Too much change, too quickly: Changes in dental office don't seem to make sense

Nov. 20, 2015
Changes in dental office don't seem to make sense

Changes in office don't seem to make sense


Dear Dianne,

I graduated from my hygiene program last year and have been working at the office I am writing about since that time. This is my first dental hygiene position. I was hired to work full-time (36-40 hours weekly) Monday-Thursday at $36/hour plus one week paid vacation, sick days, medical insurance, and the dental benefit of only paying for lab fees. I work for two very talented dentists with diverse credentials who expect nothing short of hard work and professionalism from their team. I work alongside a truly dedicated hygienist who has worked for this family practice for more than 30 years. We provide excellent care for our patients, utilizing intraoral cameras, digital photography, VELscope, and many other useful tools that are available to tirelessly educate them about the status of their oral health. We do not cut corners in providing care.

However, in the last several months, many things have changed in the dynamics of our office. Over the winter, our hygiene schedule seemed to be falling apart way more than it had in the past. In early spring, the doctors purchased a satellite office. At the same time, our office manager retired, a new one was hired, and then after months of implementing her protocols (including shortening time units for prophies), she was fired. Another business assistant quit and was never replaced. Our front desk is now manned by one overworked receptionist, an assistant who is cross-trained, and the doctor's wife. All these changes have led to a huge problem of miscommunication.

After things calmed down and the other office was partially staffed, the other hygienist and I were told we would be placed on a base-pay-plus-commission salary, specifically $250/day plus 30% of any production after $1,000. For me, this seemed like a great opportunity, but not for the other hygienist. Her days were cut, and she was told she could make just as much in fewer days, and to basically just "produce more."

We were then instructed to come up with a perio program to better treat our patients who were falling through the cracks (for example, the moderate gingivitis patient who doesn't need SRP, but needs more than a prophy), which took many hours of research and preparation. The new program is supposed to generate more production, because instead of a patient getting "just a prophy," patients are getting a "gingival therapy program" with extra visits and products that have no peer-reviewed research. Also, we are now responsible for filling our own schedules and are solely responsible for hygiene recare (outside of an automated service).

Many things are not sitting well with me, and I honestly do not know what to do. On one hand, I feel like the perio program is helpful and serves our patients well. I have seen significant progress with several patients. On the other hand, I get nervous if a patient has a single bleeding site and I don't irrigate it for fear of being quipped by my employer. Also, I do not think it is right to push out the other hygienist who has shown such loyalty and act like they are doing her a favor by "allowing" her to work fewer days for the same money (it's not even close).

On top of all the other changes, my day off changed from Friday to Wednesday. I explained that my personal life revolves around a Monday-Thursday schedule, but was given an ultimatum. To this day, I am still spending hours each month calling scheduled patients to move them from Wednesdays to Fridays, in addition to many other personal sacrifices.

Alongside my teammates, I scraped, clawed, and worked my tail off to get the hygiene department in a healthy state. Together, we produce over $50,000/month. Our numbers are looking good and our employers praise us. Then I found out that we do not get paid on what we produce, but on net production, which means roughly $4,500 of adjustments were made after insurance adjustments, family courtesies, etc. So my $26,000 in production went down to $21,500, which puts me at about the same in earnings and a whole lot more in responsibilities and workload. Also, our base pay plus production is a monthly average, so if I have a bad production day or we have our monthly 4-hour staff meeting and I only produce $600, I had better make that $400 up on another day somehow, because it counts against me.

I feel stressed, exhausted, and a lot like I had a carrot dangled in front of me just to run in circles. With no other experience in a dental office, I have nothing else to compare this to. I have learned so much, and my employers have gone to great lengths to make sure I am an integral part of a health-care team and an asset to the office, for which I am very grateful.

I would hate to leave if blue skies could be just around the corner. Am I overreacting? Should I wait until I have more data on production to make a more informed decision regarding my pay? Am I fortunate to even have this position? Should I run and never look back? Please, help!

Confused RDH

Dear Confused,

It sounds to me like your fabulous work environment has deteriorated into a money-focused workplace. I am very sorry to hear this, especially since you are new to the profession. When the practice is money-centered rather than patient-centered, high stress and low morale are typical.

Too much change in a short time can be like a ship going through a hurricane, and significant damage can occur. Without being privy as to why so many changes have been implemented, I'm sure I would feel just like you if I were in your place. There are so many problems to discuss that I could write numerous columns from your post. Problems include being understaffed and overworked, the effects of losing key staff members, promoting products without peer-reviewed scientific support, hygienists performing business desk functions, micromanagement, management disrespect, scheduling problems, and low morale-WHEW!

If you have a good rapport with the doctors, and if you want to stay in this toxic office, I would suggest that you request a meeting. You should be totally upfront and share what you have shared with me. Either way, it doesn't look good.

It might be easier to find another position. I'd start looking if I were you. I don't see blue skies ahead, and I do not think you are overreacting.

I wish I understood why doctors are so shortsighted sometimes. They make decisions that wound their staff members and make them feel disrespected and unhappy, then stand back and scratch their heads when good staff members divorce them. Losing high-quality staff members can be very expensive and can lead to patients leaving as well.

Your bosses are not thinking clearly. When employers become so money-focused that they disrespect their staff members as you have described, it becomes a no-win situation for everyone-especially patients.

You sound smart, compassionate, and motivated, and any office would be blessed to have you. I have no doubt that you will make your next employer happy to have such a great team member! RDH

All the best,


DIANNE GLASSCOE WATTERSON, RDH, BS, MBA, is an awards winning speaker, author, and consultant. She has published hundreds of articles, numerous textbook chapters, an instructional video on instrument sharpening, and two books. For information about upcoming speaking engagements or products, visit her website Dianne may be contacted at (336)472-3515 or by email [email protected].