By Edwin “Mac” McDonald DDS  

Change isn’t just about external circumstances; it’s also an inner evolution. We go on a transformative journey, and our reflections as we go touch upon our intention and legacy, our personal identity amidst the change, and decisions we make as the change unfolds.  

Challenge 1: Intention and Legacy 

When facing change, having a clear intention is like setting the compass for your journey. What legacy do you aspire to leave behind? Aligning your actions with your deeply held beliefs ensures congruence between your intentions and outcomes. But stress may cause you to move away from your most deeply held beliefs. I’ve witnessed this happen, just as I’ve witnessed deeply held beliefs guide what happens. 

Challenge 2: Personal Identity Amidst Change 

The question “Who do I want to be during this transition?” is profound. It invites introspection. Consider how you want to show up for yourself and those around you, especially those who are most important to you. Authenticity matters. 

Challenge 3: Listening and Accountability 

Change often involves decisions. Whose voices matter? Listening deeply to trusted individuals—those who respect and understand you—can provide valuable perspectives. Forming a leadership team of diverse viewpoints helps guide you toward success. 

The Importance of Values During Dental Practice Mergers and Acquisitions 

Many private dental practices are being acquired by large partnerships in 2024. These transitions have tons of potential and profit associated with them. Associated with these transitions are complex changes for the practice owner and team members…expanded ownership, more complex organizational structure, new operational systems, and a distancing of some decision making. They also come with the unknown of who will be your future partners after the next sale of the organization. Are you prepared for all of that?  

Preparing yourself and your team is essential. On the front end, asking every possible question including questions about the partnership’s core values, how they are integrated into the day-to-day operations, and communicating the importance of that to you and your team is essential to long term success. These questions and expressions are an attempt to examine the congruence and compatibility between you, your team, and your new partners. 

I am witnessing several friends transition successfully to one of these new partnerships. The common factor I observe is that each dentist has great self-awareness and received very strong assurance that they would retain autonomy to continue to practice according to the most deeply rooted values. I also observed that the large partnership was very stable with excellent systems and had high quality leadership.  

My father often told me: “The person that you have an agreement with is more important than the agreement itself.” In other words, a person of strong character will find a way to honor the intent of the agreement regardless of the specific circumstances of the moment. Values have longevity. Circumstances come and go. 

I have also witnessed an abandonment of strongly held values as an organization was going through the painful changes of decline. In abandoning their values, stakeholders were hurt and distanced themselves. It intensified and accelerated the decline. Values matter. Character counts. Clinging to our core values in times of change or decline will increase and accelerate recovery. There are countless Fortune 500 case studies to support this idea. 

Another Example of Values in Transition from My Life 

Finally, I want to leave you with a case study from my church, The Village Church. We had become a multi-site church in response to the demand of many people attending our main campus. As it grew, our leadership became painfully aware that it was not fulfilling our mission and it was not consistent with our closely held values of community and individual relationships. Over a period of several years, each church was given the opportunity to vote on becoming independent. They all voted around 95% in favor of the change. We gave away around 40 million dollars of real estate, equipment, furniture, and other assets to all of the churches.  

Today, the new independent churches are thriving as is our main campus where we attend. The decision was in conflict with everything that is happening in our business and church worlds where there is constant consolidation and scaling. However, the decision was consistent with the values that drive the purpose of the church. The change created multiple thriving churches that are serving their specific communities and growing people and their impact on our world. 

When I think of the small things my practice does on an everyday basis that have a big impact on patient relationships, patient satisfaction, and case acceptance, the first thing that comes to mind is what we call check-in and debrief.

Early in my practice years, way back when I was practicing corporate dentistry, when I walked into the operatory, the patient already had topical in place and my job was to get them numb. There wasn’t much of an opportunity to have a conversation. Over time, I learned the concept of check-in and debrief, which is really about how you can use the time at the beginning and end of the appointment to influence the relationship you have with the patient.

These are ideal times to build value for what the patient has agreed to do at that appointment and to tie the goals of the patient to the value of the treatment the patient is receiving, or you hope the patient will accept.

Usually, the check-in and debrief each take about two minutes. My assistants participate in this process with me, so they have increased understanding as well.

Previous Conversations Inform Me

I can be mindful and successful with my conversations if previous conversations with the patient were documented. My assistants take notes for me during my conversations with patients. I need to know:

• What is important to them,
• What they are hoping for, and
• What could get in the way of accomplishing what they believe is best for themselves?

My Check-in Conversation

During the check-in, I aim to converse about what we have planned to do and how this fits the overall goals of the patient. Usually, I enter the room and there is a little chit-chat. Then I ask, “What is your understanding of what we are going to do today?” The response helps me gauge the patient’s awareness. Following this conversation, I may ask, “What is your understanding of how this is part of your long-term health plan?” Or, if the patient has a stated a good understanding of what we are going to do, I say, “Yes, and this is how it fits into your long-term goals for your teeth.” They should now have a good sense of why the appointment time is of benefit to them.

My Debrief Conversation

During the end-of-the-appointment conversation, I aim to thank the patient for being cooperative, talk about what they can expect as a result of today’s appointment, and what they can expect as we move towards their preferred future. No matter what happened during the appointment, I want my patients to hear how much we appreciate them being our patients and being there today. When we talk about what to expect from today’s appointment, we can go over any post-op instructions, which are also presented in written form. Lastly, I want to give them hope that we are accomplishing steps on the road to their preferred future and that we can get there with their continued cooperation. I want to see the rays of hope register on their faces.

I believe all of this is of high value to the patient personally and in building value for the practice. It is well worth the time, and for me, it is a standard part of every patient visit.

When we love what we do, we do it better. This is a popular lesson in literature and in life. Tom Sawyer had an aha moment after convincing his friends to whitewash the fence his aunt had tasked him with by making it seem like play rather than work.

This quote from Mark Twain says it all: “If he had been a great and wise philosopher, like the writer of this book, he would now have comprehended that Work consists of whatever a body is obliged to do, and that Play consists of whatever a body is not obliged to do.”

Obligations v. Choice: Loving Dentistry

While there was a time that I felt obliged to do dentistry (to pay off debt, to take care of family, etc.), I am now blessed to choose the vast majority of what I do and how I do it. I still have plenty of debt to pay off and am a long way from financial freedom, yet I find myself most days with a smile on my face.

This is because of the conscious choices I’ve made over the last 18 years after I first learned of Dr. Pankey’s Cross of Life. Many of those choices have helped blur the line between work and play for me.

When Work Becomes Play

When any of my mentors would talk about their work as any semblance of play, my initial response was one of significant skepticism. I had even seen my childhood dentist, Dr. Mark Stetzel, truly loving his work, his team, and his patients.

But early in my career, I had a difficult time envisioning that for myself. With the ‘Golden Age of Dentistry’ supposedly in the rearview mirror, I wasn’t sure my work could ever actually feel like play.

Today, I am so grateful to have a team around me that has chosen me and vice versa. They believe what I believe. We are pulling on the rope together because we get to do more of what we enjoy doing each day. We have learned about our own and each other’s strengths and we play to those strengths more and more.

So much of what we do on a daily basis has become play for us because we have realized we’re not obliged to do dentistry in a way that doesn’t align with our own values. We get to help people who want to be healthier make choices to do just that.

The choice to incorporate Dr. Rich Green and Don Clifton’s work on maximizing strengths in a dental office was such an important one for me. It created an aha moment much like Tom Sawyer’s. When people get to do what they are good at on a daily basis, they don’t feel obliged to go to work. Rather, most days can seem more like play!

After building my dental practice from scratch, my work life began to get more and more intense. I knew I had to slow down, but I didn’t know how until I decided to take a leap of faith and visit the Pankey Institute.

Creating a Work Life Vision at Pankey

At Essentials One, I was blown away by the faculty to student ratio. It was almost 1:1! The quality of the education was outstanding, but what I found most impressive was the encouragement, mentorship, and passion from all the faculty and staff.

Pankey taught me how to help my patients value dentistry, develop communication skills, and learn co-diagnosis. Most importantly, Pankey helped me create a vision of what I always knew I wanted — a low volume fee for service practice that allowed me to have a good family-work life balance.  

Returning to My Dental Practice Recharged

When I came back home from Essentials 1, I immediately stopped working six days a week. I started some training exercises with my team to show them what my vision was.

One month later, I went out of network with my first insurance plan. This plan was one of my biggest — it made up 25% of my patient base, but I was determined. Six months later, I evaluated our progress. We did not lose a single patient and our revenues had actually doubled. When I saw this, I went out of network with six more plans immediately. We were on a mission.

Today, two years after Essentials 1, I am only in network with one remaining plan. Our practice has continued to grow. We have worked less hours, seen almost half as many patients per day, and our practice revenues have increased.

Additionally, I have also taken more time off every year and taken more continuing education than I have in the past. My team continues to be excited in our journey together to achieving our professional and personal goals.  

My story is nothing special. I truly believe anybody can develop the clinical, leadership, and communication skills to create a successful relationship-based practice. For me, the Pankey Institute provided all the resources I needed. Pankey has changed my life. I hope to give back one day. 

What’s your dental practice story? Join the conversation in the comments! 

Five years ago, I started a dental practice from scratch. Brand new building, brand new equipment, zero patients, and zero cash flow.

Building a Brand New Dental Practice

We were in a network with over 15 insurance plans, opened early mornings, and stayed open until late evenings — our patient base grew quickly. After two years, I found myself still working the same long hours, attempting to accommodate as many patients as I could.

I was working at my own practice three days a week and at another practice the other three days. I was totaling six days a week! I always valued continuing education, but my schedule only allowed for online education on the weekends or the “slow days” during the week.  

Burning Out or Slowing Down

As my own practice got busier, I found myself doing over 30 hygiene exams a day, along with seeing 12-15 restorative patients per day. I was jumping room to room nonstop. I started to realize I would not be able to keep up this pace forever. Something had to change.  

I had conversations with my team about going out of network with some insurance plans. The feedback I got from them was, “I think we will lose a lot of patients. Our patients are all insurance driven.” As a result, we kept “grinding it out.”

Shortly after, I attended a lecture by Dr. Jeff Baggett at a dental conference in town. When I saw his dentistry and his enthusiasm for dentistry, I thought to myself, “Man, I wish I was that enthusiastic.” I loved what I do, but I didn’t see myself going down a very good career path in dentistry.

I kept in touch with Jeff after the conference and he convinced me to go to the Pankey Institute. I was hesitant at first due to the time I would have to take away from work. Eventually, I took a leap of faith and signed up for Pankey Essentials 1 (E1).

To be continued…