Occupational burnout: a cross-sectional study among Jordanian pediatric dentists

2.1 Study group and design

A cross-sectional study was performed among pediatric dentists in Jordan. To ensure sample representativeness, census sampling technique was used to recruit participants. The list of pediatric dentists registered with the Jordan Dental Association (JDA) and actively practicing in the country was officially provided by the JDA. A sample-size calculation was conducted using the Z equation; N = [(Z_α + Z_β)/C]² + 3, where α = 0.05, β = 0.20, and the expected correlation coefficient (r) was moderate at 0.30 [21]. A minimum sample size of 84 participants was determined by the equation. To account for potential missing data, non-responses or recording errors, all pediatric dentists in Jordan were surveyed. During the study, there were 140 pediatric dentists practicing in Jordan. We recruited 92 participants for the study, exceeding our target sample size. From March 2022 to September 2022, data were collected.

A structured questionnaire was designed to meet the specific objectives of the study, and participants were asked to answer the questions. The questionnaire consisted of two parts: The first part enclosed socio-demographic characteristics and the second assessed burnout syndrome using the Maslach Burnout Inventory Human Services Survey (MBI-HSS). MBI-HSS is the most extensively applied scale in the literature, especially pertaining to human services and education [22, 23]. MBI-HSS comprises 22 statements linked to each burnout domain: EE, Dep and PA. Using a seven-point Likert scale, respondents indicated how often they experience the feeling described by the statement, ranging from 0 (never) to 6 (every day). Scores are derived for each domain by summing the appropriate items [22, 23]. EE consists of nine items, Dep consists of five items and PA consists of eight items. Burnout is characterized by high scores on EE and Dep and low scores on PA. Burnout should be conceptualized as a continuous variable, ranging from low to moderate to high levels of experience. It should not be viewed as a dichotomous variable which is either present or absent. In the MBI manual, norm scores and cut-off points are provided for each burnout subscale. Normative scores are high if they are in the upper third, average if they are in the middle third, and low if they are in the lower third. MBI psychometric properties are well established [22, 23]. Burnout is conceptualized as a continuous variable in this study. Nevertheless, within each subscale, categorical classifications of low, moderate and high are employed. This approach aligns with the clinical perspective, where practitioners often prioritize identifying pediatric dentists at high risk of burnout rather than solely relying on continuous scores. Categorization facilitates the identification of clinicians who may benefit most from targeted interventions or support programs. For both researchers and practitioners, categorical data facilitates communication and interpretation of findings.

2.2 Pilot study and reliability

A pilot study was conducted on a group of six pediatric dentists who were not included in the main study to evaluate the clarity of the guidelines and the average time needed to complete the questionnaire. A reliability test was conducted by asking 10% of the participants to complete the questionnaire twice, with approximately 2–3 weeks between each attempt. To ensure the reliability of the second part of this survey, a reliability coefficient (Cronbach’s alpha) was calculated for the overall Maslach burnout inventory human services survey (MBI-HSS) which was satisfactory, equaling 0.704. Burnout syndrome reliability coefficients were calculated for each of the three domains, EE equaled 0.821, Dep equaled 0.712 and PA equaled 0.742. These values were close to those described by the inventor of the scale (the reliability coefficients for the subscales were 0.90 for EE, 0.79 for Dep and 0.71 for PA [22].

2.3 Data analysis

Data analysis was performed using IBM’s SPSS version 25 (Chicago, IL, USA). MBI-HSS responses were analyzed using descriptive statistics in the form of frequencies and percentages. Using independent-sample t-tests, mean MBI-HSS domain scores were compared based on dichotomous independent variables (such as gender, practice city and pediatric patients exclusively). Group means of categorical independent variables with more than two levels were compared using One-Way Analysis of Variance (ANOVA), followed by Bonferroni post-hoc analysis when necessary. The binomial correlations between each of the MBI-HSS domain scores and continuous variables (age/year, years of experience, working hours per week and number of patients seen per day) were tested for their correlation with each of the three burnout domain scores (EE, Dep and PA), using Pearson’s correlation coefficient (r). The direction (positive or negative), strength and statistical significance of each correlation were tested. In order to test research hypotheses, a statistical test was considered statistically significant if p value was < than 0.05 [24].

4.1 Burnout domains and demographic factors

Age and either EE or Dep were not significantly correlated in this study. PA scores, however, were significantly correlated with age, indicating young dentists exhibit lower PA scores and consequently higher burnout. Although some studies [26, 32] did not find age-related differences in burnout among pediatric dentists, others [33] found increased burnout risk in younger dentists. With limited clinical experience, younger dentists may encounter greater stress and challenges in their practice. Younger clinicians may also face greater pressure to impress colleagues, staff and family members than more established senior colleagues. In Maslach’s opinion, burnout and age may have a negative relationship. Those who cannot cope well with burnout are more likely to leave their jobs. Burnout is usually best resisted early in a career, probably by refining coping strategies and becoming more resilient to work-related stress [34]. Years of experience were found to have a weak but significant positive correlation with PA scores, suggesting less experienced dentists were more burnt out. Given that this study was conducted shortly after the COVID-19 pandemic, age and years of experience likely played a significant role in influencing PA accomplishment among pediatric dentists. Younger dentists may have experienced significant financial strain, while older dentists might have been subject to heightened health risks and career disruptions [35]. Infection control measures and maintaining financial stability may have been easier to adapt to for experienced dentists during a pandemic. Alternatively, younger dentists may have struggled with these adaptations and experienced greater career disruptions. Burnout and compassion fatigue are likely to have been exacerbated by the pandemic among participants. Compared to younger dentists, older dentists may have had more effective coping mechanisms. Reduced personal accomplishment has significant implications for pediatric dentists. This can result in increased burnout, decreased patient care quality, higher turnover rates, and workforce shortages. Addressing these challenges requires a multifaceted approach, including strategies to reduce stress and burnout. This involves improving workplace culture, promoting work-life balance, and implementing measures to enhance patient care quality, increase job satisfaction and retain talented dentists. These efforts are crucial for the long-term health of the pediatric dentistry profession.

EE and PA scores did not differ significantly by gender, but Dep scores were significantly higher among males. The findings are consistent with previous research [33, 36] which reported that male dentists tend to have higher Dep scores and to be more prone to burnout. However, other studies [26, 27] found no gender-related differences in burnout. Confounding variables may account for discrepancies in findings regarding gender and burnout among dentists [37]. Moreover, a male dentist may work longer hours and treat more patients, whereas a female dentist may employ more effective burnout mitigation strategies. Furthermore, different study populations and cultural contexts may also contribute to observed differences across research investigations.

Marital status was not significantly associated with any of the three burnout domains. This finding is consistent with pediatric dentists research [26]. Other studies, such as one on UK dentists, reported lower Dep scores among married individuals [26]. Married individuals may experience lower burnout due to factors such as greater psychological stability, improved interpersonal skills and enhanced problem-solving abilities fostered by family life [26].

4.2 Burnout domains and practice setting

Our findings revealed significantly lower levels of EE among pediatric dentists practicing in the private sector than those employed in MOH. Dep and PA scores did not differ statistically significantly between the two sectors. The disparity in EE may be due to the greater autonomy of private practitioners in managing their clinical settings, including patient volume, daily schedules and income. Conversely, we found that pediatric dentists working in the public sector often face higher patient volumes, limited space and constrained clinical settings, which may contribute to increased EE. This observation aligns with Ciğerim et al. [38], who reported higher levels of EE among dentists employed in oral and dental health centers.

The majority of participants in this study practiced in Amman, Jordan’s capital city. Amman participants had significantly lower mean EE scores than those practicing in other cities, but there were no statistically significant differences in Dep or PA scores. There may be several reasons for the lower EE score among dentists in Amman. There is typically more government attention given to capital cities, which leads to improved infrastructure and resources. Cultural centers, parks, museums, recreational and sports facilities can provide opportunities for relaxation and stress relief. In addition, capital cities may have a wider range of career opportunities and year-round events. These factors contribute to a more enriched environment, potentially facilitating stress reduction and improving overall well-being.

Studies have consistently linked extended working hours to increased EE among dental professionals [27, 39]. A study found a 10.59-fold higher likelihood of high EE among pediatric dentists working 40 or more hours per week compared to those working less than 20 [26]. Additionally, a systematic review identified increased weekly work hours as a significant contributor to EE [27, 39]. These findings are supported by studies in various regions, including Yemen and other Arab countries [27, 39]. However, in the present study, no significant association was found between weekly working hours and any of the burnout domains, despite approximately half of the participants working 40 or more hours per week. Among pediatric dentists who worked 40 hours or more per week, most were employed in the public sector (MOH, universities, RMS). Therefore, they may also have administrative duties, research responsibilities and teaching responsibilities as part of their job description. Burnout can be mitigated by increasing work diversity.

A weak, positive correlation was observed between EE scores and the number of patients seen daily, but no for Dep or PA scores. One previous study demonstrated a significant positive correlation between daily patient volume and EE levels among dentists [40]. Another previous research has shown that the number of patients treated daily significantly correlates with Dep and PA, contributing to burnout [32]. Physical and mental fatigue can result from working long hours due to an elevated patient volume. Due to the inherent pressure to expedite patient throughput, breaks and personal time may be limited, contributing to exhaustion. In high-volume settings, pediatric dentists may experience diminished control over their schedules and patient flow, potentially engendering feelings of overwhelm and loss of autonomy. The lack of control can further exacerbate emotional exhaustion. Exercise, relaxation and social interaction may be limited as a result of demanding schedules. Emotional exhaustion and burnout can be exacerbated by this lack of self-care.

4.3 Impact of pediatric dentistry practice exclusively

92.4% of participants exclusively treated pediatric patients. When treating exclusively pediatric patients, mean Dep scores were significantly lower than when treating both pediatric and adult patients. PA or EE scores, however, were not significantly associated with pediatric patient exclusivity. Depersonalization may be mitigated by the inherent nature of pediatric dentistry, which necessitates genuine care and affection for children. Dedicated pediatric dentistry research will be necessary to investigate this hypothesis further.

This study has limitations that must be acknowledged. First, as a cross-sectional design, this study captures burnout at a single point in time, which does not allow understanding burnout’s dynamic and longitudinal nature. Future longitudinal studies are needed to evaluate changes over time and identify causal relationships. Second, the self-reported MBI may have introduced self-reporting bias, as participants may underreport or overstate their symptoms due to social desire or their personal perception of burnout. This bias might have led to an overrepresentation of burnout among those already experiencing stress, as individuals with higher burnout may have been more likely to participate. It will take further studies to confirm the generalizability of this study to pediatric dentists in other countries with different workloads, resources and cultural perceptions of burnout.

This study underscores the critical significance of burnout syndrome in pediatric dentists and its effects on productivity and service quality. Burnout can be effectively addressed through a multi-pronged approach: improving work-life balance, enhancing workplace culture and support, optimizing patient care and communication, and promoting self-care initiatives. Burnout must be identified early, particularly in dental students. Taking proactive measures early in a pediatric dentist’s career can reduce the risk of burnout and foster long-term professional and fulfillment. Identifying and addressing burnout is essential both for their well-being and to ensure children receive optimal oral health care and a positive dental experience.