It's a Long, Long Road…
It's a Long, Long Road…
In March of 2013, the American Dental Association commissioned a California based health policy consulting firm, Diringer and Associates to conduct an environmental scan of emerging trends that affect the future of dentistry. The report, completed in May 2013, is based on a comprehensive literature review and key informant interviews with organizations throughout the United States. The report concluded that there are many challenges confronting dentistry and "the status quo is unsustainable." Their opinion, in a nutshell is that this is a critical moment for the dental profession.
The report is organized into five key themes into which are synthesized 12 salient trends that will affect the future of dentistry. You can read the full report at www.ada.org, but let me give you another option. Read this e-book, because through my experience and observations I can help prepare you for a long and worthwhile career in what can still be a wonderful profession.
I graduated dental school in 1973. I am a member of the Baby Boomer Generation. Many of us will be leaving dentistry through the next few years. In 1973 the vast majority of graduating dental students went into private practice. Of the approximate 190,000 dentists practicing today, 92 percent are in private practice and 80 percent of those are practice owners. I am still in that number. In the coming years, the solo practice will become less dominant, as more cost-efficient, larger practices will predominate. The landscape is changing for many reasons.
Students today are saddled with an average of $200,000 in debt upon leaving school. The composition of dentists is changing with more women and part time practitioners entering the field. The cost of treatment and the economy has turned patients into dental consumers, looking for the best care at the most affordable price. Patients will be seeking more sophisticated high tech solutions for their dental needs, which will be mostly available through the larger more efficient dental networks. The Affordable Care Act will mandate more pediatric dentistry, and public programs will make dentistry available in high need areas. Dental hygienists and dental therapists will assume a greater role in the care of patients. I am not sure if dentists can collectively change these trends. But after forty years of practice I think I understand that if a dentist is to stay in the game for a long time…as a career, certain conditions must prevail for his or her well-being.
As the Boomers leave, the GenXers and Millennials will be taking over dentistry's leadership positions. Regardless of the differences between the generations, which developed because of the events we witnessed during our lives, I believe that biology will prevail over biography. What I mean is that in order to live a life well lived, certain components are required. I could not have survived forty years if I had to go to work every day without the ingredients of a happy life. The point of a career is to go beyond surviving and toward thriving and flourishing. The positive psychologists tell us that our well-being is dependent on five nutriments. Dr. Martin Seligman from the University of Pennsylvania uses the acronym PERMA to describe the five nutriments:
P - Positive Emotion. For us to experience well-being, we need positive emotion in our lives. Any positive emotion such as peace, gratitude, satisfaction, pleasure, inspiration, hope, curiosity, or love falls into this category – and the message is that it's really important to enjoy yourself in the here and now, just as long as the other elements of PERMA are in place.
E - Engagement. When we're truly engaged in a situation, task, or project, we experience a state of flow: time seems to stop, we lose our sense of self, and we concentrate intensely on the present. This feels really good! The more we experience this type of engagement, the more likely we are to experience well-being.
R - Positive Relations. As humans, we are "social beings," and good relationships are core to our well-being. Time and again, we see that people who have meaningful, positive relationships with others are happier than those who do not. Relationships really do matter!
M - Meaning. Meaning comes from serving a cause bigger than ourselves. Whether this is a specific deity or religion, or a cause that helps humanity in some way, we all need meaning in our lives to have a sense of well-being. We need to create our own meaning. This implies a sense of intent and the ability to purposefully design our own lives and practices.
A - Accomplishment/Achievement. Many of us strive to better ourselves in some way, whether we're seeking to master a skill, achieve a valuable goal, or win in some competitive event. As such, accomplishment is another important thing that contributes to our ability to flourish.
Hope in the Face of Reality
Dentistry has changed over the last forty years and the manner in which I practiced is beginning to change. Many of the forces I wrote about in my first book, The Art of the Examination are coming to pass. The role of government will increase especially with pediatric dentistry. Corporate dentistry or Dental Management Organizations (DMO) are springing up all over the country. Dentistry is becoming less affordable for the middle class. All of these forces are making the younger dentist very wary about opening his or her own private practice. Many of the Millennials are openly expressing desire to leave the profession. Unlike my generation, the younger generation has traded money for meaning and is not willing to "sell out." Their dental school dreams of autonomy and freedom are less realistic after graduation. I wrote this book to provide hope for these dentists. To show them how I created a practice that was fulfilling and sustainable in every way and provided me with a life that could best described by the concept of PERMA.
If after reading this book the dentist feels that achieving his dream of practice is still unreasonable, I will provide a section that will discuss how to create PERMA as an employee. I am not against other modes of practice, other than solo practice, but I do believe that the human universal of well-being is the key to surviving in dentistry. Not everyone is cut out to own his or her own practice. Some do not want the administrative responsibilities. Others do not enjoy some of the required tasks. I still believe, that no matter the circumstances, most dentists dreamed about a certain ideal that was possible while they were in dental school.
For most, that dream involved what I like to call "reconciling the paradox between duty and desire." Most dental students want to be good doctors. They want to provide their patients with the best possible care. They want to do meaningful work…helping people to become healthy. At the same time these dentists want to have a great lifestyle. They want to work comfortable hours so that they can spend time with their families. They want to live in nice neighborhoods and afford better than average amenities. I believe that, regardless of what generation we come from, this paradox has always
I remember reading practice management books from the 1920's that discussed the same issues. I went through the same issues during my first ten years in practice. I went to the Pankey Institute and learned about "balance" and how to achieve it. I spent years putting together my practice to achieve that balance. For me it was more important than money because of the stress I suffered. I was burned out after ten years. Stress comes from three factors: work overload, loss of control and a lack of meaning. It took some time, but gradually I gained control of my time and work. More importantly, I learned how to do comprehensive dentistry and how to present it properly which gave meaning to the work.
This will be short. I purposely made this into a short guide. I understand it would take years to learn and apply everything that I mention in this book. I wrote it mostly to give the reader a taste of what is necessary to learn and do. The 31 Secrets of a Sustainable Career will give the reader enough to get started and will list further resources if he or she wants to pursue them. I would love for this book to be a springboard for a curriculum to be used in dental schools. With the amount of time and money that a student invests in making a career into a passion, they should be better equipped to apply their
knowledge in the real world. My gut tells me that if students didn't have the massive sunk costs in time and money, many more would leave dentistry. I want to prevent that. Dentistry can be a wonderful profession as long as the dentist has control and provides a meaningful service.
I have been accused of taking too much of a philosophical approach to dentistry—that I didn't give dentists enough practical advice. I disagree. In my prior two books I gave dentists systems to help them get more control over getting their technical skills off of the shelf. Henry David Thoreau said, "To be a philosopher is not merely to have subtle thoughts, nor even to found a school…it is to solve some of the problems of life, not only theoretically, but practically." The problems that we find ourselves having in dentistry are less about finding the technical answers and more about the interpersonal and intrapersonal problems we face every day in our practices. This book is meant to teach what the Greeks called practical wisdom or phronesis.
The heart and soul of creating a dental practice that endures and sustains itself is based on the idea of turning a small flame into a burning desire and finally into a sustainable passion for people and the work of dentistry. It requires a level of commitment that can be kept alive through the ups and downs of daily practice. What is necessary is a commitment to success. Author Heidi Reeder tells us that there are four variables that predict a person's level of commitment about anything: a career, a relationship or any goal. In her book, Commit to Win, she describes the Commitment Equation:
Treasures - Troubles + Contributions - Choices = Level of Commitment
The treasures are the rewards we receive from the goal or activity. As a younger dentist I studied the Pankey Philosophy. Dr. Pankey's Cross of Dentistry had in its center the word "happiness." He claimed that happiness was achieved by attaining both material and spiritual rewards. Today, the social psychologists would likely call these the intrinsic and extrinsic rewards. The extrinsic rewards would be money, fame or status. The intrinsic, or spiritual rewards would include the positive emotions, the fulfilling relationships, the engagement in the work, participating in something meaningful, the feeling of control and mastery over your day. The irony is that over time, researchers have found that it is the intrinsic rewards that have a stronger effect on the level of commitment.
The equation suggests that the level of satisfaction is not only a function of the rewards we receive but also the troubles we must endure to achieve satisfaction. It is interesting to note as well that the researchers claim we need approximately five times the number of rewards to the number of troubles in order to sustain commitment. With that kind of ratio it is important that we keep difficulties to a minimum. The troubles in a dental practice can come from anywhere and everywhere. Most of us try to reduce the technical problems by taking courses and gaining more experience. This is a good strategy. In the end we want our work to be predictable. The predictability gives us a sense of control.
Most of our troubles come from other people. Staff relations, patient relations and getting patients to accept our best dentistry are the most unpredictable situations that occur in practice. When enough problems develop because of our inability to control other people, we tend to blame ourselves and stop trying. Our commitment gets shaken to the core. We tend to get lazy and stop trying. I believe this is why many dentists want to bail out. A fulfilling and rewarding career takes much perseverance. The social psychologists call that ability to persevere as having grit. Although grit is an admirable trait, I will attempt to give you advice that will help you interpret the negative events so that they don't affect the treasure/trouble balance.
Interpretation of the events is a key factor in one's success. How we see the problem is the problem. Our brains are wired to see the negative first and foremost. This is called negativity bias. Many of you are familiar with the adage: One thousand complements + One insult = One insult. That's the short version of the negativity bias. I find that many dentists grit out their entire career because of the third element of the equation: contribution.
As noted above, dentists spend a small fortune to get the privilege to practice dentistry. And money isn't the only thing they have invested. They spend a minimum of four years after college and place themselves into a pigeonhole in terms of what they can do with their dental degree. Their talents are both a blessing and a curse—a blessing because of the opportunities they have and a curse because… if they are not happy, their choices are limited. They're invested whether or not they are committed. Heidi Reed the author of Commit to Win calls this the Entrapment Effect: "When contributions lead us to stay with a commitment, even when it's costly or not in our best interest." Most unhappy dentists have way too much invested to quit.
The final piece of the equation is the choice element. As I hinted above, the choices are limited. One thing I always noticed about dentists is that so many are looking for a way out. Many try outside businesses to create income that will free them from doing dentistry. Network marketing of various products from water filters to shampoo is a favorite among dissatisfied professionals. It blows my mind that dentists are willing to abandon their efforts to create a successful, rewarding career in dentistry for "sales" of products that they must create a false passion about. I just don't get it…until I look at the commitment equation. The goal is to develop passion for dentistry by increasing the rewards and minimizing the troubles. This e-book will show you how. If you're still with me, tweet the sentence: maximize the rewards, minimize the troubles, @barrypolansky.
It's a Marathon, Not a Sprint
A career is a long time. I must admit that when I graduated dental school my plan was to retire at forty, but as they say, "Man plans and God laughs." My first ten years in practice were not a walk in the park. The advice that is found in this book has been earned through hard work and many mistakes. These days I write to give back to a profession that I have learned to love. I wasn't born with a passion for dentistry…it developed and grew like a fire. I know that any dentist can have the same experiences. What I did is not unusual; it just requires commitment. Forty years is a long time to wander through the desert. Let this e-book be your guide…a primer or starting point to ignite within you a desire to learn more about human nature, psychology, philosophy and business…what you never learned in dental school.
My first tip, a bonus piece of advice is something a wise man told me long ago. He said, "You only have to know two things in life, where you want to go and who you are taking with you…and never get them out of order." Think about those two things, not only in reference to our work, but to our whole lives. Essentially he told me to create a vision (where I want to go) and make sure your traveling partners are the ones you want to share your life with. I have been married for forty-two years to my high school sweetheart. I have staff members who have been with me for over thirty years. I would like to believe this is not an accident…it's commitment. The rewards have outweighed the troubles, and the fire keeps burning.
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