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Interview with Dr. Manente

For Dr. Sal Manente, the last eight months have been unlike anything he’s experienced in his 20-plus years as an orthodontist. On February 28th, Manente Orthodontics officially became part of the myOrthos OSO network. Two weeks later, Dr. Manente and his new myOrthos partners made the difficult decision to temporarily close the practice due to COVID-19.

Navigating the last eight months has certainly been a challenge for Dr. Manente and his team, but the innovative decisions they made during and after the shutdown have allowed them to emerge safely. In a recent interview with Dr. Manente, we discussed the impact of COVID-19 on his business, the changes he and his colleagues made that allowed them to continue seeing patients safely, and his advice for other orthodontists considering joining the myOrthos family.




How did COVID affect your business? When did you shut down, and what restrictions did you face?

By March 15th, the whole office was shut down. We’re in New York, and of course, New York City at the time was becoming the real epicenter of the pandemic in the country. The imposition probably fell harder on New Yorkers at that time than it did on any other part of the nation. Right away, it felt very serious.

Once you shut down the office, what were some challenges you faced? What was particularly difficult for you?

As orthodontists, we treat people continuously. We have a family of patients under our care whom we see on a regular basis—and all of a sudden, we couldn’t do that anymore. That’s a very different mindset from what we’re used to. We were planning what to do in that next visit, which all of a sudden couldn’t happen anymore—and what’s more, we had no clue when a next in-person visit could happen.

How did you handle that?

I remember just coming to the office by myself and walking around. And of course, you can only clean out so many drawers and so many closets. It was very surreal.

After I got over that hump, I worked with some of the people at myOrthos, and we decided to start doing some virtual exams.

What did those virtual exams entail?

Even though we weren’t seeing patients, orthodontic emergencies were still happening. If I got a call from a patient with an urgent problem, I would have them take a picture of what was going on—whether it was a loose wire or a loose bracket or something poking them—and text it to me. Based on the photo, I would be able to call them and tell them exactly how to handle it without their physically having to come into the office.

We were able to manage this way for the 10 weeks we were shut down. During that time, I only saw three patients in my office. Given the volume of patients we have under active treatment, that’s very good—and it was possible because I was able to help virtually with photos, texting, and virtual visits.

Did you treat only emergency cases virtually, or all patients?

Well, from that point we sort of thought: okay, we have all these new patients who are already scheduled. Why don’t we call them and have them send us pictures? Then we were able to set things up remotely. They would email photos to us, and we would do a virtual new patient exam through a Zoom call. The financial arm of our office is also a web-based program, so we were even able to have them log onto their account, sign a contract, and make an initial down payment. We knew that as soon as we opened, we would see them, I would be able to formally take X-rays, validate my treatment plan, then actually initiate treatment.

We were able to do that for probably six of those 10 weeks. I was so impressed with our treatment coordinator, Sue, and our financial coordinator, Joanne, who coordinated all that and got so many new patients signed up, even while we were closed.

That’s excellent. Do you expect virtual consultations to continue?

Orthodontists are a little bit different than other physicians, because we ultimately need to see our patients in person: we have to take an x-ray, and we have to be able to see someone’s mouth to start braces or deliver Invisalign. But there is such a convenience to virtual consults—for both orthodontists and for patients—and I really see that as another positive thing that has come out of this pandemic: not just for our office, but for the whole profession. I think virtual consults will become more mainstream in orthodontics moving forward, because of the convenience on both ends.

It’s wonderful that virtual consultations could allow you to interact with patients while your office was closed, which I’m sure was a priority at the beginning of the shutdown. At that time, what was your biggest concern?

Without a doubt, it was my patients. At the time, we had no clue when we were going to reopen. I immediately jumped on some Zoom calls with all of the team here, and I think that sort of quelled any fear that I had regarding my employees. At that point, everyone knew we were able to touch base twice a week and throw ideas off each other and make sure we had everything covered. So my biggest concern was for my patients, and then for retaining employees if the shutdown continued for a long time.

And of course, that’s where myOrthos stepped in. They navigated that whole situation for us, which was exceptionally nice. My employees and I met as an office, and I was able to handle any questions or concerns that they had. And if I didn't know the answer, I had five or six people at myOrthos who were only a phone call away.

How did myOrthos help you navigate those challenges?

It was such a relief initially just to have a team of people to be able to be in contact with. As an orthodontist, you’re kind of on an island by yourself. If I weren’t associated with myOrthos, I wouldn’t have been able to have that extra layer of people who were able to help immediately and examine information from more of a business mindset than a clinical mindset.

And of course, all of my colleagues were having to lay people off and furloughing them, because we just didn’t know how long this was going to last. Because of myOrthos, we were able to keep paying our employees for a whole month after we closed. In addition to helping the employees, it was a tremendous help and weight off my shoulders. I think that really solidified the care and mindset of this management group to the whole team. They say actions speak louder than words, and that certainly did.

And jumping forward: every one of my employees came back. I think they felt that love, and they knew they had a team that was looking out for their best interests.

Congratulations! That’s wonderful to hear. How did things go with you and your employees when you actually were able to return to the office? What were some of your concerns then?

Many of our calls dealt with that. Our proximity to New York City and a general lack of knowledge about the virus and the specific mode and rate of transmission had us worried. Our biggest fear was protecting our patients and ourselves.

As we tried to come up with a new normal, I had many calls and meetings with the myOrthos team. We developed protocols that all the offices would eventually use (e.g., our use of PPE including gowns, masks, eye protection, face shields), and we physically changed our office. We decided to close the waiting room and have patients text us when they arrived. Once they got here, we would take their temperature and screen them for symptoms. All those protocols and procedures were in place before we even stepped foot in the office. And again, that was driven from the top-down: the myOrthos team to me to my employees.

How has it been since you reopened? Do your staff and patients feel comfortable?

Whenever something negative happens, I think a lot of positive things result from it. Because of this crisis, the safety of our patients and our new procedures and protocols are definitely much better than they were in the past. I think that’s such a positive thing, both for us and for our patients.

And indirectly, some of the changes we’ve made that have limited the number of people in the office have driven efficiency. Now, when a patient enters the office, we bring them in to sit in the chair, treat them, and dismiss them. There’s no longer this fragmentation of people trying to manage two or three patients at one time. We’ve actually become very efficient as a result of that. Those two things, in my opinion, will continue going forward.

What would you say to an orthodontist colleague who might be considering joining myOrthos?

I’ve had this conversation with many of my friends, whom I’ve pushed in that direction. I think the philosophy of myOrthos, of maintaining the clinical autonomy of the orthodontist, is so different than that of any of the other DSOs or OSOs that are out there. In other groups, clinicians have to conform to the treatment modalities of that group. myOrthos is totally different.

Nothing has changed in my office, other than having this awesome management team that helps me treat patients and see patients and be more efficient. And there’s security for all the employees here, too. The benefits they receive didn’t change—in fact, they’re almost enhanced. And I know that as this group gets larger, the economies of scale will get even bigger, and some of what is created by these economies of scale will filter down and very positively affect the employees.

Having a network of like-minded people and peers that you can rely on and ask questions of is a huge benefit. Many orthodontists try to do that now using Facebook groups. But with myOrthos, we have live people who are interacting and problem solving together. Those are the things that are so different with myOrthos compared to other DSOs or OSOs.

And who knew—timing is everything. I would venture to say how much more difficult it would have been to navigate this crisis without myOrthos. Although it wasn’t planned, and it happened two weeks after I joined, I couldn’t imagine a better position for myself or my team to be in and a better partner to navigate these unknown times with.

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