Authority issues

Unless you work in a state that allows independent practice, your working career as a dental hygienist will be under the authority of a dentist/practice owner ...

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How to work as a partner with the boss

by Dianne Glasscoe Watterson, RDH, BS, MBA

Unless you work in a state that allows independent practice, your working career as a dental hygienist will be under the authority of a dentist/practice owner or management group. You will have a boss who has the power to control certain aspects of your work life. Is it possible to thrive in that environment, and what should your attitude be as an employee?

Partnering at its best

Tammy, RDH, has worked in the same dental practice with Dr. Fred for more than 20 years. They seem to have a wonderful working relationship. Tammy says she can't imagine working with anyone else, and Dr. Fred expresses his appreciation for Tammy's work and dedication. The positive synergy between this doctor and hygienist is no coincidence. It is borne out of mutual respect. There is no "big I, little you" issues with the doctor and no authority issues with the hygienist. The working environment is low stress, and patients can readily sense the camaraderie that exists in the office.

Obviously, Dr. Fred has learned that being a good leader does not mean he has to rule his practice with strict authoritarianism. His management style is participative (democratic), in that he values the efforts and seeks the ideas of those under his authority. He embraces partnering with his staff members and values their contribution to the success of his practice. Dr. Fred understands that no one is perfect, including him, and that no good purpose comes from nitpicking his staff members.

Tammy is happy to partner with Dr. Fred and has no problem with his implicit authority as the practice owner. Because he treats her respectfully as a fellow professional, she has developed great loyalty to Dr. Fred and his patients.

Over the years, Tammy has been Dr. Fred's greatest source of referrals. She has referred those in her church, her children's teachers, and many personal friends and family members.

Partnering at its worst

Dr. Bill has employed 11 different staff members over a six-year period, including four different hygienists. Turnover of this magnitude indicates that Dr. Bill has some management issues that are working against him and his practice, primarily a dictatorial – or authoritative – management style. He uses a combination of intimidation and mean-spirited, demeaning remarks designed to show staff members "who is boss." Staff members do not feel respected or appreciated. Dr. Bill is not interested in partnering with his staff members and feels superior to them in every way. His long string of departing staff members has caused him to mistrust anyone who comes into his employment. Unless Dr. Bill can improve his management abilities, he will continue to have turnover problems, which hurts him and his practice. He can be helped only if he comes to the realization that he is his own worst enemy.

Many commentaries have been written about so-called "rotten bosses." In fact, lawmakers in several states have introduced legislation that gives employees grounds to sue superiors when the workplace is deemed to be an abusive work environment. A union group launched the "My Bad Boss" contest to "expose what is a growing problem" and give workers an opportunity to vent their bad-boss experiences. In 2006, the winning entry was Dr. X, a dentist who took $100 out of each employee's paycheck for every canceled appointment. Another contestant recounts the day her boss offered to buy everyone in the office lunch and took them to a discount warehouse, where he instructed them to dine on free samples in the grocery section.

Bosses aren't the only ones with rotten attitudes. Mary, RDH, has been fired from two different hygiene positions. In both situations, she was fired for being insubordinate. She has difficulty submitting to people in authority and cannot contain her hostility when confronted with an authority issue.

Often our feelings on authority figures go back to our first authority figures, our parents. According to Dr. Suzanne LaCombe (myshrink.com):

"If your mother or father (or caretakers) felt it was better to evoke fear to get you to obey them, then you probably have ambivalent feelings about authority. Indeed, if they had ambivalent or conflicted feelings about authority figures, then almost certainly you picked up on them, albeit subconsciously. In particular, if you experienced abuse at the hands of your parents/caretakers or anyone you trusted when you were very young, then you're much more likely to have authority issues."

Three theories of authority

Sociologist Max Weber describes three theories of authority: traditional, charismatic, and legal-rational. A traditional authority style has a purely patriarchal structure. In the dental practice, the doctor takes on the "parental figure" role and staff members accept him or her as a traditional authority. Charismatic authorities are leaders whose mission is to inspire others. Staff members can develop deep-seated loyalties to charismatic doctors when they feel that the boss appreciates their "potential for greatness" and value to the practice. Legal-rational authority is based in formal legal and/or rational guidelines. The doctor is legally empowered to operate a dental practice and is the rational authority figure. He or she is the boss because the board of dentistry in that state has granted such power.

It is important to understand that there is a difference between power and authority. Basically, power is the ability of one person to influence the behavior and/or attitudes of others, whereas authority is the right to control workplace actions. Therefore, a dentist can function as an authority with little or no power if he or she cannot influence the behaviors of staff members on the job. Likewise, a dentist can be powerful without having to be authoritarian, based on his or her ability to influence staff members.

Partnering and patient care

The attitudes that hygienists develop about their bosses can influence their quality of care and relationships with patients. Negative emotional issues – such as resentment, frustration, and anger – can occupy the mind and distract from the central purpose of the job, which is excellent patient care. Learning to let go of past hurts and grudges is key to managing stress and maintaining good emotional health.

Employers have many challenges in their journey to becoming the powerful leaders they need to be to lead their practices well. They need to:

  1. Create a positive emotional atmosphere that is conducive to continual growth and professional development
  2. Set high but not unrealistic performance standards
  3. Encourage initiative and responsibility
  4. Praise openly and personally and provide instruction privately
  5. Practice equity and collaboration
  6. Express appropriate confidence in staff members

Hygienists have their own set of challenges on their journey in learning how to become the consummate partner in care for patients' dental needs. They need to:

  1. Understand their role in the success of the business
  2. Be interested in learning new things that will improve efficiency and the care they deliver
  3. Refrain from any negative discourse about the doctor
  4. Come to work each day with a thankful heart
  5. Accept things they cannot change, and learn to be flexible
  6. Express confidence in coworkers, including the doctor

Examples of great and not-so-great working relationships

Here is an account from a hygienist with a great working relationship:

"My boss is a pediatric dentist in his 25th year of practice. I've been there four months, and I wish I'd found him 20 years ago. Our relationship is good because we communicate, we respect each other, and we complement each other. I respect him as a clinician, a friend, and an employer. He respects me as a friend, an employee, and a coworker with rights and responsibilities. He pays me a compliment at least once a week, and he does the same with other employees. I think he makes a conscious effort to do that …"

Here's another account of a happy working relationship from a hygienist in Virginia:

"I value my relationship with my employer because he respects me and believes that I do a wonderful job. Whenever a patient says he or she had a good cleaning, the doc usually says, 'Yes, Michelle is the best.' It is really nice to feel appreciated. He also makes sure that we know we are valued by taking us (each staff member) out for our birthday, to a show at a local theater every summer, and in the winter he takes us out to a very nice restaurant for a holiday meal. Once, his wife pitched in and cared for my daughter so that I could work when my babysitter was not available. Another time I was very sick but too stubborn to go home. He told me to go home and he moved the patients around immediately for me. It's nice to have someone looking out for your best interests."

From a dentist who enjoys partnering with his hygienist:

"My hygienist makes it a pleasure for me to come to work. She is professional and warm with patients. She provides excellent care, and I do not have to worry about whether or not she is thorough. I have complete trust in her abilities, plus she is a great person."

Here are comments from another dentist:

"Debbie has been with me for 10 years. The thing I most admire about her is her good-natured ability to make patients feel at ease. She takes good care of my patients and makes my job easy. I hope she never leaves, because I can't imagine practicing without her."

From a hygienist who feels unappreciated:

"I feel like I have gone over and above what other hygienists would do for the practice. At this time, I accept the fact that I will not receive any benefits, bonuses, or even a thank you from my employer."

From another hygienist:

"The doctor I work with never gives me a kind word and even acts like he is mad at me sometimes. I have no idea why. He is often sullen and moody and has said demeaning things to me. I haven't had a raise in two years, and I'd leave this practice if I could find another job close by. But I stick it out and work in this unhappy place because I have bills to pay ..."

From an unhappy dentist:

"My current hygienist has caused me plenty of headaches. Several patients have complained to me about her rough treatment. She is often late for work, which drives me crazy. But the most frustrating thing for me is her absenteeism. I know I need to fire her, but her father owns my building."

Partnering is good for our patients

A fellow speaker and writer, Dr. Greg Psaltis, says that the dental practice can be likened to a physical body, and staff members make up the parts. The business assistants are the mouth and ears of the practice, being the first to interface with patients and hear their needs expressed. The clinical assistants are the hands and feet, performing a myriad of duties and guiding the smooth flow of patients in and out of treatment. The hygienists are the eyes, because their extensive training allows them to identify oral conditions and point the doctor in the direction of any immediate and future dental needs the patient may have. The doctor is the soul and brain of the practice, being the leader and making treatment decisions based on advanced skills gained through education and experience. Happy, low-stress work environments happen when all the members of the "body" work well together.

Partnering with the boss is possible when there is an atmosphere of mutual respect. The respect must be bidirectional, in that doctors should respect the clinical expertise of the hygienist as the preventive specialist, and the hygienist should respect the doctor for his or her advanced education and implicit authority as the practice owner. In good partnering relationships, respect goes deeper than mere clinical expertise. Trust, loyalty, and dedication are also necessary to build a fabulous partnering relationship. When these traits are in place, the people who benefit most are the patients.

Dianne Glasscoe Watterson, RDH, BS, MBA, helps good practices become better through practical, onsite consulting. Her book, "Manage Your Practice Well," is available at www.professionaldentalmgmt.com. Dianne also provides a variety of continuing education courses for dentists and dental staff members. For more information, visit her Web site, e-mail Dianne at dglasscoe@northstate.net, or telephone (301) 874-5240.

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