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There are many challenges facing dental hygienists. Over the years I’ve had discussions with colleagues and students about some of the bigger ones we face in our profession. This is a review of what I consider the top 5 issues we face and some advice on how to approach them.
COMPENSATION:
This is always a hot topic. Compensation isn't just our income It includes health benefits, retirement plans, continuing education allowance, sick leave and paid holiday/vacation time, etc. Usually, this is contingent upon your employment status. A clinician needs to ask themselves these questions.
1. Are you part time or full time?
2. What does the office consider full time?
3. Are you working for a private practitioner, large practice or a corporate office?
All of these factors need to be considered when evaluating if you are fairly compensated. In most cases only full-time employees will qualify for the entire compensation package while part-time employees may receive some additional benefits beyond income.
Let’s focus on income. How do you decide between hourly, salary and production based paycheck? This is a very tough question. One that requires very clear and open communication with your employer. In regards to salary based on production, the average going rate is 30%-35% (1/3) of what the dental hygienists produces. This should include patient care and products sold. There are variable factors such as dental exam and x-rays. I have seen some offices give the dental hygienist credit for the dental exam while in others it falls under the dentists production column. There are a variety of reasons for either case. No matter what, it is important to have a clear understanding of what the hygienist receives credit for. The pro’s of this method is the hygienist truly gets credit for the work he or she accomplishes. However, if a patient doesn’t show or other complications come up it can create for an unknown monthly income. If you are a new RDH to working field this may not be the best option for you to begin with since your speed and experience are still growing.
Salary is becoming a very popular option for many offices. This means the hygienists gets paid the same amount of money each month regardless of how many patients were seen or how many hours were worked. This allows the clinician to have a reliable monthly income. If you happen to not have a patient show and get to go home an hour early it wont impact your pay. But this also means that if you end up working into your lunch hour or run past the end of day you aren't getting compensated for your time either.
Hourly is the most traditional method of income compensation. When evaluating your hourly rate be aware of what your average daily production is. This will give you a starting point to understand your value to the practice. Remember about one-third of production is industry standard. It is VITAL to have a clear understanding of what is considered "paid time" with your office. While I don’t believe it is appropriate, there are some offices which require the hygienist to clock out during times of non-patient care. I have also heard of other instances in which the RDH is required to come to the team meetings prior to patient and not get paid for that time. Depending on which state you practice in this could be illegal. So be aware of your employee rights.
When looking at the rest of the compensation package employees really need to consider that this could impact their income. It costs employers money to provide these items for their employees. So, while your monthly income may be less, you are gaining so much more by having the rest of the package. If you do not receive any additional compensation I say go for the top dollar!
As a side note....
Through all of the reading and research I have done regarding the inequality of pay for women, one of the underlying themes I always come across is that women generally don't advocate for themselves when it comes to pay. If you want to make more money you need to advocate for yourself! Arm yourself with the data of your value and present it. If you don't get the raise or the dollar figure you had in mind at least you tried and brought it to your employers attention. Then ask again and again and again. If they value you as much as you value being a part of their oral health team they will listen.
TIME WITH PATIENT CARE:
This is an issue for new to seasoned professionals. At some point, we as an industry have created time constraints on how much time is spent with a patient. How does someone come up with the appropriate amount of time to spend with a patient? As we all know, and can agree upon, we schedule enough time to meet the oral health needs of our patient without sacrificing quality care. So let's reverse engineer our dental hygiene appointment to come up with the appropriate time.
This is what I consider the “must do’s” with a patient appointment.
• Health/Dental history review-including any new updates and medications from the last visit
• Vital signs (BP, Pulse, Respiration)
• Head, Neck and Intra-Oral exam DON’T FORGET THIS!!!!
• Risk Assessment: Periodontal, Caries and Oral cancer…you know the perio assessment, radiographs, etc…
• Home-care instructions
• Treatment
Wow, that is a lot to do especially in the traditional 50-60 min appointments. The unfortunate reality is often times the hygienist isn’t the one calling the “time shots”.
How do you manage your time and accomplish all of this essential high quality care? One step is to communicate with the scheduling coordinator, or whoever is in the office calling the “time shots”. Communication makes the world of difference. Perhaps the individual scheduling isn’t considering or doesn’t understand all that it takes to get the job done right.
I know there are some situations the above just isn't possible. If there is still a time constraint to deal with, another option is to multi task. Can you review some of the home-care instructions while you are assessing and treating the patient? How about discussing medication updates while you are taking vital signs? What about polishing, does your patient really need it or is it just a nicety?
I am going out on a limb and I know some of you will want to grab some floss and hang me by my toes for saying this. Perhaps the least important thing we do is remove the supra calculus from the lower anterior teeth. I am going to say that again. The least important thing we do is remove supra deposit from our patients teeth! What if we did the best we could, left a little behind, and spent more time talking to our patient on how to improve their oral health and actually completed an in-depth extra and intra-oral health exam? Will the stain on the lingual of #9 really have a negative impact on our patient? I say no! Use that 2 minuets you would have used to make sure your patient is "spic and span" clean to educate them on how to properly care for their oral health. Use that time for some nutritional counseling, or reviewing the need to complete an at home oral screening for our patients that smoke. This is where we can be the difference makers.
BODY PAIN:
Dental hygiene…wait all of dentistry is a physically demanding career. We struggle with neck, back, shoulder, arm wrist and hand pain. It’s a rampant issue in our field, decreasing our career longevity. Ladies and gentlemen we must take care of ourselves!
Have you purchased loops? There have been numerous studies and articles discussing the ergonomic benefits of this eye-wear. With proper fit, you can keep your neck in a more neutral position while you are instrumenting. If you add a light as well you can see so much better. No more moving the overhead light all around just to avoid the shadows our heads make by trying to look inside that little cave! If I was told I had to choose between magnification or the light, I would pick the light every single time.
Along the same lines, what are you currently using for your instrumentation? There is a special comfort level with hand instrumentation and it still serves a purpose. I know several fantastic hygienists that will go to the grave with a universal curette in their clawed hand. However, ultrasonic instrumentation is not only highly beneficial for our patient (perhaps another topic to discuss) but it is a wonder for the health of our body. We can use a light grasp and guide the instrument....aahh... I can just feel the thumb cramp going away.
Varying the position of our body while we work can reduce strain as well. Perhaps alternate between sitting and standing. Since I am on the shorter side of the ruler I find standing to be much easier on my body. It allows me to keep my arms and upper body in a neutral position and the freedom to move closer and around my patient with ease. As a side bonus proper ergonomics is like a free workout too!
Oh did I say workout? What are you doing for your own physical fitness? With our arms continuously in front of our bodies we become imbalanced in our musculature. This makes me picture the good old fashion zombie movies with our arms out in front of us.
I know I have sounded like a zombie after a long week of patient care. Talk with a personal trainer and see what exercises you need to get stronger and maintain a pain free life! Those of you who know me have heard me preach the benefits of fitness. Go take care of YOU!
LICENSE PORTABILITY and LICENSE SECURITY:
There are times in our lives when we need to move from state to state. The challenges we face is the ability to move our career to different area’s of the country. I know it's frustrating, we all know the patients oral health status is no different in North Carolina or California. Here's the thing, CODA regulations require all hygienists to have the same standard of education. So, how do we manage the struggles of portability?
The best way is to support these efforts is as a dues paying member of your professional organization, the American Dental Hygienists’ Association (ADHA). The ADHA provides support for so many professional issues including this one. Our professional association has the ability to work on our behalf. If you don’t have a membership you are missing an amazing connection with other professionals.
ETHICAL CARE:
What happens when you are working in an office that has unethical care? This dilemma is more common than we want to admit. When you encounter care which doesn’t live up to industry standards you MUST communicate with the individual who is in violation. This needs to be done with tact of course. More often than not the clinician is making this mistake in ignorance or is overwhelmed with the demands of the day.
Be sure to discuss this with the individual privately. Also, give the practitioner the benefit of doubt. You may end up needing to speak with your supervisor or the other persons supervisor as well. When doing so make sure to offer assistance or solutions to solve the issue at hand.
I encourage you to have the standards of care in front of you when discussing these topics. Grab the HIPAA or OSHA manual along with the state governing board rules.
If there has not been improvement then you must make a decision. Your ultimate responsibility is to the patient. You may be held just as liable as the person initiating the unethical care. Reporting the violation to the state governing agency or the appropriate entity may be in order. Also, clinicians need to be able to lay their head down at night. If there is an issue you are facing and can’t sleep because of it, maybe it needs more of your attention! If you don’t see the change towards improvement then it may be time to move on.
The list could go on and on regarding the challenges we as dental hygienists face. But with some communication and refocusing your thoughts they can be handled. Talk with your fellow colleagues in the area and join your professional association ADHA. These resources will provide the support you need. Taking continuing education courses to stay on top of these issues and collaborating with your professional peers is one of the keys to successfully navigating these waters.
Looking for more employment tips? Head to https://www.teachertinardh.com/employment-tips to get more tips and resources. See you there...