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Which road? It's your choice!

April 1, 2001
Do you want to be a consummate professional or a "cleaning lady?" Which road will you choose?
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Sandy is a hygienist in a small solo practice. Her doctor/employer has infrequent staff meetings, usually in response to a problem. The doctor never shares any of the office statistics with the staff members, so Sandy has no idea about the profitability of the hygiene department. Sandy never bothers to track her own production or the number and cost of broken appointments on her schedule. She actually enjoys the one to two broken appointments per day, because this gives her time to relax and do busy work or take care of personal business. Sandy works on a straight per diem salary.

Brenda works in a busy solo practice. Her doctor/employer believes in monthly staff meetings. Brenda is responsible for preparing and presenting statistics for the hygiene department each month. The statistics include total practice production, with a breakdown of procedures (how many prophys, periodontal scalings, fluoride treatments, bite-wing and full-mouth radiographs, etc.), number of unfilled/broken appointments, comparison of last month with the same month a year ago, and treatment recommended and accepted. Brenda works on a salary plus commission.

Different as night and day

In comparing the two hygienists, we notice a huge difference in motivation levels. Sandy, our first hygienist, is very typical of hygienists in many dental offices. She goes to work each day and treats the patients on her list, knowing that everything she needs to do her job will be provided. She does not consider how the hygiene department impacts the rest of the practice, nor is she concerned with profitability. Sandy knows that her paycheck will be the same whether she has a patient in the chair or not.

On the other hand, Brenda has been given a responsibility for reporting her department's statistics. She and the hygiene coordinator have a personal stake in the practice. Brenda knows that when she has a great production day, she will share in the profits. She is concerned when patients cancel or break appointments, because it does affect her paycheck.

There probably is not much difference in the clinical skills these two hygienists possess. The most striking difference is that one hygienist is an employee, while the other is a team member. What difference does this make?

Employees vs. team members

Employees are more concerned with what the business can do for them, rather than with what they can do to make the business more successful. They do not feel any sense of "ownership." More often than not, they demonstrate a feeling of indifference about the problems faced by the business.

Team members know that they are not an entity to themselves. The success or failure of the business depends on each person on the team. Team members are given a stake in the business by being included in business decisions and confidential information relating to operating expenses and overhead. Team members are considered an important and integral part of the business, and the doctor solicits their opinions and comments regularly. They know that when the business is profitable and successful, it will have a positive impact on their paychecks.

Most business owners will agree that having "team members" rather than "employees" is more desirable. However, the doctor sets the tone in how staff members feel about their jobs and whether staff members share in the practice as a business. Too many doctors want "team members" in an "employee" environment. This is like attempting to grow oranges on an apple tree.

The hygiene department

Hygienists are typically the highest paid staff members ... and rightly so. The professional skills and expertise that all registered dental hygienists possess are valuable to the practice and to its patients. A strong, healthy hygiene department is an integral part of a thriving practice.

However, it is so easy for hygienists to take a casual attitude when it comes to the business in general. Have you ever considered what costs are involved in running the hygiene department? You might be surprised!

Consider the costs

As you can see from the chart on the next page, the initial costs of equipping and maintaining a hygiene department are significant. However, the costs do not stop here. There are additional costs with salaries, maintenance, supplies, and other peripheral expenditures.

The industry standard is that the hygiene department should produce about one-third of the total practice volume. This can vary, depending on what is counted as hygiene production and how many hygienists and doctors are employed in the practice. Another factor that can affect this standard is whether the practice is involved with managed care. Hygiene departments in heavily managed-care practices typically do not produce anywhere near the one-third standard, but rather 18 to 25 percent of total production. However, in these practices, hygiene serves to get the patient through the door and into the practice.

Dental practices are businesses. For a business to thrive, it must be managed carefully to ensure that overhead costs do not drain profits. All businesses need to produce a healthy profit so that all who work in the business can have their financial needs met.

Dental practices also are service-oriented. The practice provides services (as opposed to goods) to people who entrust their care to them. Being able to provide the highest quality services to its patient population is dependent upon several things, including purchasing high quality dental materials and hiring and retaining exceptional staff members (neither of which is inexpensive).

Being the consummate professional

While business ownership does not typically belong to the hygienist (except in those states that allow independent practice), every professional dental hygienist should accept responsibility for the success or failure of their department. What does that responsibility entail?

Know the numbers for the hygiene department. Track production, broken appointments, recare systems, etc.I f there is an inefficient system in the hygiene department, develop ways to overcome that inefficiency. Use your head.

Take responsibility in seeing that patients who frequently miss appointments are handled appropriately. Work out a plan that is satisfactory with the doctor.

Do not expect other staff members to constantly help you pull your load. When others do help you, show gratitude to them and reciprocate.

Go the extra mile with your patients. Show a genuine concern for your periodontal patients by checking on those who have to be anesthetized for a procedure. Call these patients in the evening to see how they are doing. Send get-well cards to patients you know who have upcoming surgery, etc. Always be on the lookout for opportunities to make your patients feel special.

Come to work each day looking professional and well- groomed. Avoid excessive jewelry, gaudy hairstyles or wet hair, dirty or worn-out shoes, chewing gum, and poor grammar or off-color speech. Keep your operatory neat, clean, and well-organized. Get rid of clutter. As much as possible, maintain clear countertops.

If your doctor/employer has not expressed his or her wishes to you regarding recommending treatment to patients, take the initiative to find out what the doctor wants. When the doctor comes to you with a problem that needs a solution, do not become defensive. Try to walk in the doctor's shoes. If you need to make a correction, just do it. Show the doctor that you are interested in the business side of your department. Consider how you would feel if you owned the business.

Use down time wisely. Large corporations are divided into departments that are overseen by department managers. These managers are responsible for ensuring that their departments operates at peak efficiency.

Likewise, if hygienists are to be consummate professionals, diligence must be exercised in recognizing the connection between the business and clinical areas of the practice.

Dental hygienists can transcend the stereotype of the "cleaning lady/guy" by accepting responsibility for the success of their department. Finding the balance that gives equal consideration to providing excellent patient care and excellent business sense is the hallmark of the consummate professional.

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 [email protected], phone (336) 472-3515, or fax (336) 472-5567. Visit her Web site at

A Tale of Two Hygenists

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