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D. A. Denton, J. T. Newton, E. J. Bower British Dental Journal 2008; 205: E13

Editor's summary

Being a dentist can be intrinsically stressful, and also very rewarding, as any dentist knows. The changes to NHS dentistry over the past two years and the well documented fee-per-item treadmill prior to the new contract have made anecdotal reports of the severe work pressures experienced by UK general dental practitioners, particularly those providing NHS dentistry, commonplace. This study investigating just such pressures is therefore timely and relevant.

The research looks at two different but related concepts, occupational burnout and work engagement. The first is associated with a persistent negative work-related state of mind and the second with a positive and fulfilled work-related mindset. Reassuringly, 83% of the respondents to the survey had scores indicating moderate or high levels of work engagement. However, the results also showed that a small but significant proportion of the dentists surveyed had scores that indicated burnout on all three of the scales used to measure this construct, and a further 18.5% showed burnout on two of the three scales. In line with the anecdotal reports mentioned previously, dentists who spent a greater proportion of their time in NHS practice were more likely to have high burnout scores and low work engagement scores. Interestingly this was also the case for dentists with no postgraduate qualifications and those working in small teams.

As the authors state in their answers to our questions (right), this study provides a baseline assessment of burnout and work engagement levels in UK dentists. It will be interesting to see if any future follow-up studies show changes in the levels of burnout and the dentists who are most likely to experience it, and the work provides a starting point for further research into the characteristics of dentists who experience burnout. While the numbers experiencing burnout appear to be mercifully small, the fact that NHS dentists seem to be more prone to this condition is a cause for concern. It is small comfort to know that in this case, the anecdotes were correct.

The full paper can be accessed from the BDJ website ( http://www.bdj.co.uk ), under 'Research' in the table of contents for Volume 205 issue 7.

Rowena Milan, Journal Editor

Author questions and answers

1. Why did you undertake this research?

The practice of dentistry in the United Kingdom has undergone rapid change in recent times. While the changes in the system of remuneration for NHS practice have received a great deal of attention, other changes have included the increasing involvement of groups such as the dental body corporates, a perceived influx of dentists from the European Community and the compulsory registration of dental care professionals with an accompanying expansion of their roles. We were interested in identifying the impact of this rapid process of change on the working experience of dentists.

2. What would you like to do next in this area to follow on from this work?

The research described here provides a baseline assessment of levels of burnout and work engagement amongst dentists in the United Kingdom. We would like to conduct a follow-up survey in a few years time to identify any changes in these important aspects of the work experience of dentists. In addition, we have argued elsewhere that there is a need for more research to identify mechanisms of effective intervention for the small but significant group of dentists who are experiencing burn out. We would also be interested in exploring in more detail the characteristics and working practices of those who find dentistry a fulfilling and engaging career.

Comment

The fact that dentistry is a tough profession, demanding much of the dentist's emotional and physical condition, is well-recognised. It is not without reason that throughout the last decades a series of reports have been published highlighting aspects of the dental work environment that are considered major contributors to dentists' experienced work stress. Among these aspects are working under time pressure, difficult patient encounters and several difficult or annoying aspects of practice management. Work stressors such as these, but also factors such as lack of career perspective, are major determinants for professional burnout among dentists.

On the other hand, it is also well understood that many dentists enjoy what they are doing and have a warm feeling for their profession. They feel their work contains many stimulating, resourcing aspects. Being a dentist gives them energy and these dentists care about the results of their work and feel positively engaged with their work.

In their representative research among UK dentists, Denton, Newton and Bower have provided us with an indication of the percentage of (active) dentists at serious burnout risk (about 8%), and have shown that the large majority of dentists feels positively engaged. So far, only Finnish and Dutch studies were available in which burnout and engagement were measured among dentists. The present study therefore serves as an important reference point for future studies on this topic.

It is considered highly important to regularly monitor wellbeing at work, both among dentists and among dental staff. Drop out of workforce, caused by chronic demotivation, may well be reduced by timely preventive attention. Recognition of demanding work aspects and paying attention to stimulating work aspects may help the individual dentist create a more satisfying work environment. Furthermore, by creating a variety of measures to pay attention to work stress and burnout risk – such as intervision groups, personal feedback by internet, etc – dental associations could contribute to keeping the work force mentally healthy. Dental schools could take a lead by implementing curriculum courses on stress coping and the pitfalls of dental practice.