Occupational burnout and work engagement: a national survey of dentists in the United Kingdom

IN BRIEF • • • Burnout is a state characterised by exhaustion, cynicism and inefficacy. Work engagement is a positive construct characterised by approaching working life with vigour, dedication and absorption. Dentists with postgraduate qualifications and those who work in larger teams had lower burnout and more positive work engagement. Dentists who spend more time in NHS practice showed lower work engagement and higher levels of burnout. RESEARCH Occupational burnout and work engagement: a national survey of dentists in the United Kingdom D. A. Denton,1 J. T. Newton2 and E. J. Bower3 VERIFIABLE CPD PAPER Objective To determine the levels of burnout and work engagement among dentists in the United Kingdom. Study design Postal survey of 500 dentists selected at random from the General Dental Council register. Methods Respondents completed a questionnaire pack comprising the Utrecht Work Engagement Scale (UWES-17) and the Maslach Burnout InventoryHuman Services Survey (MBI-HSS), together with questions on demographic characteristics. Results Approximately 8% of respondents had scores suggestive of burnout on all three scales of the MBI-HSS and a further 18.5% had high scores in two of the domains. Eighty-three percent of respondents had work engagement scores suggestive of moderate or high work engagement. Dentists with postgraduate qualifications and those who work in larger teams had lower burnout scores and more positive work engagement scores. Dentists who spend a greater proportion of their time in NHS practice showed lower work engagement and higher levels of burnout. Conclusions Burnout affects a small but significant proportion of dental practitioners in the United Kingdom. A larger proportion of practitioners show low work engagement, suggesting a negative attitude to their work. Higher burnout scores and lower work engagement scores were found in dentists without postgraduate qualifications, those in small teams and in those who spend a greater proportion of their time in NHS practice. Dentistry as an occupation is considered to possess many positive qualities,1,2 however it also has the reputation of being a stressful occupation,3 which may result in emotional and physical ill health.4 A recent survey of British general dental practitioners (GDPs) reported that 60% were experiencing symptoms of stress.5 Occupational burnout may develop in response to prolonged chronic and interpersonal stressors in the work environment6 and is associated with high levels of exhaustion, cynicism (depersonalisation) and inefficiency (reduced personal accomplishment). Schaufeli and Enzmann7 defi ne burnout as ‘…a persistent, negative, work related state of mind in “normal” individuals which is primarily 1 Senior Dental Officer, North Lincolnshire, 2*Professor of Psychology as Applied to Dentistry, 3Clinical Research Assistant, Oral Health Services Research & Dental Public Health, King’s College London Dental Institute, King’s College Hospital, Caldecot Road, London, SE5 9RW *Correspondence to: Professor Tim Newton Email: Refereed Paper Accepted 1 February 2008 DOI: 10.1038/sj.bdj.2008.654 © British Dental Journal 2008 BRITISH DENTAL JOURNAL characterised by exhaustion, which is accompanied by distress, a sense of reduced effectiveness, decreased motivation, and the development of dysfunctional attitudes and behaviours at work. This psychological condition develops gradually and may remain unnoticed for a long time by the individual involved. It results from a misfit between intentions and the reality of the job.’ Often burnout is self-perpetuating due to inadequate coping strategies that are associated with the syndrome.7 Humphris,8 in his review of burnout among dentists, speculates that dentists are prone to burnout due to the nature of their work. He comments that burnout is an issue of great relevance to the delivery of dental care since it is assumed to have an adverse influence on the quality of work. However, what is quite clear when examining studies on burnout among dentists is that the majority of dentists are not victims. Apparently, a large percentage experience their work to be stimulating and engaging.9 Schaufeli et al.10 comment that the turn of the century has brought with it a more positive approach to psychology, with a focus on the positive rather than the negative. Seligman and Csikszentmihalyi11 argue that in the latter half of the 20th century, psychology had become more focused on mental illness and as a result had developed a distorted view of what normal and exceptional human experience is like. In line with this approach, the concept of ‘work engagement’ has been proposed as the antipode to burnout. This model suggests that burnout is one end of a continuum, the other end of which is work engagement, which has been defi ned as ‘…a positive, fulfilling, work-related state of mind that is characterised by vigour, dedication and absorption which rather than being a momentary and specific state, is a more persistent and pervasive affective-cognitive state.’12 However, recently it has been shown that burnout and work engagement are different but related constructs and not opposite ends of the same continuum, and as such should be measured using different instruments.12-14 In order to ascertain an accurate picture of the impact of dental practice on the working 1 RESEARCH lives of dentists, it is important to assess both burnout and work engagement. Work engagement is associated with positive attitudes to work, for example learning motivation and low turnover intention, and positive behaviours such as being proactive, as well as increased job satisfaction. It also leads to improved job performance. Health benefits include low levels of depression and psychosomatic complaints.10 Clearly these issues relating to the well-being of dentists are of great relevance to the delivery of dental care in the United Kingdom. The current study aimed to assess the current levels of occupational burnout and work engagement in dentists in the United Kingdom. The most recent European study of burnout in dentists that used a representative sample15 identified 13% to be in the high burnout category. There has never been a study measuring burnout in a representative sample of dentists in the United Kingdom. Work engagement has also never been measured in dentists in the United Kingdom, there being only one study measuring work engagement among dentists carried out in Finland.16 Since these concepts are strongly related but separate aspects of the work experience of dentists, the authors argue that it is essential that both are measured in the same sample. MATERIALS AND METHODS A cross sectional postal questionnaire survey was conducted on a random sample of dentists working in the United Kingdom (UK). The survey method, in relation to questionnaire design and timings of mailings, followed guidelines on design of surveys to maximise response rates,17,18 details of w (...truncated)