Wellness

Get free, unlimited access to over 20,000 on-demand audio and video workouts including strength, cardio, stretching, meditation and more. ADA members can also receive a 15% discount on in-person classes at top studios and gyms throughout the country.

Explore options.

Access free resources to help reduce debt, manage your finances, and plan for a more comfortable financial future. Watch on-demand webinars, review handy guides and learn about discounts and assistance from ADA partners.

Explore resources.

The ADA teamed up with NAMI Chicago to develop wellness programming and ways to support members and staff during the COVID-19 pandemic. Provided in part through a grant to the ADA from Crest + Oral-B, these resources were designed to help new dentists and their teams support each other’s mental wellness.

The Ultimate Workplace Mental Health Toolkit, created in partnership with Launchways, includes:

• Key mental wellness concepts
• Guidance on an overall approach to workplace mental health
• Quizzes and surveys that can help start the conversation among your team

Download the Ultimate Workplace Mental Health Toolkit (PDF).

Explore other NAMI Chicago resources:

• Protective factors and challenges (PDF)
• Recognizing burnout at work (PDF)
• Monitoring wellness inside and outside of the workplace (PDF)
• Wellness and work (PDF)

Hope For The Day

Hope For The Day (HFTD) is a non-profit movement empowering the conversation on proactive suicide prevention and mental health education. Below are info sheets regarding mental health and the workplace + dental profession.

• Mental Health and the Dental Profession
• Mental Health and the Workplace

Dr. Betsy Shapiro:  Welcome to the American Dental Associations practice podcast, Beyond the Mouth where we won't discuss clinical dentistry, but everything else is fair game. I'm Dr. Betsy Shapiro, a director with the practice Institute of the ADA. In this episode, we're talking about keeping you and your staff mentally healthy during COVID-19 and any other time. Joining me is Alexa James, the chief executive officer at NAMI Chicago. NAMI Chicago is an affiliate of the National Alliance of Mental Illness. Its mission is to improve the quality of life for those who are affected by mental health conditions. Ms. James earned a bachelor's degree in psychology and a master's degree in social work from Loyola University, as well as a second master's degree in child development from the Erikson Institute. Hello, Alexa, and welcome to our show.

Alexa James: Hi Betsy. Thank you for having me.

Dr. Betsy Shapiro:  We're delighted to have you. This is a very stressful time and we are so fortunate to be able to spend a little time and chat with you about it. To start, can you tell us a little bit about NAMI Chicago and what led you to work there

Alexa James:  Oh, it's so funny. I was just asked the same question yesterday in a meeting and I thought, "How do I want to tell this story?" NAMI Chicago is an advocacy organization. We do not really provide direct service, so we're not doing therapy or psychiatry, et cetera. What our hope is, is to connect people to care and with the least amount of trauma. The mental health system is super complicated. It's so complicated in fact that you really need a broker agency to help you navigate the system, which is a problem. So a lot of our work is to advocate for a more equitable system that has more access, less expense, but also to make sure that people feel safe and comfortable seeking services. There is so much stigma surrounding mental health still. I do think that COVID-19 has actually really changed that conversation, which is a little bit of a silver lining of all of this. And we do so by connecting people through our helpline, support groups, the tremendous amount of training and education and really corporate wellness right now is at the core of our work.

Alexa James:  The way I ended up at NAMI was an accident. I was finishing grad school, as I'm sure many of you listening can understand, broke. And I thought to myself, I need one more internship. And the internship had to be very specific because I was getting two master's degrees at the same time. So it had to be mental health, but it had to be developmental and system focused. And I said, I need to only be an intern where they're paying me. And I remember in grad school director said, "That's not a thing." And I was like, "It's a thing. Let's find it." And she said, "Oh, you know what? NAMI Chicago is paying their interns. They're paying their interns to do some crisis intervention work." And I was like, "Okay, sign me up." So that was 2009. I worked there for a while. I worked in a psychiatric hospital and then I came back in a leadership position and I'm so glad I was broke in grad school because I may not have ended up in this space. So that is my story of how I got into NAMI.

Dr. Betsy Shapiro:  That is a perfect story. I don't know if there are accidents or good planning on your part and on NAMI's part, but I think we're all fortunate you're there. Let's start out this conversation for dentists on a big topic. What is the baseline for most people? In other words, what does it mean to be well? If we start from a point of wellness.

Alexa James:  I love that question. And it's interesting. It's being asked more. It never used to be asked. And I think that is because we all understand that mental health is a component to us daily, that it's no longer this like, Oh, some people are impacted like come on. Our brain is connected to our body, but our relationships are connected. So it's interesting that you asked about foundation because foundations of your mental health will change throughout your life and change depending on what your environment and experience looks like. But generally mental health or wellness looks like having functioning relationships where there's reciprocity. Now listen, some people really want to be alone and that's how they energize and that's fine. I have a lot of friends who are like, I don't like to be around people. So actually the beginning of COVID, some people were like, this is for me. And that makes sense. Not everybody's an extrovert.

Alexa James:  But as humans, we do crave connection and we do heal in connection. It doesn't have to be 50 people at your birthday party, it can be one really important person, so that there's some level of connection there. So having a functioning relationship or relationships, really being able to manage trauma and stress in a way that doesn't interfere in your relationships, in your work, in your purpose, having a sense of purpose, something that we should spend some time talking about because it's been really missed during COVID this luxury of being creative and innovative and collaborative, and also having the ability to adapt to change. Change is very difficult and very triggering for most of us. Change isn't fun. But what is required of all of these behaviors is the idea that our foundation is strong enough, that our connections are strong enough and healthy enough, that we are working on healing and protective factors like exercise and eating well and reading and being stimulated, that all of those things are available for us to pull from when we need that additional support.

Alexa James:  The challenge of course is when we don't have those protective factors, what we call those coping resources available to us, and then change is thrown at us and adversity and trauma is thrown at us, the relationship change, that's when we see people really start hurting and often suffering by themselves and not even knowing that's what's going on. That's, what's fascinating too, is the lack of mental health literacy, which I think is required to be really in touch with your wellness. So that was a long answer and I apologize, Betsy. The truth is there's really no standard operational definition of wellness because it is so based on how we feel and how we interact in community.

Dr. Betsy Shapiro:  It makes perfect sense that it's a long answer. We are not one person across the board ever. And so I would suspect we're all responding a little bit differently to what is our level set. Not to joke about COVID or the pandemic, but I would tell you that my introvert self has been in training my entire life for a stay-at-home order.

Alexa James:  Yeah.

Dr. Betsy Shapiro:  I found it much less frustrating than many people I know. So I appreciate that it's different for everyone.

Alexa James:  And you know what else is interesting is that folks who have managed high levels of depression and anxiety and worked really hard on it and understood their triggers and understood what they needed from their coping resources, are teaching us a lot. People who have not experienced that. People who are experiencing that for the first time are teaching us a lot about how do you cope in an uncertain environment where there's very little for us to control. And that's been super interesting. So there's folks who have fared differently because of their past lived experience.

Dr. Betsy Shapiro:  Can we unpack that just a little bit. When your purpose has been shaken by something like COVID or any other experience and when your environment has drastically changed, how do you cope? What are those things that you're learning from people who have been through this and learned to cope?

Alexa James:  Well, I think it's super important to acknowledge what hurts. Our body gives us data that we be often respond to with an intervention from an expert. We don't do that with our mental health. We don't use the way we feel as data. So the first thing is to identify, I am feeling grief. I am feeling loss and it is out of my control. What do I need to do to process how that feels so that I don't feel stuck in that emotional stress state. And actually a lot of what we use are our foundational tools to get us out of that. So purpose is making sure that your values and what you're doing match, and that you have an opportunity to be creative. I started coloring. I'm an adult with a three and a six year old. It's really lovely. I am not a good artist.

Alexa James:  I do not care. I'm not going to be putting my pictures on the refrigerator with a magnet, but it's finding that outlet that really honestly serves the purpose of removing you from the rumination of what's making you feel out of control. That's what we need to stop and the definition of trauma and being traumatized is powerless. So it's identifying the grief and the pain, identifying what you're powerless over and frankly, putting yourself in positions that are a bit uncomfortable, because that is how growth happens in this new arena. Does that mean, well, I'm not typically a runner, but the gyms are closed, maybe I'm going to run, jog with a mask on around my neighborhood.

Alexa James:  Creating new competencies is critically important. So identifying and then finding that safe person in your life. COVID has taught us and taught a lot of people that have called us how interesting it is to be forced to spend time with people who are not validating and who don't make us feel good. Our call volume has increased dramatically because people say, "It's just nice to talk to a clinician once a day and feel validated." So figuring out what conversations make you feel good and which conversations make you feel worse and trying to avoid those. I would say those are the first two steps.

Dr. Betsy Shapiro:  You talked about acknowledging and saying, "This is what I'm feeling. I've got this grief, I've got this pain. I feel this sadness." Are there warning signs we should be looking out for either within ourselves or within our staff or members of our household?

Alexa James:  Absolutely. What's interesting about the workplace, particularly with essential workers that are physically together is that you can notice behavior change and you can decide what to do with it. It doesn't have to be diagnostic. If somebody that you work with is more quiet than usual you can say, "How are you sleeping? Are you sleeping okay?" And maybe they say, "Gosh. No. I'm having wild dreams," which is actually happening a lot with COVID or, "I'm not sleeping," or, "My kiddo was up all night," or whatever. And then the next day you get to lean in again and say, "Did you sleep better last night?" So you start to find a connection. So things to look out for are behavior change, things to look out for too are agitation, maybe like sloppy work or details missed. When we are in a space of anxiety, which means that we're worrying all the time and we're hypervigilant and maybe we're even having physical symptoms. We want to see how people physically look, do they look more tired? Do they look less put together? Where they typically wearing makeup and mascara and lipstick, and now they come in with nothing?

Alexa James:  Some other warning signs would be real morale issues, like folks who are feeling really hateful about their work, cynical about the bureaucracy or the leadership within work. That typically to me is a sign of burnout and also lack of insight, which is really a bummer because when we get burnt out, we get this compassion fatigue. When we get tired that this new environment that we have to work in, we often lose insight that what we're feeling is actually powerlessness. It really has nothing to do with the institution. So those are also some signs to look for.

Alexa James:  And there's certainly remedies and things that can support folks, but physical signs, agitation, withdrawal, significant change in behavior, work product changes pretty dramatically. Or you may see your employee or your colleague throw themselves into work, which also happens a lot because some people freeze and some people just distract, distract, distract by working, and then also have the risk becoming burnt out from a different way.

Dr. Betsy Shapiro:  It's very interesting as you go through that list and I'm sure this is happening for many of our listeners. I'm picturing different people in my life. And there were particular responses. And I was thinking, Oh yeah, that's a flag or that happened, now it seems to be getting better, but I should be aware of that. Dentists in general, we run a small shop for many of us and we're trying to do three things. We are providing essential healthcare to our patients, the brushing and the flossing and the physical health of their oral cavity. We need to be a leader to our dental team. And we also need to keep ourselves well in order to do those first two things. We can't do those if, if we're not healthy ourselves. How does a dentist include supporting the mental health of their team as part of their leadership model when they are struggling themselves?

Alexa James:  I know this is so hard. It's just a hard time. I don't mean it's hard to do because we are going to give you those tools and you're going to feel good about them and we're going to support you as well as leaders. But I remember one of my chief integration officer said to me, like our second week of stay at home, he said, "We're all peers now." This isn't like, I'm good. I'm a clinician, I have two degrees, I'll take care of you. We're all like what is happening and then layer and layer on everything else and the complications of life. And there's no more separation between work and home now. We're all working too much because we can in this space so it's really tough for leaders.

Alexa James:  The first thing I'll say is create equity in your big shop or small shop. And what I mean by that is safety of your patients has changed significantly and the protocol and all of these things you are doing to maintain safety of your patient population so that they feel good getting their healthcare needs met. Are you doing that for your employees? Are you creating a community that feels that safe for them and ask them what they need? I noticed that as a leader of this organization, we are housing people. We spent like $85,000 putting people up in hotels when stay at home started because our shelter system in Chicago was so fragmented. And I thought to myself, we are really going above and beyond for community because that's our mission. But I'm looking around at my team and they're tired and they don't want to go to the grocery store and they lost their gym membership. And I thought, if I'm going to do this for community, I'm going to do this for my staff too.

Alexa James:  And we completely reframed the way we think of wellness. As a leader, we don't have the luxury of not being well during this time, we just don't. We are resourced people of privilege, having jobs and being employed during this time. And we can be sad and vulnerable, but we have to first figure out who we lean on so we can maintain and continue to encourage. It is okay to say to yourself, I am really low today. Today's a tough day. I realize I'm in month nine. My three-year-old can't go to school because there's a COVID stick air. I didn't get my workout in. I can't feel tight, whatever it is. I feel low today. I'm going to ask you to step up a little bit more. Thank you. Lean on your community and tell them how feel in and start to normalize that conversation in your community.

Alexa James:  But just like we say, when you're getting on an airplane, put your mask on first, before you help others. We as helpers think that we are in control and nothing will bother us. And so it's super important to say, I am not of service to anyone, particularly as a business owner, as lead doctor, as leadership, if I am that while myself. And it doesn't mean you have to be perfect and it doesn't mean you can't ask for help. The first thing that I did is set up free therapy for everybody on my team. Some people used zero sessions, some people used 25, so we just paid for it. We found a clinician who was willing to do that. We set up breaks in a much more substantial way for people so they could really decompress. There is just constant stress all the time. And I'm sure many of you and your employees are afraid of getting sick too. So there's that going on all the time, again, this powerlessness.

Alexa James:  How do you create wellness? I think you have to do it in buckets. You have to be well, you have to make sure that there's policies in place that support your employees, including safety, but also health insurance. Is your health insurance adequate to provide adequate mental health services, particularly teletherapy? And there also has to be engagement, which the associations are just so great around mental health awareness to increase mental health literacy. And the best thing I think you can do as a leader besides being well yourself is when you're onboarding or when you're having staff meetings, or one-to-one saying, "When you feel stressed or out of control, what do you need?" Some of them may say, "I need a really healthy lunch. I need to be able to take a walk during the day. I need to work more," whatever it is so that you can monitor and identify when they're feeling that way and then offer them a resource. They will work harder for you if you create that space for them I'm sure of it.

Dr. Betsy Shapiro:  Thank you so much. That was incredibly powerful. Just the concept of we are all peers in this, there isn't a particular leader in this instance because we are all in the same boat, little variations of the same boat. In dentistry, many of us hold a morning huddle to go over the schedule for the day. It's a very short five minute meeting. We touch base. Here's where we have a space for an emergency. What are we concerned about? Anything like that, but it can also be a time for team building. Can you give us some specific ideas and tangible ways that dentists can incorporate team building into their staff meetings and focusing on mental health and wellness for our staff.

Alexa James:  For sure. You can do a check in and check out every time you do a huddle. Name how you feel emotionally and physically. And we just had a meeting and our chief wellness officer went around the Zoom and said, "What are you doing to make it through today?" And I thought that was really a good question because part of wellness is insight, right? And so when you are allowed to take a moment and think about it, that in of itself is self-regulating. That is self-compassion right there. Oh my God. I'm thinking about myself for 30 seconds. When does that happen? Especially as a leader of a medical group, and it also tells your leadership or your colleagues, or it gives them an opportunity to be accountable to you.

Alexa James:  You can do check-in when you're doing your huddle, you can say, who's your accountability partner today to do this one thing, to eat that healthy lunch to meal prep, and you check in with each other. We just start this culture of coaching and support around specifically mental wellness. And that topic will become normalized I think pretty quickly, particularly in this culture where people really are hungry to express how they feel.

Dr. Betsy Shapiro:  Following up on that. What do you feel about if you're doing that in your morning huddle and someone says, and I would be the person saying this some days, "I got a great pan of brownies and I'm just eating them and powering through." And that's not a particularly healthy habit to deal with my stress, but that's my answer. Is that a time to try to intervene on that level?

Alexa James:  No.

Dr. Betsy Shapiro:  Or do you just accept it and-

Alexa James:  You say, "Eat those brownies," and put no shame around it.

Dr. Betsy Shapiro:  Okay.

Alexa James:  Yeah. You're welcome. Now, all of you good folks listening are like cavities, but I think that that's honest. So this is a such a good point Betsy, there is a difference between healing behaviors. I think of healing and behaviors as things that move you through the emotion so that you're stronger on the other side. And then there's coping. And frankly coping is to manage a feeling that feels uncomfortable when you just don't have the space for it. I'll go home after my kids go to bed and all the glass of wine and watch a silly show because I just needed to like numb a little bit. And that is fine to do once in a while. And we should not have shame around it. This is too much right now. Have any of you woken up and think what else is going to happen in this country? So give yourself some grace to eat those brownies or to make yourself like a cheesy something or to binge-watch. Give yourself some grace because you are surviving in a world and you're building resilience.

Dr. Betsy Shapiro:  Thank you a million times over.

Alexa James:  You're welcome.

Dr. Betsy Shapiro:  My own part and everybody else who just heard you say that sometimes it's okay.

Alexa James:  Sometimes it's okay.

Dr. Betsy Shapiro:  Just grant yourself that permission and be as good to yourself as you would be to anybody else, you who said that?

Alexa James:  Exactly.

Dr. Betsy Shapiro:  One thing I do want to touch on. I admit that I looked at the NAMI website more than once as we were going through this. And I noticed that you did seem to have some team building resources. Are those available to anyone?

Alexa James:  Anyone.

Dr. Betsy Shapiro:  Okay. Is it a guide for someone to use for instance, in a dental office setting? Can they pick pieces of it that would be useful?

Alexa James:  Absolutely. Yeah, we developed a toolkit around how to create wellness in the workforce. Now we think sequence is important. So don't implement a new policy without first doing the mental health training, but it's all in there. One of the things that is good about this remote work environment is we are far more accessible to places now outside of Chicago, to provide that consulting support around how you implement this stuff. The great news is none of this is rocket science, but you need leadership buy-in. You need to really believe that mental health impacts your employees, impacts your return on investment, impacts you, impacts your patients. And then what are some low hanging fruit ways in which to start to acculturate that idea. And many of you are probably already doing this and you're probably already doing it without even knowing it. When you give flexibility, when you give grace, when you listen with intention, that's what it is.

Alexa James:  And now it's just building upon that and making sure that policies and programs are in place. It's even little things, Betsy, like changing six days, your PTO to well days. Frankly, I don't care how people take their sick days. If they're taking it because they're depressed and they can't get out of bed, if they're taking it because they need to celebrate something to be joyful, it's none of my business. This is your PTO, and this is your wellness and it should be comprehensive. And you can find that resource at namichicago.org, and also know that there's other resources on the website.

Alexa James:  I'm sure many of you have kiddos. We have really interactive resource around how do you talk to your kids about their mental health? How do you listen actively instead of just the car ride, which I know is always the best time to talk to my kids because I'm not intensely looking at their eyes. But there's a lot of really helpful information. How to love somebody who's struggling. And also you can always call us at 833-NAMI-CHI. We are open seven days a week. We are free. We are available to help you find resources, but also coach you through conversation.

Dr. Betsy Shapiro:  Before we let you go, is there anything else you'd like to add for our listeners?

Alexa James:  I think that we are really worried as a community about what's going to happen, how our kids' mental health is going to be impacted by this, how our mental health is going to be impacted, all of the fears, our business longevity, all of this. And I think that there's obviously reason to be worried, but what I also don't think is being talked enough about is the fact that stress is okay. Stress really builds your ability to be resilient and resiliency is what we need and what we need to model to our employees, to our colleagues, to our family, that we can get through this if we are honest and accountable, if we lean on community. So what I would say is think of creative ways to maintain connection to community because that's really where we're going to start to feel better. And I know that it's difficult in this remote environment or in this disconnected environment where we're not hugging and spending time together in the same way, but that is important. And when that starts to slip, then I get worried.

Alexa James:  But I think that we can model real strength here while still grieving. A lot of pretty terrible things that have happened. So you're not alone in feeling overwhelmed. You're not alone in feeling anxious and you're not alone if you feel low and hopeless, we got to find that hope for you though. And that's hopefully what NAMI Chicago can do to support all of you.

Dr. Betsy Shapiro:  Thank you again for joining today, Alexa, and we truly appreciate you being with us. 

Alexa James:  Thank you, Betsy.

Dr. Betsy Shapiro:  If you have questions for Alexa, you can visit the NAMI Chicago website at namichicago.org. And even if you aren't in the Chicago area, NAMI has over 600 affiliates across the country. Visit nami.org to find your local chapter, free nationwide peer support service is available through the NAMI helpline 800-950-NAMI, that's N-A-M-I. 800-950-NAMI.

Dr. Betsy Shapiro:  We are now at the part of the show where we answer a member question of the day. To help provide an answer I'd like to welcome Erica Colangelo. Erica is a manager in the practice Institute here at the American Dental Association. Hello, Erica, and welcome to our show.

Erica Colangelo:  Thank you, Betsy. I'm happy to be here.

Dr. Betsy Shapiro:  In the practice Institute here at the ADA, we answer member questions every day and we wanted to share one we've received with our listeners. So let's dive right in. I'm inquiring about the health and wellness programs. And if there are any resources you could provide for dealing with anxiety and depression as a dentist.

Erica Colangelo:  That's a great question Betsy. If a dentist or a team member is feeling out of balance, we have a lot of great resources ready to go at ada.org/wellness. Our intention was to pull together and share the best resources for people who need support in managing stress and also situational anxiety or depression.

Dr. Betsy Shapiro:  Thank you Erica, for helping us answer that member question and for helping develop so many of those resources. Listeners can find more information about mental health and wellbeing by visiting ada.org/wellness. And if you want more information on any other practice management resources, you can visit our website at success.ada.org, or contact us at our email address centerforprofessionalsuccess@ada.org. We want to thank our sponsor ADA Member Advantage for their support and to Sandberg media for producing this podcast. And thank you for listening to Beyond the Mouth.

Betsy Shapiro: Welcome to the American Dental Association’s practice podcast, Beyond the Mouth, where we won't discuss clinical dentistry, but everything else is fair game. I'm Dr. Betsy Shapiro, a director with the Practice Institute of the ADA. In this episode we're talking about dealing with burnout. Joining me today are two dentists, Dr. Bill Claytor and Dr. Jim Willey. 

Dr. Claytor graduated from the University Of North Carolina School Of Dentistry and also holds a certificate in Chemical Dependency Counseling from Union College. He currently serves on the Dental Well-Being Advisory Committee of the ADA. Dr. Claytor lectures around the country on the opioid epidemic, burnout, perfectionism and addiction.

Dr. Willey retired from the American Dental Association in 2019. Prior to coming to the ADA, he practiced general dentistry in Elburn, Illinois for 26 years. During his tenure at the ADA, Dr. Willey was senior director of the Practice Institute. He initially explored his interest in this topic while earning his MBA, writing his master's thesis on the topic before it was truly identified as a syndrome and has continued exploring on this subject to this day.

Until now, burnout has been called a stress syndrome. However, the World Health Organization recently updated its definition and it now refers to burnout as, “A syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.” We're going to explore that a little bit today and see what that really means in the real world practice.

I'd like to suggest that you, Bill, have a lot of experience in the everyday world of burnout with some thoughts about how to identify it and how to prevent it or cope with it. And Jim brings a very futuristic look for us, as he's a student, of the trends and the forecasts and thinking broadly about what we need to do as a profession. Welcome to the program, both of you.

Jim Willey: Thank you very much.

Bill Claytor: Thank you Betsy.

Betsy Shapiro: Really appreciate that you're here today. So I'm understanding that burnout is just more than a rough patch. It's a deeper problem and we're seeing it creep up more and more, and it's being talked about more and more. So let's lay a little bit of a foundation here. Bill, how did you get started? What led you into getting your certificate in this area and doing what you do today?

Bill Claytor: Well, thank you Betsy for that question. It's kind of an interesting path, if you will, that I took. After my residency in my late twenties, I went into private practice and got married, started having children; the normal thing that a lot of people do. And as time went on, I started noticing that I was having some real, emotional exhaustion. I would come home and I was not the same person that I used to be. I mean, I knew it; I saw it myself.

And at the time I didn't know exactly how to handle it. You know, in the 1980s, when I was going into private practice, I'd never heard of the term burnout. I didn't have any clue what it was. And so I started experiencing a lot of stress and just exhaustion that something wasn't right. As time went on, you go to the doctor’s and they're checking you out and nothing's wrong. You're normal, there are no problems.

And then one day I had a panic attack. At the time, panic was not a word that was in my vocabulary. I had never heard of the word panic attack. I'd never heard of treatment for panic. I did not know what was happening. And of course after that, it followed with prescription medications and then abuse, and then on to a life of recovery where I am now. The thing that I would like to stress, for me, as far as burnout is that when your body tells you there's something wrong, it's time to listen.

I like the term, listen to your body. When you wake up in the mornings and you dread going to work, you dread the conflict at the office, the interaction with the staff; those kinds of things are not normal. You need to get help. And so for me, that was my first experience with stress and burnout.

Then a couple of years ago I came to a sort of a crossroads as to what I was going to do with my life. As far as, am I at the point to where I need to rejuvenate my practice, possibly relocate, hire an associate, build a new building, focus another eight or 10 years into this practice, or was it time to take a different direction? And those in and of itself are two kind of simple directions, if you will, go to the left or go to the right.

The problem was, I was starting to notice things like cynicism. I was very short with people. My wife would say, "Well, maybe it's just you're getting older, you don't have to put up the stuff anymore. That's just part of aging. It's not really burnout." And the other thing, the exhaustion part, I remember having a conversation with my accountant one day.

He at the time was about 68 years old and I had just turned 60. I said, “Oh, Paul, I'm going to practice until I'm like 80 years old.” I've just loved industry. And I still do, you know. He said, "Well, I'm going to suggest that things may change." And I said, "What do you mean things may change?" And he said, "You just wait. Just wait." And he didn't say any more than that.

Well, a few years later, it was almost like when you get to a certain point, your body kind of slows down. Things don't work the way that you used to. And you start wondering, whoa, what's going on? You go to the doctor and they say, you're normal, you're healthy. It's just part of the aging process.

And so I was toying with the cynicism and the physical exhaustion that I was feeling, had I lost my compassion for dentistry? And so I had to recognize the signs and then determine what direction I was going to take. And so that's sort of how my path over the last 40 years, the four decades of dentistry, has been looking at my physical well-being and my mental well-being. And so of course I took the path to retiring and to go into teaching.

Betsy Shapiro: I think we're fortunate as a profession that you chose that path. I'm sorry for your patients, but I think it's going to benefit all of us. You pinpointed for yourself, you know the emotional exhaustion, the crankiness or that get-off-my-lawn attitude. Was it just aging or was it really a symptom of something underlying and not being entirely sure whether or not you were experiencing burnout? How do we tell if we have it? Is there a way [to know]?

Jim Willey: Basically researcher Christina Maslach looked at the phenomenon of burnout. The term itself was coined in 1974, but the initial research that she did, she put together, what's today still called, the Maslach Burnout Inventory. It's a series of questions that an individual can take, and not that long a list, and it scores and identifies for three different component dimensions.

The three dimensions are depersonalization, which Bill kind of alluded to with his comments about cynicism. The second dimension is personal accomplishment. This is a reverse dimension. If you feel real good about what you're accomplishing and what you're doing, that's low for burnout. But if you don't feel like you're being productive in a profession that's rewarding to you, that would be high for burnout. 

The last dimension is emotional exhaustion. And what happens when you take the Inventory is it basically kicks out a score which identifies you as high or low for each one of the three dimensions. So when someone takes the Inventory and it shows you’re low, low, low; basically you have a pretty good idea that you're not really having problems with burnout.

But if you come back and you're high, high in two areas and low in another; or you're high, high, high in all three areas, you know that you've got a problem that needs to be addressed in some fashion. At least it increases your awareness of what you're experiencing and what you're feeling in private practice.

Betsy Shapiro: Now you, Jim did an interesting thing. I think when you did your graduate work in this area, you created a version of the Maslach Inventory that was specifically targeted questions as they relate to a dentist, right?

Jim Willey: I took Christina's Burnout Inventory, which was really originally designed to work with federal workers, and I just changed some of the verbiage to make it seem more appropriate to what dentists were feeling and experiencing in the dental office. Very simple changes in the words. We didn't take my inventory and actually go and validate it like Dr. Maslach did, but it still speaks to the same basic questions. And I will say also back when I was working on that paper, I was looking for answers for me. I felt very good about what I was doing clinically in my dental practice, I was frustrated. I had started a practice from scratch and was struggling with the business side of dental practice. And I was looking for answers for me; having no idea what a huge problem burnout was going to become in the next 30 to 35 years.

Betsy Shapiro: Well for those of you who are listening, we'll provide a copy for you of Jim's version of the Maslach Inventory. You can come to success.ada.org and look for the podcasts. We'll have it downloadable there for any of you. And of course Maslach Inventory is out there in the internet world for people if they want to take a dive into that.

I'd like to follow up. Jim, you said you had no idea how prevalent it would become, how big it would become. How big is it in the dental community?

Jim Willey: Well, the first observation I would ... This is actually good news for dentists is that the physicians are way ahead of dentists. There's a biennial survey that's done by the Physicians Foundation and their latest, the 2018 data came back saying that 62% of physicians are pessimistic about the future, 78% of physicians are sometimes, often or always experiencing burnout. This is what they're self-reporting. And I think it's really fascinating that 49% now of physicians would not recommend medicine as a career for their children.

This is a huge shift that's occurred in the last 10 to 15 years. You go back to like 2000, 2005, and 90% of physicians and nurses would recommend medicine as a career for them. So we need to look very closely at the experience of the physicians because that environment is becoming what dentistry is dealing with today. And the more we can learn from their experience, I think it's going to help us address the issues that are occurring in dentistry.

Betsy Shapiro: Bill, do you think that it is the nature of the practice of dentistry? Is it the nature of the practice itself or the people who choose it or the isolating factor that if you're in a small practice?

Bill Claytor: I think it's a little bit of all that. You know back about maybe five years ago, The New York Times came out with an article that said to Jim's point about one out of two, or about 50% of the physicians looking at the physicians were burned out and the question was, is it due to their environment or is it due just some susceptible individuals who are just quote unquote weak. And I think the answer is pretty clear: It's the environment in medicine today. The number one issue, the latest surveys that I'm seeing say, that physicians say that one of their biggest headaches, like 90 plus percent are the EHRs, the electronic health records and the inefficiencies there. In dentistry I think we are going to probably go down the exact same path for a different reason. And the reason that I see is you mentioned the isolation factor.

I love to tell the story about a football team versus a professional golfer. I look at medicine sort of like a football team. They have multiple players; 11 players on the offense, and 11 on the defense. The team itself probably has 16 or 18 different individualized coaches for every specific position. They work a lot of times from external pressures and control.

In other words, if you're one of the 11 players on the football team playing, you can only control your part of the field. You can't control the overall product. So they have many coaches. They have people who give them advice, they're asking questions, they're not going to play unless they're being accountable to somebody, a coach or a section of the team.

In dentistry, I look at it like a golfer. We're there by ourselves. And that's unfortunate because I don't think we were really meant to be that way. I think we need coaches. I think we need people to help. And I love the story about how dentistry is an isolating cottage industry; that we used to use those terms. But think about it, we put on these loops with the light sources and we focus down into just millimeters of the margin of a crown and we focus there all day.

So we're focused there, but yet our lives are becoming that way too because we tend to be a lot of times defensive. We don't take instruction well. We have to be in control when in reality we're very much out of control.

But it's amazing how well our dentistry really works for the public. It really is. The longevity of our services that we give. I didn't do that by being perfect. I did it by being imperfect. I think the isolation, confinement, and our strive for perfectionism. And also always feeling like—that we're not good enough. I would like to have an environment in dental schools that could teach you that you are good enough. And it's not just because you say it is but because we cannot achieve perfection. We can only achieve excellent work. And I'm all for that. And not accepting perfectionism is not substandard work.

Jim Willey: Bill something you said really resonated with me. I remember after spending a long day at the dental office, working with magnification all day long and coming out of my office and for some reason just looking up at the stars and just going, "Wow, I'm really missing something here." You know, there's a whole great big universe out here that's not within the scope of what I'm dealing with all day long.

And I also agree with you. I think there's a bias. The tendency is for everyone to put the blame for burnout on the individual. Like you're not tough enough. You're not strong enough. There's no crying in dentistry. You've got to straighten up and fly right and do better all by yourself. And it's often much more complicated than that. The environment is definitely involved. One of the things that I tell dentists who are struggling is that the first thing is when you're feeling this, is to do something different. Don't let it paralyze you. Don't get where you're just going down that road with the blinders on and thinking that you can't do anything.

Change your schedule, move some things around. Don't do procedures that you don't enjoy doing. Get rid of those procedures. Treat yourself fairly. Reward yourself for what you're doing. Make sure that you feel good about what you're doing in the dental office.

Bill Claytor: Right. And I agree with you 100%. I like the saying that when we do nothing, we're doing something. So doing nothing is doing something. We have to take action.

Jim Willey: Take action, I agree.

Bill Claytor: And I think one of the things along your point is that community is a foreign word a lot of times in dentistry. I mean you've heard the old adage that physicians look at their fellow physicians as colleagues and a lot of times dentists look at their fellow dentist as competitors and that's sad.

I was talking to someone and they said, "I just can't believe I've had two new dentists move into my area, within a mile of where I am. They're going to take all of my patients away." And I told him: "No, this is the wrong attitude. Look at your own practice. See how you can improve. Not what you're doing wrong, but how you can improve. It's about you, not what they're doing to you."

I kind of gave him a different perspective on things. Like you say, you have to do something. One other point about burnout, if I may make, I don't want to give the impression that burnout is an older dentist syndrome. Most of the people that I work with now are in their 30s, young. I mean we have the student debt issue, which is a huge problem. So it's, it's a continuum of different levels.

And to your point about taking the burnout, the Maslach Burnout Inventory. Do it often. Do it frequently throughout your career because this is a dynamic flowing kind of ever-changing process. It's not, I don't have burnout at 31 therefore I won't have burnout at 61. It's not that kind of process. You need to always have people reflecting, what you're giving and you have to have people to look at where you are. That's why I'm big on mentoring. Have a personal mentor that's not in dentistry, just a person you can talk to, go to lunch with colleagues. There are so many resources out there. But like you say, we have to do something. You have to change.

Betsy Shapiro: I think something interesting that you both are talking about is the community aspect. Being connected or having people to talk to. I've always thought physicians did something right in that they allow themselves to discuss their failures with each other in group settings and learn from those teachable moments. Our profession doesn't do that so much. What I wonder is with our newer professionals coming in, or new dentists, who communicate much more often, and much more frequently with each other by text, if they will feel a little bit more connectedness? Or will that add to the stress level? I used to enjoy going to my branch meetings, my component meetings, and I felt like that was a safe space. And I could ask someone how this case wasn't going right. What did they think?

Bill Claytor: Yeah. Well, and to your point, you may be familiar with Dr. Michael and Enid Balint from England. They started the Balint Society for medical residents where they could come and talk about human matters, not human doings, if you will.

So we talk about human being matters and you can talk about, I just lost a patient that passed away. How do you deal with these emotions? Because we're all supposed to be able to be a doctor and take all these problems on ourselves. One of the things that I would like to see done. …

And I would love to see the concept, which is basically going into the dental schools while dental students are learning dentistry. It doesn't have to be a faculty member. It can be, but it could be an outside person. I have a vision that maybe someone like myself or others could take 10 boxes of pizza in and go to a little room and have the students come by and talk about these issues that deal with their emotions and feelings and how they're handling this. I think it's so important because the answers are not found with an instructor coming in and saying, okay, the answer to take care of this is to do X, Y, Z.

The answer is found in the community, the peers, and it's so interesting to me that when we go to dental school and we look at our first tooth number 19 with an occlusal decay area and we say, "I can put an occlusal composite in that." Or we see a tooth with a mesiolingual cusp broken, you say, "I'm going to put a crown on that."

You do that in dental school over and over and over, and then you go into private practice and all of a sudden here comes tooth number 19 with occlusal decay and you say, "I can do that. I’ll cut that out and prep it and I’ll put in a composite.” Or "I can do that. I'm going to make a crown on this tooth." You've had experience, relevance, and you take it out in private practice. We don't do this a lot of times with issues that surround burnout.

How do you deal with patients who are demanding and exacting? And then another student may chip in and say, "Well, I've had this before but I didn't have this," and another one may say, "Well, what I did in that." And then a person like myself or Jim or faculty member, can just facilitate the meeting; sort of like a lunch and learn. You’re just sitting around, you're not bringing X-rays, and you’re not bringing models. You're not bringing root canal files. You're just talking about how you feel and how you deal with those feelings.

Then you get out of dental school and you'd go into private practice and then that person shows up and you're going like, "Oh my gosh, this is one of those exacting patients. I remember what I felt. How do I deal with that? What did I do in dental school?" So it's kind of an opportunity to talk about the emotional, mental side of our being, not just the, can I prep a tooth kind of thing.

Jim Willey: I think one of the things that we have to remember is the physicians basically get a lot of their social environment through their relation to the hospital. Dentists don't really have that available to them. Every dental office is its own emergency room. So I think it's also a strong case about why dentists should belong to their local dental societies and their groups where they can get some feedback.

To your second point about social media, I'm hopeful that social media would help the younger dentists and the way that they're learning to relate now. However, it seems to me that the more social media we use, the lonelier America is getting. And I hope we can find some very constructive ways for dentists to share information over social media.

Betsy Shapiro: That would be wonderful. I don't have any statistics. It seems to me like you might be right about that though; not only feeling more isolated, but also more opportunity to feel less than perfect about yourself as other social media influences impact, you didn't get a good review on Google from yesterday's 4 p.m. patient. But hopefully we'll see a change. Bill, you mentioned this dream and I think it would be a wonderful reality about having schools establish this forum where we can get together and talk. I happen to know that you do go into schools to talk about this.

What do you see when you go in there in terms of the perceptions of the students about themselves? Do they think that they are on that path? Do they think it's never going to be them?

Bill Claytor: Yeah, most of it is the latter. It's like, this won't happen to me; unfortunately that is something that can... You know when you go in and talk it's more like, well it may have happened in your situation because your story is horrific or terrific, whatever the term may be, but to me it won't happen. Most of the students that I've talked with are very confident.

The two dental schools that I talked to, they're very confident about their future. I do think the attitude of it’s not going to happen to me, but you know Betsy in the middle of all this, after the lectures almost inevitably we have one or two students that come up and they take you over to the side and they say, "I'm having a problem." Or "My mom's drinking too much." And so there are issues there. Fortunately in a lot of the dental schools today, there are avenues that they can pursue for getting help and I stress that usually initially to go to the source there in the school for a source of help.

But I use this analogy back in the 70s when I was in dental school, we used to get the ADA Newsletter and they would have stuff about office design, how to hire an architect, how to contact an accountant, how to do this with an attorney. And I just remember sitting and reading all this stuff and the school was kind of sending out a little paper too about the same stuff and all of it was just like, I've got to do my test bridge. I've got patients coming in at 2 p.m. I'm not listening to anything that they're talking about.

So the problem is trying to make it relevant to the students at that point in their lives because they're thinking about clinical stuff, as they should be. But it's hard to bring in stuff that they can't relate to.

Besty Shapiro: I think that's human nature. When we're 22 we never think we're going to have a bad knee that needs to be replaced at 55; it's just, we're invincible.

Jim Willey: I think it behooves us though as a profession to really pay attention to what's going on in the dental schools. There's research out of the Mayo Clinic. It stops short of causation, but basically sets up an increased risk of suicide amongst physicians that begins in medical school. And the rates of both suicide ideation and depression are higher for dental students than they are for dentists.

Dental schools really need to have programs in place that identify who may be having suicide ideation, identify students that are at risk of having a problem during their time at the dental school, and programs to help support them. And they really need to have that there and at each dental school because it's there. You can pretend it's not, but it is there. Students are struggling.

Betsy Shapiro: We were very fortunate in the first season of this podcast series to have Dr. Erinne Kennedy speak with us who had some challenges through dental school. She talks very strongly about her personal story and how she sought help. But one of the key takeaways was that for her, she recognized, first of all, that she did need help and likened it to any other physical, or if you are having trouble with your weight, maybe you go to Weight Watchers. If you're having trouble with headaches, you go see a neurologist.

She knew she needed help and she said it took a little to understand that going to use the resources that the school provided doesn't go on your permanent record. It doesn't mean you don't get a dental license. It doesn't mean anyone knows; it's just helping you find the tools and getting help. That's something we tend to forget in all of this, that sometimes there's a little bit of stigma about that and dentists don't want to say, "I think I'm burning out. I'm must be weak."

Bill Claytor: We feel like we should be able to handle these things as if not only emotional issues, but even things like more in the clinical practice, in today's market with the social media that's out there and how you have to play that game, if you will. I'm not an expert in social media. I need someone just like you hire an accountant to do your taxes. You hire a lawyer to help with business transactions. You need a specialist that can do that. I mean, I'm all for getting people who can help me because I'm not the specialist.

Betsy Shapiro: We dentists think we can fix everything with ourselves. I mean, I recall taking an X-ray of a toe of mine that I was pretty sure it was broken and I figured I could just tape it myself and I didn't need to go... We're invincible. Jim, what else can we learn from the world of medicine and the path they're going down? Are there any other big takeaways that that we should be mindful of?

Jim Willey: I think we should just be observing what they're doing in terms of recognizing and dealing with it so that we're more prepared for it. I think on the larger scale, a lot of the trends that we're seeing in medicine... I have a slide in a presentation where I talk about why are dentists less burned out than physicians. And the answer to that question is it's just a matter of time.

The same pressures that the physicians are dealing with today are eventually going to come into dental practice. Only 18% of physicians believe that quality value measures will reduce costs or improve care. Ninety percent of physicians believe that third party authorizations have an adverse effect on care. We're dealing with all of those same trends and you throw in artificial intelligence and do-it-yourself dentistry and all the pressures that are out there that dentists deal with.

Bill Claytor: My daughter is an internal medicine resident out on the West coast. When she went into her orientation, they were very strong on talking about we have resources when you have burnout, we have resources when you have depression and went through the whole thing and they have to take a class in it. That's great.

She said the issue is finding time to go. Now it used to be that they told you that you could go while you were at work and if you needed to take the last hour off, a day off and go see a counselor, you can't do that anymore. She said, people are so busy you have to go on your day off. And so you take the whole day to get an appointment to go see the person. It's just finding time to get help. And in private practice … some of the ones that have dual roles at the hospital and also in private practice, she said, when do they go? You know, if they're not at the hospital, they're in their private practice. And so it's an access issue.

Betsy Shapiro: So give me a quick recap here. When it comes to a person-to-person level, and when I'm looking at myself, what do I want to look for to see if I'm becoming burned out? How do I do my self-investigation? And then the follow-up is, what do I do then and there?

Jim Willey: What I always look for in myself is putting up walls, taking that initial step of depersonalizing, just getting tired with human relationships and shutting down, shutting myself away for a while. That's telling me I need to recharge a little bit. When you're not feeling good about what you're doing on a daily basis that should be a big hint to you. You should look forward to coming to work. You should be pursuing your passion when you come to work. And when you do your dentistry, you should feel good about what you're doing.

I mean, the last one you probably should have already addressed, but before you get there—the emotional exhaustion. That's when a dentist is saying, "Cancel my afternoon. Just get rid of all the patients. I'm going to go somewhere and do something else." They've really exhausted themselves. So those are the things I look for.

My big takeaway is just when you feel that way, you've got to reduce the load or reduce the amount of energy that you're putting into something. That way, you can kind of save yourself, and then don't be afraid to ask for help. I think that's a real key point when you're feeling that way, you've got to find somebody to talk to and try to get after what's happening.

Bill Claytor: I think the issue of compassion, we haven't really used this term yet, but “compassion fatigue.” It’s where you see this depersonalization or detachment. You don't like people very much. You don't really want to be around people. I'm exhausted, don't have anything else to give. That's sort of what I look for. Am I getting exhausted with patient care? Am I projecting things that aren't happening?

So compassion fatigue for me is something that I have to really be aware of, and I will stress that compassion fatigue, this burnout is more with human relationships. I mean, you're not going to get burned out over a bad computer and you keep trying to fix it. You're just going to throw it away and get another one. But with humans, you can't just throw away relationships there. Your people at work, your people at school, your environment, your home life.

And just one comment about that is for me, I have to look at myself. It's not the other person, it's me. There's something about me that's not right, and so if I'm burned out, if I'm exhausted, if I don't really like what I do or don't feel like I'm making much of a difference, it's a bad place to be for a dentist. I tell my students, look at burnout as a positive opportunity for change in your future.

If you can identify it and you say something's not right and then you reach out to help, whether it be the ADA, success.ada.org. Or your state dental societies. I know here at the ADA, they have a list of resources to help. Burnout is not a weakness. Burnout is an opportunity to change because you recognize something's not right.

Betsy Shapiro: Thank you. Thank you both. You've provided some excellent information for our listeners. I really appreciate it. Before you leave, I'll do one more thing. We have a member question at the end of every episode. One of the questions I get fairly often will be from a dentist who wants to get out of dentistry and do something else. And almost always when I listen to them, I realize they don't really want to get out of dentistry. They want to get out of burnout. They've hit some stage where it's just not quite right.

When I'm talking with them, the answers that I would give them would be things about looking at what you're doing every day. What is it you like or don't like? What can you change? What's your vision? Talk to someone, be kind to yourself, which is harder for us to do because we're perfectionists. And very often they will say to me, "Okay, so if I do these things, is it really going to get better?" Here's my question to you. Is it really going to get better?

Jim Willey: There's always hope. I mean, if I could sum up just very briefly what, what we've talked about, make sure you are getting the skills that you need. Like when I self-identified as not having the business skills I felt comfortable with. Go get those business skills. Go learn how to delegate, make sure that you're the best that you can be first and then when you're stuck, do something different. Try something different because you're going to be able to react to that and it's going to bring you to another solution. And then the last thing is, ask for help. Make sure that if you're really at the end of your comfortable coping limits, that you take the time to go ask for help.

Bill Claytor: I think one of the things that we are not taught early in our dental careers is to define who you are. Are you a dentist who is going to be one that thrives in private practice or should you maybe work in public health or military or be a consultant? There are so many different other areas that dentists can work in. I think we have this image that when we get out of dental school, we all are prepared for private practice. Some are, some aren't. The ones that aren't, it's not a bad thing. So what I would do first of all is define who you are and find a practice in your area or someone you know and you like what they're doing. Go visit them, another dentist, see how they practice and say, "I want that. I never want to do this procedure ever again, but I want to do these."

You have a choice. You have a right to choose. Define who you are because you have to live with yourself. Define who you are, control your schedule. Schedule is probably the number one thing that we can do as dentists to control burnout. Asking for help can be very, very difficult. I understand, it's a tough place to be in and I would not look at asking for help as a weakness, but like I said earlier, it's an opportunity to change. You know, there are so many resources out there, there are so many people in the world today that want to help you as a dentist and I highly recommend that wherever you want to start, whether it be the ADA resources or other areas, ask questions, and ask for help. Tell somebody something's not right and you need help.

Betsy Shapiro: I think you both gave long answers that both said yes, there is hope and so you are both examples of how life can be refocused and restructured and changed and still contribute and be a part of the profession that we all love. Thank you again to both of you for spending time with us today. It's been a really meaningful conversation and I appreciate your time.

Bill Claytor: Thank you.

Betsy Shapiro: If you want more information on any other practice management resources or on specific resources for stress management or career changes or how to find help on any of these topics, you can visit our website, success.ada.org or contact us at our email address centerforprofessionalsuccess@ada.org. We want to thank our sponsor, ADA Member Advantage, for their support and to Sandburg media for producing this podcast and thank you for listening to Beyond the Mouth.

Betsy Shapiro: Welcome to the American Dental Association's practice podcast, Beyond the Mouth, where we won't discuss clinical dentistry, but everything else is fair game. I'm Dr. Betsy Shapiro, a director with the Practice Institute of the ADA. In this episode, we are talking about volunteer work and giving back to the community. And joining me is Dr. Katie Vincer Sears. Dr. Sears graduated from the Ohio State University College of Dentistry and currently runs her practice called Scarlet Dental in two Ohio locations. Dr. Sears came to our attention when she received the honors of the ADA's 10 Under 10 Award in 2018, which recognizes the top 10 dentists in all of the United States who have been practicing 10 years or less. Dr. Sears has taken a nontraditional route in her career, choosing to focus much of her time on providing dental care to individuals primarily on Medicaid or with no insurance. She has also made a number of trips to Africa where she provides dental services for the Maasai tribe of Kenya. Katie, welcome to the show.

Katie Vincer: Thank you. Thanks so much for having me.

Betsy Shapiro: Let's start with your work here in the US. We'll start close to home and then expand out in our discussion today. You're pretty active in volunteering on your local level. Can you talk a little bit about that?

Katie Vincer: Yes, so since probably, for at least the past 10 years, I've been participating in ADA's Give Kids a Smile every year. I also participate in different functions just around the community that may be providing free dental care. And then we also have an extraction clinic here in Columbus, Ohio where they are looking for doctors on Mondays, and so I volunteer there as well. So there's just lots of different opportunities. I feel like there's never enough time, but lots of great places to be able to volunteer locally.

Betsy Shapiro: Now, do you do the Give Kids a Smile in your office or do you go somewhere to help out with that?

Katie Vincer: So I actually have it in my office. And even when I was an associate, the practice that I was working at allowed me to host it within the practice. And so that's just what I've been able to do throughout the years. And for me, that's been a great experience because some of my patients that I treated through that stuck with me and everyone has different situations that happen in life. And so we reach out to local schools, and we had one family where they had fallen upon hard times during the recession. I saw the boys during Give Kids a Smile, and once the parents got back up on their feet, they stay patients with me for years after that.

Betsy Shapiro: Was that one of those things that you started while you were in dental school and then it just grew as you grew in the profession, your ability to participate more and more?

Katie Vincer: Yeah, reflecting on it now, I really enjoyed traveling with... we had an instructor who we traveled with, Dr. Soller. And we would do screenings at headstarts. And looking back, I really enjoyed it doing that. That was completely elective. We would just email her and sign up for it. So to me, it just felt natural to continue that once... participating in Give Kids a Smile once I was practicing.

Betsy Shapiro: That's excellent. You are now at the point where you're traveling overseas fairly regularly. Can you tell us a little bit about how you got started in that?

Katie Vincer: So just in dentistry in general, I feel very blessed to be a dentist and that it's somewhat of my social responsibility to give back to those who cannot afford dental care and being able to donate locally has been wonderful, but I really want to see the world as well. Traveling international, especially having been to Kenya twice now to be able to do dental work, it was kind of the catalyst to get me to Kenya and it's been such an incredible opportunity. But also though too, I've been out of dental school for 11 years, so I now have the financial means as well to do something like this. I know there were some mission trips in dental school. I didn't even have extra $5. I really struggled with having the money to be able to do something like that as a student, and even when I was first practicing. So now, it's been a great opportunity to be able to travel the world and to provide dental work to those in need.

Betsy Shapiro: Are you able to take your family with you when you go?

Katie Vincer: Yes, I have three young kids right now. They're six, five, and four. That's hard to leave them for a long time. In order for me to want to leave for a long time and travel across the world to do dental work, my husband and I we take them with us. And my husband is not a practicing dentist. Well, he's not a dentist at all, practicing or not. But he's not a dentist. And so when we travel, it's nice because it allows me to be able to focus on the work that I need to do and then obviously he's with the kids.

Betsy Shapiro: Do you have your children seen the clinic? Do they experience that part of what you're doing there?

Katie Vincer: Yes, I have volunteered now at the Maasai Dental Clinic twice, which is in the Mara of Kenya. And how that clinic is set up is the dental clinic is on the first floor and then the apartment where the dentist and their family can stay at is on the second floor. So the kids are essentially when they play outside, they're running around. So I can see them while working on patients, running around, trying to chase the monkeys or whatever they're doing. And then they walk through the clinic and they see the patients outside waiting. And so, yeah, everyone's right there together during the time and just hanging out and walking through to see all the patients. And that's been really fun for them to experience.

Betsy Shapiro: What a wonderful opportunity. How did you happen to find this particular clinic?

Katie Vincer: We became aware of the Maasai Dental Clinic when the founder, who is Dr. Ray Damazo, received the ADA Lifetime Achievement Award. We were at the meeting in San Antonio. The ADA had done a little video about his clinic. And my husband and I were both present for that. And we saw that and we both thought to ourselves, "Oh my goodness, that would be an incredible place to go. It would be an amazing opportunity." It just called to us, I guess you could say. And so I reached out to Dr. Damazo at the time. There was a little bit of a waiting list for dentists. We got a spot pretty quick and a dentist was unable to come because life happens. But then our life happened and it ended up I was pregnant and we could not go.
So the first time we weren't able to go that we had planned. Then we had our baby and decided in 2017 would be our first time to go. So we went in 2017 and then we just went last month. It's been awesome to be able to go twice, and I would recommend it to anybody. It's incredible. We look forward to returning in the future.

Betsy Shapiro: Let's talk a little bit about the clinic setup. The apartment is upstairs, which is fantastic to be able to have your family there. Is it like kind of clinic in the United States? What would we find if we went over there to practice?

Katie Vincer: It's very much like a clinic in the United States. So there's three chairs. They're actually all a deck, very nice chairs with lights and handpieces. Everything's attached on the chair. Their X-ray units, you're able to take X-rays, light wings or PAs, whatever you may need. And then all handpieces, slow speeds, extraction instruments, whatever you may need is there. And then I bring my own materials for restorative and disposable items that I prefer to use just because it shouldn't be a burden on the clip. And I also like my own instruments and tools. I tend to get in my own routine and like the stuff that I use. And so I like to bring my own composite and bond and that type of stuff.

Betsy Shapiro: Do you have an assistant to help out chairside?

Katie Vincer: Yeah, so there's actually three dental assistants, and it's really nice. Not only are they fantastic, some of them are also trained to be able to do provi, which is beneficial, but they also speak the native language. Kenya was an English colony, so those that went to school speak English. However, the native language is Swahili. But most of my patients, because they're members of the Maasai tribe, they speak their tribal language which is Maa. I am not fluent in Maa or Swahili, so it's really nice to use the dental assistants to act as translators.

Betsy Shapiro: What do you find are the differences in the dental disease over there? Does the Kenyan diet affect things? Are you providing similar treatments to what you do here or is it a little different?

Katie Vincer: That's a great question. I currently practice in underserved areas. I see the underserved and underserved areas here in the United States. When I tell people I'm traveling to Africa to do dental work, usually their first response is, "Oh my, what are their teeth like?" And my response is beautiful because there's not the access to soda like there is here in the United States. I see a lot more just rampant decay here in the United States. In Kenya, there's some gum disease going on because there's not a lot of regular dental care being sought. There's a lot of extractions of third molars. Sometimes, some molar does well, but the extractions are nothing compared to what I'm doing in my offices here in the United States. The cavities tend to be higher in the children and that's because a lot of the tourists bring candy when they come to visit, and so they pass it out to the kids.

When you're driving around in the Mara, you'll see kids chasing after the van and they're screaming, "Sweets, sweets," because they're usually given out candy. That is probably where most of the decay is in kiddos. There's not a lot of soda drinking. They don't have a 7-Eleven with Big Gulp. Their normal diet is what... here in the US we would consider clean or organic. What they eat is very natural to them. And for us, we would be going to Trader Joe's or Whole Foods. So it's interesting to me how that totally flipped. Right here, we are in the first world where most people drink soda and soda is cheaper than water, and yet when you travel to a third-world country, their soda is more expensive.

Betsy Shapiro: Are there any particular challenges you face there that you don't see here?

Katie Vincer: I would say my biggest challenge is there is no one to refer to. So I'm a general dentist and one of the aspects I enjoy about general dentistry is that I get to refer to specialists if there's a challenging case or a challenging patient. And when serving the Maasai at the Maasai Dental Clinic, the closest dental office is a three-hour drive. One issue I run into this past visit was just children not wanting work done, and you just had to get it done. And that was hard for me. That's not really my approach with kids, and maybe a pediatric dentist wouldn't mind that.

Betsy Shapiro: Do you think their reluctance for treatment was just a more matter of kids being kids or is there a cultural difference or an acceptance challenge for you there?

Katie Vincer: It's probably many things. I think just probably being scared is very natural. The dental clinic is going to be a very foreign setting for them. On top of that, the whole situation is different. Probably, I imagine the smell they're different. And also, I am a white woman and so that's probably very different as well. I look different than most people in the Mara of Kenya. I'd imagine that could be scary. It's just a very different environment for those kiddos, and I think most of them do so, so well. As I said, that was just the challenge for me that I don't experience here in the US. But that's because I tend to just refer out to pediatric dentist, so I get lucky here in the US for that.

Betsy Shapiro: You've been there enough times now that I imagine you're starting to develop your own routines in terms of exploring when you have free time, what's the culture like or what have you done for fun when you're there?

Katie Vincer: We go on safaris when we're there and really you can see wildlife at the dental clinic, but it's about a 10-minute drive to the Mara. And once you're in the Mara, you can see everything from lions to cheetahs to rhinos. And when we were there in the summer, it was the great migration with the wildebeest crossing the Serengeti into the Mara and it's absolutely incredible. The afternoons with the kiddos, we like to wash the trash hole, which sounds a little ridiculous.

Betsy Shapiro: You then need some explanation please.

Katie Vincer: So obviously, there's not trash pickup, so they just dug a hole in the ground and it's a large hole. I was joking, I'm like, "In the United States, we call this a grave." But they just dig a big hole and then they throw the trash in there and they burn it, but they don't burn it every day. Usually, in the afternoons, baboons come through and they hop in the trash hole and they pick stuff out. We'll watch the baboons and then the vervet monkeys come through and then the mongooses. It's incredible. It feels like we're living in a zoo. Yeah, I feel like I'm at a loss for words to describe how majestic the pocket of this world is. I just feel very blessed to be able to go there and experience it.

And on Mondays, the local town has their market. And so we go to the market and I just love looking at all of the vibrant colors. And there's just goats walking around and dogs, so the kids really enjoy that. And the one evening we were driving back from the market and ran across the tower of giraffes, which a group of giraffes is called a tower, a little fun fact. And so that was incredible to just see them walking along the road heading towards the rivers. Yeah, it's incredible. You might watch a video on National Geographic about places like this, but to experience it every day is phenomenal.

Betsy Shapiro: Have you had any interesting experiences with the Maasai outside of the clinic?

Katie Vincer: Yes, one really interesting fact about the Maasai is there's such a strong community. While in the United States, we may have federal funding or something like that to help people when they fall on hard times. The Maasai help each other. And it's not just financially, but it's also personally. And so when you're in the town, you may see a little kiddo in the town and you're thinking, "There's not an adult near them who's watching them." Well, everybody's watching them.

And we had an example of this when in 2017 when we went to Kenya, at the time, my kids were four, three, and one. And we're at the market, we get out of the vehicle, they literally all ran in separate directions. And so we go running after them. There's a guard at the clinic and there's a couple of guards there at the clinic just to make sure you're okay, walk you to and from dinner, and just make sure that essentially protect you from large animals really. And the one guard, John, appears out of nowhere. And he has our one-year-old who's also named John by the hand and he's just bringing him back. It's a perfect example of how the Maasai treat each other, where they're all watching out for the children. It's just a beautiful community.

Betsy Shapiro: That's very sweet. I like that concept and the picture you're painting.

Katie Vincer: It was really fascinating for me to talk with my assistants who are essentially working moms to hear about how they're managing being a mom and working and in a very different culture than mine, coming from a very traditional culture. So they bring their clothes to work to do the laundry because they don't have running water at home. So they'll bring the laundry with them in between patients or during lunch. They're washing the clothes and hanging them in the back of the clinic and definitely multitasking and hustling and it's quite impressive.

Betsy Shapiro: That's just like the working parents back here too, I think.

Katie Vincer: Mm-hmm (affirmative), yeah. And you're trying to provide a better life for yourself and your family and you're still trying to manage it all.

Betsy Shapiro: I'd like to bring you back to the United States now for just a minute or two and talk about what happens to your practice here while you're gone. Who takes care of it and what happens for patients with emergencies?

Katie Vincer: Yeah, so I have been fortunate enough to have either associates who are working with me or even just docs who are willing to come in and sub for a short amount of time while I'm gone. But what really allows me to leave is I have a director of operations, and she and the leadership team that I have here at Scarlet Dental is really incredible. It's because of my trust in them and knowing that they're going to take great care of the practice of our patients and of the team that I know that I can leave and it will be okay. And that took years to establish. That's really hard to be able to walk away from your business for that long.

And I feel like my maternity leave prepped me for it. So it was just a continuation of what I had done for that. But the hard part is it's hard to have access and communication when you're that far away with the time difference. I also struggled at times with Wi-Fi, so I wasn't able to always be able to communicate through text messages or emails. So really there were times where I couldn't communicate at all. So I just had to trust that my leadership team had it and they were handling everything.

Betsy Shapiro: It sounds like you've built a wonderful team that you can rely on and that is a skill itself. So kudos to you on that.

Katie Vincer: Thanks. I feel very fortunate. It's hard. It's a challenge, and I feel like the team that we have is wonderful. And it's definitely taken some time to establish. But once it's established, it's great. So it's worth all the effort.

Betsy Shapiro: When you are preparing to travel overseas, what do you have to do in terms of your malpractice insurance or your license? What are the ins and outs of that?

Katie Vincer: Yeah, so I applied for a Kenya dental license. The World Health Dental Organization, who is the organization that organizes the Maasai Dental Clinic, they helped me out with all of that. So I completed all of the paperwork and sent that information to them, and then they went ahead and filed for me to receive a Kenyan dental license. I do not have malpractice. My malpractice won't cover me when I go over there. When I was first going over there, I had asked the clinic, "What do I do about malpractice?" And they essentially said not to worry about it, that it's not a concern or an issue there.

Betsy Shapiro: That saves you a lot of grief in trying to figure things out, and it speaks highly of what you're able to offer to them and how willing they are to accept that. And that's also a positive about this program, I think.

Katie Vincer: Yeah, and I should also add too, the Maasai Dental cClinic, they tell you don't do anything out of your comfort zone. Like now's not the time to try and start new procedures. The other aspect of it too is there's usually a new dentist coming through every two to three weeks. You can prescribe antibiotics and just have someone come back when the next dentist is there for them to perform the procedures. I will also say while it is remote in that it's a three-hour drive to the next dental clinic. Never once is there pressure to feel like you have to do a procedure. So stay within your own wheelhouse. That way you're able to provide really great dental care and do the best that you can for patients.

Betsy Shapiro: You've given us some really good tips in terms of practical matters, staying within your wheelhouse and how to organize your staff back home. And you discuss the World Health Dental Organization helped you a little bit determining how to actually practice in Kenya itself. Is there any other advice you would give to someone who's planning to do this?

Katie Vincer: I would say just go. There's obviously the factor of fear as to what to expect. I will say too, even leaving my practice, I'm open with my patients if there's a reason why I can't see them. And so we told all of my patients exactly where I was at and what I was doing. I never had a patient complain that they couldn't be seen. If anything, I feel like my patients here in the US they just think it's so cool. They want to know more and they love hearing about it. But I know when I first was going there, it was really scary. I'm kind of like, "What am I getting myself into?", I feel like safety's always a concern, personal safety as well as safety for my family. And I will say I feel so safe as well as... my husband and I we would never put our children in a situation that we didn't feel safe in.

Those are all questions to ask when you're looking into a certain program. And I think it's totally fair to look into those different concerns that you have and also just have an open mind. I've also found that the more that I give back to others, the more I receive. However, emotionally and even financially, I feel so fortunate to be able to give back. But I feel like what comes back to me is tenfold. And the lessons that I've learned and the experiences that I've had have been able to make me be a better dentist and a better person and just a better human. I would encourage anyone who is even somewhat thinking about it to just do it because anyone you talk to, who's traveled international... I don't know, I've never met anyone who didn't love it. I guess I should say that. I'm sure there's one person who did it. But anyone that I've met, it's just this incredible experience that will give you more back than what you ever expected.

Betsy Shapiro: Now, I happen to know you just returned from Kenya fairly recently. Are you planning your next trip already?

Katie Vincer: We are. We would like to go back in 2021. You know what? Here's the other thing too, like now, the assistants and the clinic director and people, just local, have become our friends. It's wonderful to see them and there were really long hugs when we were leaving. But to know that we're coming back makes it a little easier on the heart because we were sad, but we're excited. We hope to return God willing in the summer of 2021. And every other year works well because it's a big commitment both financially as well as leaving the practice. So going every other year so far has seemed to work. I would love to later in my career be able to go and stay for a month or two at a time. I'm just not there right now, and that's okay. You make the adjustments that can work in the season of life that you're in.

Betsy Shapiro: Well, I think that piece of testimony and your plans to go back are a perfect way to wrap things up here.

Katie Vincer: I would encourage anyone listening who may even be considering some type of way to give back for dentistry to totally pursue it. There's so many different opportunities on so many different levels that you can do it in your backyard, across the ocean, across two oceans. It's really, it's incredible. And I don't really think you'll regret it. If you do regret it, let me know. I would like to know because I really haven't heard anyone who didn't just love their experience.

Betsy Shapiro: And for anyone listening who wants to share a tale with Katie about a trip that they hopefully loved, you can reach out to her through her website for her practice, scarletdental.com. Scarlet is with one T, S-C-A-R-L-E-T dental.com. Thank you again.

Katie Vincer: Thank you so much, Dr. Shapiro. This was awesome.

Betsy Shapiro: Now, we're at the part of the show where we answer a question we've received from a member. In the Practice Institute here at the ADA, we answer these questions every day. And we wanted to share one that we've received with you, our listeners. To help us, we've got Genevieve Koester, the manager of International Relations here at the American Dental Association. Genevieve, let's say I'm a dentist and I'm trying to volunteer opportunities. How do I get started?

Genevieve K.: Thanks for asking. The ADA has a best in class, one of a kind website, purely dedicated to providing information and specific volunteer opportunities to dentists looking to volunteer overseas. The web address for that is internationalvolunteer.ada.org, so fairly simple to remember. And at that website, there are three main resources that are really helpful for anybody considering this kind of volunteer work. The first is there's a running list of current opportunities sorted by date and location on the landing page.

Second is there's a directory of organizations that do overseas volunteer work that you could contact to arrange or see when their next volunteer trip would be. You can sort that directory by geographical region or country, you can sort it by religious affiliation, you can sort it by type of services you want to provide when you're volunteering. So there's a lot of usability in that resource. And then the third is there is a downloadable PDF called The International Dental Volunteer Guide. And it's just a really great primer of things to think about and prepare for and know about for anybody who's new to volunteering overseas or considering doing this kind of volunteer work.

Betsy Shapiro: Sounds like you've given me everything I need to know from how to start and then where to go and who I might go with if I pick a particular group.

Genevieve K.: Yeah, yeah.

Betsy Shapiro: Thank you very much, Genevieve.

Genevieve K.: Thank you for having me.

Betsy Shapiro: If you want to learn more about international opportunities, please remember to visit the website Genevieve mentioned, internationalvolunteer.ada.org. If you want more information on any practice management resources, you can visit our website at success.ada.org or contact us at our email address, centerforprofessionalsuccess@ada.org. We want to thank our sponsor, ADA Member Advantage, for their continued support and to Sandburg Media for producing this podcast. And thank you for listening to Beyond the Mouth.