Staying Well in the Dental Profession
No one is completely immune from addictive disorders, psychiatric illnesses, infectious disease, family and relationship problems, or the many varieties of human challenges. In fact, professional training instills values and behaviors antithetical to self-care — deferring other life goals during long and rigorous educational programs and placing a patient’s needs ahead of one’s own, to name a few.
- Many professionals have focused on professional goals from an early age, and may have jeopardized their development of crucial emotional and relationship skills.
- Some aspects of dental practice — isolation, for example, and access to controlled substances, a DEA number, nitrous oxide, the knowledge about how drugs work and an office in which to use — may create an environment that actually aids the development of problems.
- Dentists in solo private practices work without the interaction and scrutiny of peers that is often available in a hospital or clinic setting. In the solo practice setting, coworkers are subordinates and the dentist holds the power of authority and money, making it very difficult for staff to intervene in a problematic situation.
And so, it can happen that good dentists can become impaired in their practice.
Dentist well-being programs and other professional assistance and advocacy efforts operate on the belief and experience that, in the majority of cases, practice impairment comes as the result of an illness that can be treated. Dental societies are in an ideal position to facilitate much-needed support to dentists with personal problems, and in fact, many have been doing so for years. Many offer programs, but the type of program varies. Each has its advantages and disadvantages.
- Volunteer programs are inexpensive and can provide very meaningful professional involvement for members. These programs are under the direct control of the dental society. On the other hand, there is a risk of volunteer burnout, dependence on one or a few individuals, and, perhaps, difficulty in coordinating adequate monitoring of recovering dentists. Since volunteers are not credentialed mental health professionals, the limits and boundaries of their activities must be very clear.
- Staffed programs have a high level of accountability to the dental society. Dentists may be well served when the staff member has the time and skill to coordinate volunteers in intervention, outreach, and educational efforts. Calls of concern to the dental society about impaired dentists can be easily transferred to program staff. Staffed programs are expensive, however, and there may be issues of liability if the staff person is not a credentialed mental health professional.
- Multidisciplinary programs are agencies charged with administering identification, referral, and monitoring services to several professional groups (typically physicians, dentists, nurses, pharmacists, veterinarians, etc.). These programs are usually adequately funded, staffed by individuals with credentials and expertise in behavioral health and addiction medicine, have established procedures and appropriate liability coverage.
- Contracted programs offer many of the advantages of the staffed programs in accountability, dedicated time, and familiarity with the needs of the state’s dentists. When the contract is with a medical society program or an employee assistance provider, access to expert consultation and liability coverage is usually assured.
- Structural Models of Well-Being Programs
- Peer Assistance: What it is and What it is Not
Designing an Assistance Program
- Dentist Well-Being Committees
- Protocols and Procedures
- Points to Consider
- Training Volunteers
- Collaboration with Outside Agencies
- Services to Dentists: Nuts, Bolts, and Building Blocks
- Calls to the Well-Being Program
- Criteria for Inclusion in Programs
- Evaluation and Treatment Referrals
- Post-Treatment Follow-up
- Practice Coverage
- The Significant Others — Family and Staff
Privacy, Confidentiality, and Immunity
- Applicable Federal Laws
- Applicable State Laws
- Disclosure to Staff and Patients
- Funding Sources
- Risk Management
- Program Marketing
When the Problem is ‘Something Else’
- Infected Providers
- Mental Health Disorders
Program Accountability and Evaluation