Vacations vs burnout

Dentistry, Lifestyle

Contractually, I get ZERO paid vacation days a year. That is not to say I cannot take time off. In fact, my employer is quite accommodating of my vacation requests. However, when I am not in the office and not seeing patients, I am forfeiting any and all income for that period of time. Needless to say, that causes some internal conflict.

When I was younger, I remember someone telling me about the concept of ‘opportunity costs.’ They pointed out an example of how because Bill Gates’ net worth is worth so many several billions of dollars; that it literally would not be worth his time to pick up a $100 bill if he were to drop it on the ground. In fact, he called it a ‘poor investment’ of his time.

In the early part of my dental career, that same decision-making process always stirred in the back of my mind. Essentially, when I go on vacations, not only do I not bring in an income but I am also spending money on restaurants, hotels and flights. The other thing that weighs on me is that I work in pediatrics – so the times when it is usually most convenient to go on a trip (i.e. summer time, spring break, winter session) we are usually the busiest and therefore, the most productive. For these reasons, in my first few years of employment, I practically took no time off.

As time has progressed; I am settling into my career, my kids are getting older, and, more recently, with my health issues – I realize more and more how finite my life and time with my family really is.

I have said it before and I will say it again – I feel blessed to practice pediatric dentistry. Truly, I do not think any other profession could have brought me this level of satisfaction in my life. However, I work in a heavy Medicaid office where I am constantly surrounded by patients in pain from rampant decay, frequently get grief from parents about appointment wait times, and unfortunately, am often times immersed with a sense of hopelessness on whether we are even making an impact. Honestly, it can all start to wear on you a bit.

My family took a week long vacation last week to Yosemite National Park and a quick trip up to San Francisco. On our way back to Las Vegas, we drove along a small stretch of the Pacific Coast Highway. Lots of beautiful sites!

In the weeks leading up to the trip, I couldn’t help but feel a little more pep in my step. Just planning for it, packing for it, and the anticipation of it made me excited and really gave me something to look forward to. Since coming back (a week ago), I have put in a request for even more vacation days.

My goal from here on out is to find that right balance between work and play. Admittedly, going in to work every day feels quite repetitious and mundane. However, it is hard for me to say that I have truly felt burned out by it. I never dread going in. I look forward to conversing with the families and my co-workers. Conversely, I do want more time with my family, and want to get out and explore the world.

I wish I was rich enough to leave $100 bill on the ground. Heck, I would pick it up even at the risk of my back giving out. Seriously though, I feel fortunate that I am now stable enough financially, settled enough professionally, and (thankfully) healthy enough physically to take some time off of work and enjoy life a little more with the ones I love.

I am always interested in what others experiences are, please feel free to agree/disagree and give me your take on things! Thanks for taking the time to read this post.

Empathy and Ethics

Dentistry, Uncategorized

Not to come off as conceited, but I am pretty good at what I do. I practice evidence-based dentistry. I follow guidelines set by the American Academy of Pediatric Dentistry. And probably the most important thing is that I try and approach every child’s case with empathy.

When I was in dental school, I came across a video of a young physician giving a lecture to a class of dental students who, not long before his speech, had been diagnosed with Stage IV terminal lung cancer. He had been given something like a 6 month life expectancy. This doctor spoke about the ascent in his medical career, how his professional choices were always guided by his pursuit of wealth and acquiring materialistic things. He ultimately achieved what he thought was the pinnacle of ‘success’. He shared photos of his mansion, his multiple fancy cars, him posing with A-list celebrities, you name it. A luxurious lifestyle indeed.

And then, tragedy struck. After exercising one day, he felt a pain in his back. A physician friend evaluated him, and the grim diagnosis was made. In this lecture, he talks a great deal about regrets. Regrets in valuing the wrong things in his life. How, when he would view his patient’s charts – that is all they were to him, charts; not patients, not people with stories to tell and families at home that cared for them. The irony being, that he was now a chart on someone else’s stack.

I keep that doctor’s lecture in the back of my mind with every exam that I do. I tell the parents I talk to, that the recommendations I make are the same for their child as they would be for my own. I try and enter every exam and every treatment procedure with a mindfulness of ‘how would I want myself and/or my loved ones to be treated?’ As a health care provider, I feel like that principle and way of thinking has been a guiding light for me.

I had a residency instructor tell me once “you will not be able to satisfy everyone.” I am glad to have gotten that advice early into my career. I spend a good amount of time explaining to parents my visual and x-ray findings. I try to present in detail my treatment recommendations for their child. And I thoroughly try and answer any questions they might have. If they continue to have any disputes or doubts, I will attempt to resolve those concerns but, beyond that, I am a big believer in families getting second opinions as other dentists may be able to be more accommodating to their desires and expectations.

I have had parents wanting to extract cavitated but still very much savable teeth because they “were just baby teeth.” I have had parents decline any form of sedative being given to their child despite the kid being extremely uncooperative for their exam and needing lots of dental work done. I will try, to some extent, to hear the parents out, understand their point-of-view, present my own side of the story, offer my experience and insight; and hopefully we all can find some common ground to accomplish what needs to be done. However, never do let parents flat out dictate my course of care; and if I get the sense that they are dismissive of or lack trust in my training and experience, then I often times feel it is best for all parties involved to go their separate ways.

Probably one of the most hurtful and offensive things I have heard is when a parent believes my treatment recommendations are financially motivated. Coming up through professional school, we all take the Hippocratic oath to practice in the best interest of our patients. And, while that hopefully sets the high standards of care by which most (if not all) medical and dental professionals care for people; it is undoubtedly idealistic. Honestly, I cannot blame people for having that perception and that kind of cynicism that their doctors might be driven by greed.

When I draft a treatment plan for a patient, I take into consideration their age, their health history, their behavior and temperament, their nutritional habits, their home oral hygiene routine (or lack there of), all to try and gauge their cavity risk. I can proudly say I have never made a clinical decision where I put my own self-interests above what I think is best for my patient. But I do have a genuine concern for the direction I think the business of medicine and dentistry seem to be going. With the rapidly rising costs of tuition for these professional schools (nearly an average of $300k for dental school according to Student Loan Hero), with constantly decreasing reimbursements from insurance companies, and with dental schools graduating and saturating the job market – I hate to say it, but I think it may be a legitimate thing to wonder if all that debt burden starts to affect the way we practice in some way.

On that somber note, I want to thank you for reading this post. Hopefully there are some interesting points for discussion somewhere in all of this. As always, I welcome any thoughts and input. Until next time…