The rush hour: Story of my life

Each patient needs to be assessed by their particular need and scheduled appropriately.

Jun 1st, 2001

Dear Dianne,

I have been doing dental hygiene for the past 15 years, but I am coming to the point in my life where I think it may be time for me to find something else to do. For me, going to work holds little joy. I feel so tired and stressed at the end of the day that I cannot bring myself to think of the next day.

Part of the problem is being booked too tightly. In a typical day with all routine prophys, I will see 10 to 12 patients. There is little time for doing anything more than just scaling the calculus off my patients' teeth. Often, I do not feel I do a thorough job because of time constraints. From the moment I walk in the door until I finish with my last patient, I feel rushed. I find myself working into my lunch hour or after closing time many days. The stress of being in a continual rush day after day is wearing me down.

When I began my dental hygiene career, I loved going to work each day. I felt excited and motivated. Now, I feel tired and guilty. I am tired of the rat race, and I feel guilty because I know my patients deserve better.

Is there any hope for me? Is it possible to regain that energy and motivation that I used to feel?

Feeling Hopeless in Hartford

Dear Feeling,

I certainly sympathize with you. You have reached the point where the joy of helping people has been smothered under the blanket of overscheduling and the accompanying stress. Your situation is a good example of the proverbial "prophy treadmill" that we sometimes hear about.

When I read letters like yours, it is little wonder to me that there is such a high attrition rate in the dental hygiene profession. A report from the ADA Survey Center, the 1998 Survey of Dental Practice (Employment of Dental Practice Personnel), had some startling numbers in it. The mean number of years that dental hygienists spend in practice is 6.4, with a total of 13.7 years of experience (thus coming into the practice with a number of years of practical experience). For specialists' offices, the mean number of years in the practice is 7.2; the total number of years of experience is 14.5. This information shows that most hygienists do not stay in the profession for the duration of their working years.

What is typically expected in a routine dental hygiene appointment? On the next page is a chart with the number of minutes needed for each step of an appointment.

When I add up these numbers (using an average for those with ranges), the total is 97 minutes. Excuse me, but this is a little more than 11/2 hours. Is there a hygienist anywhere that gets this much time for a routine patient? They are probably few and far between! Many hygienists are expected to see two patients in this amount of time.

However, when I look at this list, I see numerous duties that could be accomplished by a qualified assistant. Take a look at the other chart on the next page and see if you agree. With this model, the assistant is responsible for 50 minutes; the hygienist is responsible for about 46 minutes. A hygienist can see more patients and not feel stressed, because an assistant fulfills many of the duties in the appointment. The hygienist can focus on doing those things that only a licensed hygienist can do. The person who benefits the most is the patient, because the quality of care is better. Of course, for this model to work, two operatories must be available for the hygienist.

I have worked in offices with and without an assistant. I much prefer to work with an assistant. I felt less stress throughout the day, and the quality of care I delivered to my patient was better.

In trying to work a schedule like yours, something has to be omitted in order to stay on schedule. Usually, the things that are omitted are blood pressure screening, discussing dental needs, measuring plaque control/homecare, and periodontal charting. Further, it is not unusual to find patient records with no sign of a medical history update. In my opinion, these are some of the most important aspects of the dental hygiene appointment. If the patient presents with heavy deposits, the whole time can be spent doing nothing but scaling. What chance is there to help the patient modify his or her behavior to obtain better oral health?

Therefore, it is very easy to see why dental hygienists become stressed, disillusioned, and discontented. In studying the situation, you have some options:

  • Set up a time to talk with the doctor about your concerns. The quality of patient care should be the focus of the conversation. Explain how you are concerned that patients are not receiving what they need because of time constraints. Show the doctor a breakdown of how much time is needed to do certain procedures. Then, offer solutions for correcting the problem. Maybe a fee increase is needed in order to allow you more time to deliver quality care. However, let the doctor know that you feel you cannot continue working like you have in the past.
  • If a second operatory is available, consider adding a dedicated hygiene assistant. Make sure the assistant is well trained to keep the hygiene department flowing smoothly.
  • Make sure you are well organized. Use tray set-ups that allow for quicker room turnover. Come in early to get ready for the day; schedule 20 minutes of flex time before lunch and at day's end, which will ensure you get a full lunch break and finish on time in the evening. Make sure you use all down time wisely. Make yourself a valued member of the team by helping out in other areas when you are not busy.
  • Anticipate future needs of the patient. If, for example, you know that, during the patient's next visit, he will need radiographs and/or a full periodontal charting, allow appropriate time for those procedures.
  • If the doctor is inflexible and indifferent to your concerns, keep in mind that not all doctors are this way. Many dental offices are concerned with quality patient care and are willing to give the hygienist the proper amount of time to do a thorough job. You may need to find another dental home.

How much is the proper amount of time for a hygienist to treat an adult patient? It all depends on the patient. Some adults require little in the way of scaling, have immaculate homecare, and beautiful dentistry. Others are loaded with calculus and debris every time they come in, which could be as often as every three months. Each patient needs to be assessed by their particular need and scheduled appropriately. I believe hygienists should have some latitude in deciding how much time is needed. Further, when a patient requires more of the hygienist's skill, expertise, and time, that patient should be charged a fee that reflects those differences from the norm.

The thing that causes us to lose our love for our profession is when we feel we're not making a difference. The rigors of working on the prophy treadmill will burn out even the best of hygienists eventually. It is demoralizing, demeaning, stressful, and physically tiring. I do think it is possible to regain that first love, but only if you find a way to put meaning back into what you do.

Dianne

Dianne Glasscoe, RDH, BS, is an adjunct instructor in clinical hygiene at Guilford Technical Community College. She holds a bachelor's degree in human resource management and is a practice-management consultant, writer, and speaker. She may be contacted by e-mail at dglasscoe@northstate.net, phone (336) 472-3515, or fax (336) 472-5567. Visit her Web site at http://www.professionalden talmgmt.com

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