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Surviving long days: The business climate of dentistry points to more stressful working conditions

Feb. 17, 2016
By Anne Guignon: The business climate of dentistry points to more stressful working conditions


Dentistry is a business. Any and all business enterprises need to remain profitable in order to keep the doors open. It has been interesting to watch the business dynamics of dental practices change since I first went to work as a dental assistant in 1968 while I was in college.

In that era, most dental offices were very small enterprises, typically handed down to an aspiring family member or sold to another solo operator. Big group practices, full of associates that are employees, had not become the norm. Today's dentists graduate with a mountain of debt. Half are women trying to balance a professional career with an active family life, so often do not put in the same number of hours as their male counterparts.

The range of clinical services offered to dental patients is enormous as compared to 50 years ago. Offices have undertaken the development of "comprehensive and cosmetic" dental services. Many of today's consumers expect to have a great smile until the day they die. More offerings mean more equipment and a bigger dental practice overhead.

"Dental insurance," truly a misnomer, began in 1969 as a member benefit negotiated by the International Brotherhood of Teamsters in their national contract. For the most part, dental benefits (dental insurance) have changed very little since that time. Workers in the early years received around $1,500 per year in benefits. Many service reimbursements were capped or had extensive eligibility requirements. While there have been some changes since those early days, the net benefits to patients and reimbursements to providers still resemble what was offered close to 50 years ago.

At the same time, another interesting shift in the landscape occurred in the academic arena that was destined to change the profession as a whole. In the late 1960s, a huge number of community colleges opened dental hygiene programs. The state of Texas is a perfect example. Two schools graduated dental hygiene students in 1970. One year later, 13 schools in Texas had dental hygiene students graduating. Dental hygiene programs started popping up everywhere, and today there are over 330 dental hygiene programs in the nation. This discussion is not casting aspersions at the programs; I'm merely saying there are a lot of dental hygiene programs around.

Why the history lesson? While dental offices frequently succumb to the operational pressures of "dental insurance companies," the business nature of the dental office has changed significantly. Today's dental offices have much higher operational costs than 50 years ago. Due to expansions in the workforce and changes in the statutes, non-dentist workers are now allowed to provide procedures that were historically performed by dentists.

In the early years, dental hygiene procedures were never billed at a true business rate. They were considered a loss leader, a way to entice a patient to join the practice. Our profession has suffered under the casual classification of "it's just a cleaning" without a real understanding of the true health benefits.

Like all businesses, owners must look at the bottom line. Many look at ways to increase efficiency and production that will cut costs or boost revenues. Several recent trends are designed to produce more profits in a given amount of time. An increasing number of dental offices are extending service hours past the traditional four-days a week, eight-hour day.

While this may look fine on paper, working a 10 or 12-hour dental hygiene shift puts dental hygiene workers at increased risk for developing a wide range of problems, including an increased risk for a workplace-related musculoskeletal disorders, inadequate rest, and insufficient family or personal time.

Similarities with nursing

To date, there are no specific studies regarding physical and mental fatigue among dental health-care workers, but there is ample research among our nursing colleagues. Research in nursing shows fatigued heath-care workers make more on-the-job mistakes.1-8 Nurses who are fatigued, either mentally or physically, are also at risk for providing compromised patient care. 1,2,5,6 Home and personal life is also compromised for those working excessive hours.1,3,4

Where are the similarities? Most nurses and dental hygienists are women.5 Many work more than one job to make ends meet. The mean age of both professions is increasing, and it is well documented that the workers between the ages of 40-60 are at substantial risk for an MSD.7,8

How are the two professions different? Most dental hygienists work day shifts, while nurses can work multiple, rotating shifts that create havoc with the internal body clock. Most nurses have some kind of health-care benefit and disability plan, and work in larger environments such as hospitals with established worker safety standards and protocols. While nurses may work a 12-hour shift, they move from patient to patient, which is less risky than assuming an awkward, static body posture for hours on end as we do in dental hygiene.

Both nursing and dental hygiene are hard work, and we both serve patients. To compare the two professions is nuts, but to think that 12 hours of dental hygiene practice in one day is safe and sane is also a risky proposition. If you don't agree, just step back and ask yourself if you would like to be a patient sitting in your chair at the eleventh hour. Rest and time away from work are the necessary ingredients to providing outstanding patient care. All of us are super women and men, but we all need sane work schedules and adequate rest. RDH

ANNE NUGENT GUIGNON, RDH, MPH, CSP, provides popular programs, including topics on biofilms, power driven scaling, ergonomics, hypersensitivity, and remineralization. Recipient of the 2004 Mentor of the Year Award and the 2009 ADHA Irene Newman Award, Anne has practiced clinical dental hygiene in Houston since 1971, and can be contacted at [email protected].


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