Burnout – Physicians

From The Lancet 13 July 2019.

Hui Wang, a 32-year-old Chinese ophthalmologist, experienced sudden cardiac death on June 30, after working with fever for 6 days in Beijing. Hui was the father of a 1-year-old girl, and married to a doctor, who donated Hui’s corneas to two patients after his death…

According to a viewpoint published in the Chinese Medical Journal, reports on sudden deaths among Chinese physicians sharply escalated from 2008 to 2015, and most of the deaths, resulting from heavy work load, were male surgeons and anaesthesiologists in tertiary hospitals in large cities…

Physician burnout, defined as a work-related syndrome involving emotional exhaustion, depersonalisation, and a sense of reduced personal accomplishment, is not only a serious concern in China but also has reached global epidemic levels. Evidence shows that burnout affects more than half of practising physicians in the USA and is rising…

Physician burnout, defined as a work-related syndrome involving emotional exhaustion, depersonalisation, and a sense of reduced personal accomplishment, is not only a serious concern in China but also has reached global epidemic levels…

Evidence shows that burnout affects more than half of practising physicians in the USA and is rising. The 2018 Survey of America’s Physicians Practice Patterns and Perspectives reported that 78% of physicians had burnout, an increase of 4% since 2016. Furthermore, 80% of doctors in a British Medical Association 2019 survey were at high or very high risk of burnout, with junior doctors most at risk, followed by general practitioner partners. Increasingly, physician burnout has been recognised as a public health crisis in many high-income countries because it not only affects physicians’ personal lives and work satisfaction but also creates severe pressure on the whole health-care system—particularly threatening patients’ care and safety.

The 11th Revision of ICD (ICD-11) in May, 2019, provided a more detailed definition of burnout, characterising it as a syndrome of three dimensions—feelings of energy depletion or exhaustion, increased mental distance from one’s job or feelings of cynicism or negativism about one’s job, and reduced professional efficacy…

Addressing physician burnout on an individual level will not be enough, and meaningful steps to address the crisis and its fundamental causes must be taken at systemic and institutional levels with concerted efforts from all relevant stakeholders. Tackling physician burnout requires placing the problem within different contexts of workplace culture, specialties, and gender. Physician wellbeing has long been under-recognised in LMICs, and physicians’ sudden death and suicide due to overwork—the consequences of extreme burnout—have not been uncommon in many Asian countries. With rapid development of medical sciences, it is time to use medical advances to benefit the health and wellbeing of all people, including physicians themselves…

Not quite as easy as it looks is it?


Colosseum Dental Press release via “Curious PR” 16th March 2018: LINK

“One of the pillars of Colosseum’s recipe for success in the UK will be embedding each practice as a “good neighbour” in its local community….each practice will retain its connection as an integral part of its community.”

454 days later

GDPUK report, 13th June 2019: LINK

“Portsmouth is once more in the news, with the closure of three dental practices leaving ‘thousands without access to NHS treatment’. Colosseum Dental Group, which is owned by an investment company based in Switzerland, is closing the practices next month…

According to a report in The Times, up to 20,000 residents of Portsmouth will be without a dentist when a chain of practices closes its doors next month. With no surgeries accepting adult NHS patients, the nearest practices are in Gosport, which is a ferry-ride away, or Havant, a half-hour drive away.”


Blackpool’s Centre for Dentistry to close by end of August due to ‘high costs’ LINK

“…We understand that travel to Preston may not be for everybody, but it’s just half an hour down the road.…”

….The company also plans to close its Cardiff surgery by the end of August, and merge its two London practices into one.

When I visited Sainsbury’s store in Cardiff a couple of days ago the practice was still promoting itself and its “deals”. There was no mention that there would be no continuity of the membership plan or that the closest SFD practice is nearly 40 miles away on the other side of the Severn Bridge.

At least the London practices are in the same city and both north of the river.

SFD’s spokesperson said, “The costs of staying in Blackpool are very high. The rates in Sainsbury’s are much more expensive than they would be on the high street.”

You have to wonder what their projections were like in the first place; we’re all optimistic when drawing up business plans – if we weren’t nobody would ever raise any finance at all.

This is just the tip of the iceberg with several larger groups or “corporates” clearly unable to make the figures work and therefore closing or off-loading practices over the past 2 – 3 years.

I take no joy in seeing this happen. I once had to close one of my practices due to pressure from the bank. At that time I didn’t have the strength, fortitude and experience that I have now. They (the bank) clearly had no understanding of the business of dentistry, the potential professional consequences and little patience with, or confidence in, their client. The fact that the businesses had already turned the corner meant nothing. 

The experience was hard but enables me to help my clients better these days. The worst thing was leaving some patients, who were unable to move to the other site, in the lurch.

Ultimately it is the patients that suffer, followed closely by any laid off team members and the reputation of the profession. In my case it could possibly have led to bankruptcy which would have left me permanently scarred. With corporates? Who knows?

One of the mantras for success is, “Same Place, Same Face”, when that trust goes so does the customer.

But that’s the market for you.




Working with a (Dental) spouse.

Knowing your spouse’s MO can help the relationship thrive at work and at home.

Increasingly in Dentistry spouses / life partners are working together. Some of these working relationships thrive whilst others produce tensions between the partners which can lead to stress outside the workplace. If you don’t get on at work then that is likely to overlap into the home.

When I explain to partners about the Kolbe A assessment and the effects that different *MO’s (Modus Operandi) can have on a relationship there is usually a moment of clarity and comprehension. Knowing how any colleague or team member will instinctively take action is of great value. Being able to use the knowledge to enhance a personal relationship can be inestimable.

(* M.O. refers to an individual’s Modus Operandi and consists of a numerical representation of one’s instinctive way of taking action as measured across the four Kolbe Action Modes®.)

Sometimes there is a close similarity between the partners results, they take action in the same way, they tend to agree on many things. This can lead to problems because all the bases are not covered. In other cases (mine for instance) Kolbe A results are very different but are close to mirror images, and my wife and I compensate for each other. It’s no surprise that our working relationship was successful long before our personal one emerged. 

Cathy Kolbe has written about same MO Marriages HERE.

To find out more about how knowing and understanding your Kolbe A can transform your working life and that of your team take a look HERE.

To discover how I can help you to build your perfect team HERE.

Mis-en-place. Do your prep work.

Mis-en-place is a French culinary term which means putting in place or everything in its place. It refers to the set up required before cooking, and is often used in professional kitchens to refer to organising and arranging the ingredients that a cook will require for the menu items that are expected to be prepared during a shift.

It transfers well to Dentistry (and many other fields), as a dentist I tried to ensure that my surgery was “closed down” for the night with everything ready to start the next morning. All instruments were autoclaved, notes, X-rays, letters and lab work were all to hand and had been checked. The paperwork from the day before was either completed or was in its rightful place.

It means that everyone knows what materials, instruments and other resources are required before starting a case; on of my clients tells me that his nurse must often leave the surgery because something else is needed. When the “something elses” are repeated day in, day out there is something going on. Time to learn about mis-en-place. Not to embrace this means that you will operate at the speed of the slowest team member – not a recipe (excuse the pun) for success.

The lead for this must come from the top, if you’re a mess your business will be a mess, if you get behind with paperwork, so will everyone else, if you roll in late and unprepared, then don’t be surprised if your team and colleagues do the same.

It means that if the first patient has an appointment at 8.00am you and your team are ready, poised and smiling at 7.55.

Anything else means you’re not taking things seriously.


Clinical freedom in a time of austerity.

First published online in Dentistry Blog on 8th April 2019. Full article.

Clinical freedom is becoming an aspiration rather than reality.

I regularly have to straddle a line between what principals need and what associates want, whilst attempting to keep both sides happy.

Often this involves money and the phrase ‘clinical freedom’.

Amongst the things they never teach you at dental school is that you must cover your costs before you can take anything out for yourself.

Increasing overheads makes this hard.

For instance, a 13% increase in CQC fees to ‘better align the cost of regulation’ must be borne by business owners.

As far as NHS practices are concerned, the minimal rise in fees during a decade of austerity have been swamped by rising costs.

Where contracts are fixed and consume a week’s full-time work to achieve them, there is little or no room for increasing productivity.

Associates, who have the dubiously privileged position of being self-employed, must take their share of the repeated squeezes on practice owners.

Either earn more (difficult with a fixed contract) or cost less.

Because previous generations earned a bigger slice than you, unfortunately does not mean that there is any divine right.

In any profession it is time and expertise for which people pay.

The third party fee setter (the NHS) took a set of fees from a decade and a half ago and continues to run with them.

This ignores the flexibility and evolution that existed in the dental contracts for nearly six decades, which helped practices stay agile in order to remain profitable.

Sometimes these money pressures are manifested in a reduction in quality of working conditions; for instance equipment might not be maintained, materials and laboratories are chosen on cost and choice is limited and staff might be ‘bargain basement’.

As the first casualty of war is truth, so clinical freedom can become an aspiration rather than a reality.

It ain’t what you do, it’s the way that you do it.

The recent CIPD research in partnership with Simply Health was completed in November 2018 and covered more than 3.2 million employees across the UK.

The top causes of long term sickness were mental ill health & stress with 59% & 54% respectively.



The top three causes of stress related illness are:

  • Workloads / volume of work.  62%
  • Management style.   43%
  • Relationships at work. 30%

Your style as a manager needs to vary depending upon the different environments and employees. Management styles can be categorised as autocratic, democratic and laissez faire. What do you think your’s is?

If you need help with either your own management style or your managers’ style then drop me a line at alunrees@mac.com – it’s what I’m here for.

The full report is available here.

CIPD’s Top tips to support managers to minimise stress in their teams is available here.



Patient? Customer? Client? What really matters.

An interesting conversation in a practice about what the people that are treated/served/cared for should be called. I have been around the block a couple of times over the past 30 odd years and have returned to, and will remain with, patients. But that’s my opinion, you use whatever is comfortable for you.

“We sometimes make assumptions based on our opinions about a customer’s Patient’s wants and needs.

It’s hard to be objective about our ideas when we are invested in the outcome.

But that shouldn’t stop us trying to stand in our customer’s Patient’s shoes for long enough to understand how he feels.

Our opinion is immaterial if it doesn’t align with the story the customer Patient believes.”

Adapted from Bernadette Jiwa.

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