre-op view. (Figure 7b) BioTemps Provisionals (Glidewell). (Figures 7c and 7d) Final lithium disilicate restorations (IPS e.max [Ivoclar Vivadent]) on teeth Nos. 7 to 10.|
The second part of our program, chairside mentoring, is what I really think sets us apart. It is critical to accelerate young doctor development. In the first part of the Vision First program, we have helped doctors to create a vision, plan treatment, and discuss cases with their patients. Next, we need to help them chairside. We have developed a very intense one-on-one mentoring program. To demonstrate our commitment to the process, I personally work, on average, in more than 50 offices each year with more than 50 different doctors. Our doctors from all over Florida can schedule me to come to their offices to help them with a case. Often, I see the patient for the consultation and treatment planning appointment. From that initial appointment, I help the doctor through every step of the process. We document each case with photographs and video (part of the Barrett Protocols). When the case involves lab-fabricated restorations, I work with the doctors on proper communication with the dental laboratory team, seating of the final case, follow-up photographs, and video documentation. It is in these one-on-one treatment interactions where doctors learn how to put into practice those skills we learn about and discuss during our monthly meetings. In addition to me, mentoring doctors in each region follow my lead and support this unique aspect of our model. By working chairside with so many doctors, we have a real-world perspective and can better evaluate our doctors’ understanding and implementation of the protocols. Every dentist knows that each case has its own nuances, and helping doctors address those unique issues chairside is invaluable.
Let me add one more item that I think is very important to the overall success of our mentorship. Working with our lab partners and our in-house lab and clinical consultant (Nick Azzara, Dental Network Solutions), I gather current cases from our partner dental laboratories and, through a series of specific pictures, evaluate our doctors’ progress. During one-on-one consultations, I have an opportunity to encourage each doctor to self-evaluate his or her own cases. This also gives me the opportunity to reinforce our protocols and tailor my mentorship to be more impactful for our doctors.
Let me just highlight a few key metrics regarding the success of the Vision First program: There has been a 10% increase in all anterior restorations, a 20% growth in lower anterior restorations, and a 40% year-over-year growth in cosmetic restorations since 2017.
That sounds like a lot of work and traveling on your part.
Dr. Barrett: Yes, it is, but I love what I do and am still very passionate about being able to help change patients’ lives. With more dentists in our group accelerating their skills faster, we have more opportunities to help our patients. Dentists who have a clear vision and confidence are giving patients smiles that they never dreamed were possible. This is a major motivational factor for me, even today, because I personally visit the dental schools and share with them the great things dentistry has to offer. I interview and hire doctors, so I take the responsibility to help train them to heart. I don’t do this alone, however. Every year, more dentists complete the Vision First Mentoring Process, enabling us to develop regional mentoring doctors. These regional mentors share in the responsibilities and create a daily learning experience for young doctors. I refer to this as a “real-life GPR.”
|Figure 8. Teeth Nos. 3 to 14 with individual single unit crowns. The lower arch with a bridge on Nos. 22 to 27 and single crowns on Nos. 19 to 21 and 28 to 30. This work provided a life-changing transformation for the patient. (Figures 8a and 8b) Pre-op photos. (Figures 8c and 8d) BioTemps Provisionals (Glidewell Dental Laboratories). (Figures 8e to 8h) The final zirconia restorations.|
Many DSOs have training programs. So how do you measure that the training is translating into doctors becoming more confident and productive?
Dr. Barrett: Great question. It is important to understand that we have no quotas, but we do have expectations of our doctors. These expectations are based on 42 years of experience. Let me explain the difference and why working within a group owned and operated by dentists is so valuable. Our philosophy is built around always striving for clinical excellence. We teach doctors how to develop their vision, and we give them the tools to achieve this. We provide data to our dentists measuring their commitment to the fundamental elements of the Barrett Protocol. This data is shared with the doctors during our monthly meetings. From there, we can further evaluate the growth of each of our doctors based on other relevant metrics that are unique to them, such as office location, levels of experience, and the makeup of their staffs. All these things and much more help the owners, who are dentists, to evaluate each doctor’s individual circumstances and growth. We are committed to the process and believe that time should be spent developing better habits, not chasing better results. This is the essence of the Vision First program. This same process applies to dentists at any point in their careers. For me, it took 6 years in practice until I realized the full power of Visionary Dentistry and Esthetic Protocols. I did not know how to measure progress through conscious habit building. We are now seeing more of our experienced doctors taking this journey and wanting to get to their next levels faster.
For the past 3 years, I have had the honor of presenting and highlighting parts of our Vision First program during the Glidewell Annual Symposium. The topic “Provisional Restorations: Planning For Esthetic Success” is a key component of our Barrett Protocol. The use of BioTemps Provisionals is highlighted as a way to help achieve a predictable result by providing a preview of the final restorations. Our commitment to the use of BioTemps and helping our doctors to develop good habits has made us the largest user of BioTemps in the world. This is a key component of our Vision First program and is designed to help build a doctor’s confidence in his or her abilities sooner. This year, I will be adding a full-day continuing education course as part of the Glidewell education platform. The experience of teaching on a national stage and speaking directly to dentists from private practices, as well as other groups, has validated that our Vision First approach and direction have great merit.
Does outside CE play a role within your training?
Dr. Barrett: Partnerships are very important to us. Companies such as 3M, the Danaher Companies (Kerr, Orascoptic, Implant Direct), Dentsply Sirona, GC America, Geistlich, Ultradent Products, Ormco, Align Technology, GlaxoSmithKline, Ivoclar Vivadent, and Brasseler USA have all been highly engaged in our learning initiatives. We have found it more productive to match the information from each company and align it specifically to how we use their products and technologies in our offices. We vet each speaker, develop our own internal subject leaders, coordinate with our specialists, take our own procedural slides, and often present the information ourselves or co-present with the companies. In addition to our Vision First training and the manufacturer-supported initiatives, there is a $3,000 doctor benefit that goes to support any relevant outside CE. Doctors can also use their CE benefit to help them with the purchase of a quality DLSR Camera from Lester A. Dine (part of the Barrett Protocol). Our lab partners play a critical role as well. We bring all these critical partners together each year for a laboratory and manufacturer symposium. We present, collectively, to these partners our results from the previous year and lay out our clinical goals moving forward. The success of our doctors is due to this collective effort.
|Figure 9. Dr. Barrett and Samantha Montenegro, implementation specialist, engineering & technology, Glidewell Labs, with the iTero Intraoral Scanner (Align Technology).||Figure 10. Dr. Antony, one of our mentoring doctors, hosts an overdenture live patient course for our doctors at the Greenberg Teaching Facility in Lake Mary, Fla.|
|Figure 11. This is a perfect example of how to use photography to highlight your patients. This patient did not have any dental work done, but these photos were taken to highlight the types of pictures you can do in the office with studio lighting.|
Well, Steve, you have explained so well why your group is unique and so successful. Do you have any final thoughts?
Dr. Barrett: Dr. Adams, it has been my honor to participate in this dialogue with you and your readers, and to have the opportunity to share my thoughts on doctor development. Speaking on behalf of my partners, we could not be more excited about the accelerated development curves we have witnessed and are even more committed than ever to improving the Vision First mentor program. As a privately owned, multi-specialty, general dentist practice, we have all the components of a “real-life GPR” already in place within our model. This structure enables us to accelerate a young doctor’s career, as well as add new levels of motivation for experienced doctors. It is important to know that our dentists have autonomy in treatment decisions within the dental office and to direct the care of their patients. The Vision First program supports this philosophy. As dentists and owners, we encourage, support, and mentor our dentists to make decisions that are in the best interest of their patients.
I am very grateful to have had great mentors throughout my career including people like Andrew Greenberg, DDS, our co-founder. It is important for me to carry on this tradition. My partners and I have made the commitment to expand the Vision First philosophy to help future dentists create a clearer vision for their careers. I talk in depth on this topic during my visits to many different dental schools and through my involvement with undergraduate pre-dental societies. At the heart of it, I have exceeded my own expectations. It is now my chance to help others exceed their own expectations!
Dr. Barrett, after graduating from Case Western Dental School (1988), served in the Navy during Desert Shield and Desert Storm, for which he was awarded the Navy Achievement Medal. In 1991, Dr. Barrett joined Greenberg Dental & Orthodontics in Orlando and, now, as the clinical director, provides mentorship for 92 offices, 152 general dentists, and 58 specialists. Over 29 years, Dr. Barrett has developed novel clinical protocols for achieving predictable aesthetic outcomes in an affordability minded practice. Dr. Barrett co-treats patients and teaches, lectures, and writes extensively on restorative dentistry, practice management, and career development. He can be reached via email at email@example.com, by phone at (321) 356-7951, and at the Instagram handle@stevebarrettdds.
Disclosure: Dr. Barrett has been a featured speaker at the Glidewell Symposium for the past few years.