The 6 Things That Can Lead Dentists to Burnout

On this episode of The Dentist Money Show, Matt sits down with psychologist and life coach, Dr. Craig Spiel, to explore what can contribute to burnout and how dentists can recognize the warning signs before it impacts their practice, team, and personal life. They discuss the six areas that can contribute to burnout: workload, control, reward, community, fairness, and values. Tune in to hear practical ways dentists can identify what’s creating stress and build a more sustainable, burnout-resistant practice.

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Podcast Transcript

Matt: Welcome back to another episode of the Dentist Money Show where we help Dentist make smart financial decisions. I’m a guy named Matt and super excited to be sitting across from sort of sitting across, virtually sitting across from Doctor Yeah,

Craig Spiel: Mostly sitting across.

Matt: Yeah, Doctor Craig Spiel. Craig, how are you today?

Craig Spiel: I’m doing great. Thanks, Matt.

Matt: Yeah, so it’s so good to have you. And this is a really important topic, something that we’ve talked about over the years. I don’t think it’s any shock to Dentist or any surprise when we talk about the importance of this topic of burnout. Wanna that’s kind of the the the extent of this show is doing a deep dive into burnout. But before we do that, Craig, I’d love to to just give you a chance to introduce yourself and kind of maybe start off with like this journey of how you got to dentistry and and kind of share your background here today.

Craig Spiel: Absolutely. Thanks so much. And it’s great to be here with you today, Matt. So yeah, I’m I’m Dr. Craig Spiel. and I’ve been a psychologist for the past 10 years and have had the privilege of working with many people who carry enormous responsibilities. medical professionals and dentists whose precision and judgment and composure is required every single day as they show up. And as I’ve been practicing over this last 10 years, what I’ve noticed is that time and time again. often the same drive that helps someone excel, excel at one part of their life, can be the very thing that can hold back, keep them from stepping back, recognizing that they need help or or or asking for help or seeing that anything anything’s wrong. And dentists live right there in that tension. They’re the ultimate entreprofessionals. You know, they they their ambition, their drive, their attention to details are skills that lead them into dentistry with the goal of helping people and providing a good life for themselves and their family. But then they get in the trenches and everything that happens in the clinic ultimately falls on them and it is really, really hard. and they compare themselves with other successful practices and feel like they must be doing something wrong. And so sometimes they just take on more patients. They work longer hours and that’s right where burnout starts out that that’s

Matt: Yeah.

Craig Spiel: Right where we see that grow. And then sometimes they get to the the point where they’re just so emotionally exhausted that they wonder why they’re even doing this, but they also feel trapped because of the sunk cost. They put so much time and effort into this practice that they don’t feel like they can stop, but they also don’t see a way forward. And that’s why I built Spill Coaching, which is a practice devoted just to dentists and helping through Some of that emotional landscape, work through problems like burnout, so they can cut through the noise and feel the joy of dentistry again.

Matt: Yeah, love it. we need to call this out from the very beginning that you’ve got a family kind of intertwined in dentistry. Yeah. People people

Craig Spiel: I do, yes.

Matt: Maybe hear the name Spiel, like, wait a second, I know that name. So we were connected through your dad, through through

Craig Spiel: Mm-hmm.

Matt: Bob Spiel, say no to the DSO. And he’s he’s been in dentistry for a long time now. Maybe can you talk to just about that component and how that how that has maybe impacted your your drive to get into dentistry as well?

Craig Spiel: Absolutely, yeah. So my dad, Bob Spill, has been working in the dentist field for the last 20 years or so, and he’s really approached it from the business angle, the leadership angle, and I know he’s he’s changed a lot of lives in in that way. And so hearing him talking about some of the work that he’s doing, and me from my psychologist background and training, I can kind of see how actually this would really benefit that area as well. And so my dad kind of did shine a light onto this need and what’s going on behind those scenes and how bringing in some of these skills I’ve learned as a psychologist and and as a coach can really help in that area.

Matt: Yeah, yeah, really cool. So I’m just glad we got that out of the way that people so we can just rel relieve the confusion if people are like Spiel.

Craig Spiel: Yes, absolutely.

Matt: I know this. it’s really cool. Bob, your dad is such a great guy, and I’m so glad that he we were able to connect, connect here today. So want to dive into to burn out more specifically, but you said something super interesting, Craig, that’s something that I think about a lot, and we’ve talked about kind of in different avenues. And I wanna make sure I’m saying I’m summarizing what you said correctly at the very beginning, which is kind of this idea that our greatest gifts are are also kind of our biggest curses. It’s kinda like this give and take of like you’re saying the precision, the drive, all these things that make a dentist successful also can be something that holds them back in other aspects of their life. Another way that I’ve heard this phrase in another podcast was something to the effect of what you’re praised for in public often is what you how d how did he say it? What you’re praised for in public is is what you’re punished for in private. I think

Craig Spiel: Hm. Yeah.

Matt: it’s kind of an interesting way to phrase it. I I that’s kind of what you’re saying, right? A lot of this burnout is almost the result of of all the things that made you successful as well. It’s kind of two sides of the same coin.

Craig Spiel: It often is, you know, it is almost set up like a classic Greek tragedy. You know, the the the thing that helps us so much of the first act is a thing that starts getting in the way in the second act. And largely we do what we do because of what’s worked for us before. But what happens when the thing that worked for us for before is the very thing that starts maintaining broken systems that starts

Matt: Yeah.

Craig Spiel: Hurting us? Mostly we just keep diving further into what’s already worked for us before, hoping that that’s gonna get us out this time when it comes to problems like burnout, it it it takes actually more of a paradigm shift. It takes stepping

Matt: Yeah.

Craig Spiel: Back. It takes a different approach than some of the same ambition and drive and attention to detail that was so helpful at first that’s

Matt: Yeah.

Craig Spiel: Later on, yeah, be becomes what punishes us.

Matt: Yeah, so I think this is tricky, Craig. I love that we’re going here. So look, I wanna I wanna focus on first like what is actual burnout, right? Because I I wanted to throw some stats out at you really briefly. We did this, we did this just recently on a show where the ADA and the Health Policy Institute releases data every quarter. And one of the pieces of of data that they provide is the like a dentist’s busyness, their schedule, basically. And I I wanted to throw this out to you because I think this will help kind of give some context of when we talk about burnout, I want to get your take on like, is this is this a black and white definitional thing? Is this a spectrum? but but before we do that, so the ADA released this data this last quarter of this year, and they they broke it into th four categories, which will which I’ll just read really quickly. This will be a recap, but too busy to treat all patients requesting care. The next was treated all patients requesting care, but feeling overworked. The neck the third category was treated all patients requesting care, not overworked. And then the last was not busy enough, could treat could have treated more patients. So of the two categories that would fit into some level of burnout, it was about 33% of the total dental space

Craig Spiel: Mm-hmm.

Matt: Who was who responded to this, who said, I’m too busy. And then the other one was saying, I treated everyone, but I’m feeling overworked. So just according to this data of that kind of that definition, it was about thirty-three percent. So with that said, could you extrapolate this and say, thirty-three percent of the dental space is burned out? Or is it more specific than that? How do you define burnout from your standpoint?

Craig Spiel: Yeah, so the the WHO has defined burnout as having three main components to it. And the first is probably what most of us readily recognize, and that is emotional exhaustion. So burnout is starts with this exhaustion that it just y you can’t really recover from it after a good night’s sleep or a weekend or a vacation. It’s this feeling depleted, completely drained and unable to recover after a normal amount of rest. So that’s the first thing that we’re looking for with burnout. But that’s not the only thing. Another thing that we look for is depersonalization or cynicism. So burnout comes with this detached stance. It comes with a lot of kind of a sarcastic or callous stance toward patients or or other colleagues. And where empathy used to be, sometimes you have this emotional numbness. So that’s the second part. And the third is a reduced self of self-accomplishment or self-efficacy. So this is where we feel like I can’t make a difference. I can’t change this. Nothing I do matters. So it’s that belief that starts to come in as well. So all three of these things is how we would define what burnout is. So those 33% that you’re talking about with those statistics, definitely we can see that they may be on that path towards that emotional exhaustion because I’m

Matt: Sure.

Craig Spiel: Doing way too much. I’m taking on way too much. I don’t feel like I can get it all done, which is also a little bit of that third part, which is that reduced self of self sense of self advocacy as well.

Matt: Yeah, interesting. I also wonder, so this

Craig Spiel: Mm-hmm.

Matt: What I what I provided that data was talking about the categories of overworked, but I’m curious from your perspective of the the the catalyst for this, because there’s also twenty-six percent of this group in Q2 who said they’re not busy enough and could have treated more patients. Is it is it fair to like is it too simple to be like, that thirty-three percent. They’re overworked, they’re busy, so they must they’re the candidates for being burned out. But is it, could you take this further and say that other 26% who don’t have enough patience who maybe are struggling and stressed and like trying to grow their business and their could that also lead to burnout? I guess more specifically, what are the catalysts that that could lead to this?

Craig Spiel: So great question. I think it’s important to recognize that burnout, although we recognize it on an individual level, is often a interpersonal systems problem. Okay. So it’s very job driven. Once you change the job conditions, that’s when burnout starts to lift and starts to ease. Now there are a lot of individual characters individual characteristics as well that influence that interpersonal system. And so often the dentist is our entry point into this system. And as we find what needs to change within the system leading to burnout, it often brings out the individual characteristics that we need to confront as well. And so as you’re talking about this data set, that it very well could be that, yeah, the people that are like saying, I’m not seeing enough patients, that could be indicative of of burnout as well because I’m not getting enough. I need to be doing more. I need to be doing more. That could be that perfectionist aspect that could be kicking in as well. and it could be that those are saying, hey, I’m I’m I’m full, I could be seeing more people. That could also be a lack of burnout, honestly. It could be them saying, I’m feeling energized by this work. I feel like I’d be could could be seeing more. So I wouldn’t take that data and necessarily say, therefore, this is the percent that’s burnout.

Matt: Yeah.

Craig Spiel: Kind of it’s a very case by case basis, but we’re looking for those

Matt: Totally.

Craig Spiel: Three components of it too.

Matt: Yeah, that’s a really good point. I was just curious around I I’m just wondering if when we talk about this we like meaning just we as in like the people talk about burnout,

Craig Spiel: Mm-hmm. Yeah, yeah.

Matt: If we’re always looking at the people who feel overworked. But I’m I’m also wondering if there’s kind of a lost category of dentists out there that are like, Well, I’m not overworked, but I I wanna be because I’m I’m just not growing enough and

Craig Spiel: Mm-hmm.

Matt: I’m feeling emotion the emotional toll. I’m feeling those three categories Craig talks about because I’m working so hard to get more patients. And you know, like

Craig Spiel: Mm-hmm.

Matt: I just wonder if there’s more nuance than just the dentists who are overworked. If there’s like a secondary lost category of dentists.

Craig Spiel: Definitely. Absolutely. Yeah. Mm-hmm. Yeah. So it’s not just being overworked. In fact, when we look at burnout, there is there’s been studies by a group, Maslick and Leader. They’ve done lots of research in this area. They’ve developed some burnout rating scales to kind of measure it. And they’ve actually found six different areas of mismatch that often lead to burnout. Workload is only one of them.

Matt: Interesting. We’re on to something, Craig. We’re on to something. Let’s go, yes.

Craig Spiel: The others that often lead to it are things like control. There we go. Yeah. Control is a big one. fairness, reward, a sense of community, as well as values is what I’m doing, aligning with my values. And so it resolving burnout isn’t necessarily working less. It might be some of these other areas of mismatch that we need to resolve to be able to address the burnout too.

Matt: Interesting. Okay, sorry, can you list those six again?

Craig Spiel: Absolutely, yeah. So the first one is workload, and that’s just kind of the the one we think of the very most. the second is control. Are there too much or too little?

Matt: So do I have control over my life?

Craig Spiel: Yes, do I have control over my life? it’s you know, the mismatch between responsibility a person holds and the authority or autonomy that they have over the j way the job goes. So do I feel like I have control over what I’m doing, or do I feel like it’s externally controlled by billable hours, by What insurance does I need to do? But you know, those sorts of things.

Matt: So I imagine I’m thinking of like a real world scenario, and an associate at a DSO who’s maybe working normal hours, not not feeling overworked, but has no control or the

Craig Spiel: Mm-hmm.

Matt: KPIs they’re being held to, the things that they’re being forced to do, procedure mix, whatever, they don’t have control the control, the feeling of control. Got it.

Craig Spiel: Exactly. That’s right. Yeah. Yeah. another example is sometimes dentists and medical professionals like to measure their progress based upon patient ratings. You know, I’m trying to get the patient ratings up. I want to get that five star review. Also something we have influence over, but we can’t control necessarily. And so if we’re

Matt: Yeah.

Craig Spiel: Really working hard to get that, but we’re not seeing that, that could also lead to that discrepancy that leads to burnout.

Matt: Got it. And then sorry, what was the third? I just wanna kinda break these down if we can one by one. What was third?

Craig Spiel: Yeah, yeah, yeah. Uh-huh. So third is reward. This is insufficient recognition. this could be financial or social. It’s not just financial reward. It’s a sense of pride, a sense of meaning in what I do. so someone can be paid well in this area but still not feel recognized and feel like what they do is pointless, and that can lead to burnout in that reward area.

Matt: Yeah, interesting. I I think of so many times we hear and we see the loneliness that dentists like the that feeling of dentistry being lonely. And I think a lot of that comes down to the fact that the dentist is, let’s just for a second say like they’re they’re one of one in their practice. Sometimes there

Craig Spiel: Mm-hmm.

Matt: May be multiple dentists there, but they’re also the leader. They’re like

Craig Spiel: Mm-hmm.

Matt: The one leading and out. You mentioned it earlier that that entreprofessional and and leadership is super lonely. It’s i it it really can be lonely and and dentists I think feel that. So I think it’s interesting

Craig Spiel: It can be, yeah. Mm-hmm.

Matt: You’re talking about there and I’ve seen this firsthand. They’re paid well, everything’s going really well. But there’s no often feedback mechanism to

Craig Spiel: Mm-hmm.

Matt: Be like, Am I does my team care? Does anyone like think I’m doing a good job? Am I am I making a difference? Yes.

Craig Spiel: Might make a good difference, right? I’m only hearing the complaints. Exactly. Yeah. Uhhuh.

Matt: And I don’t think there’s anything like I think the whole I think the the reason for that, I would love to get your take on this is just team dynamics. Meaning I don’t know if I think everyone just bel quote unquote below the dentist, below the leader, just assumes like you’re the leader. Like why do you you don’t need to be like told you’re doing a good job.

Craig Spiel: Mm-hmm.

Matt: Like you’re you’re the power dynamic is like you run this show. Of course you’re doing a good job. Whatever. I think just as an

Craig Spiel: Mm-hmm.

Matt: Assumption of the people below them that they’re I don’t need to like boost you up at all. But the leader, the dentist is kind of like, no, I kind of need to know like, am I doing a good job or not? Like I that’s an interesting I’d love

Craig Spiel: Absolutely, yes.

Matt: To get your thoughts on this.

Craig Spiel: Yeah, I think that that you’re right that as the leader, there is this lack of upward feedback of, hey, you did a really good job there, I appreciate what you did. The the dentists, of course, you know, I mean, I’m hoping that they’re providing a lot of that feedback toward the people that to their own team, praising their own team,

Matt: Praising. Yeah, yeah. Yep.

Craig Spiel: but it doesn’t really reflect back sometimes. And

Matt: Yeah.

Craig Spiel: so building in mechanisms within the practice to recognize the good work that’s being done and We can I mean, if dentists are uncomfortable receiving that praise in themselves, you know, no one wants to throw a parade for themselves, like, hey, I did amazing here. But as a team,

Matt: Yeah.

Craig Spiel: We did really good here. This was a difficult case, and I love how, you know, we all did this together, trying to praise the the team work that’s going on and including themselves in that can be a part of it.

Matt: Yeah, really cool. Okay. So reward number number four.

Craig Spiel: Number four would be community. So closely aligned with what you’re talking about before, it can be really lonely as

Matt: Yeah.

Craig Spiel: A dentist on the top. I know you’re working with people all the time, you’re constantly interacting with people, but there is a sense of loneliness that can sometimes come with it. A la

Matt: Yeah, definitely.

Craig Spiel: Lack of community. and community sometimes where we get burnout in the community setting could also look like feeling like you need to be everything to everybody.

Matt: Yeah. Yeah.

Craig Spiel: Socially, my door is always open. If you have any complaints, always come to me. Patient has a problem, I’m gonna take care of it, right? It’s that I feel like I always have to show up for everybody all the time. That

Matt: Interesting.

Craig Spiel: Can also lead to burnout in that area.

Matt: Yeah. Yeah. And I I I wonder if there’s dentists out there. I mean, I I think there are for sure are dentists out there who feel like they might have that community with their team, like maybe they do out of the office type things, but maybe lack a community with other dentists

Craig Spiel: Mm-hmm.

Matt: Peer groups who they can feel like relate more to them.

Craig Spiel: Absolutely, yeah.

Matt: So you could have one but not the other.

Craig Spiel: Yes. Yeah, you can. And some

Matt: That’s interesting. Yeah. Yeah. Anything else you’d add to the community piece? Yeah.

Craig Spiel: I mean, I’m just thinking like a for example, sometimes that community piece shows up within the dental practice. Sometimes it can show up in in your own personal life as well. So like I’m thinking of example of a a physician physician that I I worked with who was really stressed and anxious and afraid that he’d never be able to retire. He’s like, I’m gonna be working until I’m 90. And so we dive into why that is, what’s going on behind the surface and he was really worried about finances because turns out that this really loving father had two middle-aged kids who are racking up ten to twenty thousand dollars a month on his Amex card. right? That’ll

Matt: Yep, that’ll do it. That’ll do it.

Craig Spiel: Do it. That’ll do it really, really fast. And it it turns out, you know, as we’re exploring this, like, okay, obviously we need to change this this system. Something something’s wrong here. But as we started to explore it, there were so many feelings of guilt, so many feelings of shame, of I missed out so much of their life and I want to show up for them now because

Matt: Mm.

Craig Spiel: I worked so much, I divorced their mom, and so now this is my only way to maintain contact with them. There were so many reasons that he was terrified of being abandoned by them. And that kind

Matt: Wow.

Craig Spiel: Of shows that, you know, yes, this is a systems problem. He is he’s overworking, he’s stressed about the finances, but it’s an individual, internal set of beliefs and concerns that’s maintaining that broken system. And

Matt: Wow.

Craig Spiel: So first we had to address that sense of burnout with the community within his family of needing to be everything to everyone and set some boundaries there. And then once we could do that, then we could move on and change the work system that was leading to burnout for him.

Matt: Wow. You you unraveled a whole web of things from that credit card bill. That’s that’s that’s incredible. There’s so much there. Yeah, it is. I

Craig Spiel: Yeah. Yeah.

Matt: Mean, yeah, I’m so glad you brought that up because in the work that we do every single day around money, we’ve we’ve said this a lot that that most of the problems around money have nothing to do with money. It’s the stories behind them. It’s the it’s the reflection, it’s

Craig Spiel: Mm-hmm, absolutely.

Matt: The feeling, it’s the emotions, everything behind it. So really interesting.

Craig Spiel: Yeah.

Matt: What’s so what’s number five?

Craig Spiel: Number five is fairness. So this is the perceived inequity. this could be in pay, workload distribution, promotions, how policies get enforced. Do I feel like things are handled fairly across the office?

Matt: Got it. Is this could could you say, Craig, would this be where comparison comes in? Bec dentistry’s so connected

Craig Spiel: Mm, absolutely. This is a lot of comparison.

Matt: Yeah, yeah. So yeah, could you just speak to that, kind of where the fairness and and and comparison might might apply?

Craig Spiel: Well, and it definitely could apply both within an office, but I think it might be more comparing your practice with another practice too. It’s not fair that they’re being so sexual, exactly. He he took

Matt: Yeah. Your b your buddy from dental school. Yeah.

Craig Spiel: Off to this other place and he’s doing so much better, or I left this place, I’ve enjoyed another place, and now the other place is doing so much better, and it just

Matt: Yeah.

Craig Spiel: Doesn’t feel fair. So it is a lot of that comparison looking at where I expected things to be for myself and the reality I wake up to every day bigger the gap between those two things, the more that feeling of unfairness starts settling in.

Matt: Yeah, it’s so interesting. It’s like w none of us look at these things objectively, right? Because objective truth

Craig Spiel: Mm-hmm.

Matt: Versus subjective comparison, like you could be making more money than you could have ever imagined making as a child or as a high school or whatever, as a young adult, and be there objectively killing it.

Craig Spiel: Mm-hmm.

Matt: But if you fall prey to this fairness comparison, you know, kind of like way of thinking, if you’re not doing as well as your buddy who is your rival in dental school. It just doesn’t feel good. So such a wild thing to think about.

Craig Spiel: Yeah, exactly. Mm-hmm. And there’s a little bit of a restricted range problem as well of who am I comparing myself to. Usually

Matt: Yeah.

Craig Spiel: When I feel like things are not fair, I’m comparing myself to the people at the very, very top, rather than actually stepping back and seeing the full spectrum of what’s going on around me.

Matt: Yeah, yeah. Interesting. That’s so cool. And then what was the the last one here? Number six.

Craig Spiel: Last one would be values. So this is a conflict between personal values and organizational demands or culture.

Matt: Interesting. So would this be would this be fair to characterize this as maybe this is too simple, but kind of the the knowing doing gap like like you say family is your top value, but you’re working eighty hours a week and never see your kids?

Craig Spiel: Yes. Yep. I value my family, but I’m not spending the time with them. or I value patient care and yet I only spend five minutes with them. I don’t have the time I want to to be able to really connect with them. Or I I value their experience and yet everything we’re measuring is billable related, right? When there’s a gap between what we actually care about and what is rewarded, measured, and focused on that’s where we could really start struggling in this area of values.

Matt: Got it. And and I’m curious, Craig, from all of these things, these six components that you’re talking about that all feed into burn? I’m so glad we went down this road and you’ve done like you’ve been able to break all this down. I’m curious from your perspective, how often, if ever, when you talk to a dentist about these things or about burnout and these components come up, or you, you know, you know about the components, they don’t, they haven’t articulated it this way. How often is it like that they They know that this is the problem, meaning they can say like, yep, I am working in a way that’s not aligned with my values, versus just like they’re just burned out and don’t know why. And then you’ve got to dig in and uncover it.

Craig Spiel: It’s a little bit of both. Of course it’s gonna be it’s gonna be mixed in there, but often it’s reported is just I just feel stressed, right? And I need to work on my stress

Matt: Yes.

Craig Spiel: Management. I need to take a vacation. I need you know, it it’s often viewed as if I do this individual work, then it’ll relieve on its own. You know, there’s

Matt: Yeah.

Craig Spiel: There there’s this saying that I’ve heard several times that burnout is about what happens outside the office. And I hope the message you get today is that’s absolutely not true.

Matt: Yep.

Craig Spiel: It’s not just about what happens outside the office it is what’s happening within the office. That’s what we need to change. And so when we’re just focusing externally, like, I need to get more massages or I need to start doing cold plunges, or I just need to take a mindfulness break, that’s not gonna hurt, but it’s also not gonna resolve burnout itself. It goes

Matt: Yeah. Yeah.

Craig Spiel: A little bit deeper. And often, you know, as we imagine what a new system might look like within that office space, that’s where the individual beliefs and emotions start showing up that maintain the broken system that

Matt: Yeah.

Craig Spiel: Keep us going in the system that’s not working. So like for example, I worked with another medical professional who was doing about 14 to 15 hours of work per day.

Matt: Ooh, okay.

Craig Spiel: Weekends, you know, was much better, only four to five hours. And he felt like that was a win, right? only four to five hours on the weekends, right? Just just

Matt: Yeah. Yeah.

Craig Spiel: Way overworked. And so it you know this person it was easy for for them to see like, yeah, I gotta be working less hours. So it was a little apparent that I gotta change this system. But as we dove into it, we found okay, only about seven of those hours were actually patient facing. But because they prioritized patient care, they really cared about their patients, they were spending the maximum amount of time with each patient, just going straight from one to the next without any time for recharge or billing or charting or anything like that, which left everything for the end of the day. So they’d come home, they’d have dinner and then they’d open up And do all the charting, the billing, the messages. And they were so articulate. They really wanted to get all the information down so written really long medical notes, responding to all the messages. And so we talked about okay, what would it be like if we cut this back, if you limit it just to these hours, and all this fear started showing up? Well, what if I’m letting them down? What if I miss something? What if someone dies? You know, all these fears started bubbling to the surface. So Although it it seemed obvious that you know what we need to address here is you need to decrease the workload, what we have to do first is address that fear

Matt: Yeah.

Craig Spiel: of how do we how do we sit with the fact that you’re human, that you can’t do everything, that they’re not even expecting this of you. let’s let’s just sit with that for a little bit and work through that cognitively and emotionally, and then we can fix the system. You

Matt: Yeah.

Craig Spiel: know, there’s there’s this saying by Joseph Campbell. He said that the very cave you are afraid to enter turns out to be the source of what you are looking for.

Matt: Mm.

Craig Spiel: And we often find that’s true. That

Matt: Yeah.

Craig Spiel: We want we want to be able to resolve things at work. We want this to be working smoother. But before we can get that, we gotta face our own fears. What’s going on in here? What are the internal struggles that are maintaining this broken system? And that’s often much less obvious.

Matt: Yeah.

Craig Spiel: That’s what’s hiding under the surface. Whereas the problem at work may be very obvious to a lot of people, that’s what we’ve got to work on first.

Matt: Yeah, it’s so it’s so interesting, Craig. I love that saying. And I couldn’t help but think again what we talked about at the very beginning of this when you’re talking about this dent or this this medical professional that you worked with is again their gift of caring and attention to detail and

Craig Spiel: Mm-hmm.

Matt: Wanting to do an amazing job and make sure that all everything’s done correctly, it was a gift and that made them very good at what they did, but also was a curse and had and had

Craig Spiel: Mm-hmm.

Matt: Consequences far greater than just like I work too much. So it’s it’s really really interesting.

Craig Spiel: Exactly, yeah. Just like you were saying, what was praised in public. I mean, she definitely got lots of praise, but it was punished in private.

Matt: Yeah, really interesting. so let’s let’s come back to so again, really appreci

Craig Spiel: Yeah, yeah.

Matt: You breaking down these detailed components because I think it’s really critical to go deeper than just again the stats I gave, like, you work too much, so you must be burned out. There’s just so much more to it than that. But what are what are warning signs for for dentists out there listening? warning signs that maybe they’re missing something that’s sh like they’re not at burnout level yet. But there’s things that they should be thinking about or maybe they’re on the the the fast track to that.

Craig Spiel: Absolutely. Yeah. So there was a study that came out in 2008 to break in associates to this study. It was a two-wave longitudinal study looking at the chronicle order of how burnout develops. They use some structural equation modeling with a representative sample of Dutch dentists. And what they found is that the very earliest sign is that emotional exhaustion. And I think that that’s important because it is really easy to normalize exhaustion. You’re exhausted, I’m exhausted, everyone’s exhausted, that’s just part of it, right? Right?

Matt: Yeah, you got kids, you’re exhausted. Let’s just call it what it is. Yeah.

Craig Spiel: We never sleep, you know, it’s it’s okay, it’s just part of part of it. But if you’re feeling exhausted and you don’t feel like you can ever get that battery full where you’re just always running on fumes, that’s the earliest sign. That’s the what’s super important to pay attention to. It’s a place to intervene before it hardens into that cynicism toward patience or that collapse of professional self-efficacy, which are much more hard difficult to reverse and a lot more corrosive to practices. So that’s one thing that I would say dentists should pay attention to, but there are also other signs that we can notice. So for example, productivity dips, but so does judgment. Dentists who are burnout tend to make treatment plans that get either more conservative or more rushed. And either

Matt: Hmm.

Craig Spiel: One is a tell. And they themselves report increased errors and near misses. So, noticing that in how I’m actually doing my craft, team turnover often precedes the dentist’s own recognition of burnout as well. The staff feel that shift before the dentist even names it. And

Matt: Hmm.

Craig Spiel: Then the patient relationships suffer themselves with that depersonalization, that cynicism, patients can feel that detachment even when clinically nothing has changed. And exhausted dentists show measure measurably reduced reduced attentiveness and communication during the visit. So while we think about burnout as kind of this separate wellness issue sitting next to my business, I would suggest it is a business problem. It’s not

Matt: Yeah.

Craig Spiel: A wellness problem next to a business problem, it is a business problem.

Matt: Yeah, especially in dentistry, you are the business. Like you are if you

Craig Spiel: Yeah.

Matt: You are the business. So yeah, absolutely it is. I can’t help but think, Craig, as you’re going through this, that one of the hardest part maybe maybe the hardest part of this would be actual d I guess to use medical term, like diagnosis. Like meaning you’ve gotta you’ve gotta be able to like have a system in place of identifying this. Like the whole saying of like a problem half sol or a a problem defined as a problem half solved, but like you’ve

Craig Spiel: Mm-hmm.

Matt: You’ve got to define that problem. So I guess before you even get to like something needs to be intervened on here, how do dentists stay aware of this? Like I I cause I I think it could be easy for a dentist to be like, well, yeah, I’m freaking tired. I run a practice. I’ve got three kids at home. Like I just bought a house or you know, whatever. W

Craig Spiel: Mm-hmm, yeah.

Matt: How do you identify like or what are are are there things that dentists can be like feedback systems or just things that they should be thinking about of how to identify this first.

Craig Spiel: I think that, you know, one thing is when they listen to to podcasts like this one, right? You know, they’re becoming more aware. What does it look like? How how

Matt: Yeah. Like, wait a second, I am exhausted. Yeah.

Craig Spiel: Is this? and and it is, you know, internally it starts feeling like that exhaustion that just never lifts. And I start feeling detached from others and I feel like I can’t make a difference. If you’re recognizing those signs, that’s that’s what burnout looks like. That’s the time to reach out. But

Matt: Yeah. Yeah.

Craig Spiel: Also again, if you’re noticing these these other signs, okay approach productivity is dipping. There’s a lot of team turno turnover. patients are are are feeling this this tension and reporting it. You know, if we’re seeing those other signs showing up in the numbers, that might be a good time to take a look inward and say, okay, could this be burnout? Is that what’s going on here or is it something else that I gotta change?

Matt: Yeah, I would imagine ha like needing you’re talking a lot about systems and having something a trusted business partner or a trusted

Craig Spiel: Mm-hmm.

Matt: Advisor or your your spouse or partner or your team. I’d imagine that having like some type of regular feedback system would be critical for this because I think we’re probably

Craig Spiel: Mm-hmm.

Matt: The worst observers of our own life. Right. Like we like I think we just kind of adapt and it’s like I’ve always been like this. So having something

Craig Spiel: Yeah. Mm-hmm.

Matt: There that your team can provide you like, Hey Doc, you kinda been an extra jerk today, like or this week or this month or this year. Like something there.

Craig Spiel: Right, there’s something going on there. If you’re getting that feedback from your team, your spouse, other dental partners, first of all, try not to get defensive with it, right? Take t

Matt: Yeah, yeah, gotta be open to this, yeah.

Craig Spiel: Take it as like you think I’m busy, you know, look at what I’m doing, right? I could see a tendency to take that feedback and and not receive it for for what it is, which is a kindness.

Matt: Yeah.

Craig Spiel: They’re trying to express a kindness to this. They’re only saying this because they care about you as a person. And

Matt: Yeah. Yeah.

Craig Spiel: So rather than brushing it off or saying, it’s no big deal, I can keep doing it, take take stock, take a moment, go, okay, hold on. Is there something behind this? Yeah,

Matt: Yeah.

Craig Spiel: Are there warning signs I’m I’m missing right now

Matt: Yeah.

Craig Spiel: That maybe I should address?

Matt: Yeah, well yeah, for sure. And I think it’s interesting as this is such a helpful topic, even for dentists who are not feeling these warning signs, because the time to prepare for those things and build these systems would be prior to them actually showing up.

Craig Spiel: Mm-hmm.

Matt: Like having a because that that comes down to the to the coming back again, this idea of the leader. The leader is the one that should be building a system and setting a precedent of we have an open feedback loop. So I know if and when something changes with something like this, my demeanor, my approach, my diagnosis, all these things, I I’ve got to have that in place. So is it almost i I’m kind of maybe saying or I wanna hear from you, like is it almost if you don’t have those things in place, like maybe it’s sort of too late if you’re already at the burnout stage. Not saying you can’t fix it, it does it just make it harder.

Craig Spiel: You can absolutely fix it. And I think what you’re talking about is how to create like a burnout proof practice. How do we do it ahead of time so it doesn’t get to that point? There we go.

Matt: There you go. That’s the title of this episode. You just nailed it. There you go. Thank you. You’re doing you’re making our job very easy, Craig. I appreciate it.

Craig Spiel: And so if we want to build that burnout proof practice, then I would say start with those six areas. And whatever we measure tends to improve, right? So have

Matt: Yeah.

Craig Spiel: it what are ways of measuring these things? And some of it, you know, values, kind of difficult to measure, but try to determine, okay, if if a patient walked into this clinic, how could they be able to tell our values just from how we interact? What would they be able to see? Can we make it very behavioral? Can we move toward that? And then So it’s not just like a one-time rollout thing. How do we regularly come back to this? What are our values? What are we doing to connect with them? How are we measuring them? and looking at all those a areas between the workload and the fairness and the control and the reward, the community. how I’m measuring these things, how’s the feedback loop and creating that culture within the practice to reduce burnout, not just for the dentists, but for their staff as well.

Matt: I knew d honestly, we were on the same wavelength. As you’re going through that, I’m like, wait a second. We’re sitting here talking about the dentist, which clearly that’s that’s our main focus. But

Craig Spiel: Mm-hmm.

Matt: As you’re going through that, we were both on the same page. I’m like, what about the staff? This should be a burnout prop Yeah.

Craig Spiel: Yeah, this is not just for them. Mm-hmm.

Matt: So I’m curious about that. When you’re when you’re going through this with doctors and medical professionals, how often are i is it part like the staff’s a part of this as well? What what do you see there?

Craig Spiel: Quite often, because again, within these systems, when one part is struggling, the others try to compensate for it.

Matt: Yeah.

Craig Spiel: And so it’s rarely that just one person is burning out in isolation. Usually we see it’s it’s got its ripple effects in other areas throughout the practice, as well as through the dentist’s life. with with relationships with family, with community commitments, with religion, with in a lot of different areas we can see that burnout is a fire that rarely is contained. It starts

Matt: Yeah.

Craig Spiel: Spreading to other areas. And so with that in mind of building that burnout proof practice, it’s not just about the dentist, it’s how can I create these systems where others also feel like things are handled fairly, that they’re rewarded and and acknowledged and compensated fairly, where they have a sense of community amongst everyone here, where it’s really in line with our values as we show up every day.

Matt: Yeah. Super helpful. I I’m curious, Craig, what, if anything, do you have you seen holds dentists back from getting help around this? Like I I I would imagine there’s some dentists out there listening and and I’ve I’ve seen it myself who it’s like they know they’ve got some issues in this arena, but something’s holding them back. W what do you see those things maybe being?

Craig Spiel: I think it’s the belief that I can do this on my own. And again, going back to one of the themes of this whole podcast, that is a very helpful belief in so many areas of your life. That is not a bad belief. Absolutely. It’s a very

Matt: Yeah. It got you to where you are. Yeah.

Craig Spiel: Helpful belief that I can do this. I got this. But when when you’re faced with burnout like that, it’s kind of like you know, you’re you’re rock climbing and you’re in the middle of in the middle of the climb. And when you’re right there on the wall, you can’t really see where the handholds are. You can’t really see where to put your feet. You can’t really see how to navigate because the wall is just right up against your face. And you need someone on the ground with a different perspective. You

Matt: Yeah.

Craig Spiel: Need someone to go say, hey, actually come down this way and then go over this way, and then there’s the hold there, and this is how you make your way up. And

Matt: Yeah.

Craig Spiel: So I think that that belief that I can do this on my own, I don’t I I I got this, is one of the big things that keeps us stuck as well, that keeps us from reaching out for help. So if you’re listening to this and you’re really resonating with it and you’re like, Yeah, okay, definitely I’m showing all these signs of burnout. reach out. Reach out to professionals who understand what burnout is and how to help you navigate this. and again, that’s why I created the still coaching is to be able to help Dentist navigate that and I find it an an honor to help anyone off that rock wall ’cause it’s a very lonely place. It’s

Matt: Yeah.

Craig Spiel: Tough to be there.

Matt: Yeah. And I think again this applies to every single dentist out there, whether you’re feeling these things or you’re not, because again, it’s if you’re not feeling these things, first of all, that’s great. It’s I’m I’m we’re glad that’s the case, but there’s going to be like you want to set up those systems, like you said, building a burnout free career, a burnout free practice. So this applies to to to everyone. I want to come back to something you you touched on and maybe just expand on just

Craig Spiel: Mm-hmm.

Matt: briefly, is this idea that we’re not talking about a wellness, a personal wellness problem. We’re talking about a business problem. You you’re hitting on this idea that we talk about all the time, which is the interconnectedness of a dentist’s life. You

Craig Spiel: Mm-hmm.

Matt: Mentioned it, this entreprofessional. They’re kind of the last frontier of that. Could you expand on that just a little bit of getting dentists out of this mindset of like, compartmentalizing, like, yeah, that’s my my mental health, but that isn’t, that’s not my business. Cause I think that maybe sometimes holds dentists back.

Craig Spiel: Yeah, it definitely can. That view that, yeah, you know, I I I struggle with stress management, but that’s not impacting my work and I can keep doing this and all I gotta do is put these things in place. The the right vacation or the right meditation app will fix this. but going to to examples of, you know, the professional working fifteen hours a day, a ten minute meditation break is not gonna fix that. That that’s not what we’re looking for, right?

Matt: Yeah. Yeah.

Craig Spiel: It’s not a problem with stress management. It is a systems problem that that we have to address to be able to relieve the burnout. now, yes, there are individual factors that contribute to it, and we’ve got to address those as well, but it is primarily job focus and when we change the job conditions, that’s when the burnout lift lifts. And it also, you know, it it’s not limited just to the person’s feelings of stress either. This spreads to relationships. How often do do dentists focusing on their practice, focusing on building it, focusing on pulling on more patients or or hiring a a dental partner start sacrificing things at home and start seeing problems in other areas of their life too. So this this isn’t something that’s contained it it impacts it has influences on a lot of different areas of our lives. And when we can start to see that, then we can reach out for help.

Matt: Yeah.

Craig Spiel: Beginning, start asking for help. Cause then you get that different perspective and then you learn new tools and then you get to practice it and then things start changing.

Matt: Yeah. This is again such an important conversation. Craig, and I can’t even as we’re going through this, I can’t help but the countless amount of examples of of working with so many dentists over the years that we’ve experienced where dentists think it’s think their problem is one thing to only find out it’s another. Right. And and just generally speaking, around this idea where dentists, one of the answers a lot of dentists think. Especially as they get like mid or kind of like second half of career is like, I gotta get out of dentistry. Like that’s clearly the answer. I gotta get out. I gotta retire. I gotta get out of here. And then as you dig in and and and start to f ask the questions and and really start to examine what’s happening, it’s oftentimes just as you’ve mentioned multiple times through this discussion, a systems problem, a structural problem, a procedure mix issue, staffing, whatever it is. And there’s some tweak or something they need to change that opens up the their world of like, my gosh, that’s the answer was not exiting. The answer is just making some of these changes. It feels like that’s what you’re talking a lot about much, much,

Craig Spiel: Yeah, yeah it is.

Matt: Much deeper on a much deeper level.

Craig Spiel: Mm-hmm. Absolutely.

Matt: So I’m curious, Craig, for dentists who are out there, again, this is helpful across the board, but the dentists specifically who are feeling these symptoms and that they’re like, Yes, I’m I’m somewhere on the spectrum of burnout. Where do they begin? What’s the what’s a step they can take today to to get on the right path?

Craig Spiel: A step they can take today when they’re realizing that, okay, yeah, I’m exhausted, I’m feeling that depersonalization, I feel like I can’t do very much right now. Begin with identifying which of these six areas where am I feeling the most burnout? Where are the problems lying for me? reaching out to people that they trust and getting their opinion as well. Again, you know, it’s sometimes hard for us to see it within ourselves, but sometimes others with a different perspective, they can lend that to us. And then once they get a a better sense of where the burnout is is occurring in their life. this is a time to to reach out to for help from professionals that are really good that understand what it’s all about that can help guide you through it. And I wish you could say that you could do it completely on your own. I know that you’d love that answer, but it is so, so challenging to do that when you’re stuck on

Matt: Yeah.

Craig Spiel: That rock wall. So notice within yourself, kind of identity where it’s coming out, reach out For help, reach out for assistance. There’s a lot of people that’d be willing to help you through this.

Matt: Yeah, it’s interesting, Craig, that you say that that part about doing it on your own. What is it about us, meaning humans, especially high achieving people like dentists, I think, who think that’s a failure? Like where we gotta shift that mindset a little bit of like, I can do this on my own as if that’s the only that that is the definition of success. I know it’s a bit of a set.

Craig Spiel: Like if I reach out for help, I’m I become a burden, I’m a failure, I’m letting people down. Yeah. Uhhuh. Yeah.

Matt: Yeah, or or I fail. Yeah. like where where along the way did we fail where where along the way have we equated reaching out for help as I failed? I feel like there is something weird about that.

Craig Spiel: It definitely is a pretty common sentiment, right? We

Matt: Yeah.

Craig Spiel: feel like reaching out for help means that we’ve failed. And I mean the short answer is no it doesn’t. No, it we we

Matt: Yeah no it doesn’t.

Craig Spiel: we haven’t failed. In fact, reaching out for help is one of the the greatest signs of emotional maturity. It’s how we learn, it’s how we grow, it’s how we see, okay, yeah, I’m I’m outside of the comfort zone, I’m over here in the growth zone. I need

Matt: Yeah.

Craig Spiel: I need a guide, I need someone to to help me navigate through this so that we can do it in a way that is healthy, in the way that helps us feel the joy that we started off with and capitalizes on the strengths without it getting in our way as much.

Matt: Yeah. Yeah. So yeah, that’s interesting. really, really helpful. So Craig, could you maybe just kind of summarize key kind of key takeaways, key points that

Craig Spiel: Mm-hmm.

Matt: To to wrap this up, Dentist what Dentist should be thinking about around burnout and the things we discussed today.

Craig Spiel: Absolutely. So key points walking away from this. First of all, burnout has the three components. There’s emotional exhaustion, there’s the depersonalization or cynicism, and there’s the decreased sense of self-efficacy that I can’t do this anymore. Recognizing that within yourself, within your team is really important. Now, there are several different areas where burnout might show up, mismatches like we’ve we’ve talked about. these are the things like recognizing values, fairness, community, reward, control, or workload. And seeing within yourself where those things might be showing up, what’s going on there. And if I’m see seeing it there, recognize you don’t have to go through this alone. Reach out for help. We’re there are several here to support you through it.

Matt: Yeah, that’s awesome. And so Craig, how do people reach you? If someone’s out there listening and they’re thinking, Whew, it’s time. I need I need to get some help here, how do people reach you?

Craig Spiel: So to reach me personally, I’m at Craig Spiel @ spielcoaching.com That’s my email address, or I have a website that’s spielcoaching.com lots of ways to contact me there. I’d be more than happy to to hear what you’re going through and provide a consultation to see if that’s something I can help you with.

Matt: Awesome. Well, Craig, really appreciate the time, the wisdom you know, you g you giving of your knowledge over the, you know, so many years of you doing this. I think at the very least, this discussion is hopefully out there helping somebody to to kind of take some steps to you know, helping their situation. So really, really appreciate that. so i if you’re out there listening and you’re you’re feeling this, I Yeah, definitely reach out to to Craig. He he like you said, he’s he’s here to help. Really appreciate it. And then of course, all things finance, money, investing, tax accounting, we’re here at dentistadvisors.com as always. So Craig, thank you again for being here. Really, really appreciate it. Everyone, thanks for listening. Until next time, take care. Bye bye.

Keywords: dentistry, burnout, mental health, practice management, systemic change, emotional exhaustion, professional well-being

Practice Management, Work Life Balance