|Year : 2021 | Volume
| Issue : 2 | Page : 104-110
Prevalence of burnout and practice-related risk factors among dentists in Saudi Arabia
Ammar Talal Abdelrahman Asali1, Fawaz Pullishery2, Nada Mohammed Ibrahim3, Wasmah Waheeb Tobji4
1 Department of Pediatric Dentistry, Dentistry Program, Batterjee Medical College, Jeddah, Saudi Arabia
2 Community Dentistry and Research, Batterjee Medical College, Jeddah, Saudi Arabia
3 Division of Endodontics, Dentistry Program, Batterjee Medical College, Jeddah, Saudi Arabia
4 Dental Intern, Dentistry Program, Batterjee Medical College, Jeddah, Saudi Arabia
|Date of Submission||07-Sep-2020|
|Date of Decision||14-Feb-2021|
|Date of Acceptance||05-Jul-2021|
|Date of Web Publication||21-Aug-2021|
Dr. Fawaz Pullishery
Department of Community Dentistry and Research, Dentistry Program, Batterjee Medical College, Jeddah 21442
Source of Support: None, Conflict of Interest: None
Introduction: Dentists are exposed to a high level of stress at the workplace and are at higher risk of experience burnout. Burnout has profound consequences on quality of life, patient care, and also on the health-care system.
Aim: The present study aimed to assess the prevalence of burnout among dentists and identify its relationship with the work-setting factors in Saudi Arabia.
Materials and Methods: A cross-sectional online survey was conducted using a pretested and structured questionnaire. A mixture of convenience and snowball sampling was used to collect the responses from dentists using two versions of the 22-item Maslach Burnout Inventory Scale that had three domains: emotional exhaustion (EE), depersonalization (DP), and feeling of decreased accomplishment. Dentists with scores on EE ≥ or DP ≥10 were considered to have the manifestation of burnout.
Results and Discussion: The prevalence of burnout in dentists was found to be 33.4% and Saudi dentists experienced more burnout than non-Saudi dentist (P < 0.05). Among different dental specialties, prosthodontists and endodontists showed more prevalence than any other specialties (P < 0.05). Dentists who worked in clinical settings and also who worked more than 40 h/week experienced more burnout than others (P < 0.05).
Conclusion: The prevalence of burnout among dentists working in Saudi Arabia was found to be 33.45%, and it was significantly more among Saudi dentists than expatriate dentists. Occupational burnout among dentists is a serious problem and should be dealt with appropriate interventions such as stress management training, coping up skills, organizational or structural change to reduce workload, and effective use of leisure time activities.
Keywords: Burnout, dentistry, dentists, occupational burnout, psychology, quality of life
|How to cite this article:|
Asali AT, Pullishery F, Ibrahim NM, Tobji WW. Prevalence of burnout and practice-related risk factors among dentists in Saudi Arabia. Saudi J Oral Sci 2021;8:104-10
|How to cite this URL:|
Asali AT, Pullishery F, Ibrahim NM, Tobji WW. Prevalence of burnout and practice-related risk factors among dentists in Saudi Arabia. Saudi J Oral Sci [serial online] 2021 [cited 2021 Dec 1];8:104-10. Available from: https://www.saudijos.org/text.asp?2021/8/2/104/324192
| Introduction|| |
According to the World Health Organization, occupational burnout (OB) is a chronic psychological syndrome that occurs due to exposure to chronic emotional and interpersonal stressors caused by work or at the workplace. OB among health professionals includes three components: Emotional exhaustion (EE), depersonalization (DP), and feeling of decreased accomplishment (DA)., This would reduce academic and clinical performance, poor interpersonal relationships, and may negatively affect patient satisfaction., This may ultimately lead these professionals to adopt unhealthy practices, including bad diet, smoking, uncontrollable alcohol consumption, insomnia, troublesome behavior, and could also lead to stress-induced systemic diseases such as diabetes mellitus, hypertension, and cardiovascular diseases.,
Most dental procedures consume a longer duration, which often puts dentists' minds at stress and could impact the quality of life and the patient outcomes., Dental practitioners are subjected to extremely hazardous situations such as infections through aerosols, spatter, and sharp objects (HIV/AIDS and hepatitis, etc.,), work-related stress, allergic reactions (latex, dental materials, chemicals, etc.,), musculoskeletal problems (posture related), and radiations (X-ray and light cure).,,, Among these hazards, individuals who experience work-related stress have a greater risk of developing burnout syndrome. A systematic review shows that burnout among dentists is high, and many factors such as workload, laborious shifts, long hours, inadequate training and skills, poor relationship with colleagues and patients, low income, designation, and departmental organization.
In Saudi Arabia, dentistry has undergone a rapid revolution, and the government has taken possible measures to support the dentists in their clinical practice. It is essential to maintain a stress-free working environment to achieve good physical and mental health for all health-care providers. A recent study done among oral and maxillofacial surgeons and residents in the Kingdom showed that work-related stress was higher among residents than surgeons. Although there are studies done to assess the work-related stress and burnout among dentists in Saudi Arabia, however, they lack information related to few work-related characteristics and their relationship with burnout which needed to be evaluated. Hence, this study aims to assess the prevalence of OB and its relationship with work-related characteristics among dentists practicing in Saudi Arabia.
| Materials and Methods|| |
A cross-sectional study was conducted using a pretested and validated self-administered questionnaire in the Arabic language between November 2019 and February 2020. The Research and Ethics Committee of the principal investigator's Institution approved the study (UB-RES-2020-0005). The items in the questionnaire were adapted from the English version of the Maslach Burnout Inventory (MBI). The English version was translated and validated in the Arabic version, which was then used to collect the response through the online survey method. One independent bilingual translator (proficient in both English and Arabic) who was native Arabic speakers translated the questionnaire from English to Arabic and there were no major changes made in the new Arabic version of the questionnaire when compared to the original English version. Another independent bilingual translator subjected the questionnaire to back-translation from Arabic to English. One of the authors assessed the two translated versions of the questionnaire to verify the content and sense. The back-translated English version was matched and verified with the original English version by the senior author. The respondents were given the choice of answering one of the two versions according to their convenience.
We conducted a pilot study using the Arabic version to pretest and calculate the minimum sample size. A minimum sample size of 215 was calculated using the following formula (n = NZ2P[1 − P]/[D2+Z2P (1 − P)]) considering the power of the study (β) at 80% and α-error of 5%. We adopted a mixture of convenience and snowball sampling to collect the responses. The new Arabic version showed a very good internal consistency correlation coefficient, r > 0.7, and reliability (Cronbach's α ≥0.8). We had received 278 complete responses and there were no incomplete responses as it was mandatory to complete all questions for the submission of the survey.
The questionnaire included two parts: the first part contained sociodemographic details of the participants and also the details about the purpose, benefits, and consent to participation. The second part contained items that measured burnout. The responses for items that measured burnout were divided into domains, namely EE, depersonalization (DP) and personal accomplishment (PA). In accordance with previous researches, responses to these three domains were categorized into low, moderate, and high.,, The scoring for each domain was as follows: EE, low ≤18, moderate 19–26, and high ≥27; DP, low ≤5, moderate 6–9, and high ≥10; PA, low ≥ 40, moderate 34–39, and high ≤33. According to the scoring criteria given for health-care professionals, dentists with high scores (EE ≥ or DP ≥10) were considered to have burnout. The scores of PA were not considered in the determination of burnout.
Statistical analysis and data management
Data collected were entered and tabulated in Microsoft Excel first and transferred to the SPSS version 23.0 (SPSS Inc., Chicago, IL, USA) for the statistical analysis. An independent statistician carried out statistical analysis who was blinded about the groups in the study. We used numerical figures and percentages for the categorical variables and Pearson's Chi-square test or Fisher's exact test was used to assess the statistical association between these variables. The continuous variables were expressed using mean and standard deviation (SD), and comparisons were done using the Mann–Whitney U-test. The relationship of the dependent variable with other independent variables was analyzed using a multiple regression model to identify the predictive factors for burnout among doctors. The significance value was set at P < 0.05 and any value above this was considered statistically not significant.
| Results|| |
The current study was conducted among dentists practicing in different provinces of the Kingdom of Saudi Arabia to assess the different levels of OB. The demographic data showed that 53.23% were male and 46.77% were female. The age of the participants showed that 20.9% belonged to the age group of 24–28 years, 20.1% in 29–32 years, 20.9% in both 33–35 years and 36–39 years, and 17.3% above 40 years. We separated out Saudi citizens and expatriates dentists for our analysis that showed 56.1% were Saudi dentists and the rest 43.9% were non-Saudi [Table 1]. The other characteristics related to the practices of the participants are also given in [Table 1].
The prevalence of burnout in our study population was found to be 33.45%. The mean MBI scores for each category, EE, DP, and PA were found to be 23.59 ± 14.23, 32.97 ± 8.45, and 8.30 ± 6.46, respectively. The prevalence of burnout according to different age groups and gender showed no significant differences (P > 0.05). However, the nationality of the dentists showed a statistically significant association, where Saudi dentists had comparatively higher burnout (39.7%) than others (P < 0.05), [Table 2]. When we assessed the relationship of the prevalence of burnout and with the specialty of dentists, it was found that the prosthodontists (57.9%) and endodontists (37.7%) had comparatively more prevalence than others (P < 0.05). Dentists who worked in clinical settings had a higher prevalence of burnout than others (P < 0.05). The prevalence of burnout did not show any statistically significant association with the sector of practice and also the experience of the dentists. However, dentists who worked for more than 40 h/week had comparatively higher burnout than those who had lesser practice hours that showed a significant association (P < 0.05) [Table 3].
|Table 2: Relationship of prevalence of burnout with age, gender, and nationality|
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|Table 3: Relationship of prevalence of burnout with various factors related to practice|
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Based on the MBI subscales for EE, 36.8% had high, 17% had moderate, and 46.2% had low scores. For DP scores, 26% had high, 40.4% had moderate, and 33.6% had low scores. The PA scores were found to be low in 45.1% of dentists, 23.1% had moderate scores, and 31.8% had high PA scores [Figure 1]. The EE of high risk was more present in Saudi dentists (39.7%) than non-Saudi (32.8%) that showed a statistically significant relationship. It was also observed that dentists working in the private sector had “high risk” EE (43.7%) more than others and dentists. The prevalence of “high risk” EE was found to be more in dentists working in the private sector (43.7%), P < 0.05, and also those who had an experience more than 15 years (46.2%), P < 0.05. Dentists who had more than 50 h of practice per week experienced high-risk EE (66.7%) than those who worked fewer hours (P < 0.05) [Figure 2].
|Figure 2: Emotional exhaustion distribution according to personal and characteristics|
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The depersonalization (DP) of the high-risk category showed statistically significant relationships with dentists who were working in a clinical setting (44.9%) than academics or both (P < 0.05). Dentists who had an experience of fewer than 15 years had more prevalence of high-risk DP than those who had more than 15 years of experience (P < 0.05) [Figure 3]. The personal accomplishment (PA) scores showed a significant association with age and nationality only. Dentists who were below 40 years had experienced low PA scores more than (P < 0.05) and also non-Saudi dentists showed comparatively more “low PA” scores than others (P < 0.001) [Figure 4].
|Figure 3: Depersonalization distribution according to personal and characteristics|
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|Figure 4: Personal accomplishment distribution according to personal and characteristics|
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Multivariate logistic regression was performed to assess the risk factors of OB. It was found that age >40 years (odds ratio = 4.0 [1.7–9.6]; P = 0.002) and Saudi nationality (odds ratio = 2.0 [1.2–3.5]; P = 0.014) recognized as independent predictive factor for burnout in our study.
| Discussion|| |
The current study investigated burnout among dentists and its association with personal and practice environment-related characteristics. The prevalence of burnout among dentists in our study was 33.45%. The mean score of each of the three MBI domains showed lesser scores compared to a recent study conducted by Lee et al. among Taiwanese dental staff that showed a mean EE score of 26.31 (SD = 12.32), DP score of 9.60 (SD = 7.44), and PA score of 19.23 (SD = 6.09). Maslach et al. have mentioned that the degree of burnout is severe when the EE, DP, and PA scores are ≥27, ≥13, and ≤31, respectively. There was no significant difference noted in the prevalence of burnout in different age groups and gender, but Saudi dentists showed more prevalence than non-Saudi dentists. Furthermore, the EE score was significantly higher in Saudi dentists than other dentists. When assessing burnout syndrome, EE is the key domain. The burnout symptoms are believed to vary according to different life stages of occupation and are also related to various experiences in the work, problems, and challenges encountered at the workplace, work-family conflicts, etc. The reason for Saudi dentists experiencing more burnout could be due to their work nature as most of the consultants work in multiple places (clinics and/or academic institutions) compared to non-Saudi dentists who are allowed to work only at one workplace as per the country's law. This could also be related to other factors such as sleep deprivation, time-related pressure, work family conflicts, or musculoskeletal-related problems., A national survey conducted among dentists in the United Kingdom had reported that 31.9% of the dentists showed poor PA.
Our findings showed that consultants in prosthodontics and endodontics had experienced more burnout symptoms than other specialties. A recent study done in Riyadh among dental staff reported high stress and high EE for consultants irrespective of the specialties. This could be due to the workload these specialties experience, and most of the dental procedures are time-consuming.,, Furthermore, our study showed that dentists who work only at dental clinics/hospitals experience more burnout symptoms than others, which corroborates the above findings. Increased working hours were significantly associated with burnout symptoms, and also, high EE was more present in dentists who practiced for more than 50 h/week. Dentists who worked in the private sector experienced high EE than those who worked in the government sector. Studies have shown that longer working hours irrespective of gender are a predictive factor for OB.,, Longer working time would lead to sleep deprivation that could become a perilous act cautioning health-care workers' health.
Burnout is often regarded as a psychological response to work-related stress and all the factors related to health-care services such as long working hours, increased patients, lack of patient appreciation, time-consuming procedures, rising costs, displeasing laboratory work from technicians, appointment cancellations, all could lead to stress in dentists.,, A study done in Northern Ireland reported that lower remuneration was the main cause of job dissatisfaction. Another study done in Brazil by Maciel et al. reported that lack of leisure time and work overload caused dentists' distress.
This study's findings clearly show that some of the practice environments can lead to stress in dentists, which could simultaneously cause burnout. Identifying and measuring all these stress factors are the key to burnout management. The employers and the administration of the health-care settings should annually measure the data related to dentists' workload, mental, and physical health. Appropriate interventions to reduce burnout should then be initiated, such as dentist-directed and organization-directed interventions. The dentist-directed type includes stress management techniques, mindfulness, behavioral and communicative skills to boost job competence and communication, coping strategies. Organizational-directed interventions can incorporate changes in work schedules such as reducing workload, embrace teamwork, the participation of dentists in decision-making in matters related to workflow, and operation of health-care settings.,,
There are some strong points to support the generalizability of our findings. The study used a suitable and validated scale (MBI) for assessing the burnout that was translated into the Arabic language and tested for cross-cultural adaptability. Respondents were also given options to choose any of the two language versions (English or Arabic) in answering the items. Another strength of this study is that we followed a homogenous convenience sampling rather than a conventional convenience sampling technique. The former technique is proved to have clearer generalizability than the conventional one. The present study was conducted before the COVID-19 pandemic hit (November 2019–February 2020). Most dentists were allowed to work only on emergency dental procedures to minimize the virus's transmission. COVID-19 situation could have reduced the burnout severity as most dentists did not attend the workplace during this period as dental clinics and academic institutions were temporarily closed in Saudi Arabia.,
As most of the cross-sectional study designs, this study also carries certain limitations. The confirmation of causality of the factors with burnout syndrome may not be well established, and there is a need to do a longitudinal study that should assess the impact of social, psychological, and environmental factors to gain more insight into this. A mixture of convenience and snowball sampling may cause sampling bias. An attempt was made to minimize this bias by asking the dentists to mention their national practice license number to confirm the identity that was kept confidential by the researchers. Finally, self-reported burnout measures in dentists might have caused social desirability or response bias, as there could have been a discrepancy between actual and reported measures.
| Conclusion|| |
The study findings showed that the prevalence of burnout was about 33.45% and was found to more in Saudi dentists than expatriate dentists. Some practice-related characteristics such as long working hours, dentists working in clinical settings alone, and specialties such as Endodontics and Prosthodontics showed more burnout than others. The job-related factors that could influence burnout should be identified by dentists when choosing their practice settings, and appropriate strategies should be taken to recognize and reduce burnout. Employers should provide appropriate preventive and stress coping strategies like early screening of burnout and providing effective interventions at earlier stages to prevent further consequences.
All the authors would like express their deep gratitude to all the persons who helped in data collection and also all the participant dentists who devoted their time for responding the questionnaire.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3]