The future

We predict that you'll unlock the door to your own practice

by Julie Young, RDH, BASDH

Imagine leaving for work every day, unlocking the door, and stepping into your own dental hygiene practice. What about working beyond the four walls of the traditional dental operatory and practicing in nursing homes, public schools, or with a medical team? Before long this will no longer be an aspiration, but a reality for many dental hygienists. Does this sound exciting to you? If so, you're ready to take the next step into self-employment and becoming a business owner.

The ADHA's report, "Dental Hygiene: Focus on Advancing the Profession," identified six focus areas that require a call for action. This article focuses on the recommendation made by the ADHA to identify risks associated with these new roles.

In a recent interview, Ann Battrell, executive director of the ADHA, discussed that the profession of dental hygiene will diversify. Similar to the nursing profession, the advanced dental hygiene practitioner (ADHP), or dental therapist, will practice in multiple health-care settings. Battrell also said that the economic state, coupled with the lack of availability of oral health-care providers, would compel dental hygiene to change as a profession. Therefore, it is in your best interest to be prepared and learn from those colleagues who have tackled the challenges of practicing in an expanded setting. It is important to prepare yourself, the team, and patients for the changes in the profession.

(For purposes of this article, expanded settings are defined as independent or collaborative hygiene practices and/or traditional clinical settings, such as nursing homes, schools, or public health facilities.)

Think like a business owner

As dental hygienists, we tend to think like care providers and not like business owners. Many dental hygienists, including myself, are guilty of thinking in terms of "I just want to take care of people." Unless we have taken business and marketing classes, many of us are not business savvy. Now is the time to think creatively, sharpen our business skills, and build strong relationships with dentists and patients.

As a potential business owner, one must conduct a prudent risk evaluation by implementing the "Six Enterprise Risk Management Domains" (see sidebar). Taking into account the operational and financial domains, one of the biggest considerations is start-up cost. Depending on the direction you take, you should be ready to take out a small business loan to purchase portable equipment, instruments, and even a laptop. Independent practice ownership could mean taking out a much larger loan to purchase or rent space, along with purchasing necessary equipment, instruments, and a computer along with dental software.

Business considerations:

▲ Decide what type of business to start.
▲ Choose the services you will provide.
▲ Determine finances and apply for loan.

Looking at the strategic domain, another major consideration is protecting your business through adequate insurance coverage. The process is not as difficult as you may think. My first phone inquiry was successful at obtaining professional liability insurance for self-employment, and it was very affordable. Bear in mind, a separate policy that covers business property should be purchased. Something to look for in a policy is the possibility of portable equipment being stolen from one's vehicle. Is this covered under your homeowner's insurance? Consequently, one must carefully review separate business, equipment, and medical professional liability policies to ensure that all aspects of the business are covered and protected.

Insurance considerations:

▲ Obtain malpractice insurance policy.
▲ Obtain separate business property insurance.
▲ Carefully review policies to ensure full coverage.

The Legal and Regulatory, along with the Technology Domains, overlap one another when discussing office computer usage. By 2015, health-care facilities should be converted to electronic health records (EHR). If you are not starting out paperless, you will need to consider it for the very near future. When referrals, insurance billing, etc., are being done online, is the information being transferred securely? What if someone broke into the office and stole your computer, hard drive, and/or back-up tapes with patient information? (It would not be mentioned if it had not already happened!) The office needs to have a security system for this very reason. Are all HIPAA regulations being followed?

More business considerations:

▲ Security for electronically transmitted patient information.
▲ Building security system.
▲ Insurance for cyber risk.
▲ Privacy and security policies and procedures that are HITECH compliant.

Professional relationships = success

Finally, enough emphasis cannot be placed on professional relationships. As a dental hygiene business owner, you must be proactive in maintaining relationships. For instance, a nursing home could promote a new director, and if a relationship is not established with key people within the facility, the dental hygienist is the "outsider" who will get lost in the shuffle. Be an active participant within the establishment and take part in a few different social functions. This will speak volumes about you and that you really care about the patients and caregivers, and are not there "just to clean teeth."

Professional considerations:

▲ Be proactive in building and maintaining professional relationships.
▲ Know the names, emails, and phone numbers for key contacts.
▲ Participate in different activities within the facility.

Another key relationship is with the consulting dentist. Knowing what each referring dentist expects and providing that service for his or her patients is a major component to that working relationship. How would they like their referrals to be completed? Who is going to provide what service, such as radiographs or sealants? Some dentists prefer to do their own. Excellent communication is essential to make the relationship a successful and long-lasting one. It is beneficial to patients as well, because they will feel at ease and know that their care and needs are a priority to both their dentist and dental hygienist.

More professional considerations:

▲ Secure dentist collaboration.
▲ Establish what services the dentist expects you to provide.
▲ Uphold excellent communication between you and the dentist.

Using the Six Enterprise Risk Management Domains will help you eliminate the initial concerns of starting your business. Building a collaborative or independent practice demands close attention to business development with careful, strategic marketing. As dental hygienists, we need to show dentists that we are their allies and want to cooperatively work with them. We cannot do their work, or ours, without them. Pam Grabowski, RDH, who opened a collaborative practice in New Mexico, commented that some dentists who agreed to collaborative practices have increased their production because their schedules and operatories are open for more lucrative procedures. (Sunstar E-briefs, 2010)

Dental hygienists are being given an opportunity to take on new independent roles to make a difference in the health of people. In an editorial, Tammi O. Byrd, RDH, past president of ADHA, stated, "The climate is right to move dental hygiene more dominantly into the forefront of total health as an interdisciplinary partner with other medical professions." The solutions to the oral health-care access problems are within our grasp. In light of this call for action, our next step is to follow those already in expanded roles and build collaborative endeavors. Get ready for the future of the dental hygiene professional because it is here!

Six Domains for Enterprise Risk Management

1. Operational. Risks resulting from core business practices including clinical risk. (Ex. Patient records, coding and billing policies, office policy and procedures.
2. Financial. Risks associated with the ability of your practice to make money and remain fiscally sound.
3. Human capital. Risks related to your staff, encompassing recruitment, training, and maintenance of these individuals.
4. Strategic. Risks associated with external events and trends that can impact the growth and value of your practice.
5. Legal and regulatory. Risks associated with state and federal rules, regulations, and statutes affecting dentistry.
6. Technology. Risks resulting from rapidly evolving technologies and equipment, biomedical products, computers, or teledentistry.

Julie Young, RDH, BASDH, recently completed the baccalaureate program at St. Petersburg College. She works with dental professionals who desire to expand their clinical horizons. In addition, she works part-time in private practice in Orange Park, Fla. Visit Julie's blog at http://ohsrdh.blogspot.com.

References

1. American Dental Hygiene Association. (June 2005). Dental hygiene: focus on advancing the profession. [Electronic version]. Retrieved Feb. 6, 2011 from http://www.adha.org/downloads/ADHA_Focus_Report.pdf.

2. Battrell A, (Dec. 15, 2010). Episode 7: special guest Ann Battrell/The DEZiree Show [Electronic Audio Recording]. http://www.thedezireeshow.com/.

3. Byrd TO, (2010, March). "Alternative" practice settings for dental hygienists – What does the future hold? [Electronic version]. Access, 24(3) 2, 32.

4. Harvey L, (2007). Managing risk: protecting your million-dollar practice. Banks L, Banta D, Bobrow G, et. al., (Vol. 2) The academy of dental management consultants, Powerful Practice, Roswell, GA: James & Brookfield Publishers.

5. Sunstar E-Briefs. (October 28, 2010). Up to the challenge of collaborative practice. Retrieved Feb. 12, 2011, from http://www.gumbrand.com/n/pdffiles/ebrief/ebrief-102810.pdf.