The burnout cycle in dentistry – How could it be improved?
Delving into the world of dentistry with undergrad programs through dental school, aspiring dentists may have found the field of dentistry captivating and stimulating. Dentistry is truly a rewarding scope of work, an ever-evolving work field that is free of any limiting walls and comes to grasp an insurmountable surge of never-ending knowledge. Mounted with a rapidly growing learning curve, a dentist can never get bored with their toys and infinite wisdom. However, like most nine to five-ers, dentists also master in one common workplace habit – feeling burnouts. Burnout has been recognized by the WHO as a syndrome elicited by chronic workplace stress that hasn’t been effectively managed or addressed. This has given rise to many disillusioned and burnt out dentists, the trend of which has fundamentally demolished the patient care system and caused the collapse of many dental care ethics and morals.
Although it is normal for employees to at times drag themselves out of bed and to unwillingly muster enough energy to put on a facade for their customers or colleagues, it isn’t normal when you are feeling a constant state of exhaustion when pondering on your views about your job and work environment. If you regularly feel like you are walking on eggshells and bending over backwards for a job that doesn’t give you the appreciation and contentment you desire, you may be exhibiting signs of a fatigue-impelling burnout with your workplace. Literature reports an impermissible number of dentists who have shown critical signs of exhaustion or burnout with a good portion of them considering leaving the practice prematurely.
What is Burnout?
In May 2019 the World Health Organisation (WHO) included burnout in its 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon. It has been promptly classified as NOT a medical condition, rather a causative agent for the further deterioration of health. It is described in the chapter: ‘Factors influencing health status or contact with health services’ – which includes reasons for which people contact health services but that are not classed as illnesses or health conditions.
Burnout is defined in ICD-11 as follows:
“Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:
- Feelings of energy depletion or exhaustion;
- Increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and
- Reduced professional efficacy
Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”
Burnout is characterised by mental, physical and emotional exhaustion, cynicism, resentment, increased detachment and a significant decrease in professional satisfaction caused by a multitude of factors. It reduces your productivity, saps your energy and leaves you feeling increasingly helpless and astray.
“The condition is an occupational hazard that occurs frequently among professionals who do ‘people work’ of some kind”, Dr Raj Rattan, Dental Director of Dental Protection stated. Burnout is distinctive and separate from depression. While burnout may improve with a break or some time away from the workplace stresses, depression does not. Burnout is a problem strictly circumscribed to the area of work while depression can affect all domains of a person’s life.
Burnout in dentistry
In the recent report published by Dental Protection, Breaking the Burnout Cycle, burnout has rightfully been narrated as one of the greatest paradoxes affecting the dental industry. As a soiling oxymoron mocking the profession, it is of great contradiction that at a time when facilities and technology have been evolving to cultivate the full capabilities of a dental officer, an unforgiving number of dentists have evidently shown signs of burnout. Documentations extracted from many international studies reveal that burnout is a global phenomenon that has been targeting dentists all over the world.
Dentistry has been understood as a “lone” profession for there is a direct one-on-one relationship between a dentist and a patient. Unlike jobs that work with a good team system and often harbour a foundation from the entire community of employees, dentists work much like independent entities in building, maintaining, treating and managing a recurrent or new patient. This produces a direct pressure on the dentist. Thus it comes with no surprise that the third annual report (in May 2019) stated by the Practitioners Health Matters Programme (PHMP) outlined a 60% increase in the number of health professionals seeking help for depression, stress and burnout.
Burnout has also seen a proliferating mandate in the dental industry of the UK. Research compiled by the British Dental Journal (BDJ) in January 2019 established high levels of stress and burnout amongst a survey of more than 2,000 UK dentists, 54% of which revealed that they were currently experiencing high job stress. 48% of the respondents stated that they were unable to cope with the level of pressure in their role. The number of dentists lamenting about the terminal burnouts they experience has been increasing drastically, creating a welter of confusion and exhaustion and having reached an “endemic” level worldwide. While the rates may vary by country, gender and career stage, a vivid depiction of the impact of burnout on these dentists’ personal and professional lives are building grave concern and setting off a national alarm.
Risk factors that may influence burnout
Studies have quantified that about 84% of dentists have either shown signs of considerable burnout or succumbed to the pressures of burnout. Some studies have also revealed that 26% of dental auxiliaries also have experienced significant deterring burnout in their careers. More than 1 in 3 dentists have considered leaving the profession due to a disbalance in their professional and personal lives, with 50% of dental officers claiming that they find it difficult for them to take short breaks.
Burnout isn’t always about the individual employee. In isolated circumstances when there is a mismatch in the nature and persona of the job and the dentist, or for depression-ridden individuals, the burnout may be self-contained, but organizational forefront and personality is most important for the presence of or the absence of burnout. Christina Maslach, Professor Emerita of Psychology at the University of California at Berkeley, has proposed six characteristics of work as diagnostic aids to better recognise the presence of burnout and has been a reputed tool of measure to assess burnout worldwide.
Greater workload, limited time and long hours without sufficient time to rest and recover maybe some of the predisposing factors that lead to burnout. Most organizations feel external pressure from regulators or competitors that can cause the workload to be inevitable. 26% of respondents suspect that emotional exhaustion coupled with physical weariness have contributed to irreversible clinical errors and their frequencies.
In order to feel completely satisfied with one’s work environment, dentists need to feel like they are in control of their job regulations, duties and morals, as control reflects the demand-control model of job stress. A lack of autonomy has resulted in dentists feeling exhaustion, pressure and stress with their commitments and obligations. Dentists working in chaotic practices reported lower job control and job satisfaction.
A reward system in a dental space can mean adequate monetary guidance from the organization or the superiors, however, that is not all. Workplace rewards can materialize in the form of adequate financial compensation, social pride though recognition from coworkers and supervisors, and intrinsic rewards like the feeling that you are doing well. If you are lacking any of these three reward systems, you may experience the pitchforks of burnout.
A sense of community is essential for a content work experience. The quality of social interaction in the workplace including support, conflict, teamwork, and amiability among the coworkers produces a great job equilibrium. In order for dentists to thrive in the dental industry not only feeling like an appendage to the system but a valuable organ, an atmosphere of tranquillity and respect is important for their mental wellbeing. Isolation and incivility can contribute to burnout and exhaustion.
Fairness is a fundamental desire of all employees where they not only feel like their work is being treated with clarity and equity but that this fairness is recognised and depicted in their treatment. A perceived lack of fairness can lead to feelings of being disrespected or powerless. If dentists are constantly in a dispute about the inflexibility of their schedule as compared to their coworkers’ or the differences in their treatment, financial benefits and job promotions due to favouritism from the overhead management, they may feel like their works are stagnant in scrutiny and disrespect, and can lead to the branding of gradual burnout.
The flawed and peccable field of dentistry can be governed with a variety of differences and detachments in regards to many cases. 23% of dentists have reported a hopeless conflict between the values of the company and their individual ethics and morals. In such situations, dentists may often find themselves playing devil’s advocate and may lead to a disillusioned view of their job and duties. A mismatch may also follow after the company fails to walk the walk in respect to their prior commitments to the dentist, ensuing burnout.
How can you improve burnout?
An individual can work to promote engagement and quell the harsh pressures and effects of burnout, however, since burnout arises as a result of excessive demands and limited resources, most of the will power for change must come from organizational interventions.
Prioritize your mental well-being
Dentistry is a critically demanding profession, both mentally and physically. A dentist should be prioritizing their mental and emotional health such that the collaterals align and create for an ambience that lets them operate at maximum proficiency and optimal efficiency. Consistent mindfulness achieved with the help of various calming exercises and rituals like meditation can bolster the mood and quality of work and life for the individual. Hard work and methodical motivation require adequate recovery time in order to replenish one’s cognitive, emotional and physical reserves. Enough rest, quality time with family and friends, and scheduled alone time for hobbies and activities can reflect in a lowered risk for burnout.
Take control of your schedule
The dental industry is a creatively motivating workspace to be a part of. Constant stimulation is sought after and instantly found in this field of work, hence why so many dentists are solemn workaholics. Dr Christina Maslach understands the restless nature of dentists and the need to relentlessly feed their hungry curiosities and passions. She emphasizes that one of the keys to overcoming burnout in dentistry is to control workload problems by evaluating one’s workload frequently. Taking control of one’s schedule and knowing what plan works best for them is the best way to stay in charge of one’s satisfaction and prevent the occurrence of a chain reaction leading into burnout. This could mean taking longer breaks, working only through a certain number of patients a day, and changing rotas to fit their convenience and mental health.
Recraft and empower your job environment
Before going back into your drawing boards, adopt the culture of evolving and transforming. The notion of recrafting one’s job is to ensure that the most fulfilling perks of the job are indulged in. Spending more time doing these satisfying activities keep you on track with your goals and work and let you involve yourselves in your job with more zest and passion. This ensures that the job description isn’t compromised. An office environment that encourages mutual respect and fairness and good communication amongst the employees, is associated with lower burnout levels. Dental practices that promote or are neutral to traditional top-down hierarchy, negative talk and gossip, and unfriendly communication amongst staff is an office space that is unsafe and should not be tolerated.
Dispose of the idea of perfectionism
Disengage with the idea of perfectionism regarding your work life. People who set unrealistically high bars for personal achievement and demanding standards for duties are often victims to burnout. Fear-based perfectionism is also linked with a higher burnout. Although it is okay to have high aspirations, it is also important to be kind to oneself especially in a fast-paced work field like dentistry.
Engage in dentistry and diversify
Dentists have reported that with the help of new technology and taking up new techniques and learning new skills, they have been rewarded with a revived attitude and a refreshed mindset. Diversifying in the various aspects of dentistry has been linked with infinitely increasing the positive workflow and has been successful in reinvigorating the lost passions of dentists. Constantly innovating new ways to redefine the parameters of dentistry has shown great help in engaging the dental staff.
A restated perception among dentists is that by changing occupations they may be able to effectively combat the cynicism linked to burnout. Although this may be accurate for dentists whose true avocation isn’t dentistry, it may prove unverifiable for dentists who have had a passion for dentistry initially but have come to lose it due to a number of reasons. A fresh change in profession may be certain to help dentists who would like to explore more options and are looking to make a difference doing something other than clinical work. That being said, dentistry is an incredibly valuable and rewarding profession with endless possibilities. Dentists who have had negative experiences at work but carry a deep-rooted love for the profession can opt to explore more areas in dentistry like being an educator, an advocate for dental hygiene, an administrator, or a researcher in public health. The possibilities are limitless.
The burnout associated with dentistry is truly a cynical allegory that has made considerable impact on the dental workers. It is important for the respective organizations to ensure that they improve their work environment to encompass and address all the dentists’ complaints and grievances. It is also vital for the dentists involved to make sure that they do not let the environment they work for reduce the sense of value they get from being a dentist. Dental Protection seeks a commitment from the wider dental system and government to improve the working environment for the members and to truly begin tackling the endemic problem of burnout in dentalcare.