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. 

Cogito, ergo sum is a philosophical proposition developed by René Descartes translated as “I think, therefore I am.” The proposition went on to become a fundamental element of a developing secular Western philosophy. Descartes asserted that the very act of doubting our own existence served as proof that we exist. 

But that’s pretty thin gruel.  

I believe Descartes got it backwards. I contend that he should have said, “I am, therefore I think.” Each of us has been given an amazing gift. In fact, we’ve been given many gifts such as life itself, but I am referring to the gift of thought and contemplation. And it’s a gift which can either “make us” or paralyze us into a state of inaction and failure. 

Success in practice today comes down to one thing and one thing only. Those of us who master the ability to think and solve problems quickly and efficiently with foresight will ultimately win the game, set, and match. The rest will be marginalized, consumed, controlled, oppressed, and limited by third parties. 

Our brains work like an executive committee of three members, each with its own primary purpose, which either work in harmony to achieve great things or which work at counter-purposes on a level that is counter-productive or even self-destructive. 

Our executive committee is made up of: 

1. A primal “reptilian” brain which is focused on very basic functions and maintenance.  
2. A rapid pre-cognitive information gathering, analysis, and response system designed for the purpose of self-preservation, known as the limbic system. 
3. A super-computer information processing system that can take new and stored information, reorganize it and then CREATE things like the Declaration of Independence or the Toccata and Fugue in D minor. It’s called our “prefrontal cortex.” It’s our brain’s CEO. 

How well we are able to coordinate these three aspects of our mind largely defines our future. And that coordination is only possible when we are clear about our central purpose in life and practice. Have you become clear about who you are…what you want for yourself…what you want for others? What are the sacrifices you are willing to make to achieve them? And how will others benefit from it all? These are the kinds of questions that help keep our executive committee on the right course, allowing it to be adaptable, as well as progressive in a rapidly changing marketplace. 

L.D. Pankey taught us that creating a written practice philosophy was the most important step in building the practice of our dreams. Why? Because it puts our executive committee on-task and keeps it there.   

“I think, therefore I am,” or “I am, therefore I think?” Understanding the distinction and leveraging it will make all the difference in the world. 

Positive psychology and dentistry are closely linked, especially for professionals who own their own practices. Human beings are all too good at focusing on what’s going wrong at any given moment. But the key to experiencing maximum success is determining what’s going right, and how to take full advantage of those strengths. 

What’s the tie in with dentistry? Dental patients come in all stripes and shapes, and the success of dentistry is dependent upon understanding people and strategies for dealing with what happens in your practice and personal life. During my study of positive psychology, I focused on: 

• Understanding how and why people tick from studies on human behavior and how the brain and body are wired. I thought a lot about the implications for my practice of dentistry and personal pursuits. 
• How to effectively communicate with and lead/teach others. 
• Research-based tools for interacting with people from a variety of backgrounds and experiences 
• Understanding happiness through personal fitness, gratitude, cultivating relationships, mindfulness, and savoring what is going right. 

During my study, I found my personal happiness was increasing through greater feelings of personal and professional success, improved physical health, and stronger social networks. So much so, that I proceeded to earn a Certificate in Applied Positive Psychology (CAPP). Having Type 2 Diabetes and having experienced significant treatment for cancer, living my life in the healthiest way I can physically, mentally, spiritually and socially has become of increasing importance, not for my career aspirations alone, but for me personally. I believe all four of these aspects of life go hand in hand for total wellness–and a life well-lived. 

Beyond Positive Psychology 

As many of you know, reading is one of my favorite pastimes, and I do it with alacrity and joy every day. Studies from the fields of positive psychology and emotional intelligence played heavily into my reading throughout my career, and lately, I have been immersed in studying the philosophy of Stoicism which, when rolled over with the above, has naturally taken my passion beyond the soft skills (behavioral skills) of life to a philosophy of “total wellness.”  

This philosophy and enjoyment of it have made my transition from practice to a “retirement” life outside of practice an enlightening and wonderful experience. I have not left Dentistry in total, because I have a lot more to share and say that I will be writing about in the future.  

For Every Problem…a Spiritual Answer 

Wayne Dyer used to say, “For every problem, there is a spiritual answer.” Now that I am retired with much more time to think about my practice, aging, longevity, and philosophy—and when I see young dentists online writing about their issues and problems, I am more convinced than ever that the answers lie in philosophy. And so, it has come to pass that all roads of my life have led back to philosophy, since my first consideration of it, when I began The Pankey Institute continuum almost 30 years ago.  

With a few exceptions, The Pankey Institute being a major one, the dental community continues to undervalue and neglect the role of philosophy in being the best health care provider and wellness influencer one can be. The fields of positive psychology, emotional intelligence, and success in dentistry are undeniably linked. There is scientific evidence to support this. Your philosophy of life and practice (or lack of this) impacts how you go through life and your career, how your life influences others, what you achieve, and how well you feel about the life you are living. To me, the fields of psychology, dentistry, and philosophy are inextricably linked. I’ll write more on this later. 

Fifteen years after graduating from dental school I was searching for answers.

I barely knew what questions to ask because there was no guidebook to learning how to practice dentistry and live the life I imagined. I read every book including Juggling for Dummies. Then I stumbled across The Pankey Institute, and I knew my search was over. Back then the program consisted of five continuums. At C1, I was lucky enough to meet Dr. William Davis, the co-author of the then recently published book A Philosophy of the Practice of Dentistry, with Dr. L.D. Pankey.

At the end of classes one day, I stayed behind to talk with “Bill” about philosophy.

I always had an interest in philosophy, but Bill discussed how Dr. Pankey applied philosophy to a dental practice. We spoke into the evening and through the week. I told him that this philosophy sounded a lot like a garden variety of personal development. It was loaded with quotes from Napoleon Hill and Dale Carnegie, yet I felt there was more to it; after all, Pankey had studied “real” Aristotelian philosophy at Northwestern University.

I was never satisfied with the explanation of the philosophy consisting of the graphical “Pankey Crosses.”

From that week on I took my studies deeper. My search for answers continued, but now I was on a path. I realized that if I was going to apply philosophy to my practice it required behavioral changes. The Pankey Philosophy was more than a moral philosophy which is projected and leads to judgements about the way others do dentistry. I realized that this philosophy was a personal and practical philosophy which was designed to direct my own behavior.

The examination process became very important to me, because by continually perfecting it, I could focus on my behavior and the changes it made. Those personal changes lead to more success and more enjoyment. Slowly I began to appreciate dentistry. I focused on the “apply your knowledge” arm of Dr. Pankey’s Cross of Dentistry. Then, while taking courses in positive psychology, I realized that in order to make real changes I would have to focus on my “character strengths and virtues.”

“Dr. Pankey and the Greek philosophers used the word virtues.”

Dr. Pankey and the Greek philosophers used the word virtues. I never truly knew what that meant. Somewhere I read that a virtue is a habit of the mind that is consistent with nature and reason. It can be argued that when L.D. Pankey spoke about care, skill, and judgement, he was speaking about virtues. Not surprisingly the positive psychologists have written about character strengths and virtues.

They have defined twenty-four separate strengths divided into six virtues: wisdom/knowledge, courage, humanity, justice, temperance, and transcendence.

By studying these strengths and virtues and working them into my daily habits, a funny thing happened. Not only did I become a better dentist, but I became a better leader for the first time in my practice. Leadership was the answer I was searching for, and character was the answer to leadership. It has been a long and worthwhile journey that may have ended differently without understanding Dr. Pankey’s philosophy was a personal and practical philosophy that had real meaning for my life.

When asked about The Pankey Philosophy, L.D. Pankey famously responded, “What do you mean when you ask me about The Pankey Philosophy? I am not familiar with the document, although I do recall writing an essay entitled A Philosophy of Dentistry by L.D. Pankey.”

Most dentists are comfortable acknowledging that L.D. Pankey was a great philosopher and that he was the first well-known philosopher in dentistry, but most dentists don’t think of themselves in a similar fashion; rather they like to think of themselves as being prototypes of practicality. This is why most dentists never even think about the value of writing a Philosophy Statement.

Just what is a philosophy statement?

A philosophy statement is a statement of core beliefs, and a validated philosophy is a philosophy statement which has been affirmed through its frequent use, reference, and revision. It is, therefore, a living creed around which a person or group of people live their lives.

A great example of a validated philosophy statement was how Wilson Southam and the Group at Cox operated a number of years ago. Cox was a progressive dental equipment designer and manufacturer located in Stony Creek, Ontario. Wilson Southam was an investor, a co-owner, as well as the philosophical leader of the company. Cox had developed a philosophy around which all of its equipment would be designed – a concept is called, “the computerized dental cockpit,” fashioned similarly to how a fighter pilot might operate. And Cox preferred to sell its equipment to only those who understood its philosophy…only to those who understood the “why” behind the “how” and the “what.” Cox believed in this so strongly that it held workshops centered around its philosophy at Stony Creek.

A philosophy statement can also be called a “core beliefs statement.” A good example of a philosophy statement is the Nicene Creed, co-authored after the center of the Roman Catholic Empire was moved from Rome to Constantinople. At that time, Christianity was in a fractured state, with many different sects, and with many different belief systems. The Nicene Creed was co-created by the Roman Catholic leadership with the intention of having it function as a unifying document around which everyone could agree, so that the church could again move forward.  It states, “We believe…. We believe.”

It’s a well thought out basis for behavior.

So, a philosophy statement represents a statement of beliefs, which is so basic and so fundamental that it provides a rational and comfortable basis for you and your care team to determine what it is that each member of a care team should do, as well as what they should choose not to do.

William James was a physician who lectured at Harvard in the late 1800s on Philosophy and Psychology. He is considered to be America’s first psychologist and was thought of as a “pragmatic philosopher.”  In this regard, James said, “There is nothing more practical than having a personal philosophy.” In the case of dentistry, an applied philosophy (validated philosophy) is practical as well, as it naturally leads to an organically-driven team, deep in mission, and high levels of personal autonomy and interpersonal trust.

A philosophically-aligned team is essential for the creation of a philosophically-driven community.

Barkley a year or so before his untimely death in 1977, said during an interview with Avrom King said: “If I had one wish that could be granted, it would be that every dentist would take the time to create a written philosophy statement.” Let’s talk about why Bob would make such a statement.

The creation of a relationship-based/health-centered practice is a perfect example of the creation of a philosophically-driven community, with the word community being used as a reference not only to the creation of a care team, but also to the patients of a practice, its associated suppliers, mentors, and facilitators. All of the members of this community are philosophically aligned through either careful selection, development, or both.

A community of this type begins with the creation of a care team which has co-authored a written statement of philosophy. This is because you cannot have a true health-centered dental practice without a philosophically-aligned care team which listens well, are true helpers, and who facilitate healing in each other, as well in those with whom they come in contact. One or two people acting alone, simply cannot apply a practice philosophy as others, who are in contact with patients, will create too much confusion and mixed messages in the minds of the patients.

A personal philosophy statement starts the ball rolling.

The dentist might begin the process of thinking through a personal philosophy statement by answering these questions:

1. Who am I? (What are my values and core beliefs?)
2. Who do I want to become? (How do I want to see my life unfold?)
3. Why do I feel this way? (What is my personal purpose in this life?)

To develop your philosophy-driven community (care team, patients, suppliers, mentors and facilitators) the dentist next shares his or her personal philosophy with care team members and leads them in co-authoring a practice philosophy statement.

Remember: A philosophy statement is a statement of core beliefs, and a validated philosophy is a philosophy statement which has been affirmed through its frequent use, reference, and revision. It is, therefore, a living creed around which a person or group of people live their lives.

A co-authored and applied practice philosophy statement produces multiple benefits.

Here are four concrete benefits of co-creating a written group philosophy statement with your care team:

1. It will establish a standard of behavior for everyone to live up to and aspire towards.
2. It will allow for that standard of behavior to be used in a situationally appropriate fashion, and therefore not be used dogmatically, as everyone recognizes that every person and every situation is unique.
3. It will function as a centripetal force…as a kind of principle-centered psycho-social glue which will hold the care team together during times of change and challenge.
4. It will function as the foundational document out of which a practice vision (where are we going long-term) and a mission statement (how we will get it done) can evolve.

Once you want to be a leader and you know yourself well enough, you’re ready to move on to helping others effectively. We have already taken a look at the first two parts of Dr. Rich Green’s leadership definition:

“A leader is a person…

Willing and Able

To influence behavior;

Their OWN FIRST

Then others

To a preferred future.”

-Rich Green, DDS

Leading Others

Building on our willingness and ability to influence behavior (our own first), now we will talk about leading others. It is by leading ourselves well that we “earn the right” and have the highest capacity to lead others.

I’m going to use the four essential areas I discussed in the previous blog as a framework for discussing our leadership of others.

Let me start by saying that we can train someone to assist us or do a great job greeting our patients, or to do stellar financial arrangements, etc. But when we hire, what we really want to look for is someone who has similar values and is inspired by our vision and purpose.

If we are clear about our own values, vision, and purpose/mission, which means we have done our own work to get clear, we will know if our prospective employees are a good fit by asking questions.

If we already have employees and are in transition, meaning we are changing our practice and/or doing work to get more clear on our values (what the practice is about and where we’re headed), we have an opportunity to be in constant conversation with those around us.

The people around us – in this case our team, specialists, lab technicians, and patients – want to know what we believe in and what we stand for. People are hungry for connection on that level.  

Influencing Others

Now let’s look at the four areas I discussed previously and how they help us in our ability to influence others:

1. Our competency and skills.

What we are doing and how we are doing it models for our team what we expect and what we are about. When our team feels competent and skilled, they feel confident and pleased about the quality of their work.

Especially in a high level practice, taking our team to CE and taking the time to work with them on their technical skills as well as communication skills is vital to their success. Most of us know this and probably do this pretty well already.

2. Knowing how we are wired helps us understand how others are wired.

The patterns, beliefs, and behaviors are not the same, but knowing that we have all been programmed and that this is part of the human condition helps us have compassion and a deeper understanding of how people tick.

Remember, most of this programming we were either born with or was “installed” from 0-7. In some way, even if it doesn’t make sense, we all do what we do in order to feel safe, loved, competent, and a sense of belonging. Knowing this gives us compassion for why people do what they do. 

3. Emotions

Being able to be with our own emotions allows others to be with theirs. As we model this and help our team learn it, they will increase their capacity to be with their own emotions and those of others.

Empathy is one of the most important skills to have as a healthcare provider. We have the opportunity to be the leader of this in our practice and in our life. When we work with humans, we work with their emotions and experiences (whether we like it or not).

4. Knowing and owning our truth.

This is an empowered and empowering place to stand. When we own and are clear about our truth, our desires, what we stand for, and what we are about, we can lovingly set boundaries and make clear decisions.

This also helps us honor others as they stand for what they believe. Once we are clear about these things for ourselves, we have an opportunity to share them with our team so that we are all moving toward the same preferred future, which we’ll talk about in the next blog.

Stay tuned …  

After building my dental practice from scratch, my work life began to get more and more intense. I knew I had to slow down, but I didn’t know how until I decided to take a leap of faith and visit the Pankey Institute.

Creating a Work Life Vision at Pankey

At Essentials One, I was blown away by the faculty to student ratio. It was almost 1:1! The quality of the education was outstanding, but what I found most impressive was the encouragement, mentorship, and passion from all the faculty and staff.

Pankey taught me how to help my patients value dentistry, develop communication skills, and learn co-diagnosis. Most importantly, Pankey helped me create a vision of what I always knew I wanted — a low volume fee for service practice that allowed me to have a good family-work life balance.  

Returning to My Dental Practice Recharged

When I came back home from Essentials 1, I immediately stopped working six days a week. I started some training exercises with my team to show them what my vision was.

One month later, I went out of network with my first insurance plan. This plan was one of my biggest — it made up 25% of my patient base, but I was determined. Six months later, I evaluated our progress. We did not lose a single patient and our revenues had actually doubled. When I saw this, I went out of network with six more plans immediately. We were on a mission.

Today, two years after Essentials 1, I am only in network with one remaining plan. Our practice has continued to grow. We have worked less hours, seen almost half as many patients per day, and our practice revenues have increased.

Additionally, I have also taken more time off every year and taken more continuing education than I have in the past. My team continues to be excited in our journey together to achieving our professional and personal goals.  

My story is nothing special. I truly believe anybody can develop the clinical, leadership, and communication skills to create a successful relationship-based practice. For me, the Pankey Institute provided all the resources I needed. Pankey has changed my life. I hope to give back one day. 

What’s your dental practice story? Join the conversation in the comments! 

Five years ago, I started a dental practice from scratch. Brand new building, brand new equipment, zero patients, and zero cash flow.

Building a Brand New Dental Practice

We were in a network with over 15 insurance plans, opened early mornings, and stayed open until late evenings — our patient base grew quickly. After two years, I found myself still working the same long hours, attempting to accommodate as many patients as I could.

I was working at my own practice three days a week and at another practice the other three days. I was totaling six days a week! I always valued continuing education, but my schedule only allowed for online education on the weekends or the “slow days” during the week.  

Burning Out or Slowing Down

As my own practice got busier, I found myself doing over 30 hygiene exams a day, along with seeing 12-15 restorative patients per day. I was jumping room to room nonstop. I started to realize I would not be able to keep up this pace forever. Something had to change.  

I had conversations with my team about going out of network with some insurance plans. The feedback I got from them was, “I think we will lose a lot of patients. Our patients are all insurance driven.” As a result, we kept “grinding it out.”

Shortly after, I attended a lecture by Dr. Jeff Baggett at a dental conference in town. When I saw his dentistry and his enthusiasm for dentistry, I thought to myself, “Man, I wish I was that enthusiastic.” I loved what I do, but I didn’t see myself going down a very good career path in dentistry.

I kept in touch with Jeff after the conference and he convinced me to go to the Pankey Institute. I was hesitant at first due to the time I would have to take away from work. Eventually, I took a leap of faith and signed up for Pankey Essentials 1 (E1).

To be continued…

Clinical competence is a requirement of a successful practice. If people are going to seek you out rather than just going to someone who is contracted with their benefit provider, they need a reason. Clinical results are clearly one of those reasons.

Leadership Through Knowing Your Work

That being said, how well do you know your work? How well does your team know their work? Do the specialists and technicians that you work with make you better? Becoming highly competent in clinical dentistry begins with a decision. Have you made it?

If you have, are you maintaining that decision in the midst of all the resistance that you encounter as you try? Leadership, at its core, is about making a decision and maintaining that decision in the midst of pressure to do otherwise. Your clinical competence begins with a decision to be competent. How well it continues and develops depends on how important being highly competent is to you.

8 Complex Skills of Clinical Dentistry

Although clinical dentistry is not always complex, it requires a variety of complex skills. This includes:

1. Examination, Diagnosis, and Treatment Planning
2. Spatial Relationships & Esthetics
3. Biologic Principles
4. Local Anesthesia
5. Tooth Preparations
6. Provisionalization
7. Materials Application
8. Patient Management

You can add many more to my list. All of these skills are important in uniquely different ways. This is why continuing education and professional development in dentistry is so vital.

It is just plain difficult to develop so many skills and move them toward competence and mastery. Dentistry is both extremely rewarding and extremely demanding. So how are we going to develop competence that is moving toward mastery?

We need a plan that develops specific habits. We need the habits to serve our WHY. We need great teachers, leaders, and institutions that help us pursue the limits of our possibilities. It is a journey that never ends as long as we are given the gift of caring for another human being.

What does it mean to treatment plan your transition? It’s all about thinking strategically when it comes to the future of your career and the important relationships you will inevitably align with your goals.

Many dentists in the prime of their career decide it’s time for an associate to join the practice. Often it is because there is an overflow of patients or the senior doctor is interested in slowing down, taking more time off, and eventually planning for their retirement.   

Over the course of my career I’ve had four associates. One who took over a satellite practice I had purchased and three who moved on for various reasons. Even one who walked away from the “altar” when we had spent months planning to formalize the legal documents for a partnership.   

Lessons From a Professional Transition

What I’ve learned is that although the legal documents are important, it’s really the Core Values and Philosophy of the potential partner that form the glue capable of binding a solid long-term relationship.  

Once you have determined (usually with the help of a good practice management expert) that your business can financially support another dentist, it’s important to then reflect and put into writing the core values that are unique to you, your practice, and your philosophy of practice and life.

Share your core values with all potential associates and future partners. Make sure you are aligned in your principles and ideals. With a shared set of values you now have the blueprint for a successful future.  

I eventually found a partner to transition my practice to. It is our shared core values of Excellence, Relationships, and Balance that solidified our future and kept us on course for a successful transition.

What professional skills have you acquired over the years that have helped you throughout your career?