The Keys to Letting Go As A Dentist

Episode #240 with Dr. John Cranham

I think for a lot of us, the COVID pause had us all thinking about what is, what sort of matters most and, and, you know, got us to think about where we are.

05:06

This is maybe a bit of an announcement to the dental world, but I always envisioned that I would simply gradually stop practicing and primarily just teach. I figured at 60, I would probably not have the energy to do both anymore because doing dentistry is hard work and the grind of the road and teaching while it's very, very exciting, it is taxing. And so I, I really thought that I would devote all my time to teaching, and just to continue to be the clinical director at the Dawson Academy. And when the COVID thing hit, I just started to realize that as my daughter was leaving dental school, that I was going to have this window of time to practice with her and teaching 60 or 70 days a year took me out of the practice and off a lot. So knowing that I couldn't do both things anymore, at once I thought about it, and again, it is inherent to the values of the Dawson Academy and of what Dr. Dawson taught us. There really wasn't much to think about. It was time for me to step down as clinical director, still staying involved with the Academy, still going to be teaching some of the seminar classes. I know the Academy is going to be announcing shortly who the new clinical director is that I'm very excited for. And I'll definitely be sort of co-clinical director for this year during this transition.

06:44

So that is a huge decision for me, but I think that it's important that as you evolve as a dentist, and it may even be as simple as letting go of certain procedures that you're doing as you hone what it is you do and want to do. And Kirk, you've driven this home over and over and over that as a dentist,

07:06

we really get to choose just about everything. You know, who's with us when we work, you know, if you're a morning person, you can be there at 6 o'clock. If you're an evening person, you can be there until 10 o'clock. But I think that this was a humongous decision for me, but now I'm probably two months into it.

07:29

Caitlin started with me August 1st. And it's emotional for me to, to talk about what it's like to have her here with me. And as I look at it, my most important student of my life as having her and making sure that I can spend this time with her, a lot of you have heard the story of my son.

07:52

That's going to be our next podcast, Kirk talking about the book. That's going to be released soon in regards to him. But you know, he's in the practice, he's doing a lot of the digital mounting, and a lot of the lab stuff for us. So it has become quite a family affair, but yeah, but maybe we start there and talk about how we make some of those decisions, then maybe we can kick around, you know, what's my practice like now, because what's fun is like, I'm just a dentist again. You know, it sounds kind of crazy, but for so long, I pretty much just focused on large things and teaching, which sounds amazing. And it is to some degree, but it's also, it's also challenging from the standpoint of it being, taxing. Now I'm doing some fillings again and molar root canals and doing just a general dentist again. Today we're going to get to get inside the mind of a great restorative dentist.

08:52

Kirk: And I got a lot of questions I want to ask you, but let's speak to the obvious, you know, you spend a whole life of in what you and Pete taught me was just the predictability. You spend a whole life trying to get things predictable, be in control. And let's just face it dentists that are really good about their business and dentistry they're control freaks. And so now you're kind of swimming upstream of this control issue and letting go, and you're in a good phase. That's a huge shift for you to step down from Dawson, you know, and step away from that. But you got your daughter coming in. It's gotta be hard to let go of control a little bit.

09:52

Dr. Cranham: During the COVID thing, my friend Henry Ghermezian died in his sixties. And then that sort of hit me a little bit, you know, cause he worked really, really hard. And so you just start to come, you know, having conversations with my own physician and he's like looking at my schedule going, dude, you can't go to Japan and lecture for two days and fly back and go right to the office.

10:21

You know what I mean? He's having these heart to heart. So, you know, I do think that we have to, you have to balance what's realistic with what you love doing. And for me, teaching and doing dentistry is fun. I mean, it's work, but it's what I absolutely love doing. And the other thing that sort of transitioned was my kids were now finishing up with university. I was trying to cash flow all of their education and all of a sudden, you know, all of a sudden when your kids don't have apartments that you have to pay for anymore and you don't have tuition to pay for. And you know, Kim and I have been pretty frugal and paid things off. I don't need a whole lot of money to live on anymore.

11:00

So that's changing, you know, those are all the things that sort of change that allow you to sort of step back and start to really evaluate, okay, what do I really need to be doing? And what do I want to be doing and where do I want to spend my time? And so when I started to think about just teaching,

11:18

I really started to realize, you know, I have these patients that I've been taking care of for 30 years. I love that part of my life. And the other thing is, as I can do it without having to get on planes and flying all over the world, and I'm still gonna do some of that, but I'm going to do it a lot less. And that's the balance. That's where I am right now. It's like, how am I going to schedule it and be a little bit more strategic? You know, Pete was brilliant with how he did it because in his later years, I mean, everybody came to see Pete. So, you know, he really didn't do much traveling and what people might not understand. And you can attest this to Kirk that it takes energy to teach, but what beats on you as the travel and hotels and delays and airports and all those things, that's what kind of grinds on you.

You know, when you're a great restorative dentist and this really gets going, you know, you only want to have about eight cases in your brain at one time. People that say they're doing full mouth all the time, that's just not real. And then you want to reengineer your days and that's some of the stuff I want to get inside your mind is when we're talking about letting go, like you let go of the long hours, you even let go of the four and a half day work week, you got down to four, you were even going to three. It wasn't how many hours you put in. It was about re-engineering your thinking. And just embracing these things and knowing yourself as a dentist a little bit more.

13:20

I equate it to this little fishing story that I once heard where the fishermen, when they first start, when they're a little kid, you know, at first, all you want to do is just catch fish. And so you go anywhere, you possibly can, and you don't care if it's a couple pound trout or a two inch minnow, you just want to catch fish. So then you, get a little bit more sophisticated and you just want to catch big fish. You don't really want the little ones anymore. You want to catch the big ones. And then you get to the extreme place where you want to catch really big fish and really nice places. So that's kind of the pinnacle. And then you get a little bit older and then you're back to being comfortable just catching fish. And in my fishing career, I'm back to, I just like catching fish. I don't really care what they are anymore. So I feel like I'm a little bit like that with my practice. I worked really hard in my practice to really hone it down to pretty much just focusing on large cases, catching those big fish. And that's what challenged me. And that's what I love to do. I was balancing the general side and the specialty side as I like to call it. And about eight cases a month was a lot, you know, that's a couple of weeks. So then when the teaching got really busy, I was pretty much just teaching and only doing large cases. And my associates were doing all of it, not the bread and butter stuff, but what I'm finding is that I'm really enjoying, balancing some of the specialty stuff back with the general stuff again, because I just love doing it. And I can do it where I can focus. It's almost mindless dentistry a little bit, but it's very relaxing for me, but I I'm good at it. And I can spend time with the patient and I still get the same reward of creating something.

15:26

Kirk: But Now I want you to go back to that because that's one of my favorite concepts you've ever taught me is general and specialty. So if you've been a member of the Dawson Academy bender courses, you've heard that concept, but this is real, this is a game changer for a lot of dentists once you have that classification system. So can you shed some light on what that is?

Dr. Cranham: I'll say it this way: The first time I heard Pete, I think that I went through the programs two times and all he was showing was large case dentistry. And I think I came away from my early time with Dr. Dawson, where I thought that the pinnacle was only doing large cases. And so when I was back in my general practice, which was a very simple, three operatory practice, one hygienist, where I started at in Portsmouth, Virginia, I felt like a loser. Anytime I was doing a filling or something, you know, and it finally occurred to me one day that he had other people working with him that was doing that. Like, if you have dental hygienists, they're going to find little stuff for you to do. And so the general stuff that goes on at a dental practice, what I look at is what really should be driving pretty much paying the overhead and the payroll and all that stuff. When you start to be able to do some specialty things like larger sets of cases, or large implant cases, or occlusal reconstruction, I call that the specialty things. And when I'm doing one of those procedures, I want to make sure it's scheduled in a way that that's the only thing I'm doing.

17:17

So a good way to think about it as the general things are, tend to be more one tooth or maybe two teeth at a time. You tend to be working in multiple rooms, and it's a little more aerobic, but when you do specialty, you're generally working off of a treatment plan where you've mounted models, you studied photographs, you've got an architectural plan of where you're going, and it's very cerebral. So when you're executing that, everything has to be done in a very specific way in my office. We had general time and we have specialty time and never the Twain shall meet.

18:00

So if I'm in a specialty case in the morning, the staff knows that there's no emergencies, there's no buckle pits or check denture. In huddle, what I have to communicate to the team is if that's no man's land, where are we putting the emergencies?

18:20

Like, where are we working them in? And so that's how we operate it. So for a long time, I kinda did my specialty stuff in the morning and my general stuff in the afternoon that worked fine. But when we went to the straight seven and started skipping lunch, that was the big move. When I discovered I didn't even like lunch. You know what I mean? It was just like, I would drive around for a complete waste of time. So we started to go to a seven hour day that gave me another hour at the end of the day to write up my notes and do my lab scripts and do a little treatment planning if I hadn't done my morning stuff. But now what we're actually starting to do is specialty stuff happens in one room. So I might have two specialty type things in the right column. And then they know where they can put some of the general stuff and it sort of mixes it up throughout the day.

19:22

So the point is there's lots of ways to do it, but I do think it is really, really important that you have a conversation with the team about procedures that you need to be a hundred percent focused on. Like, to me, molar endo for me is a specialty procedure. Like I'm doing molar endo for the first time, but I can't do it in my sleep. I haven't done a ton of them. So I'm all in and I have that hour and a half also for an endo buildup and crown. They know that that's kind of a specialty time, but if we switched to an aerobic thing, we can be a little bit busier right now.

19:57

Kirk: So you were letting go in the evenings, you even started embracing the morning. So when you guys went to the straight seven, walk me through this. Cause I'll never forget. You said to me, you said, Kirk, one of the things that you notice is nobody's on the road, you know, at six something in the morning, and you do a lot of your thinking in the morning. So walk us through what you let go of and the way you think as you matured.

20:40

I let go early in my career that I wasn't going to be able to be everything for everybody. So I do think that one of the first things that dentists have to do is get clear about what it is they want to be good at. Because if you're trying to be everything to everybody, then I think it's hard to really get known for anything. You just kind of get lost in the crowd. So I gravitated quickly when Dr. Austin talked about being the go to dentist.

21:21

I wanted to be known in my community as a person that could solve problems that most people couldn't. So that was the first thing, to have a little courage that I was going to put that out there and do whatever I needed to do. So taking all the Dawson and taking all the Pankey stuff and taking up an early class with Bill Dickerson back in the day and listening to Ross Nash. And I was trying to take all of the traditional occlusion information and blend it with the hottest cosmetic information.

22:07

So that's what sort of got me known a little bit was the cosmetic-occlusal connection and blending those two. It's amazing now, but those concepts were diametrically opposed back then for me to put those two things together. And then the next thing was letting go of the fact that I had to be open.

22:26

I worked seven to seven and I would take a two hour lunch, but I was there in the morning till five or till noon. And then I would come back and work two to seven, and I hated it. I hated everything about that day. But it was just in my mind that you had to have evening hours. It was just a mindset that I had and my staff hated it. And one of the things that we always noticed though, was the days that we started seven, I tended to have morning people in the practice, the seven o'clock appointments, never no showed. They tended to be people that were business, people that were more affluent. And the ones that we, a lot of times we were sitting there, you know, at six o'clock waiting for the six o'clock appointment. And meanwhile, my wife's at home with my three kids I'm missing dinner and they would not show up. So that was when I was listening to you. And you started to talk about this trend and I was pretty quick to jump on it.

23:48

And so what was happening was I was trying to work on it while I was at the office. And so then we flipped gears and said, well, if I go seven to seven to seven to two, then I can just completely focus on my office till two o'clock. And then I can flip switches and do my calls with Dawson.

24:27

So Dawson stuff was two to six or two to five or whatever. And so, you know, as soon as we did that, we really didn't lose anybody. You know, I remember you said when people asked why everybody in the office had pictures of their family that we put at the front desk and we just had a little sign that said: This is why we're switching our hours and people bought into it.

Kirk: Talk about this. Like, you've micro engineered a lot of this, and some of the things that you and I would talk about, you would have your chief chairside assistant, her job was to put together a case that you would be thinking about or talking about or talking with a patient about. And I can't remember her name, but she was great. And then you told me about the two screens, Mariah. Yeah. Then you had the two screens in the back that you added, where you had the digital information, then also the clinical information. And then just having a chance to review something before you talked about a patient. And then the other thing that kinda blew my mind is you were like, I don't know that you always want to start a day with the prep. There are some days I liked it. And then there were days I just liked, you know, looking at a case and you would be doing a consult in one room, and then you'd be meeting a new patient in another. I can't remember the details, but Let's talk about.

25:39

Dr. Cranham: So one of the number one metrics that Dr. Watson talked about from the focus group if a dentist was doing somewhere between about 12 to 16, and we're not going to call them new patients, let's call them advanced records, but 12 to 16 advanced records a month, which means that you're taking photographs, you're mounting models, and you're doing a whole workup. That 12 was a really good number. And I find that if I try to do many more than that, it's hard to pay attention to it enough.

26:24

So thinking about that, if you're a practice that sees maybe 40 new patients a month, there may be 10 or 12 of those that have more advanced needs. And rather than just firing off from the hip and trying to make a treatment plan with the patient there, you invite them back for what we call this advanced records visit. And at that point, that patient now becomes a specialty patient because we're going to be doing a workup. We do the same photographs we've always done, but we do internal scans. We are mounting in three shapes, not on the three shapes scanner, but in actual lab software. So we can still do our wax ups and the calibrations and all that. We're just doing it all virtually.

27:11

But my mindset even today is that if I can do one records visit and I can do one consult, if Bill and I can do one treatment plan, if that happens four days a week, I can do all that dentistry. And then you have to find out when you're going to do that.

27:31

So Kirk's exactly right. One of the things that still hasn't changed is my most favorite time of the day is to get here about six before anybody else is here. And I have that quiet time.

27:50

So today, Kristen is going to stick on my, my appointment book the one that I'm going to work up. And so I come in, I get that hot cup of coffee, it's quiet. And rather than having an articulator, my son's mounted it virtually. So I've got a computer where my virtual articulators are. So that's waiting for me. And then I'm just pulling up the wizard and doing a treatment plan. So that's fun for me. And again, sometimes it's not. Sometimes we get to the end of the day and she goes, you don't have one tomorrow. That's fine. But I'm doing a couple each week and I have a couple of consults a week.

28:36

That's what drives the whole thing. And then sometimes we'll have a situation were we are presenting something large, but maybe there's financial issues. I think the other thing that I've let go of is feeling like I had to work all the financial issues at that second when the patient's there. Sometimes you can't....