By John C. Cranham, DDS  

Sometimes you can see clearly where you want to go with your dental practice. I can vividly remember driving my car to St. Petersburg for my first class taught by Pete Dawson. It was 1989. When the class was over, I drove my little car all the way back to my 800-square-foot office in Portsmouth, Virginia, and arrived at four o’clock in the morning. I had just bought the office from a doctor who did mostly silver fillings—maybe only four crowns in the entire year. I remember I could visualize what I wanted to do with “my” practice but deciding the first steps was overwhelming.  

A dental office can be the loneliest place in the world. I had to figure out the attainable steppingstones. We didn’t have the internet back then. Finding mentors and connecting with supportive, sharing colleagues was more difficult. In dentistry today, it’s easier to find those steppingstones. One of the most rewarding things I do today is helping dentists develop. 

I caution dentists to not assume they will achieve their big goals fast. There is a temptation to give up when progress is slow. You’ve got to stay on the path to get to where you want to go. Think about your goals and steppingstones every day but be kind to yourself if it takes more time than you visualized.  

Remember that everyone is different. All your buddies are going to be in different cities, different socioeconomic areas, and different practices. They’re going to have different opportunities. Social media can be your enemy when it comes to self-confidence and determination. There will be certain people that develop faster.  

I can remember being very frustrated the first year or two in my little town of Portsmouth. There were dentists going through the same classes I was and were already doing the kinds of cases that I wanted to do but wasn’t doing yet. During the first two years in practice, I sometimes wondered if I would ever do the kind of dentistry I wanted. But I kept in conversation with my patients, eventually they began accepting treatments, and the floodgates finally opened.  

One of the greatest things about this profession is we can always strive to be great. I don’t think I’m there yet. It’s the striving part—the working at it and seeing things improve that makes it so fun and rewarding. I love it.  

People ask me, why are you setting BHAGs at this stage in your life? You’ve already accomplished so much. Why are you totally reinventing your practice systems? Why are you going fully digital after practicing on analog articulators for 35 years? 

What I’ve been able to do in dentistry is constantly reinvent myself, and I feel like I am growing in what I can do. So, I say it’s because reinvention is awesome. It’s fun. And my staff knows that if I get something working well, I’m going to find a way to make it even better tomorrow. 

By John C. Cranham, DDS 

Even today, after decades into family life, dental practice, and continuing dental education, I sit down every January to outline my BHAGs (Big Hairy Audacious Goals) for the year. I block out the first Monday after Christmas to do this, but for the previous month, I’ve been thinking about what new goals will excite me most. I commonly do this type of thinking while I am exercising and driving.  

It’s during these alone times that I can intentionally mull over the things I could do next. I pay close attention to which possibilities excite me most. Oftentimes, these are goals that I feel will benefit others. 

Successful people have the ability to create daily behaviors that direct themselves towards their goals and take them forward on steppingstones. One of the simplest, yet powerful things I witnessed Dr. Pete Dawson do is how he started each day. He would go to his desk and spend 15 to 20 minutes writing six things on a 3×5 card. These weren’t a To Do list. These were six things that would direct him toward his next BHAG. He would place the card in his breast pocket. He did this day in and day out. 

Two weeks before he passed, Pete came to my lake house on oxygen. When he arrived, I had to help him out of the car and into the house on his walker. I looked at his shirt pocket, and there it was, the 3×5 card.  

We don’t have to use 3×5 cards to make notes for ourselves. We can use our phones. But it is powerful to reflect daily on steps that will take us in the direction we want to go and record those steps to lock them in our memory.  

In dentistry, we need to carve out habitual time to think about our goals and steppingstones. We need to carve out time to take the identified steps. The point is to have a system in place where you are thinking about it every day, because there is so much coming at us all day long that we are at risk of drowning in the noise.  

When we get caught up in the mundane, life is less interesting and less fulfilling. At least that has been my experience. When you sense you are becoming bored, you might just need to identify the next big goal that excites you. The challenge of getting there will bring you back to full life. 

After about ten years in practice, I had “one of those days” when I sat down at the end of the day and said to myself, “Is this what it’s going to be like for the next thirty years?” I was working hard, making money, and considered successful by my friends and peers. But, patients were not saying yes to the dentistry I was capable of delivering. 

I had a long talk one evening with Dr. Loren Miller while at The Pankey Institute. His parting comment stuck with me, “Son, it’s time for you to do some straight-line thinking.” I then realized that I needed to change if I wanted my patients to change. I needed to practice in a manner that allowed me to be happy and serve my patients well. In order to do that, I needed to define what I wanted out of my life – personally and professionally – and start living that life.

Starting Point 

Each of us will find our core philosophy in our own way, but you don’t have to reinvent the wheel to get there. There are many resources to help you get started. What follows is a list of ideas from Jim Rohn that I like as a starting point.

1. Set some key goals for life – personally and professionally. Then be like a sailor. No matter where the wind is blowing from, keep tacking toward the goals. 
2. Learn from both success and failure. Don’t take everything personally. Analyze when things go right and wrong, and learn from your mistakes. Success is a series of small steps toward your goals. 
3. Read. Reading requires concentration and focus. These are skills we need to find success. Reading allows you to learn from the experience of others. The brain functions differently when you are reading and writing than when you watch a YouTube video. 
4. Keep a journal or write a blog. Keep track of your path to clarifying your philosophy. You don’t really have a personal philosophy until you are able to explain it to your team and others. 
5. Practice the art of active listening. It is a learned skill that is valuable in your practice and your family. Surround yourself with people you admire. Observe and listen to them.  
6. Be disciplined. Every day is filled with a myriad of choices. We know the difference between good and bad options. It takes discipline to make good choices and stick to that path. 
7. Don’t neglect your personal and practice life. If you don’t take care of yourself, your relationships and your business no one else is going to do it for you.  

This all sounds similar to what L.D. Pankey wrote and said, doesn’t it? 

Moving to Fee for Service Care 

I had many mentors on my path to change: Avrom King, Sandy Roth and The Pankey Institute. It was neither quick nor easy, but these sources came together for me to help me have the courage to commit to change. That change was not driven by money. It was driven by the desire to help people willing to commit to seeking outcomes they desired that were within my capacity to facilitate. That may seem “fluffy,” but from a client perspective, it is a really big deal. We asked our clients to take ownership of their own health. If that was not within their capacity, we chose not to be involved in their care. Our philosophy evolved over several years and allowed me to move from insurance dependence to fee for service care. We called our practice an “outcomes-based” practice, thirty years later, and three years out from handing off my practice to my former partner, it is still a successful fee for service practice. 

Moving from insurance dependence or mixed dependence to a completely fee for service care takes commitment to a special kind of practice philosophy. The listed seven steps above can start you on the way to clarifying your own.