By Edwin A. McDonald, DDS 

Case Study 1 

Early in my practice I was introduced to a periodontist in Dallas. We began a close working relationship for many years. He was a great mentor to me. His work was superb, and his patients had great experiences. He got to know our patients so well he could guide them to the best treatment decisions.  

One day we met, and he told me that he was retiring. I told him that he couldn’t do that to me! His response was that he had found the perfect person to partner and transition with. He had.  

The most important thing that happened was my mentor took the time and made the effort to communicate with me about what was happening. It made me realize that I was important and significant in all of this. The incoming periodontist, Ron, was a young version of his predecessor with the same meticulous surgical technique, superb results, and great patient experiences. In fact, in many ways he became better.  

Years later, Ron’s office is in the same location, just beautifully remodeled and updated. The hygienists remained for many years as did most patients and almost all referral sources. Ron has been extraordinarily successful. That makes me happy. He makes me a better dentist. 

In this case, the two periodontists were philosophically aligned, clinically similar, consistent in their judgement, and had great ability to build high trust relationships. Those four components created a powerful foundation to move smoothly from the past to a great future. 

Case Study 2 

Unlike the first case study, most transitions have gaps between the old and the new. In addition, often the existing practice needs an infusion of energy, a new and expanded mindset, and a more powerful vision to move toward what is possible. 

I have a friend that bought a very traditional relationship-based practice with tons of potential. He is different than his predecessor in his management style, approach to relationships, and desire to grow his practice. He has more than doubled it in just a few years. He also has had a complete turnover in the team. In this case, he needed a team that fit how he wanted to practice. He hired individuals who were prepared to embrace a new approach to practice.  

My friend needed to become a more effective leader of his team and develop a deeper understanding of how important they are to his current and future success. That meant investing more time and energy into getting to know everyone, communicating his career goals and learning about their career goals as they together cast a vision of the future …a worthy destination that honored the past as it created an abundant future. That meant leaving behind some beliefs, assumptions, and patterns of thinking as he matured and as they matured. 

“All of the stakeholders around a practice transition will embrace the change if they see the incoming dentist and new team members living the values that have kept them connected to the practice for many years, there is clear and frequent communication, there are genuine efforts at building trust, and there is an expressed understanding of what is mutually beneficial to all parties.”
–Dr. Edwin A. McDonald (LineofSightCoaching.com) 

By Deborah Bush 

Imagine this: a valued member of your dental team walks in, resignation letter in hand. It’s a blow, not just to patient care, but to the overall morale of your practice. But what if you could have prevented it? Enter the “Stay Interview,” a powerful tool used by thriving dental practices to keep their top talent happy and engaged. 

Why Stay Interviews Matter 

Studies by Gallup and Pew Research show that money isn’t the only reason employees leave. Often, it’s a feeling of being undervalued, lacking growth opportunities, or simply not having a voice. A Stay Interview allows you to proactively address these concerns before it’s too late. 

Benefits of Stay Interviews for Dental Practices 

• Reduced Turnover: Replacing an employee costs a significant portion of their annual salary. Stay Interviews can help you identify and address issues that lead to departures, saving you time and money. 

• Improved Morale: When employees feel valued and heard, their morale soars. This translates into a more positive work environment for everyone, including patients. 

• Increased Productivity: Engaged employees are more productive. By identifying and addressing roadblocks, you can help your team work smarter, not harder. 

• Enhanced Patient Care: A happy, stable team provides better care for patients. Stay Interviews can help ensure your dental team feels supported and equipped to deliver top-notch service. 

Turning “Stay” into Action 

Here’s how to implement Stay Interviews in your dental practice: 

1. First, focus on high-performing team members, those critical to the practice and whose departure would be a major loss
2. Schedule private, dedicated time for the interview. Ensure a relaxed atmosphere. I recommend having a stay interview twice a year and strategically schedule one of the interviews before planned vacations. This way your valued team members have happy thoughts about their employment while gone and look forward to returning. If you are going through a practice transition, you may need to adjust when you do stay interviews to make sure you meet with each employee early in the transition to help them see the value of the transition for them. See Effective Strategies for Managing Transition in Your Dental Practice Part 3  – The Pankey Institute
3. •  Start and continue a conversation. Remember that “the relationship is the conversation.” Two-way listening and recognition are key. 
     • You might start the conversation with this question: “What do you enjoy most about working here?” 
     • Go deeper by asking: “What could make your job even more fulfilling?” “Have you considered leaving?”  
     • Trigger their professional drive by asking: “Do you feel challenged?” “Have I given you enough opportunities to grow professionally?” “What would you like to do more of?” 
     • Affirm their value. “I may not say it often enough, but I value you and recognize your contributions to the practice. In fact, recently….” “Would you consider leading on our next project to _______. It’s important to me that I have someone like you I can rely on to champion this and help make sure we make headway.” 
     • Ask: “What could we do to improve our office culture?” “Do you think I have been clear enough about the direction we are headed?” “Am I providing you with enough feedback?” “How do you like to get feedback?” See How Do You Like to Receive Feedback?  – The Pankey Institute. 
4. Actively listen and respond without becoming defensive.
5. Summarize the key points of the conversation and create a plan to address concerns.
6. Follow up with more conversations as needed. 

Remember, the key is to listen, respond, and act. Let Stay Interviews be the bridge to building a thriving dental team with happy smiles all around! 

About Deborah E. Bush: Deb is a contributing writer specializing in dentistry and a subject matter expert on the behavioral and technological changes occurring in dentistry. A graduate of the University of Michigan and a student of positive psychology, Deb has more than four decades of technical writing experience for medical and dental outlets and authorities. Before becoming a dental-focused freelance writer and analyst, Deborah served as the Communications Manager for The Pankey Institute for Advanced Dental Education and as Director of Communications for the Preeclampsia Foundation. Her work with leading dental brands includes Curve Dental, Patient Prism, and Alatus Solutions (which includes DentalPost, Illumitrac, and Amplify360). She has co-authored and ghostwritten books and articles for multiple dental authorities. 

By M. Johnson Hagood, DDS 

 As a general dentist in Vero Beach, Florida, who does a lot of restorative whole mouth dentistry, I rely on a wonderful interdisciplinary team but lately I’ve wanted to have more resources in my own practice.  

 A year ago, I decided to purchase a practice with a larger office on the beachside of town with the aim of bringing on an associate dentist with a background in periodontics and prosthodontics. I wasn’t sure if I would need to keep the 900-square-foot space I had practiced in for over two decades, so I only recently put my bungalow-style building on the market and moved fully out of it.  

 The transition has been fraught with challenges…the financing, the physical move, the tech setup, accommodating the exiting dentist and his team two days a week for a few months, and transitioning patients to a new location. Some might say I am going through a mid-life crisis, and they would be correct. My team and family have been incredible. I don’t think I could have done it without their support. They keep me going through the choppy waves. 

Many of you know that I am a surfer. I still surf in my 50s but for the last six months, I haven’t had the time. Something with the transition is always rising to my attention. Many days, I feel the kind of burnout that I haven’t felt in years. Six months from now I hope to be writing again about what has transpired and how I am finally feeling on top of my game again. But for now, I can say that it’s been tough. 

 Some of you know Debbie Bush, who helps as a remote editor for Pankey. She was in the office a couple of days ago. She knows about the trials and tribulations we have been going through, and we spent some time talking about them. 

 She observed, “I’ve been here twice, and my husband has been here twice since you moved. I can tell that your patients think the change has been seamless. From their perspective, you and your team are providing them with the same personalized attention, interest, encouragement, and care. The other dentist’s patients are getting to meet you and your team. They are sensing the positive culture of your practice. It’s okay, Doc. You will get where you want to go. It’s going to be okay. You’ll be on an even keel in a few months.”  

 That meant the world to me.  

I was able to tell her, “I wish it were easier, but I would do it all over again because I have a vision for the future, and this is the path to getting there.”   

She reminded me that much of “the chop” we are weathering through is due to things outside our control. Our values and culture have remained the same. She asked me what the biggest benefits have been since moving to the new office, and we started talking about “the bright side.” 

For starters, I am grateful for the greater space. We have one more operatory, and all our rooms are larger. It “feels good.” There is tremendous natural light coming in, pristine walls to hang my paintings on, and we have moved from a tiny, gentrified environment to an expansive more modern environment. My team is more physically comfortable. Patients have greater privacy and don’t overhear conversations outside the room they are in. On top of that, most of my patients live on the beach and are delighted I have moved closer to them. 

 The other thing I am excited about is my new CBT system. Moving into a larger space meant I could finally do 3D imaging for my patients in-house. Many patients come to my practice specifically because they are seeking treatment for TMD. I want cone beam images for every TMD patient. For years, I sent them to my endodontist for the 3D images, but now I do those images right away in my own office.  

 When my patients see the 3D images there is a wow factor but more importantly, I can be more thorough with diagnosis, and there is practically no radiation. In addition to the value-add of CBT with TMD, I’m seeing abscesses in teeth that don’t show up on regular X-rays, and the CBT will be important to a partner doing surgeries. 

 Debbie encouraged me to write about the choice of technology I made because it might help others in a similar situation. So, here goes. I considered the cone beam options on the market and decided to go with the Dexis OP 3D LX platform with a 12×15 cm field of view that enables us to see the entire dentition and TMJs in one high resolution image—the mandible, maxilla, bilateral TMJs, sinuses, and pharyngeal airway. I have always been impressed by the quality of Dexis imaging products, and the latest software with the OP 3D is intuitive. 

 I still have a long way to go to achieve my vision for expanding practice. I’ll report back on my experience early next year. I am grateful for the encouragement I receive from you, my colleagues, as I step up to pay the price, continue taking a leap of faith, and stay on course to reach my goals. 

By John C. Cranham, DDS 

 When I’ve looked at and really studied my practice numbers over the years, my favorite has always been productivity per hour. I have aimed to focus on a low volume of patients who need advanced dentistry. As my practice developed, I was able to earn more per hour on fewer patients. I was able to earn as much or more while working fewer hours, and my overhead went down because the office was open fewer hours. 

 Rather than just firing off from the hip and trying to make a treatment plan with the patient who is in the chair, I now invite them back for what I call an “advanced records visit.” Then I focus on making comprehensive records and studying those to create a well-thought-out treatment plan. The time spent planning the treatment may be an hour.  

 When you become good at treatment planning, it may take as little as 20 minutes. But the idea is to do better dentistry for your patients and get to where you are working on about 12 big cases each month. I have found that doing more than that is exhausting and makes it difficult to maintain general patients.  

 As you develop your reputation for being a “go to” dentist who solves problems, the big cases will flow in steadily. When you are planning a big case, you are generally working off a treatment plan where you’ve mounted models, you’ve studied photographs, and you’ve got an architectural plan of where you’re going. It’s very cerebral.  

 When you’re executing the plan, everything must be done in a specific way. So, in my office, we have time scheduled for executing planned dentistry—without interruption. We have another time scheduled for seeing general patients and moving between operatories. In the morning huddle, we review the plan for the day and decide where we can fit in an emergency appointment if one is needed. 

 Over the years, my schedule has changed. I’ve tried various schedules and had to experience them to know what works best for me. Now, I like to arrive at 6:00 AM, do my cerebral case workups in solitude, schedule patients with advanced needs in the morning, and have short afternoons for general dentistry. I don’t bother with lunch because I have determined that I don’t need that break in my day.  

 You’ll find what works for you. Keep in mind that your schedule might change over the years in response to patient needs, staff needs, family needs, and your pursuit of other activities. That’s okay. There is no perfect one schedule that fits all dental practices all the time.  

 Once I had a steady flow of big cases coming in and productivity per hour was high, I no longer felt the need to keep my office open long days or to offer evening appointments. I discovered that evening appointments were the ones patients most often cancelled. And when we cut back on our afternoon appointments a few years ago, patients were accepting once they heard it was because the team and I wanted to spend more time with our families.  

 You may discover that when there are fewer appointment slots available, your patient’s perceived value of them rises, and patient calls to cancel or reschedule diminish. 

 Starting out in practice means delaying the gratification of shorter workdays. It will take some time to get your steam engine rolling but stay the course, balanced with being kind to yourself so you can keep going. Keep your vision alive and educate your patients toward the comprehensive dentistry that will serve them best. Be patient. Your low-volume/high-earning productivity per hour will grow slowly and then faster. 

 At every stage of practice, I think there is one thing all dentists have in common. They relish the quiet hours when they are alone planning treatment. Those are the hours when they feel most at peace, most able to solve complex problems, and actively create plans for efficiently delivering dentistry. As a young dentist, you might experience this once per month, and after a few years, you may experience this nearly every day. Those quiet hours are powerful hours for driving productivity. 

By John C. Cranham, DDS 

Every hour you invest in your practice is an hour invested in your future, so invest time in thinking about how you are spending your time. 

I am often asked if I have advice for young dentists starting out in practice. As I reflect on my own experience in practice and on conversations with other dentists in private practice, several thoughts emerge.  

There will be times when you are working in a chaotic, undisciplined environment because you are trying to care for as many people as you can fit into your day. You will become physically and emotionally tired. At some point, you will recognize that you can’t go on that way. You will need to create more disciplined systems for you and your team. You will need to develop your team members, so they can do more and save you time. You will need to hold yourself and them accountable.  

A young dentist must understand that when you run around and do many procedures, you could be confusing activity with productivity. When you’re working on highly thought-out treatment plans, you’re sitting down, you’re doing more well-organized dentistry on fewer patients. You’re also usually executing the dentistry better, which means fewer remakes.  

How do you position yourself to have the luxury of working on those types of cases? The advanced CE at Pankey and other top programs will move you along, but you need to be patient with yourself…and your patients. You will be bringing them along with you through the opportunities you have to educate them about their oral health, where it is headed, and what can be done. Don’t assume you will achieve your goals fast. Eventually, you will become known as the go-to dentist to solve problems and the cases will flow.  

Know your patients. Be thoughtful about moving them along. Enjoy them as you do. 

I’ve written about this before…for the first few years I felt my colleagues were surpassing me. They were doing more advanced cases and utilizing what they were learning at Pankey and Dawson. I had purchased a tiny practice filled with patients who valued dentistry when they were in pain. I aspired to do more than fill cavities. Sometimes I thought I would have to give up on my dream. But I kept talking with my patients, building relationships, raising their awareness, and eventually they began accepting treatment. I had to stay hopeful and employ the behaviors I was being mentored to employ before I could employ my advanced clinical skills.  

I learned a lot about people, not just dentistry, in my early years. I look back upon the experience with fondness now. 

By John C. Cranham, DDS 

Every dentist finds it challenging to take time to train their team members.

Here are a couple of examples of how I’ve added time to my own day by advancing my team’s skills:

 I fired myself as the practice photographer. My goal was to have multiple people in my office who know our intraoral and extraoral image protocols and who can take the photos at the same high level of quality. To do this, I built “training time” in our schedule to teach photography. Now, while the patient is in the chair, I have the “photographer” show me the photos. We look at them quickly. Occasionally there is one that needs to be retaken, and I will explain why. The quality has become consistently high. By having multiple photographers in the office, my primary dental assistant can focus on something else when needed.  When I am working up a case, I often show them why I needed a specific photo. They take interest in their part of the process and the case. Engagement in their work rises. Always clearly share the why. 

I’ve also trained my team on how to fabricate deprogrammers. I’ve trained them all, checked their work, and explained the why behind our standard. We now have four people who can do that, too. This means we have a good product we offer patients and get it out in a timely manner when my primary assistant is busy.  When it comes to training your team, you will set a standard, and your team needs to know you are serious about it, but you can do this without being stern or making them feel bad. For example, in my office, if they take a bad photo or make an unacceptable deprogrammer, I explain why and ask them to retake the photo or remake the deprogrammer. As they redo something, they learn from their mistakes. I am patient with them. I tell them I made the same mistakes while I was learning. 

By Edwin “Mac” McDonald DDS  

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

Phase Three: New Beginnings  

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

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

Strategies for Managing this Phase 

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

Keep in Mind 

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

By Mary Osborne, RDH 

Dr. Rachel Naomi Remin says, “Doctor, you may know what’s best for the disease the patient has but that’s not the same as knowing what’s best for the patient.”  

It’s difficult to let go of our own assumptions about what we’re supposed to do, how healthy this person should be based on our criteria, and what is the best path forward in every situation. Our clinical training leads us to believe that we’re supposed to know what’s best for our patient. 

There is another quote, from Dr. Albert Schweitzer, which has challenged my thinking about patient care for a long time:  

“Patients carry their own doctor inside.”  

I believe that every one of us has opinions, ideas, and knowledge about our own health. That is the doctor inside. Dr. Schweitzer said patients come to us knowing we have expertise, but “we are at our best when we give the physician who resides within each patient a chance to go to work.” When we do that, we help people become healthier. 

There is a place for our solutions. There is a place for our expertise to show up. But if we slow ourselves down a half step, we are often amazed at the answers patients come up with. They can be downright creative and elegant. The reason they are elegant is because they are their solutions, and patients are more likely to follow through with solutions they conceive. I’m not saying we shouldn’t guide them to understanding the advantages and disadvantages of their solutions and other possibilities that you we know are out there, but we should be open to allowing them to think about solutions and not prejudge their choices. 

For example, if a patient says she or he doesn’t have time to floss, I was trained to say, “Well, don’t you watch the evening news? You can do it while you’re watching the news. Right?” That’s about me having the solution. But now I sit back and say to the patient, “Well, it sounds like you’re very busy. Is there any time at all during the day when you’re sitting, and you feel that you could floss easily?” When I ask the question, they usually have a better answer than the nightly news. It’s a better solution because it’s their solution. They have bought into it at some level.  

In many cases, we see the “treatment” for a problem as we’re seeing the problem. That’s something that we take a great deal of pride in. But when we come together with our patient, sitting eye to eye, we can often come to a much more elegant treatment plan, one that moves us more comprehensively toward our goal of improved health. In between what is and what is possible, we encourage the patient to discover the level of health to which they aspire. We come to mutual agreement about going forward in a certain way to accomplish some things that are bigger and better than just solving “a problem.” 

By Edwin “Mac” McDonald DDS  

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

Phase Two: The Neutral Zone 

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

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

Strategies for Managing this Phase 

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

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

By Paul A. Henny, DDS 

In Part 1, we looked at personal boundaries in dental practice. I mentioned scarcity bias and how it is prevalent in undifferentiated dental practices but not so much in dental practices where providers and patients mutually share the values and agenda of the practice. Because scarcity bias is so human, so ingrained in us, I want to discuss two things in Part 2: healthy relationships and also how to address scarcity bias as it occurs in our differentiated dental practices. 

Insight Into Our Boundaries Leads to Healthy Relationships 

Healthy interdependent relationships are only possible through first understanding our personal boundaries (Who am I? What am I responsible for? What am I not responsible for?). That’s critical because psychologically speaking, boundaries are like fence lines with consciously regulated gates.  

The aphorism “Good fences make for good neighbors” prevails.  The same logic applies to the practice of dentistry and the nature of the relationships that we create—consciously or not, within it.  

And Now, We Circle Back to Differentiation  

Healthy interpersonal boundaries lead us toward more interpersonal authenticity, which leads us toward higher-quality communication of our values and purpose. Higher quality communication leads to a more sophisticated level of collaboration and healthy results, including healthy interdependent relationships, self-reflection, self-responsibility, improved oral and total body health, improved mental health, and a constantly growing reputation for your values. That’s differentiation. That’s personal authenticity. That’s success. 

Addressing Scarcity Bias 

Once we understand ourselves well and we communicate consistently with personal authenticity, we still have the challenge of “knee-jerk” scarcity bias in our patients. This is where patience comes in and empathy—understanding and recognizing their feelings. 

People are biased toward the here and now. The mind is naturally focused on meeting immediate needs at the expense of future ones. We procrastinate important things such as dental treatment unless we have an urgent need for it. We fail to make investments, even when the future benefits are significant or the costs of not doing so are substantial. 

When the dentist and patient participate equally in a co-discovery examination process and co-discovery consultations to discuss health history and current findings, and the patient is empowered and becomes comfortable mentioning everything on their mind, we have already begun the powerful process of leading each other through understanding what is happening in the body and what is happening in the mind (feelings and thoughts). We can start to talk about what the patient would like to achieve long term—the patient’s beyond-the-moment oral health goals. We can start to talk about what is possible to achieve together and introduce the notion that we can take steps at the speed that is mutually comfortable for us. 

Inspiration to do “the work” is often planted with just a few words that create a future desirable image in the patient’s mind. If we have the patience to let the inspiration grow, without overwhelming the patient, scarcity bias can dissipate. Often patients come back to the conversation the next time they visit us and say, “I was thinking about what we talked about, and I think I am ready to…”  

Negotiating health goals between two adults starts as an invitation to agree upon common goals. We can start early in the doctor-patient and hygienist-patient relationships by instilling the thought that preventive health care is a partnership. They can’t do it alone and you can’t do it for them. Everyone must play their part responsibly.