Don’t Shut Down—Reboot by Dr. Norman C. Culver

Feeling burned out? The problem might not be dentistry but how you practice it. These changes can help.

by Dr. Norman C. Culver

Dislike dentistry? I did once, and I wanted to quit. I had enjoyed dental practice, but it became mere work and production. What little enjoyment remained was overpowered by business turmoil.

To ease my discontent, I tackled a difficult diversion: a 1½-month voyage in a small sailboat around remote Vancouver Island, where I confronted blinding fog, dangerous coastal rocks and continual mechanical breakdowns. And I forgot dentistry.

The diversion and solitude freed my mind and gave me the opportunity to consider my innermost yearnings. As I traveled, I wrote down my thoughts, because writing defines thoughts and clarifies objectives.

For example, I’ve always enjoyed handicrafts. Why couldn’t I approach dentistry the way a wood craftsman enjoys his creative works? In fact, dentists have skills no other craftsman has: They can cut dense calcifications in sharp detail and restore them to last for years. And they can do all that through an opening the size of a knothole. Wouldn’t it be a shame to give all that up? And why would a new career be any better?

I put aside thoughts of quitting. Instead, I vowed to make dentistry enjoyable again. And here’s how I did it.

1. Find a better office.
After a decade in an old, cramped, 750-square-foot office, I moved to a modern, 1,650-square-foot office, designed the way I wanted it. This not only increased our income growth rate by three times but, more surprisingly, I was also far less tired at the end of each day. It was the best single step I’ve taken since beginning practice.

2. Cut stress.
Stress has two requirements: an outside cause and a receptive host. When I was feeling stressed, I closed the operatory door and allowed no interruptions, isolating me, an assistant and the patient in the cubicle.

For me, associates caused stress; the longer they were with me, the more they wanted (and what they wanted was mine). After a day of listening to complaints about which chairs they wanted, and how one of my dental assistants had offended one of theirs, and how I was making so much money from them, I came home exhausted. After that, I didn’t take another associate until I needed one for taking over my practice when I was phasing out.

3. Stick with teeth, rather than business.
I gave my staff greater responsibilities, and myself fewer. With each of their added responsibilities, an invisible weight was lifted from my shoulders. They told me which patients to see next and what I was to do on them, while I might have been sitting in my private office with coffee. My receptionist became my business manager and handled staff supervision. Instead of me being the SOB, she was.

Our staff of seven may have been too many for our practice, but it made my work easier. To me, percentage overhead means less than how hard you work for your net. If you’re not overworked for say $250,000 net, does it matter if your overhead is 50 percent or 75 percent?

4. Stay on schedule without feeling rushed.
High production equals high stress. I scheduled 20 percent more time for all procedures, which allowed me to stay on schedule and produce at a comfortable level without feeling rushed. I also shifted my weight to the backrest and let my shoulders settle.

5. Increase production without stress.
I aimed to make my movements count and I timed myself with procedures I felt slow with—and that time decreased. My auxiliaries injected anesthetic, packed retraction cord, held and removed impressions, made and placed temporaries, and did other expanded duties.

6. Increase income.
I raised my fees as much as possible. Though I lost some patients by doing this, it was worth it and the bulk of the patients remaining must have thought the work was worth it.

7. Improve staff performance.
I hired the best staff I could get, paid them well and defined their duties in writing. This effort took some time, but it made me happier.

8. Improve or eliminate difficult patients.
I set treatment conditions such that difficult patients eliminated themselves. I gave patients my recommended treatment plan, and rather than responding to all of their arguments, I simply told them that that was the only treatment I thought they should have. Yes, I lost some patients. Do you want them?

9. Improve laboratory work quality.
I hired a quality lab technician and equipped a room the way he wanted it. Though the lab work did cost more, crowns and bridges fit better and when patients saw the shades and translucencies, they smiled—and so did I.

10. Improve the quality of the dental work.
The better the quality of my dentistry, the better my day. Dentists frequently don’t enjoy their work because they produce it mechanically, like an assembly linesman, rather than carefully, like a craftsman. And quality equals 90 percent motivation and 10 percent ability.

Psychologists say the key to enjoying one’s work is an old, nearly forgotten principle: “Do your best.” Do your best not for the patient but for yourself. The patient’s “Thank you, that was a good job” is the bonus.

The reality of this old saw struck me while I was stationed at West Point, where I spent half of my time replacing relatively new but failing restorations on cadets—some of our most fortunate young citizens from equal portions of the country who should have exhibited the best of dental care.

11. Take more time off.
I reduced my work schedule to four days a week and 10 months a year. The next year, our family took a two-month sailboat trip to the Bahamas. Work is important, but so is play. It gives you a chance to recharge, and to do a better job—for yourself and for your patients.

12. Limit your responsibility.
If a patient developed caries or periodontal disease after I had repeatedly informed him of the need for better plaque control and shown him proper brushing and flossing, I learned to feel no further responsibility. How much of the population smokes knowing it may kill them? We obsessive-compulsive dentists think our work should never fail—one reason for our high suicide rate—even if circumstances outside our control affect them.

13. Get study club help.
I didn’t do all of the above by myself; I joined a study club for help. We met regularly for critical evaluations of each other’s offices, and this rigorous review revealed what we couldn’t have known working alone. After my first such visit, I made 21 changes, including dismissing one assistant, adding operatory rugs, decreasing staff tension, keeping my armpits farther from a patient’s face, contouring gingival areas less and using fewer silver endo points.

With this new approach to practice, most of my previous problems were solved. And I enjoyed dentistry 100 percent more.