The Pankey Institute is the world’s oldest, most prestigious learning center for advanced dentistry. Our Traverse City, Michigan dental practice has been involved with The Pankey Institute for the last 27 years. You will often hear or read that the purpose of the Institute is to narrow the gap between what is known and what is practiced. And the unique thing about this nonprofit organization is that the faculty promote and facilitate learning around the behavioral aspects of dental care as well as the technical aspects.

The technical things we do in dentistry are transactional. Those are the clinical procedures we perform every day. But the behavioral training we receive at The Pankey Institute is truly transformational. It transforms how we approach patient care, placing focus on building relationships of trust based on genuine concern for what is in the patient’s best interest. It transforms how we thoughtfully and collaboratively lead our patients to improving their oral health. It teaches and encourages us to provide the highest standard of clinical excellence so our patients can achieve optimal oral health, comfort, and beautiful smiles.

During our years of association with The Pankey Institute, we have learned how to predictably manage and treat complex dental cases, and how to help patients who, at first, are anxious and lack trust. We’ve learned how to understand where individual patients are coming from and work from that basis to open their minds to what is possible for them and help them access fine care.

The greatest benefit of returning to the Institute for continuing education has been the total immersion that we experience at the Institute as we learn from, interact with, and are mentored and encouraged by like-minded individuals. We’re learning from some of the best dentists in the world. They’re flat-out experts in what they do. They flat-out care about their profession and want to help other dentists become the best they can be. They also want to help the dental professionals on our care teams, whether they are clinical or administrative, become more effective in their roles.

The year 1994 was the first time I attended a course at the Institute in Key Biscayne, Florida. And now I have progressed through the Pankey continuum of courses to where I am part of the visiting faculty to help teach and mentor other dentists. And, I am now the Coordinator of the Pankey Scholar Program, which is the pinnacle of the Pankey Learning Experience.

Since 1994, our dental practice in Traverse City, Michigan, has grown to be the largest “Pankey practice” in the world, and we’re proud of that because of what it means for our patients. We have a common culture here–among our five dentists and all team members, and a vision of patient-centered, comprehensive care that is easily articulated. It positively impacts our work, our lives, and our patients’ lives. It has enabled us to provide a consistently wonderful patient experience.

The Pankey Institute is the voice, the home, and the hope of private care dentistry. The Pankey Institute experience and its supportive community of learners has helped our practice thrive as a private practice that offers expertise in restorative and cosmetic dentistry, including full-mouth reconstruction, implant dentistry, and IV sedation. At Traverse Dental Associates, we are facing today’s business challenges well, we are proud to provide the finest care, and we are strongly committed to private practice.

If you are new to the Institute and I have not met you yet, please let me know. You are the life blood of our profession and may one day be a standard-bearer, if not a missionary for The Pankey Institute, the Pankey community, and everything it represents. I look forward to meeting you.

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.

It may not be this week. It may be next before you have a practice continuation plan in place and have communicated fully with your team and patients. When you do find you have some time, I encourage you to sit back and think about everything you have experienced over the last month and what new learning you have discovered. Then reach out to colleagues and talk over your learning. Continue sharing with each other throughout this time of social distancing. 

I am mindful of a quote from Carl R. Rogers: “The true wonder of learning is discovering for yourself.”  

Starting out in my career, I felt well trained technically, yet I must have subtly believed I was a “hardware” salesperson. Or, maybe it had to do with my tendency to be introverted. Whatever the reason, I found it easier to talk “hardware and technique” than to listen well and then help patients clarify their health objectives and the benefits they were seeking in their dental health care experience.  

I went to a workshop led by Carl R. Rogers titled Client-Centered Therapy. This workshop was significantly different than any of my previous educational experiences. It was a participatory experience. It took some time for me to assimilate his educational concepts into my life and practice, and I noticed right off that I had retained more from a workshop experience and could apply my understanding of what I had learned. When I returned to my office, I attempted to create a participatory learning experience for my patients. I learned from these early attempts more about learning and witnessed behavioral changes in myself and my patients.  

I sought out many other workshops at this time in my life. One was Parent Effectiveness Training, facilitated by a local devotee of Dr. Thomas Gordon. Then, I became reacquainted with Dr. Karl Olson, the retired President of North Park University where I had done my undergraduate schooling prior to going to Northwestern University Dental School.  

Olson had joined forces with Bruce Larson and Heidi Frost of Faith-At-Work and created The Leadership Training Institute, which focused on discovering your leadership potential through three separate weeks of “experiential learning.” The first week was focused on Know Yourself, the second-week focus was Know Yourself in a Small Group, and the third-week experience was focused on Designing Small Group Experiences for Others. Each of these three weeks was separated by six months of intentional application and reflection, which created a powerful learning period of discovering myself.  

From my point of view, there is nothing more rewarding than a learning experience in which one can become aware of one’s own learning in “the moment” or upon reflection. So, now that you have been thrust into participating in Knowing Yourself, your practice, your team, and your patients on a new level where there is a concern for everyone’s safety and wellbeing on an elevated scale take time to reflect on what you learned in “special moments” of the past month.  

Are any of your discoveries blog-worthy to stay in communication with your patients? They will appreciate your personal “touch.” 

Making a comment in response to this blog is one way you can encourage a “continuing conversation” of Pankey participants’ “new awarenesses.” 

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.

Like many aspiring students on a track toward dental school, I studied Latin with the hope that someday my understanding of Latin root word forms would translate into a greater value to me as a dentist.

That day never really came as an obvious epiphany, but rather as thousands of subtle moments later while reading, listening, or learning.

Not Your Standard Definition…

And it also came the day when that I started to attend The Pankey Institute and saw the tag line was “quid pro quo,” and it confused me. It confused me because all standard definitions of quid pro quo sound transactional – something is given or taken in return for something else, so it did not line up with the Institute’s preferred definition: “Give before receiving,” which has a much different tone…a much different intention.

Even today, due to my Latin training when I see “quid pro quo,” I have to stop myself and insert the Pankey definition when thinking about my profession. And I would argue that it is deeply important that we all do so, because viewing dentistry primarily as a transactional business is to devalue it down to a highly skilled trade. And this totally neglects the spiritual and more holistic aspects of our work which are the true source of joy, fulfillment, and meaning over long careers – a lesson Dr. Pankey routinely taught.

The Pankey Institute’s definition of quid pro quo is more aligned with words like Scott Peck’s “love” (selflessly giving to another with the sole agenda of helping them to grow and to become healthier and more fully functioning). The Institute’s definition is more aligned with trust and investing…investing in the sense that we believe that if we selflessly facilitate in others’ greater self-knowledge, self-understanding, and personal empowerment, they will reciprocate by gifting us an opportunity to help them achieve their goals.

What is the quid? What is the quo?

In other words, we offer our true and sincere caring as the “quid,” and if done in the right way, at the right time, with the right person we get the “quo” in return, as a reward experienced as a new trusting and deeply helpful relationship which yields respect, admiration, and appreciation in an ongoing fashion.

We get emotional confirmation in return. As dentists serving patients in our professional capacity, we get proper financial compensation in return as a SYMBOL of how much the person values the relationship and what it has brought into their life.

“Because I care.”

In a recent sermon, our minister said: “The summons for us as people of God…those who are called to be full of compassion, mercy, and love, is to live in such a way that people ask ‘Why’? Why do you feed me? Why do you clothe me? Why do you visit me when I am sick? Why do you do these things for me? And our response will be, simply, because I care…because I love you.”

Quid pro quo…THAT is what it means to me.