Working In A Multiple Hygienist Office
By KAREN E. DONALDSON, CDA, RDH, BS
The job market continues to be a challenge in finding the perfect dental hygiene job. Today’s graduates are flooding the market while seasoned dental hygienists who have decided to stay in the workforce longer are seeking new positions due to office changes and a need to continue to work longer than planned.
In the ADHA 2007 Survey of Dental Hygienists in the United States, 26.4% worked for group offices. All of these offices were private practices. But now as the twenty-first century progresses, there has become a move toward corporate owned practices. Many dentists who had planned to retire by age 60 are continuing to work. They are selling their practices to corporations that own many offices in the region and becoming employees themselves with minimal responsibilities. Offices with multiple doctors and hygienists are being opened by corporations to provide dental care in areas considered to have a low access to care. This creates a different approach to the dynamics of the practice staff.
If you are in the market for a new job, this type of office may be an option for you. There are many factors to consider when making a change from a solo practice to a group practice that employs multiple hygienists and other staff. Perhaps you have worked in a solo practice most of your career without having any competition for responsibility or department changes. Now you must determine if you can fit in and become an accepted member of the group. One important part of an interview should be to evaluate how the department functions and to get plenty of information about details that will affect your performance in the job.
Let’s explore some of the factors to consider when interviewing for one of these jobs.
What hours will you work?
Most large offices are insurance driven practices and are open extended hours to increase production. If you have worked the traditional four-day week that many solo practices use, you may have to change your availability to work a rotating schedule or a five-day week with some extended hours.
Who’s in charge?
When an office has multiple hygienists working, someone is usually the department manager. Find out if there is an official hygienist in charge of making decisions that will affect how you work. If there is not an assigned leader, there will probably be one hygienist who assumes unofficial control of the rest. Understanding who this is and making sure your personalities are compatible is important in your success.
Some multiple practices have a liaison who represents the hygiene staff. This person, usually a dentist, is the spokesperson for the hygiene staff; he or she attends the hygiene meetings and reports to the dentists at their meetings. The lead hygienist and the liaison work to achieve total continuity and a positive working environment between the hygiene staff. If the office doesn’t have this type of team approach, you may want to consider another option for a positive experience.
Do you have the option to choose your instrumentation and equipment?
Most large offices with multiple hygienists will provide the same instrumentation and equipment in each treatment room. If you are used to certain instruments or equipment, be sure to discuss this during the interview to confirm the choices you will have if you take the position. Always request to see the instrumentation and equipment provided.
Offices that have been open for several years may still be using older number 2 handled instruments. Due to a higher turn-over of staff, instrumentation may be in poor condition with dull and worn-down blades.
Some offices may actually continue to use traditional radiography requiring developing radiographs. Don’t take for granted that digital equipment will be available. Always evaluate equipment and instruments!
What computer program is utilized by the office?
Many corporate owned offices actually have their own computer program developed to meet their needs in data collection, scheduling, and patient information. Be sure to ask about what programs they are using and determine if training will be provided before you begin to see patients. It’s difficult to stay on schedule when you are struggling to enter data in a system that you are unfamiliar with or have not used recently.
Make sure you ask if the office is paperless. Coming from an office where you used paper charts could be a challenge if this office is completely paperless. Recent graduates trained in a quality dental hygiene program should be ready for a paperless format.
How many patients will you see per day? What will be expected of you to accomplish during a new patient appointment?
The focus on production is number one in these larger practices. You may be asked to see 10 to 12 patients during an eight hour day. During a 45-minute appointment you may need to accomplish all the same tasks you used to do in one hour. Did you have an assistant that helped you chart, probe, and breakdown or set up your room? In these larger offices you may have staff assigned to help you, but frequently you will be required to complete all tasks alone.
Appointment time limits, standard of care changes, and working alone to complete patient care normally achieved assisted by a team may be changes you will face in a multiple hygienist office. Understanding what compromises you may need to take in patient care will be important in determining if this position fits your patient care standards.
Will they provide training in how they want you to discuss care with the patients?
In a solo practice, most dentists guide the hygienist in how they want patient care presented and performed. But in these larger practices, many have no specific plans other than insurance guidelines, and may expect the hygienist to utilize all her legal abilities to provide care for the patient. Some offices may have a practice management company or in-house manager that delegates what is expected of the hygienist when providing patient care.
Does the office have a periodontal therapy program with expected guidelines for care?
Many larger offices have a standardized periodontal care program that may be more aggressive than you have previously used. Make sure you understand if you are required to schedule and treat a quota of SRP patients each month. Will these patients be seen in the same appointment time as a regular hygiene patient?
Does the office have regular staff meetings?
Communication is one of the most important characteristics of a good job. Be sure to find out what type of practice management staff the office has and if they hold regular monthly staff meetings. How about the hygiene department? Do they have monthly meetings to discuss problematic situations of patient care? Will the lead hygienist represent the department at meetings limited to dentists? Is there an appointed liaison that speaks on behalf of the hygiene department?
Will you have an opportunity to meet the other hygiene department staff?
Most corporate offices will give you a tour of the facility and introduce you to the staff. Have questions ready to ask staff members if the opportunity arises. Many times these larger hygiene staffs do not have time to discuss the office dynamics during appointment schedules.
What about a working interview?
Most offices today of any size will want you to have a working interview. Usually they assign a staff member to assist you that day for time utilization. Be sure to ask lots of questions about the dynamics of the practice to help you make an informed decision about the position.
Where will job opportunities in a multiple hygienist office lead you?
A job search can be a very stressful experience. The more organized you are and prepared with questions and concerns, the easier the interviewing process will be for you. In today’s job market, we must present ourselves as professional and emphasize our best qualities so we remain at the top of the list of applicants. The more specialized skills you are certified for, according to your state’s practice act, the more marketable you become.
Most positions available in metropolitan areas have as many as 30 applicants. This means you must work hard to stand out, and once you have procured the job you must continue to perform at your optimum best, or take the risk of being replaced. After all, there are many applicants out there waiting for the opportunity to replace you.
Make sure that you stay focused on continuing education that will increase your value in the office. If you stay on the cutting edge of performance, you will be a valuable asset for the practice. This includes reading journals to get the latest information on timely topics and continually advancing your technique of treatment to the most modern and accepted as standard of care.
Multiple hygienist offices are a high production and busy place to work. They can provide you a place to utilize your highly technical skills learned in school, cultivated with repeated practice, and advanced with quality continuing education. These offices can give you a network of fellow hygienists to develop strong professional ties.
One advantage of corporate practices is that they usually provide better benefit packages, including health care, sick, vacation, and holiday pay, and investment opportunities. However, most of these offices also offer a salary on the lower end of the current pay scale. You must balance the hourly pay with your benefit package to understand the true value of your salary level.
Dental hygiene is changing rapidly. The market is developing toward a corporate office, and job opportunities are tight. During the next 10 years, there should be a large number of hygienists over age 50 who will retire. This should create a need for hygienists in all types of offices. Hygienists who have chosen any type of multiple hygienist office should be ready to work in any of the new office dynamics that will be developed over the next 10 years. As our profession changes and develops toward dental hygienist practitioner roles, these multiple hygienist practices will be open to developing this role as a principal part of the practice. That could make this type of position even more valuable in the future.
It takes a special person to be a quality dental hygienist and with a little focus on your own dynamics, you can be that person now and in the future of dental hygiene. RDH
Jackson B. “IT Challenges of Multi-location Dental Practices.” 2008 http://www.marketingdds.com/Article.aspx?id=474.
Survey of Dental Hygienists in the United States, 2007: Executive Summary. Copyright © 2009 by American Dental Hygienists’ Association.
Andrilla HA, Hart GL. “Practice Patterns and Characteristics of Dental Hygienists in Washington State.” Final Report #114, August 2007. http://depts.washington.edu/uwrhrc/uploads/CHWS%20FR114%20Andrilla.pdf.
KAREN DONALDSON, CDA, RDH, BS, has worked as a dental hygienist since 1989 when she graduated from the University of Southern Indiana as a nontraditional student. She graduated magna cum laude in 1990 with a Bachelor’s Degree in Health Sciences with a Geriatrics and Social Services emphasis. She also holds certification from DANB as a Certified Dental Assistant and has had expanded functions training. Karen has worked in three different corporation-owned offices that employed multiple dental hygienists. She now practices clinical dental hygiene in NW Arkansas in a one-doctor practice that employs two hygienists.
Past RDH Issues