I recently spoke with the HR Director at a large national DSO and was not surprised to hear that her major concern is burnout amongst her team. Burnout levels following the pandemic had gotten so bad that on May 23, 2022, the Office of Surgeon General issued an advisory “highlighting the urgent need to address the health worker burnout crisis across the country”.1 Even before the pandemic hit, the World Health Organization (WHO) included “Burn-out” to its 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon and updated its definition to read as follows:
“Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:
- Feelings of energy depletion or exhaustion;
- Increased mental distance from one’s job, or feelings of negativity or cynicism related to one’s job; and
- Reduced professional efficacy”.2
Productivity
In my research, I have found ample evidence suggesting burnout impairs focus, attention, motivation, and problem-solving skills and leads to severe emotional and physical exhaustion, all of which drain productivity. In addition, burnout may lead to health-related issues and businesses might see an increase in absenteeism and employee turnover. Consequently, a practice fraught with burnout could experience a negative self-perpetuating cycle similar to the following:
- Revenue drops as team members are out sick more frequently, leading to less patient visits
- Team members are less engaged and motivated at work, leading to lower case acceptance rates and new patients
- Team members must take on others’ work while they are out, leading to increased cynicism and resentment among the team
- Patients pick up on the tension between team members and have a poor experience
- The practice's reputation suffers as the quality of care declines, limiting the number of new patient consultations
As entrepreneurs and leaders, dental practice owners need to be mindful of their own well-being, as well as their team’s, to ensure they are running a productive practice. Just like when the airlines encourage you to put your own oxygen mask on first, you need to take care of yourself properly so you can be the leader your team needs and provide the clinical care your patients deserve. Below are a few suggestions that can help you become reenergized and productive in the office:
- Remember your why- a byproduct of burnout is detachment and experiencing a loss of meaning in work.3 Most dentists did not go to dental school to learn how to run a business; rather, they went to school to learn the skills to care for patients. It can be easy to lose sight of your why when having to keep up with the day-to-day demands of not only being a business owner, but also a health care provider. By intentionally contemplating your why, you can reignite your passion for practicing dentistry and/or being a leader, which will hopefully lead to a more productive and enjoyable day.
- Delegation- by constantly revisiting your why, you will become more aware of the areas in your life and daily responsibilities that detract from your happiness and productivity. Remember, as a business owner, you have the power to structure your business however you want. If there are items that drain your energy, find someone that enjoys doing that type of work and empower them to do it well.
- Take control of your day by owning your calendar - If you don’t take control of your own schedule, someone else likely will. A common factor leading to burnout is feeling a loss of control,4 so be mindful of how you structure your day and do not compromise. Furthermore, consider timing certain events to occur at specific times of the day to optimize the results. For example, in my reviews, I found a plethora of research that encourages making key decisions early in the day while you have the brain power to make good decisions; decision fatigue is a real thing! In addition, timing your exercise and meals can give you the energy needed to power through your day. Finally, you must prioritize getting proper sleep to stay healthy and function at a high level.
Don’t forget about your team; they also need to prioritize self-care and are looking to you as the leader to empower them to do so. Remember that what works for you may not work for others, so be empathetic to the needs of your team members and be patient as you work together as a team to strike the right balance as a group.
As a CERTIFIED FINANCIAL PLANNERTM working with dentists, I understand the positive impact running a profitable practice can have on the well-being of dentists, their families, and team members. As your practice becomes more profitable and cash flow improves, you will have opportunities to reinvest in your team’s well-being, reverse the self-perpetuating cycle of burnout, and increase the overall value of your business. As burnout declines, likely, morale amongst the team will improve, patient care will improve, and the virtuous cycle will fuel itself forward.
Discretionary Income and Spending
Another hidden cost of burnout relates to personal disposable income and expenses. Specifically, individuals coping with burnout could see their income drop over time. As health declines, people will be out sick more frequently and need to see the doctor more often, resulting in higher medical bills. For both dentists and team members, less time in the chair means less money. Furthermore, those participating in an incentive compensation plan may receive lower bonuses because they have grown disconnected from their work, resulting in lackluster performance.
In addition to making less money and spending more on medical bills, burnout can also impair judgment leading to poor spending decisions. When someone is overworked, underappreciated, and exhausted, they can justify spending more money on themselves. Whether it is out of convenience, like paying more for food delivery services, or large splurges to treat oneself for their hard work, burnout can impair your impulse control and willpower.5 When exhausted after a long day, people don’t have the energy to diligently monitor their finances and are prone to impulsive purchases.
Bad investment Decisions
People experiencing chronic stress will likely find it more challenging to properly analyze potential outcomes, which is paramount to a successful investment strategy.6 In response to a stressor, the nervous system triggers a “fight or flight” reaction in the body, which prompts people to eliminate the threat and seek safety at all costs. The “fight or flight” response is hard-wired in our brains as a survival mechanism and happens automatically. In the event of life or death, there is no time to think through all aspects of the situation or to contemplate various possible outcomes. Though what we perceive as a “threat” has evolved, our brains still behave the same way today when we feel threatened. When someone is experiencing burnout, the “persistent overhang of stress results in chronic exposure to elevated levels of cortisol- and permanently higher levels of cortisol in our bloodstream is a very bad thing. Similar to acute cortisol exposure, it reduces the quality of our judgment and our ability to assess objective probabilities”.7 From my experience working with investors during the 2008 Financial Crisis, and the 2020 and 2022 bear markets, I have witnessed impulsive fear-driven reactions first-hand. Despite all the research that promotes staying the course and discouraging “panic-selling”, investors give in to their emotions when things are uncertain in the financial markets and economy.
In my experience, an effective method to prevent “panic-selling” is implementing a rules-based, disciplined approach to managing a portfolio. For example, automate your savings so you continue investing during both good and bad times. Counterintuitively, investing during a bear market is suitable for long-term investors because assets are acquired at discounted prices. Furthermore, consider rebalancing your portfolio using pre-defined thresholds or at periodic intervals. The key is to stick with whatever game plan you develop and to remain disciplined. Lastly, consider hiring an objective third-party fiduciary to oversee your investment strategy on your behalf.
Fortunately, people can recover from burnout and regain their motivation, focus, productivity, and health. Much of the research relating to burnout focuses on health and well-being, as it should; however, the financial ramifications can be devastating as well. If you or anyone on your team experience symptoms of burnout, consider seeking help from a professional or contact the ADA or state dental society to inquire about available programs in your area.
- https://www.hhs.gov/about/news/2022/05/23/new-surgeon-general-advisory-sounds-alarm-on-health-worker-burnout-and-resignation.html
- https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases
- https://www.ncbi.nlm.nih.gov/books/NBK279286/
- https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/burnout/art-20046642#:~:text=Job%20burnout%20can%20result%20from,need%20to%20do%20your%20work
- https://www.cnbc.com/2022/07/25/cognitive-depletion-how-burnout-can-affect-your-shopping-habits.html
- https://www.cnbc.com/2018/11/19/stress-brain-can-lead-to-you-making-some-bad-financial-decisions.html
- https://www.institutionalinvestor.com/article/b1mjs9g9947v19/Stress-Is-Bad-for-Investing-So-What-Do-You-Do-When-There-s-No-End-in-Sight#:~:text=Stress%20increases%20our%20reliance%20on,we%20should%20be%20most%20circumspect
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