The Business of Dental Hygiene

Every year RDH conducts a salary survey among dental hygienists. Comparisons are made between degrees obtained (associate vs. baccalaureate), full-time vs. part-time, and among states.

by JoAnn R. Gurenlian, RDH, PhD

Every year RDH conducts a salary survey among dental hygienists. Comparisons are made between degrees obtained (associate vs. baccalaureate), full-time vs. part-time, and among states. Some of the key points from the 2013 survey revealed are listed below.

  • Forty percent of dental hygienists have not received a pay raise in more than five years.
  • There is little to no difference in benefits provided for dental hygienists who earned an associate degree when compared with those hygienists who earned a baccalaureate degree.
  • While hygienists may work full-time hours, those hours occur in multiple practices vs. one practice setting impacting benefits.
  • ADHA members earn slightly more income and job benefits than nonmembers.
  • Less than 40% have health insurance covered by the employer's plan.
  • Almost 60% of hygienists do not have disability insurance and 33% do not have malpractice insurance.

While promoted as a great job opportunity, these data indicate that dental hygienists may be shortchanged when it comes to job security. Undervalued and underpaid have been touted among dental hygienists since the 1970s. Concerns have been expressed that dental hygienists are viewed as the "cleaning ladies" of the office, doing little more than removing calculus and stain from teeth as opposed to preventing and treating oral disease and improving overall health of their patients. Hygienists struggle to find one full-time position because employers can offer less in terms of benefits if the hygienist has restricted hours.

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These circumstances are not new, but one has to wonder why dental hygienists have tolerated them for so long. In looking at the salary survey results as well as state practice acts, it appears that dentists have been very effective in suppressing dental hygienists not only in terms of functions, but also with respect to a business relationship.

For all of the strides made to advance dental hygiene as a discipline and profession, we have failed to address the business of dental hygiene. We have foregone multiple opportunities to examine business models for practice and are timid about launching a different approach to the cottage industry. While some states have embraced self-regulation or independent practice, all dental hygienists need to consider what they do as a business as well as a profession.

Rather than be tied to an employer-employee relationship, dental hygienists need to consider other approaches that would allow them to manage their money, benefits, schedule, supplies, as well as the conduct of patient care. For some, this is exactly what they want to do, while others will shy away from these responsibilities. However, being uneducated about running a business puts dental hygienists behind in terms of garnering the rewards of a successful practice. And we all know this concept is not taught in entry-level dental hygiene programs.

Perhaps it is time to reframe our concept of dental hygiene practice. We talk about creating oral health homes outside of the traditional practice setting and the need for alternative oral health-care systems. While our focus is on public service, we also need to be able to pay bills, support and educate our families, have regular health care, and plan for retirement. That cannot be accomplished well with a part-time mentality. If we want to rely on ourselves to realize those goals, we need business savvy and expertise. How do we acquire these skills and the wherewithal to change dental hygiene practice parameters?

One option is to further our education by taking business courses. Another option is to teach dental hygiene students that they are responsible for their practice from the beginning of their education experience, and expand dental hygiene programs so business concepts and alternative models of practice are provided. A third option is to have these courses provided at national meetings such as the ADHA Annual Session and RDH Under One Roof. Really, how many perio and ergonomic courses do you need? Perhaps if we demanded business and entrepreneurial courses, we would find ourselves looking at a very different picture in a few years.

One thing is for certain. Shying away from learning business skills means much of the salary and benefit situation that exists now will remain the same. Waiting for your employer to value you more and improve your quality of life is right up there with waiting for those unwanted pounds to miraculously be shed. Making this type of change requires us to work more than usual. It means we have to invest in ourselves. It means we have to be willing to grow, grow up, and make mistakes. And it means we have to stop blaming our employers for our dissatisfaction and stand on our own two feet.

We must be willing to find our independent spirit and become the boss of our dental hygiene practice. We have trailblazers in dental hygiene who have created their own business models. It is time to invest in learning from them and other successful persons in business, and share that expertise so that others may do the same. Perhaps in this next century of dental hygiene one of the things we can give up is being an employee. RDH

JOANN R. GURENLIAN, RDH, PhD, is president of Gurenlian & Associates, and provides consulting services and continuing-education programs to health-care providers. She is a professor and dental hygiene graduate program director at Idaho State University, and president of the International Federation of Dental Hygienists.

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