Dear RDH:
Since I found my name boldly written in the January 1998 issue of RDH, I felt compelled to write and explain another point of view concerning the Washington State ballot Initiative 678 from last November.
The initial mailing from SHOUT that arrived in my mailbox from the self-described "dirty half-dozen plus three" really did not portray any concern for the patients or improved dental care, but glared of words such as, "existing simply to serve dentists," "treated as professional property by them," "dental hygiene is a subservient profession," "end years of oppression," "male vs. female," and "economic mobility." Does this sound like a group of hygienists truly concerned for the well-being of patients or merely themselves?
The scope of dental hygiene practice has not been recently imposed upon our profession. The parameters were in place at the time we accepted a position in school. Washington State enjoys one of the most liberal practice acts in the nation, and I use it to the fullest. We are also some of the highest paid hygienists in the nation. We are not oppressed.
Over the years, I will have to honestly admit that there were a few days when being on my own seemed like a really great idea. However, this initiative was not the answer. There were too many unanswered, open-ended, we-will-decide-that-later points. I am going to answer the points printed in your article and then add a couple of my own.
- Greater consumer choice. This issue is probably true. Patients could go to another location to see their favorite hygienist.
- Safety. Explain to me how it would be safer for the patient to see us practicing independently than jointly with a dentist. I still believe that the safety level is higher when we are practicing together.
- Bringing dental care to more people. How? The same number of practitioners would exist dispersed to different corners of town. Mobile clinics might spread us around, but it is an interesting concept. Where and how would your regular recalls find you? Which parking lot would be occupied this week?
- Emphasis on preventive care. There shouldn`t be any difference in either setting.
- More affordable. How? If we were to establish a second location, we would also have to furnish the operatories, buy supplies, and employ assistants. Our office expenses would be conceivably greater because of increased expense in coordinating with the dentist of record. Who would have the final accountability for making sure that X-rays are current and that they are shared? Insurance companies are not going to pay for exams in two locations. Preventive dental procedures are not the highest dollar-producing procedures performed in an office. To make the books balance, working independently, patients would have to be herded through rapidly. I am concerned that unnecessary root planing and curettage would be performed just to keep income high.
- More appropriate care. In what way? Treatment shouldn`t be any different in either location.
The initiative would have permitted a dental hygienist working under another dental hygienist for five years to apply for an independent status. I do not feel that any hygienist, who has never worked closely with a dentist, could ever begin to understand the art of dentistry. I learn more every day and plan to continue to do so for the rest of my career. The initiative would have permitted us to write prescriptions for drugs, but the drugs or drug classes were not outlined.
I had fears that this initiative, if passed, would have reduced dental hygiene credibility to that of a hairdresser or masseuse. Secondly, I feared we would lose credibility as a therapist and become a cosmetic procedure. I have had a few patients come for that reason just because they wanted to look great for the wedding pictures. Thirdly, of course, managed care approved, because then patients could be forced to enter the profession through a lower-cost professional. I personally want nothing to do with managed care.
During my opposition to the initiative, I met a few dentists who were hygienists first. They commented that our education didn`t give them a solid foundation for dental school. They were able to see the issue from both sides. All of the dentists with whom I have worked closely are highly concerned about the patient and quality comprehensive dental care (which working independently we could not provide).
I will always believe that working closely together with a dentist, as a team, we can provide the highest quality comprehensive treatment for our patients. There are things that my eyes miss; and, conversely, there are occcasionally things that I point out to my teammate. Two eyes and two bodies of knowledge working with mutal respect of the skills of the other are the best way to practice dentistry.
Incidentally, for those who desire to practice in the state of Washington in care facilities, it is already legal. Only a very small percentage of the hygienists actually take advantage of this opportunity.
There are better ways to address this issue. After in-depth study, our state legislators voted against independent practice for hygienists for more than 15 years. I, personally, want nothing to do with the self-centered feministic attitude of the dental hygiene leadership and, fortunately, in this country, I have the right to speak out for my belief whether or not it will be considered worthy of press in RDH.
Nancy Randall
Clarkston, Washington
