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10,000 hours, more or less

Jeff moved into my neighborhood from New York City in the seventh grade. He and I quickly became good friends. We enjoyed all the things that 13-year-old boys liked. We rode our bikes, explored the backyards between our houses and walked to the local arcade to play pinball.

Jeff's mother had an interesting ritual. Every Friday night they had franks and beans for dinner. I used to love to sleep over at Jeff's house just for those Friday night franks and beans. One Friday after school, I made my ritual skateboard trek to Jeff's house at the end of the block. With me I had a bag with pajamas, walkie talkies that I got weeks earlier for my birthday and a new record album of the Beach Boys (you remember those black plates with grooves in them). I had the whole night planned. We would eat dinner and play outside with the walkie talkies until Jeff's mother called us in. Then we would listen to music and read comic books.

That night when I arrived at Jeff's, there was a buzz around the house. Jeff's parents had bought a piano and it was delivered that day. I had been playing the piano for two years. I took lessons from our next-door neighbor Mrs. Feinman, your stereotypical piano teacher. She was 60 years old, her kids were grown and she taught classical music only. Most of the kids in my neighborhood went to her house once a week for a one-hour lesson. Because I was a typical teenage boy in 1974, my interest in and enthusiasm for playing classical music was waning. I practiced maybe once or twice per week and I told my mother that I wanted to stop my lessons.

Jeff, on the other had, was fascinated with his new toy. That night after dinner we sat at the piano. I gave a concert of my two most polished pieces, and I must say that I didn't have much more than that. Jeff, on the other hand, had never played up to that point.

Over the next few weeks I found Jeff was busy after school and was less available. One afternoon a few weeks after his family got the new piano I went over to his house. He played a simple one-handed version of Dylan's "Blowing in the Wind." Jeff was learning how to play by ear.

Shortly after that, Jeff began lessons with Mrs. Feinman. Unlike me, he practiced and played a few hours per day. Jeff was hooked and highly motivated to play. He quickly became quite good. With each hour that he played he got closer to becoming the professional that he would eventually be. At that same time I stopped, and watched my little talent disappear like a sinking ship.

Recently, sociologist and author Malcolm Gladwell wrote the best seller, "Outliers," in which he offers anecdotes like my story about Jeff to explain why successful people become successful. He writes about the thousands of hours spent by teenagers like Bill Gates (Microsoft) and William Joy (Sun Microsystems) on computer programming in the early 1970s. They found themselves in the unique position of having expertise in computer science when the personal computer became a desktop business tool by the late '70s.

He also writes about Canadian hockey players and schoolchildren from around the world. He makes the argument that timing is important, but that practice and a strong work ethic are just as crucial to success. Simply stated, you need to do something hour after hour after hour if you want to become an expert.

I suppose that is why we call it the practice of dentistry. Dental school gave us a starting point. We can all remember the first crown or the first root canal we ever did. What a scary experience that was! I was pleased with myself when I completed six root canals prior to graduation from dental school. I was really full of myself when I finished my endodontic residency and had completed over 200 root canals. Sadly, I had an instructor at that time who told me that I would not be an expert in my field until I had completed 5,000 root canals! Oh my, I thought. I felt that I was already an expert.

Gladwell discusses the 10,000-hour rule. Statistics show that expertise comes with approximately 10,000 hours of work. Whether it's playing the piano, hockey or performing root canals, one must practice approximately 10,000 hours to become an expert.

At one time dental education began with pre-clinical instruction and continued with direct patient care followed by the move to private practice. Today many recent dental school graduates opt to attend a general practice residency to enhance their clinical skills through more hours of supervised clinical care. Once the recent graduate enters the workforce, time and the number of procedures are a large part of what separates him/her as an expert from a novice.

We all remember what it was like when our first few patients sized us up. Do you remember how you felt one someone asked you how many crowns, extractions or root canals you had done? Remember how you just couldn't admit to five or six, but would say something like, "Oh, I've been doing these for three years." This of course would refer to the two years of clinical practice in dental school and the one GPR year.

But becoming a great dentist does not just involve hours of practice. Gladwell argues that one must also have some innate skill, the opportunity and the desire. While some find themselves in dental school without knowing why, most make the decision to go because at some point something hooked them on dentistry. Like Jeff seeing the piano in the living room and pretending to be Elton John or Bob Dylan, most dental students have found something about dentistry that they like. Maybe they knew a dentist who was a role model.

Perhaps some became interested because they felt handy with projects that required hand-eye coordination, or just loved science and had a desire to practice the healing arts.

Opportunity comes when hard work in college earns acceptance to dental school. Once in dental school it is up the student to learn. At this point self-motivation determines how much you got out of your program.

Desire to be the best starts early but ultimately is a lifelong component of success. Desire gets us through school, but success can only be achieved with a continued commitment to mastery of the profession. Continuing education and striving to do your best ultimately makes us better at whatever we do. Even professional golfers and musicians continue to practice long after they have achieved success. Dentists must do the same to be the very best. Dental school is only the beginning of dental education. 10,000 hours goes by very quickly!

Dr. Terry is the editor of the Pennsylvania Dental Journal. His comments, reprinted here with permission, originally appeared in the March/April issue of that publication.