The shift in dentistry from single owner practices to corporate offices is apparent in the dental world and also virtually on various dental message boards. A recent Facebook group post created a whirlwind of comments about the overall business of dentistry. Many hygienists wrote about their employment woes including the rise in corporate dentistry.
I was inspired to learn more about why corporate dentistry is more prevalent and how dental hygienists feel about working in that type of setting. According to the Academy of General Dentistry a “decreased utilization of oral health care services, preceding and exacerbated by the Great Recession of 2009, has reduced opportunities for graduating dental students to find jobs in traditional solo or small group dental practices.”1
With the overhead of a practice being close to 90%,2 including salaries, supplies, rent, bills, and dental insurance write-offs, this leaves next to nothing for a practice to grow and thrive. Dentists receive little training on the business side of dentistry while in school, which has opened a door for dental management companies to come in and help run their practices.
Corporate dentistry has found a place in our society because of the cost-saving measures it has, a number of patients they can see daily, a number of insurance companies they are contracted with, and the fees associated with treatment. Corporate dentistry has affected the lives of patients and the dental professionals who provide care to them.
What hygienists don’t like about corporate dentistry
In a survey conducted of 61 dental hygienists throughout the country, who have been or are currently employed in corporate office, 60% stated that licensed dentists own their corporate offices. The requirement of dentists to be the only owning bodies of dental offices is a ruling created by some states so that corporations cannot influence the care given by licensed health-care professionals.
With that being said, a majority of the responding dental hygienists (60%) have/had office managers whom they feel influence the care that they provide to the patients; 37 out of the 61 surveyed also stated that the office managers do not hold dental licensure and are dictating the procedures they perform.
Many of the respondents who felt that decision-making opportunities were limited stayed in their positions for short periods of time due to issues with patient care. They felt that excessive treatment plans were pushed onto providers and to patients to create production by nonclinical staff.
One reason for leaving these practices includes prophy procedures being given to assistants who performed coronal polishing only — a procedure patients loved because of its gentleness and quickness. Some felt that the time allotted for procedures did not allow for thorough work to be performed with one hygienist citing an example of a four-quadrant full mouth scaling and root planning procedure having to be delivered in an hour. Another hygienist was told by her office manager that if she picked up a scaler the procedure was no longer being charged a prophy fee but periodontal fee instead.
Working conditions were commented on in the survey as well. Many felt micromanaged and were often reviewed and evaluated on their performance by nondental personnel. Hygienists stated that raises were based on production from a schedule they had no control over and cited that they were scheduled multiple DMO patients and Groupon coupon patients, and felt that they were being set up for failure by their office manager.
Burnout is due to seeing 16 to 20 patients a day without an assistant or breaks created high turnover in the office; 59% of survey responders did not feel that they were viewed as professionals in their office. Almost half of the hygienists surveyed were told to clock out during the hours they were hired to work when patients failed to show for appointments.
What hygienists like about corporate dentistry
While many responders felt negatively towards the corporate offices they work(ed) for and the working conditions that they experience(d), a few had very kind words for their office managers, doctors, and the corporation as a whole. Those who had positive experiences with corporate dentistry stated that:
- They “love it”
- There are “many people above me that manage”
- They felt that they had “autonomy regarding our treatment”
- There was “no interference from office staff.”
- Being able to get full-time hours and benefits are pros to working in a corporate office. One hygienist “love(s) the standards and the structure” of the corporate organization and felt that having an HR department was a plus, too.
As any researcher is required to do, I must disclose that I have worked in both private and corporate dental offices. There were times I encountered these negative experiences in the corporate office in which I worked. My particular corporate office took me from excited and motivated to work with a dentist I respected to riddled with panic attacks and burnt out in six weeks flat. The day I gave my four weeks notice was a day I felt empowered and professional again.
Upon reflection, I realized that the relationship with that office and its personnel was doomed from the beginning because I didn’t have a corporate mindset.
The corporate world has invaded dentistry, and we must begin thinking of ourselves as business men and women. These results of this survey have brought to light many issues about the employment of hygienists. Many of us interview for positions and agree to work with a handshake. Those days are gone. Hygienists should demand to be viewed as professionals with firm employment contracts including the hours hired for, maximum patients are seen per day, daily breaks, consequences of patient failure, PTO, and yearly reviews.
While this survey was not scientific, but merely a list of questions asked of hygienists throughout the country, it did satisfy my curiosity about the thoughts hygienists have about corporate settings. I also realize that many of these questions could have been asked to private practice dental hygienists, and the answers may have been the same. There are good and bad practices everywhere.
Corporate offices are here to stay as they supply a much-needed service to a population that is living longer and who are retaining more teeth as they age. This requires access to affordable care, which the corporate offices can supply.
Hygienists have the power to provide preventive dentistry to those patients in any type of office we wish to be employed. We must understand that we are providers of patient care, not just hands that perform tasks dictated to us by the business side of the office. We must advocate for our rights as valued employees and for our professional scope of practice through any avenue we can whether it be through our association or other dental hygiene advocacy group. The business of dentistry is changing we need to change along with it.
Christa Crilley McConaghy, RDH, PHDHP has been a licensed registered dental hygienist since her graduation from Montgomery County Community College in 1996 and has recently received her bachelor’s in oral health-care promotion from O’Hehir University in 2013. Her career goals are to improve oral health care by implementing disease prevention programs into offices and help dentists realize the potential their dental hygiene department has on their practice through clinical and consultative services and through her website www.opencontactdental.com.
- Brown, DMD, FAGD, W., Armstrong, DDS, MAGD, C., Bromberg, DDS, M., Dycus, DDS, MAGD, R., Hardesty Jr., DDS, FAGD, W., & Radjabli, DDS, E. (2013). InvestIgatIve Report on the Corporate Practice of Dentistry. Retrieved May 29, 2015, from http://www.agd.org/media/171772/corporatedentistrystudy.pdf
- Practice expenses should include owner dentists' salaries, CDBP says. (2013, April 15). Retrieved May 29, 2015, from http://www.ada.org/en/publications/ada-news/2013-archive/april/dental-office-overhead