6 Bolsters Against Burnout by Dr. Jarod Johnson

Pediatric dentist Dr. Jarod Johnson shares his mental health journey and discusses areas of the workplace where his fellow dentists can focus their energy to make changes that benefit themselves and their practice.

by Dr. Jarod Johnson

My struggles started during the peak of the pandemic, when new demands were placed on all of us in our work and home lives. New regulations, uncertainty and infection control protocols (just to name a few of many) affected me. Eventually, I became absent at home. At my lowest point, I broke down crying in my office. I realized I needed help. I am so grateful I did, and I was able to begin my wellness journey. 

That journey started by seeing a psychiatrist, who recommended medications and therapy. The psychiatrist routinely adjusted my medication’s dosage to determine the effective level, and while I don’t see a therapist as often as I did during the months when I struggled most, it was beneficial to help compartmentalize things going on in my life. 

 One story I told my therapist was when a patient yelled at me and my receptionist in front of a waiting room full of adults and children. By telling the therapist this story, he was able to help me understand that the behavior of that individual was not normal—that they likely had their mental health challenges as well.

 The therapist also recommended other changes in my life that relate to well-being. Exercise, spirituality and meditation are three that positively impacted my life. I’ve even been able to implement exercising over the lunch hour. I also found a church and frequently use the Headspace app for meditation and sleepcasts (a kind of sleep content that uses sound and visualization to create the ideal conditions for healthy, restful sleep). Through medication and therapy, I was able to improve my well-being and get back on track.

 Understanding mental health is essential for dentists. Mental illnesses exist on a spectrum from mild to severe, and they are diagnosable and treatable. Each one of us experiences varying states of mental health, ranging from good to poor and everything in between, which can change at different stages of life. Good mental health isn't guaranteed by the absence of illness, just as having an illness doesn't equate to poor mental health. 

 Checking in on myself and where I am in my state of well-being has been important to help me recognize when improvements need to be made. I have been diagnosed with depression and anxiety. In the beginning phase of my treatment, my state of mental health was poor. I started a selective serotonin reuptake inhibiting (SSRI) medication and a beta-blocker, and was able to move from a poor state of mental health to a moderate one. By making further changes to my lifestyle, I have stopped taking the SSRI and am now in a good state.

 By slowly making positive changes in my life, I moved toward a more positive state of well-being. Once I was taking better care of myself, I was able to start taking better care of my practice.

Resources

The most recent (2021) ADA Dentist Well-Being Survey Report indicates that cases of anxiety have more than tripled since its 2003 report. In addition, anxiety and depression continue to rank high among the most common conditions dentists experience.

In April 2023, I was selected as a participant in the Mayo Clinic Well-Being Index (WBI). The WBI is a web-based, nine-item monthly survey with other instruments that measure quality of life, fatigue, burnout, suicidal ideation, dental error and intent to leave a job. After one assessment, I discovered I had scored below average in some areas and one in particular stood out—the risk for burnout.

The WBI assessments have since helped me maintain my wellness by providing valuable insights into my status as a health care professional even when I’m not actively struggling with my mental health. After recognizing my higher risk for burnout, I knew I didn’t want to slip back into a state where I wasn’t well. 

I looked for resources to improve my situation. Looking at the professional wellness resources from the American Academy of Pediatric Dentistry and the ADA, I stumbled upon the FDI World Dental Federation Toolkit, which breaks down well-being and provides resources for individuals, businesses and organizations.

The individual level is different for everyone, because we all have a different lived experience. For me, a combination of therapy, medication and other changes has worked so far. Once I had a handle on my mental health, I was able to work on making organization-level changes so my professional life didn’t create a higher risk of burnout. 

At an organizational level, The FDI toolkit breaks down the workplace into six different areas: demands, control, support, relationship, roles and change. Here’s a breakdown of those areas and examples I implemented in my office that I hope benefit others. 

Demands 

Addressing the demands of the dental practice can make a considerable impact on the well-being of the practitioners and dental team. Appointments that are overbooked or planned at the wrong time can cause a considerable amount of stress on providers and team members. Not having enough time to complete procedures or having too many difficult patients or procedures scheduled at the same time can be unhealthy if done regularly. 

I recommend creating an “ideal” schedule with block-outs for certain procedures at a time that is appropriate for the provider. These block-outs will vary from provider to provider and office to office. Each office must understand the demands and needs of each type of procedure and appointment to determine the appropriate block-outs for the organization. 

Two block-outs I use at my office are for new patients and limited exams. A block-out for a new patient makes them feel like they don’t have too long of a wait to be seen and keeps our office competitive to get new patients in the door. Limited exams for me are best seen when I can appropriately have time to diagnose and perform the necessary treatment to address the patient’s chief complaint. Seeing a limited exam in the hour right before lunch or right before the office closes doesn’t leave a lot of time to accomplish what we need to do for the patient; thus, we schedule them earlier in the day, when our team has time to adequately care for the patient. 

I’ve also found it helpful to have existing patients do virtual consultations; this allows me to tell my dental team the exact best time to see that patient, which reduces stress on the team’s workload.

The working environment of a dental team is important. Adequate access to personal protective equipment, a comfortable room temperature, natural light and support for a healthy lifestyle all can play an important role in a dental workplace.
 

Control 

Control is one area that varies by employment situation. Dentists working in solo practices may have more control than those working in a large group practice or dental service organization. Dentists and team members need to help identify areas of concern in workload, patterns and the working environment to see if they can be improved to reduce the chances of burnout. Failing to address issues long term could be unhealthy and lead to increased stress and the likelihood of providers searching for other opportunities outside of the business. 

 One method I use to empower my team to have control over our office is having biweekly meetings to work on our challenges and re-evaluate our systems. It is a safe space where all ideas are welcome, and we can continue to come up with solutions. By focusing throughout the year as a group, we ensure a positive control on our systems.

Support within an organization can come in many ways. It can be something as simple as having enough instruments, materials and operatories for the office to run smoothly. Not having adequate resources in these areas can cause the dental team to run behind, which delays care and causes increased stress on the dental team. Teams should also encourage each other and celebrate achievements and accomplishments. In addition to direct positive feedback to an individual, teams can also provide recognition at a morning huddle or at team meetings. 

Adequate training should be provided for dentists and dental team members. This can be done through in-office training, developing standard operating procedures, and continuing education opportunities for team members and providers. Having adequate training will help reduce the stress of performing certain tasks or procedures and give everyone an overall better sense of control. 

Support

One area that has made an impact in my life is having peer support. I work as a solo practitioner in a rural community and often I find myself undergoing stressful situations. It has been helpful to have a colleague to call and discuss issues that come up in my daily practice. I usually find that my peers have experienced a similar situation and can provide support and practical advice. 

 For example, I encountered a case where a parent preferred a holistic approach to dentistry and their child was extremely uncooperative, needed many pulpotomies, only wanted white, and did not want crowns or any type of sedation. She demanded that I do the work because I was the only provider she could find who would take their insurance. 

 I later discussed the situation with my colleague, and he helped me understand that it is OK to walk away from a situation if I don’t feel comfortable meeting expectations. There will likely be another dentist who will be able to take on the case. 

 Support comes in many forms, whether it’s a single colleague you trust and speak with about the daily troubles of practice, or online communities like Dentaltown. 

Relationships 

Team relationships are the cornerstone of a healthy work culture. The principles of a positive working environment and open communication cannot be stressed enough. In such an environment, team members can feel valued and supported. Open communication is pivotal because it encourages transparency, trust and the free exchange of ideas. This foundation allows for the cultivation of a learning culture instead of a blame culture, where mistakes are not met with reprimand but instead seen as opportunities for improvement. By prioritizing learning and development, dental teams can navigate challenges more effectively. 

I look to my whole team to provide feedback and make improvements in our systems and patient care. In a recent situation, we were trying to address challenges with the length of time patients would have to wait until they were scheduled for operative treatment. We asked the team to brainstorm ideas, and we put all the ideas up—even though we knew some of them would get vetoed by me. We were open that it was a possible solution to the problem and accepted that in our communication. Collectively, we also were able to come to an agreement and everyone was on the same page. 

Roles

Defining roles within a dental office is crucial for ensuring smooth operations and the delivery of patient care. When each team member has a clear understanding of their responsibilities and duties, it can minimize confusion and enhance efficiency. 

In my office, there are defined roles that help provide a sense of accountability because team members know exactly what is expected of them. The definition of roles also facilitates better communication and collaboration among team members, because everyone knows their responsibilities and where to get and provide feedback. 

When roles are well-defined, it improves the workflow of a dental office and contributes to a more positive and productive working environment. Each team member should be cross-trained to a practical extent. In my office, we have even divided up some of our systems to be managed by a team member. This ensures they understand their role and creates accountability throughout each area of the office. 

Change

Changes can be hard for dental offices to make. The first step is having open communication with the team to understand the challenges the office and team members face. If the team understands the problem and openly discusses solutions, then changes can be made in a collaborative effort. When this is done, team members will be more likely to adapt to the solution.

Sometimes changes are made and they don’t work out. Teams need to constantly evaluate outcomes from the changes that are made and adapt when opportunities for improvement present themselves. 

Conclusion

Frequently checking in on your well-being and your peers is extremely important to your wellness journey. Dentistry is a tough and challenging profession but is also a rewarding profession. By recognizing the areas in our life that affect our mental health, we can make positive changes and be more in control. 

I share my story because I know others may be struggling or in a poor state of mental health and want help. I know from my experience there is hope.

Dr. Jarod Johnson earned a bachelor’s degree in biomedical engineering from the University of Iowa in 2009 and his DDS from the same school in 2013. He earned a certificate in pediatric dentistry from the University of Nevada, Las Vegas School of Dental Medicine. Johnson, a fellow of the American Board of Pediatric Dentistry, is in private practice in Muscatine, Iowa, and provides pediatric dental education monthly through Pediatric Dental Seminars.