Survival strategies

July 1, 2011
Over the past year, the practice where I work has seen a gradual downturn in the "busyness" level. My schedule has been about 75% full ...

by Dianne Glasscoe Watterson, RDH, BS, MBA
[email protected]

Dear Dianne,

Over the past year, the practice where I work has seen a gradual downturn in the "busyness" level. My schedule has been about 75% full, whereas the doctor's schedule has gaping holes.

Last week, the doctor cut my days in half! Now I am only guaranteed two days instead of four. I am worried to death over how I'm going to pay my bills.

I know I have to look for more work, but do you have any advice on how I can position myself better in the future and feel more secure in my work?

Tara, RDH

Dear Tara,

This is a small consolation, but the situation you are experiencing is happening all over the country. Practices near and far are experiencing varying levels of decrease in demand for dental services due to stagnant economic conditions. When people lose their jobs and benefits, they have to reposition their finances and rearrange their priorities. For some people, dental care is relegated to the "emergency-only" category.

Recently, I presented a seminar to about 40 dentists. I asked for a show of hands of dentists who were sufficiently busy, and two hands went up. One was a prison dentist, and the other was a Medicaid dentist.

The practices in the most trouble are those with high debt loads, specialty practices, and general practices that are tightly niched into the cosmetic market. The practices that are seeing less negative economic impact are those that accept a variety of insurance plans, provide a large variety of services, and have a large, loyal patient base.

I have heard of situations where doctors are firing their hygienist, or reducing their hygienist's hours and filling up the holes in the doctor's schedule with hygiene patients.

My feeling is that dentists should be performing hygiene services only when:

  • The practice is a startup with a small number of patients
  • There are no hygienists available in that geographic location, which is extremely rare as most states report more hygienists than available jobs.

Many hygienists have shared with me that their hours have been reduced. Particularly frustrating is being called and asked not to come in until later because the "schedule fell apart," or being asked to clock out when a patient no-shows and there is downtime in the schedule. This blatant disrespect of the hygienist's time is an affront to the profession in general and hygienists in particular.

Hygienists, just like other dental auxiliaries, need a set schedule. Holding the hygienist hostage to a roller coaster schedule is all too common today.

If downtime becomes problematic, the first place to begin finding a solution is at the business desk. When times get tough, the tough get going! Is there an inefficient recall system in place? Is it part of someone's job description to keep the hygiene schedule busy? Do business assistants understand how to identify patients who have fallen through the cracks and know how to reactivate people who are past due for preventive care? Does everyone understand that the hygiene department drives the rest of the practice, that if hygienists are not busy, eventually the doctor will not be busy?

In your situation, it would be better to reduce your working hours by 25%, or one day/week (rather than 50%) if you are able to stay busy 75% of the time. The two-day per week cut seems too dramatic. Also, the recall system at the front desk needs to be analyzed for efficiency.

Hygienists are the preventive specialists in the practice and bring value through the production they generate as providers. However, the value a hygienist brings to a dental practice should not be measured by production alone. Hygienists also bring indirect value through promoting the doctor's services and helping patients understand options available to them in the office.

Hygienists are well-positioned to discuss options such as whitening, implants, crown and bridge treatment, veneers, and other services the doctor may provide. A hygienist who is a good communicator can become a great communicator with an intraoral camera. Yet, how many hygienists see their intraoral camera as a nuisance rather than an excellent tool to increase their value to the practice?

Think about it. Do you think a doctor would place a higher value on a hygienist who presents treatment options to patients proactively over a hygienist who simply does root planings and prophies and does not concern her/himself with "talking dentistry"?

Given the high level of job insecurity today, hygienists should also exercise sound personal financial management. This means you pay your bills on time, you do not carry credit card debt that you cannot pay off each month, and you have a cash reserve savings that will cover six months of living expenses and bills.

Obviously, there are economic problems across our country that we cannot control. It is true that dentistry, just like all other businesses, is subject to supply and demand problems. At present, the demand for dental services is down because of declining discretionary income related to job losses. However, that fact alone should not prevent hygienists and all dental auxiliaries from identifying weak systems and taking action to improve.

According to the Bureau of Labor Statistics, there are 13.5 million (8.8%) unemployed Americans. While 13.5 million is a substantial number of people, the fact remains that there are far more people employed than unemployed. According to the Bureau of Labor Statistics, approximately 138,000,000 are employed.

I'm not trying to minimize the problem of unemployment, but we do need to keep the right perspective. We are bombarded with bad news every day, and it is human nature to focus on the bad. It is time to retrain our focus toward the positives and see the glass half full. Fatalism should be replaced with greater determination to have the practice systems functioning at top efficiency.

Periods of downtime are great times to "sharpen the saw" and rally the team through training and systems development. It behooves every dental hygienist to be the consummate team member and build value within the practice directly through production and indirectly through promotion of elective restorative dentistry.

We can all remain optimistic that the current business downturn is not permanent and that things will pick up in the near future. In fact, many of my client practices had very positive first quarters in 2011, some even showing growth. In the meantime, continue to increase your value in the practice by these suggestions:

  • Know the monthly statistics for the hygiene department.
  • Be a problem-solver, not a problem-maker.
  • Promote the restorative side of the practice by talking dentistry.
  • Pull your own load.
  • Go the extra mile with your patients.
  • Look professional every day.
  • Keep your operatory neat and well-organized.
  • No gossip!
  • Use downtime wisely.
  • Consider the feelings of others.

Let's get back to solid practice management basics and build strong, connected relationships with our patients. It is a daily process, one patient at a time.

Best wishes,

Dianne Glasscoe Watterson, RDH, BS, MBA, is a professional speaker, writer, and consultant to dental practices across the United States. She is CEO of Professional Dental Management, based in Frederick, Md. To contact Glasscoe Watterson for speaking or consulting, call (301) 874-5240 or email [email protected]. Visit her website at

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