Heidi Emmerling Jones, RDH, BS
Once upon a time, right after I graduated from dental hygiene school, I knew exactly what type of job I wanted. The employer would offer ideal periodontal treatment planning, unlimited instruments, supplies, and patient aids. The scheduling would be appropriate and consistent, and I would never run late. I would arrive at 9 a.m. and be out by 5 p.m. every day. The office would be less than a ten-minute drive from my home. The staff would be friendly and supportive. The building would be totally new and boast state of the art equipment. The office would sparkle. I would be respected and treated as a
professional. I would be able to listen to Rod Stewart all day. And I would earn a fat paycheck...
...then I woke up. No heroic dentist in a white lab coat and shining caps to make my dream job come true. Any job would be a compromise, I soon realized, and it was to be my job to determine where I was willing to compromise. For a year, I chose to work only temporary, part-time jobs in an effort to better learn my own quirks. During that year, I acquired thirteen W-2s.
I also found myself in a number of different situations:
- A periodontist who did not allow hygienists to root plane.
- A dentist who insisted on verbatim, script dialogue from which I was never to stray.
- A dentist who asked me to phone his colleagues to solicit campaign funds for his buddy, a gubernatorial candidate.
- A dentist who boasted, "Of course I sexually harass my employees - consider it a fringe benefit."
Just when I thought I had seen it all, a different scenario would surface. During my journey, I found there are basically ten areas to consider when deciding whether or not to accept a job.
Always look around the office before committing to work.
Without ever seeing the office she worked in, I once offered to fill in for a colleague for two weeks. I arrived 15 minutes before my first patient was scheduled. There was no dental lamp. The patient chair dripped grease and would not recline.
"Do your best," I was told. I did. I left. Since I was counting on two-weeks worth of pay, this was an expensive lesson for me. But it was a valuable lesson nonetheless.
Before committing to a job, look around. Sit in the operator chair. Test the handpiece, the suction, and the air-water syringe. Snoop in the supply closet. If the sole bottle of fluoride is dusty and the expiration date reads June 1985, this gives you a clue about what you can expect.
If this is to be a temporary position, decide if it is something you can live with or not. If this is a permanent position, will the employer address your concerns before you start?
Check out the instruments.
I have been in situations where the instruments were inadequate - both in quantity and quality. Two sickle scalers and two universal curettes. That`s it. Or else all of instruments were sharpened to the point they were dangerously thin. Or else the instruments were as dull as butter knives.
One office refused to allow me to sharpen, saying sharpening ruined instruments. In another, I couldn`t find a single periodontal probe. In another, the mirrors were so scratched, they were useless.
Checking out the instruments can prepare you for whether you need to dig up your instruments from school. Ideally, you shouldn`t have to do this. Again, if it is a temporary position and the employer is making it worth your while, it may or may not be worth it. This is something you need to address with a potential employer before accepting a job.
Never begin work without knowing what you will be paid.
This seems almost too obvious to mention. However, it is often awkward. Right after I finished school, a seasoned veteran gave me what turned out to be awful advice. She told me never to bring up salary. She felt the employer should be the first to mention the amount.
I put her advice to use. I committed to filling in for a day and did not even bring up compensation. At the end of the day, the dentist asked what he should pay me. My reply: "Whatever`s fair." Guess what? I ended up getting paid $20 a day less than what I was used to. Before agreeing to a job, tell the employer exactly what you expect. Don`t sell yourself short.
Remember, if you are filling in, you are doing the office a huge favor, and you are not getting benefits. Consider asking for an additional $10 to $20 per day more than the going rate. It usually works.
Speaking of benefits, decide for yourself whether you consider vacations, holidays, or sick pay as benefits. I have found that dentists do not pay hygienists, or anyone else, to take vacations, go on holidays, or to be sick. They simply withhold some of the salary until you go on vacation, take a holiday, or get sick. This way, you have a constant income throughout the year. Do you want to be compensated this way - implied promises to cash in later - or do you want to earn your money upfront? And what happens to the benefits if you decide to leave the job? Decide what works best for you.
Be very clear about how you are getting paid.
After agreeing to a daily salary, employers have called the night before telling me to come in an hour later because my first patient canceled. They expect me to come in later so they can dock my check by one hour. Or the last patient of the day cancels. Or a patient forgets to take the premedication and has to go home.
Same story: no production, no pay - all after deciding on a daily salary. I`ve learned to be upfront with employers. I explain the entire day is reserved for the office and, when I count on a certain amount for the day, I expect to earn that amount.
If the employer pays on commission or per patient, it is a different story. This can be a lucrative way of getting paid. It usually has the potential for higher pay than a daily salary.
For example, in one office I was compensated for 55 percent of my gross production. I averaged $100 per day more than the prevailing daily salary - some days more, some days much less. When considering commissions, you`ll need to know the fees and the percentage the employer is offering. Also, is there a base salary? Or a minimum guaranteed amount? Is commission based on production or collection? Are exams included as part of your production? Decide whether or not you`re in a position to take the financial risks of cancellations and no-shows. Since you will not be getting paid for no-shows, can you leave to attend to personal business, or are you still considered "on duty?" Know the story before beginning work.
Additionally, a dental hygienist is not an independent contractor in most states, even when working strictly on commission or as a temp. This means the employer must pay taxes on the hygienist. Some dentists try to save money and shift the tax burden to the hygienist by not withholding taxes. This means that, at the end of the year, the "independent contractor" receives a 1099. She usually pays more in taxes than she would as an employee.
Again, in most cases this is illegal and wrong for the dentist to pay a hygienist this way. Always check with your accountant before agreeing to be paid as an independent contractor.
Be very clear about when you will be paid.
If you fill in for one day, will you get your check at the end of the day? You should stipulate it before agreeing to work. Simply say, "When I fill in, I usually get paid the same day." It is usually not an issue if you are upfront about it.
I once had an employer withhold my check for six weeks for a one-day, fill-in job. And I had no one to blame but myself for not discussing it beforehand. Although it seems awkward, an employer so inclined can and will eventually take advantage if when you will get paid is not clarified.
Confirm that the employer is OSHA-compliant.
Some employers are still having employees provide and launder their own work garments. Some employees actually think this is merely an option. It is not. We should all know that the employer is responsible for providing and maintaining (that includes laundering and replacing) personal protective equipment.
Employees must not bring home contaminated work garments. I am surprised and appalled to learn employees are still laundering their own protective garments.
Before committing to a job, I always ask, "What size are your gowns?" or "Which does the employer provide - disposable or cloth gowns?" Never do I ask, "Do you provide gowns?" I always know in advance whether the office complies with the personal protective mandate by OSHA. I also send the message that I expect compliance.
If you are allergic to latex, are non-latex gloves available? Are the gloves your size? Verify that there are goggles or face shields. Verify that there are masks. Remember, even if you are filling in for just one day, you are still exposed to blood and other potentially infectious material. So the employer must provide you with appropriate personal protective equipment.
It is better to know beforehand than to show up for work only to find out that the office is one that does not comply with OSHA regulations.
Observe office sterilization methods.
Unfortunately, universal precautions are not practiced universally. Techniques vary from office to office. Again, take a good look. Does the office utilize either a chemclave or an autoclave, or are they merely dunking the instruments in glutaraldehyde? Do staff members use good technique? Or do you see staff going from the contaminated operatory to the supply cabinet or the phone without removing gloves?
Do you see soap and paper towels at the sink or does the staff merely slap the gloves on and off without washing their hands? Are they discarding the gloves after each use, or are they washing and reusing the gloves? Do you see a single "wiping" cloth towel that is continually used all day long to either wipe down the operatory or to wipe hands on?
Are disposable items actually disposed of after each use? Is biohazardous waste kept separate from other trash, and is it kept in an appropriate area (not the staff lounge or supply closet)?
Find out how patients are scheduled.
If you notice that all hygiene patients are scheduled as prophies, this could indicate the office doesn`t do much conservative periodontal therapy such as root planing or periodontal maintenance. If the office does offer varied dental hygiene procedures, is adequate time allotted for the procedure?
Are you expected to do a full series of radiographs, periodontal and dental charting, and full-mouth root planing in a 45-minute time slot? Is there a dental hygiene assistant? Are pedo prophies appropriately scheduled with the dental hygienist or are they scheduled with an auxiliary? Is the staff cooperative, or do hygienists and assistants refuse to touch each other`s instruments or X-rays?
Is lunch scheduled? Is it truly your lunch hour, or is it merely an opportunity for the employer to schedule an unpaid staff meeting?
Communicate with the "other" hygienist.
Whenever possible, try to do this. Speaking with the other hygienist in the office gives you opportunity to get the inside scoop. How did this position come to be open? Who quit, or who was fired and why? Can the patient-base support another hygienist?
What are the dentist`s quirks? Is the dentist easygoing or formal? What about the pay? By the way, it is not illegal or immoral for individuals to discuss salary - that is a myth invented by employers in an effort to keep salaries down. California dentists accused the state hygiene association of price-fixing several years ago, but the case was readily dismissed.
Don`t be afraid to ask about salaries. Try to reciprocate by being honest if a colleague needs the same information from you. Even though individual egos might delight in being higher paid than others, keep in mind that having a lower-paid hygienist around puts downward pressure on other hygienists` paychecks.
Be wary if the hygienist refuses to say anything negative. In my experience, I have never worked in a single office where there was not at least one minor or major annoyance. If the picture is too rosy, it?s probably fake. In order to be well-informed and adequately prepared to make an employment decision, you need to know all the issues.
This is the most important rule of all. Your colleague may brag about working with state of the art equipment, but you know that her office reeks of practice management consultants that are not very staff-oriented. The office environment would drive you nuts.
You love your efficient, friendly staff. You are paid well and treated with respect. But another colleague cringes when she finds out you have to listen to gospel music and look at orange carpet all day. Who cares?
The most important person in making an employment decision is you. Any job is going to require some type and degree of compromise. Having the confidence that certain items are not negotiable like OSHA compliance, sterilization methods, policies regarding patient care, and self-esteem enables you to avoid job pitfalls. Knowing your individual needs and becoming aware of what aspects of a job are critical and not so critical to you are steps towards finding a suitable job.
Only you can choose the job that is right for you. These ten rules can give you the power to make your choice.
Just like Cinderella?s slipper, the job that fits you might not fit another colleague. In fact, if you had your own magic wand, you might even create something different. Cinderella herself might have even wished for a different color or style. But the fit can still be just right.
Heidi Emmerling Jones, RDH, BS, is a consulting editor who practices dental hygiene in Sparks, Nevada.