Forever late

Oct. 1, 2002
I am so frustrated with my job that I am ready to start looking for another position! The problem is that I rarely get a full lunch hour nor do I ever get out on time at the end of the day.

Dear Dianne,

I am so frustrated with my job that I am ready to start looking for another position! The problem is that I rarely get a full lunch hour nor do I ever get out on time at the end of the day. I usually get 30 minutes to 45 minutes for lunch, which means I have to bring my meal to work and hurry to eat. Additionally, I never get out of the office before 5:30 p.m. It is so frustrating to see all of the other staff members leaving while I am still working or cleaning up.

My average wait for a doctor check is 10 minutes to 15 minutes. Over the course of the morning or afternoon, I get behind schedule, sometimes as much as a full appointment.

Everything else about my job is fine except this time problem. I do not like the idea of starting over in another office, especially since this is the only office in which I've ever worked. Sometimes, I feel like the doctor should be paying me overtime.

Can you help me with this problem?
Frustrated Francene

Dear Francene,

You have highlighted a problem faced by many hygienists. I know of no greater stress-inducer for dental hygienists than running behind schedule. Your frustration is so great that you are considering leaving the practice. I'll wager that many of your patients feel the same way. One thing is certain — patients do not like to be kept waiting!

Having to wait 10 minutes to 15 minutes for a doctor check is entirely inappropriate. However, I suspect you are waiting until you are completely finished before summoning the doctor. You can easily remedy that situation by instituting an interrupted check system. What I recommend is that you seat your patient, update the medical history, take the patient's blood pressure, do your oral examination, expose any necessary radiographs, begin scaling and summon the doctor. By doing this, the doctor will have several minutes to get to a suitable stopping place and come to your operatory to do the check.

When I suggested this scenario in one office, the hygienist asked how the doctor could check her prophy if he checked before she was finished. Let me state emphatically that the doctor's goal in doing a hygiene check should not be to check the quality of the hygienist's work, but rather to diagnose any pathology and/or restorative needs presented by the patient.

Admittedly, not all hygienists perform the same quality of dental hygiene, just like dentists do not all perform the same quality of dentistry. However, when hygienists graduate from accredited dental hygiene programs and jump through all the hoops necessary to obtain licensure, they do not need their prophy "checked." Any doctor who feels the need to "check" the prophy is being too meticulous and will probably have a hard time retaining a hygienist. Constant scrutiny by the doctor is demeaning and stressful. Enough said!

I see another problem in your dilemma — lack of teamwork. Other staff members often are jealous of the hygienist because of the higher rate of pay that hygienists typically enjoy. Additionally, some doctors do not respect the hygienist's time by being prompt with checking.

Many doctors have related to me that checking hygiene is one of the most stressful aspects of their day, as it pulls them away from their dentistry. However, most state laws require that the doctor personally check hygiene patients at least once per year. Sometimes the doctor's schedule is so tightly packed that there is no time left to do hygiene checks. If that is the case in your practice, the doctor's schedule needs to be lightened just a bit.

One of my favorite practices has instituted an interesting concept. This particular practice has four doctors and five full-time hygienists. On Tuesdays, one doctor will dedicate his/her schedule to nothing but checking hygiene and an occasional emergency. That frees the other three doctors to do their dentistry with no hygiene interruptions.

If each hygienist sees 10 patients, that is 50 hygiene checks. At $25 per patient, the production for that doctor is $1,250 — and he never even picks up a drill. The doctor gets to enjoy a change of pace out of the usual routine, and hygienists are happy to get a prompt check.

You mentioned overtime. Small businesses are not required to pay overtime unless the employee exceeds 40 hours. However, if you were punching a time clock, you would probably be getting more hours on your check than eight per day.

One of the best ways I have seen to ensure a full lunch and prompt ending of the day is by blocking 20 minutes before lunch and 20 minutes at day's end. By tightening the schedule up earlier in the day, you are not sacrificing productive time. Many patients who currently receive a 60-minute time slot can be seen in 50 minutes, especially if no bitewings are needed. Personally, I would rather start my day 10 minutes early than miss part of my lunch hour.

I recommend going to the doctor and expressing the dilemma like this:

"Dr. Smith, I want you to know how much I enjoy working in your practice. I've come to love many of the patients like my family. However, the problem of constantly running behind schedule is literally eating me alive. My average wait for a hygiene check is 10 to 15 minutes. I know your schedule is demanding, but I don't feel it is fair to keep patients waiting like this. Sometimes I get behind a full patient time slot, and this puts me under tremendous stress. I never seem to get out when the others do, and I rarely get a full lunch break.

"So, here's what I'd like to suggest. First, I'd like to start an interrupted check system where you check my patient before I'm finished. The second thing is slightly tightening my schedule earlier in the day and blocking 20 minutes before lunch and at day's end to allow me to tie up loose ends and restock. I think these two modifications will help me stay on time better and keep the patients happy by not having to wait. What do you think?"

If your doctor is reasonable, he or she should be willing to try it.

I sincerely hope this works out for you. You have invested much of yourself into this practice, and I would hate to see you leave for this reason alone. For every problem, there is an equitable solution. Sometimes we just have to search for it.

Dianne D. Glasscoe, RDH, BS, is a professional speaker, writer, and consultant to dental practices across the United States. She is CEO of Professional Dental Management, based in Lexington, N.C. To contact Glasscoe for speaking or consulting, call (336) 472-3515, fax (336) 472-5567, or email [email protected]. Visit her Web site at www.profession