May 11, 2010
RDH eVillage recently asked its readers about what one thing they would change in their dental offices, if they had the power to do so.
In its April 23 issue, RDH eVillage asked readers, “What is the one thing you would change in your dental office today if you had the wherewithal to accomplish it?”The question prompted 251 readers to respond, and we share some of their comments with you in a regional breakdown.Don't forget to offer your opinion on what to change in the comment boxes below.New England
(Responses came from Connecticut, Maine, Massachusetts, New Hampshire, and Rhode Island. Vermont was mum on the subject.)
• I would appreciate a better understanding of the schedule frustrations for the hygienist from the assistants. It seems that they are inconvenienced when we ask them for any help. It is an attitude that is palpable each time they are paged for a probe or to suction, or if we get behind and we need them to take X-rays on the next patient. I don't think they fully understand what it is we do with each patient. Therefore, they think we just gab too much and get behind. I have often thought, "What if I had a hygiene assistant?" But I’m afraid that my patient time would simply be reduced to 30 minutes with each patient to do nothing but scale. That would mean burnout for me. It seems to be an insurmountable problem to me.• I’d like to see consistent standards and expectations for all hygienists. We have a procedures and protocol manual for hygienists. I follow this, but the other hygienist does not. She does not routinely complete periodontal probing, FMX, or oral cancer screenings. If she does any of this, she does not indicate it in the patient's chart, although she has been told several times that she must do so. Although we work the same number of days each week, I have more duties in the office. I have been in the office 18 years, and she has been here five years. We both get the same pay and benefits. Why if I conform to the boss' expectations and go the extra mile and she does not — and he admits this — should she be paid the same amount?• I do not want to be on production. Pumping out human beings like automobile parts was not my vision when I signed up for hygiene. I have to process 12 to 15 patients per day, sometimes 10 patients in a row without a break. I work for a community health center, and volume is all they are interested in. They cannot hold on to a hygienist because of this grueling schedule. I need the medical insurance so I have no choice but to put up with this dictatorship. Why can't private offices get on the ball and offer medical insurance to hygienists? Now the CHC is also requiring us to work nights and Saturdays. Where will it end? Sunday is being considered as a workday as well!• My boss is a great dentist but a lousy person. This creates a stressful work environment, but in this day and age, who can be choosy? Having a job is a good thing. Having a stressful job is not healthy. One minute everything is all party, and the next minute it becomes a yelling, accusatory hellhole. We wonder when the next explosion is going to happen.• I would like to be given back the sick and vacation time taken away from the hygienists. It has changed morale, and it is now affecting the workplace.• I would like the receptionist to actually understand what I actually do. To her, I "just clean teeth," and she has no idea what that truly means and what else my responsibilities involve.• The assistant doesn't listen, and is dangerous.• I’d like the hygienists in our office be respected for the professionals that we are. I don’t want to see us undermined by the office manager who has never been in a clinical setting and doesn't understand how hard we work, and doesn’t understand that we are valuable assets to the office. Every position is important, and we hygienists need to be acknowledged for our contribution as educators and income producers. The office manager can’t collect money if the hygienists don’t bring it in.• Everyone complains about coworkers to somebody else rather than just dealing with that person directly.• I would like for each staff member to receive praise from the dentist once a day. The dentist should be able to find one thing each person has done right and praise them for it.• I would like more office communication. We do not have regular staff meetings. Even when we do, it's the office manager conveying the doctors' wishes to the staff, and the doctors aren't even present. I think they're afraid of us.Mid-Atlantic States
(Responses came from Delaware, New Jersey, New York, Pennsylvania, Maryland, and Virginia. The District of Columbia and West Virginia were mum on the subject.)
• I would like the office to provide intense, quality education for all.• I would have a very strict policy with regard to patients who are late. I work on a 45-minutes-per-patient schedule, and I personally would not see a patient who is more than 10 minutes late. (I am not talking about the occasional traffic problem. I am talking about the repeat offenders.) I think that seeing patients who repeatedly arrive late only encourages the behavior and punishes all of the subsequent patients who are there on time.• It would be nice if people would actually show up to the office ready to work. Most seem to be more concerned with what others are doing or not doing, and they are not focused on what they should be doing.• I would like my employer to talk to employees directly and not through other employees.• I would like to routinely have a review with my employer each year as opposed to her only having reviews for a small number of employees. The situation makes my employer appear to show favoritism.• I am pleased to say that after working in the field of dental hygiene for 35 years, I have found my “forever” office. I now have the ability to change things. This office wants things to change, and all I have to do is identify the concern and offer a game plan as to how I plan to solve it. All credible concerns are met with sincere dialogue and genuine implementation. The rest is up to the staff to complete. I now go to work with a whole different attitude and can't wait to get to my operatory!• I would like to have whatever up-to-date equipment I need to work more efficiently.• I would like the doctor to respond to my request for a hygiene check in a timely matter and not keep me waiting. I let him know when I am done with my X-rays, perio charting, etc., in the hope that he will make it into the room sometime in the next 40 minutes. Very often, I have to call him again, sometimes several times, to get him in the room. One day he kept me waiting 30 minutes into my next appointment. It makes what could be a wonderful office a very stressful one.• I would change the schedule so everyone stays on time, we all get lunch, and we can all leave on time at the end of the day. This past week, our new dental assistant came up to me complaining that she only gets 20 minutes for lunch and she is supposed to have an hour. I said, “Welcome to the practice.” This is common in the practice where I work. I have been here for three years and have stopped planning anything for my evenings because I never know when I'll get out of the office. It’s very frustrating and tiring.• I would change my employer's view on spending money! More specifically, he needs to update equipment or at least make needed repairs on equipment. This would include purchasing needed supplies on a timely basis so that I don't have to bring garbage bags, toilet paper, and paper towels from home. If we could extend that thought to making repairs before an incident rather than repairing after an incident, it would make the office look like a professional place to receive treatment. Patients have asked me why they should spend money on an implant. The office looks dilapidated. It makes us all think maybe the dentist isn't doing too well financially.• The way that a registered dental hygienist is perceived and treated by the other staff members should improve. I feel that we are providers but are not treated that way by the receptionists and assistants. Yet the dentists treat us like providers because they want us to bring in a particular level of income. As a dental hygienist, I have many ideas and suggestions that would benefit the entire office, especially since the patients have great relationships with us and feel comfortable sharing their likes and dislikes. I just wish we could be treated like the professional providers we are.• The office politics is a problem, as is the cattiness of other female coworkers. For as many years as I have been in dentistry, this seems to be in every office and is the No. 1 reason why good employees leave and bad ones always stay. Dentists just don't get it!Deep South(Responses came from Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee. Alabama and Arkansas were mum on the subject.)
• I’d like to be included in choosing office equipment purchases. Perhaps I could offer an opinion from my experience.• I would like for our front office staff to keep a "cancellation/available on short notice" list and combine that resource with the "unscheduled list" to actively keep my schedule full. It would benefit the whole team as we have a daily production goal, but they feel it is the hygienists’ responsibility to fill our cancellations on our down time. I would rather not have any down time due to cancellations.• I'd work unsupervised and fire the dentist.• The dentist must realize that we are all on a rigid schedule, and he should examine the hygiene patients in a more timely manner. I've actually had to dismiss patients to the reception area to await exams so I can proceed with my next patient. As this issue was discussed ad nauseam, and to no avail, I chose to leave that practice.• Office management must improve. The dentist is a great practitioner, but the adult son of the dentist (you got it ... too lazy to work anywhere else) works in the lab, and the doc's wife works up front doing insurance. This would be OK, but their attitude is that unless we are family, we aren’t really valued as the professionals we are. There are no distinct sets of rules for everyone. It depends on the mood of the dentist how a person is perceived that day, whether someone is guilty of doing something they consider wrong or not. It's like trying to please a moving target. He doesn't mistreat me as much as he does the assistants and front office girls. But it still causes conflict and makes for an unpleasant workplace. No one knows what to expect. Why can't we all just do our jobs? Everyone is good at what they do. It could be so different.• All of us want to work in an office that offers quality dental care. Due to everyone’s varied dental backgrounds and expectations (no matter what department) the definition of quality care and the level at which it is performed varies. I would like us all to be of the same understanding of quality and level of care so that we are able to set goals as an office and attain them.• Last year our office signed a contract with a very well known management company. This company has never once been to our office; everything is done long distance. I would love to go back to how things were before this company came into the mix. I'm all for change if it's for the better. But so far no positive changes have been brought into the office. A small but significant change was being told that becoming too friendly with each other leads to "cliques and conflict" within the office. We are now almost afraid to be seen chatting while we are in the sterilization area or waiting for an exam. We don't want to be written up by the new team leaders and have it held against us! Coming from an atmosphere where we literally referred to each other as family, this has been hard to take! So if I could change anything, it would be to dump the management company and let us go back to being the wonderful patient- and family-oriented practice we were before they were hired!• We need ergonomics in the hygiene room. Studies should be done prior to construction or remodeling. I have been in my current practice for over 20 years, and 10 years ago we moved to a remodeled office that had no hygiene input.• I would have annual reviews of each employee and give them cost of living raises as warranted. I have been with this dentist for 12-plus years producing well over $1,200 per day with only one raise five years ago.• If I could change one thing in my office it would be that the doctor is not so consumed with the personal issues of the receptionist. I understand friendship, but when it is obvious that the duties and pay (she is extremely overpaid) of the receptionist are far greater than the true producers in the office, it causes resentment.• I wish the dentist's wife were not our office manager. I can't tell you how often I have to bite my tongue when this young woman, with absolutely no dental experience, tells me how to do a hygiene appointment.• I would like to have more control and a budget to order instruments when I need new ones instead of using the same old ones for years and years!Upper Midwest(Responses came from Illinois, Indiana, Michigan, Minnesota, Missouri, Ohio, and Wisconsin.)
• I would change the floor plan. We have an old office, tiny lab, and one bathroom located behind the front desk — literally! (At least it is barrier-free for our patients.) There is no place for staff to take a break — our lunchroom is the reception room. We have loyal patients, a great staff, but I wish we had a fairy godmother to wave her wand over our building! Economics are tough in Michigan; our staff is glad to have jobs, although our hours have been cut.• We need the doctor to stay off the computer and phone during the workday, and stay focused on dentistry.• I wish each RDH could have his or her own set of instruments. We have three hygienists in our office, and I am the only one who ever sharpens the instruments.• I would like our dentist to be a better leader and lead by example. I also wish the office affair would end; it's very distracting!• I don’t care for the way CDAs and receptionists interact with the hygienists and see their jobs as separate and not part of the team. They don’t think they have anything to do with the hygiene department, and that isn’t good. • I would have no problem numbing the doctor’s patient if the CDA would help with bitewings or probing. After 32 years as a full-time RDH in various offices, I have found this is seldom the case. I've always believed that if every staff member acted together rather than independently, offices would experience a better flow and more harmony. I’ve tried to become sensitive to their stresses so I can be more understanding and help when the opportunity presents itself. I even ask what they need from me that may impact their job. But I do not get the same respect. They claim they have enough to do and are not interested in learning anything about the hygiene department. Over the years, more focus has been placed on production and more responsibilities. I love my job and am open to taking on more if it will impact patient care. What I find so discouraging is the segmented job mentality. There is no acknowledgement of the overlap of any jobs. Doctors have directed me to use the CDAs to assist with X-rays, developing, or probing. However, on more than one occasion I’m told, "I'm a dental assistant, not a hygiene assistant!” or, "Since they make enough money, let them do their own work!" It's this behavior that I find so distasteful, and I've often contemplated leaving the profession.• I feel if an office raises its fees, then the staff should get a raise. When I see this happen and there is no raise for two years, it really makes me mad.• I wish my boss would be interested in discussing with me the care I’m giving his patients rather than spending all his time with the front office staff worrying about payments and how cheaply we can get supplies.• I work in a corporate office, and there is a lot of division between the front desk and clinical staff. We need to focus on teamwork to provide the best possible care for patients. There are meetings held just for front desk staff, who are told to focus on production. So the schedule gets overloaded. It's impossible to stay on schedule and it’s frustrating for everyone. Patients complain about wait times. It's true, and the clinical staff takes the brunt of the complaining. The over scheduling continues.• My office needs to be better about communication. Although the office is fairly small with six people, there are still things that don't get communicated to everyone at the same time. A couple of employees are part-time, so they don't always know what’s going on. I think weekly staff meetings would be great.• We need a total personality change of the doctor.• I would like an employer who can take control and confront the employees who are not up to standard or who have poor attitudes. He doesn't like confrontation and just lets things slide. Instead of bringing all members up to par, he wants us to accept others as they are and work at their level. What does that say for those of us who are licensed and formally trained, who put forth the effort in CEU and online professional journals and professional organizations? Should we let our integrity go just so we don’t make waves?• I feel like the face of dentistry is changing into a marketing monster. Our office has finally succumbed to it. Our patients are bombarded with products and technology as soon as they walk in the door. While the technology might be impressive, they are still wondering how much of their bill is paying for it. Also, the phone/text recall system is not personal and is somewhat bothersome with over three reminders about one appointment. As soon as patients sit in the chair, we ask them about doing additional treatment not covered by insurance such as oral cancer screenings, adult fluoride, etc. Of course, I am audited about how often I offer additional treatments and have patient compliance. I need the job as a single parent and have been at my current office way too long to go somewhere else and start over again. I still get competitive pay (even after two pay cuts). I'm sure that works against me, considering there are new hygienists waiting to take my job for far less. A contract of employment with fixed pay would be nice so I don't feel like I'm always teetering on how well I'm "selling."• I work with an assistant, and I would like to have a say in the hiring of the hygiene assistant. The office manager interviews and hires the hygiene assistant, and if we don't click it is difficult to terminate someone and start over.• All front desk personnel should have clinical experience.• I wish the doctor would fire the "queen bee" hygienist who thinks she's the best hygienist in the world. She does nominate herself for hygienist of the year every year! She is rude and condescending to the assistants and cuts me (a hygienist of 32 years) down to all the patients. The front office and even the dentist are slightly afraid of her. She has already sued twice and participated in insurance fraud. She's a bully and is spoiling our good reputation, not to mention my name among long-time patients. She's smart but evil! I was hoping to work here with patients I have had for years until I retire. I love the assistants and the front office is great. The doctor is health-oriented and a good guy. Why doesn't he get rid of the "entitlement queen" of the office?• We need to have sharp instruments available. My current employer does not want to order new instruments often and feels that we do not need to sharpen our instruments for each patient. Certainly there are patients who have excellent home care, and medium or low quality instruments are functional. But some of us feel that it should be up to the hygienist as to whether we need new instruments. We save the good instruments for the difficult patients, but some of the old instruments are getting thinner and not easy to work with.• I’d like a better work ethic in the young girls I work with. I truly care about my patients and doing a good job. The girls I work with in their 20s and early 30s are there for the paycheck. They complain about the doctor and do 10-minute appointments to get people in and out so they can talk on their phones or do Facebook. Our doctor is so laid back he lets them run all over him. He’s a good doctor, but not a good manager. I stay and do the best I can and my patients are truly grateful and continue to be loyal to me.• We need to reestablish professionalism in all areas of the dental practice! I left an office three years ago because I could no longer tolerate the assistants and even the hygienists smoking on the job (standing just outside my operatory), wearing questionable clothing (low-cut tops), speaking in a horribly unprofessional manner to male clients, revealing too much personal information, and more. Patients complained to me regularly, and the practice lost them as a result of no action. I have found this to be a common problem in some of my subsequent temp positions. I work in a different health care position now, and practice only enough dentistry to maintain my license.• Our hygiene salary is 100% production based. I work in a large group practice and this way of compensation results in over-loading of schedules, "patient stealing" by hygienists, and inadequate time to properly perform hygiene as it should be practiced. Patient care suffers when money is the bottom line. Even a good hygienist can lose sight of why we are hygienists — to care for patients in the best way possible. Salary should be patient-care centered, along with merit pay for a job well done.• The dentist I work for is not warm and fuzzy. She and I do not have a friendship. It is a total work relationship. I have the feeling she doesn't even like me. She must think I do my job well because I have been in the office for almost six years. But in that time I have received one compliment on my work. The other dentist and I get along fine. So if I could change one thing, it would be the relationship I have with my boss.• I would like to get the doctor's wife out of the office! The effects of the economy are bad enough, but we are losing many patients because of her. She wasn't always a problem, but she has developed personality issues, causing too many problems in the office (both with staff and patients). The doctor is more than aware of the situation but is afraid to do anything because he has to live with her. This is so frustrating, yet there are no other jobs out there. Sigh.Plains States and Mountain States
(Responses came from Colorado, Idaho, Iowa, Kansas, Montana, Nebraska, North Dakota, Oklahoma, and Texas. New Mexico, South Dakota, Utah, and Wyoming were mum on the subject.)
• I want everyone, including the doctor, to practice dentistry on the same consistent level that is most beneficial to the patients’ health. No being lazy and cutting corners just to get a paycheck. We have an obligation to patients to do the best we can.• I would have the dentist’s wife not be involved in the practice. He is a wonderful guy to work for, but his wife makes our lives miserable.• I would increase the supply budget or allow some of the supplies that support profit centers to be outside the supply budget. I would like to add that the small supply budget is a manageable problem. The company is very supportive of its employees, and the office members are very supportive of each other.• Two years ago, our doctors hired a consultant for a three-year overhaul of our practice. The changes included removing three staff members, putting everyone on salary, removing hygiene bonuses, (staff is to receive a bonus if we hit a certain goal as a team), having every new patient start with an interview with the front desk before moving on to hygiene, having every patient leave with photos and X-rays, having a full discussion of the patients’ long-term goals, and if the patient wants his or her teeth cleaned, doing so that day (but not necessarily taking probes). The patient then comes back for a treatment plan appointment with the doctor at no charge, and a plan is put in place. Mind you, probes are to be taken when patients are numb; however, I’m not quite sure how the treatment plan is set for perio simply from X-rays and how this fits into what the patient wants. This shift is scary to all six hygienists, moving away from traditional hygiene. I have practiced hygiene for 35 years and am willing to continue my education as long as I’m practicing. But I find this new trend frightening. The hygienists all still take probes, as we feel this is critical to the patient’s health. We have had several discussions with the doctors on this matter. So, if I could change one thing, I would like to not be under the advice of this consultant.• There is constant underlying tension between hygienists and assistants. In many cases I feel that assistants do not want to help hygienists because they are not as well paid. The assistants seem to think that because hygienists are paid more, we should have to work twice as hard and should not require their help. It is hard to create an environment of teamwork with this attitude. I’m not sure what the answer is. I think assistants should be paid more, especially if they are well trained and capable. If that were the case, I think they would be more willing to be team players.• I wish that the office functioned as a whole with everyone pitching in wherever needed. I have been in this field for 36 years. We seem to have moved so far away from the dreaded "prima donna" hygienist of yore that no one helps the hygiene department do anything now! If I don't have a patient, I jump in and help wherever I can. At the end of the day, the assistants are done and waiting at 5 p.m., while I'm trying to finish my patient, my notes, set up for the next day, take out the trash, and more while they stand in the hall with their purses, waiting, since we are all required to leave at the same time!• The one thing I would love to see change in our office is the employer (dentist) leaves his grumpy attitude at the door just like he tells us to leave our troubles at the door. I know you will get a lot of suggestions regarding salary, staff members, etc. I have been a hygienist for 20 years, and it is getting old working with a dentist who is grumpy and takes it out on the staff. I would love to see this publicized. Then maybe if the dentist reads it, he will get an attitude adjustment!• We need to stop treating patients according to their insurance coverage. We should treat all patients the same no matter what type of insurance they have.• I would like the dentist to hire an actual office manager, not his girlfriend —a newly trained D.A. It’s a very tense situation.• We need patient compliance! Patients need to keep appointments, perform good home care/oral hygiene, and more.• I would change the time spent waiting for a patient exam. Hygienists are slowed down at the end of an appointment while they wait on the doctor to check the patient. I compare it to shopping at Walmart. No matter how fast you get your shopping done you are still stuck at the checkout waiting forever.• I would change the doctor. He is cheap to the point of endangering patients’ health by reusing disposable items, not doing proper maintenance on necessary equipment, and not keeping up maintenance on the building he owns.• I would change the behavior of the dentist toward the staff, in the sense that he would wait for his staff to finish speaking to a patient instead of interrupting when he comes into an op. I would like him to act like he appreciates things that are done specifically for his benefit, such as patient preassessment, instead of appearing insulted, and that he would value all the little things we do for patients, such as warm towels, instead of begrudgingly accepting them.• We should not allow cell phones in the office for patients or employees. They are very distracting.• There is a lack of appreciation and no cost of living raises in our office. I have practiced for over 30 years and have never had any employers give any of their staff cost of living raises, although fees are regularly raised.West Coast
(Responses came from Arizona, California, Hawaii, Oregon, and Washington. Alaska and Nevada were mum on the subject.)
• I would change the standard one-hour prophy for each patient. I would like to be able to perio chart and look at the X-rays when a patient first comes into the office, then evaluate time needed for each patient based on difficulty, amount of calculus, stain, and time since the last prophy. I do not feel each patient fits a cookie-cutter one-hour mold. Some take a long time, and some are shorter. This would allow my schedule to flow much more smoothly.• I would like for my doctor to not be (mentally) in retirement mode because it changes the entire dynamics of the office.• I would change where my ultrasonic scaler is located, which is behind my chair. I have to reach behind if I need to adjust it and drape the hose up over my light handle to prevent dragging. This is very ergonomically challenging.• I would like more lucrative benefits and more frequent pay raises. We do not get pay raises every year and have fallen behind the average pay scale for our area.• I wish all staff members would have a positive attitude daily. A few come into the office with a grumpy attitude.• I wish there were no nasty hygienists! I’m shocked at how territorial some hygienists can be. The dentist and the dental assistants all complain about it. Why would anyone who could use the help of others alienate themselves so much from those who can help? I've met way too many unprofessional hygienists who give the rest of us a bad name!• I’d like more privacy in the open bays operatories.• The dentist should put his daughter on commission. She is a dentist. She does not make her monthly production and gets paid a salary. She spends the majority of the day in the lunchroom playing word games with often one patient on her schedule for the entire day.• My schedule is very tight, and I do not have an assistant. So the one thing I would change is the length of time it takes for my dentist to examine my patients. Sometimes I have to wait 10 minutes or more, and then he sees it as an imposition. That wait puts me behind and my patients end up waiting. If this happens early in the day I’m behind the whole morning.• We need to make the patients and their health the most important consideration, not the "bottom line" and how much money can be squeezed out of patients.• I’d like the doctor to be on time in the morning and after lunch, and not wait until the last minute to come in the operatory to do an exam. It would also be good if he would roam the office more and stay in his office less. Our staff is generally very good, but if "the boss" were around, there would be so much more productivity and less chatting and eating.• There should be a separate appointment or room for all doctor exams. Anytime the doctor has to come into the room, it takes valuable time away from patients’ hygiene care.• The assistants need to be more understanding of all the things hygienists do in an hour and not resent when we ask for a bit of help or some clean instruments. The assistants run to the doctor all the time to complain. Shoot, we don't have time to even go to the bathroom, let alone time to gripe and moan!• I wish everyone would be considered an "owner" because there are too many employees who just don't understand what it means to run an office and keep it profitable. They seem to have “just a job” mentality instead of an "ownership" mentality.• I would like our employer to appreciate how hard her staff works for her. Instead of griping at us on the few occasions that we don't perform perfectly (and it is rare considering our patient load) a thank you or you're appreciated would go a long way.• We have one dental hygienist that feels she is above doing some of the shared tasks. She is not a true team player. If it were my decision, I would terminate her employment with us based on her inability to treat everyone equally and be a good team member.• I would change the dress code. We all wear uniforms. Some are so wrinkled that they look tacky even though they are clean. Some staff members look so great when they go out in the evening but don't bother doing their hair or putting on make-up for work. More effort needs to go into appearances. I realize that this is a touchy area and difficult to enforce. The worst offenders are excellent in their jobs.• I wish the hygienist would get paid vacation like the rest of the staff. The assistants and office staff get two to four weeks paid vacation. The doctor has never given paid vacation to the hygiene department. I've been here 18 years as a hygienist. He says it is just not his policy.• Wow, where to begin? I believe in being a hard worker and in helping people better the conditions of their mouth to make them healthier overall. Through the years, most of the people I have worked for think only of themselves, taking from the business and not putting forth the hard work it takes to make a business work. I have never dreaded going to work through my many years of hygiene, primarily because I know I am a good hygienist and I deliver a great service to people, but the drama of the office has got to go!• I’ve been in this job 28 years. It’s the same as in all offices. Dentists must realize that who they hire changes the way their practice functions. They must realize that if the person they hire doesn't have the desire and skills to perform the needed functions, this alters the care they can deliver. My employer has consistently hired simply to fill a position, and he hires people without the skills or desire to deliver good treatment. It happens in almost all offices. Dentists think of hygienists as tools, but they think they are all interchangeable. Their skill levels are vastly different.