No one needs to tell you that being a dentist, while rewarding, can be very hard. Consider how often you’ve had a long day, seeing one patient after another. Many are cooperative, some are even appreciative, but there are those who are difficult—argumentative, resistant to dental treatment, or unhappy with their results. After your last patient appointment, there are often administrative tasks to deal with.
By the time you leave your office, everyone else has gone home and the sun is long set. When you get home, perhaps your kids are asleep and maybe your partner is irritated about what you missed while at work. Maybe you find yourself considering whether it’s time to sell your dental practice and do something else more often these days. Does this sound familiar?
If so, you are not alone.
If this description resonates with several typical days in your month (or week), you are likely experiencing burnout—a common phenomenon among dentists, especially right now. Dentists experience stress at work each day, in fact, one study found that 82.7% of dentists surveyed experienced moderate to severe stress levels, while another study put the number closer to 86%. Dentistry as a field has a burnout problem, and it can help to know it’s not just you.
There is hope, but the first step is understanding what is happening clearly. Most of us want to skip or gloss over this step, but mental health experts have discovered it’s essential to take a step back and be honest with ourselves about our negative state first so we can effectively restore our zest for life.
While we at DDSmatch are not mental health experts, we work very closely with dentists in both professional and personal ways. In an effort to support those we serve, this month we have gathered the latest data from those who are the experts on the subject that may offer some helpful insight.
What is Burnout?
While you may think of burnout as simply a colloquial term, the World Health Organization has a definition for it: “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.”
Stress, especially workplace stress, has been talked about for decades. But why is it so dangerous? When humans perceive a threat (that is, become stressed), our amygdala produces hormones and neurochemicals that activate the body’s “flight, fight or freeze” response. Signals go out from our brain to increase our heart rate, raise our blood pressure, and increase our energy levels, thereby better equipping us to deal with the threat, to run from that primordial tiger.
When this stress becomes chronic, however, the body doesn’t have the time to recover from the response. As a result, we live in a constant state of that heightened response, overtaxing our physical and mental systems. Over time, this will impair our physical, mental, and emotional well-being. And when that happens, we experience burnout—day-to-day life becomes overwhelming, leaving us exhausted and drained.
Symptoms of Burnout
Typically, a person experiencing high levels of of stress will exhibit the following symptoms:
- Disturbed, unrestful sleep
- Lack of energy and chronic tiredness
- Negative thoughts and emotions
- Loss of motivation
- Reduced productivity
- Anxiety and Depression
- Desire to take a mental and physical break from co-workers, or people in general
- Loss of interest in work and other activities you once enjoyed
In more formal psychological assessments, burnout is measured by looking at a few key areas. The three most significant dimensions of burnout are:
- Emotional exhaustion: feelings of energy depletion or exhaustion. Emotional exhaustion may lead to you not feeling you can effectively give of yourself anymore.
- Depersonalization: increased mental distance from your job or feelings of negativism or cynicism related to your job. Depersonalization may result in you inadvertently conveying the message to patients that you are not fully engaged or do not care about their concerns or needs.
- Reduced personal accomplishment: diminished professional efficacy. Reduced personal accomplishment results in a tendency to demonstrate an inability to cope. This can fuel a negative impression of yourself and dissatisfaction with your work and accomplishments.This may lead to job turnover, absenteeism, low morale, insomnia, and increased use of drugs and alcohol, as well as marital and family issues.
What Causes Burnout?
If you are experiencing these symptoms, it is essential to be able to step back a bit and look into the specific causes of your stressors. This is important, because when the causes of stress seem nebulous or all-consuming, it can be easy to take our unfocused frustration and become overwhelmed. We may make a rash decision to, say, sell your dental practice. While some may still ultimately come to the decision to make a transition, it’s important for your future contentment to first thoroughly evaluate the workable solutions which may be available.
Even if you are not yet experiencing burnout, taking time to recognize those aspects of your personal and professional life that create undue stress for you can be key to avoiding it in the future. And if you feel you are experiencing burnout, it is necessary to identify those areas where you need to focus most.
Some of the most common stressors for dentists are:
- An overwhelming amount of debt or overhead
- Lack of human resources and business training
- The day-to-day exhausting nature of the profession
- An unsustainable workload
- A perceived lack of control
- An insufficient reward for the effort you extend
- The lack of a supportive community
- The lack of fairness
- A mismatch between your values and skills
- Difficult or dissatisfied patients
- The threat of complaints or litigation
- Time pressures
- Regulatory pressures
- Employee issues
Some other causes are worth exploring in a little more detail. If you recognize yourself having problems with one or more of these areas, it’s time to sit down and think about each area—your schedule, your earnings, and your life outside of work to determine whether what you are doing is helping or hurting you, and how you can make adjustments where necessary to rebalance.
Time management and work/life balance – Dentists are under unique time pressures. You have the constant stress of keeping up with a demanding appointment schedule. In addition, you have all of the administrative responsibilities that go with running a small business, including employee issues, dealing with insurance, maintaining proper inventory, and whatever else you find yourself doing after hours.
If you’re like most dentists, you spend most of your time indoors, in small, confined spaces. Apart from your assistant, you may be alone with a patient (who can’t really talk with you) for the entire day. This can feel isolating. You may have few opportunities to interact with and work out problems with your peers, and this can be magnified by the competitiveness that may arise between local dentists. When combined with the long hours and tight schedules of a typical work day, it can leave little time for family, friends, and rejuvenating social activities.
The good news is that, as you question your assumptions about where you may feel trapped, and as you become increasingly clear about your priorities, you will begin to see how you can shift schedules and make needed changes to make sure your needs are better met.
Physical Stress – Unlike many professionals, dentists engage in taxing physical activity. Although not much body movement is involved, prolonged static postures with minute hand and eye movement can lead to muscle fatigue and, ultimately, tension and related pain can collect in the back, neck, and shoulders. Combined with handling vibrating instruments, which may cause numbness or tingling sensations in the hands, dentists are uniquely susceptible to musculoskeletal disorders.
These may force dentists to prematurely quit their practice or severely reduce their hours. It’s critical to be in tune with your body, honest about your limitations, and to value the balance between your physical and mental well being.
Financial Pressure – Most dentists start their career with hundreds of thousands of dollars of student loan debt. Soon, a practice loan may be added to this burden. Your practice has to earn enough to cover your overhead expenses, pay for your own personal expenses, and cover the debt you’ve accumulated. Often, dentists will work long hours and forego vacations or time off, trying to earn however much they can to alleviate these burdens. This can lead to feeling trapped.
With both of the above, it’s important to recognize that overemphasizing financial priorities over your mental and physical health—putting making a living over living itself—is not a successful long-term strategy for anyone. Your physical, mental, and relationship resources must be set on equal footing with your financial resources—as true wealth consists of a combination of all of these areas.
Pressure to Upgrade – As mentioned above, dentistry can be a competitive practice. Dentists may feel a lot of pressure to keep up with the latest techniques, continually improve their clinical skills, and upgrade to the newest equipment or software. This can be expensive, time-consuming (a resource of which you already have too little), and create feelings of insecurity about being behind the curve.
Again, getting clear that your quality of life— enjoying a positive inner state from day to day—is your actual goal, can help you prioritize the external demands and pressures and make wiser decisions. Then you will not worry as much about any roads not taken.
The Stressor that Need Not Be Named – One thing that has so far been left unmentioned is the undeniable impact of the COVID-19 pandemic and subsequent upsets taking place on a personal and global scale. Even when things are going well personally, we all feel the heightened stress around us. Much ink has been spilled over this topic, and we have nothing to add here other than to offer a gentle reminder that you are a human being, just like the rest of us, and this prolonged uncertainty has been hard on everyone and has made all of our jobs, and our lives, much more stressful and difficult. Keep in mind that the world you practice in now is not the same as it was in 2019 and cut yourself—and those around you—a lot more slack.
Self-Imposed Stressors & “Thinking Errors”
There is one aspect of a personality common among dentists that comes with it’s own built-in stressors—an inclination toward perfectionism. Perfectionism is a tragic flaw. While it is certainly admirable to always strive to do one’s best, and to push oneself toward constant improvement, those efforts are undermined when one consistently judges oneself as lacking. This tendency can lead to unrealistic expectations about what you and your staff can do. Consistently failing to meet unrealistic expectations often leads to depression and substance abuse.
Perfectionism—setting unreachable or unreasonable goals—can be debilitating and experts tell us it is a very common source of burnout in all walks of life. You cannot offer all types of dentistry. You must be realistic in your production goals. Setting unrealistic expectations is simply setting yourself to fail and be disappointed. Your goal for the treatment you provide should not be perfection, but it can be excellence. When a case doesn’t turn out as expected, that is not necessarily a failure. But it certainly is an opportunity to learn. Mistakes aren’t a sign of weakness. They’re inevitable and the process by which you improve. The goal should be continual improvement. Staying open to improvement is the key to excellence.
A dentist with a healthy set of expectations will set achievable goals. When clinical outcomes are less than hoped for, this dentist looks honestly at the situation, sees where improvements can be made, determines how to make those improvements, and moves forward. Once you have learned what you can from a mistake, leave that mistake in the past.
While it is easier to blame external factors, mental health experts advise us to evaluate our internal thoughts and emotions such as perfectionism—and that they tell us that these are actually what primarily dictate how we feel about and react to our external experiences. Our expectations, beliefs, upbringing, our definitions of success, meaning, happiness, and security—these also require regular, objective inventory to see if they’re still true for us. Therapists refer to “thinking errors” such as the “all or nothing” of perfectionism as incorrect habits of thought that subconsciously cloud our perspective of reality and cause us unnecessary suffering and negativity.
How to Cope with Burnout
Hopefully you aren’t too discouraged at this point because we’ve now got some good news. If you are feeling burned out, you can change that! While this process of evaluating each of these areas takes some effort and can feel difficult when you’re already feeling a bit depleted, recognize that by addressing it head on, you are getting back in the driver’s seat. You will soon discover that you do in fact hold the keys, and have within you the ability to create a life you enjoy. We all do—but burnout can make us feel powerless. This too is a thinking error.
Whether you are currently experiencing burn out or simply want to avoid it, recognize the risks and make efforts now to balance your priorities and mitigate your key stressors proactively. We sincerely hope that you will, both for your sake, and for the sake of your family, friends, staff, and colleagues. All of those people care about you and your well-being, and addressing or avoiding our own burnout is one very real way we can stay available to help support and uplift those around us, something the world needs more of.
For more specific ideas on addressing or avoiding burnout, see this article on “Practical Steps to Addressing or Avoiding Dentist Burnout.”