Dr. Jack Fisher, Practice Profile

Changing smiles, changing lives

What can you tell us about your background? 

I grew up in Mayfield, a very small town in western Kentucky. After my undergraduate studies, I attended the University of Louisville School of Dentistry and then went on to residency at the Medical College of Georgia where I received a certificate in orthodontics. Upon completion of my formal education, I returned home to begin a practice limited to orthodontics.

Realizing very quickly that the small community could not support a full-time specialist, I acquired a private pilot’s license and started another practice in a larger community where I could practice 2 days a week with an oral surgeon. Owning my own plane allowed me to raise a family in my hometown while also allowing me to expand my professional career and see more complex cases. It also gave me the opportunity to treat many surgical cases together with the oral surgeon. I was able to scrub in on many cases, which I greatly enjoyed. After our two boys graduated from high school, we were able to liquidate the practices and relocate to Memphis, Tennessee. I took a position with a corporate dental group to treat their orthodontic patients. This experience turned out to be beneficial because I began to realize that corporate dentistry did not fit my personality or meet the standard of care I wanted to provide my patients. So, at the age of 58, I started over again. In 2006, I was able to develop a temporary skeletal anchorage system (TSAD). This has afforded me the opportunity to be involved with several residency programs. For the past 7 years, I have conducted a cadaver course for the insertion and use of TSADs. The company conducting this course is Elite Ortho. I am also currently practicing orthodontics in Cordova, Tennessee, 14 days per month, and I am a faculty member at three residency programs. After 30-plus years in this great profession, I still enjoy going into the office every day, and I truly consider it a blessing to be able to teach and to help people smile.

Why did you decide to focus on orthodontics? 

My motto is, “Change a smile; change a life.” I enjoy orthodontics because it employs both art and science to create a great smile. I really feel that about 80% of what I do as an orthodontist is art. To be able to help patients achieve great smiles by altering their facial features, in conjunction with improving their oral form and function, is one of the most rewarding fields in healthcare. The demographics of most orthodontic practices are predominately teenagers. This age group is still early in its development, and most young people are very impressionable. We are privileged to be able to develop a relationship and spend time with them on a regular basis during the course of treatment. After the braces come off, which is a very exciting day in our office, we are then able to continue this relationship during the retention phase of treatment. This affords the orthodontist a distinct opportunity to be a positive influence for a significant amount of time in  young people’s lives. 

How long have you been practicing, and what systems do you use? 

I have been practicing orthodontics for 30 years. I use a pre-adjusted fixed orthodontic appliance on more than 95% of my patients. Most of all our patients are treated with segmental mechanics initially and then are finished with continuous arch wires. Approximately 25% of our patients receive some type of a skeletal anchorage device. I do utilize DICOM imaging on approximately 80% of the cases. 

What training have you undertaken? 

I attended the University of Louisville School of Dentistry where I received a DMD. I furthered my education at the Medical College of Georgia where I received a certificate in orthodontics. 

Who has inspired you? 

I was inspired by a high school guidance counselor who asked me what I wanted to become. I responded by telling her that I wanted to become a dentist. When she laughed at me and told me that in her professional opinion, I would not be able to become a doctor, it drove and inspired me to prove her wrong. Her attitude toward my abilities, or lack thereof, has been a driving force for me for many years. I was also blessed to have parents that made sure I was surrounded by successful people during my formative years. 

What is the most satisfying aspect of your practice? 

I enjoy the ability to help young people with their self-confidence by improving their smiles. 

Professionally, what are you most proud of? 

Being invited to teach residents and other orthodontists techniques that they had not been directly exposed to previously. 

What do you think is unique about your practice? 

We have a therapeutic dog in our office that makes our patients and team members feel comfortable with their treatment and our working atmosphere. 

What has been your biggest challenge? 

Meeting my own expectations. 

What would you have become if you had not become a dentist? 

A machinist, or perhaps a mechanical engineer, or a commercial airline pilot. 

What is the future of orthodontics and dentistry? 

The future of the specialty of orthodontics is a big concern of mine. The fact that residents are finishing their residency with such a large amount of debt is a challenge. Can we really advise them to buy a million dollar practice with so much debt? Should we advise them to start a practice? This advice is difficult in most cases because of the market saturation. It leaves three options for the graduate: 1) to associate with an existing practice, 2) to take a job in the corporate dental atmosphere, or 3) to become employed by a pediatric dental group. The second option opens the door for a long discussion, depending on someone’s opinion of the business model for delivering dental services to the public. The more the corporate side of dentistry grows, the more it will keep the specialty side of dentistry in-house. The more these patients stay inside the corporate market, the fewer patients there will be for the private practice model to treat, whether it is for the private general practices or the private specialty practices. 

The market will become more limited for all private practices. Though there are fewer seats in first class, they are rarely empty. It does seem that there will always be a market for the high-end private practices, just a smaller version, which makes it difficult for these practices to thrive. The dental industry has been a relatively low-risk venture with good profit margins. The corporate world now knows this and can also hire the new graduates who are desperate to pay off debt. Also, pediatric specialists have a ready-made orthodontic practice and are often eager to hire recent graduates as well. It seems that because orthodontic practices are able to be owned and operated in most states without the owner being an orthodontist (i.e., corporate dentistry, general practitioners, pediatric dentists, and so on), that we are beginning to see the erosion of the first, and in my opinion, the greatest specialty in dentistry. 

Another challenge facing the orthodontic specialty is the traditional education model for residency programs. The traditional learning experience has usually consisted of a department chair and one or two full-time faculty members. Of these faculty members, one usually focuses on research and the other serves as a clinical director. The program then has orthodontists from the surrounding community who donate 1 or 2 days of their time per month to treat cases with the residents. This model has served the residency programs very well for many years. However, with the technological advances in recent years, the learning curve for many practitioners is difficult to maintain. 

Two examples include 3D-imaging technology and treatment modalities using skeletal anchorage devices. Many practitioners are either unable or unwilling to keep pace with their changing specialty. This is alarming to many residents who are paying hundreds of thousands of dollars for their education and find out, after the fact, that they weren’t fully equipped. Also, the use of aligners by general practitioners is growing rapidly, and this further eats away at the nature of the specialty. 

When we consider the shift to corporate dentistry, the debt load of newly graduated residents, the steep learning curve of the diagnostic tools and recent treatment modalities, the orthodontic specialty seems to be “dumbing down.” It seems this trend is in large part because residency programs are unable to keep up with the advances in the field. Many programs have also become seen as “cash cows” for financially strapped universities, and as a result, the gap between the standard of care delivered by clinicians who did not attend a residency and those who attended a 2- to 3-year program seems to be narrowing. I realize these comments could be offensive to some, and I do apologize if they are ill received. It is my opinion that we who choose to volunteer in residency programs have a responsibility to the future of the specialty, the residents we are teaching, and most of all, the patients we are treating to stay abreast of emerging diagnostic tools and treatment modalities. Otherwise, what will separate a recent graduate from an accredited orthodontic program and a GP who has taken a few weekend courses? 

What are your top tips for maintaining a successful practice? 

Focus on the details. The practice will not run itself, so the owner must focus on the business details, or there will be no business to focus on. There isn’t any one marketing strategy; it’s all the little things together that add up to something great. You have to do a lot of little things well. 

Neglect the personal relationships, and the practice will go away. Building relationships is the key to any success, whether in business or in life. 

What advice would you give to budding orthodontists? 

Colleges, dental schools, and residency programs do not teach or emphasize, to any degree, the value in understanding personality types and understanding how to build solid relationships (at least I am not aware of any that do). Whether it is with a spouse, a child, a team member, a patient, or a referral source, to be successful in this era, it is vital to understand these principles. Any graduate from a CODA- approved program knows how to help patients improve their smiles.

It is the rare graduate that understands the value or has been taught how to build relationships. My advice is to seek out a mentor who is trustworthy and possesses these skills. Then, learn and apply the wisdom offered by the mentor.

Lastly, budding orthodontists need to understand that just because they graduated at the top of their class and attended a residency program, they are not entitled to anything. They still have to earn what they seek. Many budding orthodontists seem to have an entitlement attitude concerning what they want out of life, just because of their academic achievements. If they take a job position, they need to understand and accept that the position will pay only what the job is worth, not what they are worth. The market for the service they provide dictates to a large degree their earning potential. In their defense, I will say that I believe it is wrong for either a corporate office or private practice doctor to hire recent graduates and not pay them a significant percentage of what they earn for the practice. In this sense, I feel perhaps medicine has been a little more humanistic than we have been in dentistry. The recent graduates are not expendable and should be treated the way you would have wanted to be treated, if you were in their shoes graduating with such a significant debt load. Ten to 15 years ago,  recent graduates could expect to start a de novo practice and to do well, or to find a senior doctor who valued their education and was looking for a partner or associate. Now, graduating residents are forced to work in a piecemeal fashion — a day per week here and a couple of days there — just to survive and to pay off student debt. We as a society of orthodontists must begin to address these issues in the very near future for the well-being and survival of our great profession. 

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

Teaching and flying.