The Corporation

Oct. 16, 2014
A reader wrote and asked if I would consider writing about corporations that purchase dental practices, and of the undesirable happenings that occur after the change in ownership.


A reader wrote and asked if I would consider writing about corporations that purchase dental practices, and of the undesirable happenings that occur after the change in ownership. She's heard numerous stories from RDHs, and since her own doctor was nearing retirement age, she was worried about what the future might hold. She cited huddles that took place at the start of the day to discuss the need for increased production, and the expectation to promote unnecessary dentistry.

Since I don't know any hygienists who work in this type of environment, I felt skeptical about how to approach the topic. I'm forced to rely on the word of RDHs who wrote to me. As I read some of their letters, however, I felt that they spoke from the heart about their concerns.

I thought about some of the practices I've worked in clinically through the years. In several, consultants were utilized. We were absolutely encouraged to start the day with a huddle to discuss how we would approach and reach production goals. Note: This did not involve the promotion of unnecessary dentistry. So, the idea of goal setting for production, and a discussion of how we might achieve those goals, was sounding like a perfectly legitimate business practice.

The letters described in detail shortened appointment times for hygiene visits. In a 30 to 40 minute visit, the RDH was expected to review the medical history, take radiographs, provide an oral cancer screening, do a complete exam including periodontal charting, and provide a prophylaxis. It was the responsibility of the RDH to promote ViziLite exams, and if five of these were sold, the RDH's name would be entered in a drawing for an iPod. In other words, much was expected, and inadequate time was provided in which to do it. Any patient with pocket depths of 4 mm or higher (no mention of bleeding) was to be presented with periodontal therapy.

After reading a number of these types of letters, I thought about some offices I had temped in during my clinical lifetime with similar working conditions. These offices had single owners and were not part of big conglomerates. Yet the doctor-owners, like the conglomerates, were guilty of sacrificing quality for profit. As a temp, I witnessed doctors doing exams and prescribing treatment that was aggressive, and in my opinion, not appropriate. Since these were temporary assignments, I could opt out of returning to these practices.

I guess the point I'm trying to make is that substandard care, poor working conditions, and unnecessary treatment being prescribed are not limited to practices that are part of big, corporate entities.

What I grapple with is a solution. I hate to disappoint my readers, but I don't really have a solution. I had the sense that one hygienist wanted these behaviors and expectations and working conditions to be banished. How? With strong moral statements and condemnations from those more righteous and caring?

The reality is that's not going to happen. Stuff like this goes on every day in health care, and everywhere. We're aware when it happens in dentistry, but probably not aware when it happens in a law firm or insurance company or restaurant, for example. So we can't necessarily control it. "But what about the patients who trust…" you say. "It's just not right!" Yes, I hear you.

The only thing we can control is choosing where to place ourselves. That's where the going gets tough in a saturated dental hygiene marketplace, with positions not exactly growing on trees.

We have to decide what we can live with. In these instances, "the system" is not likely to change. Can we come to peace with the care that's being provided? Should we justify that substandard care is better than no care? Recognize that patients have the right to say no, or to seek second opinions to treatment?

There are no easy answers. I understand that it's difficult, and many of us are struggling to earn a living. If you're walking in these shoes and just can't take it anymore, a reality is that another hygienist will gladly jump in to take your place. Realize also that what bothered you may not be a problem for the next hygienist in the least.

As an old friend of mine used to say, "That's why there is vanilla and strawberry. There is something out there for everyone, and not everyone cares as much as you do."

Onward we go; it is in our hearts' core…

EILEEN MORRISSEY, RDH, MS, is a practicing clinician, speaker, and writer. She is an adjunct dental hygiene faculty member at Burlington County College. Eileen offers CE forums to doctors, hygienists, and their teams. Reach her at [email protected] or 609-259-8008. Visit her website at