Dear Dr. Donut, I quit!

May 1, 2005
During the last 17 years, I�ve become acquainted with a number of dental hygienists - many of whom have quit their clinical positions.

by Shirley Gutkowski, RDH, BSDH

During the last 17 years, I’ve become acquainted with a number of dental hygienists - many of whom have quit their clinical positions.

Of those who quit, only a few told their employers the truth about why they left. Sure, some decided to leave the area, some left to enjoy their families or take care of loved ones, and on occasion, they told the truth about why they left. Other official reasons - finding an office closer to home, looking for more or fewer hours, changes in focus from one specialty or another - often are diversions from the real reasons for job changes.

For your reading enjoyment, a composite resignation letter follows. It includes actual reasons dental hygienists gave when they left practices.

Dear Dr. Donut:

I’m resigning my position as dental hygienist for your practice effective immediately. My last day will be 28 days from today. I’ve never been truthful about leaving a job before, but now that the children are gone, my husband and I agreed that if I don’t work in this field again, we’d sell the house and move in with his mother. I have nothing to lose. The philosophers say that by being truthful in this resignation letter, I’ll have an opportunity to grow and I may help the next hygienist who comes to work for you. I have listed below the reasons for my leaving.

1 Progress - Dr. Donut, I love progress. During my ­interview nearly six years ago, you assured me you loved it, too. You said you take four or more weeks a year to travel around the country for courses on becoming a better dentist. You graciously invited me to come with you on some occasions. We learned so much, and we were so excited when we got home to try out the new ideas. But after a few weeks, all the ideas went dead. It seemed that your fire for progress fizzled. This is by no stretch of the imagination an issue only with this practice; it’s pervasive in every practice where I’ve worked.

2 Periodontal disease protocols - In the six years I’ve been here, I’ve developed five protocols at your request. You agreed to them all, liked them all, and we implemented them together for a few weeks. After a lot of reflection, I concluded you don’t have the stomach for charging higher fees for what you deemed modified prophys. I don’t think most dentists understand what dental hygienists do for patients and practices.

3 High staff turnover - OK, I’ll say it: Dr. Donut, you’re not easy to get along with. There have been seven other full-time hygienists come and go in the last five years and more than six part-time hygienists. Your rye sense of humor is difficult to appreciate, but the main thing that prompts hygienists to fly out of here is your mood swings. Some days you’re happy and easy to get along with, then the next day a dark cloud floats over your head and nothing is good enough. We each have our own dramas to live through; people shouldn’t have to deal with this at the office. You’ve asked us to leave our troubles at home and bring bright, shining faces to work, and we’re happy to do that. But when our team leader brings baggage to the office, morale plummets.

The support staff turnover is also high in this practice. I don’t know what you pay people for these positions, and I don’t want to know. The reality is that you don’t pay them enough to take the abuse you dish out. Throwing instruments, yelling down the hall, or belittling them in front of others is never called for. It makes you look like a tyrant to your patients and makes it impossible to harbor the level of respect that we need to have for you. Having to continually train new staff members is challenging. We must always cut staff members slack because they’re always new. I can’t remember a week when everything went smoothly, everyone helped one another, production goals were met, and everyone went home as tired as everyone else. Working under these conditions puts a huge strain on us personally and physically.

4 High fees - These are great. They make our production look good. Or should I say they could make our production look good. For the past two decades, you have been doing your patients “favors” by patching this or that. I’ve asked you often to show me the research that supports placing two amalgams up against each other. I haven’t practiced as long as you have, and I’m not a dentist, but we were taught at my school that it is not good practice. If new research has proven this to be sound dentistry, please let me know. I’d like to expand my thinking.

During the years, I realized you felt physical pain when you recommended crown or bridge or esthetic dentistry to patients. Do you remember the time we came back from the course in Terri Haute? You wanted me to talk to patients about full-quadrant dentistry. We learned it is a better way to help patients achieve oral health. Plus, practicing that way would maximize their dental insurance benefits. I discussed full treatment plans with all the patients in my schedule for several weeks. Even Rita Receptionist was on board. Dr. Donut, what happened? I remember the day distinctly. You did Paul Patient’s exam and decided only to replace one filling with another amalgam. The crown was perfectly indicated by the standards you set. I think you knew that he and his wife were having financial problems, but what you didn’t know was that he had won $10,000 in the lottery the day before his appointment. I was too dejected to even tell you. It affects me negatively when I spend a 40-minute appointment encouraging a patient to accept premium dentistry, then you shoot it all down and give them second-rate dentistry. If you decreased the cost of the crowns, you could bring yourself to offer excellent dentistry.

I had similar thoughts about the perio programs. If less is charged for quadrant therapy, more patients with periodontal disease could be treated and the fees wouldn’t interfere with your recommending it. In light of the evidence of the effect of chronic infection on the heart and other body systems, I think my therapies save lives or increase the quality of life for many of our patients.

5 Poor future planning - Every employee who left commented that a leadership course should have been next on your list of continuing education courses. Your leadership style is to micromanage, which is fine for a group of 10-year-olds. Hygienists are college-educated, and most of the support staff has taken some college courses. Micromanagement makes everyone feel like an idiot. You’d make higher production goals if you’d cut us all a little slack. You also could share the burden of making decisions.

6 Creative insurance billing - I’ve spoken to you about my discomfort in this situation. Until the law allows dental hygienists to conduct clinical examinations and diagnosis, it’s not fair to patients, insurance companies, or me when you charge for exams when you aren’t in the office. My reputation and license are at risk every time you use that tactic. I don’t want to arrive at work one morning to find the office closed because of insurance fraud. If you’re cheating insurance companies, I can only imagine what else is slipping through the cracks.

7 Delegating - You and I both know there are tasks dentists can delegate to assistants and dental hygienists. I know dental assistants must have special training before taking radiographs, and your assistants don’t. Assistants are not allowed to take final impressions, yet I’ve seen you delegate that as well. Just last month a co-worker told me she came in Saturday to re-cement a crown. Dental assistants are not allowed to see emergency patients while alone on a weekend.

There are many things you could delegate to me that you choose not to. I could triage emergency patients and have them ready for you to diagnose. I could even place temporary fillings, but you’d rather have me supporting the assistants during stressful emergency times.

8 Premedication issues - Dr. Donut, I read your journals and understand that there is some controversy over who is at risk for heart or prosthetic joint infection. The number of people who contract SBE from dental treatment is low. That doesn’t discount that the authorities - the American Heart Association and the American Orthopedic Society - have guidelines. Disregarding these recommendations means you don’t appreciate the relationship the mouth has with the body. The risk of a reaction from an antibiotic is also slim. I’ve been tempted to contact your insurance carrier for their advice on this topic.

9 Bonus systems - I’ve followed the advice of every consultant you’ve hired during the years and pre-blocked my schedule to make it the most profitable. I’ve placed sealants on children during their prophy appointments, and I’ve placed whichever antibiotic was your favorite for the month on patients who needed it. I’ve produced more than any hygienist I’ve talked to, and I have never received a bonus. I don’t know of any other hygienist who would practice under the vague rules you have set for the bonus system.

10 The office manager - This is the only position that seems to have any longevity in this practice. I’ve only worked with three office managers, and each is allowed more latitude than the prior one. I’ve been scheduled through lunch, stayed late, come in early, and seen patients who were 10 minutes late for a 30-minute prophylaxis. I’ve fallen asleep at stop signs on the way home from work. When I approach you on the subject you always take the manager’s side. I understand that the manager is supposed to take the reigns, but no good manager works the staff into the ground. The managers I’ve worked with here don’t understand that the staff is flesh and blood, not nuts and bolts.

11 Open margins - You’re afraid to recommend extensive or expensive dentistry, and I wonder about your clinical skills. You wear glasses to read, but only plastic safety glasses without a prescription to practice dentistry. I see open margins around crowns clinically and on X-rays. You don’t take periapical films before placing cast restorations, and you don’t screen for periodontal disease before cosmetic treatment plans. I need to feel good about the dentistry I recommend to patients.

12 Instruments - I’ve tried to educate you on the necessity of replacing instruments. Dental hygiene instruments wear out. If we had a sharpening machine, maybe they would last longer. With as many hygienists who have worked here, the instruments are beyond sharpening. I’ve brought this to your and the office manager’s attention time and again. Your patients are suffering, and they are not receiving the kind of care I want to provide. The combination of too little time and poor instruments is not conducive to high-quality oral care. The power instruments are weak and need replacement. I mapped out a plan for the office to purchase new equipment in proportion to production goals, but you didn’t go for it.

13 Finally - I chose dental hygiene because I wanted to help people achieve optimum health. I learned about the functions of the entire body and the interrelation between systems. I learned and studied, at some level, all the courses you did, Dr. Donut. I was excited to put all the knowledge I learned from those classes into practice. I learned about tribes in South America, about the Ego and the Id, and that sometimes a cigar is just a cigar. I learned about pathogens and parasites, physiology, chemistry, and other things. I tried to use that knowledge, but my actions were met with resistance. It’s over. I’ve spent much of my professional life moving a rock up a hill, and I’m tired.

Yours very sincerely,
Heidi Hygienist, RDH