Through the Keyhole - Dr. Andrew Trosien

Dr. Andrew Trosien tells Orthodontic Practice US about what makes his practice rewarding

What can you tell us about your background?

I grew up in Michigan. No one in my family is in the fields of either medicine or dentistry. My mother was a teacher and my father was a mechanical engineer. In high school, I played a lot of music and did a lot of art, and seriously considered attending art school at the time. In college, I found out through a friend of mine about dental school, and that’s how I became interested. After residency, I worked as an associate for a couple of years before joining a partnership and eventually becoming a solo practitioner. After the residency, I also worked part time for Align Technology (Invisalign^®) for a few years, and I maintain a consulting relationship with them currently. I am a director of La Clinica de la Raza, where I teach University of California, San Francisco (UCSF) orthodontic residents Phase I removable treatment.

When did you decide to become a specialist and why?

I wanted to become a specialist from the beginning of dental school. I’m not sure why; I just think I saw that as a challenge and wanted to do it because of that.

Is your practice limited solely to Orthodontics or do you practice other types of dentistry?

Exclusively orthodontics.

Why did you decide to focus on Ortho?

Like most dental students, I was interested in ortho right at the beginning of dental school. After doing some rotations through other specialties, I also became interested in prosthodontics and oral surgery. But, I always kept coming back to wanting to be an orthodontist.

Do your Ortho patients come from referrals?

Yes. About 30% of our patients come from family or patient referrals; the rest come from general dentists and other specialists.

How do you retain a healthy referral system with your GPs?

For the most part, we just try to do the best orthodontics we can and offer the best customer service we can. I make it a point to stay on top of new technology and adopt what I think will help improve patient care. There are a lot of technologies out there that look flashy and are good for marketing but don’t necessarily add anything to the quality of treatment. We avoid those. But for anything that can help patient care, we are inherently interested.

With respect to treatment, I don’t short change a patient’s treatment needs or diagnosis. For example, we perform a lot of orthognathic surgery in our practice, rather than just assume that the patient won’t want it. And we use TADs if we can get a better result for the patient. The bottom line is, I don’t like compromised treatment, so we do whatever it takes to get the best result.

We also try to maintain good communication with our referring doctors. That keeps them in the loop with their patient’s care, and keeps us in contact with them.

How long have you been performing Orthodontics and what systems do you use?

I’ve been doing orthodontics since 1997. I use the .022” GAC In-Ovation^® self-ligating bracket (Dentsply GAC International) with the Roth prescription. I’m also using TADs for certain cases, and Invisalign^® and Invisalign^® Teen.

Can you tell us more about the training you have undertaken?

I received my DDS from the University of Michigan, and then attended the 3-year ortho residency at UCSF, where I received my certificate and MS in oral biology. I was #1 in my class at U of M, and Chief Resident at UCSF. I also completed the Roth course during my residency. Of course, I also attend CE on Invisalign^® and other technologies.

Who has inspired you?

I’m inspired largely by orthodontists who put their treatment and patients ahead of their income. Drs. Ron Roth and Vince Kokich are two of my heroes. I’m also very inspired by maxillofacial surgeon Dr. Bill Arnett. With a straight-wire appliance or Invisalign^® it’s very easy to do sub-par orthodontic treatment that goes unnoticed. Most patients and many dentists can’t tell a great occlusion from a poor finish. So there’s no one to call you out if you do a bad job. We’ve all seen cases with a poor finish where the doctor says, “The patient wasn’t concerned about her Class II relationship.” Of course she wasn’t – that’s our job. Essentially, I’m inspired by anyone who has the integrity to put the quality of their work above all other practice-management decisions. I was blown away the first time I heard the story about how Dr. Charlie Tweed re-treated 100 cases he originally did non-extraction by calling them in and re-treating them just to get the right finish. That’s dedication.

What is the most satisfying aspect of your practice?

We do a lot of reduced- fee and pro bono treatment, especially for cleft palate patients and other extreme sorts of cases. Being able to give those patients the treatment they deserve, and seeing the results, is a very satisfying feeling. I also like that we are able to develop close relationships with our patients, as compared to the other fields of dentistry. Orthodontics is a unique field, and it’s hard not to have fun at the office.

Professionally, what are you most proud of?

It sounds geeky to say, but I’m most proud of my complex cases. I always joke with the staff and patients that I’m going to take the final photos of the patient and put them in my wallet, and when I’m feeling down, I’ll pull them out to take a look. The cases that keep you up at night because you chose the more ideal, but complicated treatment plan, are the ones that give the most satisfaction at the end of treatment.

What do you think is unique about your practice?

A lot of orthodontists say, “You can’t get all of the cases perfect, and you just have to accept that.” In my practice, we believe that to be a slippery slope, and instead, make a conscious effort to make every case as close to perfect as possible. We try to set ideal goals for each case and don’t stop treatment or create a plan that doesn’t or can’t reach those goals. This leads us to adopt new techniques and technologies. It also leads us to do some treatment that looks like the long way around. But we don’t want to take short cuts because ultimately, the patient will have to live with the result for the rest of his or her life.

What has been your biggest challenge?

It is challenging to educate the referring dentists and patients about which techniques and treatments are based on science and which are not. For instance, if I tell a patient that it is not necessary to do a Phase I for mild upper and lower anterior crowding, and another orthodontist says it will make the teeth more stable later in life, it is difficult for the patient and family and their dentist to know which way is correct. Unfortunately, many practitioners base their treatment decisions on practice-management issues rather than science and the patient’s best interest.

What would you have been if you didn’t become a dentist?

I’d say that if I didn’t go into medicine or dentistry, I’d like to do software programming or architecture. They’re both creative fields that require science to make them work, much like orthodontics.

In your opinion, what is the future of Orthodontics?

Orthodontics has a great future if we are careful not to get too greedy. As orthodontists, with today’s technologies, we should be able to churn out great case after great case. If we allow ourselves to accept mediocre results because of the desire to use a certain appliance, or to stay on a company’s provider list, or to make a higher margin, then we will find ourselves in direct competition with those who cannot achieve the perfection that we are capable of. In other words, if we, as orthodontists, start doing “C” quality work for a short-term gain, we risk commoditizing the profession, and soon will lose the distinction of “specialist.”

What are your top tips for maintaining a successful Orthodontic practice, and what advice would you give to budding Orthodontists?

From a philosophic perspective: Make sure you make the patient and the end result the top priority. Don’t sell out. Successful careers have a slow and steady rise and are built on a solid foundation. And then, you’ll have a lucrative and satisfying life. Remember that you didn’t go into ortho to be incredibly wealthy. You would have gone into some other kind of business if you wanted to do that. Know that you could work really hard and become very wealthy, but life will pass you by, and you’ll look back one day and regret all those hours at the office.

From a practical perspective: Be careful about buying another orthodontist out. Do your homework, and get good advice from impartial third parties (i.e., a dental lawyer and dental CPA). There are plenty of horror stories of senior doctors who took advantage of the junior doctor and didn’t have enough respect for their own practice to ensure a smooth transition. If you are going to start from scratch, get some experience in the type of practice you want to have rather than the one that will pay you the most. And don’t go in halfway – build a nice ortho-only office and be open enough days to be considered full time in the community.

Invest in your office, but make sure you don’t buy frivolous things. It’s important to keep your overhead low, or you’ll work a lot for very little. No matter what you do, get computerized right at the start. I strongly recommend Ortho2 (Ortho Computer Systems, Inc.) because of their customer service and all-in-one package.

Get a good CPA – someone who deals only with dentists and doctors. They can be a valuable asset in guiding your purchases and keeping your overhead in check.

What are your hobbies and what do you do in your spare time?

When I was in college and dental school, I played guitar and bass in rock bands. I’m not currently in a band, but I still love to play and record music. I also enjoy doing art work when I have time, as that has been a long-time passion of mine. I am also active in my Rotary club. And of course, I spend most of my free time with my family.

Andrew Trosien, DDS, MS, owns Trosien Orthodontics in Tracy, CA. The 4,000-square-foot practice houses 8 open-bay chairs, 2 consultation rooms, and 2 records chairs. His staff of 13 includes an office manager, 2 appointment coordinators, 1 treatment coordinator, 1 marketing coordinator, 1 insurance coordinator, 4 assistants, and 3 lab techs. Dr. Trosien is married to Trang Duong, DDS, MS (who has an orthodontic practice in Manteca, CA). They have two daughters, Quynh and Thao, and a son, Hanh. Dr. Trosien’s professional interests include Invisalign^Ò, TADs, Craniofacial anomalies, TMJ treatment, computers, and software.

Top Ten List

Ortho2 (Ortho Computer Systems, Inc.)

iCAT^® (Imaging Sciences International)

TADs

In-Ovation^® self-ligating brackets (Dentsply GAC International)

Tablet PC (Microsoft®)

Wacom^® tablets for desktop PCs

X-ChargeÔ Credit Card Processing Software (CAM Commerce Solutions, Inc.)

Invisalign^® (Align Technologies)

Invisalign^® Teen