Trisha E. O`Hehir, RDH
Is there a shortage of dental hygienists? The dental associations say, yes, there is a shortage. Hygienists counter by saying there isn`t one. It`s all in your definition of a shortage. The shortage perceived by the dental associations deals with supply and demand for existing positions. My guess is they think an adequate number of dental hygienists would be 10 applicants for each position. Lots of choices and an opportunity to play one against the other for the lowest salary.
If you ask dental hygienists about the shortage - pointing out a few offices which have been unable to hire a hygienist - you will find good reasons why those offices don`t have a hygienist. They will also tell you that, no matter how many hygienists are looking for work, those offices would still be without a hygienist.
I would suggest there is another shortage - a serious shortage of dental hygiene care. However, this shortage is unperceived and, for exactly that reason, it is never discussed. In the long run, this unperceived shortage is much more serious and should be addressed before worrying about the supply and demand of hygienists for current positions.
The remedies suggested to address the perceived shortage will do nothing to resolve the unperceived shortage.
The fantasy of inexpensive hygienists
Solutions to the perceived shortage suggested by the dental associations are interesting. But they are not what you would expect from such highly educated, business-oriented professionals.
The suggestions range from increased class size to preceptorship. The most creative solution, of course, is the suggested preceptorship programs. A few weekend courses for dental assistants combined with some on-the-job training will cause the shortage problem to disappear, according to some in the dental community. The best part of this solution, for the dentist, is obtaining a hygienist who will work for less, one who knows they can`t have an assistant, and one who won`t be so uppity as to tell the dentist what to do.
Preceptorship sounds great, except for a few little undiscussed aspects.
Why would a dental assistant - who takes on the responsibility of a dental hygienist, yet notices that patients are still charged the same fee - work for less than a dental hygienist? Oh yes, for the good of the practice. That`s right, I forgot.
What would we then do about the shortage of assistants? If the experienced dental assistants move into the dental hygiene slots, it appears that we will need to build more dental assisting schools.
As mentioned above, preceptor hygienists will not overstep their boundaries and tell dentists what to do. The preceptorship experience does not teach the knowledge necessary for rendering that service. Dentists would no longer be bothered by hygienists reporting on their examination of the patient. Dentists would have to do their own exams, taking the time to be thorough. This, of course, cuts into the restorative schedule. Any money saved by hiring a low-cost dental hygienist disappears with the reduction in restorative treatments.
Good business sense?
The business aspects of preceptorship is most interesting. In order to save a few dollars on the salary of a dental hygienist, the dental associations are suggesting that dentists would choose to provide lower quality care, reduce their available time for restorative production, and take on the added responsibility of diagnosing and discussing periodontal disease and treatment with the patients. It doesn`t make good business sense to me.
It sounds like the dental hygienist proclaiming, "I don`t mind cleaning up rooms and sterilizing instruments. That`s something I already know how to do. So, from now on, I will do that for the dentist`s operatories as well as mine."
Having a hygienist do the assistant`s work is as foolish as having a dentist do the hygienist`s work. It`s bad business. None of the dentists I know or have worked with would seek that kind of solution. It`s a political solution, not a business solution.
The numbers behind a shortage of quality care
Speaking of bad business, let`s look at the unperceived shortage of dental hygiene care. For every 1,000 patients who are being seen twice a year in your practice, there will be a need for eight dental hygiene visits per day, five days a week, 50 weeks a year.
That`s a conservative estimate. More realistically, the 1,000 patients would fit into two groups. Half of them have gingivitis and require one visit a year. The other half has periodontitis, and they need four visits a year. This translates to a total of 2,500 dental hygiene visits per year for every 1,000 patients in your practice or 10 visits per day, five days per week, 50 weeks per year.
New patients are not included in this calculation, nor are periodontal debridement appointments. These figures simply tell us how many visits are needed to maintain 1,000 patients.
Take a look at your own practice and determine the actual dental hygiene need. How many patients does your practice have? You may have a thousand or less active patients, but how many charts does the practice have? How many patients have fallen through the cracks of the system? Add to that the number of new patients seen each month.
Do you see a shortage of dental hygiene care being provided in your practice? If your team were to provide ideal dental hygiene care to all the patients in the practice, what would it take?
Another aspect of this unperceived shortage is the low compliance rate with recommended oral hygiene care. Studies show compliance to be disappointingly low. To check the compliance level in your practice, simply note, over the next week, whether or not each patient returned within the recommended recall interval - or if they were late.
This leads to the next problem, scheduling. If a patient has to cancel a dental hygiene visit, the book is usually so full that the first opening will be several weeks later, extending that patient`s recall beyond the recommended interval.
A helping hand
The obvious solution is to add more dental hygiene visits, probably by adding another dental hygienist to the practice. Then we really would have a dental hygiene shortage!
In solving this problem, we have the perfect opportunity to address a related problem: Why do hygienists leave the profession?
Two reasons are burnout and physical problems. If we are going to change the dental hygiene department, why not create a better work environment at the same time? Instead of adding another dental hygienist to the practice, why not add two dental hygiene assistants, one for each dental hygiene operatory.
Now don`t jump to the conclusion that the hygienist would just become a scaling robot. It`s just not true. Imagine each patient being scheduled for an hour and the hygienist having 30 minutes to do nothing but pure dental hygiene - listening to the patient, identifying problems, formulating a treatment plan, instrumenting and polishing with an assistant, and directing the assistant to reinforce the oral hygiene aids decided upon by the hygienist and the patient.
If you can`t imagine this and are still skeptical, look at your appointments now. How much time do you spend seating patients, exposing and processing radiographs, updating the medical history, waiting for the dentist, cleaning the room, sterilizing instruments, and setting up the room? Now subtract that time from the entire appointment and see just how much time you actually have for high-quality dental hygiene time with the patient. Remember, don`t forget to add the pressure of the clock ticking all day long on top of everything else!
This is just one idea for dealing with both the perceived and unperceived dental hygiene shortages. Put your thinking caps on. I`m sure you can come up with several more workable ideas.
Perhaps the most effective solution to these dental hygiene shortages would be to demand that all dental schools teach basic business concepts, or better yet, have dental hygiene programs teach business concepts associated with high-quality dental hygiene care.
Trisha E. O`Hehir, RDH, is a senior consulting editor of RDH. She also is editor of Perio Reports, a newsletter for dental professionals that addresses periodontics.
