Chris Bundy, MD, MPH: Healing Our Wounded Heroes

Chris Bundy, MD, MPH
Executive Medical Director, Washington Physicians Health Program

Many of us are feeling the joy and relief of returning to a semblance of normalcy as we emerge from the siege of the COVID-19 global pandemic. However, for some of us, the effects of isolation, loss, social unrest, political divisiveness, and financial hardship linger.

The practice of dentistry, even in the best of times, is stressful. It requires mastery in clinical and business domains, has unattainable expectations of perfection, and often involves managing painful procedures in patients who are unhappy to be in the chair in the first place. The profession selects for, and then reinforces, trait compulsivity. Guilt, self-doubt, and an exaggerated sense of responsibility drive excellent clinical performance at the cost of self-care and routine maintenance. Compulsivity among health professionals is socially desirable, yet personally costly. Professional burnout is common among dentists as is early retirement due to disability.

Most dental practices in Washington closed during the first wave of the COVID-19 pandemic and then had slow openings in the months that followed. This resulted in financial hardship and the attendant stress of retaining staff and keeping the practice afloat through some very lean times. Meanwhile, the need for emergency procedures continued, placing dental professionals at uncertain risk working in the oral cavity with dental aerosols during a time when virus transmission via these routes was unknown. Though data are lacking in the U.S., dentists in the U.K. experienced high levels of stress, anxiety symptoms, and depression during the height of the pandemic.¹ As part of the critical health care infrastructure we need to support he mental health of dentists and the sustainability of the dental workforce now and in the years ahead.

For more than 35 years, the Washington Physicians Health Program (WPHP) has been a resource for health professionals, including dentists, struggling with stress-related illnesses. Anxiety, depression, and substance use disorders are common reasons for referral to WPHP and, while WPHP is often thought of as a program for addicted health professionals, 60% of referrals are for non-substance related health concerns. WPHP can assist dentists with any health condition.

Unfortunately, dentists are under-represented among WPHP participants. This is due to the relative isolation of dentist practices compared to physicians, the dependence of practices and staff on the dentist, and misguided fear and loyalty among subordinate staff who may, understandably, be reluctant to provide feedback to the dentist or make a confidential referral to WPHP when concerns arise.

It is important that dentists, and those who care about them, understand that WPHP is a confidential, therapeutic alternative to discipline. Practically speaking, this means that the laws in Washington allow dentists to get help from WPHP without ever being known to DQAC. Though WPHP has a reporting requirement for dentists who do not follow WPHP direction and pose a risk to public safety, WPHP is forced to act on that obligation in only about 5% of cases. In addition, less than half of professionals referred to WPHP are recommended for a monitoring agreement. Most get an initial assessment, support, and referral to additional resources without the need for ongoing involvement with WPHP. This model is designed to effectively assist individuals who can benefit from support upstream of health-related practice impairment while also addressing more severe concerns before practice, patient, and life are at risk.

85% of WPHP graduates describe the program as extremely useful or lifesaving on exit surveys and nearly 90% are working in their field at program completion. Last year, only 10% of participants reported burnout compared with 40-50% of health professionals nationally. Learn more about WPHP outcomes and success stories at www.wphp.org.

One of the silver linings of the COVID-19 pandemic is that it galvanized efforts to support professional well-being and workforce sustainability. It is my hope that dentists and those who care about them will take this opportunity to help themselves or another who might be suffering in silence benefit from WPHP’s services. Whether wounded by the pandemic, the chronic stress of dental practice, or a combination of both, our dentists are heroes who deserve the compassionate support that WPHP provides. A call to WPHP is a courageous act of compassion and our mission and commitment to you have never been more critical.

^{1. Ranka MS, Ranka SR. Survey of Mental Health of Dentists in the COVID-19 Pandemic in the UK. J Int Soc Prev Community Dent. 2021;11(1):104-108. doi:10.4103/jispcd.JISPCD_401_20}