Th 244917

Low on the totem pole

April 1, 2007
I have worked in the dental profession since 1986. I started out as a receptionist and worked my way up to office manager.

Dear Dianne,

I have worked in the dental profession since 1986. I started out as a receptionist and worked my way up to office manager. I also worked as a surgical assistant in a periodontal practice during an employee’s maternity leave. I graduated from dental hygiene school in 2006 and have been employed with a highly respected dentist ever since. My employer is brilliant in the clinical category but seems lacking in the leadership category.

We are currently marketed as a high-end, upscale implant and restorative practice that does not accept children or insurance. We help patients with paperwork so they may receive any benefits due. We do not have a healthy influx of new patients, so we are not generating new scaling and periodontal procedures. Our treatment plans are comprehensive and cost close to $30,000. The problem is not many people accept them! Also, we do not have a call list to refer to when we have last minute changes in our schedule.Lately, we’ve been having problems keeping both hygiene schedules full.

Recently, I was called into the doctor’s private office with the other hygienist. We began our employment at the same time, though she has three more years’ dental hygiene experience. I was told the more experienced hygienist’s schedule will be filled first, and mine after that, even if the patient has seen only me in the past. Basically, I was asked to use my time marketing the practice, organizing study club meetings, and filling open time in the schedule. I offered to reduce from three to 2.5 days a week in an effort to help the scheduler for the next two months.

I will be paid my hygiene rate of pay in the down time, but I feel denigrated being asked to fill the other hygienist’s schedule. The doctor stated that the feedback from my patients has been excellent, but the other hygienist “blows the patients away with her ability,” and during this time I might be able to learn from the other hygienist. I was insulted and humiliated, to put it mildly.

I am a mature, dedicated, and positive employee who wants time to refine my dental hygiene clinical skills. I invested lots of money to go back to school and I graduated near the top of my class. I honor my relationships with my patients and am disheartened to know that they will fill my colleague’s schedule until her schedule is full. Then the overflow will come to me, along with anybody else who happens to call and want an appointment.

My heart is saddened, but the reality is that I am viewed by my employer as second-rate to my hygienist coworker.The office manager shared that she is sickened by this situation, and that it happened with the last two hygienists, who both left due to the ill will the situation created. It is hard for me to believe someone with my principles and work ethic is struggling to work more than two days a week when I have $66,000 in student loans.

I am torn between looking elsewhere in a tough market, or trying to find a silver lining in this overcast sky. Any encouragement or support would be greatly appreciated as I am feeling unappreciated and disillusioned with my career choice for my life!
Disheartened Dana

Dear Disheartened,

I was touched by your letter and can feel your pain. Nobody wants to feel like a second-fiddle employee. You are the victim of a business cycle lull where demand is low.

In a way, dental practices can be compared to retail stores. There are “Dollar Store” dental practices, “K-Mart” practices, “Sears” practices, “Macy’s” practices, and “Nordstrom” practices.

Dollar Store practices are often located in bad neighborhoods, have out-of-date equipment, need serious updating, still use pegboards, are old, failing, and cluttered, and offer low fees and discounts to the hilt. They attract people who are willing to overlook the obvious obsolescence to relieve their pain and have only the most basic dentistry. Some of these practices never hire a hygienist. Staff meeting? What’s that?

K-Mart practices are a little better but still need updating. Lacking technology, they use cheap materials, hire cheap labor, and are always looking for a cheaper alternative. They attract bargain shoppers. These practices are often involved in HMO dentistry and always involved in PPO dentistry. Raising fees does little to affect the bottom line because of too much managed care participation. There are no staff meetings.

Sears practices do a little bit of everything. They have large numbers of patients, and hygiene is “slammed.” These practices participate with several selected plans, see everybody who requests an appointment, and portray a kind of happy frenzy. The office is adequate but crowded and always in need of new carpet, even though it was only installed last year. The high volume of patient flow destroys the reception room furniture and carpet. Computers are located only at the front desk. Fees are a little low, but they make it up in volume. Staff meetings are rare. These practices attract lots of people and are user-friendly.

Macy’s practices have nice, upscale, clean décor, but are not posh. They use technology throughout the office, have computers in every operatory, are digital, and the doctor is technologically with it. The doctor is always open to things that will improve the practice. Staff meetings are held once a month. There is limited participation in PPO plans. The doctor may be a CE junkie. Fees are moderately high.

A Nordstrom practice has no plan participation. The office is very nice, very upscale, often posh, with very high fees, often in the 90th percentile or higher. These practices lean heavily toward large treatment plans or “full-mouth reconstruction” cases and esthetics.

The Nordstrom practice does not accept insurance reimbursement, so patients are all on cash basis, but staff will sometimes help patients with paperwork. The doctor spares no expense in CE. There are only a few new patients each month, primarily because of the community perception of high end, high fees. These practices see few or no children and market to the upper 5 to 10 percent of the population. Sometimes these practices are not very patient friendly and often feel the pinch more acutely when the economy is sluggish. The practice holds frequent and intense staff meetings.

Now, some practices might be between, say, a K-Mart and a Sears practice, but from the analogy, you can see the differences in each practice profile.

You work in a Nordstrom practice. The doctor has consciously steered his practice in that direction and has niched himself into a market that attracts roughly 5 to 8 percent of the population, namely, the affluent. Even though his dentistry might be impeccable, the practice is not very patient-friendly in that it does not take insurance or children. This does not attract large numbers of people. His low new-patient numbers make it hard to keep the practice fresh and busy.

Since you have experience in all phases of practice operation - front desk, chairside, and hygienist - the doctor obviously feels you have some talents outside dental hygiene that extend to marketing.

However, you did not go to school to work the phone to bring in patients and market the practice. I’m certain the doctor is looking for ways to keep you there during this business lull, but can he afford to pay hygiene wages to a hygienist who is not producing? Only he can answer that. This situation is very similar to a young dentist being hired and given hygiene work to do. No dentist will be happy under those circumstances for long, because he or she went to dental school to learn restorative procedures, not preventive/hygiene procedures. Similarly, you are being asked to do front-desk duties when, no doubt, you would be happier doing what you went to school to learn, i.e., hygiene procedures.

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If the expectation is that you will be paid your regular wage to come up with a magic marketing plan to bring in new patients, you have been given a very tough assignment. You cannot change the community perception of a Nordstrom practice to a Sears or Macy’s because that’s not what it is. You can’t make the practice more patient-friendly by insurance participation or taking children. The practice is what it is because of the doctor’s conscious decision to build that type of practice. It’s good when the economy is good and bad when the economy is sluggish. There are problems with all kinds of practices, but this practice is what it is. Many doctors strive to move their practices to the Nordstrom level, as if it is a kind of dental Nirvana, without thinking of the inherent problems that exist there.

I also would feel insulted if I was told that the other hygienist’s schedule would take priority, especially if it meant taking

my patients to keep her schedule full. There is no seniority issue since you both began employment at the same time. I sense some strong resentment in your words, and I fully understand it. You are in the unfortunate position of being low on the totem pole.

You have two choices. One is to stay and try to weather this business downturn which may or may not get better. The other is to find another practice. This is what I would do if I were in your shoes. Some practice will be lucky to get you, and you won’t have to play second fiddle.

You worked hard to become a dental hygienist, and I commend you on a great career choice! There is nothing more professionally gratifying than taking a patient through a series of appointments from a state of disease to a state of good oral health. You just need to find a practice that needs you and will appreciate your talents.
Warm regards, Dianne

Dianne D. Glasscoe, RDH, BS, is a professional speaker, writer, and consultant to dental practices across the United States. She is CEO of Professional Dental Management, based in Frederick, Md. To contact Glasscoe for speaking or consulting, call (301) 874-5240 or e-mail [email protected]. Visit her Web site at