Have you ever been exposed to a situation as a dental hygienist where, in your mind, you questioned a proposed treatment recommendation? Have you ever been asked to perform treatment that you thought may be unnecessary? Have you ever been pressured to push elective treatment and sell dental products in an effort to increase production in a dental practice?
These situations can make you feel uncomfortable and create a moral conflict between what matters more in dentistry: the importance of an office to be successful financially versus doing what's best for patients. Complicating the issue is the fact that dentists can have widely varying opinions on when treatment is necessary, such when one practitioner prefers to watch an area to see how it progresses verus another practitioner wanting to treat immediately.
As students in dental hygiene school, we were taught to perform the appropriate treatment for each patient so that everyone received the optimal level of care. However, in a dental practice, cost often comes into play. Dental hygiene school clinics tend to offer greatly reduced prices compared to a typical dental practice. In the real world of dentistry, making a profit is a necessity, and the line separating what level of treatment is required/acceptable and what is not can get blurry.
For example, consider a scenario in which you are interviewing for a position in a practice that only allows you 40 minutes to perform an unassisted adult prophy. Many hygienists would feel uncomfortable working in this situation because it would be difficult to perform a thorough prophylaxis. But as part of the job opportunity, you are offered an impressive hourly wage along with an excellent benefits package. The situation would likely present a moral dilemma: Should you work in a practice where quality of care could potentially be compromised? Factors like potential income and the physical demands of the work would also factor into your decision.
A better solution for financial stability
Sometimes people may think that they have to make a choice between being financially successful and doing what's best for patients, but in reality, both goals can be achieved at the same time.
For example, say you have a patient who insists on only getting a filling when it is clear that the tooth needs a crown. The patient wants this because crowns are expensive, and her insurance won't cover much of the expense. If the patient gets what she wants, everyone loses because the patient does not receive the best care that ensures the long-term stability of the tooth, and the practice misses out on income. Solving this issue begins with patient education of why the proposed treatment is necessary. It also involves creating trust and overcoming financial barriers. If all these things are in place, chances are the patient will feel that her dentist office is looking out for her best interest and not just padding the bottom line. The patient opts for fixing her problem with a crown, and then everyone wins!
Another choice that can negatively affect a practice's financial well-being is when a practice agrees to be a preferred provider for multiple insurance plans that have steep write-offs. In this scenario, the dental office may be extremely busy yet have increasing difficulty in turning a profit. Every office has expenses, from supplies to rent, that need to be covered, and when reimbursement is too low, limited funds are left behind to fill that need.
Ways to positively build income
There are many potential ways your office can produce income that does not cause moral concerns. It all starts with your office being fairly compensated for the treatment it provides. If your office is struggling due the amount of reimbursement received for common dental procedures, your office manager may need to negotiate with the insurance plans that your office has signed up with. With this extra effort, your office could bring in up to 10% more per procedure. (1)
Another way to increase your practice's income is to offer a membership plan to your patients. (2) Many patients, potential and existing, lack dental insurance. Membership plans allow members to receive regular preventative care with affordable monthly payments. These plans eliminate the hassle of dealing with an insurance company, and they are easy for patients to understand. Furthermore, they give your office a steady source of income from loyal patients who don't have to worry about their dental plans changing.
Block scheduling is an additional way for your practice to reach production goals without pressuring patients or charging them more. (3) It begins with scheduling a predetermined number of high-value procedures, such as crowns, bridges, or large restoration cases, in a day's schedule. Then, the amount of low-value procedures, such as single restorations, crown recementations, and bite adjustments, are limited within a day's schedule. The result of this method is that your office can more reliably reach production goals without feeling the need to pressure patients.
Another simple way to create income for your dental office is to provide patients with the opportunity to purchase products that may help them improve their home care. A Waterpik water flosser is a product that I frequently recommend to my patients because so many people don't like to floss or have difficulty doing it properly. When they hear that they have a convenient option for oral care that is ready to be purchased in your office, it's a win-win situation. Similar benefits are found when offering whitening products to patients.
Building income can also be done by sticking to treatment that is necessary. By that I mean don't ever give a patient a reason to second guess treatment recommendations. I have subbed in offices that unnecessarily recommended fluoride treatments to every patient, and I really think people begin to question the necessity for that, especially if their risk of decay is low. On the other hand, when you know a treatment is necessary, stick to it confidently. If a patient needs root planing and scaling, do not ever downgrade that recommendation to a "bloody prophy." With this behavior, your patients will know that you are concerned about best serving their oral health needs and everyone benefits.
Putting it in practice
The concepts of doing what’s best for patients and looking out for the practice's bottom line have often been viewed as two conflicting ideas. But realistically, if a proposed treatment crosses an ethical boundary to create profit for a dental office, the office is focusing on making a quick buck and not thinking about how to earn money long-term. One of the best ways to become a success in dentistry is to have a practice where patients can place 100% trust in the dental staff and feel completely confident in sharing their experiences with others. That is the office that will stay busy and flourish for many years to come. That is the office I would be more than be proud to be a part of.
References
1. Burniston K. Negotiating insurance fees. Dental Economics website. https://www.dentaleconomics.com/articles/print/volume-105/issue-5/practice/negotiating-insurance-fees.html. Published May 15, 2018.
2. Comstock J. The rise of in-house dental plans. Dental Economics website. https://www.dentaleconomics.com/articles/print/volume-108/issue-3/practice/the-rise-of-in-house-dental-plans.html. Published March 20, 2018.
3. Absher M. Scheduling for Success. Dental Economics website. https://www.dentaleconomics.com/articles/print/volume-101/issue-6/features/scheduling-for-success.html. June 1, 2011.
Also by this author:
Dental probiotics: Has a better way to fight bad breath finally been found?
Dodging the dreaded dry socket: Tips on preventing this painful possibility
The dental hygiene job market: Have we finally turned a corner?
Editor's note: This article first appeared in RDH eVillage. Click here to subscribe.
