A matter of economics

June 1, 1997
I enjoyed reading the April issue, but several aspects of the articles troubled me for they show a chronic misunderstanding of dentistry, dental/hygiene practice, science, and reality.

Dear RDH:

I enjoyed reading the April issue, but several aspects of the articles troubled me for they show a chronic misunderstanding of dentistry, dental/hygiene practice, science, and reality.

In the editorial, editor Hartley brings up the issue of preceptorships (for new hygienists) and the ADA. I believe Mr. Hartley is right ... the ADA is dying a slow death with fewer and fewer new dentists joining and increasing numbers of older members retiring/dying. By my count, fewer than half the dentists in the United States are full members of the ADA.

In many states, the need for personnel to clean teeth (hygienists) is increasing, but the supply and productivity of classically trained hygienists is not keeping up with the demand. This is good for the hygienists for increased demand generates higher wages and less competition. It is bad for the dentists, insurers, and patients who must pay the bills. They are in the majority. As a result, para-hygienists are being produced by preceptorship, state-sponsored, expanded-duty dental assistant options (coronal polishing, for example), and dentists themselves doing high-speed, quality prophys. This trend will accelerate.

The reason for these two events is economics. The ADA system is shrinking because dentists do not find value in the high membership dues (close to $1,000) which provide little perceived benefit. The para-hygienists are being created because the existing system is not meeting the demand. If hygiene is to continue, it must become more productive for the dentist and his/her patient. That means quality work which is faster, less expensive, and more efficient.

What is happening now is that dentists, insurance companies, and patients cannot afford hygiene as we know it. That means you must be more productive (produce more income for the office, treat more patients, and conduct yourself more professionally), or other professionals will do the job for you. Punching the clock at 45 minutes a prophy no longer will do.

Don`t delude yourself. Scraping teeth requires no exceptional skills. Many people can do the same quality work, if adequately trained. Most patients and dentists will not recognize the difference. You must become more efficient than a $10 an hour para-hygienist if you are to survive in hygiene.

One area where hygienists do excel above para-hygienists is in their background of science. Hygienists are trained to understand how disease and human psychology work. They are trained to think and reason. Para-hygienists are technicians ... they just do by rote. Scrape, scrape, scrape. It`s not essential that they know how calculus is formed (or spelled). If hygiene is to survive, more hygienists must think, analyze, question, and educate themselves so that they can increase productivity for the office. If your employer sees that you are being more productive, treating more patients better, and aiding the efficiency of the dental practice, then you will usually be rewarded. If not, eventually you will be replaced.

A positive example of this situation is in the article on getting better insurance reimbursement for hygiene-perio treatments. This is something a hygienist (not a para-hygienist) can do. It increases office productivity and the economic bottom line. A negative example is in the advice Dianne gives (Fracturing OSHA protocol). Much of the advice is costly, does nothing to help the patient, is not mandated by OSHA regulations (e.g. bags to cover the Xray head vs. wiping the machine with disinfectant), and creates acrimony in the office. In a fight with your boss, you will always lose. You might start by closely reading the OSHA regs themselves and not depend on excesses fostered by third-person interpretations of the actual rules.

If you are efficient, you will prosper. If you are not, you will be seeking a new profession. Think economics and professionalism; that`s the way of the future. Good luck.

E.J. Neiburger, DDS

Waukegan, Illinois