Going the Full Monty in dental hygiene

Aug. 1, 1999
British law now allows independent hygiene practice, but overcoming the obstacles to `The Full Monty` takes creativity and tenacity.

British law now allows independent hygiene practice, but overcoming the obstacles to `The Full Monty` takes creativity and tenacity.

Trisha E. O`Hehir, RDH, BS

In May, I was invited to be part of a continuing-education program in Birmingham, England. Nexus Media Limited, publishers of The Hygienist, the British version of RDH, hosted the full-day meeting, held on the grounds of a beautiful botanical garden. "The Full Monty" or "Your Career in Oral Hygiene," as it was titled, focused on independent practice. I was one of three speakers in the morning session. I spoke on "Dental Hygiene Therapy - Science vs. Tradition," and the other two presenters spoke on diagnosing periodontal disease and carpal-tunnel syndrome.

After lunch and an opportunity to visit the exhibits, participants could choose to attend two of six small group sessions. I attended a very interesting session by a leading advocate of independent practice in England.

Recent changes in British dental laws now allow independent practice for dental hygienists. The law was changed, but not without a few constraints. Patients can only be seen "by prescription" from a dentist, and no advertising is allowed. In this country, those restrictions would be considered "restraint of trade." But you know hygienists - we are very adaptable people and ingenious at figuring out how to deal with less than ideal conditions.

The advertising ban includes not only advertising as we think of it in newspapers and on radio and TV, but you also cannot put your name on the door or building where you have set up your practice. I get the feeling dentists in England don`t want hygienists to be successful in their independent practices!

An independent hygiene practice by prescription is termed a "referral practice." That leaves out the half of the population who does not go to the dentist. One solution would be to have interested patients visit a dentist in the area to get the referral. Not a bad idea; that would be a win-win situation for both the dentist and the hygienist. However, the problem is that most dentists who see National Health Service patients are already so busy, the waiting time for new patients can be several weeks or months. The long wait is the result of England`s socialized health-care system.

The potential for profitability on dental- hygiene services also must be considered. The National Health Service pays approximately $10 per prophy, leading to a dental hygiene schedule of four patients per hour! Yes, you read that right, 15 minutes per patient! That seems to be the standard in England for National Health Service patients. Seeing private patients allows for higher fees and more comprehensive care.

It would be easier to start an independent referral practice in an area where the hygienist already knows the dentists. It`s more difficult if you select an area where you`re new to the dental community and all of the dentists employ a dental hygienist. Developing a referral practice in that situation becomes a challenge.

These constraints were viewed as a challenge by one hygienist in particular. Kate Wheller, EDH, worked for many years in London, but she and her family dreamed of returning to Weymouth, a seaside community 140 miles from London, where she and her husband had grown up. They figured their only opportunity to return would be when they retired, but the dental-hygiene law change provided an earlier opportunity.

A visit to the area, together with demographic research, suggested it could be done. Weymouth has 11 dentists, but only five of them employ dental hygienists. The next step was to find a building. Several properties were too small to be used as hotels, but too large for residential use. One in particular caught Kate`s eye - a three-story, recently renovated Victorian house that had previously been used as a nursing home.

The two upper floors could be used for the family and the main floor could be set up for the practice. The only problem Kate saw with the building was that it was still more room than she needed for her practice.

With a bit more thought and some more research, she came up with the idea of a health center, where she would rent space to other licensed health-care professionals. She divided the main floor into a dental operatory; physical therapy room; a treatment room to be used for hypnotherapy, homeopathy, or podiatry; a meeting room; a beauty center; and a reception and waiting room.

Treatment rooms are available for four-hour sessions between 8:30 a.m. and 8 p.m. each day or whatever arrangements need to be made short of full time. Rent includes all utilities, use of the reception and waiting areas, and parking. Advertising is done as a group, with costs split among all the renters.

Kate is now in her second year of independent practice, making only a small profit and still at only a third of the predicted market level. Despite that, the bank is happy with her success and sees the potential for future growth. Kate is enjoying the challenge, and her whole family is pleased to be living in this lovely seaside community.

"The Full Monty" was an interesting meeting. It was fun to meet and talk with British dental hygienists. However, I`m still baffled by 15-minute prophys!

Trisha E. O`Hehir, RDH, BS, is a senior consulting editor of RDH. She also is editor of Perio Reports, a newsletter for dental professionals that addresses periodontics. The Web site for Perio Reports is www.perioreports.com. Her e-mail address is trisha@perioreports. com.