By Andrew Goldsmith, DDS
Dr. John showed up to the office on Monday morning about 15 minutes late.
He was fatigued from his insomnia and had moderate neck and back pain. His generalized low-level depression was also playing tricks with his mind. By mid-morning he was falling behind in his schedule.
Then it happened.
With two hygienists ready for exams, two patients in the chair, and patients in the waiting room, a crown would not seat properly, and he snapped. Dr. John stood up, threw the crown across the operatory, and locked himself in the bathroom. When his assistant went to check on him, he yelled through the door to cancel all his patients for the rest of the day.
John burned out. And while his example may be extreme, burnout is a very real and serious problem that plagues our profession.
More Common Than You Think
According to one study, 84% of dentists have reported feelings of burnout.1 Another study found that 26% of dental auxiliaries also have suffered from burnout.2 While other research may vary on the exact percentages, the evidence clearly indicates increased prevalence of burnout in dental professionals.3
Sherri Bourg Carter, PsyD, describes burnout as “a state of chronic stress that leads to physical and emotional exhaustion, cynicism, detachment and feelings of ineffectiveness and lack of accomplishment.”4
Signs and symptoms include insomnia, fatigue, lightheadedness, colds, migraines, muscle aches, nausea, difficulty breathing, and feelings of not having a purpose in life.5 Burnout arises when our values are in conflict with what we are doing and when resources are threatened.6
Research conducted on dentists indicates that three personality types experience lower levels of burnout based on the Myers Briggs personality scale: introversion/sensing/feeling/judgement (ISFJ), extraversion/sensing/feeling/judgement (ISFJ), and extraversion/intuition/feeling/perception (ENFP).7,8
Dentists are more likely to be introversion/sensing/thinking/judgement (ISTJ) or extroversion/sensing/thinking/judgement (ESTJ), which often are considered “Type A” personalities, meaning they are more likely to experience burnout.
The conundrum is that we are typically driven individuals with jobs that can be stressful as we work in small dark places where millimeters make a big difference while attempting to do more in less time. Furthermore, our inherent drive for perfection in our work also increases the likelihood we will experience burnout.9
The first step is recognizing whether you are suffering from burnout. This can be a simple process with an excellent self-assessment tool known as the Professional Quality of Life Scale.10 The assessment can be downloaded for free and gives you valuable insight into your current state of mind.
Once you have determined where you fall on the scale, you will next want to strategically plan how to either avoid burnout or break free from burnout altogether by implementing five key strategies.
Make Your Work Environment Empowering
An office environment where there is a high level of mutual respect and everyone on the team feels safe to communicate has been strongly associated with lower burnout levels, yet many offices still promote a traditional top-down hierarchy and often treat staff members with a certain level of disrespect.11
Research has shown that burnout decreases for doctors and teams when negative communication is minimized and team members are encouraged to communicate in constructive ways.12 Develop an office that has open communication and encourages communication in all directions. Create an environment that has a zero tolerance policy on gossip and negative talk. By doing so, you will decrease your likelihood of burnout.
Take Control of Your Schedule
Dr. Christina Maslach is the foremost researcher on burnout, writing and cowriting more articles and books than anybody else on the topic. She emphasizes that one of the keys to overcoming burnout is to control workload problems by evaluating your workload frequently.13 For dentists, this comes down to your schedule.
You must work in a way that works for you. If you haven’t figured that out yet, keep changing how you schedule until you find something that works.
I used to work with an endodontist who took two-hour lunches every day. During that time, he would eat, meditate, and nap. I know dentists who schedule workout time, while others work multiple chairs without a lunch break. The key is to remove workload problems and find what works best for you. Your workload can increase burnout, so manage your schedule and reduce its risks.
You Need to Feel Fairly Compensated
If you have ever had times when you felt like you were working hard but not getting compensated, you were headed down the path of burnout. Dentistry can be extremely rewarding. However, if you are not getting time off, not saving for retirement, and not getting paid appropriately, the problems outweigh the rewards.
Determine what rewards would be fair for you and start to compensate yourself. You may need to work differently by scheduling for production. Or, you may need to raise your fees. But as long as you do not believe the rewards are worth the work, you’re on a slippery slope.
Engage in Dentistry and Deversify
Many dentists have said that learning a new technique or attending an institute reinvigorated their professional life. Research on burnout supports this notion.13 Furthermore, if you couple diversifying your work with supportive relationships like a mentor or coach, you become more resilient, accomplish more, and feel more worthwhile.14, 15
Centers of learning like the Pankey Institute, LVI Global, Productive Dentist Academy, and Dawson Academy offer new perspectives, fresh ideas, and support. Engaging in our profession at a new or deeper level can elevate your dentistry and your career. You can also learn a new technique like rotary endo, implants, cosmetic dentistry, or lasers.
Diversify your dentistry and engage with your profession by reinvigorating the passion inside you. Dentistry is an awesome profession. It’s up to you to remind yourself of that, and, by doing so, you will cut back your odds of burnout.
Improve and Maintain Your Physical and Mental Health
Dentistry is a very demanding profession, both physically and mentally. If your goal is to not burn out, you must take care of yourself first. Mental and emotional health are vital for you to operate at maximum efficiency. They can be bolstered by developing a calm mind and focusing on peaceful thoughts, meditation, and listening to music.16
A consistent mindfulness practice will enhance your life, and it has been scientifically proven to have multiple health benefits as well.17, 18, 19 The trick is finding time in your day to practice mindfulness. Some doctors have daily rituals in the morning, while others practice the technique at the end of the day.
Something I have found to be particularly helpful is an app called Sounds True. Through it, I use guided meditation sessions with Jack Kornfield and Tara Brack that last about 10 to 15 minutes. This has become a daily routine for me, and I often have a 20-minute block that appears on my schedule so I can intentionally take the time to work on my mental health.
Since I have started this routine, my stress has decreased, I’m more relaxed, and my team finds me easier to work with, all decreasing my odds of burnout. Preventing burnout is a priority, and maintaining optimal physical and mental health is one of the essential elements.
Burnout arises from continued negative threats to the resources we value: time, money, freedom, communication, control, health, and love. By focusing on what we can control, we decrease the likelihood of burning out.20 Furthermore, by engaging in our profession and adding diversity in our work, we embrace the very strategy that can break burnout in dentistry.
About the Author
Dr. Goldsmith graduated from the University of Nevada Reno in 1992 and Marquette University School of Dentistry. He then completed a two-year general practice residency at the University of Colorado, where he was a part-time associate professor and established a successful dental practice in Colorado Springs. After 11 years in private practice, he sold it to help establish Smile Source, a group of dental practices dedicated to preserving independent practice dentistry that now has more than 500 locations. Dr. Goldsmith has published articles in multiple journals and spoken to dentists around the world. He currently operates Process23.com and FlipFlopDentistry, which offer online CE and practice management education. He can be reached at firstname.lastname@example.org.
Reprinted by permission of Dentistry Today, c2019 Dentistry Today
1. Janulyte V. Self perceived mental health and job satisfaction among Lithuanian dentists, Ind Health 2008: 46, 247–252.
2. Denton DA, Newton JT, Bowers EJ. Occupational burn out and work engagement: a national survey of dentists in the UK. British dental journal, 2008; 205; 377–384.
3. Singh P, Avlak DS, Mangat SS, Mavlak MS. Systemic review: factors contributing to burn out in dentistry. Occupational medicine 66:1, Jan 2016, 27–31
4. Sherrie Bourg Carter, PsyD. The tell tale signs of burn out… Do you have them? Psychology today November 26, 2013.
5. Espeland, Karen. Overcoming burn out: how to revitalize your career. Journal of CE in nursing Jul/Aug 2006, Vol. 37, 4.
6. Maslach C, Hobfall SE, Freedy J. Professional burn out: recent developments in theory and research. New York: Taylor&Francis 1993:115–29.
7. Baran RB. Myers-Briggs type indicator, burn out, and satisfaction in Illinois dentists. General dentistry, 2005; 53:228–234.
8. The Myers-Briggs foundation. MBTI Basics 2014.
9. Lafferty & Lafferty. Perfectionism: a sure cure for happiness. Detroit, MI Human Synergistics, 1997.
10. Stamm BH. The Concise ProQO2 Manual. The concise manual for the professional quality of life scale. 2010.
11. Sarmiento, Laschinger and Iwasiw. Nurse educators workplace empowerment, burn out, and job satisfaction: testing Kanters Theory. Journal of advanced nursing 2004:46;134–143.
12. Jenkins & Elliot. Stressors, burn out and social support: nurses in acute mental health settings. Journal of advanced nursing: 48(6) 622–631.
13. Maslach C and Leiter. Understanding the burn out experience: recent research and its implications for psychiatry. World psychiatry 2016 June; 15(2) 103–111.
14. Potter B. Overcoming job burn out: how to renew enthusiasm for work. Berkley, CA Ronin Publishing, Inc. 1998.
15. Chang E, Eddins-Folensbee F, Coverdale J. Survey of the prevalence of burn out, stress, depression in the use of supports by medical students at one school. Academy of psychiatry 2012;36(4) 177–82.
16. Sherman DW. Nurses stress and burnout how to care for your self when caring for patients and their families experiencing life threatening illness. American Journal of nursing 2004;104(5) 48–56.
17. Hope EA, Bui E, Marques L, et al. Randomized controlled trial of mindfulness meditation for generalized anxiety disorder: effects on anxiety and stress reactivity. Journal of clinical psychiatry 2013, Aug 74(8) 786–92.
18. Daubenmier J, et al. Effects of a mindfulness-based weight loss intervention in adults with obesity: a randomized clinical trial. Obesity April 24(4) 794–804.
19. Ott MJ, Norris RL, Bauer-Wu SM. Mindfulness meditation for oncology patients: a discussion and critical review. Integration cancer therapy 2006 Jun 5(2) 98–108.
20. Maslach C, Shaufeli WB, Leiter MP. Job Burnout. Annual Review of Psychology 2001;52:397–422