Dream... or a Nightmare?

Nov. 1, 2000
Pam, a transplanted RDH, called me long distance this morning. She was very upset. OI checked the want ads again last night, but the dentists who need hygienists flunked Osharing with others? in kindergarten,O she said. She had been told that $20 an hour was too much, and that was her temping fee!

T.K. Allen

Pam, a transplanted RDH, called me long distance this morning. She was very upset. OI checked the want ads again last night, but the dentists who need hygienists flunked Osharing with others? in kindergarten,O she said. She had been told that $20 an hour was too much, and that was her temping fee!

Moving to a preceptorship state had done a number on her self-esteem. Just months ago, she was a valuable member of a progressive dental team. Now, in her new home state, she felt depressed, disillusioned, and worthless.

It seemed that education now held no great significance and experience no real merit in this preceptorship state. Preceptors and RDHs were thrown into the same futile pot, with no distinction and no contrast. Professional pride was a thing of the past.

OAs I turned out the lights, I thought about my predicament,O Pam remembered. OIf I was a dentist, things would be different. I fell asleep thinking about it. Then I had this dream!O

In her dream, Pam saw herself in a white lab coat. A woman sitting next to her in a dentist?s smock was excited about Pam?s decision to become a dentist!

OI?m so glad you decided to go through OThe Course,?O the woman whispered. OYou can do it. It?s not that hard. All we do is drill, fill, and bill anyway, right?O

That?s what Pam had heard. The woman told her that all she needed was one year of hygiene experience, and OThe CourseO would fill in the rest. Within a year, she would be a practicing dentist!

Since Pam had been a hygienist for more than a year, she was ready. When she asked what other qualifications she needed to be a dentist, she was told that there was a lot of reading. She was handed a 70-page book on the ins and outs of drilling and filling. The first chapter was called, OIs It Sticky? Detecting Decay in the Oral Cavity.O

Subsequent chapters included OWatch Those Overlaps, Detecting Decay on Radiographs,O OThis Won?t Hurt a Bit, Painless Injections,O OThis is a Drill,O ODrilling for Dollars,O and OPack It In.O

OThe CourseO continued with 14 days of clinical Odrill and fill.O

OYou can do it,O her mentor told her. OI?ll be watching from another room. If you get into trouble, try more anesthesia. If that doesn?t work, call me. I?ll be there as soon as I can. You can?t do too much damage.O

OThat?s when I sat up in bed!O Pam said. OIt took a while to get back to sleep, but the dream was waiting for me.O

When the clinical part of the course was completed, 10 weekends of billing techniques followed. Pam learned the Opayment received at time of serviceO technique and the Opay some now, pay some laterO method. Her teacher admitted there was a lot to learn, but she was sure Pam could lick it in 10 weekends.

OI had my doubts, but before I knew it, it was time for the state Boards,O Pam told me. OI was prepped with questions from the year before, and I felt ready. And you know what? I passed!O

Pam thanked her proud sponsor for her help. She was a dentist now!

Her teacher told her she could begin practicing with her on Monday. She already had set up an operatory and she had two weeks of patients waiting. Pam would get a certain percentage of production, working for her teacher now. Pam said her new boss was very pleased with herself. Her efforts had paid off.

Then, just when she was wondering how much a dentist made, her mentor burst her bubble.

She told Pam she wouldn?t get paid much, having only taken OThe Course,O but it would be better than a hygienist?s pay.

Pam walked into the office on Monday morning wearing her new lab coat with an embroidered ODDSO for all to see. Little did her patients know that she had only limited training. They never thought to ask, and she sure wasn?t going to bring it up.

She soon noticed that the fees charged for her procedures were the same as her sponsor?s, but her percentage of production was almost insulting. In fact, it was lower than anywhere else in the country. When her patients wanted a procedure such as a crown and bridge, her sponsor would send Pam to a continuing-education course over the weekend and then make the patient an appointment.

Pam also noticed that tension was building between dentists like her who took OThe CourseO and other dentists. They were the poor souls who worked to get through eight to 11 years of college and dental school, the national Boards, and were paying back money from school loans. Why did they do all that, Pam wondered, when it was easier and cheaper to go through OThe Course?O College was an unnecessary waste of time and money. They only drill, fill, and bill anyway, right?

When her hygienist friends found out about OThe Course,O they ran to sign up. They were cranking out dentists like there was no tomorrow! All the sponsoring dentists kept the graduates? salaries low, which created a whole new salary base. They loved their work, but their salaries were a tiny fraction of the money they brought in through their production.

The eight-year dentists also were having a hard time. Even with all that know-how, they were being told they charged too much when their fees were the same as dentists in other states. OToo much compared to what?O they asked. They had to either lower their fees or close up shop. Some retired early. Some moved. (Pam didn?t have that option. No other state could legally accept her license.) Others had to lower their fees just to stay in practice. They said, at this rate, it wasn?t worth working anymore. Some stayed home with the kids, while their spouses brought home the bacon. They asked Pam, OWhy didn?t you go to school like we did?O Pam and some of OThe CourseO graduates wished they had, as they soon found out the scope of what they were supposed to know as dentists. But their sponsors closed the dental department at the college, saying there was no need for it anymore. After all, they had OThe Course.O Their sponsors told them that college took too much time. With OThe Course,O former hygienists could be producing for them in a year! There was no need for college.

OThat?s when I woke up in a sweat,O Pam said. OEducation does matter, and that takes time. It shouldn?t be all about money, lower hygiene overhead, and instant hygienists!O

RDHs are not glorified, overpaid cleaning people. With a college degree and continuing education, hygienists are more capable than ever before. Add expanded functions to that and anyone can see that the more you know, the more you?re worth to the dental practice ? and that should be reflected in your salary. Is two years ? the time it takes for an associate?s degree ? too long to wait for a hygienist, or is it too unsettling to know she?ll be free to practice where she chooses and expect more pay? Is the drive toward autonomy for hygienists scaring the ADA into finding ways to set us back?

Starting a program and closing the schools can?t be the answer to creating more hygienists. With hygienists in such demand, what state would cancel funding to a college program ? especially when the same college has a department for assistants and dentists?

OIf the Opowers that be? conjured up a preceptorship program for dentists, things might be different,O Pam sighed. OBut that won?t happen because dentists are the Opowers that be.? They sway the state legislature. Hygienists are the only ones who are Oblessed? with preceptorship!O

Some of us are fighting for autonomy. But be on guard. Others, like Pam, are fighting for survival.

T.K. Allen is the pen name of a dental hygienist who couldn?t sleep last night.