Stress and burnout are prevalent in the dental profession but there are many effective ways to manage these issues. By Frank Leggett
While all occupations incur some degree of stress, dentists are so generously endowed with stressors that it often leads to burnout. The World Health Organization has recognised burnout as a syndrome that appears if chronic workplace stress isn’t successfully managed. Whether it’s time and scheduling, business processes, staffing matters or just trying to achieve a work-life balance, running a practice can often be an overwhelming experience. In fact, in the study, ‘Sources of occupational stress in NSW and ACT dentists’, authors Dr Robyn E. Johns and Dr Denise M. Jepsen identified 349 stressors.
Another factor that exacerbates the problem is the personality types that are attracted to dentistry. Generally, they are dedicated, meticulous people. They aim for extremely high standards—or even perfection—and often that goal is unattainable. Additionally, practitioners can be isolated in their environment and frequently under significant time pressure.
“Burnout is an occupational phenomenon, solely related to work,” says Brisbane dentist Dr Annalene Weston, a dentolegal consultant at Dental Protection, one of the largest medical indemnifiers in the world. “The three main factors are emotional exhaustion, an increase in the depersonalisation, and a decrease in the sense of personal accomplishment.”
It’s important to recognise the signs when stress is beginning to get dangerous. Unfortunately, because you’re living it, because you are stressed, it can be difficult to identify.
“It can be any number of signs,” says Dr Weston. “Losing your sense of humour, disruption to your normal sleep patterns, an increase in cynicism, aches and pains—there are a lot of different symptoms that mean nothing individually. Stress is a concern when actions are out of behaviour for you.”
Dr Catherine Yang, who owns and runs Chats Dental in the Sydney suburb of Chatswood, has created the program S.T.E.P. On Fear to assist fearful patients and dentists suffering from burnout. She presented her program at the 2019 Australian Dental Congress in Adelaide.
“The biggest warning sign is sustained mood change,” she says. “Unfortunately, negative mood and behaviour can be transferred to those around the sufferer. When burnout is happening to you, it can be very hard to identify.” Dr Weston agrees. “Burnout can be very pervasive. It affects you cognitively, behaviourally, physically and emotionally.”
Dr Weston speaks from personal experience. In the ’90s, she trained in the UK and worked as a dentist for the NHS for three years. At that time, NHS dentists were required to make a pound a minute to break even.
“If you extracted a tooth, you were paid eight pounds,” she recalls. “That meant you had to get the patient in, obtain their consent, make them numb, extract the tooth and ensure they’d stopped bleeding in eight minutes.
“I didn’t have the time to give my patients good care; I was rushing all the time. I felt that all the work I was doing was rubbish and I was very unhappy.”
Dr Weston was suffering from moral injury. This happens when dental professionals are prohibited from producing or providing the level of care for their patients that they would like to provide. This creates a constant state of negativity about themselves and their work. Dr Weston’s solution was to move to Australia and work in a system where dentists give patients the time they deserve.
The best way to avoid burnout is to find effective ways to manage stress. It’s all about increasing resilience in order to bounce back from stressful situations. Recovery—such as taking holidays—is the process of increasing resilience. Of course, the reality is that holidays can’t always be taken at any time.
“Practitioners need to find manageable recovery strategies they can implement during their working day,” says Dr Weston. “It’s simple things such as taking a break between patients, having a moment to deep breathe and drink water, or going for a walk at lunchtime. It has been proven in two different studies that you can reduce stress by spending 20 per cent of your time at work, doing something you enjoy. If there’s a particular procedure you love, try to incorporate it evenly across your working week.”
Dentists are busy professionals, often carrying the burden of responsibility for a business and staff. Free time is always in short supply but it’s imperative that there is some release from the constant stress of the job.
“Feeling unfulfilled, sad and upset should not be the norm,” says Dr Yang. “You should not be attending to endless tasks while trying to please and serve everyone. You need regular breaks to lessen your focus. It’s all too easy to feel overwhelmed, all the time.Professional help
If the symptoms of stress and burnout are unrelenting no matter what recovery strategies are put in place, then professional help is required.
“We encourage practitioners to talk to friends and family, their GP, or to seek counselling,” says Dr Weston. “Mental health issues, whether it be burnout or anything else, should come with no stigma.”
The Australian Bureau of Statistics has reported that 20 per cent of Australians experience a mental illness every year and around 45 per cent of Australians aged 16 to 85 will experience a mental issue in their lifetime. As Dr Yang says, “You’re not alone; it can happen to anyone. Dentists are in such a people-centric profession, it’s important they look after themselves so they can continue to look after other people.”
Dr Weston agrees: “Burnout is not a sign of weakness. It’s simply a sign of circumstance and practitioners need to be supported. The problem must be addressed by the profession as a whole.”
Dr Annalene Weston presents a podcast about burnout on the Dental Head Start website. Visit dentalheadstart.com/annaleneweston/. Dr Catherine Yang’s S.T.E.P. On Fear program can be found at steponfear.com