Stress vs. Burnout: Know The Differences!

(Part 1 of 2)

STRESSORS

Dentists must confront many stressful situations in practice. At the top of the list are time and scheduling issues, patient demands, uncooperative patients, need for high levels of concentration and focus, and team issues. A study in New Zealand revealed the most commonly reported stressors were treating difficult children (52%), constant time pressure (48%), and maintaining high levels of concentration (43%). The strategies most utilized for managing work-related stress included interactions with people (78%), sports (64%), and forgetting about work (59%).

A study by the American Dental Association (ADA) reports that 86% of dentists claim experiencing one or more of these stressful conditions in any given year. This equates to 60 days/year that dentists are significantly stressed and disengaged at work. According to Rada and Johnson-Leong, dentists are prone to anxiety disorders, clinical depression and professional burnout due to the way dentists practice and their personality traits. Chronic interpersonal workplace-related stressors have a high correlation with anxiety, depression, musculoskeletal complaints, sleep disorders, memory problems and substance-use disorders, which all can be associated with burnout. Dentists experience moderate to severe stress levels at work each day. One study found the moderate to severe stress level characterized 82.7% of dentists surveyed, while another study found the number to be approaching 86%.

The ADA’s 2015 Dentists Well-Being Survey indicated updated data concerning stress levels in the workplace. The majority of dentists (67%) reported they have a moderate level of stress at work. Less than one in eight dentists (12%) reported severe stress at work. The level of work stress was about the same for female dentists as male dentists, and for younger dentists versus older dentists. Part-time dentists were more likely to have light stress than full-time dentists. More than one-third of part-time dentists (39%) reported light stress at work, while only 18% of full-time dentists reported light stress. Fewer than 25% of part-time dentists reported they faced severe stress at work.

While only one in 10 dentists was considered at high risk for alcoholism, nearly one in five (18%) of all practicing dentists felt they should cut down on drinking. Feeling a lack of control at work and being unsatisfied with their dental practices were associated with higher risk for alcoholism. More than one in five dentists (22%) was found to have a moderate level of depression, and 4% had a high level of depression. Half of the dentists who scored a high level reported that they have not been diagnosed or have not considered themselves to have depression.

PRESSURE FROM THE START

Stressors in dentistry are ubiquitous and start early in a clinician’s career. The individual’s ability to recognize the source of stress and respond appropriately are critical to preventing burnout. A 2016 study of 121 new dentists (defined as having graduated from six months to less than five years prior) in India revealed that new dentists are especially vulnerable to stress that may lead to burnout. Factors contributing to burnout were emotional exhaustion (39.27%), frustrations (47.83%), feeling worn out at the end of the workday (46.80%), feeling worn out by the end of the evening (35.05%), exhaustion in the morning at the thought of another day at work (35.05%), feeling that every working hour is tiring (46.80%), and having less energy and time for family and friends (47.83%).

In a 2019 study of 2053 dentists in the United Kingdom, 54.9% reported currently experiencing high job stress, with general dentists noting the highest level of stress. The most common sources were worrying (43.8%), threats of complaints/litigation (79%), dissatisfied patients (75.1%), concern about the General Dental Council—the organization that regulates dental professionals in the United Kingdom (72.8%), work pressure from National Health Service (NHS) to meet financial goals (72.4%), running behind schedule (64.9%), performing NHS work (63.2%), and dealing with difficult patients (61.2%). The research also found that dentists displayed much higher levels of suicidal thoughts than the general population due to the fear of litigation and external regulations, thus making dentists more prone to stress, burnout and psychological distress.

Lloyd and Musser investigated the personality traits of medical students as compared to dental students, and found dental students are more obsessive-compulsive in degree and number of symptoms, more codependent, 50% less likely to seek help, and are more competitive and isolating. These attributes are in line with the personality types that enter into dentistry as a profession. Results indicate that dental students evidenced considerably higher symptom levels than those previously reported in a general population survey. Compared with the general population, dental students showed a mild elevation in somatic symptomatology, a moderate elevation in anxiety and depressive symptomatology, and a marked elevation in obsessive-compulsive symptomatology and interpersonal sensitivity.

It is possible these marked elevations in obsessive-compulsive symptomatology and interpersonal sensitivity may reflect, in part, a sensitization to excessive performance demands. This sensitization may manifest in cognitive inefficiencies—such as indecisiveness, blocking or memory impairment—and excess sensitivity to the evaluative judgments of other people. In comparing dental students with other sample groups, dental students were also found to display more psychiatric symptomatology than general medical subjects judged free of psychiatric illness, and to approach levels of symptomatology found in general medical subjects judged psychiatrically ill or in need of psychiatric treatment. In a 2017 study in Massachusetts, dentists were reported to have similar or higher prevalence than the general population for stress, alcohol consumption, prescription drug use, back pain, neck pain, headache, osteoarthritis and gastroesophageal reflux disease.