Striving for independence

July 1, 2018
JoAnn Gurenlian, RDH, tells the story of several Canadian dental hygienists who have established their own practices and are working independently.
Canadian dental hygienists provide oral health care the way it was meant to be delivered

JoAnn Gurenlian

I recently attended the College of Registered Dental Hygienists of Alberta’s (CRDHA) Annual Conference in Calgary and met many colleagues over the course of the three-day meeting. I was especially intrigued by the dental hygienists who had established their own practices and were working independently. Their stories of why they chose to become autonomous practitioners were both fascinating and inspiring. Since July is the month we celebrate independence in the US, I thought I would devote this column to the same topic for our profession.

In Canada, most of the dental hygienists in provinces have the opportunity to practice independently either by setting up a practice within a dentist’s office, separately in one’s own office, or as a mobile practice. The hygiene colleagues I met revealed that they took their time deliberating about creating their practice after having been in the field for quite some time—some for 10 years and others for 20. Their decisions were based on economics, family planning considerations, and a desire to create a practice that would allow them to provide a high standard of care for the public in a variety of settings.

Some dental hygienists felt strongly that they still wanted an association with a dental office and were working closely with a dentist. Others wanted the freedom of a mobile practice and the ability to work in nursing home and long-term-care settings. All of these individuals paid attention to fine details including equipment, infection control practices, patient education, instruments, advancing their education through ongoing continuing education, and adherence to monitoring by their professional organization. In Alberta, the CRDHA requires regular assessments to ensure that professional standards are upheld and the health and safety of the public is maintained.

What I found most interesting was the turning point that these dental hygienists expressed that led them to decide to move to independent practice. One hygienist said she was tired of the front office receptionist telling her how her appointments with patients should be scheduled and how much time she should be taking to provide care.

As she stated, “Why should this person who knows nothing about what I do and the care I provide be dictating to me how much time I need to deliver care?” Another colleague said that she was tired of feeling devalued by an employer who rarely took the time to be current or understand evidence-based care. Several of the hygienists said they often felt the need to justify the standards of their profession and were frustrated by being undermined and diminished in front of patients.

These women had finally had enough and thought it was time to provide preventive and therapeutic oral health care the way it was meant to be delivered. They were beaming as they talked about their practices, the setting, the quality of care they provide, the names of their businesses, and the satisfaction they now have compared to what they felt before. These colleagues showed themselves to be brave, strong, caring, and creative. Most importantly, they were steadfast in their belief that what they were doing was relevant and valuable.

As we think about our neighbors and colleagues to the north, we can learn from them and their experiences. Certainly, we have our trailblazers here in our own country. We have independent practice and collaborative practice arrangements in some areas of the country. Telehealth models are being explored as are other workforce models. What we need to do now is grow in our independence and support one another so we—and only dental hygienists—are the ones who determine how dental hygiene care should be delivered no matter what the setting.

JOANN R. GURENLIAN, RDH, PhD, is president of Gurenlian & Associates, and provides consulting services and continuing education programs to health-care providers. She is a professor and dental hygiene graduate program director at Idaho State University, and past president of the International Federation of Dental Hygienists.