Dr Linda Doan looks back at her own first steps in her dental career

It is the end of summer in 2016.

I arrive in regional Queensland, having driven some 2,000km from my hometown of Melbourne, ‘bright-eyed’ by the unfamiliar surroundings and the brilliant sunlight. My dad, standing next to me, shrivels up his nose – yet to make up his mind about the heat. I laugh, marinating in the thought that this place is to be my new home for the foreseeable future and also the place of my first job out of dental school. I am nervous, wary of the challenges ahead. Still, in that very moment, I am feeling more alive than ever. 

So why dentistry? Why and what led you to dentistry? I would imagine most of us have been asked these questions (or variations), especially early in our careers. I will reply with my original intention of entering dental school: I signed up for a career that would offer me job security for the rest of my life. Dentistry would offer me the standard hours between nine to five and, outside these times, I would be free to pursue my own interests and spend time with family and friends. On top of that, it is also a job that promises a lot of flexibility and autonomy.

Dentistry also appeared to fulfil humankind’s universal desire for freedom in our choices and actions. Of course, that is the rose-coloured view of dentistry. In our current climate, as young dentists and with most of us being associates and choosing to work in major cities where there is increased competition, we are likely to have several part-time positions across different practices and be working later hours to accommodate patient preferences. We also have to answer to the desires of our employers, who have their own business interests and pressures to sustain/grow their dental practices. Indeed, now that I have moved on from my regional job to a job in a metropolitan city, dentistry does not quite offer the job security I (naively) expected as a dental student.

I think I won the lottery with my first job. I was given two years of absolute control of my hours, working alongside the most supportive staff and principal dentist/mentor. Living in a new place without the comforts of friends and family afforded me a sense of wonder and curiosity to explore places and understand people. Clinically, I met some of the most down to earth and lovely patients. I had full but not overly busy books to hone my clinical and communication skills, and patients had absolute respect and value for the clinic’s times; there was not an FTA or late turn-up in the week. I say this not to brag at all, but to foreshadow my downfall later. 

It is just about nine months into my dental career, at the end of 2016

It was around this time I got a taste of what a small community dentistry is. In a town less than an hour away, a classmate from my graduating class, K, has found himself a position there. We had studied in Victoria together, and the last I heard about him was that he found a graduate job in his hometown at the Gold Coast. I would imagine that a lot of us young dentists can relate to the fact that the job did not work out.

For me, I was settled and very happy with my new life in this regional job. More often than not, I would come home to a sense of satisfaction and appreciation for the effort that I was putting into my work. K and I would make time to catch up on the odd weekend that we were free. I would tell K that my work and life were going well. He told me he hadn’t been as fortunate. There wasn’t as much work, and even the principal dentist struggled to fill her book. As industrial work and the economy slowed down in his locality, people were leaving in droves, and the place was becoming more of a ghost town, which was reflected in his appointment books. Some days he was seeing a total of three patients. I remember K’s defeated body language as he languished deep into his disappointment about his circumstances. To have setback after setback, and to be trialling different jobs that cannot support our need to simply ‘be a dentist’ after years of painstaking study… I would not wish it on any graduate. I know my friend’s hardship is hardly unique; I only share K’s story as an illustrative example of a young dentist’s struggle. 

It’s not all doom and gloom in K’s story, however. For all the uncertainty he encountered in his first year of work, he found fulfilling and steady work in Victoria for many years after that. I’m also happy to announce he recently found his way back to the Gold Coast and reunited with his family again, in a new job he’s also very happy with. 

Chasing perfection

Dental school gave me a more rounded view of dentistry as a profession. Besides providing the theoretical knowledge and training of the technical skills required, we were also educated on the risks and caveats of the job.

We were warned dentists are at higher risks of repetitive strain injuries and back/shoulder/neck pain. A Cochrane review reported up to 91% of dentists have suffered musculoskeletal injuries.[i] There are also the added pressures of treating patients, and the challenges of managing difficult patients and procedures. 

In addition, as we are thrust into the rigours of full-time work, we are under internal and external pressures to become better and better. We feel the need to emulate the production efficiency of our more senior dentists, which should not be the case; yet, how many of us – being naturally high achievers and always wanting to be our best selves – are completely immune from that self-inflicted pressure? If we haven’t completed that perfect filling/ exo/RCT in record time we buy into the script that we are the lesser version of our peers or even ourselves. Not to mention some days it feels like we’re racing against the clock to not be late (or even later) for our next patients.

We also hold ourselves to rigorous high standards. We are guided by the perfect treatment

Outcome: our crown prep tapered by the slightest of degrees, our root canal obturations only successful if within 2mm of the apex (to put that into context, we only have about a pencil tip’s margin of error). As high achievers with personal high standards, we chase the often elusive ‘perfection’ in already stressful clinic settings. Sometimes, our efforts are appreciated. Other times, patients and staff do not understand just how difficult some procedures are, especially for young dentists just starting out in the field.

It is the end of 2017

Work became steadier. My initial four days a week of work turned into five, then six. It was also around this time I discovered caffeine and coffee. I had ‘busy books’, steadily expanding my clinical skillset while making sure I fitted in four exercise sessions a week (including weekly pilates classes, which sorted out a lower back problem), made an effort to eat healthy and sleep the required seven hours a night. I felt productive and ‘in flow’.

This all came crashing down one night, quite literally, when I fainted after clinic hours. I woke up to a paramedic who checked all my vitals and, in all honesty, I felt better than before I fainted. My body was fatigued from all the physical and mental demands I was putting it through; it needed to reboot itself before I ruined it much further. For all the ‘right things’ I was doing for my body and myself I was also ignoring the ‘wrong things’ I was doing. I was skipping my lunches to not run late into my afternoon patients. Some days, I would rely only on a single hardboiled egg I had for breakfast, which I scoffed down my throat while driving to work. I would down coffee like it was water. I also struggled to allow myself pockets of time throughout the day to release the tension from my mind and body. I felt like I was on adrenaline; if I pulled my foot off the pedal, I was going to lose momentum and not hit my self-imposed production efficiency for the day. This would continue day in day out. Eventually, the candle burnt out. My misguided performance necessity led me to forsake my own health. 

If anyone asks what is the most important thing I learnt in dental school, or even dentistry itself, the answer’s got nothing to do with dental at all… in fact, the more challenges, failures and the realisations of my own shortcomings I face in dentistry, I am reminded to step back and take a good hard look at myself. Yes, living up to my own personal standards of excellence in dentistry is important, but dentistry only forms a piece of that standard.

Other aspects of my life that are more important include family, wellbeing and good sense of self. My successes and failures in dentistry should not define my identity, nor will the success or failure in the moment dictate the sort of dentist I will be for the rest of my long career.

I know it’s all too easy to write these words here, but to my fellow young dentists who are going through hard times, or have gone through hard times, I feel for you. Please know, however, I am a big believer that the more challenges and failures one faces, the more resilience that person will have to jump over the future hurdles that will come their way – and the more easily they’ll find their success and contentment. And on that note, I wish my fellow young dentist colleagues all the best on your journeys, and I trust that you will find the strength and perspective to overcome any challenge that comes your way.

The dentolegal perspective

Dr Kiran Keshwara, dentolegal adviser, Dental Protection

Dentistry is a highly-pressured job with multiple demands placed on younger dentists from patients, colleagues and practice owners alike. This, however, should not prevent you from doing your best for the patient and keeping their best interests in mind, both in terms of record-keeping and clinical dentistry.

A full-time dentist would spend a lot of their working life in close contact with their dental team so make sure that you are comfortable and feel supported by your team. It is important to have people that you can talk to regarding stresses that are affecting you, be it a sibling, a colleague, a friend or even the team at Dental Protection. The dental team can be a valuable resource and young clinicians should make the most of the opportunities to learn from and be mentored by their colleagues.

The majority of mistakes happen when a clinician is tired, stressed, emotional or hungry so enjoy regular breaks both during the day and throughout the year. Some time spent away from the dental surgery, relaxing and looking after yourself by sleeping and eating well and exercising, can reinvigorate and refresh your outlook and, ultimately, lead to you having a long and successful career. 

Dental Protection holds regular three-hour workshops throughout Australia on Building Resilience and Avoiding Burnout, which will help practitioners identify burnout and provide advice on preventing this from happening.

[i] Mulimani P, Ergonomic interventions to prevent musculoskeletal disorders among dental care practitioners, Cochrane Database of Systematic Reviews 2018, Issue 10, Art No: CD011261