Unchartered Territory – A New Way to Practice Oral Pathology, by Ashleigh Briody, DDS

In Business by Dental Entrepreneur

Most of my success can be attributed to taking advantage of the opportunities presented to me. In my third year of dental school, I was asked to be a student worker for the oral pathology department, mostly to gross the incoming specimens. This involves taking a biopsy specimen out of formalin, describing, measuring, cutting into smaller pieces, and submitting it in a cassette so the lab could put it on a slide for the oral pathologists to read. It wasn’t a job I sought out, but I thought that the worst that could happen is that I would learn something. I often found myself in Dr. Kitrina Cordell’s office, asking to look in the microscope at something interesting I had grossed the previous day. After about six months, I knew that I was passionate about oral pathology. In my 4th year, one of my instructors learned that I had accepted an offer for an oral pathology residency. Surprised, but seemingly well-meaning, he said “well that’s unfortunate, such a waste of a good dentist.” I like to think he was wrong. My dad always told me that if I find a job that I love, I will be successful. I didn’t realize at the time that my passion for practicing oral pathology and educating the world would translate into a successful private practice model.

Even before I accepted the residency position, I knew I wanted to go into private practice. Unfortunately, in the oral path field, private practice was (and is) unchartered territory. As much as I would like to take credit for the success of our practice, I owe most of it to my mentor, and now colleague, Dr. Carl Allen, and perhaps the rest of it to being in the right place at the right time. Dr. Allen is the reason I chose The Ohio State University for residency, as he had been teaching there for over 30 years. He is highly regarded in the field of oral pathology and is one of the authors of “the” oral pathology textbook. When I was chief resident, Carl joined a private dermatology practice, and as soon as I finished, he asked me to join him. He knew I wanted to do biopsies and see patients, and he had a backlog of patients who needed biopsies. I knew that in joining him, I would be establishing our (and my) unique practice in our community. I’m certainly no expert in business, but I can share what I did to get our practice where it is today. Ultimately, I am successful because of the people around me: my assistants, staff, managers, supportive husband and family, all of whom make it possible for me to be completely in the moment, either at work or home.

Because a private practice oral pathology office is an unknown concept to so many, I wanted to establish who we are and what we do on a global platform. I also wanted to provide an educational opportunity for health care providers so they could better serve their patients. This led me to Instagram. I created my oral pathology account, @central_ohio_oral_pathology, when studying for oral path boards, when I realized an account like this did not exist. If I wanted it, I had to create it, and I did so with the help of Carl. I didn’t have many clinical photos, but he had plenty. I share high-quality photos of cases I have seen, and the diagnosis is shown when you swipe. Much of what I focus on is how to recognize precancerous and cancerous lesions. While I am approached with many financial opportunities to partner or advertise for companies on Instagram, I want it to be strictly an educational space.

In addition to marketing my specialty, I had to market myself as a referral source to healthcare providers around me. Through my time spent in this field, my eyes have been opened to how much undiagnosed, mismanaged oral disease exists. It is not uncommon for a patient with a solitary lichenoid lesion to be told they have lichen planus, or a patient who has a well-defined leukoplakia to be told “it’s nothing to worry about” because a biopsy showed hyperkeratosis. Carl and I like to joke that we have “mouthless medical schools”, meaning medical students get virtually no education on the diseases of the mouth. This becomes a problem when a patient has an oral condition in need of diagnosis and treatment. We’ve all seen it before–the dentist tells them to see their doctor, the doctor tells them to see their dentist, then the patient gets tossed around from specialist to specialist in an attempt to find answers from someone who takes their insurance. It is incredibly frustrating for all parties involved. I sent letters out to all dentists, specialists, ENTs, and primary care practices in the area with a personalized note with my cell phone number. I made sure I was accessible, and for that first year, I answered every call, I said yes to every lecture, and I squeezed emergency patients into my schedule. I am able to set myself apart by offering a service that did not really exist yet. Sure, specialists do biopsies, but I offer to biopsy, treat, and follow patients long term. Instead of presenting myself as competition, I approached my practice model as symbiotic with other specialists. Most surgeons don’t want to follow patients with chronic mucosal diseases, diagnose burning mouth syndrome, or try to figure out when and where to biopsy the lesions of a patient with proliferative verrucous leukoplakia. Instead of performing an excision on a large precancerous lesion on the tongue, the ENTs are happy to send the patient to me for CO2 laser ablation. In addition to the flyers about our practice, I send detailed letters and include the primary care doctor, ENT, and any other specialist a patient has seen about the issue that leads them to me. This ensures that the clinicians who aren’t comfortable diagnosing oral disease have a resource for future patients with mouth problems.

From a management standpoint, I want my practice to be a place where patients feel comfortable and providers are confident their patients are getting the best care. I have found that the best way to do this is to focus on my team. My team is strong now, however, it was a rocky road to get here. For a long time, I only had one assistant. We were both overwhelmed and my clinic was busy, but we were limited in how many patients we could see each day because there was only one person to room, assist, clean, answer triage calls, and do paperwork. Looking back, I should have been more proactive in hiring a second assistant before we thought we needed one. Because they play such a critical role in the growth of my practice, I want them to know how important their job is to me and our patients. I try to create a positive environment for my staff, and I encourage them to come to me with problems AND solutions. This fosters a feeling of ownership in their job, and patients can sense the unity of my team. In a world where we are held captive by online reviews, happy patients are a walking advertisement.

Lecturing also has become an important and profitable part of my career. Over the past few years, my lecture circuit has grown from a couple local lectures a year, to several lectures per month across the United States. Most of these lectures are through the Seattle Study Club. Last year, I was selected to present at their annual symposium, and subsequently, was nominated to be a part of a select group of Seattle Study Club speakers called the Compleat Curriculum. This is a program that offers “up and coming” lecturers the opportunity to get seen. Because I have so many lectures around the United States, more providers are recognizing oral disease and how to better serve their patients.

My practice has come a long way in the short four years since I finished residency. I still have much to learn about the business aspect of managing my team within a large practice setting, especially as insurance continues to dictate what treatments are reimbursed. In an ideal world, I would be a fee-for-service practice; however, I see many patients without the means that are misdiagnosed, mismanaged, and truly desperate for answers. I hope that my experience encourages other oral pathologists to feel comfortable establishing a private practice to provide services to the patients in need throughout the country.

Dr. Ashleigh Briody is from Baton Rouge, Louisiana. She earned her DDS from LSU School of Dentistry and completed her residency in Oral & Maxillofacial Pathology at The Ohio State University where she earned a certificate and master’s degree. She is a Fellow of the American Academy of Oral and Maxillofacial Pathology and a Diplomate of the American Board of Oral and Maxillofacial Pathology. She currently practices in a private dermatology practice in Westerville, OH.