by Christopher Piehler
Herbert Hughes, DMD, brings a whimsical flair to the family business
You could say that Herbert Hughes, DMD, was destined to be a dentist. "Dentistry is in our blood," says Hughes, whose grandfather, James R. Hughes, DDS, practiced general dentistry for more than 50 years in Kentucky and Tennessee. James's son, Herbert H. Hughes, DDS, was a general dentist while in the Air Force and then a private-practice orthodontist for more than 30 years. Last year, a third Hughes celebrated his 25th year in practice.
And Hughes is hopeful that a fourth generation will soon join the family business: his oldest son, Justin, is currently a third-year dental student at VCU School of Dentistry and will be applying for an orthodontic residency next year. Two other sons, Taylor and Marshall, are currently in college and have yet to make a final decision about their career paths.
With so many dentists in the family, it's no surprise that Hughes began his dental career in high school, working at his father's office in Alexandria, Va. "I started out pouring and trimming models," he remembers, "then he gave me the opportunity to work as a chairside assistant."
When it came time to formalize his education, Hughes earned his undergraduate degree at the University of Richmond, followed by dental school at the Medical College of Virginia/VCU and an orthodontic degree at Boston University.
Location: Alexandria, Va
Office square footage: 2,400
Number of chairs: 5
Years in Practice: 26
Education: University of Richmond (undergrad), Medical College of Virginia/VCU (dental), Boston University (orthodontic)
Average Patients Per Hour: 9 to 10
Starts per year: 450
Hours worked per week: 25 seeing patients; 4 administrative
Top five products used: 3M Unitek brackets, American Orthodontics molar tubes, Crossbow appliance, Sesame Communications Web/social media services, Dolphin Imaging & Management software
Then, in 1986, he came home to Alexandria and joined his father's practice. Father and son worked side by side for 2 years, when the senior Hughes retired and left his son to carry on the family tradition.
Over the years, Hughes has opened (and sold) a satellite practice and moved the main office to a new location in Alexandria, but his roots have always been strong—he and Tammy, his wife of 28 years, now live three blocks from his childhood home.
Hughes credits his development as an orthodontist to three influential figures. First and foremost, he says, is his father. "He taught me how to treat my patients with love and respect," Hughes says, adding that, "He was instrumental in teaching me how to manage the business aspect of an orthodontic practice." Although his father has officially been retired for more than 2 decades, Hughes still consults with him on clinical and business decisions. It's an old-fashioned relationship with a high-tech edge: rather than having his father come to the practice, Hughes e-mails him digital images and photos to get his opinion on how he would treat certain cases.
Hughes' second mentor was the chairman of his orthodontic department, the late Tony Gianelly, DMD, PhD, MD, who Hughes and many others knew as "Dr G." Hughes describes Gianelly as "larger than life, yet he was very much a blue-collar worker who did not follow the latest orthodontic trends just because they were popular. To the day he died he was true to his beliefs, and we as his orthodontic disciples proudly followed him," Hughes says. "Not because we were in awe of his presence (I was), but because of the manner in which he taught us to think and evaluate every situation: methodically, logically, rationally."
Hughes learned not only from Gianelly's factual knowledge, but from his demeanor. Hughes recalls "treating patients in the clinic and Dr. G nodding his head, indicating that he wanted to discuss something with me in the hall, away from the patient. Once out of range, he would proceed to fire question after question about my diagnosis, treatment plan, bracket position, wire sequence, etc. Dr. G would be on his fourth or fifth question while I was still attempting to answer the first one. He never embarrassed me in front of my patients, and I truly appreciated his thoughtfulness and respect for me. He treated us as professionals, and I continue to model myself after his examples."
Hughes performs a “Magic Trick of the Month” six or seven times each clinical day.
If his father encouraged his interest in orthodontics and Gianelly shaped the way he practiced, Jim Krumholtz, DDS, helped add the magic. A year before he met Krumholtz, Hughes was playing gin rummy with another dentist, who asked him if he knew any card tricks. "I told him that I only knew one," Hughes remembers. "So I decided to find a book that would teach me some card tricks. One thing led to another, and I started to expand my magic to coins, vanishes, ropes, and mental magic." A year later, Hughes says, "I was cruising the intercoastal waters of Alaska in 1991 while attending an orthodontic seminar. At dinner one evening, I met Dr Jim Krumholtz, and he asked me if I was interested in joining him on a salmon fishing trip. It was a great day on the open waters, and everyone caught a salmon. Everyone except Dr K instructed the captain to package their catch on dry ice and send it home to be enjoyed in the future. But not Dr K. He brought his catch on board and asked the chef to prepare it for dinner. I learned more than just how to catch a fish that day. Dr K's zest for life was clearly demonstrated as he shared his prized catch with 22 newly found friends. From that day, I've fondly referred to Dr K as 'Salmon Jim.' "
During the same cruise, Hughes showed his new friend some of the magic tricks that he had taught himself in the past year. Krumholtz suggested that Hughes integrate magic into his practice. "He was a very successful orthodontist," Hughes says, "so I decided to take his advice. And now I'm known as the magical orthodontist."
Hughes swears by 2.5x loupes for positioning brackets and detailing finished cases.
Hughes' practice is awash in magic, from the wand in the logo to the vintage posters of magicians to the magic stand where he performs his "Magic Trick of the Month" six or seven times each day. At new patient exams, he has been known to pull a wooden coin with his logo on it from a patient's ear, then make it disappear and reappear. The coin then becomes a memorable souvenir of the patient's visit to Hughes Orthodontics. Hughes also does card tricks using a custom-made magic card illustrated with a caricature of him sitting on a tooth. Hughes says that magic has been much more than a respite from his daily routine. "It has allowed me to create a fun and whimsical environment that fits my personality."
Hughes has also taken his show on the road. He has performed in schools for Dental Awareness Month; at fall and spring festivals; and at church functions, retirement communities, and Kiwanis clubs. He may have a busy performance schedule, but there's no danger of his quitting his day job. "I donate my time and hobby to charitable organizations," he says. "I've never charged for one of my shows." Hughes jokes that, "I tell them that you get what you pay for, so I don't feel bad if the show isn't one of my best."
On a more serious note, Hughes sees a powerful connection between magic and orthodontics. "Our practice's motto is, 'There's magic in your smile,' and there really is," he says. "Orthodontists get the rare treat of changing the quality of their patients' lives. Just watch and see the patients' reactions when they first see their new smile without braces—the before-and-after pictures make it appear as if a magical illusion has occurred." Hughes also sees a parallel between the two disciplines in their demand for attention to detail. "Whether performing an illusion or properly positioning the teeth," he says, "it is critical to your success."
Practicing sleight-of-hand has improved Hughes' manual dexterity to the point that he can now hold multiple instruments in one hand as well as manipulate his fingers much better than he used to. "But even more important," he adds, "it has allowed me to improve my relationship with my patients. I love to see the patient's reaction after I ask them if they would like to see 'The Trick of the Month.' Many of my adult patients will come over to my magic stand and watch me perform. It is a great way to break up the day and to add to our patients' overall experience."
In addition to his orthodontics, his magic, and his community service, Hughes has taken up the challenge of trying to grow the biggest pumpkin in Alexandria. He started a pumpkin patch in his backyard 7 years ago, and last year's heavyweight tipped the scales at 70 pounds. His heaviest so far has been 120 pounds.
Hughes involves his patients in his pumpkin passion by taking weekly pictures of the growing pumpkin and posting them on the practice's Facebook page so that everyone can watch the transformation. It all culminates in Hughes' annual Pumpkin Contest, where patients try to guess the final weight of the biggest pumpkin. First prize? A large pumpkin, a carving kit, and gift certificates to the movies. —CP
Hughes may be the star attraction at his practice, but he gives plenty of credit to his team, which is remarkable for both its longevity and its international flavor. He has seven full-time and three part-time employees, all of whom have worked for him for more than 3 years (and some for as long as 25 years). Staff members come from places as far-flung as the Philippines, Pakistan, Vietnam, and Russia. "Some say we look like the United Nations," Hughes says. "Our community is multicultural, so our staff reflects the uniqueness of this area. It's fun when we have our office parties because everyone brings a dish from their home country. It's a great culinary experience!"
It's no wonder Hughes' staff sticks around when you consider the team-building activities he has undertaken with them. "This past year," Hughes says, "we made a road trip to Hershey, Pa, where we enjoyed many sweet treats as well as touring the Amish country and attending the play Joseph." Past outings have included Duck Tours in Washington, DC, and Baltimore; wine tasting; in-office massages; dinner theaters; and a visit to the Spy Museum. "Treat your team well, and you will reap the benefits both financially and emotionally," Hughes says.
During the working day, Hughes emphasizes effective communication by holding what he calls "mini meetings." Every day starts with a "morning huddle," a 5-minute discussion of new patients, starts, and debands. In true Hughes style, the doctor admits, "We usually finish on an upbeat, fun joke of the day."
When working in the clinic, Hughes favors the Biodimensional technique, using a .018 anterior slot and a .022 posterior slot. He is a fan of the Crossbow appliance, and has also seen transformative effects from using 2.5x magnifying loupes. "Wow, what a difference it makes in positioning your brackets and detailing your finished cases," he says. "It has been a tremendous benefit, and I'll never go back."
Every clinical day at Hughes Orthodontics is capped off with the "debrief huddle," another 5-minute meeting to discuss any problems that might have occurred during the day. This meeting ends with Hughes getting his Care Call list so he can follow up with patients who have started treatment or who had a difficult procedure. Hughes says that Care Calls are "similar to a really awesome, easy magic trick—it doesn't take much, but what a response. There's nothing like having the doctor (not staff) do a Care Call. It takes me approximately 60 seconds per call, and I get the satisfaction of hearing how excited the patient and/or parents' voices are when they know that I've called them to see how they are doing."
On the first Wednesday of every month, Hughes holds a 90-minute staff meeting to address every area of the practice—and that includes finances. "I share all my numbers with my team," Hughes says, including "production, collections, delinquencies, starts, new patients, and debands."
Informing his staff and involving them in decision-making makes Hughes' job easier. "Have your team help you develop your systems," he says. "And you will find out that there are a lot fewer fires you will need to put out throughout the day."
As you might expect from someone who has returned to his childhood home, Hughes is deeply involved in the Alexandria community. "We encourage our patients to let us know if we can help to sponsor their school or special activity," he says. "I would much rather spend our marketing dollars on the kids than to place ads. I don't know if I get a better return, but it sure does feel good, and the kids are very happy to have our support." In addition to local schools, Hughes Orthodontics has donated to a local housing charity, youth athletic association, and children's theater.
The entire Hughes Orthodontics staff went to cooking school as part of a recent team-building activity.
Hughes himself plays an active role in the Northern Virginia Orthodontic Study Club, which he helped found in 1988. He is currently the president of the club, and also serves on the board of directors for the Virginia Association of Orthodontists, which organizes continuing educational meetings for orthodontists throughout the state. He also donates his clinical time through Smiles Change Lives, providing several pro bono cases per year for patients who could not otherwise afford treatment.
In everything he does, Hughes' motto is "Don't be fair ... be extraordinaire!" Like any true magician, his goal is to "Find out what my patients, teammates, and referring dentists want and need—and exceed their expectations."
Christopher Piehler is the editor of Orthodontic Products. He can be reached at