ADEA CCI Liaison Ledger

With the Benefit of Hindsight, Would You Still Want to Become a Dentist?

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By Kathleen O’Loughlin, D.M.D., Executive Director and Chief Operating Officer, American Dental Association

Kathy O'Loughlin PhotoImagine you have been granted a do-over. Instead of being a 55-year-old experienced practice owner, you are 20 years old again, bright-eyed and eager to work with your hands and to care for other human beings by applying yourself in the realm of health care. You are smart—always at the top of your class. You are certain—almost—that you will be offered a spot in the dental school that your dad attended. You will, right?

But this second time around, you are wiser because you have traveled this road before. You know that dental school will be the hardest years of your life so far—especially that second year. You know that after you graduate, there is a high likelihood that you will pay down your $247,000 of dental school debt over what seems like a lifetime. You will experience feelings of insecurity, like one out of three of your colleagues who doubt their own competence. There is a one-in-five chance you will face moderate levels of depression, which may be due to stress at work. You may even feel the need to self-medicate feelings of sadness with alcohol or recreational drugs.

Knowing all this, would you still want to become a dentist?

In 2015, the American Dental Association (ADA) conducted a national survey of America’s dentists, asking them questions about their general health and well-being. Dentists reported on their levels of stress, sleep habits, satisfaction with their personal relationships, alcohol and drug use and other wellness indicators.

The survey also asked: “If you re-lived your life, would you still want to become a dentist?”

Some respondents expressed doubts, but most said, “Definitely.”

Are you surprised? I’m not.

Dentistry is an extremely rewarding and fulfilling career. Nine out of 10 dentists in private practice report feeling satisfied.

At the same time, dentists experience high levels of stress often associated with the unique demands of working in this field. Dentists treat anxious human beings who demand perfection, and they do it all day, hunched over in tiny environments. They are surgeons, but patients are never sleeping; patients are always awake, so dentists talk them through each procedure, explaining every step to make them feel comfortable. Most of the time it is exciting, but sometimes it is exhausting. 

High levels of stress in dentistry disproportionately affect younger dentists. In the survey, dentists under the age of 40 were less likely to feel in control of their work environments, scored higher on a depression scale and were at a higher risk of alcoholism compared with older dentists. This data led me to believe that either a dentist’s career becomes easier as time goes on as a result of experience, or the dentist learns to better cope with and manage stress as he or she grows older. 

The true answer is probably somewhere in the middle. But since we are aware of dentistry-related stressors, we may be able to teach students to cope with them so that they can feel reduced levels of stress throughout their careers, not just in the later years. 

This is not to say that dental schools should place a higher value on student well-being than they do on training highly competent dentists. I taught dental students for many years and believe that the rigor, competitiveness and high standards of the dental school curriculum are not merely stressors; they are also tools that help teach students to manage the stress they will face throughout their careers.

I am an advocate of meditation, of focusing on the moment, observing the mind and body and accepting what is observed. Self-compassion is important, especially in a stressful profession like dentistry. In the field of psychiatry, research has shown that mindfulness training can help patients manage stress through focused thoughts, self-awareness and acceptance of feelings that exist. It has also shown that self-care or self-soothing (without alcohol or drugs) enables the body and mind to achieve a quiet peacefulness that mitigates the harmful effects of chronic “fight or flight” adrenalin biochemistry. Many dental schools have added mindfulness training and wellness to their curricula.

The practice of dentistry and its outcomes are improved when a dentist is properly equipped to handle the emotional stressors that accompany a career in dentistry, and the entire profession is enriched by professionals who operate at their highest potential. That potential is reached when we possess an optimistic mindset that includes not only mindfulness but also sufficient physical exercise, healthy relationships, a balanced diet and, most importantly, a sense of purpose and compassion for others. 

Stress impairs a person’s ability to operate at her or his highest potential, and individuals do not always seek out the help they need, even if they know they need it. In the survey we conducted, about half of dentists said it would be difficult for them to seek professional help because they think they should be able to solve problems on their own. That perfectionist, get-your-hands-dirty problem-solving attitude that drew many of us to dentistry, also prevents us from asking for help when we need it.

My anecdotal experience teaching dental students reflects this data; as a teacher, you often are not aware there is an issue until a student appears in tears at your office door or simply, silently, stops coming to class or clinic.

Programs like the ADA’s Dentist Health and Well-Being Program aim to support dentists with the nonclinical aspects of dentistry, like prescription opioid abuse prevention, substance use and mental health support and dental practice ergonomics. The ADA’s research and support resources are available to faculty members and students.

Dentist wellness is a passion for me personally. My dad, a dentist, took his own life due to untreated depression when I was a third-year dental student. He never asked for help, and my family, including me, was in denial. When I was in my last year of dental school, I was pregnant. I was so stressed thinking that I wouldn’t graduate on time that my blood pressure was sky-high, and I wasn’t eating or sleeping well. My obstetrician asked me, “What the heck are you doing?” She said my stress level and how I was handling it could negatively affect my baby. What a wakeup call. I feel for dental students to this day because I still remember the feelings they experience of being overwhelmed—of helplessness, and of hopelessness—and the toll those feelings can take on the heart and mind. I am lucky I learned my lesson early. We cannot avoid stress and emotional distress, but we can learn to manage it in a way that benefits our families, our patients, our profession and ourselves.

Knowing all this, if I could re-live my life, would I still want to become a dentist?

Absolutely.


Dental insurance battles are a constant stressor.
This conflict will go on the entire time you practice.
Posted by: Jeff Rosen( Visit ) at 2/28/2017 6:01 PM


Very thoughtfully written. Practicing over 48 years, and still love this profession as much as my first day in practice.
Posted by: D. Milton Salzer, DDS at 3/9/2017 2:02 PM


An excellent article for dentists. I highly suggest that you take the time to read it.
Posted by: Barry Taylor, DMD at 3/15/2017 9:23 AM


On point,so sorry for your loss .....yep would do it again !
Posted by: louis bronko at 4/15/2017 10:27 AM


Good article for all dentist to read especially students. Still enjoy dentistry graduated in 1969. Volunteering in community dental clinic since 2003.Giving back to community should be a part of all professionals.
Posted by: Phillip Florek DDS at 4/15/2017 10:31 AM


Excellent commentary, I am in my 40th yr. of practice and still love dentistry. Every day is a challenge because every pt. Is unique! I couldn't agree more with the writers words!!
Posted by: Rick franke at 4/15/2017 11:06 AM


Thank you Dr O'Loughlin for such a great article. (Tufts D02)
Posted by: Nadia Winstead at 4/16/2017 10:41 PM


Very nicely written and thoughtful article. I am in my first year of practice ownership and balancing full time dentistry with two active kiddos. Every day is a challenge, but would choose this route again any day.
Posted by: Amy Newkirk at 4/21/2017 11:04 AM


Thank you for sharing! As a dental student, this was truly insightful!
Posted by: Jazmin Cromartie at 4/22/2017 8:28 AM


Just printed up 40 copies of this article to give to students. Thank you again!
Posted by: Barry Taylor( Visit ) at 4/26/2017 10:57 AM


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