Dear RDH:
I`ve never considered myself the covert type, but if you wish to label me a "snoop," then I`m guilty as charged! A former hygienist failed to have a forwarding order applied to her mail, and a copy of RDH fell into my hands. Ordinarily, I struggle to read my own journals; therefore, I surprised myself when I began to "snoop" through yours.
I was drawn to the article "A State of Mind" (October 1998 issue) which informally presented the results of a survey of membership on how they perceive the practice of dental hygiene. Although in my 24 years of practice, I have been fortunate to have very talented hygienists and have had an acceptable working relationship, many times there seemed to be a vague wall that was not "comfortable" - nothing I perceived serious, mind you, but nevertheless there. If your survey sampling is valid, then I may now have a better sense of this perception.
To preface my thoughts, I want to say right up-front that I personally am against any fragmentation of the profession of dentistry. The public deserves a unified approach to its dental health. Consider the following medical analogy. When our bodies give us the subtle, little hints that it is time for a medical check-up, what do we expect in our best interests? Do we want to go see a group of nurses at a facility with no physicians, no matter how talented the nurses? Do we want to take a day off work to see the nurses and then another to see the physician, when it could have been orchestrated together?
Do we want to pay fees necessary to equip and staff the nurses` office and then assume double jeopardy when we visit the physician`s office? Do we truly feel comfortable when the nurse informs us that we don`t need to go see the physician? Do we want to pay the extra portion of fees designated for the nurse`s malpractice insurance, since she now must assume a new liability? Independent practice sounds like fun, but that iceberg you are sitting on has an enormous base on it lurking just below the water where you can`t see it. Anyone who thinks a patient will pay lesser fees to a separated hygiene practice does not understand business economics.
Irrespective of the above, dental hygienists are a very capable group of care providers. However, capability in one area does not assume abilities in another. Just because I possess a doctoral degree does not mean I should be loosed on the public to start performing blood work-ups and chest X-rays under the guise that I could do it cheaper for patients than the hospital. There is an enormous amount of dental/medical education to which a dental hygienist has not been subjected. Too, there is an inconsistency from state to state regarding the level of education of hygienists. Whereas the education in dental school across the country is very standardized and you see very little difference in dentist aptitude, thus you see very consistent care across the country.
Although some in your survey would not agree, dental hygienists have been a respected and appreciated auxiliary throughout history. Dentists truly appreciate what you bring to the table. We have provided you a lofty standing in the dental care hiearchy, and deservedly so. Management skills are important to become independent, and it is important to hold all of your employees in esteem. Obviously, some responding to your survey are not up to the task. The statement that you risk allowing yourselves to become no more than "glorified chairside assistants" is indeed alarming. Shame on you - how demeaning to one of the most important of our team members! A dental assistant position is a very noble career, and, as the hygienist who stated this obviously hasn`t noticed lately, is not a minimum-wage "spit sucker." These ladies have a broader knowledge of what makes a practice tick than most others. They are in the trenches, instead of wasting time building their own pedestals from which to look down on others. It becomes difficult to interact without bias when self-promotion becomes your agenda!
To the hygienist who felt her employer would not allow her to refer her patient to a periodontist for, in her view, fear of losing the production of the quarterly quad scales; granted, we do not want to lose patients (it is difficult to pay fair hygiene wages if we cull everything but simple prophys as some might desire); however, most dentists possess the ethics to do the "right thing." I think this hygienist is simply behind the times. Does she not understand what makes up 95 percent of a periodontal practice in 1998? Does she think that his hygienist can do quad scales better than her? Does she advocate full mouth surgery or long-term quad scales with gradual improvement? Is the periodontist going to motivate the patient better than she can? In my practice, we spend a long time preparing a patient for any radical periodontal treatment. There are many, many ducks to get in a row before definitive periodontal treatment outside of quad scales is initiated - unless you want many failures. This same hygienist had a problem with assistants learning to take x-rays. Her quote, "He`d rather have inferior films than allow an extra five minutes in my schedule" is laced with ignorance and discrimination. Does she really think you have to go to dental hygiene school to take a high quality film? Please! Ill-advised remarks such as these illustrate precisely why such an individual should be practicing under supervision.
To the hygienists who express concern over the profession being a dead end, it sounds as if these individuals have more of a problem with themselves than the profession. Every profession has a dead end; it`s up to the individual to be fulfilled at the end. What more were these hygienists promised before entering school? How many more variations can you expect to realize from "cleaning teeth"? Wouldn`t we all like to go to work everyday knowing we were going to save lives and be a model for an action hero movie? Realism and satisfaction come from within, not from how far you can go.
To those concerned about the role of the ADA, yes, the ADA looks out for the dentist. It should, since it is our organization, and we pay the dues. But an intelligent hygienist should readily understand that being on the coattails of a dentist gives her a great deal of representation in our profession. Believe me, without the ADA, these hygienists have only begun to complain. The ADA has no desire to "wipe out" the profession of hygiene. You are being more than a little presumptuous to feel the ADA owes you anything more.
After chiding some of your survey respondents, I must say that overall there are multitudes of very well-trained and responsible hygienists out there who would do very well in managing an independent practice. However, when viewing the overall scope of dental care, fragmentation will only lessen our success as a profession. There is no positive benefit to the public to destroy a century of evolution of practice which has placed American patients as the best cared for in the world. Relax and enjoy the wonderful profession you chose. There is a lot to be said for walking out the door in the evenings and leaving all the "heavy" baggage behind. Realistic goals should be to lobby for expanding duties, such as giving injections, etc. There is a lot still awaiting you under supervision, and most progressive dentists support you in these efforts.
Glenn E. Vance, Jr. DDS
Bristol, Tennessee
