Burnout in healthcare is on the rise. In 2022, the World Health Organization will embark on the development of evidence-based guidelines on mental well-being and will list burnout in the upcoming revision of the International Classification of Diseases as a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed [12].
Maslach developed the burnout inventory which was named after him, which is easy to execute and yields reliable and valid information with which it is possible to evaluate and diagnose workplace burnout. Therefore, it was implemented in this study [11].
Emotional exhaustion, due to chronic exposure to unmitigated stress, makes clinicians feel emotionally, physically, and spiritually drained. This may result in affected individuals not feeling they can effectively give off themselves anymore. Often, they report being worn out, with loss of energy, depletion, debilitation, and fatigue. This may lead to depersonalization exhibiting inappropriate attitudes, sarcasm, and cynicism directed at others. Affected individuals may also experience irritability, loss of idealism, and withdrawal. Depersonalization and emotional exhaustion are closely associated, and the results may be a dental provider conveying the message that he or she does not care about the patient’s concerns or needs [9].
Compassion fatigue is associated with burnout because it expresses the fatigue and exhaustion a person can experience when dealing with difficult or unreasonable people. Compassion fatigue has been described as the convergence of secondary traumatic stress and cumulative burnout, a state of physical and mental exhaustion caused by a depleted ability to cope with one’s everyday environment [13]. A third aspect of burnout syndrome, reduced personal accomplishment, results in a tendency for people to demonstrate an inability to cope; they may have a negative impression of themselves and dissatisfaction with their work and accomplishments [4].
The present study surveyed the prevalence of occupational burnout (utilizing Maslach Burnout Inventory (MBI)) among pediatric dentists in the Egypt, and also, it aimed to study the sociodemographic characteristics of dentist suffering from burnout syndrome and to assess associated factors that increase the burnout syndrome and propose different recommendations to protect from it. A total of 74% of our sample were females, 26% were males, and most of the study sample aged between 20 and 40 years old similar to a study conducted in Saudi Arabia among postgraduate students in pediatric dentistry [14].
Most of study sample were married and living with their families; also, most of our participants had two or more kids (67.2%). More than 55% have 5 to 15 years work experience, 63% treats 3 to 12 patient per day, 61% works from 10 to 40 h per week, 25% works more than 40 h per week. 55% works as group private practice, 85% of the study group drives from 10 to 60 min to work, and 86% lives in the city.
At the outset of the study, it was hypothesized that pediatric dentists may be at greater risk for occupational burnout in comparison with other dentists because provision of pediatric dental care can be stressful with practitioners having to deal with anxious children and protective parents.
Regarding scores of MBI (prevalence of burnout syndrome), 62% of the study sample had high scores of emotional exhaustion, 36% of the study sample had high scores of depersonalization, 23% of the study sample had low scores of personal accomplishment, and the majority of subjects (97.2%) had high level of depersonalization and emotional exhaustion.
The level of personal accomplishment was low as 28%. In comparison with the US study, 23% has emotional exhaustion, 12% on the sub-scale of depersonalization, and 10% on personal accomplishment scale. This reveals that the burnout rates are higher in Egyptian pediatric dentists than US dentists. An estimate of 25% respondents fulfilled this study’s definition of occupational burnout (high emotional exhaustion + high depersonalization). This is also higher than dentists in the UK and similar to Irish dentists [15, 16]. This could be attributed to the fact that the study was conducted during covid-19 pandemic.
All the sociodemographic variables showed no significant effect on burnout scores except for distance from family, and being involved in further postgraduate studies exhibited extreme significance, revealing the stress levels to which a postgraduate candidate is exposed to in Egypt. It was found that being enrolled in a postgraduate pediatric dentistry program in Egypt is significantly related to high burnout rates. Most of the candidates work after their studying hours, to be able to meet their financial burden; therefore, this reflects significantly on the three subscales of burnout. This was similar to the study carried on postgraduate student in Saudi Arabia [14].
The present study found no gender differences regarding prevalence of burnout contrary to a random sample of US dentists wherein female pediatric dentists were more depressed than males. These results were contradicting to other studies reporting a significant association between female gender and emotional exhaustion [16,17,18]. There were no differences in prevalence of burnout in the present study based upon marital status, while married UK dentists had lower levels of depersonalization than single dentists. There was a higher prevalence of depression among US dentists who were single than those who were married. It was also reported by Gillespie et al. and Kumar whom are not in relationships may be at risk of high burnout levels as reported by other researchers [19, 20].
Moreover, working at a governmental academic institution seems to contribute to the burnout of a practitioner. It is not showing significance but stands on a borderline, as it could have been significant if the sample was larger.
There was no association between age of dentists, number of years in practice and level of education, and the scores of the subscales of burnout. While it was totally the opposite for the US pediatric dentists, as if experience exceeded 11 years in practice, the risk of having depersonalization is 2.99 times to candidates with less years in practice. It was found by Chohan et al. that working in group practice is better than running a single operatory [16].
On the other hand, it was found that the number of kids a pediatric dentist raises up is significantly associated with the level of depersonalization (P-value = 0.03). This may be due to more family duties are wanted after working hours, more stress on the dentists. It was also found that the number of working hours per week is significantly associated with the level of exhaustion and depersonalization. That was supported by Chohan et al. and Denton el al. confirming that those who worked 40 h or more per week were 10.59 times more likely to experience high emotional exhaustion in comparison to those working less than 20 h per week [16]. The study from Yemen found a significant association between the prevalence of burnout and working long hours [21]. Similar findings were reported by a study in some Arab countries which found healthcare professionals working for more than 40 h per week [22]. A lack of personal accomplishment and high emotional exhaustion were related to working long hours and a greater proportion of time spent working in NHS practice [15].
In the current study, it was revealed that long drives to work are also significantly associated with the low level of personal accomplishment (P-value = 0.048). Moreover, 92% of the study group believe that unavailability of conscious sedation adds burden to their profession. The use of sedation in dentistry has been prohibited in Egypt since 2008; moreover, even nitrous oxide gas use in dentistry has been completely banned. Reasons for the ban were not clear. Therefore, regulating the use of sedation for dental treatment will help in elevating some burden of the pediatric dentists shoulders and save the operating rooms precious time.
Findings from the present study however belied that notion over multiple MBI assessments. Mean emotional exhaustion and mean depersonalization scores of study respondents were significantly lower, while mean personal accomplishment scores were significantly higher than established MBI norms for overall population sample or medical professionals
Chohan et al. found a significant correlations in their study between moderate-to-severe depression and high emotional exhaustion, high depersonalization, and low personal accomplishment, where two out of five pediatric dentists with high MBI scores in both emotional exhaustion and depersonalization also had moderate-to-severe depression. These correlations confirmed other reports of the link between occupational burnout and depression in dentist, and the two conditions are discrete entities [16].
Given potential ramifications, raising awareness of mental health issues among pediatric dentists may be salutary even if benefit accrues only to a few. Individuals with depressive symptoms may have reluctance to seek treatment. In the USA, only 15% of the dentists suffering depression were receiving treatment; therefore, awareness is currently an essential need. It seems to be a worldwide problem which requires a bigger attention
Limitations
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1.
We had a limited sample size, so there was underrepresentation for some categories in the sample like pediatric dentists having family burden, pediatric dentists having chronic illness, and pediatric dentists not satisfied with the specialty, so these variables were not correlated to burnout properly.
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Some pediatric dentists refused to participate in the study; others were out of reach. We do not have sufficient data or information about those pediatric dentists specially whose rejection could be due to causes related to being actually suffering from burnout syndrome.
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3.
This is a cross-sectional study, so longitudinal studies and follow-up data may be needed in the future.