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How Dentists Lost Dentistry

October 16, 2013

Filed under: Business of Dentistry — Tags: , , , — Barry @ 1:12 PM

Friends having having a drink in a bar-784467

 

I recently attended the 2013 Pankey Alumni Meeting in Orlando Florida.  One night, while sitting around the bar with fellow alumni members, throwing back a few, I realized that after all these years our practices had evolved similarly.

All very different but quite similar.

I began to reminisce about the first time I went to the Pankey Institute.  It was the late eighties and I was at the lowest point in my dental career.  After fifteen years of practicing without a clue…I was ready to be saved.  What I learned was a way of doing dentistry that covered not only technical dentistry, but the business of dentistry and the behavioral components as well.

Dentistry is about way more than tools and techniques.  As a practicing dentist, an educator a coach and an owner of a dental laboratory, I find most dentists run into problems because they over-emphasize the technical component.

Meanwhile…back at the Alumni Meeting…one of Pankey’s elders, an original cadre member made a speech.  He said, “The Pankey philosophy is needed now more than ever.”

I disagree.  What is needed now more than ever is a philosophy…any philosophy, that teaches dentists a way to work their way through this incredibly complex field of technical dentistry, human behavior, business ethics, sales and marketing…in an ever changing world.

Honestly, I got lucky.  I could have continued to learn more and more fragmented technical courses without any sense of coherence.

Back then there weren’t many choices—today there are many institutions that offer a continuum of philosophical dentistry.  Many dentists have benefited from taking their programs.

But too many have not — and that is a problem.

Dental schools do not prepare dentists for the real world (an ever changing domain).  Today’s young dentists do not have the same opportunities that were available years ago.  Their student loans are higher and the cost of opening their own practices have skyrocketed. 

Between those obligations and an enormous amount to learn…they are looking for other options.

Dentists are doing more marketing than ever before.  Dentists are joining insurance plans in order to get new patients and fill their chairs.  Dentists are joining DSOs (dental service organizations-aka corporate dentistry).

Along the way dentists are losing their autonomy.  Some would argue that we always have our freedom of choice, and that is true, but to exercise it takes a lot more “philosophical training.”

Someone once told me that philosophy was a tough sell.  And I might agree…What?  Do we really need Aristotle?

But if Aristotle were alive in the nineteenth century he would have been William James—a psychologist, and if he were alive today he would be Anthony Robbins…a lifestyle coach.

After all he did train Alexander to become great.

The paradigm for how dentistry is delivered has changed.  There is no going back.

As the Affordable Care Act and DSO’s  become prominent, only those dentists who understand the complete concept of dentistry will survive with their autonomy.

And the philosophy teachers?  That role will be filled by government and corporate dentistry.  They will tell dentists how to practice.  They will take over all of the other domains that we used to call philosophy.  They will infuse the practice of dentistry with their mission…their vision and their purpose.

There are plenty of advantages of the old way of doing dentistry.  Everyone preserved their freedom of choice,  Dentists, as much as people would disagree, had to have the patient’s best interests at heart in order to survive…their goal was to help people keep their teeth rather than just watching numbers and bottom lines.

That’s how dentists have lost dentistry…by not paying attention to learning a “way” to practice. 

That is also how I came to sit at a bar with dentists who all practice very similarly…yet differently.

 

 

 

 

 

 

 

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Here’s to the Crazies

June 24, 2013

IMG_0793Bellagio_09.16.06__TNR

 

 

During a conversation about cosmetic dentistry, my  patient turned to me and said, “Oh you Americans with your white teeth.”  She is from Belgium and she said it half jokingly.  When I reflected on the comment I realized how uniform dentists and technicians tend to make teeth…People Magazine’s version of cosmetic dentistry.

I used to have a painting on the wall of one of my treatment rooms…A New Yorker’s View of the World. 

Being an arrogant New Yorker at the time (I’ve changed and mellowed significantly), I resented the way the artist portrayed east coast myopia.  But, in both cases, the painting and my patient, I listen now when others suggest to open my eyes and take a different view of the world.

When patients present for cosmetic dentistry I ask them to bring in photographs of what they want their teeth to look like.  They always bring in the same pictures…Julia, Tom, Jenifer and an assortment of the same models hawking different products.  The smiles are very regular, very standard…stock teeth.  When I point out that most of these people have natural teeth, they tell me that’s what they want.

But in the end, what they want is not natural…it’s white, bright and regular…the same look that my Belgian patient was referring to.

What I am suggesting is to break that mold…destroy the status quo and really create beauty by taking a few risks.

That’s what artists do.  They create new things by destroying the status quo…not just teeth, but ideas and approaches as well.

The dentist and lab technician of the future will have to be creative…they will have to see things differently.  Competence will no longer be enough—even expert may fall short…only the masters, the inventors and innovators will compete in the future.

In the book Iconoclast, author Gregory Berns tells the story of Dale Chihuly, a master glassblower.  His work can be seen in the lobby of the Bellagio Hotel in Las Vegas (picture above), The Metropolitan Museum of Art, and in 1986 he had an exclusive showing in the Louvre.    Chihuly’s story is an evolutionary tale of an artist, and a true iconoclast.  The word comes from the Greek eikonoklastes which means “destroyer of images.”

Essentially it is what Steve Jobs referred to when he said, “Here’s to the crazies,”  or “Think Different.”  Yes…we can do that in dentistry.

As Berns tells Chihuly’s story, as a novice glassblower he stuck to the rules.  He only produced symmetrical, balanced pieces.  That was the expected protocol, and it was rarely challenged.  He was always a freethinker and struggled to do things differently, the the available tools only allowed him to produce the same old symmetrical pieces—colorful, innovative but symmetrical.

In 1976 Chuhuly was in a car accident in which he lost his left eye.  He began to wear a patch which cut off his peripheral vision.  His handicap forced him into a new way of working by giving up holding the glass to a gaffer in order for him to get more accurate depth perception.  As a result, this adjust

English: Dale Chihuly

ment allowed him to see the glass from different angles, and his results were asymmetrical, and actually mind-blowing.  He created a new art form—he broke the existing paradigm of glassblowing.

He went from competent, to expert to master by breaking the mold—by breaking the rules of glassblowing.

Dentistry will not move forward without masters—those who break the rules—the crazies.  If our culture continues to reward the same old, same old by confining dentists and lab technicians into creating the “American Smile”  we are holding the profession back and placing cuffs on individual dentists.  They need the freedom to practice.

These days it is the “crazies,” the artists that are breaking the staus quo—and they are meeting lots of resistance.  Maybe then we won’t be making pearly whites for seventy five year old patients.

 

 

 

 

 

 

 

 

 

 

 

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The 9 Turning Points of Mastery

May 1, 2013

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I received a complimentary DVD in the mail last week.  I don’t usually give these free discs much attention, but this time I slipped it into my MacBook and started to watch.

And man, was I surprised.

It was titled The Path of a Master, Nine Turning Points That Changed the Practice of Dentistry.  Don’t look for a link because it’s not available for distribution to the general public.  That’s a shame because rarely do we get to see the evolution of a master dentist with such great clarity.

Firstly, I want to thank Jeff Baggett and Bill Lockard, from the Pankey Institute, for putting this project together.  Both did a tremendous  job of telling a story that the dental community needs to hear.

Most people who watch the video may just see a story, but as someone who has practiced dentistry for close to forty years, and had my share of ups and downs, I was reminded of how we all are on the “hero’s journey” as described by mythologist Joseph Campbell.

Campbell used to quote the philosopher Soren Kierkegaard, who said, “Life can only be understood backwards; but it must be lived forward.”  The DVD brought me to a point of reviewing my own life and career.  It reminded me of what my friend Chris Sager the retired Executive Director of the Pankey Institute told me about L.D. Pankey.

He told me that when the Institute fist opened in the early seventies, students would follow L.D. around attempting to “touch the hem of his garment.”  But he said that L.D. was as human as anyone of us…more so in fact.  We tend to deify our heroes.  I identified with Bill Lockard’s narrative because it emphasized how human L.D. was, and that the nine turning points could have happened to each and every one of us if we were aware and prepared.  There are distinct differences between a master and the rest of us, but little has to do with talent.  Sometimes it has to do with preparation, persistence and luck.

I am amazed that in my own life I spent so much time planning and goal setting when it was those few turning points that made all the differences.  I am not knocking planning and goal setting, but I am reminded of another quote from my favorite mythologist/philosopher, Joseph Campbell:

“We must be willing to let go of the life we planned so as to have the life that is waiting for us.”

Pankey’s first two turning points occurred long before he became a dentist.  His story actually started with the story of Daniel Halley-Smith who he met years later on a trip to Europe.  Smith graduated Northwestern University Dental School in 1899 (where G.V. Black was the first dean), two years before Pankey was born.  He practiced in Chicago with Dr. Frank Davis who later retired in Coral Gables, Florida, where Dr. Pankey practiced.  Those of us who understand quantum physics also understand that (more…)

Top Eleven Reasons People Fix Their Teeth

April 3, 2013

Filed under: Art of the Examination,Business of Dentistry — Tags: , — Barry @ 2:25 PM

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I was just thinking about some of the reasons why people get dentistry done.  With tongue firmly planted in my cheek—I give you my Top Eleven Reasons People Get Their Teeth Fixed.

When looking at things from a different perspective we can still find valuable lessons.

1. Trauma– This includes anything from an elbow in the face during a pick-up basketball game to breaking a tooth on a frozen Milky Way (Just happened yesterday to a patient).  There is nothing like a traumatic incident to bring on sudden awareness.

2. Embarrassment or shame.  Okay, you know this one.  Grandma didn’t fix her teeth in 60 years but when her cute grand-daughter tells her, “Grammy, your teeth look funny,”  she calls the the dentist.

3. Getting married or taking photographs.  Oh, those Kodak moments.  If not full mouth reconstruction it’s a good dose of bleach that can do the trick…maybe even a snap-on smile?

4. Got married or hit the lottery.  Nothing like a windfall to get someone off the couch.  And by the way…getting married only applies to a spouse who can afford it.

5. Someone puts a gun to your head.  As long as we’re on the subject of spouses…no one is responsible for more dentistry than dissatisfied mothers and wives.

6.Their insurance covers it. Oh, but for insurance.  Every dentist has heard the claim…”if I only had dental insurance,” or “if my insurance covers it.”  Here’s a stunner…most people leave their benefits on the table every year…because most insurance doesn’t stop out-of-pocket costs.

7. They are losing their insurance.  Patients work for the same company for thirty years and never get past a few fillings and cleanings, then they retire and boom…  They try to get thirty years of dentistry done in two weeks.  Speaking of two weeks…how many patients try to get all of their end of year benefits in every December.

8. They are getting an extreme makeover.  Yes, teeth belong with weight loss and botox on the extreme makeover list.  Less popular these days but still a big reason.

9.  A stranger makes a comment about their teeth or smile ( I said a stranger, not a family member).  Yes, shame is shame and can really work motivational wonders.
10.   The hygienist told them something needs to be done.   Hygienists still have some clout, much more years ago.
11. The dentist told me them to do it.  Well this one has been losing ground for some time now.  Lots of reasons for this…think about it.  The answer lies more with cultural reasons.  I do remember a time when this could have been the number one reason to get teeth fixed.

 

Hopefully I didn’t sound too cynical.  There are always positive lessons to take from anything.  If you look back on your own career in dentistry you will probably see many serendipitous moments when you thought that things aren’t going to get better…and then that frozen Milky Way patient walks in.  Bad luck for him… but you’re back in the game.

The key is that many business strategies are based on capturing these moments.  The practices that stay open long hours, have 24/7 emergency services, the extreme cosmetic practices, the ads that prompt patients to get their work done before the year ends.  And now with social media and e-mail campaigns many dental practices are trying to capture these moments.

So my advice?  You can never tell when the moment comes so be prepared.  Louis Pasteur said, “Luck favors the prepared mind.”

How?  Be prepared technically to take care of any issue the patient presents with.  Always, always, always keep examination, diagnosis and treatment planning as your number one priority,

Never abandon the process—and you will be one lucky dentist.

 

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Is AADPA Dentistry’s Last Great Hope

March 11, 2013

Filed under: Business of Dentistry,Ethics — Tags: , , — Barry @ 1:36 PM

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I just returned from this year’s American Academy of Dental Practice Administrator’s Meeting in Las Vegas...or AADPA for those who know.

AADPA is an organization that I became affiliated with over ten years ago.  I have met and maintained friendships with many wonderful dentists there.  This year’s meeting was one of the best ever…mainly because the attendance was up and I realized just how much more necessary AADPA is now.

The organization started in the sixties and dedicated itself to practice management and leadership.  Yes, there is some “shop talk” there, but mostly the speakers and the breakout sessions are concerned with the issues that help private practitioners really create successful practices.

AADPA is a haven for dentists that take courses at the Spear Institute, The Dawson Academy and the Pankey Institute.  Likes attract likes, or where great minds meet.  But seriously, in tough economic times and with market forces effecting dentistry more than ever, leadership is what is separating dental practices.  A dentist who lacks leadership skills will probably not be able to compete in the future.

That is a bold statement...but for the past sixty years a blind squirrel could have practiced dentistry…yes, that same blind squirrel that sometimes finds an acorn.

I am here to tell you that dentistry is changing.  It’s changing because the same forces that closed down “mom and pop” hardware and pet stores are now changing the medical and dental fields…and only the best dentists will be able to continue to maintain the old highly intimate way of practice.

That is where AADPA comes in.  There is NO OTHER organization that I know of that addresses the business and leadership issues.  There are coaches and consultants but most have their own self-serving methods and ideas.  AADPA is a place to come to compare what really works and what doesn’t.

I would make this a stop on your calendar for next year—and hopefully if enough like-minded dentists begin to rally—we can save organized dentistry.

 

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10 Things Your Dentist Doesn’t Want You to Know

January 5, 2012

About a month ago there was a blog post that got a lot of attention.  It was titled 10 Reasons Your Dentist Probably Hates You Too.  It created quite a stir and wrote a post that I called 10 Reasons Why My Patients Love Me, in response.  The author of the first post wrote it with her tongue firmly planted in her cheek, and I wrote my response to sho

English: Street dentist in Bangalore with a pa...

Wild Wild West Dentistry

w that our profession needs more relationship building in an age where the professions have tipped toward business rather than health car

What is the truth about dentistry these days?

There are many ways to practice dentistry.  Every dentist is faced with the problem of balancing the paradox between duty and desire...the desire to live a great life and the duty to be a great dentist.  We live in a material world and as much as we claim that less is more…so many of us still want more.  Yet I truly believe we also want to to find meaning in our dentistry.

It gets confusing for the dentist as he tries to earn his daily bread in an age where the business of dentistry is like the Wild Wild West.

I try to practice in a manner that helps balance the paradox…some might call it “business ethics.”  I am truly bothered when I see the breakdown of ethics in our profession…so I give you these things that I see some of our colleagues doing on a fairly regular basis…that I think patients, and the powers that be should know about.

  1. Your  dentist sees you as a profit center rather than a patient.  Everyone gets the business thing.  Football players tell us this all the time…but this is health care and an ethical dentist MUST put the patient first.  That is the real definition of professional.  Dentists who do this usually relate everything to the “time is money” philosophy.  They usually run behind and are over-scheduled.
  2. Your dentist just took a weekend course in an advanced surgical technique—-and you (more…)

10 Reasons Why My Patients Love Me

December 10, 2011

Filed under: Pankey — Tags: , , — Barry @ 11:18 PM
Does he hate the dentist?

Does he hate the dentist?

A few weeks ago a blog post ran wild on the Internet.  It was written by a young dentist who had recently left the field and wrote about 10 of her frustrations with patients.  The post went viral because there was a lot of truth in what she wrote.  Check out the post.

I laughed along with most patients and dentists.  For years we have been the brunt of comedians and the media who portray us as dullards who just inflict pain.  Some of the comments on the blog post were actually nasty.  There is no doubt that the image of dentists could use a facelift.  But what really interested me about the post was a comment I read on Frank Spear’s blog, by the author herself.

In the comment she claimed that she never really liked dentistry, and that was the reason why she left.  For that, I commend her courageous decision.  Later in the comment  she said she even took Pankey courses,  “which I loved, to try to help myself. In the end, it wasn’t enough.”

I will admit that having a successful career in any profession requires at least liking what you do.  I remember being thirty six years old and wanting to walk away from dentistry because of some of the same frustrations listed in the blog post.  Instead, maybe because I come from a different generation, I didn’t.  But I certainly can identify with the frustrations.

So many dentists try to cope with the issues by applying practice management principles…learning communication and language skills as well.  What I really feel helped me the most was developing a philosophy…no, more of a mindset, or if you can handle the word…an attitude toward life and work.  From that mindset, a culture developed, and I felt as if I had more control.  And when I stopped blaming the profession and patients…things changed.

I owe a lot of that change to the Pankey Institute and Dr. Peter Dawson.  I studied and applied the principles…the behavioral and philosophic ones were the ones that changed everything.  And today…my patients love me.

I know because they tell me.  Yep…they say it right out loud…to my face, to my staff, to their friends, online and offline.

Sure, there are those who don’t like me…but they are not in my practice anymore.

So here is my list of 10 reasons my patients love me: (more…)