Shedding Light on the Dark Side of Dentistry—a Conversation with Dr. Kyle Stanley
By Karen Hewell on October 8, 2021 | 1 commentIn August of 2021, doctors across the Spear community connected through a series of online courses exploring mental, physical and emotional wellness for dental professionals. The Breaking Through: Mental Wellness in the Dental Profession series features experts in fitness, mindfulness, stress management, and ergonomics.
One of the most thought-provoking presentations in the series was a presentation from Dr. Kyle Stanley, which explored the seven contributing factors that led many dentists to experience profound challenges with depression and anxiety later in their careers.
Named as “The Next Generation of Cosmetic Dentistry” by the AACD in 2015 and among the “Top 10 Young Educators in Dentistry” by Seattle Study Club, Dr. Stanley knows how the pressure to be the best can negatively impact those in the dental profession. Spear members can learn more about Dr. Stanley's personal experience with depression and healing — as well as strategies for safeguarding mental health — in his new Spear Online course and related pathway.
This month, Dr. Martin Mendelson caught up with Dr. Stanley to discuss his perspective on the 'dental depression path', the importance of community, and how doctors who are struggling right now can begin to make their way out of a dark place.
Let's talk about dentists having trouble separating the person from the profession.
Dr. Mendelson: I recently re-watched your Spear Online course, The Dark Side of Dentistry. What struck me was a portion in which you discuss how many clinicians don't feel like they have an identity outside of being a dentist. We're all geeked-up dentists and we love to talk about clinical things, but let's talk about dentists having trouble separating the person from the profession. What do you think about that?
“Then dentists get to a point in our career where we start failing — because that's natural, right? But it's not natural for us, because we are used to winning! We're used to being at the top of class, passing tests and excelling, so it just gets ingrained in us [not to fail].”
Dr. Stanley: “As I've done more and more research on this and talked to more people even outside of dentistry, I've realized that it's not just dentists — it's people that have a long road to success or to get some type of certification or award, whatever it may be.”
With dentists, a lot of us had to decide that we were going into medicine or biology when we were 18, 19, 20. By the time we get through college, dental school, residency and internships, it's been a decade. During that time, we are focused on, I'm going to be a dentist, I'm going to be a dentist, I'm going to be a dentist.'
Many of our friends who don't go into medicine may already have jobs, have already married or are having kids — and we're still in school thinking about dentistry every single day, taking tests and treating patients. I think it has a lot to do with the amount of time that it takes for us to get there.”
I have this section in my course where we talk about being an overachiever. If you became a dentist, you're an overachiever, whether you realize it or not. You had to get through college and dental school, and you had to pass the boards. You had to get past difficult professors in dental school that graded everybody hard. You really had to be an overachiever in some way — and often that gets you to this point where you're not used to failing.”
Then dentists get to a point in our career where we start failing — because that's natural, right? But it's not natural for us, because we are used to winning! We're used to being at the top of class, passing tests and excelling, so it just gets ingrained in us [not to fail].”
And I never thought I would be that person because in dental school, I didn't really hang out with [other dental students]. But I became this dental robot. I wanted to constantly get better. I wanted to improve. I wanted to go from two-tenths of a millimeter to one-tenth of a millimeter. That became my identity, which I now realize was the wrong way to go.”
How do experiences in dental school impact dentists later in life?
Dr. Mendelson: Studies clearly show how important human connections are for mental health — and during your Spear Online course, you also discuss how only dentists can really understand other dentists. Dental school can be such a hellacious experience, and that in and of itself draws students together. How do you think this impact dentists later in their careers?
Dr. Stanley: “So when we think about this identity, it's born in dental school. Then we go our various ways — whether that be residency or out in practice — and we all face a lot of pressure. I believe the average level of debt for the typical dental school graduate is around a quarter of a million dollars. Then you add a practice onto it, the environment of fear, and the negative media portrayal of dentists, and the seven factors that lead to the [mental health challenges] we see for clinicians.”
Dr. Mendelson: What have been your observations about people getting stuck in this mindset versus those who ask for help? What have you noticed relative to the people who seek help versus the people who get stuck?
Dr. Stanley: “In my courses over the last few years, I've seen that younger doctors are now more interested in getting help sooner. I think that has to do with the mental health crisis being more at the forefront of pop culture. If you think about someone who is my dad's age who graduated in the 1970s—at that time, you didn't necessarily tell anybody you were depressed. You didn't tell anybody that you had anxiety because you feared being perceived as weak.”
This is true in my generation as well. I remember when my friend in high school told me he had anxiety, and I said, 'Just stop. Just get over it.' That's how I thought it worked! It's nice to see a trend of doctors that are maybe a year out of school that recognize that they're not feeling how they thought they'd feel out of school. They seek help — that has been nice [to see].”
What is most difficult is when people are at the lowest point. I know how that is because that's how I was. I was lucky that I had people in the trenches with me — like my brother and my dad — because they understood what it's like to be a dentist. Although they weren't going through that at the time, I had someone that I trusted that wouldn't judge me, that I could really be honest with. And not everybody has that.”
Doctors will sometimes message me through Instagram and say, 'Hey, Kyle, you don't know me, but I'm really going through a hard time. I don't think anybody will understand. Would you mind listening?' Those are usually the two people I see: The newer doctors, and then someone at any age range at that low point.”
How can doctors set healthier boundaries between their work and personal life?
Dr. Mendelson: The pandemic prompted a lot of realizations — even for me. In March of 2020 for a period of about two weeks, I panicked because I didn't know what the future held for Spear. I later had a moment of clarity that led to resignation and confidence. When I became disabled, I didn't know where to go at that time either, and I survived. Other doctors in our community shared similar experiences during the pandemic because it's jarring to have your profession ripped out from under you.
“I think the pandemic helped us realize that dentistry is not who we are, it's what we do. You can love it and be passionate about it. You can take all these e-courses you want, read all the articles, but it can't be your purpose in life.”
Dr. Stanley: “I think it goes back to the concept of identity. For me, I went from saying, 'I'm Kyle the dentist.' Then the pandemic hits and my office is shut down for six weeks. I'm Kyle the... what? What do I do now?”
“I think the pandemic helped us realize that dentistry is not who we are, it's what we do. You can love it and be passionate about it. You can take all these e-courses you want, read all the articles, but it can't be your purpose in life.”
Dr. Mendelson: In the process of setting up this interview, you said something like, 'Well, weekends are family time,' and that stood out to me. Many doctors — specialists in particular — will bring their practice communications home every night to keep up with their restorative doctors, versus creating systems for delegation that allow others to help them. Why and how do you think doctors can create healthier boundaries?
Dr. Stanley: “Well don't make me out to be an angel because that is a constant balance. [chuckle] With me, usually I hit rock bottom doing the wrong thing. With my mental health journey, I hit rock bottom, now I'm doing the right thing. I hit rock bottom with my work-life balance too — which is why I had to make a change.”
“That came to me when I was speaking 40 times a year, running a successful practice, trying to learn and do the best — I was Kyle the dental robot. My wife had to sit me down and say, 'Kyle, I don't care how much money you make. I don't care how famous you think you are. We need you here.' That was a wake-up call.”
I had to have a year of saying no. That was a difficult time in my life because I was a yes man. I said yes to every opportunity, whether it killed me or not. I had to put a line in the sand. It started with speaking twice a month, and then trying to avoid weekends. The pandemic was good for me in that sense, because I realized what was important in my life.”
When I was at home with my family, I realized, 'All I need is my safety, a roof over my head, and my family. I don't need anything else.' Even when a good friend asks you, 'Hey, can you meet on Saturday morning?' it's easier to say, 'Sorry, that's my family time.'
Dr. Mendelson: One of the things you discussed in your webinar was the choice of patients and saying no. This concept makes plenty of dentists nervous because every consultant in the world would say, 'New patients are your lifeblood.' Yet you turned around and said, 'No! Build a practice full of people that share your common vision so that you can have a better day at the office.' Talk to me a little bit about why you think this is important.
Dr. Stanley: “You'll realize the theme here is that I do everything wrong until I hit rock bottom, and then I realize, 'Okay, I need to change something.' [chuckle] This was the same problem. I have two partners and we bought a practice that's been running for 60 years. We have a lot of history. Practices like that often have systems that aren't correct but were created that way over time. One hygienist didn't want to do this, or the other hygienist left and didn't want to do that — and then that becomes the system. We had a lot of problems with that.”
What we started to see was that many patients were simply causing more stress for us. They didn't want any other treatment, they wanted a discount on cleaning, they didn't want to do x-rays, they're already late, they talk poorly to my staff. We ended up dismissing one patient because of a liability issue about taking radiographs. Do we risk our license and our livelihood on this patient, or do we say, 'This is our standard of care, and we're not willing to take this risk. We want to do what's best for you — and if our ideologies don't align, then maybe it's best that you find another dentist.'”
It was hard — but what was interesting is once it happened the first time, no one was mad! The assistants were so happy. The front office was happy. And then we saw how the morale changed. That's easy to do for the patients that don't do the treatment.”
The hard thing are the patients that say, 'I have all the money, I have all the time.' It took having some problem patients before my partners and I got together and said, 'We need to be better about screening our patients and about finding a way to have people here that want to be here.' It was a difficult conversation, but we settled on the idea that it's more important to have a great vibe in the office than it is to make $20,000 extra.”
How can doctors who are struggling with their mental health now get help?
Dr. Mendelson: We're still well within the throes of this pandemic with no true end in sight. If you were talking to doctor who was struggling, what kind of advice would you give them relative to how to let light in to get out of a dark place?
“Dentists are oftentimes misunderstood, so if you can find those people that you can trust, and come to them and say, 'I'm having a difficult time,' that community can really support you — and they don't have to do much. Often, they just have to say, 'I've felt that before.'”
Dr. Stanley: “The first thing I'd say is that you're not alone. That's an important thing to focus on because I also thought I was the only one going through this. Then I started talking about it, and I would have people come up to me afterwards and say, 'Oh my gosh. I thought I was alone.' We have a path to depression, so it's okay to not be okay, especially if you're a dentist.”
The second thing I would say is to find the people that you can trust and that have been in the trenches [as a dentist]. People that you went to dental school are great because they had the same difficult professors who made us prep nine teeth in class. They had that difficult part on boards that we all took. These are people that can really understand you.”
Dentists are oftentimes misunderstood, so if you can find those people that you can trust, and come to them and say, 'I'm having a difficult time,' that community can really support you — and they don't have to do much. Often, they just have to say, 'I've felt that before.'”
That community element is especially important because if the first person you reach out to is a non-dentist, you may get shut down. I went through this when I reached out to friends that weren't in the profession, and they said, 'Kyle, what are you worried about? You're a dentist. You're respected. You're a doctor! I mean, come on, what's wrong with you?' Then I went to my brother and my dad [who are both dentists] and they said, 'I get it, Kyle. I was like that in 2009,' or, 'I had a colleague that went through this, and this is what they did.'”
Watch Dr. Kyle Stanley's online course — part of Breaking Through: Mental Wellness in the Dental Profession — when you become a Spear Online member.
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October 22nd, 2021