Behind the Mask: Mental Health Struggles of Dentists and Their Teams

So the number one thing that I think happens with burnout is you start to lose focus on attention to detail. So you're not going to be quite as slick with your bonding protocols. You're not going to be quite as like technique sensitive on some of the way you do things. The second thing that happens is kind of as you're getting burned out or already burnt out, you start to become the victim of something called sway. Sway is the patient who doesn't want radiographs. and you're kind of just too tired to argue with them, so you just say, yeah, whatever. Or the patient's like, can't you just put a filling in it? When you know it needs a crown, you don't want to have the fight, so you're just like, yeah, sure, I'll do that. That's Sway. Welcome to Austin, Texas, and welcome to the Phil Klein Dental Podcast. Today we're diving into a topic that doesn't always make it onto the main stage at dental meetings, but probably should, mental health in dentistry. Dentists face significantly higher rates of depression, anxiety, and burnout than the general population, and it's something we don't talk about enough. Our guest today is Dr. Joshua Austin, a full-time restorative dentist in San Antonio, Texas. He's also an editorial director and monthly columnist for Dental Economics, focusing on dental products and technology, and he lectures nationally and internationally on clinical dentistry and mental health. As you'll soon find out, Dr. Austin understands the pressures of operating a dental practice firsthand. After going through a period of intense stress, he realized something had to change. He made the decision to rebuild not just his practice, but his life. Today, we're going to hear that story, the struggles, the wake-up call, and the intentional steps he took to find joy in dentistry again. Before we bring in our guest, I do want to say that if you're enjoying these episodes and want to support the show, please follow us on Apple Podcasts or Spotify. You'll be the first to know about our new releases and our entire production team will really appreciate it. Dr. Austin, welcome to the show. Hey, Dr. Klein. How are you? Great to see you again. Yeah. And I do want to talk to the audience about your webinar that you did. It was fantastic on mental health issues in dentistry. You got very personal, which really, in my opinion, connected with the audience, I think. I mean, I watched it. It connected with me. So if anybody wants to really get a good... about some of the stressors that we have to deal with and how it affects our profession. And Dr. Austin did a fantastic job. Just go to VivaLearning.com, type in Austin, A-U-S-T-I-N. And you'll see his webinar there. It was delivered in January of this year. So really good job, Dr. Austin. Thanks so much. I appreciate it. It's my favorite educational program to give. You know, people talk to me more about that one than they ever talk to me about anything I do about adhesive or cement or Emacs or, you know, any of that stuff. So it's definitely, I think it's important to me because it's just kind of the journey. um and sharing that journey if and it can reach one person and help them realize they're not alone and that this is a common thing that happens in our field um you know that's but it's funny how you you intertwine comedy in such a serious topic yeah you have to yeah it was otherwise it just gets too heavy yeah you had me laughing several times and especially you had a video there that you had your friend animate and i got to tell you and i'm talking to the audience If you want to laugh, go to that webinar and go, I don't know if it's midway in, but you can scroll through. If you don't want to watch the whole thing, I get it. It's towards the end. It's like the last 10 minutes. Yeah, it's a video that your friend animated on RoboKiller, which is an application that kind of weeds out spam calls. And Dr. Austin, I'm not telling you too much about this, but Dr. Austin brought his car in for service and the spam software. had a discussion with the person who was trying to get Dr. Austin to come in and pick up his car. It is hilarious. It's just amazing. Thanks, man. I appreciate it. So it was fantastic. It's just like Larry David. You know, I watch Curb Your Enthusiasm and you can see like in some of the things that happen on Curb Your Enthusiasm, they're like, oh, there's something like this happened in real life to Larry David. And there's like everything you see in that video is 100% true that actually happened. Yeah. So that, yeah, I showed it to my wife just to... i said you got to see this and that's the part she watched yeah she kind of felt sorry for the receptionist and i said oh yes for sure yeah there's a lady who's like making you know 18 an hour and is having to listen to me sing yeah it was yeah don't give away don't give away too much yeah don't give away too much all right so let's get down to this one um We hear a lot about mental health in dentistry, but what are the real numbers actually showing? And what do they tell us about the pressures dentists face every day? Yeah, so it's, you know, if you're in dentistry, the one thing you've heard from someone at a cocktail party or a happy hour with people who are not dentists is they always ask about, you know, is it true? Is it true that dentists lead, you know, the world in suicide rates? And, you know, I've heard that since I was in dental school. I've heard that even since, like, when I said I wanted to go to dental school, I would hear that. And I never knew if it was true or not. And so, you know what, at some point during my career, I really started having some issues with stress and burnout and anxiety and depression and really felt alone because none of my friends talk about this. My friends that I'm, you know, that are dentists, you know, we talk a lot about labs and what cement and what adhesive and all that kind of stuff to use. But we don't ever talk about this, especially men. We don't talk about how we feel very often. And so I started doing research. And the research I found pretty much alarmed me. The first thing I found was that if you look at CDC data, the CDC just keeps data on like... how people die, like what their cause of death is, and what they do for a living. And if you just plug in the number, you find that dentists are 250% more likely to die by suicide than the general population. And that's not even the biggest number I found. I found another journal article that said dentists were 564% more likely to die by suicide. So there's definitely something there. We know that dentists have double the rate of depression and anxiety than the general population. And so it seems to be something that is kind of... I just want to say like an occupational risk of dentistry, that this levels of stress and performance and whatnot that we have to endure really do take a toll. And the fact that it kind of doesn't end, you know, it's just every day, it's kind of the same. So is it anxiety? Is it depression? Is it panic attacks? What is the condition that takes up most of that space? And why does this profession seem to amplify those issues? Absolutely. So the number one is by far major depressive disorder, what they call MDD nowadays. That's what we used to call a clinical depression or unipolar depression. And that is the one that dentists are at least twice as likely to suffer from major depressive disorder than the general population. Number two is anxiety. It's estimated that somewhere around 10 to 12 percent of adults in America experience anxiety, but it's around 25 percent of deaths. So it's, you know, it's a significant number. And I assume panic attacks are part of anxiety. Absolutely. You know, I never would have imagined at some point that I would be sitting out in my car before work, like kind of shaking because I didn't want to go into the office that day because of stuff that was on my schedule or patients I had to deal with or like. having to fire a team member or have a difficult discussion or whatever. It's happened to me multiple times. And so all of those things are things that we're at risk for. But depression is number one. Yeah, no. And a big part of it is because part and parcel of our profession is perfectionism. Absolutely. That's just the thing we do. We want to make sure we work in a very small area when we're working. It's very technique sensitive. Very technique sensitive. Things have to fit perfectly. Because there's not a lot of room for error. Right. That's exactly right. And that, of course, leads to more stress. And some dentists, depending on their personality, handle it better than other dentists. You know, I know we're talking about... health issues with dentists. But I want to veer off for just a second and talk about the patients themselves, because we're treating patients that have the same issues, not for the same reasons, but they still have panic attacks, anxiety, and they're suffering from depression. And that is something we should be aware of from the standpoint of treatment. Just comment on that if you would, and then we'll get back to dealing with our own stresses as dentists and how it affects our mental health. Yeah, so the Substance Abuse and Mental Health Services Administration last year did a study that showed that 24% of U.S. adults suffer from any mental illness and 6% of U.S. adults suffer from serious mental illness. So there's not a day that goes by in your practice that you're not seeing at least one or two or three patients that suffers from anxiety, depression, bipolar, personality disorders, things like that. And so these are things that patients are presenting with all the time. And many of them take medications to treat these. The most common ones would be things like antidepressants, like serotonin, sustained serotonin reuptake inhibitors. Serotonin and norepinephrine reuptake inhibitors are classic antidepressants. Or things like benzodiazepines for anxiety. And all of those drugs have oral health sequela. They all affect the oral cavity in different ways. And so we're treating patients who are taking these drugs. Sometimes they're embarrassed to tell us they take these drugs. And we're embarrassed to ask, so we don't ever ask. And they can affect a lot of the treatment that we do. The number one reported side effect of SSRI or SNRI medications is bruxism. And it is estimated, or there's several studies that were done, big meta-analysis reviews of studies showed that around 82% of people who take antidepressants report bruxism starting within three weeks of their treatment. And I know for sure that we have patients that either don't tell us that they're on. antidepressants or think that we don't need to know. And so if you're doing restorative dentistry on somebody and they're going to begin bruxing the restorative work that you do immediately, maybe it changes your preparation design. Maybe it changes the materials you pick. Maybe it changes your post-restorative plan, right? And so it's not uncommon for me to make nightguards for people who take SSRIs. If you just start looking for your patients in your practice who take SSRIs, drugs like Zoloft, Paxil, Prozac. Lexapro, Celexa, any of those, what you're going to start finding is that they have flared up muscles of mastication. You palpate their masters, they're going to be tender. You palpate the turboys, they're going to be tender. Start making night guards for these people. We 3D print night guards in my practice. And so we scan them, design them, and I can 3D print a night guard for somebody for usually under $6 in my cost and maybe 20 minutes of time and 20 minutes of assistant time, not my time. and we can produce a night guard for somebody. So we do a lot of night guards for people who take drugs like SSRIs. What's a typical material you like to use? Yeah, I really like a material made by Volco called V-Splint, and it's a liquid resin that we print in our 3D printer, and it just polishes really nicely. It feels a lot like an old, hard, processed acrylic night guard, which is so much easier to fabricate and replicate. And these patients do really well. Any of my patients who take like a stick, stimulant drug for ADD or ADHD, like Adderall or Ritalin or Vivanase, some of those, those are all drugs that we recommend night guards for people because they are going to Brux. You have the dry mouth problem as well. Absolutely. Xerostomia is number two. So Bruxism is one, Xerostomia is two. And so with Xerostomia patients who are taking SSRIs, like the last thing I want to do, especially if they're being successfully treated on an SSRI and their depression is better and they feel better every day. The last thing I want to do is like advise them. to talk to their doctor about changing their medication lineup when it's working. If they have dry mouth, we're going to deal with it, right? And we know how to deal with that. So those are patients that we see on three-month recall. Those are patients that we use different xylitol products on. Those are patients that honestly, like it's a non-negotiable in my practice, they get a fluoride varnish at every visit. We like one called profluoride that works really, really well. It's just one of those things that when you start treating these problems, if I can reduce their caries risk. And they can be feeling better with their anxiety and their depression. It's a win for everybody. Yeah, without a doubt. You've got to deal with these things. And you've got to be, as a clinician, you have to be aware of these things. Because like you said, they don't always spell it out for you and say, hey, I'm on this drug. And just a note to our listeners. Pro Fluorid Varnish is a VOCO product, and you can get more information on that on VOCO's website. Right. Getting back to the clinician, the main topic, we got off track a little bit, but that was okay. It was important to understand that our patients also have conditions very similar to what we're talking about from the standpoint of a clinician having it. When you zoom out... really driving mental health challenges in dentistry? Is it the way the profession is structured, the personality traits that draw people into it, or is it a mix of both? Yeah, I definitely think it's a mix of both. You mentioned that a lot of us are perfectionists, right? And a lot of us have similar personality patterns, right? We have similar sensibilities, we have similar training. You know, I remember being taught in dental school, you know, hey, a restoration is either perfect or it's a failure. You know, and if you got recurrent decay around a class two, it was because your class two wasn't sealed. And it was a problem with something you did, not the fact that the patient, you know, never picked up a toothbrush or floss or any of that and ate nothing but highly fermentable carbohydrates. Like, we were just, we're definitely taught that, like, the restoration needs to withstand hell, right? And so... that's part of it is we have these similar personality types. I think the other part of it is that a lot of us are business owners or we work in small businesses. And in those types of situations, like... the last five years. Everything's more expensive now, right? Everything's more expensive. My lab fees have gone up. My supply fees have gone up. My rent's gone up. My people fees gone up. All those things have gone up. You know what hasn't gone up? Insurance compensation. My Delta Dental reimbursement, right? I'm still getting the same $57 for a pro fee. Right. $57 for a pro fee, you said? I'm making that up. I don't know. Well, that's another conversation we have to have in the future, Dr. Austin, because it's getting to the point where it's very difficult to practice. and stay profitable, which affects your stress, your sanity, because it is a business. And these are the things that are making it more difficult for the clinician. And the insurance companies are controlling way too much. They also control it in the medical field. I mean, look what we know what's going on in the medical field. They control, they own drug companies, they own HMOs, they own hospitals. Yeah, they own the CVS and they also own the medical doctors that are associated with CVS. They own everything. They own everything. And they basically tell the doctor how to practice medicine. And that in itself could be so stressful to the actual doctor, whether it's a dentist or a physician. Let's talk about the culture for a minute of a dental practice. What can a practice owner actually do to create an environment where mental wellness is part of the conversation? It's not just something people hide. It's actually brought out into the open. So I think one part of it is, is that in my practice, we never work through lunch. That's kind of a non-negotiable. People need to have time off in the middle of the day to eat. And I also talk to my team a lot about like, just stepping outside of the office for even a couple of minutes, just get outside in sunshine. Sunshine is such an amazing antidepressant. And when you're inside all day, and you know this, like especially people in the north, when daylight savings time happens and it's dark at 5.30 p.m., you know, it's oftentimes the sun's coming up when you go to the office. The sun's going down when you leave the office. kind of a brutal feeling to like not feel any sunlight on your body or any daylight and even if you're inside you have windows and stuff like that's still not the same and so part of our deal is like we always take lunch we always have a lunch and sometimes it might be 45 minutes instead of an hour um you know sometimes it may get pinched a little bit but we are never going to work through lunch in my practice we're going to go outside for five minutes even if it's five minutes Walk around the block. We have a parking lot back behind my office that adjoins with the gym. I am totally fine. Like we have a big group membership at the gym. You want to go walk over to the gym and do some sort of physical activity for 30 minutes. Great. Any of that stuff is always part of the deal. The other thing that we don't do is we don't work late. After hours, if I'm doing a quadrant of fillings and it's 4.45, I'm not starting the next one because I don't want my employees to feel like they're constantly staying until six o'clock. So we're pretty strict with some of those things. I also don't let patients walk all over my team. So that's another non-negotiable for our practice is if you're rude to my team, we have a talk. If you're rude to my team a second time, you don't come back. And I'm totally fine dismissing patients because of that. So when you start standing up for your team and you start giving them, when you give them some personal time during the day, it does make it a lot better. The other thing is, so I'm a coffee guy. I love coffee. And so one extravagance I have for the office is we have a very nice coffee machine in the break room. What about the actual coffee itself? Yeah, I'm a Lavazza guy. I love Lavazza. And we have a nice machine that can make lattes, flat whites, mochaccinos. It can do a latte cappuccino. I mean, this stuff not only tastes great, but it's great for the soul. It makes you happy. It's that 2.30 p.m. lift up. And so that's one of those things. It's like, how much did that cost me? It cost me $4 ,000. Great. It's expensive for a coffee maker, for sure. If it makes somebody that works for me, it makes my hygienist's day 3% better, then it's worth every penny of it because it makes my day 3 % better. And if everybody on the team's day is 3% better because they get to have a nice coffee in the afternoon, it's a great thing. Find that thing for your office. I don't know. Have you ever met Diana Tadros? She's a dentist in Fort Lauderdale. She does a lot of Exocad education. She has a gelato machine in her office. And her team, it makes gelato from these little pots, kind of like a Nespresso or whatever, but it makes gelato. And that's just for her team. They do this kind of thing in big corporations. My daughter works for Indeed and she has a full cafeteria and she sends me pictures. She chats me pictures of the desserts that she's putting on. table like chocolate layer cake and extravagant cheesecakes. And it's certainly a great way to boost morale of the employees. Who's not going to smile when they're sipping a gourmet coffee made from a $4,000 coffee machine or get some endorphins from savoring homemade gelato? Absolutely. Let me ask you about younger dentists versus those who've been practicing for 20 or 30 years. When it comes to mental health, Do you see a difference in the younger guys, younger women and men coming out versus the ones that have been out for a couple of decades? Any trends that stand out? Yeah, the biggest trend is that younger dentists are more open and willing to talk about maintaining their mental health, whereas like Gen Xers like me and Boomers. tend to like cover it up and not want to talk about it all and get really uncomfortable about it. So, you know, I have a young associate in my practice who says this is his second or third year out of dental school. And he's totally comfortable coming up to me. And I think it would be even if it wasn't me, who he worked with, he'd be totally comfortable going up and saying like, I need a day like I need to take an afternoon or I need to take a day. It's mounting up. I need this. You know, I need this mental health day. I need this personal time, whatever. And he'd be comfortable telling me that. Whereas. You know, a lot of dentists that I've worked with and that I'm friends with and whatnot could never bring themselves to say that they would just try to grind their way through it. And, you know, I'm 46 years old now. I've been doing this 20 years. The only thing I want to grind through is when I have to cut off an old zirconia crown. You know what I mean? I don't have to grind through going to work every day. So let me just ask you just to, to minimize, to minimize the stress in that procedure. Do you use electric handpiece or air driven? Oh, of course you got to, there's no way to get them off without it. You got to have the torque and red striped diamond and you can actually get through using electric. Yeah. We got to throw the products in here on these. I mean, it is, it is a dental podcast where it's not like psychology today. That's not what we do here. But what you're seeing. And pressing harder on it makes it worse. So it's like the lighter stroke you have when cutting off a zirconia crown. That's the only thing I want to grind on, man. I don't want to get up and have to feel like I'm going to work to grind every day, right? And obviously work becomes more of a grind when you spend excessive hours in the operatory. What are your feelings about how many hours you should actually be in the operatory every week? You know, I'm not a big fan of like government legislation, but like you shouldn't probably work more than 35 hours a week chair side. I think that's the maximum you should work. And honestly, 30 is probably better. And what you'll find is like, as you diminish the hours that you actually see patients clinically, you stay just as productive. You actually end up doing just as much as you always would have done. It's just that you kind of compress everything together. There's less like wasted time in between. And having that extra like afternoon off or like finishing at three instead of 5 p.m. is such a different feeling. Like you can get home, you can exercise, you can. walk the dogs. You can watch a game or a TV show or whatever. And then it'd be like time for dinner versus like, it always seems like when I finish at five, I actually don't leave until five 30 and get home till six. Then it's already time for dinner. Very often dentists let the schedule control them. So their busy schedule is running the practice and they're, they're not controlling the practice themselves. And sometimes they think, you know, in order to help pay the bills, I just have to work more, be more productive. But it leads to burnout, which is my next question, actually. So in dentistry specifically, how does burnout start to show up clinically? And what kind of impact does it have on things like decision making, patient interactions, and overall satisfaction with your career? So the number one thing that I think happens with burnout is you start to lose focus on attention to detail. So you're not going to be quite as slick with your bonding protocols. You're not going to be quite as like technique sensitive on some of the way you do things. The second thing that happens is kind of as you're getting burned out or already burnt out, you start to become the victim of something called sway. And what sway is, is, you know, sway is the patient who doesn't want radiographs. And you're kind of just too tired to argue with them. So you just say, yeah, whatever. Or the patient is like, can't you just put a filling in it when you know it needs a crown? And you're just like, you don't want to have the fight. So you're just like, yeah, sure, I'll do that. That's sway. And the more burnout you get, the more prone you are to falling victim to sway. We've all had procedure where patients have talked us into doing something we don't want to do. And we always pay the price for it, right? It's always like the patient who's class three occlusion and they chip their front tooth and you talk to them about ortho. They don't want to do ortho. So they talk you into doing a bonding on it. And it's never like, oh, and it was it stayed there and was there for the next 27 years. No, of course, like it chips off three weeks later. Right. And you're doing it again. And now you own it at that point. It's interesting. I was on the actual other side of that because I had Invisalign and for the first 20 trays until I had that. my ClinCheck where they made the last set of trays. He was using Invisalign. And he's a phenomenal orthodontist, one of the best in Texas. I was doing a week for each tray. And then at the end, for the last eight trays, he goes, you know, I want to put you on 10 days on these last eight. Now that adds another... days onto this and at that point i was like i was ready to tap i'm done yeah so i said to him you know as a dentist i said to him i said you know 20 trays i was on seven days a tray now i'm now you're pushing me to 10 could we just stick to seven and he looked at me he looked very tired he goes sure let's just do seven now i was yeah that was sway and i was like i wish he told me why i needed to do 10 like explain to me Phil, I understand you did seven, but here's why I want you to do 10. Yeah, we're trying to zero in the last little tweet. Right. He just said, yeah, just do seven. And he looked tired. Yeah, you're the 74th patient he saw that day. Right, right. So that's an example of Sway. That's very interesting. But I will say he seems like a very happy orthodontist, very successful. And in reality, it was probably he just didn't feel like debating with another dentist because the upside of the extra three days based on the fact that I had high compliance. wasn't significant. So I think he just let it go. And I also want to say that, you know, when a doctor is burnt out, they get they can get angry at times. And patients will leave a practice if they feel that they've been talked to in an angry manner by the by the dentist, and they'll just leave a practice. I think you showed something in one of your webinars. Tell us about that real quick. Yeah, so it was a software that we use for like reactivation. So if a patient hasn't come in a while, it sends them like an email and a text. But they can unsubscribe if they don't want to hear from us anymore and ask them a couple questions when they unsubscribe and then sends us an email so we can archive them. And I come in and check the office email and it was an email from a guy named Chris who said that he was leaving our practice and his reason for leaving was Dr. Austin just seems so angry all the time. And I remember it being like really shocking because I thought I was pretty good at covering up the stress and the burnout and the anger and all that stuff. And I remember looking up from my computer across my office and seeing a hole in the wall that I had punched one day through the sheetrock of the office. And I don't even remember why I punched the hole through the wall that day. I don't remember what set me off that much. So, you know, there was obviously like... that was really one of the moments that helped me realize that I needed therapy and that I needed to start doing something about this or that this was going to start to take over my life and really do bad things. And so that was really a turning point for me was figuring that out. Did your staff identify what you were going through and did anybody approach you? Oh, for sure. Yeah. Was that an office manager? An office manager came up to you? Everybody in the office knew when it was a good day and when it was a bad day. And they did the deal of walking around on eggshells when it was a bad day and whatnot. But it was unfair to them. It's unfair to put your team through that. So what turned the corner for you personally to get out of that rut? move away from that and move into a life where you're actually enjoying dentistry and you're controlling all your emotions where you're actually much happier. What was the turning point for you? And what could you recommend to our audience if some of the people that are listening are going through this now? Therapy, I think, is ridiculously important. Having somebody on your team that can help you regulate your emotions, learn and figure out why you react to things the way you do, help you with relationships. It should just be part of everyone's team. Am I saying everyone needs a therapist? No. Just every dentist needs a therapist. Because again, we have very similar personality types. So therapy was number one for me. Sounds like Los Angeles with the celebrity world. And Austin too. We're getting there. Right. Number two was Lexapro. Therapy and Lexapro. So I started taking an antidepressant about four years ago or so, five years ago. And that along with therapy was pretty life changing for me. I think there's a lot of people who could handle just therapy and be okay. And then there's probably a lot of people like me who need both therapy and an antidepressant. I'm not embarrassed to talk about it. It's one of those things that I think Lexapro saved my life. And I think it helped me turn the corner. And I still take it every single day. There are other things we could do as dentists to also bring down stress and reduce anxiety. You talked about some of those things a little bit on your webinar. Absolutely. Absolutely. Yeah, I take I try to take five minutes a day to do like some mindfulness breathing, like a guided meditation. And that really that five minutes a day, sometimes I get to it in the morning, sometimes it's at lunch or in the afternoon. But every time I do it, I feel better afterwards. And you feel energized and reinvigorated. Breathing exercises are really, really important. I think we discount the importance of breathing. And if you just learn a couple of really easy breathing exercises like Ujjayi breathing or the box breathing method. All of those things can really, really help to just level when you get those spikes of cortisol, when you get those spikes of stress. Yoga is really important. Dentists hurt a lot. Dentists hurt their bodies. You know, this is what we do is physical. And yoga, for me, for many years, I just thought it was like hippy dippy stuff. It wasn't really something I was interested in. But at the end of the day, what yoga really is, is just stretching and breathing. And it's a lot of core stability. And that's the stuff you need. For dentistry, you need to be able to stretch and move your body in certain directions and breathe a certain way. And you need to have core stability. I mean, that's really it. And if you don't, you know, having a career for 30 plus years is going to be really hard. And when your body is in pain, that is, again, one of those things that adds to depression. It adds to anxiety because it hurts to do what you do every day. Ergonomics is so important and it's taught very little in dental school. I've interviewed a lot of ergonomic specialists on the show. I encourage our listeners to check out, just do a search for ergonomics on Apple Podcasts or something under my show. client at a podcast show and you'll listen to them. There are some really good ergonomic specialists that talk about this. So as we're getting towards the bottom quarter of this show, I do want to ask you how you've managed to look at stressors differently in your practice, because you've gone through a lot. You're under therapy, you're taking some medication, but therapy and 10 milligrams of Lexapro a day are still not going to make you impermeable. to some of the stressors that are typically evident in a dental practice. But you seem to be handling it very well now, coming from a time where you didn't. So tell us how you're doing that. One of the things that therapy teaches you is coping mechanisms. And we all have coping mechanisms. We all have ways that we deal with things. And typically what we do is we do things that have worked successfully for us in the past. And the problem is, is that most people, and I say dentists, it's more than just dentists, it's people, but most dentists have terrible coping mechanisms. We deal with stress in ways that are crazy unhealthy. Things like drugs and alcohol. things like gambling, junk food, like all that stuff that we do when we have a bad day, right? And what therapy can help you learn is ways to better deal with it. Does stuff still stress me out? Yeah, every day. But having strategies to help me with that and to deal with it in ways other than what I dealt with before, which was lashing out in anger. punching the wall, those kinds of things, right? Now I have ways to deal with it. I stop and breathe for 30 seconds. I do a quick meditation. I go outside for literally two minutes and breathe outside. I will turn on a guided meditation on my headphones. Stuff like that is stuff that really helps. And you're going to have stresses, right? Going to therapy doesn't make dentistry stress-free. what it does is it helps your way it helps you find ways to deal with the stress in healthy ways um and so you know it's something each of us are going to have our own different recipe on that but no matter what like therapy will teach you more healthy ways to deal with these things because you're right you're going to have a crown that doesn't fit you're going to have a patient that's rude you're going to miss a lock, you're going to break a root, you know, and you're going to have, you know, three hygienists ready for you all at the same time, all while you're trying to control bleeding so that you can get a scan for a crown, you know, that you're taking a 40% cut on because you're a member of a PPO plan, right? Well, that sounds like a nightmare, what you just described. It's like, who wants to do that? I know, I know. I hear this all the time, but I do hear the other side where dentists are so grateful that they have the skill set, the ability, the knowledge to be able to help a patient that comes in and you could do wonderful things for a human being. You know, the thing is, and it applies to almost everything in life, the lower your expectations are, the happier you will be. When you have... high expectations about everything, whether you, if it's a Broadway show or a baseball game or the Superbowl or meeting someone and having that first date, if your expectations are sky high all the time, you're setting yourself up. You're bound to be let down. Absolutely. And unfortunately they do not teach any of this in dental school, as we know, uh, with a very packed curriculum. Unfortunately, you had to learn some of this stuff the hard way, Dr. Austin. I mean, that's how it goes for most of us. Right. But it's so admirable that you're teaching it. If you have a chance, go to VivaLearning.com and listen to Dr. Austin's webinar. Just type in his name. And you can also connect with him on Instagram. What is your Instagram handle? At JoshuaAustinDDS. At JoshuaAustinDDS. Yeah. Check him out on Instagram. So as we wrap up this episode, Dr. Austin, can we close being assured that you're enjoying dentistry at this point in your life? For sure. For sure. Yeah. And it's part of it is, you know, I have been fortunate enough to be able to grow my practice to where now there's a couple of other doctors that can that are taking away some of that stress. And it allows me to do more of the procedures I want to do. And that's sort of the flow of a dental career, right? You start early, you kind of do everything because you have to. And then over time, you can start to kind of develop the things that you're really good at and the things that you enjoy. And that's kind of the phase I'm at now. And I'm down to three days a week clinically, which is really good for me. It's good for my body. It's good for my mind. And so it gives me time to be able to do stuff like this, to be able to travel a little bit. do some lectures and things like that. So definitely, you know, it's a great place to be. I think just as we close, the problem with dentistry and the problem with dentists is that we're all givers, right? That's the reason we are attracted to dentistry is because we want to give back. We want to help people. We want to help them out of pain. We want to help them with their smile. And somewhere along the way, we get the idea that we have to give everything. We have to give our wholesales away. Like if you get to the end of the day and you haven't given all of yourself away, you didn't care enough or whatever. And I think that's just really a bad way of looking at it. Yeah, you got to save some for the people that matter. And the people that matter are the people at home, your family, your friends, your loved ones. Those are the people that really matter. And so, you know, I just encourage everybody, keep something in the tank. Don't give it all away to your patients at the end of the day. I'm not saying be a crappy dentist. saying. But I'm saying, you know, I think it's just as important the work you put in to be a good dentist is to put in the work to be a good husband, a good wife, you know, a good brother, a good sister, a good son, a good daughter, a good parent. Absolutely. That stuff's way more important than the margin on the Emax crown at number three or the, the, which, you know, which bulk fill composite you use for your class twos. Like that's the real stuff. Yeah. And you've said that so beautifully. I don't think anybody could say it better. And I truly thank you for sharing all this so candidly. and your openness to talk about a subject that many people hold internally and they hide it and they don't share it with others. And by you sharing it with our profession, I think we can all benefit, especially the younger dentists who are starting their career. Appreciate everything you've done for us over the years. Thank you so much. You're too kind. You're too kind.