anxiety as a new general dentist

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Utdarsenal

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Hi everyone, I was wondering if anyone had any words of advice for a young dentist who tends to fall into frequent episodes of anxiety?

I always tend to have internal mental battles between feeling pressure from the office managers wanting production (keep in mind, in a high volume medicaid/PPO office). High production is encouraged while also pushing for perfection in patient treatment/staying on schedule/high quality work, etc..

The realities? It's very difficult to maintain all those standards simultaneously while working in a quick environment. I've never understood how I'm supposed to do fillings while having a simultaneous exam with scaling. Sure, you can numb the filling patient and jump to go do the exam, but what do you do if that new exam patient you "popped in for" requires 5+ crowns, 3+ root canals, 6+ fillings, implant/bridge/partials and that patient with the fillings is waiting in the other room? Obviously it will take time to explain this to the patient and if he has various questions you're basically screwed and falling behind with the fillings you still need to get started on. If it was a teenager with no cavities? Easy. Unfortunately, that "no-issue" patient is a rare diamond in this practice. This model just seems so broken. It's nice to make money but how do people maintain sanity when this is a day-to-day for years and years?

This is just an example, but you can imagine many things going wrong - crown not fitting, calcified canal, pt who doesn't get numb, etc. while having patients on your 2nd and 3rd columns for denture try-in's, a crown delivery.. etc. One thing that goes wrong can trigger a domino effect and just like that, you're behind and patients who had appts. are getting inpatient... not just that, but the crown that didn't fit is now a loss in production and frowned upon by management.

These scenario's make me really anxious just thinking about them. Not just that but for some reason I also get really anxious thinking about malpractice suits (especially in this type of work environment). One of my friends got sued because his patient's gum got an ulcer after a whitening. That can literally happen to anyone and I think it's just a ticking time bomb for something to go wrong. Since I feel like I have a long ways ahead of me career-wise, I'm trying really hard to not screw anything up right now that i'm starting. On some patient's, I write clinical notes the length of college essays (exaggerating) because I felt something off about them. Little things like that..

Speaking on a more personal note, I do the "recommended stuff"- a lot of exercise, 8 hours of sleep. I've been at this for two years and the anxiety has only maybe gotten a little better since I've gotten used to the grind. I don't remember ever having had conversations with myself about "why did I study this?" during school. I've only had these thoughts since I started working in this environment full time. When I take vacation's, I don't feel like going back to work.. and I turned from this super nice and caring guy to a "i'm not taking crap" kind of dude.. This work environment takes its toll on one. How do you deal with this?

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Hi everyone, I was wondering if anyone had any words of advice for a young dentist who tends to fall into frequent episodes of anxiety?

I always tend to have internal mental battles between feeling pressure from the office managers wanting production (keep in mind, in a high volume medicaid/PPO office). High production is encouraged while also pushing for perfection in patient treatment/staying on schedule/high quality work, etc..

The realities? It's very difficult to maintain all those standards simultaneously while working in a quick environment. I've never understood how I'm supposed to do fillings while having a simultaneous exam with scaling. Sure, you can numb the filling patient and jump to go do the exam, but what do you do if that new exam patient you "popped in for" requires 5+ crowns, 3+ root canals, 6+ fillings, implant/bridge/partials and that patient with the fillings is waiting in the other room? Obviously it will take time to explain this to the patient and if he has various questions you're basically screwed and falling behind with the fillings you still need to get started on. If it was a teenager with no cavities? Easy. Unfortunately, that "no-issue" patient is a rare diamond in this practice. This model just seems so broken. It's nice to make money but how do people maintain sanity when this is a day-to-day for years and years?

This is just an example, but you can imagine many things going wrong - crown not fitting, calcified canal, pt who doesn't get numb, etc. while having patients on your 2nd and 3rd columns for denture try-in's, a crown delivery.. etc. One thing that goes wrong can trigger a domino effect and just like that, you're behind and patients who had appts. are getting inpatient... not just that, but the crown that didn't fit is now a loss in production and frowned upon by management.

These scenario's make me really anxious just thinking about them. Not just that but for some reason I also get really anxious thinking about malpractice suits (especially in this type of work environment). One of my friends got sued because his patient's gum got an ulcer after a whitening. That can literally happen to anyone and I think it's just a ticking time bomb for something to go wrong. Since I feel like I have a long ways ahead of me career-wise, I'm trying really hard to not screw anything up right now that i'm starting. On some patient's, I write clinical notes the length of college essays (exaggerating) because I felt something off about them. Little things like that..

Speaking on a more personal note, I do the "recommended stuff"- a lot of exercise, 8 hours of sleep. I've been at this for two years and the anxiety has only maybe gotten a little better since I've gotten used to the grind. I don't remember ever having had conversations with myself about "why did I study this?" during school. I've only had these thoughts since I started working in this environment full time. When I take vacation's, I don't feel like going back to work.. and I turned from this super nice and caring guy to a "i'm not taking crap" kind of dude.. This work environment takes its toll on one. How do you deal with this?
Hey there! I am sorry you are experiencing this and wish it gets better for you. I'm still in school and so can't offer any input. However, I was wondering how many years out of school you are and whether you did a GPR/AEGD? Is this a corporate office? Is there an owner or a senior doc on site? How many days per week are you working?
 
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As the doc you can’t let the office manager or corporate push you around and force you to compromise your treatment. It’s your license on the line, not theirs. Put your foot down and let them know what you will and won’t do; if that doesn’t work look for another opportunity.
 
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Hey there! I am sorry you are experiencing this and wish it gets better for you. I'm still in school and so can't offer any input. However, I was wondering how many years out of school you are and whether you did a GPR/AEGD? Is this a corporate office? Is there an owner or a senior doc on site? How many days per week are you working?

Hi, i'm 2.5 years out of school. I didn't do a GPR/AEGD. This is a private practice in which I see about 16-22 pts per day with no hygienist. There used to be a senior doc when I started (owner) but after about 6 months of me being there, the senior doc semi-retired and I've been the main doctor there (Monday-Fri) for about two years now.
 
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As the doc you can’t let the office manager or corporate push you around and force you to compromise your treatment. It’s your license on the line, not theirs. Put your foot down and let them know what you will and won’t do; if that doesn’t work look for another opportunity.

They don't really "push me around" but it's more of a meaningful silence, if that makes sense? It's mentioned in a more indirect way. For example, at a daily huddle the manager will maybe mention "we need to be hitting X number" or will bring up that we've been falling behind more often. They're not mean about it, but more-so it feels like a silent jab. Basically, every morning huddle is mostly negative towards the staff, there isn't really a feeling of accomplishment and nothing ever seems to be enough. I think most of the anxiety mostly comes from me pushing myself into not screwing up. Of course I love production, but a crown not fitting (for example) just tends to happen every now and then. I also feel the need to hold myself to the highest level (getting everything done quick while not falling behind and everything going smoothly), but when anything falls short of that, I can't stop thinking about it and then think about how it's affecting the office and the office's collections. Don't get me wrong, they trust me and there's a reason why I've taken over since the owner doc quit, but it's just the general environment I really don't like. I don't know how different it is working in other clinics and that's one of the reasons why I haven't quit. Most places my friends work at all tell me it's mostly production over patient treatment where they're at.
 
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Move on!
Your present job is only the first of many jobs to come. There is no shame in moving on to the next job under your terms.
Remember your present situation is only a JOB it is not YOU. Make sure the next job is more suited to you.
 
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Few things that may help:
1. It takes several years to get comfortable with all the hands on aspects of dentistry and that will come with time, reps, and CE. Also warn patients early, like warn of hot cold sensitivity even on the easy fillings and warn of risk of root canal for every crown.
2. Sounds like it’s not the most supportive corporate job to be in. Explore other options if you can, but if that’s not realistic right now just keep an eye open and learn what you can from this environment.
3. If a patient on new patient exam/hygiene exam has more treatment than you can discuss at that time, explain that to the patient and get them back for a dedicated consultation or offer to call them later to explain their treatment plan and answer their questions. Both options give you time to sit back, review the info, and formulate a plan.
 
Few things that may help:
1. It takes several years to get comfortable with all the hands on aspects of dentistry and that will come with time, reps, and CE. Also warn patients early, like warn of hot cold sensitivity even on the easy fillings and warn of risk of root canal for every crown.
2. Sounds like it’s not the most supportive corporate job to be in. Explore other options if you can, but if that’s not realistic right now just keep an eye open and learn what you can from this environment.
3. If a patient on new patient exam/hygiene exam has more treatment than you can discuss at that time, explain that to the patient and get them back for a dedicated consultation or offer to call them later to explain their treatment plan and answer their questions. Both options give you time to sit back, review the info, and formulate a plan.

Agree with above post. I work as an orthodontist with a medium sized Corp. I work with a managing dentist who has been at the same company for over 10 years. He is their highest GP producer. From what I can tell .... his dentistry is pretty good and the patients like him. What I've noticed and this may help you is.

He takes control of the daily and monthly meetings. He directs the staff on scheduling, tx planning, number of assts, time of appts, what appts are seen at what time, etc. etc. etc. Corp defers to his blue print mostly because he is such a high producer. For myself ... the scheduling is everything. Train the staff to make sure your schedule is conducive to making your life a little easier.

It will get easier with time and experience.
 
Agree with above post. I work as an orthodontist with a medium sized Corp. I work with a managing dentist who has been at the same company for over 10 years. He is their highest GP producer. From what I can tell .... his dentistry is pretty good and the patients like him. What I've noticed and this may help you is.

He takes control of the daily and monthly meetings. He directs the staff on scheduling, tx planning, number of assts, time of appts, what appts are seen at what time, etc. etc. etc. Corp defers to his blue print mostly because he is such a high producer. For myself ... the scheduling is everything. Train the staff to make sure your schedule is conducive to making your life a little easier.

It will get easier with time and experience.

Thanks everyone for the tips.

I may be asking for too much, but, by any chance do you have an idea of what his typical schedule would look like?

I just find it difficult to find a happy medium between balancing high production, high volume (this is a medicaid/PPO office after all), and patient happiness (staying on time/adequate time to explain circumstances).

The tricky part of this is that dentistry is very unpredictable. On the schedule, things can look fine and dandy, but in reality can be hectic. If you numb your patient for fillings in OP1 and jump to OP 2 for a crown delivery, but pt is now mentioning that he has a toothache on his LR side from treatment patient received from other doc last week (for example), or pt's tooth is really sensitive and requires numbing as well.. etc, now the schedule starts to collapse.
 
I also had a lot of anxiety in the first 2-3 years practicing. I felt overwhelmed by the amount of patients on my schedule sometimes and felt sad/depressed when I didn't do good work as a result. And like you, I also felt pressure to produce, especially when working alongside pushy owner dentists or office managers.

I have perfectionist tendencies as well, but a big part of dealing with the grind of a high-volume office (esp. when you are doing your own hygiene, which absolutely sucks when seeing 20 patients/day) is learning to be okay with "clinically acceptable." I started thinking about the most important steps to accomplish in my restorative work, and as long as I can accomplish those I can live with myself. For example, for crown preps nowadays I just focus on clear margins and sufficient reductions, whereas in the past I spent a lot of time trying to make them look like they do in textbooks. In endo, I stopped being so concerned with having my GP end exactly 0.5mm away from the radiographic apex as long as I had confidence that I had cleaned/shaped/disinfected the tooth well. That doesn't mean I have stopped aspiring to do great technical work though, especially on days when I have more time. I am still constantly trying to learn new skills and grow, but this mentality just allows me to stop sweating the little things as much and leave the office with less anxiety.

Something else that has helped is becoming better at directing the workflow of assistants, telling assistants when they are not doing things well or efficiently, and also taking more control of the schedule/telling the front desk how much time I need. When I run into the situation you mentioned where something unexpected occurs i.e. patient presents for fills but his other side that the other dentist worked on is in pain, I do try to work fast to resolve his chief complaint and accomplish the original fills, but if I can see I don't have the time, I'm comfortable telling the front desk and patient that he may have to come back. It sounds like your office environment is not encouraging, but I would sit down with the office manager and work with her to reduce the schedule a bit - it sounds like you are seeing too many patients right now. If she is not reciprocative, it may be time to look for another position. I went through many positions until I found a couple of offices I can tolerate now.

I really empathize with you and what you're going through. I went through a lot of the same things and still beat myself up sometimes thinking about what I could have done better or get anxious about tough cases, but it's become a lot better in the last year or so (I am almost 4 years out) as both my technical and communication skills have improved. I can leave work at work now when I come home, whereas I wasn't able to do that before. General dentistry as an associate can be tough and unrewarding. Think about what it is about dentistry that makes you feel fulfilled and shape your environment so that it's more conducive to that. If that is doing very technical, meticulous dentistry, an office where you are seeing 20 patients/day with hygiene may not be the best fit for you, esp. at 2.5 years out.

Good luck! With a lot of states shut down right now, I hope you have a little bit of time to recharge, think about what you want, and make a plan going forward. Feel free to PM me as well.
 
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Hi everyone, I was wondering if anyone had any words of advice for a young dentist who tends to fall into frequent episodes of anxiety?

I always tend to have internal mental battles between feeling pressure from the office managers wanting production (keep in mind, in a high volume medicaid/PPO office). High production is encouraged while also pushing for perfection in patient treatment/staying on schedule/high quality work, etc..

The realities? It's very difficult to maintain all those standards simultaneously while working in a quick environment. I've never understood how I'm supposed to do fillings while having a simultaneous exam with scaling. Sure, you can numb the filling patient and jump to go do the exam, but what do you do if that new exam patient you "popped in for" requires 5+ crowns, 3+ root canals, 6+ fillings, implant/bridge/partials and that patient with the fillings is waiting in the other room? Obviously it will take time to explain this to the patient and if he has various questions you're basically screwed and falling behind with the fillings you still need to get started on. If it was a teenager with no cavities? Easy. Unfortunately, that "no-issue" patient is a rare diamond in this practice. This model just seems so broken. It's nice to make money but how do people maintain sanity when this is a day-to-day for years and years?

This is just an example, but you can imagine many things going wrong - crown not fitting, calcified canal, pt who doesn't get numb, etc. while having patients on your 2nd and 3rd columns for denture try-in's, a crown delivery.. etc. One thing that goes wrong can trigger a domino effect and just like that, you're behind and patients who had appts. are getting inpatient... not just that, but the crown that didn't fit is now a loss in production and frowned upon by management.

These scenario's make me really anxious just thinking about them. Not just that but for some reason I also get really anxious thinking about malpractice suits (especially in this type of work environment). One of my friends got sued because his patient's gum got an ulcer after a whitening. That can literally happen to anyone and I think it's just a ticking time bomb for something to go wrong. Since I feel like I have a long ways ahead of me career-wise, I'm trying really hard to not screw anything up right now that i'm starting. On some patient's, I write clinical notes the length of college essays (exaggerating) because I felt something off about them. Little things like that..

Speaking on a more personal note, I do the "recommended stuff"- a lot of exercise, 8 hours of sleep. I've been at this for two years and the anxiety has only maybe gotten a little better since I've gotten used to the grind. I don't remember ever having had conversations with myself about "why did I study this?" during school. I've only had these thoughts since I started working in this environment full time. When I take vacation's, I don't feel like going back to work.. and I turned from this super nice and caring guy to a "i'm not taking crap" kind of dude.. This work environment takes its toll on one. How do you deal with this?

I have similar experiences and worries and I've been practicing for 22 yrs! I'm so lucky to start out in the USAF that I only work one chair at a time and have an hour to do as many fillings as I feel like...sometimes just one. We don't have hygiene exams at my base. We herd troops in like cattle for their periodic and new patient exams and schedule their hyg appts afterwards. We all take turns covering exams and limited emergencies for a week so we didn't have to worry about crown preps, rcts, etc happening all at once.

In the private sector, dentists' time is so expensive because you have to figure in expensive overhead. In order to maximize that overhead, the dentist needs to see more patients and produce more. Having things go wrong happens to everyone and will continue until you retire. I've been sued by an unreported Meth user whose teeth continued to deteriorate under my watch. I looked up her arrest records after she sued me and was lucky to find a couple. Fortunately her lawyer amended my name to my employer's.

I agree with the other posters that you have to protect your license and not get above your head. You have to have the right balance of speed and quality as well as customer service. I think it's important to establish your comfort level at every procedure before you can have more speed and multitask. Can you talk to your boss about it? Your pay may suffer but you will be better for it. My USAF pay was peanuts but I lived at home to my father's shame and I was able to achieve my level of efficiency. Do your best on charting but no matter how thorough your novel is, the opposing lawyer will always find something you didn't do such as using the endo activator/ultrasonic. "If you did, why didn't you document it?" The proper question for the jury is "Did you follow the reasonable standard of care?"
 
I have similar experiences and worries and I've been practicing for 22 yrs! I'm so lucky to start out in the USAF that I only work one chair at a time and have an hour to do as many fillings as I feel like...sometimes just one. We don't have hygiene exams at my base. We herd troops in like cattle for their periodic and new patient exams and schedule their hyg appts afterwards. We all take turns covering exams and limited emergencies for a week so we didn't have to worry about crown preps, rcts, etc happening all at once.

In the private sector, dentists' time is so expensive because you have to figure in expensive overhead. In order to maximize that overhead, the dentist needs to see more patients and produce more. Having things go wrong happens to everyone and will continue until you retire. I've been sued by an unreported Meth user whose teeth continued to deteriorate under my watch. I looked up her arrest records after she sued me and was lucky to find a couple. Fortunately her lawyer amended my name to my employer's.

I agree with the other posters that you have to protect your license and not get above your head. You have to have the right balance of speed and quality as well as customer service. I think it's important to establish your comfort level at every procedure before you can have more speed and multitask. Can you talk to your boss about it? Your pay may suffer but you will be better for it. My USAF pay was peanuts but I lived at home to my father's shame and I was able to achieve my level of efficiency. Do your best on charting but no matter how thorough your novel is, the opposing lawyer will always find something you didn't do such as using the endo activator/ultrasonic. "If you did, why didn't you document it?" The proper question for the jury is "Did you follow the reasonable standard of care?"
What are practical implications of being sued (whether frivolous or not)? Does that limit future employment options even at corporate offices? I've heard your credentialing with insurance companies can get negatively affected. True? I also heard nurses and pharmacists whose license has been put on probation or been reprimanded have a really hard time finding a job. Is this also the case with dentists?
 
Good questions. I'm in the process of starting a thread about my experience with the law suit. I got hired on by another corporate DMO during my law suit a couple of yrs ago in which I had fully disclosed it to them and the credentialing process. What I'm not sure is the plaintiff changed the suit to my employer. According to my lawyer, I'm still on the hook and will be forever on the nation wide provider data base...you need to pay something like $40 to look your name up. Yes my liability ins would increase like car ins if you filed a claim. The new DMO provided it so they absorbed the cost. Also I was told the state board will investigate and post the incident for all to see but I looked up my info and they had mention of nothing. Ironically I had a colleague who is on the state board working at the same DMO and recently hired on to my new company. After the crisis, I hope to ask him about it. I don't know about difficulty in finding a job while on probation or discipline. I work mostly Medicaid which is not very glamorous so they may look past that incident.
 
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