Burnout: The clinical condition making a profound impact on our profession

While it might be a newly acknowledged illness in the US, burnout has likely existed as part of the relationship between humans and work for centuries. Burnout is a psychological syndrome produced by extensive exposure to stress in the workplace.¹ Its main components are exhaustion, cynicism toward work, and feelings of inadequacy, and it’s been linked to many physical and psychological consequences that reduce quality of life.^1,2

This malady affects workers around the globe with one recent study reporting that approximately 20% of the working population is expected to experience burnout in their lifetime.³ When we look at physicians, this number leaps up to 43%, according to the 2020 Medscape National Physician Burnout and Suicide Report.³

The dental community is in the middle of these two figures with 30.9% of dental hygienists disclosing that they’ve experienced burnout in a study published in the 2020 Journal of Dental Hygiene.⁴ Almost one third of those who experienced burnout described their symptoms as emotional exhaustion, 11.3% reported high depersonalization, and 41.1% experienced a diminished sense of personal accomplishment.⁴

Unfortunately, in the dental profession we are attuned to taking care of clients’ needs before our own, which can lead to burnout. Together as an industry, we need to learn the signs of burnout and discover strategies to guard against this harmful condition.

Is burnout a new phenomenon?

Burnout was first noted in the 1970s by psychologist Herbert Freudenberger who was studying individuals working in the “helping professions.”⁵ He created the term “burnout” to describe the exhaustion and incapacity to cope that developed in individuals faced with extreme stress in their self-sacrificing work.⁵

In the years since his discovery, burnout has moved beyond a condition that mainly affects altruistic professions. Burnout is now listed in the International Classification of Diseases (ICD-11) as an occupational phenomenon defined as “a syndrome resulting from persistent workplace stress that has not been effectively handled.”⁶ The ICD-11 goes further to explain that burnout has three dimensions: feelings of exhaustion, negative feelings toward one’s job, and diminished professional effectiveness.⁶

Burnout should be on every clinician’s radar

Burnout is an occupational hazard for all professions, especially for health-care providers, due to the high levels of emotional support these jobs demand.¹ There’s often a desire to prioritize our patients’ needs to the detriment of our own.

As care professionals, we need to learn the signs of burnout to protect our health. Over 55% of workers in a 2019 survey experienced burnout, while a 2018 study of Twitter posts revealed that mental health is viewed as an inconsequential problem.⁷ This alarming trend suggests that professionals may be ashamed to admit they’re struggling with mental illness, despite its prevalence.

Direct and indirect costs of chronic stress and burnout are a serious concern for our industry.⁷ They affect us through employee turnover resulting in more employee vacancies, more hiring costs such as background checks, increased personality testing, and training programs.⁷

Burnout also takes a toll on our bodies and psyches. It is a predictor of type 2 diabetes and is connected to increased levels of headaches, musculoskeletal disorders, gastrointestinal issues, and mortality before the age of 45.² Psychologically, burnout is linked to increased levels of insomnia, depressive symptoms, and hospitalization for mental health issues.² Burnout affects our mental and physical health in ways that impact our careers and affect relationships with clients and team members.

Chronic stress changes our DNA

Research states that there are three common dimensions to burnout: exhaustion, cynicism, and inefficacy.¹ Exhaustion is indicated by feeling depleted of energy.¹ Cynicism is characterized by antipathetic feelings toward clients and a tendency toward isolation.¹ Inefficacy is marked by diminished productivity, demoralization, and inability to cope.¹

Beyond exhaustion, burnout damages its victims on a deeper level. Recent research by Professor Elissa Epel, PhD, suggests that chronic stress negatively affects our DNA by reducing the length of telomeres, which affect cellular aging, and increases our risk for heart disease, diabetes, and cancer.⁸

Other studies show that repeated exposure to chronic stress hormones initiates alterations in DNA in the brains of mice, leading to changes in gene expression.⁹ Epigenetic marks can appear in the DNA of individuals who experience chronic stress, possibly to catalyze a more intense response to yield a greater chance of survival when facing danger.⁹

Burnout and overall mental health

Some burnout symptoms coincide with symptoms of depression, such as apathy, depressed mood, exhaustion, weakened concentration, feelings of emptiness and insignificance, sleep issues, and suicidal thoughts.¹⁰ Emotional exhaustion, a core aspect of burnout, is also positively correlated with depressive symptoms.¹⁰ Occupational stress and burnout are also risk factors for anxiety.¹⁰ In a 2012 study, subjects who described high social anxiety levels also described increased burnout levels.¹⁰ Another study in 2012 revealed that highly demanding jobs and overcommitment were connected to greater levels of anxiety.¹⁰

Signs and symptoms

It’s time that we in the dental industry took burnout seriously. We can guard against this condition through early identification of common signs such as extreme fatigue, headache, muscle pain, weakened immunity, apathy, a desire to isolate, or the desire to cope by indulging in drugs, alcohol, or food.¹¹ Other typical symptoms include:¹¹

• Exhaustion
• Alterations in appetite or sleep patterns
• Feelings of emptiness, helplessness, meaninglessness
• Feelings of failure and self-criticism
• Cynicism and negativity
• Irritability

These warning signs might feel like nothing serious, but when they consistently show up in your life, it’s time to pay attention. If you’re struggling to discern whether you are experiencing burnout, ask yourself the following questions:¹²

• Are you frequently negative, cynical, or critical at work?
• Do you have a hard time waking up and getting to work?
• Are you easily irritated with clients or coworkers?
• Do you have gastrointestinal issues or headaches that have no obvious source?
• Is your energy level so low that you can’t complete tasks?

If your answer to any of the above questions is “yes,” you might be suffering from burnout and should consult a therapist or doctor to better understand the condition and how to treat it.

How to cope

In our fight against burnout, it helps to have strategies to prevent or diminish its damaging effects. Fortunately, if you realize you’re struggling before it becomes life-threatening, there are simple tactics you can build into your routine to lessen the symptoms and heal yourself.

Practices that can make us more resilient to stress vary for each individual, but they include discussing your situation with a therapist or loved one, removing toxic relationships and work environments from your life, transforming your perception of work, finding a better work-life balance, taking frequent technology breaks, and enjoying relaxing activities such as yoga or meditation.¹¹

The Cleveland Clinic says that one effective way to handle occupational stress and burnout is by employing the “demand-control-support” tactic. This tool focuses on lowering the demands of work, making support available, and giving the worker greater control.¹³ By diminishing burdens, encouraging acceptance of help, and reframing perceptions, chronic stress can be alleviated.¹³

Burnout during the pandemic

As the entire world is learning a new way of life due to the pandemic, a new type of burnout has emerged. New anxieties about coming into contact with COVID-19 and ensuring our loved ones are safe may weigh heavily in our thoughts.

Through social media, we are bombarded with streams of information delivering the message that we should be hyperproductive.¹⁴ Experts believe that the present situation has created “decision fatigue” as stress has increased and access to coping methods has decreased.¹⁴

Pandemic-induced burnout makes sense in the face of heightened anxiety, but we need to remember to seek out stress-relieving activities such as spending time in nature or indulging in a new podcast.¹⁴ Unfortunately, many of us can’t take a vacation, but we can work with what we have and recognize that by this time next year we will be more resilient.¹⁴

Where we stand

As dental professionals, we must not miss the fundamental importance of caring for ourselves so that we can take care of our communities. Through vigilant early identification and proactive strategies to reduce stress, we can prevent the damaging effects of burnout on our communities, our bodies, and our minds.

If you’re looking for further guidance on how to help avoid burnout in clinical dental hygiene, I recommend checking out The Ultimate Guide for Dental Hygienist Burnout by Kari Carter-Cherelus, RDH, DA. 

REFERENCES

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