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 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 

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 

Even today, after decades into family life, dental practice, and continuing dental education, I sit down every January to outline my BHAGs (Big Hairy Audacious Goals) for the year. I block out the first Monday after Christmas to do this, but for the previous month, I’ve been thinking about what new goals will excite me most. I commonly do this type of thinking while I am exercising and driving.  

It’s during these alone times that I can intentionally mull over the things I could do next. I pay close attention to which possibilities excite me most. Oftentimes, these are goals that I feel will benefit others. 

Successful people have the ability to create daily behaviors that direct themselves towards their goals and take them forward on steppingstones. One of the simplest, yet powerful things I witnessed Dr. Pete Dawson do is how he started each day. He would go to his desk and spend 15 to 20 minutes writing six things on a 3×5 card. These weren’t a To Do list. These were six things that would direct him toward his next BHAG. He would place the card in his breast pocket. He did this day in and day out. 

Two weeks before he passed, Pete came to my lake house on oxygen. When he arrived, I had to help him out of the car and into the house on his walker. I looked at his shirt pocket, and there it was, the 3×5 card.  

We don’t have to use 3×5 cards to make notes for ourselves. We can use our phones. But it is powerful to reflect daily on steps that will take us in the direction we want to go and record those steps to lock them in our memory.  

In dentistry, we need to carve out habitual time to think about our goals and steppingstones. We need to carve out time to take the identified steps. The point is to have a system in place where you are thinking about it every day, because there is so much coming at us all day long that we are at risk of drowning in the noise.  

When we get caught up in the mundane, life is less interesting and less fulfilling. At least that has been my experience. When you sense you are becoming bored, you might just need to identify the next big goal that excites you. The challenge of getting there will bring you back to full life. 

By Edwin “Mac” McDonald DDS  

Effective management during transitions directly impacts overall success. By implementing these strategies, you’ll lead your dental practice through change more smoothly. In Part 1 of this series, I described Phase One: The Ending Zone, the time during which a team is feeling the loss of the familiar and coping with uncertainty. In Part 2, I described Phase 2: The Neutral Zone, the time when a team is learning to embrace the change. Let’s look at what is likely to happen in Phase Three as a team continues to transition through change. 

Phase Three: New Beginnings  

During the third phase, the grieving is now passing or gone. This is when you and your team begin to identify yourselves (your culture) with “the new”—whether that be a practice ownership change, addition of more team members, merging with another dental practice, moving to a new office, updating your technology, adding a new niche service, dropping PPOs, or changing your operational systems (how you do things). The change is affecting their daily work and interactions with patients and each other. Adding to this burden is the tendency for patients to ask questions about the change. They also want to know about and feel connected to the change. Time and energy go into that additional communication. 

But, wonderfully, uncertainty is gone and things are clearer to the team members. Commitment becomes high again, and things start to feel “normal” again. People’s sense of competence is greater, they are able to easily identify the practice’s values to what is happening and how they are personally connected to them. When leaders and team members get to this stage, they can focus on the quality of the patient experience, and a new sense of commitment is felt. 

Strategies for Managing this Phase 

• Continue to talk with your team and individuals about how they are feeling about the change. 
• Acknowledge team members that have contributed to the changes. Doing this publicly cultivates trust and gives an example for others to follow. 
• Give individuals a part to play in sustaining the change and ensuring that it becomes the way of working or operating. People need to feel as though they are a part of it. Some leaders who have a hard time with delegating may need to practice letting go. 

Keep in Mind 

• Ultimately, the leader’s ability to communicate effectively will be the leading success factor in managing transition. 
• Approach other natural leaders in your practice – these are the people that others tend to follow or listen to , so get their buy-in early in the process. This will provide more support for you during the process. 
• Expect people’s performance to drop during the process and give grace to those that are not at their highest and best. Eventually, they will reach the other side and so will you! 

By Edwin “Mac” McDonald DDS  

Effective management during transitions directly impacts overall success. By implementing these strategies, you’ll lead your dental practice through change more smoothly. In Part 1 of this series, I described Phase One: The Ending Zone, the time during which your team is feeling the loss of the familiar and coping with uncertainty. In Part 1, I also listed communication strategies to help them cope. Let’s look at what is likely to happen as you and your team continue to transition through change. 

Phase Two: The Neutral Zone 

During this transition phase known as the “Neutral Zone” or “Chaos Zone,” team members grapple with the loss of the old ways and the unfamiliarity of the new. Competency levels vary, and individuals may feel consciously incompetent or consciously competent. What do I mean by that? 

Some may feel they now know what they didn’t about the change and understand the value of it. They are ready to navigate the change emotionally. Others may feel they are starting to “get it” and deal with it. And others have become champions of the change and model confident competence in making the transition. Others will still experience confusion, stress, doubt or skepticism. This is when leaders need to step up and put on an encourager and coaching hat. 

Strategies for Managing this Phase 

• Discuss Strengths Utilizations: Encourage team members to identify how the change allows them to use their strengths differently and explore new opportunities. 
• Open Conversations: Lead them in conversation and empower them to create solutions as issues of the transition arise. Foster teamwork and purpose as you converse with them, so they feel vital to the practice. Encourage them to talk among themselves and lean on one another as a team because you want to retain that team. Express your appreciation for them navigating and embracing the change. You can take them outside of the office for a social meal that does not feel formal and they can feel connected even outside the office.  
• Provide Support: They will feel the need for information in order to feel secure. Ensure communication networks are open. Bringing in a transitions coach helps. Consider what HR resources you can make available to support individuals during this challenging phase. 

Remember, effective management during transitions directly impacts overall success. By implementing these strategies, you’ll lead your dental practice through change more smoothly. 

By Edwin “Mac” McDonald DDS  

Change is inevitable, and dental practices often experience significant shifts. Whether it’s practice acquisitions, personnel changes, or technology updates, leaders must navigate these transitions effectively. Here are some key strategies: 

Clear Communication: Effective communication is crucial during change initiatives. Prioritize clear and frequent communication with your team. 

Recognize Transition Phases: Understand the different phases your team will go through during transitions. Recognizing these stages helps you address their needs appropriately. 

Feedback Matters: Despite its challenges, providing feedback is essential. Avoiding it can lead to decreased morale, reduced productivity, and increased stress among team members. 

Remember, effective management during transitions directly impacts overall success. By implementing these strategies, you’ll lead your dental practice through change more smoothly. 

Phase One: The Ending Zone 

In the first phase of change, you are saying goodbye to the old and how people either individually or as a whole identify with the familiarity of it. People may experience denial, numbness, or resistance. The way each person feels and copes is likely to vary. 

It might feel like a significant loss to someone, so it is important that the leader understands how many people are affected at varying degrees of uncertainty and resentment due to the “loss” of what is no longer. Uncertainty and resentment create an environment in which team members may expend energy but not get much done.  

Recognize that this will be a time of loss and grieving for most. The key element that has the biggest positive impact is communication. I have walked several practices through ownership changes. One of them was a privately owned practice that was being acquired by a very prominent corporation. The initial response and reactions from the team members ranged from denial and numbness to resistance. Some employees who had been there the longest felt betrayed. These reactions varied from day to day, and week to week. What helped was constant communication. 

Before a change starts to happen, before the team sees signs of a transition coming, it is important to start communicating why and the transition that is likely to occur. Making employees feel secure and hopeful will reduce uncertainty and resentment. The more certainty you can give them about what will transpire and the future benefits they can expect the easier everyone will move forward, being productive and carrying forward the positive relationships you have invested in over the years. 

Strategies for Managing this Phase 

1. Explain the rationale for the change and the benefits of it. If you are able, elaborate for each team member or department. There needs to be a venue to express concerns or gain support to bring about the closure. People need to know that you care about them as individuals. 

1. Be transparent. Describe in detail what will change and also what will remain the same. Transparency is vital to cultivate trust. 

1. Describe and celebrate the success and values of the previous ways of working and identify how they will be enhanced by the change. 

As long as we, the leaders, recognize their feelings, we have the opportunity to effectively help our team move to the next phase, so they do not stay in the ending zone too long. 

By Mary Osborne, RDH 

How much time do you schedule for a new patient, non-emergency visit? Is your priority efficiency or effectiveness? Is your goal to gather as much clinical data as possible, or is it to begin to build a relationship of mutual trust? Both are possible if you see the new patient visit as more of a process than an event.   

Too often new patients are rushed through an assembly line: brief conversation, clinical exam, diagnostic records, and treatment presentation! Is that really the best way to help people make choices about their health?  

There is no one right way to schedule a new patient. Different practices are successful with different models based on the values of the practice, practice growth, and the personality and skills of doctors and team members. The most important determinant of success is our ability to meet each patient where they are and join them on a journey to health. I am not suggesting we should be without practice standards of care.  We have a responsibility to decide what we need before beginning treatment. Our challenge is to guide patients to understanding why we need what we need, and why that is relevant to their unique situation.   

We may anticipate that patients will resist this type of experience, but if we make it truly about the patient and are flexible, I have found that patients are more than willing to participate in an individualized process that best meets their temperament and circumstances. 

I remember seeing a new patient that I was told was a “very busy attorney” because his secretary said so when she made the appointment and his wife said so when she confirmed the appointment. I anticipated that he would be a driver and prepared to efficiently move him through his appointment.  

As I explored his health history with him he expanded on the specific answers to questions. Soon, he was leading the conversation. When I remarked that I wanted to make sure we were making good use of his time. He said, “Mary, what’s this about time?” I replied that I knew he was very busy. He said, “Mary, this is about me. I have time for me.” 

His statement has stayed with me because I realized that if the conversation had been about me going through my check list and not listening to him, it would not have been a worthwhile experience for him. It also wouldn’t have been a worthwhile experience for me. 

I have learned that when the patient feels in control of the process they are willing to give that time to themselves. A lot of aha moments occur as they learn about themselves while speaking. When patients feel like they are on an assembly line being moved through our system, they have every right to be resistant.  

Empowering patients to lead the process is both an attitude and a learnable skill. When we can lose ourselves in the moment, really listen, really encourage, and really care about the patient’s thoughts and feelings, it is easy to make connections to the next step we recommend.  It is my experience that I can more quickly become a trusted health advisor when I intentionally share control with my patient. 

Most patients are willing to invest more time in the process when they see the connection between their needs and what we recommend.  These are typically patients who have or have had complex health issues and are seeking to improve and retain health. They perceive the value of the extended process and how much value you place on spending in-depth time with them.  

The entire team’s communication can deliver the message that everyone in the practice is keenly interested in them, and their appointment is uniquely planned to meet their needs.  

What has been your experience? Are you open to scheduling more time for conversations that typically garner trust and appreciation earlier in the relationship? 

By Mary Osborne, RDH  

The questions we ask on a health history form have more to do with disease history than health history, right? The focus is on disease right away. I like to shift that focus to health by saying, “I see that you’ve filled out this history and I’d like to talk to you about specifics, but I wonder if we can begin by you telling me a bit about your health in general? How healthy do you think you are?”  

I have found that if I start with health, I’m more likely to have a patient talk about health. If a patient says, “I think I’m pretty healthy,” I can ask, “What do you do to take care of yourself?” I can relate by acknowledging that I am trying to take better care of myself and how it isn’t always easy. Or I can pick up on something that is important to the patient, such as a concerted effort to get enough sleep or stick to healthier foods or to bicycle many miles a week. I can say, “Tell me more about that. It sounds like you feel better when you do that.”   

The questions you ask shape the conversation. And by the way, that does not just apply to reviewing a health history with new patients. It applies to every single interaction, with every single patient, with everyone on the team.   

When someone comes for their routine hygiene check, I might ask about their recent vacation or how their kids are doing, but I also always ask questions that open a conversation about health. Instead of starting with, “Have there been any changes in your health history since I last saw you?” I like to ask, “How has your health been since I last saw you?” Instead of asking, “Have there been any dental problems that you want us to pay attention to,” I ask, “What have you been noticing about your teeth recently? What are you noticing when you brush or when you floss?”  

We have to deal with disease. That’s a part of our job but moving toward health is more enriching. It’s positive.   

If you want to be seen as a partner in health, then moving the conversation in the direction of health is much more powerful than focusing on disease. The truth is everyone has a personal health story. There are things they are happy about and things they are sad about. When we take a little time to explore that story with questions, we and our patient gain insight into their experiences, attitudes, and feelings about their health. We and our patient get a better understanding of their motivations and the strategies they employ to become healthier. If we invite them to share their perspective with us, they will be more willing to hear our perspective, and we can extend an invitation: “Would you like to hear my perspective about that?”  

I recognize that inviting and engaging the patient in expanded conversations about their health may take a little more time, but it is effective time. Over the years, I noticed that when I thought I was being most efficient, I was generally being less effective. And in the long run, I ended up spending more time understanding what the problem was and trying to give more information without getting enough feedback to know if I was being heard or influencing the patient.   

One of my favorite things to hear from a patient is “You know, I never thought about that before.” I remember a woman who told me that she had been a smoker, but she had quit smoking. And I asked her how she did that. What prompted her? She said it was when her daughter was born that she realized that she didn’t want the smoke around her daughter. In her health review and preclinical conversation, she mentioned one of the things she did for exercise was tap dancing lessons, so I asked her how she got into that, and she said, “I figured I could spend time with my daughter, get exercise myself, and set a good example for my daughter. Wow, I guess my daughter is really a good influence on my health, isn’t she?” 

Those are the light bulb moments that light up my day.