Are dentist burnout and patient dissatisfaction parts of the same problem?

I'm not revealing any industry secrets by saying this: a lot of dentists are unhappy practicing dentistry. It is said openly and repeatedly in public forums and professional communities.

“I hate my job.”

“I’m exhausted.”

“I can’t keep doing this.”

“Why did I go into dentistry?”

These are not unusual sentiments. They come from new dentists, experienced dentists, associates, owners, and people practicing in very different settings. The details vary, but the frustration is remarkably consistent.

At the same time, patients have their own list of complaints. Appointments feel rushed, especially after sitting in the waiting room for 45 minutes past the scheduled time. Treatment recommendations can feel transactional. Costs are difficult to understand. Insurance creates confusion. Patients sometimes leave wondering whether a procedure was recommended because they needed it or because the practice needed the sale.

Those may look like two different problems, but maybe they are not.

A profession built around caring for people

Very few dentists go through years of schooling because they dream of maximizing efficiencies in chair turnover. They are trained to diagnose disease, prevent it when possible, restore function when necessary, relieve pain, and maintain a patient's oral health over a lifetime.

The economics of running a dental practice, however, do not always reward those goals equally.

A dentist can spend extra time explaining why a patient's gums are deteriorating, talking through home-care habits, answering questions, calming an anxious patient, checking on a problem that may never require treatment, or simply taking the time to listen. All of that may be excellent patient care, but very little of it directly produces revenue.

The filling does. The crown does. The extraction does. The next patient in the chair does.

Nobody has to consciously decide that patients should be rushed for a system to gradually produce that result. If revenue depends heavily on procedures and volume, time itself becomes expensive. Ten extra minutes spent talking to one patient may mean running behind for the next three. A schedule that was intended to maximize efficiency can quickly become one in which both the dentist and the patient feel pressured.

The patient feels it too

Patients experience the same system from the opposite side of the chair. When the dentist is running behind, the patient may feel rushed. When production matters, a completely appropriate treatment discussion can still feel like a sales conversation. When insurance determines what is covered, when it is covered, and how much is reimbursed, the financial relationship between dentist and patient becomes harder to understand.

That can create an uncomfortable dynamic. Patients sometimes become suspicious of dentists because dentists make money when treatment is performed. Dentists, meanwhile, can become frustrated that their clinical judgment is treated like a sales pitch.

Neither side necessarily created the problem. They may simply be reacting to the incentives around them.

What if the incentives were different?

Medicine has been experimenting with alternatives for years. Concierge medicine and direct primary care use different financial models, but both begin with an interesting idea: instead of paying a physician only when something billable happens, patients establish an ongoing partnership with the practice.

Dentistry already has versions of this. Many practices offer membership plans in which patients pay a monthly or annual fee for preventive care and receive reduced fees on additional treatment. In most cases, though, these plans are still structured largely around a menu of services and discounts.

That raises a larger question. What if we took the idea beyond the discount plan? What if the economic relationship were built around maintaining the patient's health rather than delivering individual procedures?

What would dentistry look like if the most profitable patient were the healthy one?

Imagine a practice where spending ten extra minutes on prevention was not considered lost production. Checking on a patient's sensitivity three months later could have value even if no procedure followed. An anxious patient could be given more time because the practice was being compensated for the relationship, not simply for the work completed during today's appointment.

In that kind of model, saying, “Let's watch that tooth for another six months,” could fit the economics of the practice just as comfortably as preparing it for a crown.

That does not mean the answer is simply that everyone should switch to memberships. It is much more complicated than that. Major restorative care still costs money. Different patients carry very different levels of risk. A membership model can be priced badly. Insurance still serves an important role for many patients. Regulations matter. Access matters. A model that works extremely well for one practice or community might fail somewhere else.

There are also legitimate questions about whether concierge-style care improves access for some people while making it harder for others. Those concerns deserve to be explored seriously, not brushed aside in the interest of promoting a business model.

We are going to explore them

This is the first article in a series built around a broader question:

Could changing the way dental care is paid for improve the experience of both practicing dentistry and receiving dental care?

Over the next several articles, we are going to look at how the current system evolved, why production has become such an important part of practice management, how dental insurance influences the dentist-patient relationship, what membership practices are already doing, and where concierge-style approaches succeed or fail.

We also want to keep looking at the issue from both sides of the chair. Could a different economic model reduce burnout and improve patient trust? Could it give dentists more time to practice the way they were trained to practice? Could it make prevention financially sustainable rather than simply clinically informed?

And perhaps most importantly, could a healthier business model help create healthier patients?