A State of Mind

Oct. 1, 1998
If we could climb inside your head, is this what we`d find? You work four days a week in one dental practice. The workload is not an option; there are too many bills to pay. Regardless, you enjoy the job. You believe your patients know you and respect you as a licensed dental hygienist, even if they do not derive this respect from consumer advertising - which tends to promote the dentist as the preventive care specialist. Although you`d rather chat informally with the chairside assistant, you ar

Dental hygiene is a pretty nice place to hang out.

If we could climb inside your head, is this what we`d find? You work four days a week in one dental practice. The workload is not an option; there are too many bills to pay. Regardless, you enjoy the job. You believe your patients know you and respect you as a licensed dental hygienist, even if they do not derive this respect from consumer advertising - which tends to promote the dentist as the preventive care specialist. Although you`d rather chat informally with the chairside assistant, you are very comfortable in talking with the dentist about professional matters. Part of your comfort around the dentist is due to the fact that the doctor treats you with respect. You`re a little queasy about the prospect of suffering from an occupational illness or injury, but, for the most part, you`re confident that you`re protected from such hazards. You wish dental hygiene offered greater flexibility with career options, but you`ve witnessed the profession take a beating on several political issues, such as independent practice. If you`re not an ADHA member, the politics, though, have little to do with your decision - you just don`t want to pay the dues. The ADA, on the other hand, might as well stand for American Dentists` Association, since there`s nothing "dental" about it. But if Sonny said he might check out the college catalogs for information about either dental schools or dental hygiene schools, you`d say, go for it! He`s a good kid; he`d do fine in dentistry.

And George Clooney is kinda cute. Or maybe it`s Mel Gibson.

In the May 1998 issue, RDH published a survey designed to get a "feel" for the "state of mind" of dental hygienists. Apparently, most readers would gladly choose their careers again. For starters, the survey asked readers about how they perceive dental hygiene will be 20 years from now - the year 2018. A couple of doom-and-gloom answers were available for checking off - hygienists would be "nothing more than dental assistants" or would be "unemployed laborers" since the profession would be obsolete. Only 85 of the 719 readers participating in the survey chose such gloomy projections.

But a negative projection did come from an Arizona veteran. "Hygiene has been a good profession for me financially, and I do enjoy my patients. In the past 10 years, though, I`ve seen hygiene lose a great deal of its respectability. Hygienists are now trained at community colleges, and the majority of hygienists are former dental assistants who worked days and went to community colleges at night to get pre-reqs. Hygiene is no longer a profession that draws from the best of the graduating high school classes. The community college here in Tucson actually has a lottery to select its new class. Everyone who has a C average or better is put into the lottery. They don`t even take the best of the group. ... This type of change in the standards for hygienists cannot do the profession justice. We truly will be viewed as glorified dental assistants."

Most readers (48 percent), though, see graduates of dental hygiene schools practicing exactly the same way 20 years from now, although a sizable minority (40 percent) think the profession will be "unrecognizable" as a result of increased responsibilities given to hygienists as well as technological advances.

With such optimism in mind, readers (61 percent) said they would be very supportive of a son or daughter choosing dental hygiene as a profession. A slightly higher percentage (70 percent) said they would "support" their child`s decision to attend dental school in preparation for a career as a dentist.

A Massachusetts reader with four degrees, including a master`s in public health, stated, "After 15 years away and four careers later, I came back to hygiene. I love the patients, the caring, the pay, and the choice of hours. I`m appreciative of my original choice and the new technology."

Most of today`s hygienists are not thinking about career changes either. Even if they read about an "intriguing" career alternative in the business section of a newspaper, 47 percent of RDH readers wouldn`t give the article a second thought. On a regional basis, hygienists practicing in the region stretching from Minnesota to Kansas appear to be the happiest with their career choice; 62 percent "enjoy dental hygiene too much to consider leaving." On the other hand, an average of 52 percent in Northeastern states would at least mull over the article and think about the feasibility of changing careers. Only 38 of 102 readers from Massachusetts, New York, and Pennsylvania, for example, "enjoy dental hygiene too much to consider leaving."

Despite the overall satisfaction with their career choice, some hygienists express regrets. A Texas hygienist noted, "It has been frustrating because a hygienist never moves up. I have never had any benefits - no health insurance, no retirement. If I had chosen a different career and been in the corporate world, I would most likely be making twice the money I am making now with a nice retirement plan, benefits, and a paid vacation. In my office, every staff member except me gets five sick days a year. They do pay me for holidays, but they said I am the first hygienist for which they have ever done this. I am finally enrolled in college again, in computer technology, and I can`t wait to get out of this dead-end profession."

An Ohio hygienist viewed the "dead end" from a different perspective. "I love being a clinician and working with people ... But you know what? I am going nowhere. I am never going to move up the ladder. No matter how hard I work or what an excellent job I do I will never be promoted to a dentist. This is fine with me. I went into dental hygiene with my eyes open, having already been an assistant. I feel I have a good job with a good wage. I can make as much as a man in a skilled position in a factory."

It`s how you think of me

Across the nation, an average of 82 percent of hygienists believe a majority of their patients perceive them as a "licensed member of the professional health care community." Readers from the Midwest region tended to express a little more self-doubt about professional identity. In Michigan and Illinois, for example, 22% said patients viewed hygienists as being "another office staff member who doesn`t necessarily possess required training to administer treatment."

The demographic information about those responding to the survey included the statistic that 63 percent work full-time (defined as "four days or more") as a dental hygienist. Of the 37 percent working part-time, hygienists working in multiple offices were less likely to say patients perceived them as a "licensed member" of the staff.

Hygienists who work part-time in one office may well be the happiest. A question about whether readers could "retire tomorrow" revealed that these part-timers are less likely to be financially dependent on their careers (64 percent, compared to 90 percent for full-timers) and stay in it for personal fulfillment (17 percent, compared to 6 percent for full-timers).

A part-timer in Michigan, though, added, "I will say that if I had to work full-time I might consider an alternative career. I think I could get tired of this if I did it every day."

To finish the related demographic information started above, the survey drew:

- 336 responses from hygienists who work full-time in one office (47 percent).

- 112 responses from hygienists who work full-time in multiple practices (16 percent).

- 167 responses from hygienists who work part-time in one practice (24 percent).

- 72 responses from hygienists who work part-time in multiple offices (10 percent; the remaining three percent work in undefined job settings).

It`s an RDH thing; you wouldn`t understand

When lunchtime rolls around, RDH wonders who hygienists eat with, asking readers: Besides fellow dental hygienists, who in the dental office would be their choice for a "pleasant lunchtime conversation." The chairside assistant seems to be the "most comfortable" lets-do-lunch companion - at least with 41 percent of readers. Someone from the front office staff would suit 25 percent of readers just fine. The dentist is the choice for 20 percent.

Of the 83 readers who said they would be ready to leave the profession for an "intriguing career" change, only 15 percent feel comfortable eating with the dentist, and 27 percent would prefer not to eat lunch with anyone from the office.

RDH also asked readers about their comfort level in talking with dentists about topics related to the dental practice. The majority (68 percent) said they were "very comfortable" during professional communications with the dentist. Only 6 percent were not comfortable in such communication with the dentist, citing the doctor`s lack of respect for a hygienist`s opinion as a problem.

Hygienists who work full-time tend to be slightly more comfortable talking with dentists (70 percent, compared to 65 percent of part-timers).

Of course, a conversation with a dentist depends on the employer`s stake in the discussion. A Wisconsin reader wrote, "If I recommended a patient to see a periodontist, my doctor would have that patient scheduled with the other hygienist in order to collect money for a three-month prophy and root planing. He wanted me to show the new dental assistant, who had no dental experience, how to take X-rays. He wanted to `save me time,` meaning I`d soon have less chair time scheduled for my patients. He`d rather have inferior films than allow an extra five minutes in my schedule."

Determining the level of sexism in dentistry was the purpose of another question. Most hygienists (38 percent) believe that, in general, male dentists are "very supportive and respectful of their hygienists." Readers from Illinois (20 percent), Wisconsin (19 percent), Indiana (18 percent), and Michigan (17 percent) were somewhat more likely to note "sexist" or "patriarchal" attitudes on the part of the dentist; the national average was 15 percent.

So sexism does not appear to be an area of concern. A lack of appreciation for dental hygiene, though, appears to be more widespread. An average of 25 percent of hygienists across the country said doctors "downplay the value" of hygiene services.

The magazine also inquired about readers` concerns over occupational hazards, such as carpal tunnel syndrome or infection from a disease contracted while in the dental setting. Eighteen percent indicated that they already suffer from an occupational injury or disease. Regardless, only 10 percent believe they have a "good chance" of suffering from a occupational illness or injury before retiring. Most readers (38 percent) indicated they were aware of risks but that precautions taken were "sufficient." An almost equal number (34 percent) were more worried about suffering from an injury rather than an occupational illness, simply because of the high level of attention devoted to infection control.

On a regional basis, hygienists in the upper Midwest region expressed the highest level (52 percent) of confidence in precautions against occupational hazards. More than 60 percent of readers from Missouri, Nebraska, and Kansas believe precautions are "sufficient." The lowest levels of confidence appeared in New England and Southeastern states, typically around 33 percent.

If only you`d vote this way

Several political issues remain important to dental hygienists. For much of the past two decades, supervision requirements has generated numerous lobbying efforts in state capitals. Although the ultimate absence of dentists` supervision, independent practice, is allowed only in Colorado and experimented with in California, the issue still prompts some wistful thinking, at the very least. Thirty-one percent of readers desire the "flexibility" of going into independent practice some day, and 53 percent admitted that, while they don`t desire independent practice personally, it would be nice if colleagues had the option.

A Florida hygienist noted, "The economic pressure provided by free-market dental hygiene services would greatly benefit the public. Dental hygienists in independent practice schedule an appropriate amount of time for their services and can charge less for the same services because they don`t have an employer expecting a third of production income going into his pockets simply for having the legislated role as supervisor."

Readers from New Jersey (46 percent), Illinois (43 percent), Ohio (42 percent), New York (40 percent), Pennsylvania (35 percent), Washington state (33 percent), California (31 percent) have a personal interest in having the flexibility of independent practice.

Only 17 percent of RDH readers indicated that they believe independent practice is a bad idea. Texas (28 percent) and Florida (18 percent) were two states indicating above average opposition to independent practice.

Independent practice, of course, was part of a public initiative for self-regulation (commonly referred to as SHOUT) in Washington state in 1997. Although voters turned down the hygienists at the polls, it was generally recognized that the grouping of the hygienists` initiative with several controversial initiatives (such as gun control, gay rights and the legalization of marijuana) affected the outcome. Despite favorable pre-election polls, Washington hygienists, needless to say, were caught in the political backlash of angered conservative voters.

RDH asked readers nationally about their awareness and interest in SHOUT. An overwhelming majority (69 percent) said they were "very supportive" of the hygienists in Washington state. Of the remaining 31 percent, 24 percent of readers "did not care or know about" SHOUT.

One opponent of SHOUT who resides in Washington state commented, "I have been opposed to the national and state associations` 20-plus years of pressure for independent practice. It has only served to drive a vicious wedge between the professions of dental hygiene and dentistry. Independent practice of dental hygienists will not allow poor people better access as claimed by the associations and, in fact, will only provide a small portion of dental needs for people. The associations would better serve members by pressing for national licensure or reciprocity."

Dental hygiene`s most recent setback on the political level occurred in Kansas. After a hard fight in Topeka, the state`s legislators passed a bill allowing dentists to authorize dental assistants to perform certain hygiene functions. The legislation arose when the dental association said the lack of hygienists in rural western Kansas was hampering dental care.

An even larger percentage of RDH readers (84 percent) announced their sympathy for Kansas hygienists. Eight percent said dentists need to be able to consider "alternative methods to ensure preventive care therapy," and 8 percent indicated they were not aware or did not care about the squabble in Kansas. But in Kansas and its neighboring states - Colorado, Nebraska, Oklahoma, and Missouri - more than 90 percent were "very concerned" about what transpired.

Fitting in with the group

Most readers responding to the survey (55 percent) do not belong to the American Dental Hygienists` Association. But, rather than demonstrating a widespread discontent with the ADHA`s policies, most (85 percent) cited financial reasons for not joining. They chose the answer that stated, "Dues are too high for what I would get out of it."

One dissident from ADHA policy urged the association to stay away from politics. "We need the ADHA to get us more money and benefits," A New York hygienist wrote.

Most of the ADHA members participating in the survey have belonged for more than 10 years (55 percent) and they typically described their membership with one of two answers:

- "I have been a proud member of the association and supportive of most of the association`s policies" (43 percent).

- "I belong because it`s part of being a dental professional to participate in the association`s activities" (38 percent).

Only 9 percent of the current ADHA members are "considering not renewing my membership," and the remaining 10 percent said they belong so they can network with colleagues on a state or local level.

A Texas hygienist was sarcastic about the networking among colleagues, citing it as the primary reason for not renewing her dues. She wrote of the "lack of professional organization" on the local level: "The local levels present themselves as `little girl slumber parties or get-togethers.` I feel we, as a whole, lack the continuity that the registered nurses have."

An opposing viewpoint was submitted by a Pennsylvania hygienist who wrote of her state`s association: "PDHA is very wonderful to be in and it keeps me informed of current issues."

In general, the association`s strongest support appears among readers from western states. Veteran members of longer than 10 years tend to be more supportive than younger members.

Other trivia about ADHA members vs. nonmembers include:

- ADHA members feel more comfortable in talking with dentists about professional topics (73 percent to 64 percent).

- ADHA members "enjoy dental hygiene too much to consider leaving" (53 percent to 42 percent).

Regardless of the split support of the ADHA, readers appeared united in their feelings about the American Dental Association. The survey`s question about the ADA allowed readers to indicate that the association was "committed to the best interests of all team members, including hygienists" (a sentiment shared by just 14 percent of RDH readers). A second option allowed readers to state a suspicion that the ADA cares more about the welfare of other auxiliaries in the office (20 percent).

The most popular answer, though, was the belief that the ADA doesn`t look out for the "best interests of anyone except dentists" (66 percent). An unusual statistic emerging from the question was the 11 of 42 readers responding (26 percent) from New England states believe that the ADA is committed to the best interests of the entire team.

One Idaho hygienist wrote, "I am planning to attend dental school so that the ADA can`t `wipe out` my profession. I do plan to get involved with the ADA when I finish so that hygienists can have representation in that organization."

The survey concluded with a "fun" question, which merely asked readers who they wished their "next patient looked like." George Clooney and Mel Gibson topped a long list of celebrities with 20 percent each. The other "dream" patients were: Harrison Ford (17 percent); Tom Cruise (16 percent); Sean Connery (8 percent); Brad Pitt (8 percent); Leonardo DiCaprio (5 percent); and Denzel Washington (3 percent).

With male hygienists in mind, we offered the option of Kathy Ireland, and 4 percent preferred her looks as the next guest in operatory. Fourteen percent of readers were not amused by the question, frequently scribbling "dumb," "unprofessional," or "offensive" in the margin. A hygienist with same-sex preferences wrote, "Gay hygienists need a break as well. How about K.D. Lang?"

RDH intentionally concluded the survey on a less somber note. A Maryland reader was undecided about Clooney and Gibson. She wrote, "Either would do. Thank you for this light-hearted question."

But the best comment came from a New York reader: "I don`t care what he looks like as long as he`s compliant and has a healthy mouth."

If you read about an intriguing career alternative in the business section of tomorrow`s newspaper, how seriously would you mull it over?

47% answered, "I enjoy dental hygiene too much to consider leaving."

41% answered, "I`d probably clip the article out and save it for a while. I could go either way."

12% answered, "I`d get on the phone and check out the logistics of a career change. I`m ready to leave."

Do you think a majority of your patients perceive you as a licensed member of the professional health-care community?

82% answered, "Yes, I think most patients are aware that I am a licensed professional, specializing in preventive dental care."

15% answered, "No. I think most patients see me as another office staff member who doesn`t necessarily possess required training to administer treatment."

3% answered, "No, and patients don`t seem to care."

Do you feel that, in general, dentists are sexists, condescending, or unappreciative of the role of dental hygienists in dental care?

38% answered, "No. I think dentists, as a general rule, are very supportive and respectful of their hygienists, as well as strong proponents of sound preventive care programs."

25% answered, "Yes, I think male dentists downplay the value of the services to American consumers provided by dental hygienists."

23% answered, "No. We are cash producers who are important to their bottom line. They are aware of this fact."

15% answered, "Yes. I think, in general, male dentists convey patriarchal or sexist attitudes toward the dental hygiene profession."

Do advertisers promote dental hygienists through advertising of oral home care products?

69% answered, "I think advertising of oral home-care products tends to promote the dentist."

24% answered, "I think advertising advocates messages about oral home care in a very effective manner, regardless of which member of the dental team appears to endorse it."

7% answered, "I think advertising of oral home care products generally promotes the role of the dental hygienist."

Could you "retire" from dental hygiene tomorrow if you wanted to?

83% answered, "No, I am financially dependent upon my career."

9% answered, "No, I don`t need the money, but I do need the personal fulfillment I get from my career."

8% answered, "Yes, I could walk away tomorrow without suffering any financial hardship."