Public health 'production' is important too

Often in my career, I've listened to dental hygienists succinctly summarize the differences between treating patients in private offices as opposed to treating them in public health clinics.

by Christine Nathe, RDH, MS

Often in my career, I've listened to dental hygienists succinctly summarize the differences between treating patients in private offices as opposed to treating them in public health clinics. What they say is that one advantage of working in public health is that there is more time to provide quality dental hygiene care, without worrying about daily production. What I've witnessed while practicing in both private and public health clinics does not make this a reality to me.

The first thing I'll discuss is production. I don't believe paying attention to production numbers is a bad thing. Setting production benchmarks can help guide practitioners to focus on treatment and daily work standards. I've seen public health facilities that do not set benchmarks, with two or three patients treated per eight-hour day. If there are issues with patients showing up for appointments, then this should be addressed to ensure appropriate use of a dental provider's work schedule. Does it truly take hours to treat two or three patients per day, in a quality-focused manner? Is this serving the population well? Is this using taxpayer derived or privately donated revenues in a prudent manner?

This is not in any way meant to belittle public health clinics. Most of them do not function this way, but some do, and I guess the main objection I have is that this is not serving citizens who have the greatest needs well. If a public health clinic exists in a community, there should also be a need. So, based on the premise that the need does exist, there should be many individuals who need dental hygiene services. I doubt a public health facility would be built if there were only eight or 10 patients per week in need of the services. We should manage these clinics based on the premise of practicing quality preventive care, just like in the private sector. If, in the private sector, a dental hygienist routinely treats two to three patients per day, the practice more than likely will not remain solvent. In essence, the same principles should exist in clinics, regardless of payment sources.

Another important point is that production benchmarks do exist in private offices because in order to pay a dental hygienist's salary and overhead, patients pay for services rendered. Additionally, patients making appointments two to four times a year rarely occurs without quality care being provided. In other words, in quality-oriented practices, there is rarely a need for more patients. The dental hygienist's schedule is packed with patients because they value the care provided. The attitude they have toward dental hygiene care is seen in the action they take by continuing to present for their appointments.

I remember when we were developing a public health clinic, and some providers wanted a system similar to many clinics that have only walk-in appointments. If we truly want to serve the half of the population that is dentally underserved, then why would we develop a system that does not train them to schedule routine appointments? We try to "train" patients in private offices to obtain dental hygiene care frequently, so why should we not expect the same from patients in a publicly or privately funded clinic?

Therefore, what I've heard regarding the differences between private offices and public clinics does not and should not exist in my opinion. We should be providing quality care with no differences whatsoever between patients paying for their services and patients presenting in a publicly or privately funded clinic. Dental hygienists should be just as busy practicing prevention in any clinic, regardless of the revenue source. We have only been around for a century. We have so much further to go and so many values to increase! RDH

CHRISTINE NATHE, RDH, MS, is a professor and graduate program director at the University of New Mexico, Division of Dental Hygiene, in Albuquerque, N.M. She is also the author of “Dental Public Health Research” (www.pearsonhighered.com/educator), which is in its third edition with Pearson. She can be reached at cnathe@salud.unm.edu or (505) 272-8147

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