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Do You Recognize the 9 Signs of Practice Stagnation?

June 11, 2012

Filed under: Philosophy — Tags: , — Barry @ 10:05 PM

I am a different person than I was twenty years ago. Back then I hated dentisttry.  I think burnt out would be an appropriate term.  I was twenty pounds heavier, out of shape and spent most  nights at the Meadowlands Racetrack running away from my responsibilities.  I made money in my practice because back then everyone made money in dentistry, but I was pretty unhappy and  clinically depressed.

Then things changed.

Those who have read my book, The Art of the Examination know that the event that changed my life was getting Type II diabetes.  My life hasn’t been the same since.  I changed!  It wasn’t easy and it took incredible discipline.  Now twenty years later, I have a successful practice that I enjoy going to and work with staff and patients that I feel I make a difference in their lives.  I don’t gamble anymore.  I have lost all my excess weight.  My Body Mass Index is an incredible 23.  How I did it isn’t the point of this post…what is the point?

That most dentists get stuck in a rut and watch their practices and lives decline over time because of a natural immunity or resistance to change.  In today’s much tougher environment it is essential that we continue to reinvent ourselves in order to keep up with the current conditions. The following are 9 reasons why we resist change and some tips on how to break out of this.  This post will be continued as a 2 part series.

1. Lack of a financial safety net.  When I graduated from dental school I made up my mind that I would retire by thirty-five. Heh!  That was my first deception.  I incurred debt and and got behind the eight ball.  I got caught up in buying toys and neglected the softer side of practice, or trying to provide patients with meaningful work.  This left me unhappy.  I used to say that when I made more money I wouldn’t do certain procedures or work on certain patients (I must have been dreaming).  I continued to lie to myself and say, “someday.”  This is a common reason for not making a decision to change.

So many people, especially from my generation lived by the “more is better” philosophy.  We set “goals,” based on what our neighbors had.  Unrealistic goals, daily goals,, monthly goals.  It never ended.  We didn’t base our goals on what we truly needed to be happy.  My life changed when my relationship to my financial goals changed.  I realized that I would be happier working with people who appreciated me more.  So I fired many patients, learned how to recognize and treat those who  truly wanted my services (Tip: I used Pareto’s Principle the 80/20 Rule), and never worried about the treadmill again.

2. The fear of losing what we have. There is an expression: You can’t steal second base with one foot on first.  Let’s face it, it’s hard not to look back at the comfort and security of what you are leaving behind.  I struggled with this for a long time.  Outside of dentistry, when I got my diabetes diagnosis I felt so sorry for myself that I couldn’t eat those Sara Lee Chocolate Swirl cakes anymore.  Granted, I stopped cold turkey, but I didn’t fire all my patients at once.  I did it slowly…I took some risks at the beginning, generally looking at it by saying that getting rid of any one particular patient would be an “acceptable loss.”  People who gradually change do it slowly by taking small risks.  Of course there are those who go “all in” too.  They key is to movement…Einstein said, “Nothing happens until something moves.”

3. A lack of confidence. There are all kinds of dentists, but I bet that a lack of self-confidence and self-esteem stops most of them.  Not the cowboys mind you…those who think all of dentistry is human experimentation, but the ones who fail to learn new procedures or learn them but never apply them.  I was part of that crew, but I knew that I couldn’t change until I applied what I knew was right.  That goes for the hard as well as the softer skills.  Amazingly I am not only speaking about technical skills like placing implants, but properly presenting cases as well.  The key to change is to fail forward.  See failure as a learning experience.  Today’s younger dentists are learning so much more through continuing education that the older docs can’t afford not to move forward.  Look at NY Met pitcher, R.A. Dickey.  He almost lost everything when he had to give back his signing bonus because he ad no ulnar nerve.  Instead of quitting he learned to throw a knuckleball and is now one of the most dominant pitchers in baseball.  At first he had no confidence in his ability to learn a new technique.  He went through a lot of failure, but now he is a premier pitcher.

4. We study things to death.  This was my biggest problem.  If I learned something new I would try to master the knowledge before I decided to actually try something.  In the meantime my colleagues were already using new materials and techniques.  These days I make a decision and go.  Remember what I said about acceptable losses because saying yes to anything and everything can get us into hot water.  I have made some mistakes, but in the end many were just learning experiences.  Mostly, I benefitted from being more decisive.  Be careful that what you are saying “yes” to fits in with your guiding principles, your values and your mission.

5. Fear that no one will pitch in.  I got my first computer back in the late eighties.  I wasn’t the first on the block but I was an early adopter.  My biggest barrier to entry was my staff.  They liked the status quo.  They would have to learn the new technology.  Do I have to tell you what waiting would have meant?  Today we have technologies like CT scans, lasers and implant systems that pose a threat to the people who work with us.  I can tell you one thing…everyone wants to improve, they want to get better too.  It’s just as scary for them to change as it is for us.  I guess that is what leadership is about.

I have been in practice since 1975.  One thing I can tell you is that the way we practice today doesn’t even resemble the way things were back then (just like me).  Change is inevitable…it is the only constant in our lives.  In the next post I will reveal 4 more reasons dentists hesitate about making changes…in the meantime I welcome some of your experiences with change.  Please leave a comment.







  1. Barry,
    I can relate to all of these.  I guess no matter what type of change it is– whether it’s for our health, bad habits, our style of practice, or even changing careers– all 5 things on your list will get in the way of making positive changes.  I had no idea you were in the burnout phase at one point in your career.  Glad to see you were able to turn things around for yourself.  Great post!

    Comment by lolabees — June 12, 2012 @ 12:52 PM

  2. Hi Laura, as the say, “All saints were sinners.” I am very suspicious of those who have made it to the top without any serious adversity. Change is one of the toughest things we need to do in order to grow. As a blogger you can see how difficult it is to fight what Steve Pressfield calls Resistance– the big R.

    Comment by barrypolansky — June 14, 2012 @ 9:30 PM

  3. Barry, I don’t recall giving my psychotherapist permission to give you all my failings! As usual; GREAT job. concise and insightful.

    bill gregg

    Comment by bill gregg — June 14, 2012 @ 3:31 PM

  4. Thanks Bill…we all face these issues…I once read a book…Change or Die.

    Comment by barrypolansky — June 14, 2012 @ 9:24 PM

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