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Start With the Fruit

June 28, 2021

Filed under: Control,The Porch — Tags: , , , — Barry Polansky @ 1:12 am

It’s been a long time since I made my decision to become a dentist. I can’t even remember how I made it. I know that I was under some pressure to decide, mostly from my parents and their friends. I also know the reason I told others about why I chose dentistry…because I had spent so much time in dental offices growing up. Yeah…I had dental problems. But really I didn’t know that much about how I would spend the next fifty years of my life.

There were peaks and valleys in the early years… mostly valleys.

From where I stand right now, I believe that seventeen is just too young to decide what you want to do with the rest of your life. It was for me at least. But…as my father would tell me…“That’s life.” And I know it will not change for the younger readers out there, but what could change is the way dental education prepares students for what to expect. Dentistry is a complex field that requires students to become proficient in multiple skills and many micro-skills.

I wish someone would have sat me down and gave me some real world career advice…like I did for my kids as they were growing up, to avoid some of the mistakes I made. I would begin with Stephen Covey’s Habit #2—Begin With the End in Mind. I would ask students what outcomes they would like from their career in dentistry…and I would disqualify money as an answer. That’s the dummy answer.

Because money buys what people really want.

The great Warren Buffett tells a story from his youth in his biography, The Snowball, about how he always wanted to make money…it was most important to him. The story is about how at the New York Stock Exchange he observed that the really wealthy employed valets to roll their cigars. He thought it was “pure frippery to roll cigars – handmade, custom made cigars – for the member’s own particular pleasure.” When he observed that, he claimed that on that day the vision of his future was planted.

“He wanted money.” Because…

“It could make me independent. Then I could do what I wanted to do with my life. And the biggest thing I wanted to do was work for myself. I didn’t want other people directing me. The idea of doing what I wanted to do every day was important to me.”

I believe that there is a lot of universality in that thought. Yet we are all unique in our own lives…but ultimately it is up to each of us to determine and design our ultimate game plan.

Buffett wasn’t seeking money as much as he was seeking the things we all want in our lives. If only we could understand what those things are at age seventeen, then we could design our careers to meet those needs.

Adam Grant in his amazing book Think Again questions that very unreasonable inquiry that all kids are asked: What do you want to be when you grow up? In his book he uses his cousin Ryan as an example of someone who chose medicine…because the medical profession (dentistry included) is what every parent wants their child to become…my son the doctor. Once Ryan made his decision he spent years staying on track.

I’m sure many students can identify…staying on track no matter what…even when in the throws of burnout. Then, there is no turning back. And then there is the debt and all of the other sunk costs…physical, financial, mental and emotional. But we continually tell ourselves that when we hit a certain milestone like owning our own practice then we will be happy and have all the things we want…but as the positive psychologists will confirm, that is a poor prescription for happiness.

Once we realize we are in over our heads, instead of rethinking and pivoting as Grant recommends, we double down. We work harder and harder and take more and more courses looking for the answers to our disappointments. Grant calls that an escalation to commitment. We dig in.

Many of us suffer from a form of tunnel vision. We foreclose on our identity to become the doctor that our parents wanted us to become despite our dissatisfactions. In other words Grant suggests we need to look at careers as actions and tasks rather than the identity it gives us. The tasks involved in a successful dental career are multitudinous and complex. There are many micro-skills and tasks that are necessary but never discussed in dental school.

If you are a dental student reading this post and you are having second thoughts about the profession, I highly recommend that you read Grant’s advice on having a career checkup in his book Think Again.

If you follow my blog posts or have read my new book, The Porch, you know I am a big fan of knowing the ultimate game you are playing. That game according to the ancient philosophers and the modern psychologists is to become your best self…and that will result in happiness…or what Marty Seligman calls flourishing. Choosing a career that fits well with your best self will result in a flourishing career.

Isn’t that what we all want? To flourish.

There is an expression that claims if you love what you do, you will never work a day in your life. So the question is to create or design a life that enables us to love what we do. Psychologists tell us that passion is developed not discovered. We develop our passions through mastery. But mastery is not as simplistic as it sounds. Mastery includes a love of learning, curiosity, the growing concomitant passion, purpose and meaning, autonomy and competence.

As I suffered through my own burnout phase I realized more and more about the role of meaning and purpose and the real contribution I could make for my patients and team. Grant says the more meaning and purpose are important for our happiness, the older we get. I surmise that if happiness is our goal, the only way to achieve it is to understand the various pathways to happiness rather than looking for happiness itself.

Grant quotes the philosopher John Stuart Mill: “Those only are happy who have their minds fixed on some object other than their own happiness; on the happiness of others, on the improvement of mankind, even on some art or pursuit, followed not as a means, but as itself an ideal end. Aiming thus at something else, they find happiness by the way.” There isn’t just one path to happiness (money?)

If we begin with the end in mind…happiness, and define what happiness means, we will see clearly the diverse pathways that lead to our intended destination. By understanding the role we play and the contributions we make we will see that the road to happiness includes mastery, freedom, autonomy, positive relations, engaging work, and accomplishment.

Knowing this anyone can design a work life that will be rewarding and fulfilling.

My new book, The Porch, discuses the ultimate game —how to achieve the fruits of your work, in story form. Order now and receive a copy of my bestselling book The Art of Case Presentation absolutely free.

Once Upon a Time… in Dentistry

May 10, 2021

Filed under: Control,The Porch,The Stoic Dentist — Tags: , , — Barry Polansky @ 1:30 pm

Isn’t that how most fairy tales begin… with that stock phrase that implies how things used to be… and like most fairy tales, end with the other phrase… they lived happily ever after? If the dental profession could be told in the form of a fairy tale, I don’t see it ending as they all lived happily ever after. 

I started practicing dentistry in 1973. Some would call that The Golden Age of Dentistry. Looking back, I would say it was the end of a golden age. I have thought about the exact moment or moments that changed dentistry… like the day the earth stood still, or the day the music died, but I always come up empty. Things rarely change radically like a revolution, but rather unfold over time like Darwinian evolution. 

Let’s begin this tale in 1973… what I am calling the beginning of the end. When I graduated, most dentists just hung up their shingle and started what has come to be known as their fee-for service dental practice. This was how we did things back then. Sure, there were alternative ways of practicing, like group practices and specialty practices, but the economic framework was pretty much cash and carry or fee for service.

Things seemed to be working well. The private practitioners worked well with the free clinics and the welfare offices of the time. In 1954, labor unions sought to add dental coverage as a fringe benefit and consulted with state dental societies in Washington, Oregon, and California to develop a benefit where care would be delivered in the dentist’s office. 

I wasn’t practicing in 1954 but apparently the idea caught on. In 1966, Delta Dental was established and by that time dental insurance was on fire in the corporate and government arena. It was almost a political issue… but I don’t want to get ahead of myself. Most dentists even thought it was a good idea. I never complained in the early years. These days I am not a big fan of corporate entities getting involved in the marketplace… but that is a story for another day. In the early seventies, what did we know?

Let me diverge for a moment with another story… Plato’s Allegory of the Cave. An allegory is a story which acts as a metaphor for other points of view. Click on the link for a quick summary of the story. Imagine us sitting in the allegorical cave just watching the cave wall as images go by. In Ancient Greece, that may have truly been a cave but today I think more of a lecture hall or newsfeed, social media… or wherever we get our information. Facebook anyone? Plato used the term puppet master to represent the person who was controlling the images. 

As insurance entered into the marketplace, we were fed many stories from various special interest groups until the entire landscape of dentistry changed. In my day, we had the early development of closed panel groups which were the early versions of what legitimate insurance companies converted into PPOs. As years went by, insurance plans converted from total indemnification plans to PPO’s and the thankfully unpopular HMOs. 

But slowly people were losing their freedom of choice. Slowly… slowly… slowly… not only doctors but patients as well. If you were around back then, you would occasionally read messages sent from insurance companies that were meant to coerce patients to join their plans. (“You can keep your own doctor.” Really?)

The Stoics believed in free will. People wanted to decide for themselves free of coercion. But outside interests from labor unions, insurance companies and in some cases organized crime were coercing patients to join their plans – upsetting the marketplace… slowly, slowly, slowly. 

And it worked. We no longer have what Adam Smith called the invisible hand of the marketplace

I am probably preaching to the choir. Understanding this concept may be attacking someone’s personal view of the world or work, or life in general. I get that. It’s an uphill battle… steeper now than in the seventies. What concerns me most of all is the well-being of individuals. What is best for the good of all. Through the years I have watched the dental profession change from a highly desirable destination for young people to a battleground for the health-care marketplace. 

We need to look out for the good of all the players… doctors, patients, team members, lab technicians… all of the frontline workers.

So, I wonder what the future holds. Will we continue to devolve? Or will there be a movement of leadership that has not existed in the past. My new book, The Porch, tells the story of a young dentist who is struggling with burnout. He meets his mentor who tries to combat the forces in dentistry and dental education with his own brand of leadership—an authentic, virtues-based leadership that confronts dentistry’s gatekeepers in a subtle manner and begins to change the tide by calling out the puppet masters.

Don’t we all want this story to end happily ever after?


How to Go Fee-For Service and Save Your Life

May 4, 2021

Filed under: Control,Philosophy,The Stoic Dentist — Tags: , — Barry Polansky @ 12:45 pm

I first attended The Pankey Institute in the late eighties. I was at the lowest point of my career. Admittedly times were a bit easier for a young dentist back then, but in many fundamental ways they were the same. The fundamentals never change but how best to use them are something you must always stay on top of. Over the past thirty years things have changed but the fundamental wisdom of dental practice has stayed the same.

For that reason I believe…hold on everyone…that the best and really the only way to have a fulfilling career in dentistry is through comprehensive relationship based fee-for-service practice. Let me explain.

On the first morning at the Institute I remember feeling overwhelmed. It was like the first time I sat down to write a book…I was focused on the herculean tasks of creating the practice of my dreams…an unbearable project. Every moment of that first week tested my competence and potential to succeed…and then there was the comparisons and contrasts I made with the other students. But I paid attention and took notes.

In a lecture late in the week, the instructor was discussing how to schedule this new type of practice. He told us to reserve just a morning to practice what we were learning. I returned home and secured every Thursday morning for practicing the Pankey way. That included a lot of new techniques for me and my staff. It was an easy way to introduce the new school of thought to my staff.

How do you eat an elephant? I used to ask myself…one bite at a time.

The lecturer that day, Dr. Irwin Becker who later became my mentor was more right than he even knew. Just about the same time, during the eighties, two psychologists, Edward Deci and Richard Ryan from the University of Rochester were beginning to formulate their now groundbreaking self determination theory of human motivation.

Let’s face it, writing a book or designing a fee for service dental practice takes a lot of energy and motivation. Back then and sadly today, the advice comes down to “Just Do It.” Deci and Ryan put some science behind human motivation for me…and then I backed into it…but years later, while studying positive psychology, I was gratified that I took Dr. Becker’s advice; otherwise I may not have had an accomplished and fulfilling career.

Let’s look at the science.

Deci and Ryan defined motivation as the “energy required for action.” How many times do we attempt to accomplish a worthy goal but run out of steam. We need drive. Many people never even try. It was the Stoic Seneca who said, “It is not because things are difficult that we do not dare; it is because we do not dare that things are difficult.” Installing a fee-for-service practice is difficult…if we dare to do it. It requires resources like drive and energy.

Deci and Ryan went on to further describe the elements of the drive and motivation they were describing. Firstly they noted the difference between extrinsic and intrinsic motivation. The extrinsic drives were the material rewards we are all familiar with, as well as status and recognition. The intrinsic drives included passion, curiosity and purpose. What they found was that intrinsic motivation was more effective in every tested situation, excluding when our basic needs haven’t been met (See Maslow’s Hierarchy of Needs. That’s a discussion for another post.)

Then something interesting occurred to them. They separated motivation again into controlled motivation, a form of extrinsic motivation and autonomous motivation, a form of intrinsic motivation. If it is work you have to do or are being forced to do, that’s controlled. Autonomous motivation is doing work you choose to do. Deci and Ryan found that, in every case, autonomous motivation destroys controlled motivation. Remember that the next time you are being coerced or seduced into work…I’ll leave the politics up to you dear reader.

The psychologists further explained autonomy by saying it occurs when we are doing what we are doing because of “interest and enjoyment” and because “it aligns with our core values and beliefs.” In other words, it is in alignment with the other intrinsic drives: curiosity, passion and purpose.

When we are the masters of our own destiny, we are also more focused, productive, optimistic, resilient, creative and healthy. In retrospect, this is what I found on those Thursday mornings.

In the years following the development of the Self Determination Theory, companies like Google and 3M found comparable results. Google allowed workers to spend 20% of their time pursuing projects of their own liking. The result was products like Gmail, Google Maps and Google Earth. 3M did the same years before–using autonomy as the driving force behind their 15 Percent Rule. That created products like the Post-It Note.

Autonomy as an intrinsic driver works—so starting slow to install fee-for-service just one morning per week is a sound idea.

And then there is the riddle of mastery. Mastery sits atop Pankey’s Ladder of Competency…the question is how does one achieve mastery? Once again it has been reduced to “Just do it.” But there is more science.

In a 1953 paper by Harvard psychologist, David McClelland, a leader in achievement and motivation theory wrote an original thesis titled The Achievement Motive. Deci and Ryan acknowledged that this thesis may have described an intrinsic driver even more important than autonomy. They called it competence, but it now is known as mastery.

The pursuit of mastery has been the subject of numerous scholars and authors from Theresa Amabile and Robert Greene to George Leonard. Most agree that mastery is the desire to get better at what we do. It is the need to continually get better, to improve and to make progress. It is the royal road to growth and flourishing…and the opposite of languishing and drudgery…the low rung on Pankey’s Ladder of Competency.

Working toward worthy goals is pleasurable. Making progress produces the neuro-chemical dopamine. According to Dan Pink, author of the popular book Drive, “the single biggest motivator by far, is making progress in meaningful work.” At my lowest point in dentistry I felt stuck. Hopeless. My work had lost its meaning. Today we call that burnout. Those Thursday mornings turned on the light…the light of hope.

We need the freedom to chase mastery. That freedom comes from autonomy. Without the intrinsic driver of autonomy it is difficult to sustain the drive necessary to achieve mastery…this is based on our biology, not just some story, fairy tale, or business myth.

So after installing the Pankey Thursday mornings where I could practice autonomously, applying the lessons I needed to learn, I slowly put the complex elements of comprehensive relationship dentistry together. I started with the comprehensive examination and built on that by learning all of the components from the mundane mounting of models to the nuances of advanced occlusion. It took time…but driven by dopamine and progress, slowly I was installing my model practice.

I realized that learning the softer behavioral skills were just as important as the technical, so in time I learned about case presentation. Through the years I learned new skills like digital photography and Power Point. This is the essence of mastery. I am retired now and looking back I see how that moment when Dr. Becker suggested the Pankey Morning changed my life.

Today things are different. There is pressure on young dentists to go right into corporate dentistry or practice in a way that seeks the extrinsic motivators only. Many of the newer models of practice are an assault on autonomy. This is a mistake, but the young dentist doesn’t realize it for years to come, and I hear rumblings on social media…about the drudgery and burnout and professional exits.

My new book, The Porch, is a fable about a dentists who is losing his autonomy and breaks down. By finding a mentor and keeping his eyes on the ultimate prize he goes from despair to hope.

There is a way to enjoy dentistry…start with one morning per week and you will see, as I did that fee-for-service comprehensive relationship based dentistry is the only way to practice that makes sense.


You Don’t Own Me

January 21, 2020

Filed under: Control,The Stoic Dentist — Barry Polansky @ 12:46 pm
Lesley Gore- You Don’t Own Me

If you are a Baby Boomer from my generation, then you undoubtedly heard of Lesley Gore. She was a singer from the sixties who had many smash hits including It’s My Party (and I’ll cry if I want to), Judy’s Turn to Cry and my all-time favorite, You Don’t Own Me. Gore died at age 68 from lung cancer in 2015. According to her obituary “with songs like “It’s My Party,” “Judy’s Turn to Cry” and the indelibly defiant 1964 single “You Don’t Own Me” — all recorded before she was 18 — Ms. Gore made herself the voice of teenage girls aggrieved by fickle boyfriends, moving quickly from tearful self-pity to fierce self-assertion.”

Lesley Gore must have been a Stoic.

One of my pet peeves in dentistry has always been the concept of patient ownership. I was always bothered by the idea that doctors referred to their patients as “my patient.” Or the reverse – patients calling me “their dentist.” I am not being anal here, I wasn’t that bothered, but through the years I have come to find, sometimes painfully, that we don’t own anyone. Just like Lesley Gore was saying, she was free to move on anytime she liked.

In one of the most egregious cases of this, I treated a family of five for years. They grew up in my practice. They were like family to me and my staff. No one would have argued if we both used any terms of ownership. As a Boomer I was raised on the virtue of loyalty. Then one day (if you own a practice, you know what’s coming), they called for their records.

I felt fleeced. Betrayed. Lesley Gore was right…we don’t own other people (girlfriends or patients). As a matter of fact there isn’t much we do own. The famous Roman Emperor and Stoic Marcus Aurelius once said that we don’t own anything and that even our lives are held in trust.

Held in trust. I love that expression. If you get to know a little more about Stoicism you will see that even our bodies , physical health and our wealth are just held in trust. The trust that we take the responsibility to take care of things that have been entrusted to us…our physical health as well as our relationships.

In the The Enchiridion (“The Manual”) a short read on stoic advice for living. Epictetus ‘ practical precepts might change your life. He wrote about what’s in our control and what’s not. Some things he said are in our control and others notThings in our control are opinion, pursuit, desire, aversion, and, in a word, whatever are our own actions. Things not in our control are body, property, reputation, command, and, in one word, whatever are not our own actions.

Our own mind–and our own actions…that is all we can control.

That is why trust is so important. When we take on the responsibility with the perspective that we are just holding our relationships in trust – then we will value them more, take care of them more. Our patients won’t become commodities, and neither will we.

Being aware of being virtuous —doing the right thing all of the time- is what it takes to build trust. And like in the above example, there is still no guarantee. This all may seem obvious but the point of this is to gain perspective. We can’t control everything. Fortune and misfortune occur every day. How we see things is what will lead to a more stressless life…our well-being matters most.

Put a Human Face on It

June 11, 2019

Filed under: Control,The Stoic Dentist — Barry Polansky @ 10:02 pm

During my forty six years of practicing dentistry I had, like so many dentists, a few pet peeves. One in particular really bothered me. Whenever I met a new patient I would always ask about their previous dentist. What bothered me was when the patient didn’t remember their old dentist’s name. Right then I made it my goal to make sure that this new patient would remember my name—in a good way.

Names are important. We are not nameless, faceless robots that wander around all day. We all have our stories, and the way we differentiate ourselves, identify ourselves is with our names. Names give us our presence and our sense of importance. We remember people by their names.

Recently I took a hot Yoga class in Santa Fe New Mexico. The first thing the teacher did was introduce himself. Dave looked at my form and said he had a dentist growing up in Boston with the same last name as mine. That started a whole conversation about other Yoga teachers we both knew. My mind drifted to the time when I was a young child growing up in the Bronx. In those days doctors made house calls.

I still remembered Dr. Weltman who would come to our house. He was beloved by everyone in the neighborhood, and I still remember his name. I am not naive to suggest that we return to those times. Health care has changed. My pet peeve focuses on one change that we can do something about. We need to get to know our patients better, and they need to get to know us better – if we are going to stop the commodification of health care.

Business and marketing author Theodore Levitt once said, “There is no such thing as a commodity; everything can be differentiated.” And it starts with naming it. When we attach a name to someone we put that person in the context of their story. We begin to care more. It is the start of the trusting relationship. Things change when we put a name to every human.

Yes, call me old fashioned, but I do long for the old neighborhoods of the Bronx and Boston when everyone knew your name. We live in a world that is becoming way too impersonal. I was proud of the practice I grew. It was a close knit family of patients and we all knew each other – by name. I felt bad for those patients who didn’t remember the name of their last dentist. It told me much more about them and what they would expect from my practice.

Predictability = Control = Tranquility

April 1, 2019

Filed under: Control,Epictetus,The Stoic Dentist — Tags: — Barry Polansky @ 9:57 pm

Back in the mid-eighties I attended my first Peter Dawson seminar. It was his Seminar I and my first serious introduction to occlusion. It changed my professional career as well as my life.

I was blindsided.

What I remember most from that day was Dr. Dawson telling the students that the reason why so many dentists were unhappy was because they weren’t practicing predictable dentistry. Occlusion was the pathway to more predictable dentistry. At the time I was practicing dentistry at a very superficial level. Dr. Dawson’s explanation compelled me to take the deep dive, and I never looked back.

At the time I was searching for better ways to do dentistry, and get better outcomes. Behind those goals was a bigger goal—part of my search for meaning. I never realized that doing meaningless dentistry was the source of my unhappiness…until I heard Pete Dawson speak. Although I had already taken numerous practice management courses that left me wanting for more, who knew that the key to my problems could be found in exploring technical dentistry at a deeper level.

I went along for the ride.

Slowly but surely I began to understand dentistry better…things really made sense. I couldn’t get enough of restorative dentistry…and I was happier. I thought I found the cure to burnout. But it was only part of the story. I began to study human behavior as well with cognitive behavioral therapy (using rational thought to explain behavior). That helped too, but unlike technical dentistry, human behavior was less predictable than the laws of occlusion.

“I entered the land of Epictetus.”

If that quote looks familiar to you it’s because Jim Collins made it famous when he wrote about Admiral James Stockdale in his leadership book, Good to Great. Stockdale’s plane was shot down over Vietnam in 1965, and he was held as a prisoner of war for seven and a half years. For years before the war he carried around a small handbook, The Enchiridion, the surviving writings of the Stoic philosopher Epictetus. What Stockdale learned from Epictetus was that happiness demands that we differentiate between what is, and is not within our control. If we substitute the word control with predictable – Dr. Dawson’s philosophy made so much sense.The very first paragraph of the Enchiridion says, “Know what you can control and what you can’t.”

What we can control are our beliefs, opinions, aspirations, desires and our levels of understanding. These all fall within our circles of concern. We can influence the outcomes when we clarify our beliefs and increase our knowledge. That’s what happened the more I studied technical dentistry. What can’t we control? Plenty: Mostly the beliefs and opinions of other people.

Once we work on ourselves and what is under our control, the more influence we have with other people. We begin to realize that we can’t nor we shouldn’t manipulate other people. People become attracted to us because of who we have become internally. Our character.

I am not sure if Pete Dawson is a modern Stoic, but he certainly understood one of the key principles in achieving a fulfilling career in dentistry.

Check out the Enchiridion. Keep a copy in your pocket. Read it daily. Enter the world of Epictetus and comment below about how Stoicism helps you to achieve freedom and tranquility in dentistry.