The Story of Our TMJ Practice
Where We Are Today
My name is Bill Halligan. For the last 17 years my wife Andrea and I have run a small but quite successful practice focusing exclusively on treating TMD and sleep disorders. Andrea works in the clinical area with me and we have one front office person. Turnover? Not much. We have had the same front office person for 11 years.
Anyone—you perhaps—interested in purchasing this practice will have access to our tax returns so there’s no need to go into much depth about the financial success of the office now. Perhaps our numbers are small compared to some. That’s okay. For a Mom and Pop operation with one employee, I believe we’ve done pretty well.
We have a well respected practice here in San Diego, California. Hundreds of dentists, plus a handful of physicians and chiropractors, refer their patients to our practice. Tracking our referrals and contacts with ACT (Automatic Contact Tracking software), lets us be aware of our network of referring doctors. About 75 local dentists refer to our practice regularly enough to make Andrea’s A list.
Gross collections are generally around $600,000 per year with a net a bit over 50%. We have taken 12 weeks’ vacation per year over the last 2 or 3 years. We own a home in San Diego and another in the Mammoth Lakes area. The practice is cash only—no accounts receivable and no reliance on insurance. We bill medical insurance for our care, but do not accept insurance as payment. Insurance payment—if any– is reimbursed to the patient.
The author and prolific blogger Seth Godin urges professionals to be so good that ‘You’ll be missed when you’re gone.’
I don’t want to sound smug or particularly self-important and yet I believe that we have built a practice that would be missed if IT were gone. The continuation of this practice is important to the dental community here in Southern California. So, I’m looking for that person with the training, desire, caring attitude and skill to keep this enterprise rolling.
How We Built the Practice
I practiced general dentistry for many years but was always interested in occlusion and TMJ related problems. About 18 years ago, I sold my general practice and started this journey. Continuing education courses taken are too numerous to name, but included a mini-residency in TMJ disorders, Pete Dawson, LVI, Frank Spear, John Kois, and others. I started my TMD focused practice with a $100.000 building loan, a small 2 operatory space, and no patients.
Andrea delivered home made cup cakes to hundreds of dental offices in San Diego and offered a lunch and learn program including 2 hours of C.E. credit. I put together a power point program entitled ‘How to screen for TMJ problems: The 6 questions.’
I suspect that my presentation was rather lacking in those first days, although an early mentor made me scrap my approach and helped me put together something that wasn’t Death by Powerpoint! I gave my presentation more than 100 times over a 2-year period. And then I stopped. Most in business would encourage anyone who has a successful marketing plan to keep it going. But frankly, the practice became busy enough, perhaps too busy, to continue giving those lunch-time presentations. We received several requests to visit dental offices to give the presentation after we’d discontinued them but had to beg off. ‘Sorry. We don’t do those any longer.’
We put in hard work and long hours. We worked 6 days a week and took limited and inexpensive vacations. Times have changed for us now, but I’m simply pointing out that a lot of effort went into what we enjoy now.
When asked why we do this kind of practice, Andrea often cites herself as the reason. She suffered TMJ pain, headaches, severe dizziness, loud clicking for several years. She had 5 night guards made by 5 different dentists. None of them helped. She was told the problem was all in her head. I can’t take full credit for resolving her problems, because the journey included other practitioners. But her case was a big part of my learning and my current dedication to this kind of practice. She started with several occlusal and TMJ issues to deal with. I placed daytime and nighttime oral appliances that corrected her joint architecture. This stopped her clicking, stopped her pain, and within a few weeks resolved her vertigo. After TMJ therapy she also required orthodontics and restorative dentistry. Learning to coordinate my treatment with ortho—and not every orthodontist is up to the task—and with a restorative dentist put me on a rapid learning curve.
One early case besides Andrea’s though may have convinced me that this was my path. A 14-year-old girl was referred to me by a neurologist for TMJ exam. She had been previously diagnosed with chronic daily migraine headaches. She was taking migraine abortive medications that were not working. She was not attending school, nor was she playing with friends. She was spending each debilitating day indoors mostly by herself.
Joint imaging showed both condyles posteriorly displaced. She had severe tenderness to the TMJ lateral capsules, temporal tendons, medial pterygoid muscles, and splenius capitius muscles. I told her parents that in my opinion she didn’t have migraines at all. That’s going out on quite a limb, isn’t it? But I was correct. With appliance therapy for TMJ along with injections—prednisone and lidocaine– in selected areas, her headaches resolved. She went back to school. She started living the life of a normal 14-year-old kid. Just try having that kind of impact with composite fillings, prophys, and root canals.
Are my days filled with that kind of life changing success? Of course not. But figuring out what previous medical professionals have failed to see, seeing the faces of people who have suffered pain, sometimes for years, finally finding relief, is what has kept me on this path. And now, at 72 years of age, I’m ready to pass the baton.
Much of the hard work of growing the practice is done. Using an analogy coined by famed business author Jim Collins, the flywheel is already spinning. It just needs gentle nudging to keep on going.
Could This Be Your Practice?
San Diego is widely known for its miles and miles of white-sand beaches, amazing weather and world-famous attractions. If you can see yourself as a TMJ practitioner who can step into the role of a trusted adviser and caring professional in this Southern California community, we’d love to hear from you.