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Stand Up and Stand Out by Jen Butler, MEd, CPC, BCC

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When it comes to stress in dentistry, orthodontists often get lumped into the crowd. General dentists’ stressors become the primary focus of articles, workshops and programs. This diminishes the importance of stress management for orthodontists and limits the number of resources this cohort has at their disposal. It sends the message that orthodontists have little stress and those stressors that are apparent aren’t as important because it only applies to these specialized individuals. It further isolates those practitioners that do have stress because they feel out of place, like they have failed in some way, and are not as competent as the rest of their colleagues in building and running a successful orthodontic practice. This is far from the truth. It’s the silence and lack of discussion around stress that creates this stigma.

Researchers have discovered many overlapping stressors between orthodontics and general dentistry. However, how these stressors are addressed and resolved vary differently in orthodontic practices then in the GP office. Also, there are a number of significant stressors that are unique to the specialization that only orthodontists can relate. It’s time to stand up and stand out. Stress exists in orthodontics. The more this is acknowledged, the more services and resources become available for those who need it. Too many orthodontists accept that life is good. As famed author Jim Collins of Good to Great says, “Good is the enemy of great.” One cannot become great when the lesser is the acceptable maximum.

Stressor #1 – The satellite office

Many orthodontists use the satellite office as a business model for diversifying their patient base, increasing the number of patient starts, and gaining revenue. What often begins as the “best practice building method available”1 ends up adding significant stress for the practitioner.2 Of orthodontists with satellite offices, 79 percent stated satellite offices increase stress levels due to higher staff numbers, time requirements and business savvy necessary to manage more than one office.2 To compile the stress, 55 percent of orthodontists who previously had satellite offices claimed those coping methods that often reduce stress were sacrificed; such as family time, hobbies, exercise and socializing.2 Almost half, 45 percent, of practitioners with a current satellite office would close one or more if possible just to reduce stress.2 And a true tell of the magnitude a satellite office has on the stress level of its owner is only 18 percent of previous satellite owners would recommend to a young orthodontist to open a satellite office of their own.2

With it becoming more and more prevalent of a business model – just 32 percent of orthodontists owned a satellite office in 2003 compared to 52 percent in 20072 – it’s important for orthodontists considering a satellite to become proactive with their stress management. For those who have satellite offices, it’s never too late to thread in behaviors that reduce stress. Enhancing your time management, planning, prioritization and delegation skills are imperative to ward off stress. Have clear policies and procedures with staff to create consistency and reliability throughout the offices. Schedule personal time and commit to it. Studies show the closer a dental practitioner works to 30 hours per week the less stress they claim.3 Schedule vacation time a year in advance. Three weeks vacation is ideal for healthy stress management.

Stress #2 – Dealing with adult patients

There have only been a few research studies conducted that took a look at the specific stressors orthodontists experienced and the frequency in which they occurred. In all three studies, working with adult patients topped the list.4-6 There are several factors that make this population more stressful for orthodontists to work with than any other group. Adults:
  • more likely to have unrealistic expectations of the outcome
  • vocalize their desire to end treatment before the ideal time
  • challenge practitioner’s management of care
  • demand more flexibility with office hours and scheduling
  • give team members a difficult time with regard to patient experience

Management of this stress trigger comes in the place of acceptance. Know that adults can and will be more demanding of their experience since they have waited so much longer to finally get treatment, are spending money on themselves and want all the value possible and have a predetermined vision of what they will look like after all is complete.4 If you cannot accept this as normal of your adult patients and they consistently trigger your stress response, consider limiting or cutting out all together how many adults you take on into your practice. Create a referral program with a colleague that enjoys working with these types of patients. Build your practice on those patients that energize you and your team. Dumping those patients you are not meant to serve gives room to accept those who you are.

Stressor #3 – Motivating patients with poor oral hygiene and/or decalcification

Creating the perfect smile with decay and decalcification is never a goal and always a concern. It’s stressful for practitioners to see patients month after month knowing they are not taking proper care of their teeth and could need restorative treatment in the future.

The number one motivator for patients to attend to their hygiene is doctor interaction.5-8 Leaving the conversation to auxiliary staff is not powerful enough for patients to change their behaviors.8 When the message is delivered from the doctor, patients head warning. Another deciding motivator is ease of access to the general dentist for hygiene checks and cleanings. Those patients who saw the hygienist more frequently during their orthodontia treatment were more inclined to be compliant than those on a regular six-month schedule. The stronger the partnership between specialist and general practitioner the more comprehensive care and commitment patients received around their oral hygiene.4

Stressor #4 – Treating patients with broken appliances

There’s a cycle that occurs which significantly impacts the stress levels of orthodontists. A patient is seen with a broken appliance which causes “time pressures” (see Stressor #5) for the entire team that then interferes with “trying to keep to a schedule” (Stressor #6) causing clinicians to “fall behind schedule” (Stressor #7). Successfully manage this one stress trigger and watch others fall into place.

Again, acknowledging the realities of an orthodontic practice and making a concrete plan supported with processes and systems is key to reducing stressors. Patients with broken appliances are going to happen. You’re dealing with people and imperfect equipment. In order to realistically move forward and plan for patients with broken appliances you must first start with facts. Determine how many patients you see a day or week with broken appliances. Calculate the average time spent fixing and replacing material and schedule that time accordingly into your day. Creating a schedule without these tweaks is just setting yourself and your team up for more stress.

Stressor #5, #6, #7 – Time and scheduling management

Of surveyed orthodontists, time pressures was the most stressful category consisting of eight stress triggers.1,2,4,5,6,7 Most orthodontists listed time related stressors as the most frequent type of stressor experienced (daily) as well as severity. Some of the stress triggers were:
  • falling behind schedule
  • trying to keep to a schedule
  • cancelled or missed appointments
  • patients being late for or missing adjustment appointments

Time and scheduling management requires strict attention to trends, patterns and the ability to be proactive. When you can articulate the patterns of your patients, trends of the industry, and be proactive enough to balance it all together, you can plan, prioritize and delegate tasks and events necessary to maintain a healthy practice. Start by tracking how you and your team spend their day. By doing this you can reappoint how time is spent moving forward. Go to www.jenbutlercoaching.com/where-does-the-time-go and download a Time Management Tracking Sheet.

What Now?

It’s futile knowing how much stress you have and what your stress triggers are if you don’t plan on doing anything about it. Studies show the following solutions reduce the stress in orthodontic practices and increases overall job satisfaction from the doctor and team.4,7

1. Participate in study clubs. The greater the network of support the less amount of stress.

2. Competency training for everyone. You’re not the only one who needs to enhance their skill set. Clinical CE courses are important to stay with industry standards while non-clinical courses expand business knowledge and bring balance to the team.

3. Hire a patient coordinator. Find the right person that patients love to talk with and has a great sense of relationship building.

4. Increase staff size. If you run on cellophane everyone feels the pressure.

5. Take a stress management course. Trust an expert; your patients do. There are steps and processes to reducing your stress. It takes a methodical approach and a stress management coach knows how to get you from step one to your end goal.

References
  1. Keim RG, Gottlieb EL, Nelson AH, Vogels DS. 2003 JCO-Orthodontic Practice Study. JCO 2003.
  2. Heying SS, English JK, Bussa HI, Corbett JA. The Success of Orthodontic Satellite Practices. Angle Orthodontist. 2007;77:5:875-880.
  3. American Dental Association. 2003 Dentist Well-Being Survey. Chicago, 2005.
  4. Roth SF, Heo G, Varnhagen C, Glover KE, Major PW. Occupational Stress Among Canadian Orthodontists. Angle Orthodontist. 2003;73:1:43-50.
  5. Kaney S. Sources of Stress for Orthodontic Practitioners. J of Ortho. 1999;26:1:75-76.
  6. Ousehal L, Lazrak L, Hassani K. Evaluation of stress among 100 Moroccan orthodontists. Op J of Stom. 2011;1:1-6.
  7. Roth SF, Heo G, Varnhagen C, Glover KE, Major PW. Job satisfaction among Canadian orthodontists. Am J of Ortho and Dent Ortho. 2003;123:695-700.
  8. Clark JR. Oral hygiene in the orthodontic practice: Motivation, responsibilities, and concepts. Am J Orthod. 1976;69:1:72-82.
  Author's Bio
Jen Butler, M.Ed., CPC, BCC, has been working in the area of stress management and resiliency coaching for over 20 years. She is available as a coach, consultant, speaker and trainer. To learn more about her services and sign up for her monthly StressLESS newsletter go to www.jenbutlercoaching.com. Take the Dental Stress Self-Assessment at www.jenbutlercoaching.com/quiz/ to find out your stress levels. Her partnership with The Business Backer removes any financial barriers so you get the support you deserve. Go to www.thebusinessbacker.com and contact Jen Butler directly at 623-776-6715.
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