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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According to the findings of motivational researchers Deci and Ryan (discussed in Part 1 of this blog series), when we are the masters of our own destiny, we are more focused, productive, optimistic, resilient, creative and healthy. 

In retrospect, this is what I found I was experiencing on my Thursday mornings reserved for practicing “the Pankey way.” 

Autonomy as an intrinsic driver works—so starting slow to install fee-for-service just one morning per week is a sound idea. 

The Riddle of Mastery 

And then there is the riddle of mastery. Mastery sits atop L. D. Pankey’s Ladder of Competency. The question is how does one achieve mastery? It could be reduced to “Just do it,” but there is more science. 

In a 1953 paper by Harvard psychologist, David McClelland, a leader in achievement and motivation theory, he wrote an original thesis titled “The  Achievement Motive.” Deci and Ryan acknowledged that this thesis may have described an intrinsic driver even more important than autonomy. They called it competence, but it now is known as mastery. 

The pursuit of mastery has been the subject of numerous scholars and authors from Theresa Amabile and Robert Greene to George Leonard. Most agree that mastery is the desire to get better at what we do. It is the need to continually get better, to improve and to make progress. It is the royal road to growth and flourishing and the opposite of languishing and drudgery…the low rung on Pankey’s Ladder of Competency. 

Working toward worthy goals is pleasurable. Making progress produces the neuro-chemical dopamine. According to Daniel Pink, author of the popular book Drive, “the single biggest motivator by far, is making progress in meaningful work.” 

At my lowest point in dentistry, I felt stuck. Hopeless. My work had lost its meaning. Today we call that burnout. Those Thursday mornings turned on the light…the light of hope. 

We need the freedom to chase mastery. That freedom comes from autonomy. Without the intrinsic driver of autonomy, it is difficult to sustain the drive necessary to achieve mastery…this is based on our biology, not just some story, fairy tale, or business myth. 

Driven by Dopamine and Progress 

After installing the Pankey Thursday mornings where I could practice autonomously, applying the lessons I needed to learn, I slowly put the complex elements of comprehensive relationship dentistry together. I started with the comprehensive examination and built on that by learning all of the components from the mundane mounting of models to the nuances of advanced occlusion. It took time…but driven by dopamine and progress, slowly I was installing my model practice. 

I realized that learning the softer behavioral skills were just as important as the technical, so in time I learned about case presentation. Through the years I learned new skills like digital photography and Power Point. Today’s dentists are mastering digital 3D treatment planning. 

I am retired now and looking back I see how that moment when Dr. Becker suggested the Pankey Morning changed my life. 

Today things are different. There is pressure on young dentists to dive into corporate dentistry or adopt practice models focused solely on extrinsic rewards. Many of these newer models undermine autonomy, which, in my view, is a critical error. The Pankey Institute continues to thrive because it champions the principles of autonomy and mastery that are essential for a fulfilling and sustainable career. By embracing a fee-for-service approach and fostering an environment where personal growth and patient relationships take precedence, dentists can build practices that not only endure but flourish.  

As I reflect on my own journey, I see that the true essence of a rewarding career lies in balancing professional excellence with the autonomy to pursue one’s own vision—a hallmark of L. D. Pankey’s philosophy of practice. 

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. 

For years now, I have followed this simple reflective process. I hope it proves to be helpful for you in your personal and professional growth. My reflection BAG contains Blessings, Accomplishments, and Goals. 

Blessings  

List all the blessings you are grateful for; family, friends, satisfying work, freedom to worship, health, warm home, living in America, etc. Give thanks for the blessings of life. Gratitude is essential to the journey, and too frequently in our “push” to “get ahead”, we forget our core blessings. Compared to these Blessings, getting ahead isn’t the most important thing. INVOLVE YOUR FAMILY THIS YEAR…even your two-year-old will feel the gratitude. 

Accomplishments 

Summarize all things you accomplished throughout the year. This is such an important step to write down because it never ceases to amaze me, when I reflect, just how much I have accomplished. I always need my calendar for this one because I find I forget all the little things I did do throughout the year. The journey can be so (apparently) slow and frustrating, that seeing how far you progress each year is very important. 

Goals 

Now that you are grateful for the mess you have gotten yourself into, write down your goals for the coming year. Come up with 20-30-50 ideas. Many times, the “best” ones are the last few that pop into your head. Remember the Pankey Cross and plan in all areas, Work, Love, Play, and Worship. Know Yourself, Know Your Patient, Know Your Work, and Apply Your Knowledge (this is a part of that). Spend as much (or more) time and money on the behavioral - communication aspects of care as you do the technical aspects of dental care. Plan to integrate Joy, Wonder and Relationships into your work. 

Set Aside Quiet Time to Reflect

Please set aside quiet time to do this. The first time it may take several struggling hours. I reflect several times a year and still set aside a few hours, but it has become almost like meditation for me and is one of the most important things I do for myself. I do this to continually refocus my efforts and to enhance gratitude. This has become part of my personal Peace process.

Thinking Beats Regurgitation

Throughout our education process we dentists are taught to memorize and regurgitate…not to reflect nor to think (I believe, at times, thinking is beaten out of us). We look to others to provide us the “answers” we might be missing that will guarantee our passing the tests (success). Sometimes we glance at someone else’s success and, thus, we let others define success for us — and we all are obsessive enough to bust our butts for an “A” to please someone else. If we just miss being perfect, we feel like such a failure. And for those of you paralyzed by needing to be perfect…Perfection is a disease. The goal is excellence, not perfection. John Wooden said it best:

“Success is the self-satisfaction in knowing you did your best.”