Burned out boss

By Dianne Glasscoe Waterson, RDH, BS, MBA

Dear Dianne,
I have been in my current practice for 15 years, but I have noticed some disturbing changes in the doctor over the past two years. It's pretty clear to my coworker and I that he does not want to be at work. In fact, he's told us that he wishes he could get out of dentistry, that he does not enjoy it anymore. He comes into work late every day; most children are referred to the pediatric dentist down the street; he tells most patients that come in with a broken tooth that it needs to be extracted. But he stopped doing extractions two years ago, so they all get referred too.

We are a small practice with just one assistant and me (hygienist). The doctor is in his early 60s, but he tells us that he can't retire yet. Yet, it seems like he looks for ways to get out of working. Over the past year, I have worked a total of 60 days with no doctor in the practice. My schedule stays pretty full, but his schedule has openings every day.

Needless to say, I'm worried about my job security. We have a loyal, established patient base, and many of the patients feel like family to me. There are so many things I love about being here, such as how close the office is to my home, my coworker, and the wonderful patients. Yet I feel like I'm on the Titanic, and I don't want to be a casualty! Do you have any suggestions on how my coworker and I can help our boss?
Needing a Life Boat in Oregon

Dear Needing,
Your boss's behavior is suggestive of professional burnout. Dr. David Ballard, head of the American Psychological Association's Healthy Workplace Program, describes burnout as "an extended period of time when someone experiences exhaustion and a lack of interest in things, resulting in a decline in job performance."

What causes people to burn out in jobs that formerly gave them great personal satisfaction? What causes people to lose passion for their work?

According to a Mayo Clinic article on job burnout, there are several causes listed, with the first one being lack of control (http://www.mayoclinic.org/burnout/ART-20046642). It is my personal observation that many dentists today feel as if they are losing control of their practices due in large part to the influence of managed care. Many have watched their overhead continue to rise while profits have shrunk. Economic forces in our country, in which we have no control, have impacted many dental practices negatively. Just think how you would feel if you owned a business that for many years provided a good income but now was showing signs of decline due to economic forces beyond your control. The business owner with passion for his work will expend time, effort, and money to turn the practice around and get it on a path of growth again, while a burned out owner will sit by and literally allow the practice to sink.

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• Legal Questions About Employment
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Another important source of burnout is unclear/unrealistic job expectations. I believe many dentists went into dentistry expecting to generate exceptional wealth, and that is true for some. However, there are a significant number of dentists finding that it is harder and harder to service all their debt and take care of their families according to their expectations.

You may find this hard to believe, but I've worked with dentists that had no take-home pay after all the bills were paid. I have worked with dentists in a consulting capacity that were in deep financial trouble, and, believe me, financial stress can cause burnout. The expectation was that the becoming a dentist would bring financial prosperity, which is not the case for some.

Some doctors are very poor money managers, and they build up insurmountable debt through unwise choices and buying more than they can afford. When you mentioned that your boss said he could not retire, I assume he has not planned for his retirement through wise investing/saving and possibly has too much debt. He may have been one of the thousands that lost their retirement savings when the economic bubble burst in 2002.

Other causes for professional burnout include:

• Dysfunctional workplace dynamics. Some doctors allow the workplace to become toxic by dealing ineffectively with staff members that promote disharmony among the group. Micromanaging by the doctor can also cause the workplace to become dysfunctional.
• Mismatch in values. If the doctor feels he is forced to compromise his values to make a living, burnout is the result.
• Poor job fit. Unfortunately, some dentists would rather be doing just about anything than dentistry.
• Extremes of activity. Overwork or not being busy enough can both cause burnout.
• Lack of social support. Dentists can feel isolated and often lack a support system when problems arise.
• Work-life imbalance. When people expend so much energy into their work that they really have nothing left for their families, burnout can occur.

One aspect of your post was particularly disturbing. You stated you had worked at least 60 days with no doctor in the practice, which means that no restorative dentistry was being done on those days. While I am happy for the general supervision rules that exist in most states today which allow the hygienist to work (under certain restrictions) with no dentist physically onsite, this many days without a doctor is excessive. Outside some serious physical illness or injury, no dentist should be taking 15 extra weeks off from work. From a financial standpoint, it would be nearly impossible to sustain a dental practice with preventive care alone.

I can only speculate about what has caused your boss to become burned out. Until he seeks professional help, I expect the practice will continue to decline. You must take care of yourself. I suggest you don't go down with the ship, but rather start looking for other employment right away. Please do not delay, as you do not know how much time is left.
All the best,
Dianne

Anyone can experience burnout.

The Mayo Clinic lists some questions that can help individuals assess whether or not they are experiencing burnout. Here are the questions:

• Have you become cynical or critical at work?
• Do you drag yourself to work and have trouble getting started once you arrive?
• Have you become irritable or impatient with co-workers, customers, or clients?
• Do you lack the energy to be consistently productive?
• Do you lack satisfaction from your achievements?
• Do you feel disillusioned about your job?
• Are you using food, drugs or alcohol to feel better or to simply not feel?
• Have your sleep habits or appetite changed?
• Are you troubled by unexplained headaches, backaches or other physical complaints?

If you answered yes to any of these questions, you may be experiencing job burnout. However, please understand that some of these symptoms can also indicate certain health conditions, such as a thyroid disorder or depression. A medical evaluation may be in order. Also, it is advisable to seek counsel from a trusted friend, mentor, or advisor. It may be that discussing the situation might help clarify what is needed to reduce job stress and alleviate the resulting burnout.

DIANNE GLASSCOE WATTERSON, RDH, BS, MBA, is a professional speaker, writer, and consultant to dental practices across the United States. Dianne's new book, "The Consummate Dental Hygienist: Solutions for Challenging Workplace Issues," is now available on her website. To contact her for speaking or consulting, call (301) 874-5240 or email dglass [email protected]. Visit her website at www.professionaldentalmgmt.com.