Dr. Joel Small talks about how his study of leadership has shaped his practice and career

What can you tell us about your background?
I was raised in Dallas, Texas. I have two brothers, both of whom are physicians. My parents were home builders in the Dallas area for many years and were a significant influence in my life. I was a high school and college athlete and attended Southern Methodist University on a football scholarship. Unfortunately, injuries significantly shortened my college football career, and I transferred to the University of Texas in Austin at the end of my sophomore year, where I met, Brenda, my wife of 38 years.
Upon graduating from the University of Texas in 1972, I began my dental training in Houston at the University of Texas Dental Branch (UTDB). I was president of my dental school class, and it was through this involvement that I came to know Dr. Frank Trice, who was then the dean of students at UTDB. Frank was very active in the AAE, and along with Dr. Steve Schwartz, another significant mentor of mine, they graciously introduced me to their peers and other prominent members of the organization. It seemed at this point that I was predestined to become an endodontist.

I graduated with my DDS in 1976 and entered the endodontic residency program at UTDB in the fall of that year. After completing my endodontic residency in 1978, I set up a practice in McAllen, Texas, where I practiced for 3 years before relocating to Plano, Texas, in 1981. I am now in my 30th year of clinical endodontic practice in Plano. I have two wonderful and very talented partners, Drs. John D. Regan and David Witherspoon.

In 2007, I was accepted into the Masters of Business Administration program at Texas Tech University in Lubbock, Texas. This program, designed for dentists and physicians, and headed by Dr. Jim Hoffman, gave me a new perspective on the healthcare industry and the practice of dentistry. In 2009, I received my MBA, with an emphasis in healthcare administration.
Upon graduation, I began two significant projects. I co-founded Phase II Associates, LLC, with Kathy Hamilton, DDS, MBA. Phase Two Associates is a dental brokerage firm that deals exclusively with practice transitions for dental specialists. We are a nationwide, full-service brokerage firm with the knowledge and training to assist specialists in transitioning into or out of specialty clinical practice.

My other significant project was writing and publishing my first book, Face to Face; A Leadership Guide for Health Practitioners and Entrepreneurs. I realized while studying leadership in my MBA training that, as owners and leaders of small businesses, we must lead differently than CEOs of large corporations. We lead in a much more personal or face-to-face manner. As the size of the business decreases, the rules of leadership change. My book presents what I believe are essential leadership qualities and practices for owners of small service-oriented businesses.



Is your practice limited solely to endodontics?
Yes. We made a conscious decision not to include implants in our endodontic practice. I realize this is a controversial topic that is often discussed among endodontists, so I would like to share the rationale behind our decision.Basically, we utilized the strategic-thinking model presented by Jim Collins in his landmark book, Good to Great. Collins suggests that we identify those aspects of our profession for which we have a deep passion, and then decide if these are areas in which we can be exceptionally skilled. Finally, we must decide if these areas of passion and exceptional skill will serve as economic drivers for our business. If we can answer yes to all three of these questions, then we have identified an area that can be of strategic importance and a sustainable competitive advantage for our business.

With regard to our specific decision, we all agreed that we were not passionate about placing implants. We felt that we could become exceptionally skilled in this area, but the training would require a significant amount of time out of the office, and the loss of revenue did not appeal to us. Most importantly, we felt the current trends in the dental marketplace were indicating that implants would not be a significant economic driver for our practice. Periodontists and oral surgeons were already seeing declining numbers of implants as more restorative dentists were adding this procedure to their list of services.

Why did you decide to focus on endodontics?
I was very fortunate to have two AAE presidents as my mentors. Dr. Frank Trice and Dr. Steve Schwartz have each had a tremendous impact on my professional career. Through Frank and Steve, I was exposed to the field of endodontics while in dental school. I seemed predestined to become an endodontist, and I have never regretted that decision for a minute.

How long have you been practicing endodontics, and what systems do you use?
I have just completed my 33rd year as a clinical endodontist, and I often think about how the practice of endodontics has changed over this time frame. For several years following my graduate training, it seemed as though our specialty had stagnated, and nothing new was being introduced to our clinical practices. Then, as if overnight, we were introduced to new and improved ways to practice. Game-changing technology, like the operating microscope, apex locators, microsurgical and nickel-titanium rotary instruments, forever altered the way we practice. My practice, like most other endodontic practices, has benefited greatly from the new technology and techniques that have been introduced to our specialty.

Currently, in each of our operatories we have ZEISS microscopes and we use the TDO (The Digital Office) practice software system with dual computers and monitors. We have found the TDO software to be user friendly and efficient, and we have been particularly pleased with the way it integrates with our Kodak 9000 cone beam scanner (Carestream Health). We also use the Kodak RVG 6000 Digital Radiography System which integrates seamlessly with the TDO software. Each operatory is equipped with an ASI side-delivery system.

We offer oral or intravenous (IV) sedation for those patients who require it. Our doctors and staff are trained and certified to administer oral sedation. All of our orally sedated patients are fully monitored with a pulse oximeter/blood pressure device. All IV sedation for healthy patients is performed in our office with the services of a board-certified anesthesiologist.
Canal preparation is accomplished with a combination of Dentsply rotary nickel-titanium ProFile® and ProTaper® instruments in addition to some stainless-steel and nickel-titanium hand files. Canal irrigation is accomplished using full-strength sodium hypochlorite, EDTA, and 2% chlorhexidine in combination with subsonic agitation (EndoActivator®, Dentsply). For the past 6 years, we have been using the Epiphany™ Resilon® endodontic obturation system (Pentron Clinical Technologies) in conjunction with the continuous-wave obturation technique.

What training you have undertaken?
We are certified as providers of continuing education for the Academy of General Dentistry (AGD), and offer continuing education for dentists throughout the country. Each of us partners presented at this year’s AAE meeting in San Antonio. We also provide and receive numerous hours of CE as presenters and participants in several local study clubs and various national specialty organizations.

With regard to my training as a specialty practice broker and co-owner of Phase II Associates, LLC, I have obtained an MBA with an emphasis in healthcare management. I have the designation of Senior Business Analyst (SBA) from the International Society of Business Analysts, and I have trained as a business evaluator with the Institute of Business Appraisers. I also have extensive training as an exit planner through the Business Enterprise Institute. Additionally, I am an active member in the Practice Valuation Study Group (PVSG) and the National Association of Practice Brokers (NAPB).

Who has inspired you?
In addition to Drs. Frank Trice and Steve Schwartz, my biggest source of personal inspiration has been my mother. Mom had to drop out of college during World War II to support her new family while my father served in the war. She loved to learn and promised herself that no matter what it required, she would one day return to college and obtain her college degree. Many years passed while Mom worked with Dad in the building business in order to send her three sons to medical and dental school. She and my Dad sacrificed much so their sons could receive their educations. Then several years ago, Dad became ill, and passed away at the age of 84.

Following my father’s passing, Mom enrolled in a local junior college at the age of 83. Having a wonderful sense of humor, a desire to learn, and a lifetime of experience, Mom became the hit of the college campus. After 2 years, she transferred to the University of Texas at Dallas, a 4-year university. She spent a summer in Italy with her college class at the age of 86, and the following summer, she spent a week conducting research on a marine research vessel off the Texas coast. Mom graduated with her BA from UT Dallas at the age of 87. But she wasn’t done yet. She enrolled in the graduate program, and at the age of 90 she received her Master’s degree in psychology. Since then, she has taken a position with The Center for Vital Longevity, a University of Texas-sponsored research center that studies the aging brain. She is currently 91 years old and lectures on the importance of learning as a means of maintaining lifelong vitality…and by the way, her first book has just been published.

 

What is the most satisfying aspect of your practice?
I derive great satisfaction from the commitment of our doctors and staff to give back to dentistry and the community. We give back to our profession by conducting and publishing clinical research that we feel will be of benefit to our fellow practitioners. Additionally, we conduct continuing education for the North Texas dental community on an ongoing basis, as well as lecture locally and nationally on topics that are pertinent to our specialty. North Texas Endodontic Associates (NTEA) is always among the first to volunteer for access to care projects and pro bono work for less fortunate individuals in our local community.

Professionally, what are you most proud of?
I am most proud of the reputation that NTEA has been able to maintain over the past 20 years. Knowing that our dental colleagues trust us and consider us to be a member of their extended team is a great honor that we work hard to preserve.

What do you think is unique about your practice?
NTEA is unique in many ways. We have a unique culture that has withstood the test of time. Our average employee has been a member of our team for more than 12 years, with one assistant celebrating her 30th anniversary, and our office manager celebrating her 22nd year with our practice. An environment like this does not just happen, and it is not solely because of the doctors. We have been fortunate to have surrounded ourselves with people who love what they do, and who are very engaged in perpetuating the culture that we have collectively created.

What has been your biggest challenge?
My biggest challenge has been to recognize the importance of leadership in my personal and professional life, and to understand that leadership is one of the few duties I cannot delegate. The concepts of self awareness, authenticity, and personal engagement—the three fundamental qualities of effective leadership—are hard concepts to incorporate into our practices because as dentists, we have had little exposure to these transformational concepts.

What would you have been if you didn’t become a dentist?
I believe that I would have been a psychologist or an archeologist.

What is the future of endodontics and dentistry?
No one can predict the future, but I believe saving one’s natural dentition will once again become the highest priority of dentistry. Implants will ultimately take their proper place as a viable alternative to natural teeth that cannot be saved. Future advancements in the areas of stem cell research, pulpal regeneration, and more effective debridement of the canal system with newer instruments and cutting-edge irrigating techniques and solutions will continue to increase the likelihood of preserving the natural dentition.

What are your top tips for maintaining a successful specialty practice?
1.    Love what you do and the people that help you do it.
2.    Work hard to develop a practice culture that is self-motivating and self-policing. This frees you from the lower level function
of managing “people issues” and allows you to function at the much higher level of process management.
3.    Make your core ideology (values and purpose) your personal and professional anchor, and always act in harmony with these
beliefs.
4.    In the realm of leadership, being real is infinitely more important than being right.

What advice would you give to budding endodontists?
Always strive for greatness. Remember that good is often the enemy of great because good is easy and comfortable, and there is little compulsion to leave the comfort and familiarity that good provides. We must be willing to leave this comfort zone by challenging ourselves to achieve greatness. It is only through this process of questioning and challenging our status quo that we are able to grow.

What are your hobbies, and what do you do in your spare time?
I have developed a love for writing. It helps me organize my thoughts, and I find it relaxing. I also enjoy reading. I don’t know how I ever lived without my Kindle. If I’m not reading or writing, you may find me exercising. I am also fond of spending time with my family: my wife Brenda, my youngest daughter Abby, my son Zach, and my oldest daughter Jennifer and her husband Bennie, who are the parents of my 5-year-old twin grandsons, Caden and Braden.

Top Ten List

1.    My partners and staff
2.    The operating microscope
3.    TDO software
4.    Apex locators
5.    The Kodak 9000 3D Extraoral Imaging System (Carestream Health)
6.    Digital radiography
7.    Rotary nickel-titanium instruments
8.    ProRoot® MTA (Dentsply)
9.    Dental anesthesiologists
10.    The Internet for patient education and registration

Bio

Joel C. Small, DDS, MBA, is in private endodontic practice in Plano, Texas. He received his endodontic training at the University of Texas at Houston, and his Masters of Business Administration, with an emphasis in healthcare management, from Texas Tech University. He speaks nationally on the topics of leadership, practice management, and specialty-practice transitions. Dr. Small is a co-owner of Phase Two Associates, LLC, a specialty dental practice brokerage firm in Dallas, Texas, that deals exclusively with practice transitions for the dental specialist. He can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or www.phasetwoassociates.com. His book, Face to Face can be ordered at www.readfacetoface.com.