By Barry F. Polansky, DMD 

These thoughts were first published in May of 2021 on my blog Stoic Dentistry. Parts one and two of this blog series tell the story of how The Pankey Institute provided me with inspiration that shaped my career and provided me with purpose to live a meaningful life. 

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I first attended The Pankey Institute in the late eighties. I was at the lowest point of my career. Admittedly times were a bit easier for a young dentist back then, but in many fundamental ways they were the same. The fundamentals never change; but how best to use them is something you must always stay on top of. Over the years, things have changed but the fundamental wisdom of dental practice has stayed the same. 

For that reason, I believe the best and really the only way to have a fulfilling career in dentistry is through comprehensive, relationship based, fee-for-service practice. 

My First Day at the Institute 

On the first morning at the Institute, I remember feeling overwhelmed. It was like the first time I sat down to write a book…I was focused on the herculean tasks of creating the practice of my dreams…an unbearable project. Every moment of that first week tested my competence and potential to succeed…and then there was the comparisons and contrasts I made with the other students. But I paid attention and took notes. 

In a lecture late in the week, the instructor was discussing how to schedule this new type of practice. He told us to reserve just a morning to practice what we were learning. I returned home and secured every Thursday morning for practicing the Pankey way. That included a lot of new techniques for me and my staff. It was an easy way to introduce the new school of thought to my staff. 

How do you eat an elephant? I used to ask myself…one bite at a time. 

The lecturer that day, Dr. Irwin Becker, who later became my mentor, was righter than he even knew. 

The Self-Determination Theory of Human Motivation 

Just about the same time, during the eighties, two psychologists, Edward Deci and Richard Ryan from the University of Rochester were beginning to formulate their now groundbreaking self-determination theory of human motivation. 

Let’s face it, writing a book or designing a fee for service dental practice takes a lot of energy and motivation. Back then and sadly today, the advice came down to “Just Do It.” Deci and Ryan put some science behind human motivation for me…and then I backed into it…but years later, while studying positive psychology, I was gratified that I took Dr. Irwin Becker’s advice; otherwise, I may not have had an accomplished and fulfilling career. 

Let’s look at the science. 

Deci and Ryan defined motivation as the “energy required for action.” How many times do we attempt to accomplish a worthy goal but run out of steam. We need drive. Many people never even try. Installing a fee-for-service practice is difficult…if we dare to do it. It requires resources like drive and energy. 

Deci and Ryan went on to further describe the elements of the drive and motivation they were describing. Firstly, they noted the difference between extrinsic and intrinsic motivation. The extrinsic drives were the material rewards we are all familiar with, as well as status and recognition. The intrinsic drives included passion, curiosity and purpose. What they found was that intrinsic motivation was more effective in every tested situation, excluding when our basic needs haven’t been met. (See Maslow’s Hierarchy of Needs.)  

Then something interesting occurred to them. They separated motivation again into controlled motivation, a form of extrinsic motivation and autonomous motivation, a form of intrinsic motivation. If it is work you have to do or are being forced to do, that’s controlled. Autonomous motivation is doing work you choose to do. Deci and Ryan found that, in every case, autonomous motivation destroys controlled motivation.  

The psychologists further explained autonomy by saying it occurs when we are doing what we are doing because of “interest and enjoyment” and because “it aligns with our core values and beliefs.” In other words, it is in alignment with the other intrinsic drives: curiosity, passion and purpose. 

To be continued in Part 2. 

By Andrea Beerman, DDS 

The late Dr. Andrea Beerman (1978-2013) was a beloved member of the Pankey Institute community. She contributed this to my CoDiscovery blog years ago. I think she would be glad her words will inspire our Pankey community forever. – Paul A. Henny, DDS 

Nothing is at last sacred but the integrity of your own mind. ~Ralph Waldo Emerson 

I love this quote from Emerson and understood it with greater depth as it reconnected me with one of my personal Core Values – originality. 

It reminds me that it is my natural state to follow my own mind – my own unique ideas. Personally, I know I struggle when I try to do things like others. In these instances, I feel like I am not being my authentic self. Sometimes, I have found myself conforming or doing something “the way it’s always been done”, because it seems quicker or easier. 

I don’t have to face the truth or something that may take me to my learning edge if I do things in a rote way. I do not have to make time to enter the “classroom” of silence to know more clearly the path to choose. In these moments, I know I am not realizing the sacredness of my own mind and spirit. With this quote, I am reminded to continue to trust and tap that potential – the beautiful, unique spark of life within me. 

A friend and mentor of mine encouraged me to find a picture of myself when I was a child and put it somewhere I would see it every day. So, now I have a picture of myself at age four on my desk. I keep it in front of me, because sometimes I forget who I am in the midst of my busy days. Of course I am a dentist, but the truth is, deep down – I am still that little girl. That same bright spirit, eager to live fully, and embrace life. All I wanted then was to be loved, accepted and understood. What do I want now? If I answer honestly, I’m not sure the answers are different. 

When I see her picture it makes it really easy for me to forgive myself for all the times I came up short and for the mistakes I’ve made along the way. I see her innocence when I look at this picture, and remember I am truly doing the best I can with what I know. 

So, I have this picture on my desk – to help me remember who I am and what I really want from life. What I’ve learned – it also reminds me of the truth about others – you, my patients, family and friends. 

Beneath the layers of life, lie our bright spirits. I am at my best – in patient interactions and with my friends and family- when I can see others for who they truly are. I think e.e. cummings said it best, “It takes courage to grow up and become who you really are.” 

I wish you my very best in your journey. ~Andrea 

By Paul A. Henny, DDS 

Times change; that’s for certain. When dental advertising was first allowed in the 1970’s, there was much discussion around whether marketing a dental practice was ethical. Today, marketing ethics is an issue for dental licensing boards to decide, while most dentists have moved on to focusing on HOW to best market their practice. 

Combine this new marketing-oriented mindset with the internet, and there’s a lot of confusion, wasted time, wasted money, and wasted energy. 

Why? Because most marketing efforts are focused on bodies and not people with feelings, priories and values. To quote a popular marketer in dentistry today: “In the end, the only thing that matters is how many butts you put in the chairs.” Really? And as a result, too many dentists are hung up on paying attention to the wrong metrics: ad clicks, social media likes, a high search engine results page (SERP) ranking, new patients per month, and so forth. 

It’s nice to have lots of visitors to our website (and important), but the best question to ask is: Why are prospective patients visiting our website in the first place? The answer speaks to FIT: Is this person likely to be a good fit with our practice Mission and Philosophy? 

If the person fits in with our practice’s Mission, then we’re supporting our Philosophy and moving toward our Vision. If the person doesn’t fit in with our practice’s Mission, then we aren’t. It’s that simple. 

If the person fits, they’re much more likely to schedule an appointment. If the person is a good fit, they are much more likely to be open to a proper and thorough examination process. If a person is a good fit, they’re more likely to make good decisions regarding their dental health. And if a person is a good fit, they are much more likely to agree to appropriate treatment plans. Consequently, when most people in our practice are a good “fit,” our schedule is full of folks who show up, and are grateful they found us. 

The key to successful marketing of a health-centered / relationship-based practice therefore begins BEFORE each person visits our website and therefore BEFORE they call. And that’s all related to our reputation—what’s commonly called our “brand.” Our brand is the set of expectations the person has about us. 

So, it’s important to know who they are, what they are seeking, and how we can best address it. Knowing the answers is where marketing should begin. On this, Peter Drucker famously said, “True marketing starts out with the customer, their demographics, their realities, their needs, and their values. The aim of marketing is to make selling superfluous. The aim of marketing is to know and understand the customer so well that the product or service fits him or her so well that it sells itself.” 

And that represents a whole lot more than just getting a “butt in the chair.” Mastering person-centered marketing is a key element to realizing our dream. Failing to understand it forces us to try and manage people who aren’t a good fit—sometimes multiple times a day, and that simply isn’t very fun or rewarding. 

By Edwin A. McDonald, DDS 

Case Study 1 

Early in my practice I was introduced to a periodontist in Dallas. We began a close working relationship for many years. He was a great mentor to me. His work was superb, and his patients had great experiences. He got to know our patients so well he could guide them to the best treatment decisions.  

One day we met, and he told me that he was retiring. I told him that he couldn’t do that to me! His response was that he had found the perfect person to partner and transition with. He had.  

The most important thing that happened was my mentor took the time and made the effort to communicate with me about what was happening. It made me realize that I was important and significant in all of this. The incoming periodontist, Ron, was a young version of his predecessor with the same meticulous surgical technique, superb results, and great patient experiences. In fact, in many ways he became better.  

Years later, Ron’s office is in the same location, just beautifully remodeled and updated. The hygienists remained for many years as did most patients and almost all referral sources. Ron has been extraordinarily successful. That makes me happy. He makes me a better dentist. 

In this case, the two periodontists were philosophically aligned, clinically similar, consistent in their judgement, and had great ability to build high trust relationships. Those four components created a powerful foundation to move smoothly from the past to a great future. 

Case Study 2 

Unlike the first case study, most transitions have gaps between the old and the new. In addition, often the existing practice needs an infusion of energy, a new and expanded mindset, and a more powerful vision to move toward what is possible. 

I have a friend that bought a very traditional relationship-based practice with tons of potential. He is different than his predecessor in his management style, approach to relationships, and desire to grow his practice. He has more than doubled it in just a few years. He also has had a complete turnover in the team. In this case, he needed a team that fit how he wanted to practice. He hired individuals who were prepared to embrace a new approach to practice.  

My friend needed to become a more effective leader of his team and develop a deeper understanding of how important they are to his current and future success. That meant investing more time and energy into getting to know everyone, communicating his career goals and learning about their career goals as they together cast a vision of the future …a worthy destination that honored the past as it created an abundant future. That meant leaving behind some beliefs, assumptions, and patterns of thinking as he matured and as they matured. 

“All of the stakeholders around a practice transition will embrace the change if they see the incoming dentist and new team members living the values that have kept them connected to the practice for many years, there is clear and frequent communication, there are genuine efforts at building trust, and there is an expressed understanding of what is mutually beneficial to all parties.”
–Dr. Edwin A. McDonald (LineofSightCoaching.com) 

By Edwin A. McDonald, DDS 

It is amazing to me to realize that I have practiced for more than 40 years in a relationship based, fee for service dental practice. Dentistry has become much more complex during that time. What has not changed is the need for human beings to be loved, accepted, significant, understood, and heard. Also, people who have a high value for their health seek high clinical competence and thoughtful patient management.  

Two years ago, I started looking for a partner to continue providing my patients with comprehensive, relationship-based care. (My hands, back, and body had been telling me that it was time to slow down.) My primary goal in this transition was to create a future where the culture of my practice would continue, and the practice would thrive and grow. 

I received a call 18 months ago from my good friend, Dr. Lynne Gerlach. She said: “Mac, I want you to meet Dr. Shawn Luck.” Lynne went on to say, “I interview young dentists every day and I rarely meet people like him.” 

Shawn and I met, and I immediately understood what she meant. After a few more meetings, several phone calls with colleagues that knew Shawn well, and a thorough financial analysis, it was time for “Team Mac” to meet Dr. Shawn.  

Team relationships are critical to a successful transition. Shawn was met with enthusiasm from my team. That meant we could move forward with a detailed agreement that included terms of employment and terms of practice purchase.  

Shawn’s well-grounded character, confidence, enthusiasm, and intelligence were the factors that guided my decision. We both needed what each other had. I needed Shawn’s character, youth, energy, ambition, and strong desire to own a practice. He needed my clinical training, experience, and commitment to be a focused, consistent, and relentless teacher. 

I began communicating the transition with my team and patients a few months before meeting with Shawn. I mailed a formal letter to my patients that said that I saw three to five years of clinical practice remaining for myself. The letter began and ended with a big thank you for their loyalty, trust, and support. It let them know that I was actively looking for a young dentist to partner with who would continue to take care of them. This letter was a huge success with a thank you from almost every patient. A few patients began to schedule pending treatment that had been on their mind. 

We sent a second letter four months later to announce Dr. Luck. We began communicating about his arrival in person with enthusiasm and emailed a digital copy. The main takeaway here is that the transition immediately benefitted from consistent, focused, and abundant communication with all practice stakeholders about what we were planning and hoping for.  

We are in the middle of year one and I am focusing on mentoring Dr. Luck. We are hoping to play the infinite game as we create and pass on opportunities to the next generation. 

My hope for my Pankey Institute colleagues is you will surround yourself with great people that make you better. Build partnerships with them. Build trust at a deep level. Build community. Serve one another. Seek opportunities to pass on the values of relationship-based practice to the next generation. If you invite young dentists into a relationship and repeat the mentoring you received, we can all play this forward. Dr. Shawn Luck has already captured the spirit of wanting to do just that. 

By John C. Cranham, DDS 

Pete Dawson and I talked about this often. No matter how many years in practice, dentists never have everything figured out. The things that you are doing now are not going to be right forever.  

My advice to young dentists is to be open to new processes and new materials even if you have a predictable way of doing things now. Learning and adapting makes dentistry incredibly fun. Even in my 60’s I am always learning something new—like the digital 3D world of dentistry. I haven’t been this excited about dentistry ever. 

Starting out as a new dentist wasn’t easy for me. I wanted to be known for something in my community. I wanted to be known as the dentist who solved problems that other dentists couldn’t. The first thing I needed was courage to put myself out there and do whatever I needed to do.  

The second thing I needed was training, mentoring, and experience. I went to The Pankey Institute and Dawson Academy. I took all their courses. I took a veneer class with Bill Dickerson back in the day. I listened to Ross Nash and Larry Rosenbaum. At the turn of the millennium, I was trying to take the traditional occlusal information and blend it with the hottest cosmetic information at the time. (Those concepts were diametrically opposed back then. It was blasphemy to put them together.) I prevailed and became better at solving functional problems and improving aesthetics at the same time. Today, dentists do this all the time. 

I and all my colleagues coming up over the last 30 years have had to be open to change. We’ve had to try new things and work at mastering them. I don’t think I am doing anything today in the same way I was trained in dental school.  

My message in this blog is that it’s important to evolve as a dentist to stay enthusiastic about what you do and to provide the best care you can. It’s common for maturing dentists to let go of certain procedures and focus on what they enjoy most and develop specific expertise in niche services. It’s also common for other maturing dentists to continue enjoying general dentistry half of their time and focusing on complex cases the other half.  

Enjoy the relationships you build and take pride in improving your restorative work as you need to redo it. Patients are wowed by what you can do now and how you do it compared to how you did it years ago. They love learning about the advances in dentistry that benefit them.  

The relational part of practice will always be rewarding. Being able to choose what you do and who you do it with will always be wonderful. Passion for what you do is fueled by learning, so keep setting goals to learn something new and be open to that learning changing you. 

By M. Johnson Hagood, DDS 

 As a general dentist in Vero Beach, Florida, who does a lot of restorative whole mouth dentistry, I rely on a wonderful interdisciplinary team but lately I’ve wanted to have more resources in my own practice.  

 A year ago, I decided to purchase a practice with a larger office on the beachside of town with the aim of bringing on an associate dentist with a background in periodontics and prosthodontics. I wasn’t sure if I would need to keep the 900-square-foot space I had practiced in for over two decades, so I only recently put my bungalow-style building on the market and moved fully out of it.  

 The transition has been fraught with challenges…the financing, the physical move, the tech setup, accommodating the exiting dentist and his team two days a week for a few months, and transitioning patients to a new location. Some might say I am going through a mid-life crisis, and they would be correct. My team and family have been incredible. I don’t think I could have done it without their support. They keep me going through the choppy waves. 

Many of you know that I am a surfer. I still surf in my 50s but for the last six months, I haven’t had the time. Something with the transition is always rising to my attention. Many days, I feel the kind of burnout that I haven’t felt in years. Six months from now I hope to be writing again about what has transpired and how I am finally feeling on top of my game again. But for now, I can say that it’s been tough. 

 Some of you know Debbie Bush, who helps as a remote editor for Pankey. She was in the office a couple of days ago. She knows about the trials and tribulations we have been going through, and we spent some time talking about them. 

 She observed, “I’ve been here twice, and my husband has been here twice since you moved. I can tell that your patients think the change has been seamless. From their perspective, you and your team are providing them with the same personalized attention, interest, encouragement, and care. The other dentist’s patients are getting to meet you and your team. They are sensing the positive culture of your practice. It’s okay, Doc. You will get where you want to go. It’s going to be okay. You’ll be on an even keel in a few months.”  

 That meant the world to me.  

I was able to tell her, “I wish it were easier, but I would do it all over again because I have a vision for the future, and this is the path to getting there.”   

She reminded me that much of “the chop” we are weathering through is due to things outside our control. Our values and culture have remained the same. She asked me what the biggest benefits have been since moving to the new office, and we started talking about “the bright side.” 

For starters, I am grateful for the greater space. We have one more operatory, and all our rooms are larger. It “feels good.” There is tremendous natural light coming in, pristine walls to hang my paintings on, and we have moved from a tiny, gentrified environment to an expansive more modern environment. My team is more physically comfortable. Patients have greater privacy and don’t overhear conversations outside the room they are in. On top of that, most of my patients live on the beach and are delighted I have moved closer to them. 

 The other thing I am excited about is my new CBT system. Moving into a larger space meant I could finally do 3D imaging for my patients in-house. Many patients come to my practice specifically because they are seeking treatment for TMD. I want cone beam images for every TMD patient. For years, I sent them to my endodontist for the 3D images, but now I do those images right away in my own office.  

 When my patients see the 3D images there is a wow factor but more importantly, I can be more thorough with diagnosis, and there is practically no radiation. In addition to the value-add of CBT with TMD, I’m seeing abscesses in teeth that don’t show up on regular X-rays, and the CBT will be important to a partner doing surgeries. 

 Debbie encouraged me to write about the choice of technology I made because it might help others in a similar situation. So, here goes. I considered the cone beam options on the market and decided to go with the Dexis OP 3D LX platform with a 12×15 cm field of view that enables us to see the entire dentition and TMJs in one high resolution image—the mandible, maxilla, bilateral TMJs, sinuses, and pharyngeal airway. I have always been impressed by the quality of Dexis imaging products, and the latest software with the OP 3D is intuitive. 

 I still have a long way to go to achieve my vision for expanding practice. I’ll report back on my experience early next year. I am grateful for the encouragement I receive from you, my colleagues, as I step up to pay the price, continue taking a leap of faith, and stay on course to reach my goals. 

By John C. Cranham, DDS 

 When I’ve looked at and really studied my practice numbers over the years, my favorite has always been productivity per hour. I have aimed to focus on a low volume of patients who need advanced dentistry. As my practice developed, I was able to earn more per hour on fewer patients. I was able to earn as much or more while working fewer hours, and my overhead went down because the office was open fewer hours. 

 Rather than just firing off from the hip and trying to make a treatment plan with the patient who is in the chair, I now invite them back for what I call an “advanced records visit.” Then I focus on making comprehensive records and studying those to create a well-thought-out treatment plan. The time spent planning the treatment may be an hour.  

 When you become good at treatment planning, it may take as little as 20 minutes. But the idea is to do better dentistry for your patients and get to where you are working on about 12 big cases each month. I have found that doing more than that is exhausting and makes it difficult to maintain general patients.  

 As you develop your reputation for being a “go to” dentist who solves problems, the big cases will flow in steadily. When you are planning a big case, you are generally working off a treatment plan where you’ve mounted models, you’ve studied photographs, and you’ve got an architectural plan of where you’re going. It’s very cerebral.  

 When you’re executing the plan, everything must be done in a specific way. So, in my office, we have time scheduled for executing planned dentistry—without interruption. We have another time scheduled for seeing general patients and moving between operatories. In the morning huddle, we review the plan for the day and decide where we can fit in an emergency appointment if one is needed. 

 Over the years, my schedule has changed. I’ve tried various schedules and had to experience them to know what works best for me. Now, I like to arrive at 6:00 AM, do my cerebral case workups in solitude, schedule patients with advanced needs in the morning, and have short afternoons for general dentistry. I don’t bother with lunch because I have determined that I don’t need that break in my day.  

 You’ll find what works for you. Keep in mind that your schedule might change over the years in response to patient needs, staff needs, family needs, and your pursuit of other activities. That’s okay. There is no perfect one schedule that fits all dental practices all the time.  

 Once I had a steady flow of big cases coming in and productivity per hour was high, I no longer felt the need to keep my office open long days or to offer evening appointments. I discovered that evening appointments were the ones patients most often cancelled. And when we cut back on our afternoon appointments a few years ago, patients were accepting once they heard it was because the team and I wanted to spend more time with our families.  

 You may discover that when there are fewer appointment slots available, your patient’s perceived value of them rises, and patient calls to cancel or reschedule diminish. 

 Starting out in practice means delaying the gratification of shorter workdays. It will take some time to get your steam engine rolling but stay the course, balanced with being kind to yourself so you can keep going. Keep your vision alive and educate your patients toward the comprehensive dentistry that will serve them best. Be patient. Your low-volume/high-earning productivity per hour will grow slowly and then faster. 

 At every stage of practice, I think there is one thing all dentists have in common. They relish the quiet hours when they are alone planning treatment. Those are the hours when they feel most at peace, most able to solve complex problems, and actively create plans for efficiently delivering dentistry. As a young dentist, you might experience this once per month, and after a few years, you may experience this nearly every day. Those quiet hours are powerful hours for driving productivity. 

By John C. Cranham, DDS 

Every hour you invest in your practice is an hour invested in your future, so invest time in thinking about how you are spending your time. 

I am often asked if I have advice for young dentists starting out in practice. As I reflect on my own experience in practice and on conversations with other dentists in private practice, several thoughts emerge.  

There will be times when you are working in a chaotic, undisciplined environment because you are trying to care for as many people as you can fit into your day. You will become physically and emotionally tired. At some point, you will recognize that you can’t go on that way. You will need to create more disciplined systems for you and your team. You will need to develop your team members, so they can do more and save you time. You will need to hold yourself and them accountable.  

A young dentist must understand that when you run around and do many procedures, you could be confusing activity with productivity. When you’re working on highly thought-out treatment plans, you’re sitting down, you’re doing more well-organized dentistry on fewer patients. You’re also usually executing the dentistry better, which means fewer remakes.  

How do you position yourself to have the luxury of working on those types of cases? The advanced CE at Pankey and other top programs will move you along, but you need to be patient with yourself…and your patients. You will be bringing them along with you through the opportunities you have to educate them about their oral health, where it is headed, and what can be done. Don’t assume you will achieve your goals fast. Eventually, you will become known as the go-to dentist to solve problems and the cases will flow.  

Know your patients. Be thoughtful about moving them along. Enjoy them as you do. 

I’ve written about this before…for the first few years I felt my colleagues were surpassing me. They were doing more advanced cases and utilizing what they were learning at Pankey and Dawson. I had purchased a tiny practice filled with patients who valued dentistry when they were in pain. I aspired to do more than fill cavities. Sometimes I thought I would have to give up on my dream. But I kept talking with my patients, building relationships, raising their awareness, and eventually they began accepting treatment. I had to stay hopeful and employ the behaviors I was being mentored to employ before I could employ my advanced clinical skills.  

I learned a lot about people, not just dentistry, in my early years. I look back upon the experience with fondness now. 

By John C. Cranham, DDS 

Every dentist finds it challenging to take time to train their team members.

Here are a couple of examples of how I’ve added time to my own day by advancing my team’s skills:

 I fired myself as the practice photographer. My goal was to have multiple people in my office who know our intraoral and extraoral image protocols and who can take the photos at the same high level of quality. To do this, I built “training time” in our schedule to teach photography. Now, while the patient is in the chair, I have the “photographer” show me the photos. We look at them quickly. Occasionally there is one that needs to be retaken, and I will explain why. The quality has become consistently high. By having multiple photographers in the office, my primary dental assistant can focus on something else when needed.  When I am working up a case, I often show them why I needed a specific photo. They take interest in their part of the process and the case. Engagement in their work rises. Always clearly share the why. 

I’ve also trained my team on how to fabricate deprogrammers. I’ve trained them all, checked their work, and explained the why behind our standard. We now have four people who can do that, too. This means we have a good product we offer patients and get it out in a timely manner when my primary assistant is busy.  When it comes to training your team, you will set a standard, and your team needs to know you are serious about it, but you can do this without being stern or making them feel bad. For example, in my office, if they take a bad photo or make an unacceptable deprogrammer, I explain why and ask them to retake the photo or remake the deprogrammer. As they redo something, they learn from their mistakes. I am patient with them. I tell them I made the same mistakes while I was learning.