A great doctor-patient relationship is the key to delivering quality care. The ideal model to help people move toward optimal oral health is based on a behavioral approach that we can use every day. This approach is allowing the patient to drive outcomes.

An illustrative example:

There is a stark difference in a patient’s emotional response between being told, “You need a filling,” and saying, “You have decay in your tooth. How would you like us to address that?”

The principles of this approach are not difficult.

1. You need to honestly commit to always placing the best interest of the patient first. You cannot fake this. All of us know when others are not sincere.
2. Letting the patient drive the outcomes is a habit developed from committing to this approach and intentionally choosing your words to put the ball in your patient’s hands, then waiting for their response and listening well to clearly understand the outcome desired by the patient.
3. Is the outcome congruent with your philosophy and standard of care? Does the patient need more information and time to come to an understanding of what is in their best health interest? How might you lead them there? Most folks really do want the best for themselves and their family. They will make good decisions if we provide the proper environment and education.
4. You, the patient, and your team must be comfortable with the means necessary to get to the outcome desired. Both you and the patient must be comfortable with the time, energy and dollars involved in reaching a mutually agreed upon goal. A key element in eliminating stress and dependence on insurance, is painting the picture for your patient that they are in control of the outcome–not their insurance company. You and the patient have the patient’s best interest at heart, not a third party. I say this again. You are working on behalf of your patient, and with this approach, they are in control, not an insurance company.

Does this approach take more time and effort up front? Yes. However, once you adopt this approach you will be forever glad you did. Patients who enter your practice through this system will value you, your staff, and your care. They will commit to more and better dentistry and pay with gratitude. You and your staff will have lower stress and more fun because you are dealing with people you understand at a deeper level. Long-term, these people will refer new clients just like them.

I didn’t invent this model. I learned it from great mentors like L. D. Pankey and half a century of folks participating in The Pankey Institute and passing forward the priceless and timeless value of this approach.

Mentorship from the Institute will help you on your way to long-term success as a thriving dentist. As my colleague Dr. Barry F. Polansky often writes, “Mastery in dentistry is a continuous journey.” It’s a lifetime of learning, practicing, and reflection that enables us to more easily and fully transform the health of others who present themselves for our care. The journey, itself, propels us forward into greater and greater connection with our patients and our true selves.

Pankey Institute mentoring and encouragement made all the difference in my life and the lives of countless others. When I try to sum up the dental professionals and patients this “approach” has positively impacted, I get lost in counting the millions we have touched as a community dedicated to putting the dental patient’s best interest first.

I have spent the last 27 years developing my abilities to restore patients to the dental health they desire. One of my favorite aspects of dentistry is creating a customized plan to help patients achieve their dental health goals, and I do this by hearing each patient’s story, so I not only see the care they need but know the person that needs it. I look forward to that challenge with every patient I see.

Let me share with you my routine for setting the stage at every dental visit for a successful interaction. As I come into the room, the patient is sitting up in the dental chair, and I sit down in front of them knee to knee. Then I say, “Tell me how you feel about today’s appointment,” or “Tell me what questions you have about what we are doing today.”

This does two things:

1. It sets the stage for “I am here for you as your friend and doctor.”
2. It prepares me to be present with them. I get to hear where they are before we start that appointment.

Once we establish what they are thinking and feeling, I ask their permission to lean back the chair. It signals that I am ready to initiate the procedure.

This routine gives them comfort, and when the procedure is done, I can sit them up and basically go through the same two questions: “How do you feel about today’s appointment? What questions do you have moving forward?”

Before and after every procedure, there is intentional time in which we are in relationship. I have found this to be very beneficial in how we move forward with patients. A very small amount of time and intention helps optimize each patient’s time with me, and I believe is a key to the success of my practice.

For support organizations and dental service organizations (DSOs) to scale, they focus on developing a branding patient experience and a predictably profitable business model. They seek to maximize:

• efficiency while serving the needs of consumers,
• provide a wonderful patient experience, and
• increase both their top and bottom financial lines.

Dentists who have chosen the private practice way of life may want to reflect on the following 12 things DSOs strive to do in 2022, and then apply these tactics to their own business model. These tactics have been among the top topics of conversation at DSO meetings in 2021 and 2022 and will sound familiar to those who follow The Pankey Institute. Why familiar? Because they are top topics also discussed among private practitioners and many are addressed within the Pankey Institute curriculum.

1.Monitor more aspects of your clinical and business operations to determine what is working well and what problems need solving. Then solve the problems as rapidly as you can. As the practice leader, open your eyes and ears, and lead.

2. Track key performance indicators and seek growth in those KPIs.

3. Cultivate a positive practice culture and work environment in which employees want to work and patients want to visit. Team members should constantly check in with each other to communicate what is happening “now” and intentionally tune their senses to know how they can help one another. The goal is both a wonderful patient experience and a wonderful team experience.

4. Design systems and protocols with intention, follow them, and assess them for improvement. Make sure team members understand the Whys.

5. Invest in training your clinical and business teams. Especially important in the last two years are to:

• • Realize the potential of each team member and affirm they are valuable to the practice.
  • Educate clinical and front office teams in how to best engage and support patients with special attention to facilitating the treatments patients need. DSOs have targeted implant treatment and doctor-supervised, clear aligner orthodontics as two niches to focus their education efforts on with staff and patients.
  • Educate front office team members in how to appropriately maximize lead conversion, so the cost of expensive digital marketing can be contained. With increased new patient acquisition, reserve more time on the schedule for new patient appointments. In 2022, if new patients must wait, they tend to go elsewhere.

6. Maximize clinical technology to improve the patient experience and increase the efficiency and accuracy of clinical records, diagnosis, treatment planning, dental lab communication, and manufacturing.

7. Maximize practice management technology to improve the patient experience and increase the efficiency and accuracy of business operations, for example, AI enhanced software that automates billing and online collections or reviews insurance claims for accuracy prior to submission.

8. Migrate to a Cloud-based PMS system to ensure the security of your data.

9. Block schedule to do more procedures in a single visit. Patients and clinicians benefit from this efficiency. Maximize spaces in the visit—as you transition from one procedure to another, to enhance relationships with conversation.

10. Deploy a dental assistant to assist in hygiene, for example, to help clean and turnaround hygiene operatories between hygiene patients. This way, the hygienist’s relationship time with patients is not shortened or eliminated in the race to meet clinical demand.

11. Ensure adequate front desk coverage, so there is always time for those personable conversations that ideally occur when each patient arrives and leaves their appointment. Manage your human resources so almost all phone calls are answered live during business hours by a receptionist well versed in optimal conversation with dental patients.

12. Frequently ask, “What is our branding patient experience? What can we do better to meet the desires and needs of our existing patients and the prospective patients we target?”

Looking at this list, I can’t help but think that Dr. L.D. Pankey would smile. Just because you don’t have a corporate support organization helping you run your business doesn’t mean you can’t do these things on a smaller scale and possibly do them better.

More dental leaders are blogging on the subject of leading dental patients to improved health by learning what is important to them. Often, the next words we read are “We need to meet patients where they are.” What exactly does that mean???

To me, this doesn’t mean we meet expectations of low cost, faster care, with immediate results. This doesn’t mean we make promises that all their dental needs are met for the next six to twelve months. It doesn’t me the therapy we provide will solve an incipient or chronic problem for life. It doesn’t mean their insurance coverage dictates the value of the care we deliver. It doesn’t mean we are going to open our office after hours or on the weekend because that’s what someone wants. It doesn’t mean we guarantee a crown or veneers will last and never need to be replaced.

To me, this means understanding the individual patient, not patients (plural) as a population with trending, new expectations in 2022. It means focusing on the things each person thinks are important and relevant to their lives…where their priorities lie. Then, we can attempt to strategically tie what they value to their dental health to help them make a connection to a preferred future self. Most people, it seems, are unable to make these connections on their own.

Two Big Questions We Ask Ourselves

What do our oral health findings–ideally uncovered during a co-discovery exam, mean to a particular person? If our findings don’t have meaning to the patient, how can we possibly motivate the patient to take action? All of us struggle with these types of questions because we can’t force our values, our philosophy of oral health on others.

We can, however, create opportunities to reveal a pre-existing, unrealized value of health the patient has. If we find the patient is not health-centered, we can triage that person appropriately so we spend most of our time with patients who are health-centered.

“Revealing” Unrecognized Value Takes Time

Early in my career, I thought I could educate my patients to see the value of oral health the way I saw it. I found I was often knocking my head against the wall. Some people just didn’t value it. They wanted help when they were in pain, but preventing dental deterioration wasn’t something they felt needed immediate action. Moving forward with treatment was not on their personal agenda.

Gradually, as I read Bob Barkley, L.D. Pankey, Nate Kohn, Jr., and others, I realized they had gone through a discovery process of their own. The first task was to get to know the patient and understand the patient’s value for health and the patient’s oral health objectives. It was also to try to discover if their oral health circumstances were important to them so I could help them envision their preferred health future. But that takes time—time with each patient.

If your practice is primarily insurance dependent, you are underpaid most of the time. How do you compensate for this problem? You find ways to work faster. You find ways to see more people in a day. You delegate more. You look for a way to cut your lab technician’s salary out of your life. You buy in bulk and wake up in the middle of the night wondering why you got into dentistry in the first place.

It doesn’t have to be that way!

Many years ago, when I began spending time with new patients to learn if they are health-centered, I was able to better manage my time with them. If they valued health…if I could connect them with their dental needs on a deeper level, then spending even more time with them was well worth it.

Those who value health are the patients we can easily help understand why we take our comprehensive approach to restoring and maintaining optimal oral health.

You can be more productive per hour than you can imagine, IF you take the time to connect with patients on a deeper level and you strategically find ways to spend most of your time with people who care about their health in the first place.

L.D. Pankey wisely said, “People change, but not very much.” And that’s a critically important life lesson, one that took me years to accept because I thought my philosophy would psychologically trump theirs, and I would therefore win the day. I was wrong – very wrong.

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.

I think all dentists would agree that mutually beneficial and enjoyable relationships with patients are key to a dental practice’s long-term success. But what does that “relationship” look like in a health-centered practice?

To some, a good relationship represents two people who get along and perhaps enjoy being in each other’s company. But I would argue this is not enough to build a successful health-centered dental practice. Getting along and even enjoying the presence of another person alone doesn’t go deep enough. It only addresses good rapport, and good rapport is only the starting point of a truly helping relationship. We need more to help patients achieve optimal oral health.

The More We Need

We need shared values, shared understanding, and shared goals. And to a large degree, we also need a shared vision of a preferred future so that all the goals are oriented in a specific mutually agreed upon direction. That vision must largely originate from the patient because it is their water to carry, and not ours. We can facilitate the development of the patient’s vision, but we cannot realize it for them.

This type of relationship is often called “patient-centered” or “client-centered.” And it is only possible through mutual trust — and a lot of it at that. We must have enough trust present within the relationship to allow for open and transparent communication to occur. This type of communication is much deeper.

The Deeper Communication We Need

Communication that is deeper includes discussions around:

• concerns,
• personal challenges,
• barriers,
• fear,
• short-term agendas, and
• longer-term goals.

When a patient trusts us, they are essentially allowing themselves to be vulnerable to our actions, which could, if something went wrong, harm them physically, emotionally, and/or financially.

A first sign of trust is the willingness to have these types of discussions.

Some patients will trust us quickly because we have big capital letters after our name, but this de facto trust is becoming rare. We must EARN our patient’s trust through the quality of the relationships we build, our attitude, our philosophy, and our actions that lead to deep communication and development of shared understanding and goals.

I would argue that meaningful conversations around important issues are what distinguishes a “health-centered” or “patient-centered” dental practice from one that is an attractive and pleasant place where dental services are provided in exchange for money. A key metric to monitor in each patient record is whether the deeper discussions are taking place. A key objective is to schedule time to gently have those discussions.

Here are three tips that have helped me in organizing my practice so we can best manage same-day emergency patients and not disrupt the quality time we spend with already scheduled patients. Each of these tips enlist the help of the dental team.

Tip 1

At the morning huddle, we sit around the table, and it is the responsibility of the assistants and front desk to identify and clarify where the best spot in the schedule would be for an emergency patient. It could be a patient of record or someone who is new who has a great referral. If it is someone new without a great referral, appointing that person depends on whether it makes sense for the patients already scheduled that day.

Tip 2

Over the phone, we make sure the conversation with the emergency patient includes an important question – “How can we help you today?” In the case of a patient of record, we look at their chart and plan to address their concern that day but not over address it. Oftentimes a patient will say, “I don’t have a lot of time today. I just want to drop in and get the chipped edge smoothed and get scheduled for the restoration.” This provides us with an opportunity to slip in a short appointment to help the emergency patient and not interrupt how we are scheduled to best help our other patients that day.

Tip 3

When I walk in the operatory, I have a 3-way conversation with the dental assistant and patient. The assistant and I no longer have a conversation in the hallway that takes time, and I no longer walk into the room and have a separate conversation with the patient. In front of patient, the assistant describes the information that has been collected and the concerns of the patient. The patient can agree with, add to, or clarify what the assistant tells me. This has made us more efficient. It also spares me from walking into the room and taking over, thinking I have all the information. The 3-way conversation accelerates our ability to help the patient.

When leaves are turning red and yellow and grasses are turning shades of pink and brown, most of us start anticipating the coming holidays. It’s a season to list everything we still want to accomplish by the end of the year…and it’s also a time to think more about others.

Not everyone experiences happiness during the holidays.

It would be wonderful and remarkable if every patient in your dental practice has fond memories of the holidays and has family and friends with whom they celebrate. But proactively working year around to know your patients has provided you with glimpses into what your patients really might be feeling.

Getting to know each patient has revealed recent losses…a spouse, parent, son, or daughter. It has revealed the emotional impact of divorce, job loss, the chronic stress of work or caregiving, and then, there are a multitude of worrisome health problems.

An idea for uplifting these special patients: Mass-printed holiday greeting cards can be turned into something special that touches these patients on a deep level. Some effort needs to go into personalizing the cards with handwritten messages but the message can be as simple as, “We want you to know that we are thinking of you during this holiday season. You are someone we admire and care about.” That special touch…a small act of kind outreach can make a beautiful, memorable impression on special individuals you have come to know, think about, and may be praying for.

The entire practice team can help in listing the few dozens of patients who would benefit most from personal notes. Everyone can pitch in to write messages. Everyone can sign the cards. Social wellbeing among your team members will be elevated by creating an open afternoon on the schedule to do this as a “family” of compassionate caregivers. Add lunch or snacks to make it a team party.

Tip for a Thriving Team from Gallup’s Wellbeing at Work: Operationalize your mission. You will clearly communicate your mission of genuinely caring for patients when you demonstrate to your team that you do care by investing personal effort. Doctors, this means writing personalized messages right alongside your team—and with enthusiasm.

Many patients become hyper busy during the holidays.

Cancellations and lateness occur more frequently in December. Despite best intentions of keeping their dental appointments, some patients overbook and overextend themselves. My personal thoughts are to be patient with them and do four things.

1. If your practice is large with many patients coming through your door daily, it may not be your regular practice to make confirmation phone calls. In December, make the extra effort to follow up text messages with personal phone calls. Have team members organized to make as many calls as possible.

2. Build value for December appointments via a Happy Holidays newsletter that sparks enthusiasm for your practice. Include a digital photo of the holiday decorations in your reception area and remind your December patients that you look forward to wishing them Happy Holidays in person.

Here’s an idea: What if you were to put together oral health care gift bags for a local group home or shelter and communicate to your patients that those coming in for appointments in December will have the opportunity to put their name on a card in a gift bag? You would spread community awareness, the spirit of health, and giving back to your community as a wider dental family.

3. Update your wait list of patients who might come in on short notice. Have those names and numbers at the ready.

4. When open time occurs in your schedule, have a mindset of gratitude: “Wow, I guess we won’t feel so pushed today. We didn’t expect we would have this time to breath and catch up a little.”

Your patients want to know what to do if they have a dental problem over the holidays.

Have a clear plan that you and your team members can engage around to respond when patients have emergency or urgent needs over the holidays. Tell your patients via your media (recorded phone message, newsletter, Facebook page, website blog, etc.) what to do if a dental problem occurs. Clear communication from you tells them that you are thinking of them and want to make it easier for them to manage life’s exigencies…even during the holidays.

Here’s to a season of doing our best and thinking of others!

As a small business owner emerging from the Covid crisis, one of the issues we face is how to manage employee compensation in a fair and open manner. Are we paying our employees a fair wage for what they do in the demographic area that we live in? Often it is not possible to know what the competition is paying.

In our current job market, skilled labor knows that they can be tough negotiators. Under current National Labor Relations Act rules employees have the right to discuss wages, hours and working conditions with others. Pay discrepancies can result in potential claims of discrimination and resentment. A mix of new hires and old hands, in particular, may lead to conflict about wages.

Your Wage Budget & Scenario Analysis

One way to address this as an owner is to create a spreadsheet that establishes the range of wages you are able to pay for various positions based on your requirements and your budget. It might look something like this:

In my case, I need to know not only what I am paying and whether I am competitive to get the best talent. I also need to know how any changes will impact my overall budget. As I am considering changes in my current employee wages and what I can pay a new hire, I need to know my overall business finances.

I also need to not manage my practice revenue to cover the luxury items I want in my personal life but instead to grow and sustain my business. I need a business growth mindset plus the attitude that Dr. L.D. Pankey promoted when he admonished dentists to learn to live on less than they make. Our teams make it possible to be in business. People come first. We’re in a people business.

Professional Guidance & Standards

My state professional association conducts a survey of offices every few years that provides a reasonably accurate picture of wages and benefits based on a number of demographic variables. That information, along with discussion of this issue with my peers, provides me with an idea of what the range of wages should be in my area.

My industry ideal is to keep total overhead for staff as close to 25% as possible, but in today’s economy this is becoming more difficult. I have found it helpful to define the market value of the various positions in the business and to understand the difference between the team members who produce income and those who do not.

Ask & Answer for Yourself a Few Questions

Where are your wages relative to your peer group? Are you underpaying, or overpaying, some of your people, and if so, what will you do about it? Where are your wages with respect to your budget and to what business analysis considers Ideal?

Something Most Dentists Don’t Do

You can take the information from your spreadsheet and share what you have learned with your team on an individual basis.

Each person needs to know that there is a range of pay for what they bring to your business. When they reach the top of the range, often due to longevity, that is all you can offer in wages. You might consider offering additional employee benefits, for example, additional vacation time. But know that what you offer will very likely be shared with everyone else.

Your wage budget worksheet allows you to develop an open and fair discussion of compensation. It helps remove much of the emotion that often gets in the way when employer and employee seek to justify levels of compensation. Your team members need to know you respect and value them, and to grasp that to remain in business there must be a profit and a budget for the business that makes sense for all concerned.

Relationship-Based Dental Practices Have an Advantage

Although recent news and chat forums indicate wages are rising for dental workers and this is putting pressure on dentists to increase their fees, we have much goodwill we can use to counterbalance this. Employees are not apt to jump ship when they like the environment in which they work…where their work is respected, their work is meaningful, they enjoy their co-workers, and solutions are found to reduce stress.

Dentists, who are truly relationship-based in their philosophy of dental practice, offer a totally different working environment than the many dental practices, in which employees describe their workplace as toxic. You can leverage the goodwill of your team members to help recruit the right new employees and stay in budget.

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In the comments below, I’d love to hear how other private, fee-for-service dental practices are currently mindfully managing hiring and wages.

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.