Money, money, money!!!

March 1, 1999
I would hesitate to refer my friends and family to this practice, because I fear that treatment would be based on making money, rather than helping the person in the chair.

I would hesitate to refer my friends and family to this practice, because I fear that treatment would be based on making money, rather than helping the person in the chair.

Dianne Glasscoe, RDH, BS

Dear Dianne,

The practice where I work as a hygienist is an upscale practice in New York. We have a nice, modern office and a large number of white-collar executives.

When I first came to work here nine years ago, we saw patients from all age brackets. Then, the doctor decided not to see children anymore. He felt that they were not "productive" enough. Next, the doctor decided to refuse taking insurance. His reasoning was that patients should not let insurance sway their decision about needed dentistry. His latest move has been to dismiss any patient who doesn`t want or can`t afford to have full-mouth, comprehensive dentistry done. All of these decisions were based on information from various consultants.

The direction in which the doctor has been taking the practice concerns me. The focus of every staff meeting is money - how to be more productive, how to smooth-talk patients into accepting dentistry, ways to present treatment so patients will be begging you to crown all their teeth, etc. Now, the doctor is talking about hiring a hygiene assistant and increasing the number of patients I see per day from nine to 13. Even with an assistant, I`m worried about the extra workload. Again, the decision is being based on making more profit and not on what is best for staff and patients.

With this doctor, it seems that more is never enough. When we increase production, he just increases the production goal. At this point, I would hesitate to refer my friends and family to this practice, because I fear that treatment decisions would be based on making money, rather than helping the person in the chair. I have become increasingly disillusioned with my job and often dread going to work. Should I leave?

Never Enough in New York

Dear Never,

You have outlined a difficult, multi-faceted problem. It seems that your doctor/employer has made some major decisions about the practice without consulting staff members about their opinions. As the practice owner, the doctor retains the right to run the practice in any fashion he wishes.

However, when decisions are made that ultimately affect you and your job, I feel it is helpful and advantageous if you are allowed to voice your opinion.

Regarding the decision to refrain from seeing children, if the doctor had said, "I`ve decided to stop seeing children, because I`ve found the struggle is affecting me physically," you probably would have felt no objection. I have found many doctors seeing children who should have been referred to pedodontists. The struggle with an unruly child can be nerve-shattering. Because the doctor interjected the profit motive into the picture, this gives you a negative opinion of the decision.

The decision to stop taking insurance is another "trendy" decision some doctors are making these days. My feeling, as a dental professional, is that insurance helps some people receive dentistry that they otherwise could not afford. But, the patient must be willing to pay his or her share of the fee at the time of treatment. What I frequently see as a consultant is an accounts receivable that is driven upward by patients who default or delay paying their portion of the fee - the uninsured part.

Many doctors get fed up withpatients who only want dentistry that insurance will cover, especially when some insurance companies only pay for the bare minimum in dentistry. The doctor knows that the patient could be better served by an alternate treatment that frequently is not a covered procedure. Thus, the decision to stop taking any insurance often comes from the frustration of feeling "dictated to" by an insurance company. However, I am sure the decision not to take insurance payments will cause the practice to lose patients.

Your concern about increasing your patient load and working with a hygiene assistant only will be alleviated if you try it. Personally, I enjoy working with an assistant. I can see more patients and I feel less fatigue at day`s end, because I do not have to concern myself with taking X-rays, tearing down and setting up the operatory, doing fluoride treatments, waiting on the doctor, and teaching oral hygiene. I find the patient actually gets more attention from staff members with this model. In addition, it is wonderful to have someone to record periodontal probings and dental charting. Hygienists who work with an assistant typically receive higher wages, because their production is higher than working without an assistant.

However, I also know hygienists who do not like working in this fashion. One hygienist told me that she liked it at first, but quickly burned out. She said she literally rushed from one operatory to the next. I suspect the problem was that she didn`t have a good assistant and was trying to do too many things herself. The saddest part of your letter was when you mentioned that you would hesitate to refer your friends and family to this practice. This statement shows the depth of your anxiety over the direction of the practice. It seems this doctor`s preoccupation with profit has caused you to form a negative opinion of his business practices. I gather that you feel your own ethics are being challenged by the doctor`s unending quest for more. I sympathize with your dilemma, because I have faced this situation myself.

It would appear that the doctor has taken as "gospel" the advice of someone outside the practice and has decided on a course of action. I doubt that anything you say will change his mind. Cures are rare when someone has been bitten by the "greed bug." You have to decide if you can be a loyal, dedicated member of the new team or not. If you decide you cannot reconcile yourself to the changes that are occurring, it would be best to leave.

However, change - even though painful at first - often is good. We grow and learn from all of the new life experiences that we face each day. Best wishes as you live and learn.


Dianne Glasscoe, RDH, BS, is an adjunct instructor in clinical hygiene at Guilford Technical Community College. She holds a bachelor`s degree in human resource management and is a practice-management consultant, writer, and speaker. She may be contacted by e-mail at [email protected], phone (336) 472-3515, or fax (336) 472-5567.