How Do Masters Do It?

WHAT SETS MASTERS IN DENTISTRY APART FROM THEIR COLLEAGUES?
Based on research that was compiled for a presentation I gave last April (Boston, Mass), I discovered that masters excel at 4 characteristics. These 4 characteristics were present in all 7 masters whom I either interviewed or observed in their practice. The purpose of this article is to share the 4 mastery characteristics and how I discovered them. Implementing these “secrets of the masters” into your practice could make all the difference to your future success.

BACKGROUND
Entitled “How Do Masters Do It?” my presentation to the general membership of the American Association of Endodontists’ (AAE) annual scientific meeting focused on the endodontist, yet the essential message can be applied to all of dentistry’s disciplines. Indeed, the principles of unprecedented and sustained excellence are common to every area of dentistry.
We all know dentists who cannot wait to retire. The dream practice they once envisioned is not so dreamy any more. Many have lost their “swagger” because they are not as busy as they want to be, have lost the community’s respect, and/or validation and their identity due to pressure from insurance, competition, and government to “do it faster and cheaper.”
Retaining market share has caused some dentists to focus on quantity rather than quality. And yet, there are endodontists and restorative dentists who are thriving in this challenging economy and practice environment. Their practices represent them. They practice comprehensive interdisciplinary dentistry, are proud of their fees, do not compromise their standards, practice in state-of-the art facilities, enjoy a highly trained and competent staff (team), and develop treatment plans that are based on patient needs, not their own needs. They take the time to do it right (Figure 1). They truly enjoy their practice. They are in control.

Figure 1. John (left) with his dad Roy, a master finish carpenter from London, England, who taught John “how to do it right.” Roy built the sailboat in the background for John when he was 3 years old. Quality withstands the test of time. John dedicated his American Association of Endodontists (AAE) presentation to his dad in honor of his mentorship and his dedication to superior craftsmanship.	Figure 2. Samples of 6-item questionnaire completed by AAE members.
Figure 3a. Dr. Tom McClammy (Dr. Vision) at his microscope.	Figure 3b. Tom’s reception area, as well as his entire office, represents him and his vision of a successful endodontic practice. Yes, Tom loves horses and being a cowboy when he’s not in the office.

The irony is that both successful dentists and unsuccessful and unsatisfied dentists operate under the same conditions and with the same information. The purpose of my inquiry into mastery was to unravel, uncover, and discover what sets one group apart from the other. What I learned is that the master of dentistry does something different.
For my presentation, I proposed 4 ground rules that facilitate mastery learning:
1. I believe that the most relentless enemy to learning is what you already know.
2. I am not interested in telling you what to think, but rather, in allowing you to see for yourself what you are thinking.
3. I am not suggesting that you accept dogmatic philosophy. I am suggesting that you question everything I say, and more importantly, everything you say.
4. I am asking questions in order to discover how we got here, so we can take back our rightful place in the dental community, the healthcare field, and the community at large.

PROCESS
I chose 3 avenues of exploration to learn what makes a master unique:
1. A comprehensive review of current literature on the subject of mastery.
2. Responses to a 6-item questionnaire completed by the active membership of AAE (Figure 2) that I designed and tabulated.
3. Observations and in-depth conversations with 7 endodontists on the West Coast that I consider to be masters of their endodontic craft. Each was given a nickname for the presentation that best describes what uniquely sets him apart. The masters, along with their nicknames and significant contributions, are listed in the order in which they appeared at the AAE presentation:
Dr. Tom McClammy (Dr. Vision) (Figures 3a and 3b).
Dr. Clifford Ruddle (Dr. Possibility) (Figures 4a and 4b).
Dr. Terry Pannkuk (Dr. Innovation) (Figures 5a to 5c).
Dr. Wyatt Simons (Dr. Passion) (Figures 6a and 6b).
Dr. Steve Buchanan (Dr. Creativity) (Figures 7a and 7b).
Dr. Jason West (Dr. Artist) (Figures 8a to 8c).
Dr. Gary Carr (Dr. Curiosity) (Figures 9a and 9b).

Figure 4a. Dr. Cliff Ruddle (Dr. Possibility) sitting far left and me (sitting center) with Cliff’s multimedia team (from left to right): Mitch Goodgion, Eric Smith, and producer Glen Derbyshire at Advanced Endodontics headquarters in Santa Barbara, Calif.	Figure 4b. Cliff in his element: teaching. Photographed here by participant Dr. Florian Bertzbach from Germany. As a quintessential endodontic educator, Cliff has always strived to push the limits of teaching quality and standards. When you hear Cliff, you can’t help but see and discover for yourself the unprecedented “possibilities” of combining endodontic precision with endodontic artistry.
Figure 5a. Dr. Terry Pannkuk (Dr. Innovation) at the microscope with his chairside assistant. One of Terry’s master skills is reinventing himself and his practice as conditions change.	Figure 5b. The day I visited Terry’s practice, he saw a patient with a broken abutment screw; for him it was not a challenge, it was an opportunity. He notched the abutment screw with a Mounce bur and then whittled down a Craftsman screwdriver which made it small enough and yet robust enough to successfully remove the abutment screw.
Figure 5c. “Terry Tool” was efficiently used to remove the abutment screw (top left inset).	Figure 6a. Dr. Wyatt Simons (Dr. Passion) is one of endodontics’ rising stars. Wyatt’s passion to contribute and make a positive difference is unrivaled. And, he can do a signature quality root canal!
Figure 6b. Another of Wyatt’s endodontic passions is to stretch the limits of the gutta-percha medium and produce improved heat waves. In this image, he is testing heat conductivity depth of a gutta-percha cone.	Figure 7a. Dr. Steve Buchanan (Dr. Creativity) with a plethora of his endodontic inventions, from access to obturation. Steve is as enthusiastic about endodontics today as the day he began.
Figure 7b. Demonstrating his creativity, Dr. Steve Buchanan shrinks himself to stand in a lateral portal of exit.	Figure 8a. Dr. Jason West (Dr. Artist) at chairside with his dental hygienist, Katey, mechanically and artistically shaping a root canal system preparation where he can predictably produce the 3-dimensional endodontic seal.
Figure 8b. Dr. Artist paints the “Look” into a maxillary first molar.	Figure 8c. Endodontic artistry appears the same, whether in maxillary or mandibular teeth. Though biased, I see Jason’s results almost every day. When I need to remember why I am here, I go look at the monitors in his operatory, then I refocus on what I may have been missing to design sustainable shapes that reflect Dr. Herbert Schilder’s 5 mechanical objectives, especially number 3: flow.
Figure 9a. Dr. Gary Carr (Dr. Curiosity) and his assistant, Joy, for more than 25 years. Gary has always stood for, championed, and led the way to the highest level of care in endodontics by bringing the instruments, infrastructure, and thinking of the future into the present.	Figure 9b. Dr. Curiosity (standing far left) mesmerizing yet another audience on the virtues of measuring your short and long-term results in order to honestly assess your diagnosis, treatment planning, technique and predictability. His paperless TDO technology directly impacts more than 1,000 endodontists a day. Gary is a true endodontic pioneer.

FOUR CHARACTERISTICS
As noted at the beginning of the article, I divided my conclusions into 4 characteristics after observing and/or interviewing the masters:
1. Foundation—Masters have a belief system that guides their decision-making and their actions. They are strong in their conviction that they have a purpose and a calling.
For example, all masters believe that the job of the endodontic clinician is to heal or prevent lesions of endodontic origin (LEO). Though they may differ on how to achieve healing and preventing LEOs, all of their standards are extraordinarily high and without compromise.

• They choose to focus on their desired outcomes in spite of pressure to do otherwise.
• They live and practice by principles.
• They are clear about what they want.
• They have learned the art and science of their craft.

2. Resources—Masters have the necessary ingredients for a masterful practice: enough patients and referrals who value and appreciate them, state-of-the-art facility, capacity to reinvent themselves as times change, education in and practice of interdisciplinary endodontics and interdisciplinary dentistry, understanding the role of leader, practicing team dentistry, fees they are proud of, quality results, unprecedented service, and understanding the power of their own attitude to create the practice they want.

3. Technical Tools—Masters use the right tool (instrument) for the right job. In other words, they know the desired outcome of a procedure, where they are in the procedure and how to choose and use the most efficient instrument and technique to achieve the result they want. Their skill lies in engaging the right tool, technique, and thinking for the job at hand.
4. Feedback—Masters assess their short- and long-term results. They understand that they do not get what they want; they get what they measure. Each master:

• Has developed his own internal quality and practice control system.
• Insists on post-treatment recalls of 5 years and beyond.
• Wants clinical and radiographic evidence of success.
• Analyzes unsuccessful results so he can do something different in the future.

In summary, mastery in dentistry is about getting back our swagger. It’s about having the practice we want, in spite of outside pressures. Incorporating the following 4 action steps into your practice will put you on the path of mastery and bring back your swagger. Remember to set deadlines and measure results as you go.

ACTION STEPS TO ACHIEVE THE CHARACTERISTICS OF THE MASTERS
Foundation Action Steps
1. Vision Statement—To get the most value from this action step, a vision statement should:

• Answer the question: “If I died tomorrow, what would be missing in my community?”
• Be brief—6 words or less is ideal.
• Define your purpose, which is measurable and attainable.
• Be written in first person, present tense.
• Be the North Star that guides you and your team every day, and every step of the way.

We all want to produce the best results in dentistry for our patients, but being a “good” dentist is too general and cannot be measured. In fact, in today’s dentistry, good is not good enough. As a vision example, a dentist in an endodontic program that I recently taught in San Antonio came up with this vision statement: “We hear our patients.” To me, this says it all. If she and her team hear their patients, that means they listen to patient needs, diagnose and treat based on patient needs, are on time, are friendly and engaged, make crowns in their natural color that fit perfectly, etc.
What is your purpose? What uniquely sets you apart? Once you have written this down, own it, declare it, and lead your team using this statement as your reference and it will guide you in all your decision-making and treatment planning. Without this mandate, no one knows where to go. There is a leader, but no direction. As the saying goes, if you don’t know where you are going, any path will get you there.

Resource Action Steps
1. Team—Find the best employees in your community and incorporate them into your vision. Train them for technical skills, communication skills, and practice growth skills. Teach them your high standards and your game plan, which should be bold and even seemingly unreasonable. Start with the answer. Don’t wait for conditions to be ideal. Be comfortable being uncomfortable. When staff members are committed to your vision, you can delegate and get out of their way. They will get the job done and be accountable. Huddle briefly before seeing patients every day to share what worked well and what did not the previous day, using master characteristic No. 1, the vision, to guide and evaluate your performance and results. Schedule regular team meetings to celebrate successes and discover improvement opportunities.
2. Office and Infrastructure—Your office should be clean, efficient, state-of-the-art, friendly. It should visibly express and represent your vision.
3. Patients—They say, “build it and they will come.” This will hold true for you if you put these action steps into place. If you are your best, if you serve your patients, if your skills are top notch and if you continue your education, the patients and their referrals will come. Patients want to feel safe, to be seen, to be heard, to be recognized. They want the best treatment and the best value. They will tell their family and friends about you. If this is what you have to offer your community, then enjoy your successful ride.
4. Interdisciplinary Capability—No dentist can do it well alone. Collaborative dentistry is a key model for a successful practice. Dentists who work with an interdisciplinary team (periodontist, endodontist, orthodontist, oral surgeon, pediatric dentist, and pain specialist) have the most successful practices. Because when the specialist teaches the restorative dentist to see more, the dentist can do more. When you educate your patients to understand that bringing in a specialist is not sending them away, they will know that you are acting in their best interest. Returning from the specialist, patients should have a higher dental intelligence quotient and total health awareness, as well as an enhanced appreciation for your professional skill, care, concern, and commitment.

Technical Action Steps
1. There are superb clinicians and teachers in every discipline of dentistry. The 7 endodontic masters I have identified are all gifted teachers. If you contact any one of them, I know from experience that they can be an exceptional resource.
2. Learn the technical principles and then you will know what technique to use when and how. Masters understand the precept that “less is more.” They select the “right tool for the right job.”
3. Slow down. Then you will make fewer mistakes and become more efficient. Also, when you slow down, your quality will increase. When your quality increases, you will be more valuable and when you are more valuable, you can set fees that represent your dedication to superior performance and results. The community talks, and what you stand for gets around. Yesterday’s signatures become today’s reputations and today’s reputations become tomorrow’s legacy.

Feedback Action Steps
1. Masters are curious. They are not content to complete a procedure and get onto the next one. They document and evaluate each procedure.
2. Masters set up measurable methods for quality control. They want to see results in one year, 5 years, and 25 years. They want to know if their dentistry has withstood the test of time. And if not, why not. They consistently ask what they can learn from the past to influence outcomes in the future.
3. Masters set up mini-studies and compare the latest and greatest material or technique with their current modus operandi. Masters listen to the company representative and read the literature, but they understand that the best education in the world is their own education; their own evaluation.

CLOSING COMMENTS
These 7 masters have discovered that, when they are able to make choices, they are in control of their experience and their destiny. By (1) having a strong foundation, (2) the right resources, (3) superior clinical skills, and (4) critical feedback about short- and long-term quality, you too can enjoy the benefits of the master path.
My goal with this article has been to shed light on the secrets of the 7 masters and the 4 steps they have taken and perfected in order to achieve mastery. My wish is that through increasing awareness, more options will be generated, leading to new and profound choices regarding your future, resulting in greater control over your destiny now and in the future.
I close with this quote used by one of the masters, Dr. Cliff Ruddle, which reflects both a fitting ending for my article, as well as an optimistic future for us and our profession.
“The danger for most of us is not that our aim is too high and we miss it, but that it is too low and we reach it.”—Michelangelo

Dr. West is the founder and director of the Center for Endodontics, Tacoma, Wash. Dr. West continues to be recognized as one of the premier educators in clinical and interdisciplinary endodontics. He received his DDS from the University of Washington in 1971 where he is an affiliate associate professor. He then received his MSD in endodontics at Boston University Henry M. Goldman School of Dental Medicine in 1975, where he is a clinical instructor and has been awarded the Distinguished Alumni Award. He has presented more than 400 days of continuing education in North America, South America, and Europe, while maintaining a private practice in Tacoma, Wash. He coauthored “Obturation of the Radicular Space” with Dr. John Ingle in Ingle’s 1994 and 2002 editions of Endodontics, and was senior author of “Cleaning and Shaping the Root Canal System” in Cohen and Burns’ 1994 and 1998 Pathways of the Pulp. He has authored “Endodontic Predictability” in Dr. Michael Cohen’s 2008 Quintessence text Interdisciplinary Treatment Planning: Principles, Design, Implementation as well as Michael Cohen’s 2012 Quintessence text, Interdisciplinary Treatment Planning Volume II: Comprehensive Case Studies. Dr. West’s memberships include: 2009 president and Fellow of the American Academy of Esthetic Dentistry and 2010 president of the Academy of Microscope Enhanced Dentistry, the Northwest Network for Dental Excellence, and the International College of Dentists. He is a 2010 consultant for the prestigious ADA Board of Trustees where he serves as a consultant to the ADA Council on Dental Practice. Dr. West further serves on the Henry M. Goldman School of Dental Medicine’s Boston University Alumni Board. He is a thought leader for Kodak Digital Dental Systems and serves on the editorial advisory boards of the Journal of Esthetic and Restorative Dentistry, Practical Procedures and Aesthetic Dentistry, and the Journal of Microscope Enhanced Dentistry. He can be reached at (800) 900-7668, at the e-mail address johnwest@centerforendodontics.com, or visit centerforendodontics.com.

Disclosure: Dr. West is the coinventor of ProTaper and Wave One NiTi Systems and Calamus Obturation Systems (DENTSPLY Caulk).