Mastery sits atop L. D. Pankey’s Ladder of Competency. The question is how does one achieve mastery? Once again it has been reduced to “Just Do It.” But there is more science.

In his 1953 paper, The Achievement Motive, Harvard psychologist David McClelland wrote an original thesis about mastery. Psychologists Deci and Ryan (authors of Self-Determination and Intrinsic Motivation in Human Behavior) acknowledged that this thesis may have described an intrinsic driver even more important than autonomy. They called it competence, but it is now 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).

The Process/Progress of Mastery Is Pleasurable

Working toward worthy goals is pleasurable. Making progress produces the neuro-chemical dopamine. According to Dan 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. Remember those Thursday mornings I mentioned in Part 1 of How to Move Toward Independence in Dentistry? Those Thursday mornings turned on 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.

So, after scheduling Thursday mornings to practice autonomously, applying the Pankey Institute lessons I needed to learn and make second nature, I slowly put the complex elements of comprehensive, relationship-based dentistry together. I started with the comprehensive examination and built on that by learning all the components from 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.

Behavioral Skills and Technical Skills Are Both Important

In time I came to realize that learning the softer behavioral skills were just as important as the technical, so I learned about case presentation. Through the years I learned new skills like digital photography and PowerPoint. This is the essence of mastery. I am retired now. Looking back, I see how that the moment Dr. Becker suggested implementing the “Pankey Morning” changed my life.

There Is a Way to Enjoy Dentistry

Today things are different than when I was a young. There is pressure to go right into corporate dentistry or practice in a way that is built on extrinsic motivators. Many of the newer models of practice are an assault on autonomy, and many dentists don’t realize the root of their unhappiness for years.

My new book, The Porch, is a fable about a dentist who is losing his autonomy and breaks down. By finding a mentor and keeping his eyes on the ultimate prize, he goes from despair to hope. The book provides lessons the young dentist learns along a path of mastery, with the leadership and support of other colleagues.

Pankey Institute instructors, mentors, and colleagues inspired and encouraged my personal path. As I recall, many of them started on their personal fee-for-service journey, like I did, with focus on changing and mastering a new approach to patient examination, education, and leadership — one new patient at a time, one morning per week.

Our constantly growing Pankey Institute community has stayed “on the porch” of conversation, like the Stoic philosophers under the stoa, to grow in shared wisdom over 50 years. This wisdom is never outdated, even as dentistry has changed. There is a way to enjoy dentistry. My mission is to keep writing and awakening hope.

Happiness for me in dentistry was always doing my best for patients who appreciated and wanted the best dentistry. When third parties began to heavily impact the care patients wanted and my ability to do my best, my happiness disappeared, and burnout set it.

Independence to me meant removing myself and leading my patients away from insurance dependence. The Pankey Institute showed me the way to do this, and I was able to start restoring my happiness one patient at a time, until I was finally once again “fee for service.” Whether you can do this in part or in whole, you will achieve more dentistry and have a greater impact on more lives.

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. On the first morning at the Institute, I remember feeling overwhelmed. I was focused on the herculean task of creating the practice of my dreams. Every moment of that first week tested my competence and potential to succeed. I kept comparing myself with other students as I paid attention and diligently took notes.

Later in the week, Dr. Irwin Becker was discussing how to schedule patients so we would have time to practice what we were learning. I returned home and secured every Thursday morning for practicing “the Pankey way” which included a lot of new techniques for me and my staff. Dr. Becker was more correct than he even knew when he recommended that we “just do it.”

The Science of Motivation

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. Their advice also came down to “Just Do It.” Years later, while studying positive psychology, I was gratified that I took Dr. Becker’s advice; otherwise I may not have had an accomplished and fulfilling career.

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. Installing a fee-for-service practice is difficult…if we dare to do it. It requires resources like drive and energy.

Deci and Ryan noted extrinsic drives are the material rewards we are all familiar with, as well as status and recognition. The intrinsic drives are passion, curiosity, and purpose. They found intrinsic motivation is more effective in every tested situation, except when basic needs haven’t been met (think Maslow’s Hierarchy of Needs). They also found that autonomous work overrides controlled work because autonomy is aligned with our intrinsic drives.

Autonomy as an Intrinsic Driver Works

When we are the masters of our own destiny, we are also more focused, productive, optimistic, resilient, creative, and healthy. In retrospect, this is what I found on those Thursday mornings. When I was focused on doing a comprehensive, relationship-based new patient exam, to the best of my ability and focused on leading the special person before me to greater understanding and health without thoughts about personal gain… putting another first and giving them the gift of my time… I felt most alive and well myself.

I started with the comprehensive examination and built on that by learning all the components from the mundane mounting of models to the nuances of advanced occlusion. For those of you starting to implement a fee-for-service practice model, success can be measured one morning a week and one patient at a time. Your intrinsic motivation will carry you forward to expand your “Pankey style” approach to a greater and greater percentage of your patients.

Beyond Scheduling One Special Morning…Return to “The Porch”

My latest book, The Porch: A Dental Fable, tells the story of a young dentist who is led in mentoring relationship — by a retired dentist and an expanding group of encouraging colleagues who meet regularly on a porch. He discovers and practices a new philosophical and behavioral approach to practice that transforms his life. I’ll keep blogging on this theme, but between blogs, you might want to pick up the book and discover the richness of a life in dentistry based on intrinsic drive. If you have sampled The Pankey Institute offerings and been inspired, then stay on “the porch” of its philosophical approach, courses, study clubs, and collegial gatherings. Continuously sharing and supporting one another is what put me on the never-ending, meaningful, highly satisfying Road of Mastery…and never again to experience burnout.

After about ten years in practice, I had “one of those days” when I sat down at the end of the day and said to myself, “Is this what it’s going to be like for the next thirty years?” I was working hard, making money, and considered successful by my friends and peers. But, patients were not saying yes to the dentistry I was capable of delivering. 

I had a long talk one evening with Dr. Loren Miller while at The Pankey Institute. His parting comment stuck with me, “Son, it’s time for you to do some straight-line thinking.” I then realized that I needed to change if I wanted my patients to change. I needed to practice in a manner that allowed me to be happy and serve my patients well. In order to do that, I needed to define what I wanted out of my life – personally and professionally – and start living that life.

Starting Point 

Each of us will find our core philosophy in our own way, but you don’t have to reinvent the wheel to get there. There are many resources to help you get started. What follows is a list of ideas from Jim Rohn that I like as a starting point.

1. Set some key goals for life – personally and professionally. Then be like a sailor. No matter where the wind is blowing from, keep tacking toward the goals. 
2. Learn from both success and failure. Don’t take everything personally. Analyze when things go right and wrong, and learn from your mistakes. Success is a series of small steps toward your goals. 
3. Read. Reading requires concentration and focus. These are skills we need to find success. Reading allows you to learn from the experience of others. The brain functions differently when you are reading and writing than when you watch a YouTube video. 
4. Keep a journal or write a blog. Keep track of your path to clarifying your philosophy. You don’t really have a personal philosophy until you are able to explain it to your team and others. 
5. Practice the art of active listening. It is a learned skill that is valuable in your practice and your family. Surround yourself with people you admire. Observe and listen to them.  
6. Be disciplined. Every day is filled with a myriad of choices. We know the difference between good and bad options. It takes discipline to make good choices and stick to that path. 
7. Don’t neglect your personal and practice life. If you don’t take care of yourself, your relationships and your business no one else is going to do it for you.  

This all sounds similar to what L.D. Pankey wrote and said, doesn’t it? 

Moving to Fee for Service Care 

I had many mentors on my path to change: Avrom King, Sandy Roth and The Pankey Institute. It was neither quick nor easy, but these sources came together for me to help me have the courage to commit to change. That change was not driven by money. It was driven by the desire to help people willing to commit to seeking outcomes they desired that were within my capacity to facilitate. That may seem “fluffy,” but from a client perspective, it is a really big deal. We asked our clients to take ownership of their own health. If that was not within their capacity, we chose not to be involved in their care. Our philosophy evolved over several years and allowed me to move from insurance dependence to fee for service care. We called our practice an “outcomes-based” practice, thirty years later, and three years out from handing off my practice to my former partner, it is still a successful fee for service practice. 

Moving from insurance dependence or mixed dependence to a completely fee for service care takes commitment to a special kind of practice philosophy. The listed seven steps above can start you on the way to clarifying your own.