by Dianne Glasscoe Watterson, RDH, BS, MBA
I'm in a bit of a difficult situation and was hoping you could help. The dentist I have been working with for the past 13 years recently sold his practice. The new doctors that have taken over have turned our extremely conservative practice into one whose main concern is production, not the patient.
The previous owner was conservative in his treatment philosophy and really tried to help our patients. We are located in a poor part of town, and many of our patients have no dental benefits. We have a large segment of seniors and people with dentures.
The new owners want me to do fluoride treatments on all patients, but I don't feel everyone needs a fluoride treatment. They also want me to push intrapocket therapies at $50/site and have even offered me a commission for this service. I'm actually offended by this. Our patients have never been told they needed these adjunctive services, so I feel like it compromises my integrity to suddenly suggest they need something different. The patients see right through it. The doctors also have stated that no patient should be on a one-year recare schedule. We have some patients that have been maintained on a one-year schedule for years and are maintaining well. I feel I'm compromising my own ethics if I tell them they need to come more often than that.
I don't feel like I can practice with pride in this office anymore, and the patients deserve better. These patients mean the world to me and the thought of leaving the practice is heartbreaking. Patients ask me daily if I plan on staying, and if I would please contact them if I decide to leave, as they would also leave. The patients trust me, and I consider them friends. I would feel horrible if they came in for their six-month recall and I wasn't able to notify them if I decided to leave. However, I don't know what my options are legally and ethically.
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The new doctors are very nice and I would feel terrible if many of the patients left as a result of my leaving, but I also feel I have a responsibility to the patients as their sole hygienist for the past 13 years to let them know where I go if they would like me to continue as their hygienist. I've considered making a business card with my contact info, or collecting a list of email addresses for those who ask to be notified.
I just don't want to cross any legal or ethical lines. What can I do? Just sign me,
Sad and ethically challenged
No doubt, the former owner developed close relationships over time with his patient base and tried to accommodate many people as cost-effectively as possible, realizing their limited resources. You were witness to the doctor's generosity and willingness to place patient care over finances. I'm certain that this caused you to develop a large measure of respect and admiration for the former owner.
It is obvious that the new owners have a different treatment philosophy than the former owner. They bought the practice, but they have not developed relationships with the patient base yet. In any practice transition, keeping patients from going to other practices (attrition) should be an important concern. One of the biggest mistakes a new owner can make is coming in and making big changes to the established practice protocol. Changes have to be made very gradually over time to keep attrition low.
The change in practice philosophy can be traumatic for employees, but it's not always bad. The former owner may have been too conservative in his approach, and the new owners desire to promote the best dentistry has to offer. After all, patients are not always concerned with the cheapest alternative when a more expensive option will give them more comfort and serve their needs better.
While I understand your dedication to your patients, your first responsibility is to your employer. That may sound harsh, but it is the reality. The owners purchased the practice and all the patient records. The true value of the practice is the patient base, since the practice has no basis for survival without patients. While I sympathize with your heart for the patients, you can get yourself in serious trouble by contacting patients. You cannot legally or ethically contact patients directly to let them know of your impending departure. The patient base belongs to the new owners.
I was privy to a case several years ago where a hygienist was in a similar situation as you. The new owner immediately informed the hygienist that there would be big changes, and if she was not onboard, she was welcome to leave. So the hygienist mailed out a postcard to all the patients with appointments on her schedule, informing them that she was leaving and inviting them to come to the practice where she had acquired a new position. When the owner found out that the hygienist had contacted the patients, he immediately sued her. She had to hire an attorney, and the bottom line is that she got to keep her license, but she had to pay a substantial fine plus all the attorney fees. It was patently illegal for her to conspire to lure patients away from the practice.
That being said, in some states, it is legal for a dentist to run an ad in the newspaper or other advertising medium that states "(Hygienist's name), RDH, is now associated with Dental Associates..." I'm not sure if that type of advertising is allowed in your state, but that may be one way patients can be informed of a staff member's relocation to another practice.
It is distasteful and unethical to promote products within the dental office because of their profit potential. Nonetheless, adult fluoride is beneficial for patients with certain risk factors. In fact, the ADA has a publication concerning the efficacy of topical fluorides to guide dental professionals. I urge you to familiarize yourself with this information at their website.
Once-per-year prophies are fine for some people. In fact, there is a recent study that says there is little evidence to support the twice-per-year regimen that we have promoted for decades. The study, conducted at the University of Michigan, was published June 10, 2013, in the Journal of Dental Research.
If you think about it, you may be able to help with the transition if you can support your position with evidence. You have to approach the "profit vs. ethics" issue unemotionally and appeal to their sense of fairness. Patients do not know if they can trust the new doctors. Attempting to upsell/oversell can generate negative missionaries and patient defections. Patients are not stupid. Doctors have to earn patient trust. It does not happen as a given. I really do believe that we reap what we sow.
If you decide to leave the practice, do so with as little fanfare and drama as possible. It is never a good idea to leave on a bad note, as you may need this employer to provide a future reference for you.
DIANNE GLASSCOE WATTERSON, RDH, BS, MBA, is a professional speaker, writer, and consultant to dental practices across the United States. Dianne's new book, "The Consummate Dental Hygienist: Solutions for Challenging Workplace Issues," is now available on her website. To contact her for speaking or consulting, call (301) 874-5240 or email dglass firstname.lastname@example.org. Visit her website at www.professionaldentalmgmt.com.
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