AME: Confidence vs. Competence with Dr. Wade Pilling

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[00:01:28] Alan Mead is a dentist with too much time on his hands and too much recording equipment in his basement. Armed with an obsession to bring entertaining and informative content to the dental world in a way that's never been done before. I give you the Alan Mead Experience. Well, hello and welcome to another episode of the Alan Mead Experience. I'm your host, Dr. Alan Mead.

[00:01:52] I am a dentist, a podcaster, and an aficionado of Wade Pilling. Let's just say that right now. Joining me. I don't normally have guests, but when I started the Alan Mead Experience, I did have a lot of guests. It was what it was. It was guests having, and they were basically telling stories about dentistry. So joining me, Dr. Wade Pilling. Wade, how are you doing? Thank you for having me. Doing great. So, Wade, we just did a Very Dental with Wade that was just excellent. We just dug in. It was awesome. But one of the things that we didn't get to was something that I wanted to talk about.

[00:02:22] Wade does a lot of education. And frankly, if you're hearing this episode and you don't really quite understand, got to go listen to the first episode that we did with Wade because it was exceptional and there's a lot in there.

[00:02:33] But Wade has taught in a lot of different ways. And he mentioned at the very end of the last episode that he's kind of more comfortable with small group or even one-on-one or two-on-one mentorship than trying to do bigger groups of teaching, particularly for, you know, bigger cases like full-arch teeth, full-arch implants, that sort of thing. Because he feels like – what he said that sort of affected me is like, am I teaching people to hurt people?

[00:03:00] Because, you know, you can only teach so much before they have to go do it on their own. And so that's kind of the fear. And then you said some of these people maybe shouldn't be here or they're not ready for this or whatever. I want you to dig into that a little bit. Well, I think if you're really critiquing yourself and honest as an educator, you have to ask that question. Am I helping people? And in the process, am I hurting some?

[00:03:26] Right? Like – and I get that some people might take the approach of like, well, I got to teach as many people as I can. It's not my fault if someone takes what I learned and isn't experienced stuff and goes and hurts someone. And I get that logic. And I haven't agreed with it a bit. But, you know, if I go out and teach a bunch of people in a big atmosphere, you know, am I just motivating some people to go hurt? Am I teaching them enough? Right? Or am I – as some people there might be just looking for pearls and love it. So you have to take the good with the bad.

[00:03:55] You know, for me, when it comes into the implant realm, especially full-arch implants, the consequences are higher. Yeah. Right? I'm not teaching someone how to prep a tooth and they go and butcher a couple teeth and then they end up needing to be repaired, whatever. The consequences of full-arch implants going bad are astronomical. They're life-altering. They're expensive. They're litigious. Yeah. Right? Their boards are taking away people's licenses right now for this stuff. So the stakes are higher.

[00:04:22] So to me, I feel like – I try not to speak about implant stuff on a big level. I try to keep my teaching on a more smaller level. I want to have – you know, I'm taking some of my courses and shrinking them down to more one-on-one or two-on-one, having one or two doctors in my office or I go to them and we spend days digging into the stuff. I can customize the mentoring and treatment to them because I feel like those doctors have better outcomes. Right? I have asked myself that question. Am I just teaching someone to hurt them?

[00:04:51] Like I've had people I've taught that I've had to sit down at the end of a course and be like, you know what? I don't know if you should go back and do this. Like you were like two millimeters away from hitting someone's nerve and ruining their life before I grabbed the drill. You were completely unaware of where you were in the mouth. You didn't understand half the treatment planning I was talking about. Like we got you a good first step. You saw what's possible. Go back to your practice. Let's start with predictability. Let's get you a mentor.

[00:05:16] Right? That you can go watch your friend, you know, or mentor locally every Friday when you're off. Right? If you want to do this, you might need to dig a little deeper. Right? I'm not giving – it's like if I could issue a license, I wouldn't issue it to you today. Yeah. Not to – I give you – enter your learner's permit. I got it. But that also says you're not – you said today. In other words, here's something. In dental school, man, and I don't know if you know my story. Dental school wrecked me. I was really a mess. And one of the reasons I ended up the way that I was, dental school kind of messed me up.

[00:05:46] But I mean they made you feel bad about everything and they made you feel like you were so dumb. The one thing that no one ever said to me in dental school was, you know what? You can learn this. You'll get this. Like I did really well academically. That was no problem. It was the hand skills. It was not that I had horrible hands. I just – I didn't have a lot of practice. You know, I didn't – I mean I vividly remember the first day we were supposed to drop a distal box on a typodon. And I was like, oh! It was all new to me and everything like that. You know, and now you think about the things that you – no one ever pulled me aside and said, don't worry.

[00:06:16] You can learn this. You'll learn this and it'll be okay. They never said that. They always made you feel like you were terrible and you're going to – the difference being that probably everything can be learned, but it needs the right situation. And unfortunately, when you're taking a course with a lot of varied abilities, understandings, and experiences, it's hard to know – and you're teaching stuff like you were talking about. I know Moody wants – you know, when you go to take his week-long course, they call it Full Arch Fridays

[00:06:43] because it's Full Arch Fridays. And I suspect I would be a guy who's like, I am not ready for a Full Arch Friday having placed a few implants. You know, like there's – on some level, we're all different. We learn a little differently. It's not that they can't learn it. It's just that it's not – you know, it's not guaranteed that after a week you check the box and you're ready to do Full Arches all the time. Am I right? Exactly. Yeah. And we even have modified that Full Arch Friday to be more – half an extraction and graft, right, learning experience.

[00:07:10] And the other half is just learning how to take – I like to tell patients, I'm like, take away the flap, the alveol experience, the removal of infection, the extraction experience. And then you're just drilling six individual implants at this point, right? So, you know, mentoring, you know, it's fun. I think I'm really good at it. That's, I think, where I shine the most, rather than speaking, is really mentoring because I can drop down to that doctor's level and figure out where they are. And I try not to shame. Like I said, you're not good at this today,

[00:07:41] but you're going to. And the way I usually frame with doctors is I tell them, I say, look, every procedure you go into, you need to go in confident, that you've confidently planned it, you know exactly what's going to happen, you know exactly what you're going to change if something goes awry, and you know exactly how you're going to handle any problems that go up. But if you jump in here too quick, you are going to get burned. You're going to have a board complaint, a mad patient, a refund, a lawsuit, you have a poor outcome. And if you care about your patients, you're going to feel crappy about your work, right?

[00:08:10] And that destroys your confidence. So if you have that happen too early on in your journey, you're never going to be confident again, and you'll never learn this stuff well enough. So if we can slow it down, you know, start easy, gain some confidence when you do have those problems, and they will come, you're not, they're not going to shake your confidence. They're just going to make you question like, okay, what can I learn from this? Right? Like I had a couple this year of the

[00:08:35] biggest complications of my career, right? And I guarantee you they could happen to anyone. And if they happened in your office or in your career, you would quit dentistry. You would be worried about them locking you up in prison. Like if someone would look at this and think something went wrong, right? But we managed them, we documented them, we understood what happened. There was some like chemo involved. It was, yeah, I remember it was a, it was a medical thing that was really hard, like really hard to predict all that stuff. I remember that. It would a mess. Yeah. I'll, I'll, I like to take these cases and I'll do a case presentation and post online,

[00:09:05] like a little recording of how, cause they're good for people to see the complications. But if you got these complications early in your career, you'd never do it, you'd be lucky. You'll never touch this again. So I, I try to tell people like, if you do this and you, you know, you gotta be confident. And if you keep, if you just jump in right away on things you're not supposed to, you will, it'll botch your confidence and we need confident doctors. No, we do. I'm okay. I want to go, I'm going to dive deep in this. I've had a huge, this

[00:09:29] has been a, something I thought about a lot because okay. In dental school, I, any confidence I had got beaten out of me pretty good. Okay. And so like, I was the guy who I, I just was keeping my head down in hopes of getting out, you know, especially with the clinical stuff. Like I said, academically, I had no problem with that, but, but like clinically I wasn't, I was never confident because, and I, in the search adding surgery to that, like, man, I still, I like taking teeth out. Don't get me wrong, but I don't do, that's not, that's

[00:09:58] not what I do mostly. And so there are times I get shaken up pretty good. And I'm like, I've had a thought process that there are people that are, there were some people in dental school that were all into the blood and guts from the very beginning. And they felt like this is what I really love. And I don't know what that is. What the hell is that? Why is it that there are just some people? And I know people listening, they're like, Oh, I love the surgery. Give me, I want to suture everything up. I want to cut them in. I want to cut their

[00:10:24] face open. And there's people like me that go, Oh, that's not for me. I'm not really into that. And there are, I will say this, I was telling you about this. I took, a hands-on implant placement course back in 2015 where we went to, it was out of the country. And I will say that reps really help with confidence. In retrospect, the reps I was doing, I'm not sure they were the, treatment planning was not, was not maybe where it should have been. Definitely wasn't state of the art for the United States and that sort of things. But

[00:10:53] so the reality is I know that I think that there are, there are places where you can go to get the, the correct kind of, you know, treatment planning experience and all that stuff. But the reality is, is you do a bunch of them in a day when you're seeing five patients, you're cutting them open, placing implants and suturing them up. You do, those reps are helpful in confidence. I'm not sure that I didn't place it. I placed a few implants after I got back and they're still doing okay. So they did, I had one of them fail, but the rest of them are, and it's kind of fun to see them on

[00:11:21] recall because I did this like almost 10 years ago. But the reality is I've always been a little sketchy. And when you don't do it consistently, that's a skillset that fades, you know, it's one of those things where you can literally, like, I'm just talking about like, you know, confidence and suturing, making sure my, making sure my, my surgical sites were okay. And I've always been like, man, there's just some people that just felt okay about that. And they were, they sort of jumped in and felt in some people that didn't. You, you obviously were okay with surgery from the get go, but what do you think about it? When I say that, do you think I'm right or wrong? You think

[00:11:50] there's some people that are just more confident naturally? I think so. Um, I wouldn't know if I call it comments. They just like the blood and guts cause they're a little psychotic. Maybe, maybe I'm okay with that too. I think there's a little bit of that. Um, part of it is people are comfortable with things they know how to manage, right? You know how to manage a tooth prep and enamel if a gum gets in the way and blood and you can manage that, but how do you manage a bleed or a flap, a sewing, you know? So you're just, you're just upping the level of

[00:12:18] possible complications. And people understand biology. People understand biology are very, they love it. They're comfortable. I love doing flaps because I feel like I understand how biology works. I know what will work and what won't. So it's predictable. But I guess from the, from someone that was comfortable with that stuff before they had a right to be, in other words, you know, I'm, I'm thinking, okay, I will, I will happily throw my friend Darren O'Brien, who he's been on the show a million times. He, we, he and I went to dental school together. That dude,

[00:12:45] he went into oral surgery and strutted around like an oral surgeon. He was comfortable. He was just comfortable from the beginning. And we didn't know shit. We didn't know anything. Okay. Darren and I were both the same class and we knew the same amount and we didn't know anything. He didn't, he didn't, he didn't know how to handle complications. And he went, but he had this confidence level and I was like, shit, I want to do as little of that as possible because I just want to get out. And so on some level, Darren just had bigger balls than I did on some level. Do you think there's a correlation

[00:13:12] between motivation and comfort to do surgery and testosterone levels? I do. I actually do. I feel like on some level there is a, there is a little, it's not to say that being a cowboy makes you a good surgeon, but being a cowboy in the beginning and being willing to put yourself out to do it puts you in a position to learn and get comfortable with it more quickly. Do you think,

[00:13:38] how do you think about that? Does that sound about right? I think so. Yeah. But, but I get shocked once in a while, like I, you know, there's, there's, there's definitely, you know, people that come a little bit higher testosterone down to some of the courses and, and they're not skilled. Yeah. Yeah. And then honestly, like, you know, some of the, some of the people that come, they're a little bit more timid, you know, I like all often a couple of little old, you know, old, but little, uh, Indian ladies, right. Coming in, um, you know, thinking like, okay,

[00:14:06] what are you doing here? Are you sure you want to do this? And oh gosh, just, just last month, uh, I mentored two, two Indian ladies, uh, and they were, got into a full arch case that we were doing. It was just extraction graft and then a couple implants. And honestly, they were the most talented new providers. That's so cool. Like I explained to them what they did. They didn't, weren't all gun ho and testosterone. They went in and they did it with precision. And I was just like, oh my gosh, like you guys shocked me. You were like, So you got them, you got them over the hump. Two of the best I've ever worked with.

[00:14:35] That's really good. You got them over the hump a little bit for confidence. And they were, they were, they were knocked out of the park versus the cowboys. Yeah, but they were timid and conservative, but that, you know, but they did, did amazing work. So, but, but yeah, I think there's a, definitely a correlation with who wants to jump in and cowboy and testosterone. Isn't that funny? I often say, uh, you know, unfortunately, you know, full arch, implants has just become like the new sales bros. Yeah. You know, it's all about talking about who, who did the most arches. You got to pump those numbers.

[00:15:03] You know, you go away to events. Oh, you're doing 10. Well, we're doing 40. Well, oh gosh, I must be not doing enough. Yeah. Like, I don't know how many arches I do a month. I do a lot, but I, I care more about like how many good arches did I do. Right. And it's just, I'll never tell anyone how much I do. You know, I don't, I feel like all that does is just create people thinking, well, I got to do more. Yeah. And then the incentive structure is you got to do more, not like, Hey, I got to do what I'm doing as awesome as I can. And then I'll do more.

[00:15:29] No, that's, that's, that's kind of my whole point. There's a, on some level, I guess, here's what I'm going to ask you, Wade, for someone who there's a part of me that feels like a good dentist should be able to X. Right. And that's, that's me being absolutely mental. Cause the reality is, is there's no reason that you can't, you know, every dentist should do what they like to do. Now, if you want to learn something new and feel like this is

[00:15:57] something I'd really like to learn, what's the, how, you know, that's when you start looking for mentorship. That's when you start analyzing the best ways to learn. And, and Wade and I talked about that a lot in the very dental episode we did, but the reality is, is like, you should do it. You should do what you like. You should do what you're good at. And if you want to learn something new, that's great. But don't, I don't know. I just feel like, I mean, it's the reason that you guys put together really good educational systems like, you know, like pathway and all that stuff. Cause it's just, you can't learn it from a

[00:16:26] YouTube video and you can't, you confidence isn't enough, I guess is what I'm saying. Confidence isn't enough. No, it's not. And YouTube's not enough. I joke with patients like, where'd you learn to do this? I'm like YouTube. Yeah. I can learn it on YouTube. Yeah. Which is sick because there's probably plenty of stuff on YouTube, but, but the reality is, is like confidence isn't enough really understanding. And, and, and you said something last time that is true, sort of bothers me because we talk about it all the time, but it

[00:16:53] is true. Reps are great, but not all reps are the same. So doing a whole bunch of something, but doing it not very well is much less helpful than doing less of it and doing it well. Yes. Right. Like I know, you know, I, I talked to some of the, you know, I've, I'm friends with some of the bigger DSO owners, you know, in the country, you know, they're, I might be anti-DSO model. I feel like it's not a success for the patient, but certainly some of the

[00:17:20] people involved in are wonderful. Some of the best people I know, you know, talk to them and, you know, they'll have docs that like their whole for, they did came in and did a ton of arches, right. You know, more than I do. Right. And almost every single arch needs a revision of sorts, right. After the, after the next year and they leave. And I'm just thinking, well, what's, what's the experience that they have? They just boosted their confidence. Like I could flap and cut bone and drill. Right. But that my confidence comes from seeing

[00:17:48] cases five, 10, 15 years down the road. Right. That's where my confidence comes in. Just because you did a bunch of damage, it doesn't build the confidence. It builds the wrong type of confidence. Like, you know, and, and I've, I've been lucky enough. I mean, I've only ever had to do one revision on any of my cases over 20 years. That's cool. Right. And, and it lasted 17 years. Right. And then that probably is because you'd put in a lot of the work on the front end of it. Like the, like the treatment planning makes a huge difference. I took it slow. I started slow.

[00:18:18] I made sure these cases were done. Excellent. I wasn't loaded up all the arches I could. So I could brag to my friends how many arches I did. It was more about like, I wanted to get that one piece just perfect. And I didn't care how long it took me. Like I, I listened to podcasts and people get on and brag about how fast they do an arch, you know, like, yeah, I can do an arch in this quick. I couldn't tell you how long I, if you asked me how long it takes to do an arch, I'm like, however long it takes. I book enough time that I can take the whole day, you know, or half the day or

[00:18:46] whatever. I, I, I do whatever it takes to get the case right. I'm efficient. You know, there's no, you know, efficiency is important, especially when a flap's open, but I'm not about like how many arches I can do, how fast I can do it. This isn't sales bros. You know, this is also what's funny is like, if I told myself, you know, if I could talk to my, myself early on in my career and I can say, you know, like a regular crown, so long as the patient gets numb, I can, you know, if you're doing a crown or two, you can knock that out in 45 minutes, start to finish. And

[00:19:16] technology helps that some, I wouldn't have believed myself, but part of it is that I, I didn't get to a point where I can do these things efficiently without doing a bunch of them and kind of making some mistakes and figuring out how to, I don't know, figuring out what works for me, that sort of thing. It is, it is interesting that reps are important. Good reps are more important and, and not rushing. Like, yeah, I got to say that remember, remember they always said, okay, you gotta go to your first job so you can build up speed.

[00:19:44] And you're like, well, I mean, you're probably going to get faster no matter what you do, right? You're probably gonna get faster. I don't think building up speed is like, it's the right thing. Probably like doing a good job as efficiently as you can, maybe is the right, right answer, you know? But the problem with the full arch implants and reps is you have, you're not going to get the reps until you start like mass marketing that you're the cheapest person in town, right? That gets you the reps. And so you're like, your logic is, well,

[00:20:11] I got to get the reps to get better. But you know, when you, when you do that, it's a race to the bottom, it ruins the market. You know, the reps, yeah, getting the, getting the amount of reps, aren't they, they just have to be good reps, but in order for you to get reps, you got to do more. And in order to get reps, you would dentulate patients you shouldn't. Yeah. You do treatment, you shouldn't. And like, I, I have good friends that are like, you know, ended up, I'm like, why'd you do zygos on that case? You absolutely could have done conventional. He's like, well, I'm new to zygos. I gotta, I gotta get reps.

[00:20:40] I gotta get some reps in and learn more. Right. If, and if I don't do more zygos, I'm never going to be good at them. And I'm thinking, I get that, but there's also a patient attached here. That's the wrong answer. Right. And that's the conundrum we're in, right. You know, to get reps, to get better, you got to race the bottom, charge less, ruin the, you know, and, and probably do treatment. You probably shouldn't for the patient. Like I said, the incentive structure is for you to get reps, not for this patient to get exactly what they want. That's so true. That's so true.

[00:21:07] Like I do, I do zygos, but I, it's the last thing I ever do. You know, I've got no motivation. I don't care if I do one case a week or one case a month or one case a quarter. Yeah. You know, it's like, but I get it. It's, it's a weird conundrum that I, I don't know if I have the answer to it, but for me in my practice, my answer is always like, what's best for the patient is fine. Well, honestly, um, that's a safe place to be. Yes. And I gotta tell you, I worry sometimes that, that that's something that there's maybe dentists that don't really know what's best for the

[00:21:36] patient where, you know, and, and, and I don't know, I just feel like it's usually not that hard. Um, uh, the things that, that compromise your thoughts on what's best for the patient often have to do with money with the, with, you know, patient demands, you know, the, the, what your books are looking like that month. I mean, it's, it's hard. It's like, there's a lot of outside stuff that can get in the way of that, but I just, I feel you're right. I mean, if you, if you stick with the,

[00:22:02] this is best for this patient, then you're probably going to do okay. Yeah. Like if you, if you ever come to my courses, you know, it may, it, you may find it not as awesome because like I hit the basics very hard because I've noticed they've been skipped the basics in diagnosis. What, what does this patient have? What are their risk factors? And if you choose this treatment, how is it going to hold up against those risk factors and which risk factors can be stopped,

[00:22:29] slowed down, mitigated, and which one you're not going to be able to do anything about and which treatment's going to hold up the best to that long-term. Right. And so we're, we hit the dental school basics of diagnosis and risk factors before we even hit treatment planning. Cause I'm always telling patients, I don't care. I can disagree with your treatment plan, but if you don't get the diagnosis, you are screwed. You're screwed when I, they get called to do an expert witness on you. You get called screwed when the board looks at it. I mean, I, I'm, I love defending

[00:22:59] dentists cause that's all I do when I do expert witness. But if I have a struggle defending dentists, I didn't even diagnose. Yeah. And I have, I get cases where they did an awesome diagnosis and I can go back to their attorney and to the other attorney and be like, look, I may not agree with his treatment plan, but his diagnosis was thorough, spot on. This doc knows what he's doing. You should be grateful that you found him. I'm sorry you had about bad outcome, but it wasn't because of him. It was cause you and your body sucks and biology sucks, but

[00:23:26] he did a great job. You can find a dentist that disagrees with the treatment planning, but this guy was thorough and, and diagnosed it correctly. You should drop the lawsuit. You know, you should, I'll defend this to the hilt because you know, you're barking up the wrong tree. Interesting. But then I get, then I get cases where I'm like, uh, you better settle this. I'm going to have a hard time defending you here. You don't even, you don't even have a diagnosis. That's, that's huge. That's huge. I mean, and the reality is, is that, uh, there's a lot of

[00:23:53] dentists out there that, that look at patients and see treatment plans instead of diagnoses. That's, uh, because in some ways they, they maybe didn't, I don't know. I'm not sure that they taught us that well. It's not even being diagnosed. It's B the majority of these like DSOs, they're diagnosing them over the phone. Yeah. Yeah. And it's not even the doctor, it's a receptionist, you know, Hey, send me a photo. Yup. You're a candidate. We got you pre-approved for 40, 50 grand, you know, or whatever we can do it. Schedule fly in and our doctor will do it.

[00:24:21] And that doctor who doesn't even work at the practice or own the practice, his instructor's money and to do these arches. And he sees the patient. It's going to take a really ethical, good doctor to see that patient for the first time and say, hold up. I know everyone ahead of me pre-approved this person and diagnosed. And you flew in and I have blocked out three hours of my day to see you. And if I don't treat you, I don't get paid. It's, uh, to stand up and say, you know what,

[00:24:48] this isn't the right treatment for you. You know, these teeth need to be saved by, you know, a competent restorative doctor. And we don't do that here. I guarantee you that conversation is happening 1% of the time of that. And if it does happen, that associate is being replaced by another associate who's willing to step in and do the job. That's right. That's right. If you get a spine, you're onward, you're out of here. Yeah. If you got a spine, you're getting replaced and now

[00:25:14] you've lost your job, right? It's the incentive structure. And so this model is just bad for patients. It's bad for dentistry. Like I say that I've seen it, the lawyers will sort it out. That's rough. That is rough. The attorneys will sort it out. Ugh, that is rough. Well, shoot. Okay. This was exactly what I was hoping to get out of this one. This is really cool. It's a little shorter than the other one, but, uh, wait again, uh, if you guys aren't in the very dental Facebook group, you need to join. And I said this in the last one, go find it on Facebook. Wade is there. If you have questions or comments for him, um,

[00:25:44] confidence isn't enough. Uh, a treatment plan isn't enough. A lot of stuff isn't quite enough. You gotta have, you gotta have it all together to do this stuff. Wade, thanks a ton for being on again. This was great. Oh, my pleasure. Anytime.