75191605 © Wavebreakmedia Ltd | Dreamstime.com
Dreamstime M 75191605 61fadc894cc9d

The 3 "ships": Navigating the dental hygienist shortage

Feb. 2, 2022
Dental hygienists are a practice's lifeline, and there’s a huge shortage of them. But it doesn’t have to be that way. Bethany Montoya, RDH, lays out how focusing on relationship, ownership, and leadership can make all the difference.

Remember what a typical day at the office was like before the COVID-19 pandemic? Yeah, me neither. Within the past two years, we have had to completely change the way we approach clinical care with our patients and make some major shifts in the way we do business. Many practice owners are finding themselves in a constant cycle: they're confronted with the latest threat to day-to-day operations and strategizing ways to overcome it, only to be presented with the next obstacle around the corner.

One of the most common issues that has plagued practices nationwide is the shortage of qualified team members—specifically hygienists. You can consider yourself fortunate if you have a fully staffed hygiene department, as a growing number of businesses are scrambling to find coverage each day, resulting in decreased patient satisfaction and lost revenue.

Let’s be real: the hygiene department truly is the lifeline of the practice. It’s where lasting relationships are formed with patients based on personal connection and trust. It’s also where successful diagnosis and acceptance occur as a direct result of that bond. From a business perspective, we’re not selling treatment—we’re selling a relationship. When the hygiene department suffers, there is a profound ripple effect of patient disengagement that unquestionably impacts the overall health of the practice. Patients are less likely to accept treatment recommendations from a provider they’ve never met before or have spent very little time with. Seeing a familiar face over a series of visits is what strengthens the patient’s connection to the practice and ultimately results in more positive experiences, retention, and referrals.

With this recent mass exodus of hygienists, we need to rethink the way we’ve always done things to keep the ones who have remained, attract the best new talent, and restore the balance within the practice. When considering the possible solutions for the future, they all seem to fall into one of three “ships”: relationship, ownership, and leadership. With a genuine, steadfast focus on these areas, we can work together to create a better environment than what existed in the past, improving conditions for every facet of the dental business.

Relationship: The building block

Whether we want to admit it or not, the moment we shake hands and say the words, “Welcome to the team!” we enter into an employee-employer relationship. Many consider this relationship similar to a marriage, as the ones that last the longest are built on mutual trust, respect, and commitment. You might see sparks fly during the interview and feel an immediate chemistry between you and your prospective candidate, but those alone are not enough to maintain a healthy long-term working relationship.

That starts with trust, which should be freely given, not earned. Supplying your new hygienist with an office key, uniforms, and a permanent login to your practice management software immediately upon hire, instead of six weeks or six months later, tells them you’re committed for the long haul. Trust also comes into play in terms of resisting the tendency to micromanage once you delegate a task. Continually checking on the status of a job, feeling the need to frequently critique and insert your feedback, and unnecessarily involving additional team members tells your hygienist that you don’t trust their ability to handle your request.

Respect is another element that’s vital for a healthy working relationship. Many hygienists feel that they are merely viewed as “teeth cleaners” and not the prevention specialists that they are trained and educated to be. Taking a genuine interest in the profession of dental hygiene will let your RDH know that you value the important role they play in your practice. Being asked opinions such as, “What do you think about this case?” or “Can you tell me more about this product?” will tell your hygienist that you view them as an equal and are open to learning from them. Including their picture and bio on your practice website shows that you’re proud to have them on your team and want your patients to get familiar. Ordering personalized business cards communicates that you view them as a vital part of the business.

Ownership: Make RDHs your partners in business

While they may not formally be your business partners, hygienists want to be your partners in business. The reason so many RDHs are leaving the clinical realm for entrepreneurial pursuits is they have an innate ownership mentality that is not channeled or encouraged in the traditional practice environment. Allowing your hygienist the freedom to plan and execute change within their department is a great way to empower them, while also enabling your practice to stay progressive and patient-centric. Providing a monthly hygiene budget gives them a sense of authority to make decisions based on what products and supplies fit their individual preferences, fulfilling their desire for autonomy within the business.

During the hiring process, you’ll quickly earn your hygienist’s respect by providing a copy of your office manual and a detailed offer letter that outlines the conditions of their employment, duties, salary, working days and hours, benefits, time off, and a bonus structure. Not only does this document provide clarity for you and your team member on the expectations of the position, it also speaks volumes about your expectation of excellence. You might also consider offering salary compensation in lieu of traditional hourly pay. Hourly employees are paid for the number of hours they work, whereas salaried employees are paid for what they contribute to the business. Coming in early and staying late are often necessary to fully own an area and do a job well; paying a salary upholds this mindset.

Leadership: Invest in growth and create opportunities for fulfillment

A critical quality that hygienists are looking for in an ideal employer is the vision and passion to lead their business to success. It’s no secret that owning a practice can be challenging, and it takes continued drive and grit to effectively steer the ship. No matter the hierarchy of management within the practice, it’s up to the practice owner to ultimately determine the direction of the business. Having clear goals, values, and communication are what separate the elite from the ordinary, and hygienists long to rub elbows with leaders who drive the team culture and uphold accountability. Regular morning huddles held in the presence of the practice owner inspire the team and set the tone for the day. Without them, the day has no focus. Regular team meetings centered around achieving goals with action items and deadlines are exciting to contribute to, and keep team members engaged in the vision of the practice. Opening the floor for questions and open communication reminds your team that their thoughts and feelings matter, and that you realize their need to find meaning behind what is expected.

Investing in the personal and professional growth of your hygienist is another trait of a strong leader. Creating regular opportunities for continuing education is a great way to connect them with the specific clinical focus you have in mind for the practice. You will especially shine as a leader when you sponsor their involvement in hygiene-specific education events, reinforcing the message that you value their area of specialty and want to see them grow as a clinician. For a hygienist, there’s nothing more exciting than learning about a new area of our profession, coming back to the practice with a high level of energy to implement what we’ve learned, strategizing how we’ll use our budget to implement the change, and sharing our game plan with the team. This is the heart and soul of what hygienists need to feel fulfilled, and when this need is met, amazing things happen for the business!

The hygienist shortage is real, and we don't know when it will end. In the hygiene profession, we’re working to improve our mindset, our knowledge, and our contributions to the field of health care. We know that we have work to do, and we see room for us to improve. Perhaps the pandemic initiated a “hygiene purge” of sorts—weeding out hygienists who were not passionate about the profession in the first place and needed a change. Those of us who are left, however, would love nothing more than to see our role collectively evolve, mesh, and progress with dentistry in a holistic way. When we partner together and approach this unprecedented time as a united front, there are no limits to what we can achieve in our patient care, within our team, and our bottom line.

About the Author

Bethany Montoya, BAS, RDH

Bethany Montoya, BAS, RDH, is a practicing dental hygienist, editorial director of DentistryIQ's Clinical Insights newsletter and a key opinion leader. She has advanced knowledge and training in complex cosmetic dentistry, dental sleep medicine, and implant dentistry. Recently, she has devoted her time to dentistry’s personal and interpersonal aspects through her social media brand, @humanrdh. Contact Bethany at [email protected].

Updated February 6, 2024