Pennwell web 120 165

Has Hygiene Been Hijacked?

Feb. 22, 2010
Do the financial considerations managed by the dental office manager undermine the diagnostic goals of the dentist/dental hygienist team?

By Rebecca A. Claunch, RDH, BS

I have recently gone through the arduous task of credentialing for a license to practice dental hygiene in another state. This process is somewhat more grueling than I remember as part of my last three applications for dental hygiene licensure and so I began to think.

Who is really deciding how the dental hygiene profession is practiced and why? Gaining a license to practice dental hygiene takes stamina, effort, and verification of every aspect of life, career, and schooling. This brings to mind that this license is tough to get, tough to sustain and tough to understand how very demanding the profession of dental hygiene has become. Are the dentists and dental hygienists making professional judgments together or is the office “manager” dominating hygiene patient treatment determination?

Hygienists and dentists should work together as “hand in glove” leading to crucial communication between professionals. Unfortunately, often hygienists have been hijacked when office managers wield scheduling power making all patients fair game for the hygienist to treat. Searching out production goal dollars, quickly this paradigm becomes the standard operating procedure, ultimately steering the scheduling process. Office policy aimed toward dollars, develops into the status quo, bypassing the professional decision making process between the hygienist in collaboration with the dentist.

The dental profession should never become a one-size-fits-all machine pumping out monetary benefits. When an unlicensed staff member begins making assessments, usurping the conclusions of licensed professionals, concerning patient treatment plans along with unquestioned scheduling authority, it becomes unethical. The dentist sometimes willingly or unwittingly has handed over professional evaluation skills to an unqualified staff member. Is this meant to demean the profession of dental hygiene or is it stemming out of a greedy nature in order to GTM; get the money? Hijacking hygiene may have become a trend that devalues a worthy profession.

As a clinical professional working far too hard daily, seeing too many patients in the time allotted, out of control scheduling with a lack of consideration for patients or providers, greediness might be the culprit. Is the hygiene department suddenly the depot for all new patients, all x-rays, sealants, periodontal treatment, consultations/screenings, and anesthesia services (for all office patients) alongside any other treatments the hygienists can provide? Unfortunately, this is a model by which a hygienist is sometimes scheduled, all day everyday. It is back breaking and spirit breaking for hygienists. Every time a patient sits in an operatory, it must be cleaned and set up once again, by the hygienist working alone. Seldom do other staff members step up to help with such mundane duties.

There once was a time when professional standards related to treatment opinions were highly revered as dentists and hygienists worked together to plan treatment for individual patient needs. It now seems one size does fit all putting the patient in the position of simply filling slots required to reach production goals.

Hygienists working “under” GTM office managers are certainly demoted to the position of cash cow in the dental industry. Suffering the yoke tightening strangle hold of meeting nearly impossible daily production goals will assuredly take a devastating toll on professional staff. These practices are so physically, emotionally and mentally draining that it may be the basis for hygienists working part time or not at all, therefore never achieving the level of performance as an educated, trained professional. Dentists may enjoy monetary gains at the expense of hygienists but begin losing their own physical and emotional well-being. If the day is filled with chaos, frustration, and exhaustion perhaps the line has been crossed toward hygiene production at any cost.

Many times office managers have been given an inflated sense of self-importance when they are given “license” to set up daily production and treatment goals for hygienists. The object becomes reaching a targeted dollar amount daily which begins to trump all other priorities, come hell or high water. There is no concern for the overworked, frustrated dental hygienists, not to mention patients under their care. As the hygiene schedule changes moment to moment, this mantra is repeated daily in many offices; “run-run-run-hurry-hurry-hurry.”

Have you heard it, hygienists? It will wear you sick day after day. Do you find it interesting, that as you are breaking a sweat, the rest of the staff is laughing, talking on the phone, or enjoying a snack? While you are seeing a line up of patients, office managers will interrupt an appointment asking; “how much longer will you be?”

Squeezing patients into an already overcrowded day places unreasonable demands on any healthcare provider’s abilities. Does the rest of the staff look fresh and relaxed, while you are a sweat-bed with hair flying and mascara running? This scenario is much like beating a worn out plow horse and it plays out daily in dental offices.

Lacking the experience, training and understanding required to treat patients, office managers often do not understand the intricacies involved in the professional decision making process concerning the treatment of individual patients. The health and well being of hygienists, including patients, take a back seat to what is ethical, professional, thoughtful and right in the face of the dollar amounts produced from the hygiene department on any particular day.

Hygienists must stand firm on ethical standards when it comes to patient care needs. Learn to speak out, stay poised and set boundaries when scheduling is too demanding. Determining dental treatment based on a fee schedule is the basis for many problems. Hygienists are usually natural caretakers. They should be vigilant in assuring that ethics guide their clinical judgment concerning treatments rendered. As patients develop trust, feel cared for by professionals of the highest ethical character, they will return providing referrals of friends, family and co workers. Producing the dollars today may cause the office to suffer loss of patients, staff, morale and professional standards in the future. An ethical professional will be productive when given the means, necessary time as well as the incentive and proper working atmosphere in which to perform. Goals should be established but simply pushing a treatment agenda for profit is the mark of a self-indulgent mindset.

The moment office managers are given authority over licensed health-care providers in deciding treatment standards and scheduling; the battle has already begun toward maintaining a highly regarded professional dental business. High turnover rates will consume the office. Dissatisfaction rates will soar. Office conflict and poor atmosphere will engulf the work place. Professional staff members will seek out improved practice settings. Wonderful, professional office settings are abundant and those practices do exist. Most great working environments retain staff members for years thereby limiting that experience to few professionals.

Office managers ought to be working to enhance record keeping, insurance billing and the scheduling of patients as directed by dentists and hygienists. They are there to administrate office procedures and explain insurance benefits, not to be involved in clinical treatment decisions. If they are to be inserted into a position that gives them the power to deem how and what type of dental treatments are appropriated to patients, then certain educational, licensing, and dental board standards will no doubt need to become a part of their training and background.

Patients would likely agree when seeing a health-care provider that they do not expect the front desk person deciding on which treatment is in their best interest based on the production goal for the day. Most would expect a skilled professional deciding which treatment will be rendered without perusing insurance benefits or a fee schedule.

Working smarter not harder will enhance the dental profession. Hygienists want to “make money” for themselves as well as their dental practices.

Offering a professional dental hygienist the necessary time to utilize the educational background earned in treating patients will result in sound ethical treatments. Dentistry must work toward enhancing its professional standing by hiring and retaining well educated dental professionals always assuring ethical working conditions are in place. Monetary benefits will be attained in a principled surrounding. Dental hygienists can serve as a wonderful dental partner consistently reaping respect providing high quality care for patients. Hygienists may well be an avenue toward relaxing the strain put upon many dental practitioners if they are treated with the respect deserved as a licensed health care provider.

Reclaiming dental hygiene as a profession will be a struggle worth the effort. As professional dental hygienist’s we must come together to change this offensive situation. Has hygiene been hijacked? If office managers are in control of production and therefore scheduling patients in order to merely reach monetary goals; sadly the answer is likely yes.

Director’s Note: Natalie Claunch has been her daughter's proofreader; therefore, the above article was in her computer. Rebecca finished this article around 11 a.m. on February 5th, and passed away sometime after 5 p.m. that same day. She recently received her Bachelor of Science diploma from UMKC, which has set up a scholarship in her name. Rebecca’s mom knows that “she was on her way to accomplishing her goals.” To read more articles by Rebecca A. Claunch, RDH, BS, please follow this link.

Rebecca Claunch, RDH, BS, graduated from University of Texas Health Science Center at Houston, School of Dentistry, Division of Dental Hygiene in 1982. Ms. Claunch continues her education through UMKC School of Dentistry, Division of Dental Hygiene, with plans to pursue a Master's Degree. She is an advocate for distance education and degree completion.