Dr. Priya Kothari studied and specialized in pediatric dentistry in the United States, before returning to Canada to be closer to family and to open her own practice 12 years ago. Today Kidsworld Pediatric Dentistry in Aurora, Ontario is a busy practice, treating children from all over Southern Ontario. But what happens when staffing shortages and the pandemic hit? How will she keep her patients safe? Can her dental practice survive? Listen to find out.
Kidsworld Pediatric Dentistry
Dr. Priya Kothari studied and specialized in pediatric dentistry in the United States, before returning to Canada to be closer to family and to open her own practice 12 years ago.
Today Kidsworld Pediatric Dentistry in Aurora, Ontario is a busy practice, treating children from all over Southern Ontario. But what happens when staffing shortages and the pandemic hit? How will she keep her patients safe? Can her dental practice survive?
Listen to find out.
You can learn more about Kidsworld Pediatric Dentistry at kidsworlddentistry.com.
Al Grego:
Hello everyone. I'm Al Grego, and this is the Yes We Are Open podcast.
Aurora Ontario, a town of just over 60,000 residents about 50 kilometers north of Toronto. Thanks to the arrival of the railway, Aurora emerged as an important center north of Toronto. The town incorporated in 1863 with a population of 700 residents and in just three years grew quickly to 1200 residents.
Fun fact, the town was named in the early 1800s after the Goddess Aurora from Roman mythology. That's not the fun fact, this is. The other name in the running at the time was Matchville on a count of there being a match factory in town. In the end, sanity prevailed, the name Aurora was a more popular choice and thus ultimately chosen. Another fun fact is that Aurora was a childhood home of former prime minister Lester. B Pearson.
The town has a reputation for growth while preserving its historic charm, maintaining many of its heritage buildings. Part of the town was also built around Ontario's greenbelt, which limits growth in those areas. Aurora has a diverse economic base of over 2200 businesses with a thriving entrepreneurial spirit, but it's also home to some notable companies including Desjardins, Bulk Barn, PreGel Canada, and of course their biggest employer would definitely be Magna International, with over 150,000 employees worldwide. 25,000 of those employees based in their head office in Aurora. Magna is such a big presence in this town that if they were to rename the town today, I'd dare say Magnaville would likely be the front runner.
Aurora has become one of Canada's most affluent towns with an average house income of just over $150,000. In 2019, it was named the 11th best community in Canada overall and the ninth best for families. And speaking of families, tonight, I'm driving eastbound on Wellington Street just passed the GO train station. I turned into this business park on the north side and parked behind a standalone two-story building. I climbed the stairs to the second floor, past a landing with the display of giant stuffed animals wearing masks. This is the location of this week's subject, Kidsworld Pediatric Dentistry.
Dr. Priya Kothari:
Hello.
Al Grego:
Hi, Priya?
Dr. Priya Kothari:
How are you? I'm Priya Kothari. I don't even have my name tag on.
Al Grego:
That's all right. I'm Al.
Dr. Priya Kothari:
Come on in. Nice to meet you.
Al Grego:
Nice to meet you.
Dr. Priya Kothari:
Nice to meet you.
Al Grego:
That's Priya. I've arrived in the evening after business hours, so the office is quiet. Priya takes me on a tour of the office, but full disclosure, I've been here before. My wife and I brought our daughter here to get some cavities filled, so I'm very familiar with the layout. Large fish tank suspended from the ceiling in the waiting area, the muted colors throughout, the oval shaped layout leading to the different rooms and offices circling back to the waiting area. It's quiet and not just because it's after hours. I've been here during business hours and even then it's quieter than your typical dentist's office. Every part of the design of this office is muted in an attempt to provide a calming environment, not only for the kids, but perhaps even more importantly for the parents.
We finally settle in the conference room where Priya usually meets with the parents to talk about their child's dental needs. Like any other conference room, there's a long table with chairs, but unlike other conference rooms, there are large stuffed animals sitting on either end of the long table. Between them, Priya and I sit across from each other, a pane of plexiglass between us, and we settle in for her interview.
Dr. Priya Kothari:
Hi, my name is Priya Kothari and I'm a pediatric dentist. I'm the owner of Kidsworld Pediatric Dentistry. My practice is 11 years old now, this past September.
I was born and raised here in Toronto. My parents are from India, so I'm the child of immigrants and I went to university here, University of Toronto, but went to dental school in Boston. I trained at Boston University for dental school and then Temple Children's Hospital in Philadelphia, and so my subspecialty was always pediatrics. I lived for many years in the United States, moved back to be closer to family and I knew that I wanted to work in pediatrics because that's where I was trained, but I didn't have a connection or a network here, so I was a locum. I did some temporary work, covered people on their maternity leaves at different pediatric offices when I moved here, hoping to maybe get my foot in the door, and that was one of my struggles because if you don't train in the same place, then it's very difficult to break open the doorway.
Eventually what started happening was I realized that I really need to just open my own practice. I really wanted to find a partner or somebody to open with, but when you don't know anybody, it's a bit hard to just kind of jump in and do that. So I took a big risk, and while I was working part-time here and there at different offices, I opened this practice with the help of the dental supply company. Found a space here in Aurora and at the time, 11 years ago, Aurora had no traffic and it was relatively quieter. This site had just developed and it seemed like a good opportunity, good access, great parking. We're right near a daycare, so that's what I did.
Al Grego:
This is your original location?
Dr. Priya Kothari:
My original location was, for nine months I was down the street with an orthodontist and I shared some space with the orthodontist. He was very kind. He was the first person that I met when I moved back here and he allowed me to use his office two days a week. So Mondays and Thursdays I would work there, and then Tuesdays, Wednesdays, and Fridays I used to commute all the way out to St. Catherine's.
Al Grego:
Oh, wow.
Dr. Priya Kothari:
Yep. You do what you have to do.
Al Grego:
Sure. Yeah.
Dr. Priya Kothari:
And Cambridge, I used to commute to Cambridge. I don't know when I slept, but I did and I'd come back and slowly start building my name here. Half of the issue is just allowing people to know that you are present and that you do offer these services, so sometimes it's just informing them. Keeping them in the loop. That was a really amazing experience and I got to meet a lot of people then.
It's a specialty that a lot of people do not know about. The best way to explain to a parent what is a pediatric dentist is to explain that we are similar to pediatricians. As they are to medicine, we are the pediatricians, but to dentistry. There was another one who had been here for many years in the area, and I think what started happening was Aurora was skyrocket growing. It was really developing quickly. I probably had, I'm going to say, a quieter schedule or a slower schedule, maybe 12 months, and that's all it took.
Al Grego:
Just took a year and then a year [inaudible 00:07:14].
Dr. Priya Kothari:
I don't even know that it was a full year, and I'll tell you why. I had my formal open house in this location, May 19, 2012, then after that it's skyrocketed. So September 26, 2011 was the day that I walked into this office and I remember taking the plastic off the x-ray units and there was a family that walked in and they said, "Oh, we see that you're a children's dentist. Are you open?" I didn't want to say no.
Al Grego:
Sure.
Dr. Priya Kothari:
So I said, "Sure." And I didn't want to tell them I didn't even know where the on switch to the mechanical room was. I didn't even know where the button for the on switch for my x-ray unit was.
Al Grego:
Wow.
Dr. Priya Kothari:
Because everything was shielded in plastic, it was so brand new. But to this day what was amazing was that family has stayed with me from that day until they moved away. They moved to Nova Scotia like three or four years ago.
Al Grego:
How do you start a dental practice? Especially, I mean, the machinery is expensive.
Dr. Priya Kothari:
Yes.
Al Grego:
So do you have to go to the bank and take out a loan? How do you start?
Dr. Priya Kothari:
It's nice if you walk with or walk hand in hand with a dental supply company, they usually have some framework of suggestions. You tell them how many rooms do you want? What is your projection for the future? How large of a practice do you want? How small of a practice? How many chairs do you want to set up? Having that proposal, you take it to the bank and you sit down with them and they will look at what your potential is, whether you have any kind of insurance coverage, what your long-term goals are, and how quickly they think that you can repay that loan back to them to get the loan. And sure enough, that's how it started.
And if you ask me did I know any of this? No, I mean I had help. In my family, I have an architect and I have an engineer. So the engineer did an entire flow diagram and the architect, who is my mom, so these are retired people. My mom designed this office.
Al Grego:
Nice.
Dr. Priya Kothari:
Yes. And if it wasn't for my mom, I wouldn't be doing this. And if it wasn't for my dad, I wouldn't know what to take to the bank and say hey. And so with their support and with me saying, yeah, this is what I'm thinking, this is how it starts.
I wanted something that was quiet, not loud. When I say loud I don't mean just noisy. I mean also in colors, so I wanted sedate colors. I needed easy parking. I didn't want moms with little babies struggling to find us or to come here. I have children that have a variety of special situations requiring wheelchairs. Sometimes I have parents that are in wheelchairs, so I definitely need elevator access. The design of the office was such that I wanted a focal point, which you figured out was the fish tank. And it's very calming, even on the adults. That fish tank, oh my goodness, we found it in Ottawa of all places, on a dinner we [inaudible 00:10:06] for a dinner and I remember seeing it in a hardware store and I thought that's what we need. And there's no other like it. The company unfortunately that made it went out of business. It's suspended from the ceiling. It's really cool because the water travels through the ceiling.
But I also like the flow of the office. It's set up like an oval so that there is some flow to it. When you come in, the front desk is greeting you on one side of a semicircle. On the other side is when they're checking the parents out or letting them know what the next appointment is for. The room that you and I are sitting in is intentionally, it looks like it's a long dining table. Funny enough, it was a dining table. It's set up this way so that I can show all the parents the x-rays in this room and it's really nice for them to have some interaction and talk to me and ask me, "Well, how is my child doing?"
Each of the rooms is designed very specifically so that there's a TV above, not just in the ceiling, but it's mobile, so it travels with the child and not that I want to use again yet another device to keep them occupied, but we were using it well before the pandemic started and it's very, as soon as they realize, oh, there's something distracting, it's amazing how just that much, 50% of the anxieties released just from that. A lot of the kids that I see come in very, very anxious or nervous or maybe the parent has had a negative experience or they themselves have had fearful dental visits.
Al Grego:
I was going to say, I feel like the [inaudible 00:11:24] of this office is much [inaudible 00:11:25] parent [inaudible 00:11:27].
Dr. Priya Kothari:
It is. All of us need a little take me down time, so it's set up exactly in that fashion.
Al Grego:
When would you say you were able to finally exhale and say, this is going to work?
Dr. Priya Kothari:
That's a really good question because I remember after moving back here from the United States, I did have my doubts. I was a little worried about whether I made the right decision. I would say, about three years into the practice, I was busy. I got busier faster than I'd anticipated. And then five years into opening the practice, I remember taking a big breath going, okay, okay, we don't need to lose sleep anymore. And at this point, anything we're doing now is for the love of what we're doing and not for any other reason.
It's a customized, tailored approach that I still offer parents. Because it's a small practice, I can ensure that whoever brings their child here is going to see me. It is only this year that I was able to find an associate. Even then, it's just the two of us. I can also say that if there are any personal questions or specific things that parents want to know, I take the time to respond. I will call parents back if they have additional questions. So there's a lot of behind the scenes things happening that are not delegated to other people, that I take it upon myself to do.
You really have to want to work with children, and if you love working with children, then this is the field. If you ask me what else would I do? I don't know, I may be a pediatrician, but this is it. In pediatrics, the challenge is that you not only have to see your patient, but you have to also work with your parent, which is very different from adult dentistry. For you, if you go in and if you need a root canal, your endodontist will do, da, da, da, da, you don't have any questions, take care of it, you're done.
But as soon as you involve a minor, you have to manage the child. You have to explain everything you did to the parent and you have to document that you explained it to the parent, and at the same time, you hopefully have auxiliary support staff that can work with you to get all of this done quickly, because the other thing with children is you have a limited time and if you're not done within that time, they're not going to sit longer for you. Potentially you could maybe sit in the chair for an hour. 17 minutes, I have to be done.
The first part was, it was a struggle and there were some sleepless nights. I was worried that I wouldn't be able to manage. If you asked me how did I manage at first? I tried to think big picture, which was why did I get into this? I wanted to make a difference in children's lives and I wanted to make sure that everybody knew going to the dentist does not have to be scary. In this day and age. It can be fun. It can be a whole different experience. And to me, when I hear that from a parent, when they tell me that my kids are so excited to come here, there is no value I can put to that, and that means that I've done a great job.
Al Grego:
Up next, for 11 years Kidsworld has slowly but steadily grown into a very busy practice. Priya's problems have gone from starting and growing her business to keeping enough people on staff to handle the demand. Her personalized service is what sets her apart. There's only one of her to go around. What if, heaven forbid, she falls ill. How will she manage? Stay tuned to find out.
You're listening to, Yes, We Are Open. Dr. Priya Kothari opened Kidsworld Pediatric Dentistry 11 years ago in Aurora, Ontario. In that time, she's grown her practice the old fashioned way, through hard work, great service and word of mouth advertising. She prides herself in personalized service, which has gotten her this far. But what happens when she falls ill or when staffing shortages in a pandemic put a strain on her practice. Let's find out.
What would be the biggest struggle?
Dr. Priya Kothari:
I don't think I ever came to a situation where I felt I needed to close the doors. I did feel that I wondered if I was doing the right thing and whether it was worth it for me to just simply sell the practice.
Early in the practice, funny enough, in 2012 to 2013, in my family, there was personal healthcare struggle, pretty serious, and it required a lot of my time away from the practice and I didn't have anybody here at the time as an associate to help me. So I basically had to cancel patients. That, I think, is the hardest thing for any provider to do because, it's difficult to just bring another doctor in and trust that person to run things the way that you would when your practice is so new to begin with. You don't really even have a system.
Al Grego:
And it had to be a specialist too.
Dr. Priya Kothari:
Yes, you can't just bring any old doctor. And it would be like if you're and ear, nose, throat surgeon, you just can't bring a family GP in to cover your day. That was an anxiety ridden year, I would say.
Al Grego:
How close did you get to selling?
Dr. Priya Kothari:
I thought about it a lot, but I didn't take it any further. I didn't investigate or ask anyone. It just would play in the back of my mind. I think I've probably thought more about it now this past year in 2022, funny enough, because it definitely takes a toll on you, which you can hear. Even if you get sick a little bit, there's nobody else that can cover you.
Nobody wants to think about closing their doors. Nobody wants to think that. But I would say that anytime I was feeling like this is going badly, I had some really good colleagues around, some orthodontists that are really wonderful colleagues, an oral surgeon that I work with, and you really find everybody's in the same boat and you really try to reach out for each other because everybody is struggling with practice and the ethics of practice as well as managing your personal life. Everyone is struggling with this and some people have it figured out and some don't, and reaching out to them definitely helped me. Yeah, it helped me a lot.
Al Grego:
All right, so obviously you were able to get past that difficult time in 2012. Let's talk about 2020. I mean, what happened when things hit the fan? How did you guys deal with that year? How did you pivot? I mean, there are very few services more intimate than dentistry [inaudible 00:18:22].
Dr. Priya Kothari:
Yeah. What a year, that's all I can say. I remember everything clearly. My last normal working day was Friday the 13th of March, Friday the 13th. I was supposed to have surgery scheduled on Monday, March 16th, and I got this ominous phone call from the hospital on Friday night saying, "I think we need to cancel." And I said, "Yep, no problem." And I realized what was happening.
Things from a business standpoint that we're very rough. I had to lay off all of my employees. I remember calling my lawyer and asking her, what do I do here? So she's like, "Hey, you have to send this letter out and this is what you've got to do." And I remember, I mean, I as an owner remember, that I did not just drop everybody. I gave him two weeks worth of pay, which was difficult for me at that time, knowing that I was going to be closed for the next three to potentially six months. I know the government was saying, oh, it's only going to be two weeks. In my head I was like, no, no, no, this is going to be a lot longer. And that was that. So made sure that they were covered and laying them off was very difficult. After two months, I was able to bring one staff member back and she and I worked together to see emergencies only for three months solid.
Normally, in a full day it's normal for me to see anywhere between 20 to 25 patients in a day. That's a very busy day for a single provider. To put that in perspective, during those three months from March through the end of June, we would see on two days of the week, maybe four patients each. And that was after heavily screening those families, those kids. We didn't even have... Remember there were no vaccines available and there were no swabs. We couldn't do the swabs on the kids. So a total of eight patients per week. Eight patients per week versus 21, just take 21 as an average, 21 per day. And that 21 per day, that is what also employs all the other staff. So eight people per week is going to barely employ the one girl, nevermind anything else, so that was hard.
Al Grego:
So I mean, we're sitting here in your meeting room and I remember last time I was here, we didn't have this Plexiglas dividing us.
Dr. Priya Kothari:
That's right.
Al Grego:
There are a lot of things that you probably had... Measures you had to take to make it a safer environment.
Dr. Priya Kothari:
Yes.
Al Grego:
What did you do then?
Dr. Priya Kothari:
I'm glad you asked me about that because I had to put in an air purifier in every room. The room we're in is the least expensive one. Each air purifier, I don't know how much families know about this, but the medical grade that they wanted us to insert was $2,000. I have three operatories. One has that surgical grade one and then the surgical guy out here, and just those two alone would do the entire office. But I'm next level, I'm a little paranoid, so I put other shorter sized ones in every operatory, so every place has an air purifier.
We had to screen all the patients before they were coming in and out. For a while we did not have all the parents coming into the rooms. At some point, we didn't even have them all in the operatories. We're only now slowly allowing some of them to come back. We locked the elevator so that we wouldn't randomly have people coming in and out of the office. We would have people come up the stairs and then go down the elevator so I could keep control of that.
At the back of the building, there's an employee entrance and I put a big red sign saying employees only. Employees had to come, they still, they still come through that side. They're outside clothes they leave on a landing, their shoes, their coats. Then they come inside. They have indoor shoes, hand sanitizer. What we were doing at the time, we had to take temperature checks of ourselves at the start of the day, at the end of the day. We had to go through a self check on our symptoms. Some of those steps we haven't changed just because we're in healthcare. We work, as you said, directly in somebody's mouth and there are other children, people's children, we have to take care of them and in doing so, we can also take care of ourselves so we don't spread this to anybody else.
So the whole day I'm in an N95 on top of which I wear this. Then I have my regular glasses, then I have a shield, a face shield on, and you can see that I'm wearing a scrub cap. It looks like a very not attractive little shower cap, but it's because the way I look at it is, well, I just don't want things spreading all over the place. We're doing our best to keep it a meticulously clean environment, and I personally take note of all of it. The way I look at it is when I go to somebody else's office, boy, I sure hope they're taking good care of my family the same way I'm taking care of somebody else's.
The biggest struggle is definitely staffing. That is above and beyond the hardest aspect of running any small business. They definitely do not prepare you for this in school.
Al Grego:
Are you back fully yet?
Dr. Priya Kothari:
I would say yes. We're back fully. We have a better system in place. We have an automated system that will reach out and send text messages to families to remind them when their appointments are. If I'm not back up fully up to speed, it's simply because I personally don't have any more stamina. I had to send out a message to all the parents saying, "Yay, temporary help is on the way." I happened to find another doctor who is also a pediatric specialist. This was just fluke and sometimes you have to be in the right time and the right place, and that worked for me. And so she started in September. She's able to come two or three times a month. I would love her to come every day, but I'll take anything that I can get.
Al Grego:
Coming up after the break, we find out what the future holds for Kidsworld Pediatric Dentistry.
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Al Grego:
Welcome back to Yes, We are Open. Dr. Priya Kothari's practice is back to full capacity. Staffing issues are an ongoing concern, but things are looking up with a new part-time associate joining the team, giving Priya some much needed breathing room and the promise of perhaps more help to come. So what does the future of Kidsworld Pediatric Dentistry look like? Let's find out.
Well, let's talk about future outlook. What does the future look like for Kidsworld Dentistry?
Dr. Priya Kothari:
Well, I'm optimistic that I have a really good setup. I have a really good environment design and flow that I think any pediatric dentist, new graduate, coming in here would get a world of experience and it's a perfect situation to transition into.
It's just the right amount of room for two, maybe a third doctor, but two people would be wonderful, and I feel like they would have the benefit of somebody with experience who can guide them or coach them along. I think also from a growth standpoint, growth is nice. I'm happy to take care of all the families that I already have, but growth never hurts anybody. And I say that because as you've driven in this area, you can see just tremendous construction, tremendous. It's not getting smaller. We're getting patients from as far out as Pefferlaw.
Al Grego:
Wow.
Dr. Priya Kothari:
Yeah, far distances. Anywhere between the one to two hour drive distance. I have some families coming from Ajax, maybe their child had a really good experience. And the one thing that's amazing is if so-and-so's child has had a good experience, a parent will drive however long to make that happen again. I really respect that and I don't take that lightly. I never take it for granted. I'm so honored if they feel that... They have choices, I know that, but that they drive all the way back to see us is tremendous.
Al Grego:
Have you ever considered opening other locations, expansion that way?
Dr. Priya Kothari:
That's a good question. In all honesty, I never did. My model really was a boutique practice. I really was just looking for a boutique practice. I know that it can be done. I worked in the US in offices that had multiple branches, but I sometimes found that although that was nice to be able to reach out to those locations, there can be a disconnect if you're not all on the same page. Everybody's philosophy can be different on how they want to practice.
Al Grego:
So in your mind, growth is maybe finding another associate, just taking care of more families in this practice.
Dr. Priya Kothari:
Yeah, taking care of and following the same philosophy and the same quality of service.
Al Grego:
You have a new associate that just started in September, and it sounds like you're wishing that she was even more available. So is that something you you're open to?
Dr. Priya Kothari:
I am open to. If you know of anybody, please keep... Yeah, please. She's lovely. She wishes she had more available time too, but she's working in other offices. It's just such a good fit. It's just we are parallel. Our philosophies are the same. It's very difficult to find similar or like-minded individuals.
I feel proud that I have been able to manage and grow this practice. I should look at it as a business, but I've never looked at it as a business. I've always looked at it as, it's a small office caring for other people's children and a lot of wonderful families. I've been extremely fortunate. I'm in a good area. Parents are excited and eager to try to offer the best care for their child that they can, and I've been able to do all of that simply by word of mouth and by no other means.
I think it's a really good moral to the story of years ago that the old fashioned stuff, if you just stick to your principles, do a good job and talk to everybody, smile when you talk to them, explain to them what you did so that they know what did their child receive, people will relate to that a whole lot more versus, "Yep, your kid looks good. We'll see you in six months." I don't think that's sufficient. For the fees that the parent also has to pay, I think you owe it to them to tell them how is their child faring.
Yeah, I'm proud that I built that. I'm proud that we're able to offer all of these different services here. I don't take anything for granted, and I'm really appreciative of all the different support, levels of support that I've received, be it the bank, be it Moneris, be it the dental supply company. I just don't think you can do this as a lone person. You really need somebody to help you at each step.
Al Grego:
Priya, is Kidsworld Dentistry open?
Dr. Priya Kothari:
Oh yes, we are so open. We are open.
Al Grego:
That's the story of Kidsworld Pediatric Dentistry. A small business is risky business, especially when the product is you, as is the case with most service-based businesses trades or practices. When you're the only one who can provide the service, there is no work-life balance. There's no taking a personal day without disappointing customers. I can't imagine that kind of pressure. You can tell this weighs heavily on Priya. If she takes a sick day, that means her patients don't get their treatment and her staff are left to cancel or reschedule unhappy customers. That's got to be a tough pill to swallow for someone who obviously cares deeply for her patients and the quality of her work. As you heard in today's story, Priya is looking for help to relieve her of some of that pressure. I hope she finds it soon, because when she does, that'll be great news for her and her patients because that'll mean that Kidsworld has a future as bright as the smiles they treat every day.
Yes, We Are Open is a Moneris podcast production. I'd like to thank Dr. Priya Kothari for taking the time to share her story. You can learn more about Kidsworld Pediatric Dentistry at kidsworlddentistry.com. For more information about this podcast, visit our site, yesweareopenpodcast.com. If you'd like to support us, rate us on Apple Podcasts, Spotify, or wherever you get your podcasts. If you're a Canadian small business owner, or know of one with an interesting story of perseverance to tell, I'd love to help tell it. You can contact me at podcast.moneris.com. Tune in next week for another story of small business struggle and survival on the season finale of Yes, We Are Open Podcast. I'm Al Grego, thank you for listening.