The search for the Ideal Office

July 1, 2004
Author reaches for the stars when looking for the right employer upon relocating with her family. It was a long journey, but the effort paid off.

by Dee Vecchione, RDH

The search for a new hygiene position can be extremely frustrating. Compared to the story of "Goldilocks and the Three Bears," hygienists have many more decisions than the firmness of a mattress or the temperature of porridge. Unlike Goldilocks, we need to consider variables such as equipment, ergonomics, length of appointments, office policies, salary, travel distance, and office hours. Then factor in team dynamics and the dentists' skill, personality, and respect for the team. Finding a position that is "just right" takes patience, persistence, and careful planning.

In March 2003, my husband's promotion required us to relocate to northeast Ohio. The opportunity was too good to turn down. Neither of us was happy about leaving our family and friends, but moving forward sometimes means leaving loved ones behind.

The thought of losing my dental hygiene heaven was devastating. For six years, I had practiced in a progressive office in southern New Jersey and was responsible for the development of a successful periodontal therapy program and a dental retail center. My employer was supportive, my co-workers were great, and the long-term patient relationships were wonderful. I was doing what I loved, loved what I was doing, and practicing at an advanced level. My career satisfaction was at an all time high. Would I ever find that type of practice again?

Dental hygienists are in constant demand in southern New Jersey. Therefore, it never occurred to me that the situation in Northeast Ohio might be entirely different. It was a rude awakening to find that the supply of graduating hygienists has exceeded the demand and adversely affected wages. In addition to the scarcity of positions, I now faced earning at least $5 an hour less.

I began the search for a new position by scouring the Internet classified ads in the local newspapers. and list national, regional, and local newspaper employment opportunities. and also offer nationwide dental listings and allow registrants to post their resumes on the Internet. Despite the wealth of opportunities this could have produced, many weeks passed without a single ad. So I contacted the two local dental societies about potential opportunities but learned they only kept a list of hygienists who were looking for positions, not vice versa. This was not very encouraging.

After we settled in, I began to send résumés to prospective employers. From experience, I knew that dentists who took many continuing education courses generally had superior practices. My previous employer was a member of the Crown Council, an alliance of leading-edge dental teams throughout North America. So I began my search for a great office with their Web site. The Las Vegas Institute for Advanced Dental Studies, the Academy of General Dentistry, and the American Academy of Cosmetic Dentistry are also known for their rigorous continuing education requirements. Their Web sites permit a search for local alumni, thereby providing an ample supply of potential employers.

I also scanned the local Yellow Pages for practices that seemed to offer a superior level of care. A few ads listed a Web site, which would provide additional information.

It was important for prospective employers to know what my goals were. My résumé stated that I was interested in a position in a quality, state-of-the-art, patient-oriented practice where I could utilize all of my experience and skills as a periodontal therapist and a preventive specialist, and still be allowed room for growth. If my goals were not compatible with their practice philosophy, then there was no point in wasting anyone's time.

The mailing was designed to get my foot in the door. My attention-getting cover letter and resume were printed on very nice stationery and included two letters of recommendation. In a market as tight as this, soliciting a "wow" response and making a fabulous first impression were absolutely critical. Since personal appearance and "dressing for success" were also crucial, I invested in two nicely tailored pantsuits and a new pair of dress shoes. I had once witnessed a hygienist arriving for an interview in jeans and this was not the impression I wanted to make.

As a result of the mailing, a local LVI dentist hired me for a part-time position. Unfortunately, two days a week was not nearly enough, so I continued my job search. The mailing also resulted in an interview with another LVI dentist a month later, but he preferred a full-time hygienist and was uneasy about "stealing" staff from a colleague. At the time, I was reluctant to leave my part-time position as well.

The classified search continued and resulted in a handful of interviews spaced over several months. It was extremely difficult to find employment for two days that would match up with my current schedule. It also became apparent that some practices wanted only tooth cleaners, a role that didn't interest me. Additionally, many offices scheduled their hygienists for only 30- to 40-minute appointments. Establishing patient relationships, providing excellent care, and utilizing current technology are just as important to me as the ability to grow in my profession and expand my horizons. Dental hygiene is my lifelong career, and I could easily picture myself burned-out and debilitated if I agreed to such a rapid schedule.

One practice had me return for two additional interviews. The first interview was with the hygienist and the office manager; the next two were with the owner of the practice. I provided him with a copy of what my ideal one-hour recare visit (Figure 1) would entail. At the third interview, he told me he was very impressed and would love to have me on his team, but he could not turn his practice upside-down to accommodate a 60-minute hygiene schedule. He was also concerned that I might be a "torch bearer" for my way of practicing, which could result in office conflicts. He asked me to reconsider, but there was no point in discussing it further. My recare protocol clearly stated that my focus was on quality care, utilizing technology and time to increase diagnosis and treatment acceptance — an approach that could have resulted in far more production for the practice than squeezing in a few extra hygiene patients per day.

Another office where I interviewed was in a strip mall, but I kept an open mind and put aside any pre-conceived notions regarding the location. It actually turned out to be a very nice office. The doctor told me that his opinion of hygienists was waning. His previous hygienists had no interest in root planing or using the intraoral camera. I assured him that if his definition of a dental hygienist fit within my objectives, then he would not be disappointed. He requested a salary proposal, which I mailed the next day. I followed up with a "thank you" note and a phone call. Several weeks later I learned that another hygienist had been offered the position, but they would keep me in mind if they needed a temp.

The sheer number of applicants was proving to be a formidable obstacle. At least 100 hygienists responded to each classified ad. How could a doctor possibly remember each candidate and interview, especially those early in the process? The timing of the interview seemed to be another important factor to consider.

"Cold-calling" local practices was fruitless as they received several calls a week from hygienists seeking employment. Since offices already had lists of hygienists who were looking for temporary or permanent positions, the local dental placement agencies proved to be another dead-end.

The local "chain" dental centers and HMO-type offices verified that only 30 minutes was scheduled for recare appointments. That always ended those conversations. It was no surprise to see the same ads reappear regularly, as these offices burned out or crippled the hygienists who accepted their terms.

In the meantime, my part-time employer had hired a consultant who was focusing more and more on production. From the beginning, it was obvious that the one-hour hygiene schedule did not please him, and he frequently mentioned clients whose hygienists worked a 40-minute schedule. Coincidentally, one of his most successful practices was the one whose offer I had declined on the third interview. Concern for my current position escalated at every meeting.

The schedule became lighter and lighter and often my days began late or ended early. During the holidays the office closed for several days, further straining my financial situation. My despair grew and I considered leaving the profession altogether since I had been unable to find another position that didn't require sacrificing my health or beliefs.

Miraculously, just after the holidays, the following ad appeared in the classifieds: "New office providing excellent personal care & five-star service! Seeking outstanding dental hygienist with advanced training & interest in non-surgical periodontal care. Dentistry as it should be! Please send a letter describing how you would be an asset to our team & a resume to..."

Was this the practice I had been looking for? I responded immediately. Fortunately, the doctor was enthusiastic about me and hired me right on the spot!

My new employer values hygienists as periodontal therapists, preventive specialists, and partners in care. He values my input and ideas, and asks me to select and purchase all of the equipment and supplies that I need to practice dental hygiene. He purchased a headlight that is compatible with the magnification loupes I already own. He wants me to practice cutting-edge dental hygiene and is willing to underwrite the cost of advanced ultrasonic and periodontal therapy courses, including laser debridement.

The benefits of the position include paid holidays and vacation, a 401k plan, a uniform, and continuing education allowance. While all of this is wonderful, the opportunity to take my hygiene skills to the next level and beyond, while having the support and respect of my employer, is absolutely priceless.

Many of you also long for this type of position. Don't give up! You can live the dream, too! First, invest in yourself and in your career. Purchase magnification. Many dentists have increased respect for a hygienist who owns his or her own magnification loupes. My new employer wanted his hygienist to wear loupes for periodontal therapy. He had interviewed other candidates before me, and several of them were unaware that magnification loupes were being utilized by hygienists. So, when I referred to my own pair in my cover letter, he said he nearly had to pick himself up off of the floor! Apparently those loupes made quite an impression. Ergonomics aside, my magnification loupes demonstrated that I was willing to invest in myself in order to excel in dental hygiene.

If you want more from dental hygiene, then make it happen! Discuss your goals and the future of the hygiene department with your employer. Do you want to work with modern technology, such as an intraoral camera, digital X-rays, the DIAGNOdent, advanced ultrasonics, or voice-activated periodontal charting?

There is a business side to the practice of dental hygiene. Track your current production, the amount of treatment that you present, and the dollar value of what is accepted. Provide your employer with estimates of potential revenue increases as well as how your proposed changes can benefit the patients and the practice. Money talks when nothing else does!

Do you want to take your skills to the next level? If so, then educate yourself by reading professional magazines, networking with other hygienists, participating in RDH e-mail lists, and attending as many continuing education courses as possible.

How much periodontal therapy are you calling a prophy? How many patients in your practice are truly healthy? Insist that your employer attend courses on soft-tissue management with you. You will need the doctor's support in order to implement a program, or they will not agree with your treatment recommendations.

If a dentist refuses to consider changes or support your desire to excel, then look for another position. Don't ever accept less than you want, or less than you deserve! If you are being stifled or prevented from growing as a professional or providing excellent care, then move on. Don't let close-minded dentists steal your love for hygiene or cripple your body and toss you aside!

Want more for yourself! Aspire to it and keep reaching for the stars! That's what I plan to do!

Dorothy Newcomb Vecchione, RDH, is a 1987 graduate of Camden County College in Blackwood, N.J., and a member of the American Dental Hygienists' Association. She is the sole hygienist/periodontal therapist for a private practice in Richfield, Ohio, and is an active participant in Yahoo's RDH e-mail list. She can be reached at [email protected].

Figure 1Advanced adult recareThe one-hour appointment protocol utilizes modern technology in the co-diagnosis of disease, while providing the patient with a superior preventive maintenance visit. The patient benefits from the quality time and care provided, and the practice benefits from the increased diagnosis of restorative treatment and case acceptance by the patient. • Greet and seat the patient. Establish rapport.• Take blood pressure. Inform patients of results.
• Offer the patient an alcohol-free, antibacterial pre-procedural rinse.
• Take the necessary X-rays. Use Edge-Ease to enhance comfort.
• Perform a soft tissue and oral cancer exam. Inform the patient and document the results. Advise the doctor of any areas of concern.
• A full perio charting is to be performed on every patient annually, usually when X-rays are not taken in order to be time-efficient. Probing depths, recession and bleeding points should all be recorded. Inform the patient of findings and any areas requiring periodontal therapy.
• Perform a periodontal screening at alternate appointments. Pay particular attention to areas of prior therapy or concern. Document results. WNL is not sufficient for this exam. Probing depths of 1 to 3 mm with localized light bleeding is an example of an acceptable entry. Provide more details as necessary.
• Ask the patient how they feel about the appearance and color of their teeth. Would they like to change anything about their smile? Have they considered whitening, etc? Discuss treatment options that are available to the patient.
• Selectively polish the teeth to decrease the bacterial load. Choose a grit that is appropriate for the patient. Use Proxyt (fine) or NUPRO Shimmer for restorations to avoid scratches. Use ProClude for patients with sensitive teeth and increased caries susceptibility.
• Use the ultrasonic scaler to debride and remove bacterial biofilm, calculus and stain.
• Use an exploratory stroke, carefully checking around restorative margins for defects and decay. Hand scale as needed.
• Gently floss the patient's teeth.
• Ask them about their homecare regimen and offer suggestions or demonstrate proper techniques.• Use the intraoral camera to highlight areas of concern for the patient and allow them to co-diagnose, or use the DIAGNOdent on untreated pit and fissure areas. Alternate these technologies at recare visits.
• Provide the patient with a complimentary neutral sodium fluoride rinse to remineralize the enamel and desensitize exposed dentin or cementum. Dispense take-home products such asPeridex, TheraSol, BreathRx, DenClude, and neutral or stannous fluoride, as warranted.
• Offer the patient a moist, warm towelette.
• Call the doctor for an exam and schedule the patient's next appointment.
• Within earshot of the patient, inform the doctor of your findings, concerns and treatment recommendations.
• Document treatment that is necessary or areas that will be monitored.• Escort the patient to the front desk and inform the staff of any necessary treatment to be scheduled.
• Prepare the treatment room for the next patient.