Always fighting the clock

Because the secretary is so obsessed with filling all open time, I rarely have time to sharpen instruments or restock my operatory. I am so tired at day?s end that I feel there is nothing left of me when I go home to my family.

Because the secretary is so obsessed with filling all open time, I rarely have time to sharpen instruments or restock my operatory. I am so tired at day?s end that I feel there is nothing left of me when I go home to my family.

Dianne Glasscoe, RDH, BS

Dear Dianne,

I work in a general dentistry practice for a wonderful female doctor. Although I like the doctor, the patients, and my coworkers, I am seriously thinking of leaving. The problem is that the secretary overbooks me.

The biggest problem is that the secretary often puts two people in the same slot. If she is unable to confirm the patient`s appointment, she will assume that the patient will not show up, especially if there is any record of a previously broken appointment. Of course, many times, both patients show up! Sometimes, the doctor will "squeeze" one of the extra patients into her schedule. However, at times, I find myself going into turbo speed to see both people.

Another problem is that if a patient cancels at the last minute, the secretary will call someone in to fill the time. If I only had 40 minutes to start with, and it takes the patient 10 to 20 minutes to arrive, I have already lost half the appointment time! Then I have to do a rush job in an effort to stay on time. This scenario makes me feel terrible, because I know I did not/could not perform a thorough prophylaxis.

Also, children are booked for 30 minutes. Since most children are easy prophys, I can complete the procedure in the allotted time. However, when multiple children are stacked every 30 minutes, I always get behind schedule because of waiting on the doctor and the time necessary for tearing down and setting up the operatory. It is impossible for me to do more than two 30-minute appointments consecutively without falling behind. Yet, I have been booked with as many as four patients in a row.

Because the secretary is so obsessed with filling all open time, I rarely have time to sharpen instruments or restock my operatory. I am so tired at day`s end that I feel there is nothing left of me when I go home to my family.

I have asked the secretary to take these things into consideration, but it has accomplished nothing. The doctor seems comfortable with the way things are.

Even though the doctor pays good wages, I feel no amount of money is worth the toll that the stress of working in this "prophy mill" is taking on me. I have only been here one year and do not relish the thought of adjusting to a new office. However, I am at my breaking point! What can I do?

Speed Demon in Spokane

Dear Speed,

After having read your letter, I am certain many of your colleagues in dental hygiene are feeling your pain. Lack of time is indeed one of the most stressful aspects of clinical practice.

We all remember the painstakingly slow process required in hygiene school. Our clinic sessions were four hours, and by the time we were ready to graduate, we actually saw two people in this amount of time. Wow!!

Then we were thrust into the real world of clinical practice where we were expected to triple our speed to see six patients (one every 40 minutes). What a shock! The kinder, gentler doctors may allow a new graduate one full hour at the beginning to become adjusted to the realities of private practice. However, this honeymoon period ends shortly.

The problem you describe is quite common. The core of the problem is profit for the practice. Your employer is probably thrilled to have a secretary who is so attuned to keeping you busy. Empty chairs spell loss of revenue.

Another consideration is whether you are being paid on commission or straight salary. I find that hygienists who are on commission are happier with a packed-full schedule, because their compensation relies on how much they produce. Hygienists on straight salary know that no matter how hard they work, they will still make the same amount of money. There is no incentive to push oneself to keep production high. There are advantages and disadvantages to each method of compensation.

However, you are facing an ethical dilemma. You feel you are so rushed that you can`t give your patients the care they deserve. In addition, you are quickly burning yourself out.

It is easy to see why so many hygienists leave the profession after a short time because of having to work under these conditions. Assembly-line hygiene is neither enjoyable nor professionally rewarding. Disillusionment quickly sets in, and many good hygienists wonder why they ever chose this profession.

My advice to you would be to go to the one who could do something about the problem - the doctor. Describe your dilemma to her exactly as you have outlined to me in a non-confrontational manner. Also, be prepared to offer suggestions as to how this problem might be solved. Certainly, discontinuing the practice of double-booking should be discussed. In addition, allowing an occasional 40-minute time for children when several are booked consecutively should be implemented. You should show your concern for patients foremost. The doctor may need to consider raising her fees to decrease losses from a lighter patient load. I find that patients are happier when they feel they have been treated in a thorough, unhurried manner, even if they have to pay a slightly higher fee. Let the doctor know that you do not feel you can continue working at the current pace.

Let the doctor know that you want to stay in the practice, that you appreciate working with her, and that you are willing to allow for a reasonable time frame (no more than six months) for change to occur.

However, if your concerns fall on deaf ears and definite changes are not forthcoming, you should consider changing practices. Many wonderful practices do not feel quantity of people seen is more important than quality of treatment provided.

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.

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