Three dental sleep medicine practitioners share their advice on growing a practice purposefully and impactfully.
By Chaunie Brusie
Teamwork Makes the Dreamwork
Stacey C. Layman, DDS, DABDSM, co-founder of GoTo Sleep: Center for CPAP Alternatives with three locations in Arizona—Phoenix, Scottsdale, and Mesa—says her practice’s success boils down to one simple strategy: focusing on the team that makes it all possible.
“That means higher-than-average pay, benefits, the absence of micromanaging, and most importantly, fun,” she says. “If it were not for the three letters behind my name, I wouldn’t even be needed. That’s how amazing my team is, and I let them run the show.”
An important part of that team is an outside marketing rep who helps the practice build a diverse patient demographic, which includes veterans, a heavy population of adults over age 40, and people of varying socioeconomic levels. “We are 100% referral-based so a full-time marketing rep is essential,” she says.
The GoToSleep team also consists of one to two front office staff members per location, along with two assistants per location. New patients are scheduled for one to two hours per visit, but even with a time-intensive approach, Layman’s business structure allows for additional growth, such as consults done primarily by her business partner. “When she isn’t in the office, the schedule allows for the doctor to do some consults,” she adds. “We consult and take records the same day.”
Before she gradually transitioned from a general practice to focusing on sleep 15 years ago, Layman says balancing everything was a challenge. “It became more difficult with time because despite having associates, it is difficult to not get pulled in different directions within the office,” she says. Eventually, however, she moved her sleep practice out of her general office and renamed it GoTo Sleep. In 2017, Layman partnered with Lesia Crawford, her long-term office manager and business partner at medical billing company GoGoBilling. “The ability to focus on just sleep allowed our business to grow exponentially,” she says.
Another key to her success? Their medical billing company was one of the first ever for dentists treating sleep apnea. She explains that her team sold that business just last year, allowing them to move their own office’s three full-time billing team members over to the sleep office full-time.
With a background in medical billing, it’s no surprise that Layman’s business has grown as a result of strategic financial decisions. Her team’s motto, she says, has been focused on being the “cheapest startup ever.”
“We look at every single dollar spent and evaluate whether it helps with patient care or is it just a ‘want,’” she explains. And as a result of that laser financial focus, Layman proudly shares that her company is 100% debt free, a status that then allows her team to reinvest in the business.
“If you really want to add sleep to your existing office or focus your practice solely on sleep, have courage, and make the move” is Layman’s advice. “Get educated, treat family and friends, develop a business plan that does not put you in any debt of any kind, and just take the leap.”
Growing Referral Relationships
Nicole D. Chenet, DDS, DABDSM, owner of Sleep Apnea Dental Center with three locations in Pennsylvania, took a determined approach to expand her career in dental sleep medicine.
After graduating from West Virginia University in 2000, Chenet began her career by purchasing a general cosmetic practice in her hometown of Pittsburgh, Pa. Alongside her foray into business ownership, she went through an evolution in her practice, going through a dental sleep medicine mini-residency under UCLA’s Dennis Bailey, DDS, at the Center for Occlusal Studies in Parkersburg, West Va.
“What I recognized was that not only were friends and family asking me about this mouth appliance that could treat sleep apnea, but my patients were requesting it of me more and more,” says Chenet, who is also a dental sleep medicine provider for the Allegheny Health Network and a remote clinical adjunct professor for the West Virginia University School of Dentistry. “And that’s when I knew there was a need to educate myself on the aspects of dental sleep medicine.”
At the time, there was only one colleague in her geographic area focused on dental sleep medicine, so Chenet addressed the pent-up demand. After she achieved board certification with the American Academy of Dental Sleep Medicine, she accredited her facility, became a durable medical equipment facility, and became a Medicare provider. “We took all the proper steps,” says Chenet.
Alongside of her colleagues and her office manager/mother-in-law, Chenet focused on evolving the sleep apnea part of her general dentistry practice. So in 2015, when Allegheny Health Network approached her to be a part of the sleep medicine department it was opening, she was ready. She retired from general dentistry and became fully devoted to treating sleep apnea and snoring.
“I loved giving patients self-confidence with a smile that they could be proud of,” Chenet says. “But it’s a whole other experience to give patients their health back and treat the whole body by giving them sleep, and I feel so blessed to be able to do that.”
Chenet approached building her practice just as strategically as she had in building her own expertise. Today, between 85% and 95% of her patients come from physician referrals from the tri-state area—and those referrals are a result of her physically visiting each and every one of those physicians in person years ago.
“When I started this 12 or 13 years ago, it was me introducing myself asking for 10 or 15 minutes of their time for a coffee or lunch and explaining who I am, where I come from, my experience and background, and what I’d like to do for the patient,” she explains. “It was just slowly developing those relationships and continuing those relationships.”
Today, Chenet runs her practice with her associate, Paige Murrer, DMD, DABDSM, who also recently became boarded by the American Board of Dental Sleep Medicine. Together, the two dentists practice between three locations and do almost everything in-house, aside from outsourcing to a local medical miller who recently became educated on dental sleep medicine.
Chenet focuses on the patient experience. “I feel like for people who are diagnosed with sleep apnea, it’s been a long dragged-out process, right?” she says. “So the minute they call my office, I don’t want them to have that experience. I want it to be the opposite of that experience.”
People have asked Chenet how she has accomplished so much. “There is no secret,” she says firmly. “Go above and beyond. It’s very simple. If you treat every patient as if they are your family member or somebody you care about a lot, you will continue to be successful.
“My biggest advice for people who are starting out in this is: be patient. Give that very first patient the best experience. Educate that patient and then develop that relationship with the physician that referred him or her to you. That doctor wants to see what the feedback is from their patients, what their experience is, and what their clinical outcomes are…that’s a great experience. And that becomes respected.”
Small Steps
Srujal Shah, DDS, DABDSM, DASBA, president and founder of Spark Sleep Solutions with locations in San Jose, San Ramon, Los Gatos, Sunnyvale, Santa Cruz, and Monterey, Calif, had been practicing for two years when he realized he wanted to narrow his focus. Without a practice of sleep patients and with few resources at his disposal, he started small. “I was never focused on building a large practice but instead on just the small details,” he says.
He started from the ground-up learning all aspects of running a dental sleep practice, from treatment protocol to billing.
“Those days now feel like a start-up to me where I was really scrappy as I figured out the field mostly through trial and error,” he says. “It’s part of the reason why I feel I have such a good grasp on all aspects of the dental sleep medicine field.”
Today Shah says he runs his practice with “a lot of faith in God” as well as “tremendous support” from industry experts and his family. For instance, his brother works alongside him as the practice’s chief operating officer. What’s more, his executive team has been with him for many years. “It’s a tremendous feeling working with a team who always has their best intentions for me and my patients,” he says.
Shah views his practice’s growth as a natural extension of how he treats his patients—with care and patience. “My approach has always been to grow slowly and organically: to care for one patient while optimizing our care delivery model,” he says. “I never tried to grow my practice aggressively.”
He also says he never made a business plan. Instead, he follows his father’s lessons of “working without expectations,” a method learned from the Hindu text the Bhagavad Gita. “I try my best to focus on caring for my patients and leave the results to a higher power,” he says. “This has really brought joy into what could be an otherwise very stressful situation.”
Like many other business owners also experienced during the COVID-19 pandemic, Shah experienced challenges in finding staff. He took the opportunity to pivot how he approached his business. For example, he’d switched from physical impressions to intraoral scanning more than five years ago, and he now invested in newer, faster scanners. He tested systems to automate patient instructions. He offered select follow-up appointments as virtual visits. These new technologies were well received by patients and helped with overflow. He has since added more team members, including both remote and in-person workers. His local team in San Jose handles scheduling, billing, and clinical work. Shah hopes to add more providers over time.
Patient referrals come from a mix of word-of-mouth, referring dentists and physicians, and his practice’s direct-to-consumer marketing. “It’s no different from any other dental office, where if we do a good job and care for our patients, more patients will come,” Shah says.
For dentists looking to grow their practices, Shah’s advice is to understand your strengths and lean on support to help serve sleep patients. For instance, he suggests that dentists who don’t commit to dental sleep medicine seek out a dental sleep medicine practitioner in their area who accepts medical insurance and refer patients who need oral appliances there. “Dental sleep medicine has its own nuances with aspects such as medical billing and having a strong grasp of the different devices available to patients,” he says. “Understanding this is necessary in order to provide a high standard of care to each patient.”
