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Attitude matters

May 1, 2018
There is an abundance of dental hygienists, and many are becoming discouraged, but a positive attitude and willingness to adapt to changes will help those who truly want to be health-care providers survive.
Dentistry is trending, and where will you fit in?

Dorothy Garlough, RDH, MPA

It is not known for sure whether Winston Churchill said, “A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty.” Researchers may quibble about who first said these wise words, but they still hold a meaningful message. The outlook one has toward life’s trials and tribulations often has a direct bearing on the outcome. Staying open to new ideas, different perspectives, and multiple possibilities leads to new solutions, shifting paradigms, and change.

The dental profession appears to be currently undergoing a transformation. During the past 30 years, students have streamed into the dental field seeking to become hygienists or dentists. It is not surprising that people want a livelihood that is secure, well-paying, and highly respected. Hygienists and dentists have enjoyed a privileged position in society, working in a profession with no life or death emergencies (at least in the short term), and until relatively recently, hours that did not include evenings or weekends.

With the influx of bright young students and the multitudes of hygiene schools opening, dental hygienists have become abundant. Today there are fewer jobs in hygiene available per capita, and this results in economic difficulties for many hygienists. Some professionals have taken a cut in pay, perhaps even accepting dental assistant wages. Other hygienists have not received a cost of living increase for many years, which leads to them working for less money each year. Still others are working on a commission basis (or salary plus commission basis), which means their take-home pay is based directly on the income they produce.

Supply and demand have always affected markets in a capitalistic society. When something is in great supply (hygienists), the demand goes down. Doctors do take advantage of this market condition. Yet, dentists themselves are facing new realities. According to a recent article in Dental Economics, the average annual income for dentists in the US from 2006 to 2009 has dropped 4.4% per year.1 Thought leader Dr. Gordon Christensen says that the proliferation of dentists stems from the opening of 12 new dental schools since 1997, many in areas with an already high concentration on dentists.2

The cost of education for hygienists and especially dentists is astronomical, and the investment in setting up a practice or purchasing a practice can be prohibitive for many.3 Few new graduates are in a position to open a new practice. Obtaining the credentials to practice dentistry is out of reach for many Americans, and although it is understandable that professionals want a return on their investment, new models will need to be developed to meet the changing environment.

The American Dental Hygienists’ Association (ADHA) estimates the following tuition costs (excluding living expenses) for these degrees in hygiene: associate’s degree—$22,692; baccalaureate degree—$36,382; and master’s degree—$30,421.4

The American Dental Association states that tuition increases for resident dental students has risen from almost $17,000 in 2000 to almost $33,000 in 2010. For nonresidents, the tuition went from $26,000 to $47,000 during the same time period. 5

The opportunity

The economic challenges to becoming dental professionals are real. Pessimists might see the rising costs as doom and gloom, but optimists will see it as an opportunity to bloom. In my opinion, this new reality is targeting newcomers to the profession who are more devoted. It is weeding out those who are primarily in our profession for the money, convenience, and status.

Trends are changing, and new models for dentists and hygienists are being introduced.

Committed individuals will enter the profession because they really want to make a difference in people’s health. This is a good move and an opportunity for our profession to redefine itself. Although dentistry is still one of the most trusted professions, trust has been declining, with many people believing that dentists are at the high end of the “one percenters.” The rising cost of education is attracting those who genuinely care to be more creative and inclusive in meeting the needs of the public.

Already we’re seeing change within our profession. One such change is the shift from a regular workweek of nine to five to adding evening hours and weekends. Offering choices of appointment times is a competitive advantage for offices because the supply of dentists has risen, and they’re now looking for the ideal patients. Making dental services more available to the general public is meeting the mandate of our profession, which is to be primary health-care providers.

Shifting from a productivity model to a holistic model will uplift our profession in the public eye. More and more, oral findings are being looked at holistically, with science proving the link between oral conditions and systemic disease. Dental professionals are being seen as an integral part of the health-care team, along with physicians, pharmacists, social workers, and other health-care professionals. This elevates the dental profession as the focus of care becomes person-centered.

Trends are changing, and new models for dentists and hygienists are being introduced. Some states are allowing hygienists to work in remote areas where access to care is limited. Independent practices for hygienists are opening in some states and provinces. Technology is expanding possibilities to new environments. We’re on the cusp of change in our profession and tomorrow’s dental delivery conveyance will be limited only by our imaginations and a willingness to be open to new and innovative models on the delivery of care.

Could older adults, who are growing in numbers, be instrumental in developing new trends? Many older citizens will live in communities with other older adults. These communities are already beginning to provide facilities for recreation and health services. Could hygienists in the not-so-distant future set up facilities in these communities? This is an opportunity for those with an optimistic view and a willingness to create new business models.

Trends are created when large numbers of people want change. The number of Americans over the age of 65 is growing. We do not yet know how their large numbers will influence the dental environment, but they will drive change. We’ll need to embrace the changes and think in creative ways to better reach, engage, and serve our patients. Pessimism about what is coming will be a disability that will stymie possibilities, while optimism will lead to a plethora of possibilities. Change is a constant in life and attitude will determine how well we adapt, adopt, and drive changes that will help the great profession of dentistry thrive.

So the question begs to be asked: What’s your attitude?

Dorothy Garlough, RDH, MPA, is an innovation architect, facilitating strategy sessions and forums to orchestrate change within dentistry. As an international speaker and writer, Dorothy trains others to broaden their skill-set to include creativity, collaborative innovation, and forward thinking. She recognizes that engagement is the outcome when the mechanisms are put in place to drive new innovations. Connect with her at [email protected] or visit engagingteams.com.


1. http://www.dentaleconomics.com/articles/print/volume-103/issue-6/features/dentist-net-income-an-alysis.html

2. http://www.dmdtoday.com/news/over-saturation-of-dentists-hygienists-a-mountain-problem-in-many-markets

3. http://www.doctorly.org/cost-vs-reward-of-a-dental-school-education/

4. http://www.adea.org/GoDental/Future_Dental_Hygienists/Program_Costs.aspx#sthash.dFZf7Ca5.dpbs

5. Source: American Dental Education Association, 2010 Senior Survey