According to Markus Zusak, author of The Book Thief, he had to rewrite his book 150-200 times until he was happy with it. And he began by imagining the end of the story, then the beginning, then the chapter headings, then the writing…over and over again. In the end, Markus had a New York Times Best Seller, with 8,000,000 million copies sold and a movie deal. 

One might be tempted to view Markus Zusak as an overnight success but knowing what I have just told you allows you to understand that’s not the truth.

So too is the case with relationship-based/health-centered dentistry. The creation of the practice takes years, starting much like Zusak’s book—beginning with the end in mind. From there, each aspect is assembled from finding and forming the right care team, to developing them, and to finding better and better ways to connect with patients: truly hearing them, understanding their struggles, and sensing their desire to feel better about themselves. 

Along the way, you will make mistakes, have misunderstandings, and outright fail. This will prompt you to rethink, revise, and redo. This is the true nature of success. We learn and move upward with better understanding. 

It has been said that the main difference between a vision and a dream is the work involved.

The later requires none. The former’s work never ends. A true vision is a principle-centered thought capsule aching to be validated by reality. It has an inherent truth built into it which must be realized. And as with Zusak, if it takes 200 revisions to make it happen, then it takes 200 revisions. So be it! 

The simple secret to success is the willingness to be flexible and to accommodate new understandings combined with a sheer force of will and perseverance that only a few are willing to make. 

Dental graduates frequently say they chose dentistry because they liked science and working with their hands. Many thought medicine was their path, but in medicine, they saw the lack of control and time away from family. Dental graduates also say they were attracted to dentistry due to the monetary return they could get for their efforts.

When practicing, profitability can be elusive. You can feel like your child’s hamster trying to outrun your overhead. You can feel like dentistry is #1 in your life and there really is no other life for you, but you are frustrated because your dream was to be farther along in your debt reduction and wealth growing. You are putting in the hours but not receiving the return.

Many things and decisions can get in the way of profits.

We want to convey positivity here, not rehash the problems. You can have a profitable practice. A larger net return can be yours.

Let’s have a frank discussion about you, the leader, THE one who wants very much to win in the game of profitability. The keys to profitability involve YOU–your attitude, your team’s attitude which comes from you, and systems you need in place to be more efficient.

YOU are the key to opening the profitability gate. What is your current attitude about life, your success, and your situation? This is a challenge as you are slightly prejudiced. Do you have a family member or a really good friend who can assess your attitude (your positivity about yourself)? Years of negativity can be a challenge.

How do you feel about the future?

Here are some questions to help assess your present attitude about yourself:

• What are your goals five years from now?
• What are you looking forward to?
• What do you want most out of life?
• What do you like best about yourself?
• What do you feel motivates you?
• Do you have any personal power in your life?

At Blatchford Solutions, when we work with dentists and teams, we ask them to assess various life choices, such as the place they choose to live, and the friends, marriage partners, courses and schools they choose, even cars, vacations, restaurants and more. We all have a Comfort Zone for each of these areas and when pushed out of your comfort zone, you reply, “I would never go there, do that, try that, spend time on that”, and more. Our comfort zones have a floor and a ceiling.

You need to know if your “Deserve Level” allows you to be profitable. You can sabotage your success if you feel you deserve less. You can modify your Comfort Zone (Deserve Level) with a clear vision, strong determination and possibly some outside help.

What is profitability to you?

Put some numbers down; spell it out for yourself at this time. Is a net of $500K unreasonable for you? Do you deserve to have 60% overhead on $1.2M collection? Is a net of $750K unreasonable for you? Is a net of $1M something you deserve? Do you deserve to be debt-free? What would change in your life if you were debt-free?

Your Deserve Level also affects the quality of team members with whom you choose to work, the building and area in which you choose to practice, the continuing education courses you take, and so many non-dental activities, too. Our goal is to help you realize you can be as profitable as you feel you deserve. Dentistry is not just about your clinical excellence. It can also be about your excellence in the business of profitability.

A patient’s feeling of comfort and trust is increased when you demonstrate you appreciate your team.

Showing appreciation to your team in front of patients demonstrates you respect the people who support you in serving patients. This only raises their opinion of your quality of care.

• When patients witness you calmly moving through moments of stress with instructions to your team delivered in a calm tone, a smile, and thanks, it speaks volumes to patients who are eager to have confidence in their care.
• When you spend time informing team members well and empowering them with knowledge of “the why” of your diagnoses and treatment plans, they naturally and appropriately prepare patients for your case presentation, answer questions, and encourage patients to move forward. Expressed gratitude for this support is a positive affirmation that creates growing team confidence, competence and job satisfaction. And this fosters a happy work environment and employee retention. Patients are highly attuned to team happiness and are relaxed among your loyal team members they have come to know. Again, this increases trust.
• A team’s feeling of appreciation will be undermined, and individuals easily become stressed when they are chronically overworked or asked to perform tasks they are not well prepared to do. Be alert to lead them through stress with assurances and demonstration that you care enough to take measures that will restore work balance and comfort.

There are multiple situational stresses that occur every day in your practice that produce the flow of stress hormones, 112 of them to be exact. And when there are stress hormones building up in the bloodstream, the physiological and psychological consequences are noticeable to patients. Fortunately, PankeyGram readers and participants in Pankey Institute courses and study clubs receive a constant flow of fine examples of colleagues showing appreciation for their teams. Showing gratitude doesn’t always have to be done in a big way or at great expense. A positive spoken affirmation in any given moment is going to release some oxytocin. And that’s what we want!

I’d like to tell you about my neighbor up here on Bent Mountain. His name is Mike Stockton. He personally designed the house we live in. He drew every line of it and then supervised, as well as participated in its construction. Mike had no formal training in architecture or construction. He just loved it and then studied it long enough to master it. His history is that of an artist.

We are all born with certain gifts and talents.

The key is to discover them, develop them, find ways to connect them with others in a fashion that they will be valued, and then to share them. Of course, applies to dentistry as well. We will only be willing to invest the time, energy, and attention necessary to master something if it brings us joy and satisfaction. That’s the pay-off—the ability to step back and say to ourselves, “That was pretty good, but next time I think I’ll try this instead and see if I can make it even better!”

But that’s not enough to be successful. To be a masterful and successful dentist, you also must be able to connect and inspire others to become better versions of themselves. And that, of course, includes team members and patients alike.

What else do you need?

You need to be able to promote yourself. You must be willing and able to share what you know and can do with others in a way that they feel it will be helpful. And there’s a word for that. It’s called “marketing.” Marketing is not a dirty word if it’s done from your heart and you deliver on your promises. No, let me correct that. You over-deliver on your promises.

When you go into that private coffee shop and they take a moment to create a heart in the froth of your latte, that’s marketing too. That’s caring enough about what you do to take the extra steps that demonstrate you sincerely care about what you are doing and how other’s feel about it.

So, now we have five key things:

1. Gifts and Talents

2. Mastery

3. Inspiration

4. Communicating What You Can Do to Help Others

5. Extra Steps that Show You Care

How others perceive how well you do these five things, will determine your financial future, because people will give you their money in exchange for your gifts, talents, skills, and caring when they perceive that you do the above five things exceptionally well and they benefit significantly as a result.

Passionately practice these things, and you will have a bright future ahead!

It’s early in the morning and the first sip of coffee full of that fresh aroma just went down with a sigh, a sagging of the shoulders and a feeling of here we go for another day. My mind is starting to run the list of what is on the day’s agenda…work deadlines and meetings…the kids’ schedules…what is my spouse doing today? Did I pay that electric bill or not? Then it hits. Oh, that’s right! I have a dental appointment today!

The morning life puzzle pieces all start to come together as they always do.

Everyone and everything are in their place. And off I go to the dentist with that fearful thought, “I hope they don’t hurt me today.” Parking in a rush and taking a breath before entering the dental office door, I worry, “Am I just in time?” A gentle face looks up, smiles and greets me by name. With that kind hello, I begin to relax and mentally whisper to myself, “I’m safe here. They know me. They want to take care of me. They’re happy to see me. I’ll be okay.”

The reality is this kind of personalized attention and care is slowly going away.

In medicine and dentistry, consolidation of practices into corporate entities has forced doctors to “run” on a patient-number schedule and production list. Statistics and numbers are slowly pulling their want and desire to give personalized care away from them. And I, the Patient, don’t want to be treated this way.

I’m glad my dentist takes time to know me and my concerns, spends time diagnosing and planning treatment that is individualized and best for me, and doesn’t let insurance companies limit my choices and the quality and quantity of care I receive. What’s important to me is I trust this type of dental care, I think I deserve this type of care—and the comfort I feel during my dental visits is priceless.

Viktor Frankl believed the key to the successful creation of a happy and successful life was to aim toward a deeply significant and meaningful life purpose. On this, he commonly referenced Friedrich Nietzsche’s quote, “He who has a Why to live for can tolerate with almost any How.” Suffering is no fun, but suffering for a deeply significant purpose becomes much more tolerable when you know that the end will justify the means.

Loving Others

On love, Frankl said, “Love is the only way to grasp another human being in the innermost core of their personality. No one can become fully aware of every essence of another person unless they truly love them, because by love we are enabled to see the essential traits and features in the other person; and even more importantly, see that which is potential in them—that which is not yet actualized, but ought to be actualized.” So, this begs yet another challenging question: Do we love our patients enough to suffer with them, as well as help them to become more of what they are capable of becoming through our collaborative work in dentistry?

Finding Courage in the Face of Adversity

The practice of true relationship-based / health-centered dentistry represents a counter-cultural decision with regard to mainstream thinking and behavior, as corporate dentistry is rapidly moving the profession in the exact opposite direction. Consequently, dedicating oneself to a truly patient-centered philosophy requires courage, commitment, and perseverance. Additionally, one is likely to experience tepid local support for it, as most peers will be following a very different philosophy – a philosophy focused on what they want or need to get out of dentistry, and not what life expects of them. Regardless, the striving for a cause greater than oneself, allows us to experience more meaning in a month than most corporate dentists find over their entire career.

Regarding Success

Regarding the achievement of material success, Frankl wrote, “Don’t aim for it, because the more you aim at it and make it a target, the more you are going to miss it. For success, like happiness, cannot be pursued; it must ensue, and it only does so as the unintended side-effect of one’s dedication to a cause greater than oneself, or as a by-product of one’s surrender to a person other than oneself.”

Personal Meaning

As you can see, meaning and personal relevance can’t be bought, copied, or transferred. Rather, it’s an inside-out process which must be discovered within ourselves and then refined over time. If this is the kind of challenging, growth-oriented journey which motivates and inspires you, then The Pankey Institute represents the very best place to both begin it, as well as nurture it all along the way.

The original owner of our practice recently retired.

Although he had been planning on retiring and a new associate had been identified by both of us months in advance, this transition was very profound and stressful for the entire team. So, with a long term game plan in place, we began the transition between associates. It became evident that each individual within the practice was struggling with this change in their own unique way. Supporting others through change became my part-time passion.

While some team members were engaged in the process, no one was fully comfortable with the transition to this unknown “new practice.”

We had 1.5 years of an office atmosphere that was taking us to this destination with new team members that we did not fully know. We were wondering if it was going to be an office environment with which each person would want to identify. Thankfully, one of the values that binds us—education, came into play in a positive fashion.

In recent years, our team has attended continuing education together, locally.

However, it has been a long-time goal of mine to travel greater distances with the team. Coincidentally, The Pankey Institute unveiled the first Pankey Learning Group for hygienists. The effect that this had on my practice has been amazing thus far.

Although I offered the opportunity to the entire hygiene department, only one hygienist chose to attend.

She attends this learning group, and it has been meaningful to her personally and professionally. She has become highly engaged with her patients, and while leadership and gratitude had not been her most prominent attributes in the past, they certainly are now.

Upon her return, she begins to pull the rest of the team enthusiastically through this transition that embraces a new associate and has us enthusiastically embracing our new unknown. This one hygienist has been embedded in my leadership for twelve years, and now it turns out she has always been absorbing my vision and philosophy. She just needed a little bit of investment from me to become a leader within the team.

The value of having a team member learn, from the colleagues who have helped frame my personal and professional growth, has been priceless.

With more education planned for each of my team members at The Pankey Institute, I am thinking this will be the foundation for a cohesive group of similarly minded professionals working together to provide the best comprehensive dental care for our community.

Theresa Duncan from Odyssey Management has been one of the top 25 women in Dentistry, and for over 20 years, she has advised dental offices on how to correctly use insurance to their advantage and how to carry out a conversation about insurance.

Why? Because one of the biggest barriers to patient conversion is fear about how much it is going to cost.

Her book, ‘Moving Patients To YES!‘, doesn’t help only insurance dependent dental offices. It also helps insurance independent or blended practices have easier conversations about nonparticipation and out-of-network services.

The latest trends she is reporting will set you on the edge of your seat, because just when you thought it couldn’t get any worse, it has. And, this brings us back to the consideration that nonparticipation or getting off of plans might be best for you.

In a recent conversation, Duncan reported there are big changes being made in plan designs and how patients are getting their information. The plans are so difficult to understand that the front office of the dental practice is put in the spot of having to translate them. Patients get their plans and don’t understand what they mean. The plans are confusing even to professional insurance coordinators.

Patients are paying more for their benefits, so they are expecting to get more, which is unfortunate because dentists can’t deliver more. Duncan is seeing a lot more deductibles. The upshot is that more employees are opting out of dental benefits.

Dental practices, especially solo practices, now have less power to negotiate with insurance plans.

In the last twenty years, dentists have gone from “laughing at plans to getting on plans,” even rushing to get on them. And then, reimbursement got pushed down. The average dentist (according to the last ADA numbers) will participate in 8 to 10 plans, but Duncan sees the trend is now swinging back towards being selective and getting off of plans. Many dental offices are happy being in 3 to 4 plans. They don’t want to deal with plans that are costing them too much in revenue and time.

If you drop plans (or have never participated in plans), it doesn’t mean you lose patients, says Duncan. It means your team needs to be highly skilled at having conversations with patients when the topic of insurance arises.

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.

There may be times when you see an unfamiliar brand of material on the tray before you. If you do notice, it’s likely because the brand of this particular material has come to matter to you.

You know the brand you prefer is predictably reliable, and you have worked with it a lot.

A while back, I went to take a Centric Relation bite record for a patient so we could fabricate an occlusal appliance. After I dried the upper teeth and reached for the bite registration silicone, I realized it was an unfamiliar material in the gun. While trying to complete the procedure, I rotated the gun to read the label. Sure enough, it was bite registration silicone, but not a brand I had used before.

After the procedure was completed and the patient dismissed, I found a few minutes to talk to my assistant that handles ordering. She has been very effective in managing supplies and an incredible team member. I started with a simple question that I hoped would not sound accusatory. “That was a new bite registration material I haven’t used before.” She was pleased to say the brand was less expensive and they were having a special, so it was even less expensive than usual.

Now many of you might think all bite registration silicone is created equally, and I learned my assistant thought so as well. Her cost-saving thought process works well for many for the things we use in the office where I don’t have a brand preference, such as 2 x 2 gauze. However, I do have a strong brand preference for bite registration silicone. They are not all the same hardness, and they do not all have the same set time or moisture tolerance. This was not the staff member’s fault because I had never communicated this to her.

This has prompted me to take a moment, sit with my staff and go through the materials we order and identify any other places where my preferences are very brand specific. While doing this, I explain why I have each preference.

From time to time, I try new materials and brands of materials, adopt some and reject others. My preferences change. Therefore, I offer this little story to remind myself and to suggest to others that we periodically review with our teams the brands we like, the ones we don’t like, and the ones we would like to try.