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 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  

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…