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‘Are you fed-up with dentistry or is it something else?”
I asked. The question was to a colleague who was seeking some career advice. A thoughtful pause followed. “It’s the practice – it is a bit shambolic” came the reply.
My question was for clarification, but it also draws attention to a bias that occurs when we attribute our feelings to the wrong source. It makes me wonder how many dentists say that they no longer enjoy their dentistry when what they really mean is: “I no longer enjoy my dentistry in my place of work…”
My conversation was with a dentist who had been on my vocational training scheme many years ago. She described her practice as having a high staff turnover, faulty equipment – a triple syringe that could not provide dry air, poorly stocked, little respect for patients and inefficiently organised. Her pleas for help, via email, to her absent principal went unanswered.
Dentistry is difficult enough without these avoidable challenges.
Many dentists choose their practice after visiting, meeting with the manager or principal, and sometimes, what is said about the practice may be very different to what is experienced once a dentist starts working. This creates a type of ‘description-experience gap’. It arises when there is a difference between the information given and the reality. At a time when recruitment is challenging, exaggerated claims about the practice, its potential, and opportunity only widen the gap.
Members often seek advice if they are unhappy with specific aspects of their working environment, especially when if they feel that we they observe creates collateral. Examples include but are not limited to patient safety concerns (infection control breaches for example), ethical concerns, so-called gaming or, as in a very recent case, suspected fraudulent claims to help achieve targets.
Many of these concerns can be addressed with a little effort. Ethical concerns, however, are more challenging because they may be deliberately overlooked by business owners, who turn a blind eye to certain behaviours. The owner’s perception is biased by self-interest. It is an example of motivated blindness – a psychological phenomenon where people fail to notice unethical behaviour when it is in their interest not to do so.
When unethical or questionable practices are ignored, it creates moral tension for those who do notice. Over time, this tension breeds ethical dissonance - a discomfort between one’s internal values and the reality of the workplace. This dissonance is a powerful driver of job dissatisfaction.
Other reasons for dissatisfaction include:
Inefficient working methods
Poor stock control
High staff turnover
Pressure to meet unrealistic targets
No opportunity for career progression
Career stagnation
Inability to apply advanced skills
General job dissatisfaction
Patient-related factors
Pay-related issues
These are among the major stressors in dentistry. They are connected and cumulative and impact wellbeing. They also increase operational risk when viewed through a human factors’ lens.
Meaningful work is not defined by status or pay, but by the extent to which it aligns with a person’s values. It is about what the work is and how a person experiences it.
In his book, Outliers, Malcom Gladwell outlines three criteria for meaningful work.
Complexity: Mastering new skills
Autonomy: Having control over work and decision-making processes can enhance a dentist's intrinsic motivation
A connection between effort and reward: The return is proportionate to the effort. Rewards can be financial or non-financial such as recognition, job satisfaction, opportunities for growth, and a positive work environment.
The effort-reward ratio is based on their personal expectations, practice culture, and comparisons to peers. Effort-reward imbalance results when the effort exerted does not correspond with the rewards – whether measured in terms of financial remuneration, professional recognition, or job satisfaction. It is the discord that then leads to stress and burnout.
Studies confirm that there is a negative correlation between effort-reward imbalance and self-rated health, while job satisfaction and work engagement had a significant positive correlation with self-rated health.1
When it comes to dentistry, we can add meaningful connection to the list. This connection – with patients and peers – is achieved one’s efforts are recognised, valued, and make a tangible difference. It is about internal motivation. Easily overlooked in world increasingly driven by external rewards, internal motivation is about mastery, personal fulfilment, and professional development. When dentists discover meaning in their work, they are more likely to be happy in their work.
Extrinsic motivation also important when it comes to job satisfaction. It includes financial rewards, recognition, opportunities for career development. Both types of motivation are complementary and contribute to job satisfaction.2 Practices that offer a balance of internal and external motivators are happier work environments.
Dentistry is a profession of purpose. Well-managed, organised, ethical practices have much to offer and will retain team members. The service profit chain applies – employee satisfaction directly influences patient satisfaction, which in turn drives patient loyalty and business profitability.3
Disillusionment with the profession is complex and multi-factorial. This is distinct from dissatisfaction with the working environment. Conflating the two is an example of misattribution and may lead to disproportionate actions. At one extreme, it can plant thoughts of leaving dentistry, but the other end of the continuum offers a more appropriate response – changing places.
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