Coaching dentists to believe in their capabilities
What can you tell us about your background?
Fife, Washington, population 1,500, where I was born and raised, is a small rural farming community where my parents were also raised 30 years earlier. Fife is an hour south of Seattle, Washington. My mother was a second-grade schoolteacher, and my father was a mechanic who owned a gas station and garage. My interests when younger were the same as most small town boys — sports, fishing, hunting, and eventually, girls and cars. When I left for college, I went to Pacific Lutheran University (PLU), the same small college my parents went to about 30 minutes from where I grew up. I really didn’t have any idea what I wanted to be, just that I wanted to play football in college and have a good time. And I did have fun, finishing my first year of college with a 2.3 GPA and a D in a religion class.
My second year in college, it was required to choose a major, so I chose physical education, with a goal of becoming a football coach. One of the hardest classes for that major was anatomy; I decided to sign up for it first semester of my second year. I loved the professor, a woman named Ruth Sorenson, and the class and topic. At the end of the semester, she asked if she could meet with me after finals. She looked at me across the desk and asked me what I was going to do with my life, to which I replied become a football coach. She said that was what she thought and, she then asked me what else I had considered; I had no answers.
Next, she asked if I had ever considered becoming a physician, a dentist, or perhaps a veterinarian. I replied no to all three. In my small town, both of my parents were raised very poor, and we viewed the physician, dentist, and veterinarian in the town as being at a different level than we were; there was no way I ever would have considered becoming any of the three. Ruth Sorenson then looked me straight in the eye and said, “I think you should consider one of the three, because I see a lot more capability in you than you do.”
She then informed me that she had arranged a meeting for her and me down the hall. We walked down to a room that I had never been in before — it was Harald Leraas, the Pre-Med Pre-Dent advisor’s office. We sat down across from Harald, and it turned out he was a dentist. Fifteen minutes after sitting at that desk, I decided to become a dentist; to this day I can’t tell you how that happened. I went on to finish my undergrad with one B in a lab class, and all the rest A’s — how motivating clarity and direction can be. I did still finish playing football for all 4 years — just gave up on the physical education part as well as becoming a coach.
From there I went to the University of Washington School of Dentistry for my DDS and then onto an MSD in Perio-Pros.
What originally attracted you to dental education? What aspects of your training inspired you to add “educator” to your list of accomplishments?
As I said, my mother was a second-grade schoolteacher, and both my mother and father believed very strongly in education being the most important thing you can give anybody. In addition, mom was very gifted at what she did. She passed away at age 92 in 2014, and many of her former students attended her memorial service, some she had taught over 50 years earlier. They all remarked how much they remembered the experience of being in Mrs. Spear’s second-grade class.
In addition, while I was in my senior year of dental school, I was chosen as a faculty member to help teach second-year dental students in their first clinical denture course. Part of that experience involved the students giving the prosthetics department written feedback about each member of the faculty. Thankfully, my feedback was very positive, and I realized how much I enjoyed helping others learn.
Along with those experiences, in my Perio-Pros residency, you had to learn how to give presentations. We had an entire year course on every aspect of a presentation — graphics, title slides, organizing content, timing, etc. I loved it, and our final exam was a 1-hour presentation in front of the faculty of the periodontics, prosthetics, and restorative departments. I had taken some public speaking courses in my undergrad days, and I was very comfortable with it, so extending that to dentistry was enjoyable for me.
Who has inspired you as a clinician and an educator?
The list of people I have been inspired by would be fairly long, but some names definitely stand out. I have already mentioned the one who had the most impact on me as an educator, Ruth Sorenson, my undergrad anatomy professor. Without her and that meeting after finals with Harald Leraas, I wouldn’t be writing this for you right now. In fact, one of my major prayers is that I can be Ruth Sorenson for people in my audiences. In other words, I can help them see that they are more capable than they believe they are.
In dentistry, the one who most formed the direction I went was the director of my Perio-Pros program, Dr. Ralph Yuodelis. He was gifted as a clinician, but he was one of the least dogmatic educators I have ever seen in dentistry. While everyone else would be telling you there was a right way and a wrong way to do things, and their way was the right way, Ralph would be telling us to try all the different ways and learn for ourselves what works for us as individuals. Not to mention the work he would show was so inspiring, I knew that was what I wanted to do.
Another name that readily came to mind would be Dr. Lloyd Miller from Tufts — one of the true gentleman of dentistry — massively talented esthetically and so nurturing of young dentists. He wanted only the best for everyone he taught. Dr. Richard V. Tucker is another in that same vein as Lloyd, so humble, but his work was simply spectacular.
And finally I would add Dr. Pete Dawson, someone I have considered a friend for 30 years. I have learned so much from Pete, and I also had the good fortune of teaching with him a week a year for 9 years starting in the mid-’90s at The Pankey Institute. We would stay in the same condo for the week, and after the day was done, some of my most enjoyable memories were he and I drinking a Scotch and talking about life and his history in dentistry.
What are your proudest moments in the clinical and teaching aspects of your life?
As a clinician, I have always loved the experience of watching a patient’s self-confidence transform following treatment that took a debilitated dentition and turned it into something beautiful. In addition, anytime a patient gives you a hug because of what you have done to help him/her, that is hard to beat.
As an educator, the greatest rewards for me have always been watching students who didn’t think they could see something, do it, or understand it, and then those students suddenly gets it. Seeing that aha flash across their faces is wonderful. The other thing I love about education is getting feedback about how what you have taught someone has impacted their life, either in practice or personally. I have been fortunate to have been doing what I do for close to 35 years, and I have gotten lots of cards, letters, notes, etc., from students over those years, and I have kept all of them in “attaboy boxes.”
You are probably wondering what an attaboy box is. I mentioned that I played college football, and my coach was one of the most amazing men I have ever met. His name was Frosty Westering; he coached football, but in reality, Frosty coached young men about life. In his 32 years at PLU, he won six Division II national championships and was in the finals game another 6 times, so he was very successful as a coach. He would tell us life lessons he had learned, and one was about his attaboy box — a box where he kept all the things people sent him that were positive so that when he was down or life seemed hard, he could go to the box and remind himself who he really was. It is amazing how well it works.
What do you think is unique about the topics that you teach?
I would like to think I am like Frosty. I teach dentistry, but in reality, I would like to think that I am also a coach about the life of a dentist, so it is not a procedure or technique necessarily, but also how to integrate what you learned into your practice, your case presentation, and your fees. One thing I learned a long time ago about dentistry is that if you teach dentists a technique, but not how to integrate it into their practices, they will learn the technique but never get to do it.
That philosophy fits perfectly with our goals at SPEAR Education for our students. We have four very simple-to-understand goals for the dentists we work with:
- Help you have more fun in practice on a daily basis, basically help you enjoy dentistry more.
- Help you become more profitable.
- Help you have more free time.
- Help you grow as a clinician to whatever level of clinical excellence you aspire.
We accomplish those goals by not teaching just techniques, but on focusing on all aspects of the practice, including TEAM training.
As an educator, what have you learned from your clinician-students?
The greatest learning I have gotten from students comes from the evaluations that I want to see the least, ones with negative feedback. At first there is a tendency to rationalize the feedback, blame it on whoever wrote it as being incompetent, etc., but almost universally, if you allow yourself to read it and ask the question, “How could I have presented this differently so this person would have understood it?” you will become a better teacher. To this day, all of us who teach at SPEAR Education read every one of our evaluations, and to this day, I learn how to improve after every course I teach.
One of the things I am most proud of about my teaching is getting feedback that I take complicated topics and make them easily understandable, but part of why that has occurred is because of the feedback I have gotten over the years about what students didn’t understand.
What has been your biggest challenge in sharing information and educating clinicians?
The answer to this is interesting because it goes back to me at PLU and sitting across from Ruth Sorenson. I had never considered being a dentist because I didn’t believe it was possible. My students are dentists, they have already gotten there, but the biggest issue I have is helping them get a clear vision of what is possible for them in practice — most don’t clearly see the possibilities.
I hear things such as “I just don’t see those patients in my practice,” “My patients only want what the insurance will cover,” etc. In other words, they don’t believe that any patients in their practice want more than basic single-tooth dentistry. Yet I promise in almost any town in America there are patients who want more and the dentists who are providing it. But if you don’t believe that is possible, it is a self-fulfilling prophecy because you won’t present anything more because you believe it will be turned down.
To clarify, our goal for our students is not for them to have complex restorative practices or boutique cosmetic practices, but instead a robust patient base with a good hygiene-recall program, while at the same time hopefully treating one or two patients a month who do want more. My experience is that if a general practitioner can do one or two more involved cases a month, it moves them significantly in the direction of our four goals: fun, profitability, free time, and clinical growth.
What would you have become if you had not become a dentist?
The first thing that comes to mind would have been a football coach, but you heard that story. My most likely other choice besides dentistry would have been plastic surgery, but I am happy I chose dentistry.
What are your top tips for maintaining a successful practice?
My top tips are not very complicated — solid clinical quality and a great patient experience. I view dentistry the way I see any customer service business — you have to identify who you want to be as a practice, clearly communicate that to your potential client base so they have the correct expectations about who you are, and then deliver what they were expecting. One of the biggest problems I see for many dentists is they don’t know who they are, and they don’t know what they would like their practice to be like; instead they just take whatever comes their way.
Also learning how to treatment plan and to communicate that plan to patients is imperative. Learn to present the results of your examination as a report of findings instead of a treatment plan. Most dentists examine the patient, look at radiographs, and then sit down and formulate a treatment plan, agonizing over how much or how little they should present. That plan then gets put on paper, and now the anxiety level goes up higher as the paper is handed to the patient who immediately looks at the bottom line. Now the dentist tries to justify why they put what they did on the paper; it is a completely illogical order to the process.
Instead, do the exam, get radiographs and photographs, and sit down with patients with three goals in mind: 1) to make them aware of all the problems you found, 2) to tell them what you think the consequences will be if no treatment is done, and 3) finally, to inform them of how treatment will benefit the prognosis. Ask patients if they would be interested to hear what the actual treatment options and costs would be for the problem; and if they say no, move on to the next problem. If they say yes, write down the problem, and list potential treatment choices. The fees will be listed later after all the problems have been covered. This allows you, as Dr. Bob Barkley used to say, to “co-diagnose” the patient’s mouth and co-treatment plan, having the patient identify what is a concern for him/her.
At the end you may need to phase the treatment over time due to finances and insurance, but the patients now actually know the condition of their mouths, and what the most urgent concerns are, instead of the dentist not sharing the reality of what is going on out of the FEAR of scaring the patients away.
I would also say I cannot emphasize enough the importance of a cohesive well-aligned and trained TEAM to both growing and maintaining a successful practice. At SPEAR Education we have surveyed thousands of dentists about what they see as their biggest obstacles in practice, their TEAM always comes out as the number one or two issue they want help with, which is why we have added an entire TEAM training curriculum for all the different TEAM members.
What advice would you give to clinicians who are starting their practices?
My daughter got out of dental school in 2008, so I have recent experience with this issue. There can be many different ways of addressing the issue, all of which can be right for different dentists. Whether going into a residency of some type, corporate dentistry, working as an associate, purchasing an existing practice, or opening your own office from scratch, all can work but have different challenges and risks. And one driver today that has to be realized is the amount of debt the new graduate is carrying and what the rate of payback will be.
My wife, who retired after 28 years in practice, and I told our daughter we really wanted her to get experience before having her own practice, and we wanted her to get a lot of different experiences. Over 4 years, she worked as an associate in several different offices — some in urban settings, some in rural settings, some fee-for-service-only practices, some all PPO practices — all of them were great learning opportunities for her, but not all were enjoyable learning opportunities, which was part of our intention for her. Dentistry can be very enjoyable, but it can also be very stressful, and the nature of the practice, the patients you are seeing, people you are working with, and procedures you are doing, all impact the ratio of enjoyment to stress, but most dentists never consciously consider that. They just assume if they are busy with patients, all should be fine.
After the 4 years, our daughter had a clear picture of the practices she liked, the procedures she enjoyed, and also those she didn’t, which prepared her to move forward looking for a practice suited to her. Her choice was to purchase an existing practice in a suburban setting that was 16 years old. It wasn’t large or fancy, and was roughly 60%-70% PPO patients, but had a fairly large, mostly blue-collar demographic she could draw from, had four operatories equipped with decent equipment, and could be enhanced esthetically fairly inexpensively with some paint and furniture. It also was very reasonably priced, as the previous dentist wasn’t overly productive, meaning there was a lot of dentistry left to do.
My point in telling our daughter’s story relates to one other piece of advice I would give young dentists; when it comes time to have your own practice, if you can, try to avoid getting underneath too much overhead too soon. The enjoyment and stress level of practice are highly correlated to financial burden. Our daughter’s approach allowed her to see patients and get to know them without feeling she had to run them through and produce something every minute of every day.
My last piece of advice to young dentists is to continue your education as soon as possible. Dentists are interesting in that they tend to only talk to patients about things they feel competent doing. The reality is there is a lot that a new graduate doesn’t feel competent at, and there is a lot they simply don’t see in a patient’s mouth. An example may be how to diagnose and treatment plan a patient with significant tooth wear. The reality is that we can only treat what we see, and we only see what we have been taught to see. Continuing education expands your vision and competence, and those two things lead to an increased confidence, which leads to an entirely new set of patient conversations. Suddenly, you have patients choosing to do dentistry that you never would have even presented.
What are your hobbies, and what do you do in your spare time?
Photography, music (particularly listening to vinyl LPs), golf with my wife, our two mini-Australian labradoodles (Barney and Bailey), fly-fishing for trout or steelhead, cars, food and wine, and most enjoyably, spending time with family and friends, either on trips to Europe, or just hanging around the house.
Top 10 favorites
Unlike perhaps some people in education, I tend to be somewhat material agnostic, meaning that I believe there are several different bonding agents that can work well, several different composites that are excellent, and I tend to tell students to find what works for them, and stick with it until there are some obvious reasons to change. I can certainly tell students what we use in the office, but that doesn’t mean there aren’t other products just as good. If I was to tell you the things I think are indispensable in practice, the list would look like this:
- A digital SLR clinical camera, Nikon® or Canon®, both work well. Learn how to use it, or have someone on your TEAM learn how to use it. Take photos on every adult patient in your practice at the new patient appointment and at any recall where you re-do radiographs. Show the patient the photos, and he/she will ask for more dentistry than you ever would have presented.
- Brasseler USA®/NSK electric handpiece. I switched from air to electric in 1995 and would never go back.
- Straumann® implants have been my primary implant system since 1994. I have never had an implant or component failure with the system, not even a loose abutment screw.
- 3M Rely-X™ Luting Cement, a predictable, simple-to-use, resin-reinforced glass ionomer cement.
- 3M Scotchbond™ Universal bond dentin adhesive can be used as a total etch, selective etch, or self etch product, will also bond to zirconia, and can be used as a light-cure or dual-cure product. We use it for our direct composites in a light-cure mode, as well as all of our indirect-bonded restorations.
- 3M Rely-X™ Veneer Cement, a light-cure-only cement for translucent veneers or all ceramic restorations. I has excellent color stability, easy cleanup, and great shade choices.
- 3M Rely-X™ Ultimate Adhesive Resin Cement, a dual-cure resin cement for all ceramic inlays, onlays, and crowns, contains the catalyst for the Universal adhesive, making their use together seamless.
- Magnification, at least 4x power. I have and use both Designs for Vision, Inc., and Orascoptic™
- 3M Protemp™ 4 Temporization Material is incredibly durable, especially if cured in a light- and heat-curing oven for 2-3 minutes and also easy to work with and esthetic.
- Ivoclar Vivadent® IPS e-max® Lithium Disilicate is just a great product, and almost the only material I use for indirect restorations.