Why the chameleon loses its tail

Sept. 1, 2006
A tale about dental assistants in the 21st century

A tale about dental assistants in the 21st century

By Cynthia McKane-Wagester, RDH, MBA

Dentistry is a complex business that has evolved throughout history with some peculiar twists and turns. From century to century, the image of the dentist has fluctuated . . . perceptions often colored by the presence or the absence of knowledge and technology, social needs and expectations, and additional variables influenced by economics, culture, law, and even politics. The image of the individuals who became a part of the dental profession in “supporting roles” has undergone similar permutations.

In the last century, for example, the informal assortment of aides and helpers’ training, education, and skills package was largely a matter of on-the-job training. This was structured as a sort of in-house apprenticeship designed to meet the specific needs of individual practitioners. Often, the same person was required to serve the practice in multiple roles - helping in the operatory, scheduling appointments, attending to billing, ordering supplies, and even cleaning the bathroom. Sometimes the dentist’s spouse assumed this role as a secondary career to homemaking.

If a practice grew, and the workload assigned to this individual became overwhelming, one or more additional people were hired to help out. Eventually, the amorphous “supporter” position was subdivided into differentiated roles. One person began to answer the telephones and schedule appointments, another attended to bills, and a third spent most of his or her time helping the dentist in the operatory.

As the 20th century progressed, the profession evolved and so did the training and education of the dental support team. Specialized training became the order of the day. Individuals with skills and education suited to a particular practice function replaced generic team members. What eventually emerged was a phalanx of supporters trained to work in specialized areas of the practice. Hygienists were sent to the operatory and clerical people went to the front desk, each assigned fairly specific and discrete job functions that rarely overlapped.

Also emerging and evolving within this new structure was the position of dental assistant, whose functions were somewhat less discretionary. This individual’s job description hovered between the operatory and other areas of the practice and frequently included peripheral “catch-as-catch-can” duties that sometimes filtered into the assistant’s domain because no one else had the time or inclination to deal with them.

In the current century, team roles and responsibilities have undergone new changes. Mega-practices with several partner dentists have become common. Moreover, as dental practitioners have begun to recognize the great power and potential of hygiene, hygiene departments have replaced single hygienists. As the functions of the front desk receptionist have become more and more specialized, front desk administrative teams have emerged to accommodate the need for financial coordinators, scheduling coordinators, and others involved in the clerical or business aspects of dentistry.

Somewhere in this mix are the dental assistants who continue to do their work in a sort of hazy background that is part of the team structure, but not truly part of the egalitarian team spirit that has evolved over time. For many dental assistants, the position is a stepping-stone to elsewhere (many dental assistants, for example, decide to go back to school to become hygienists or move on to practices that pay better). Dental assisting, even within the newly restratified concept of integrated teamwork, continues to lack the luster and star power of other positions, and many assistants experience the same frustrations once endemic among hygienists who tried to convince the dental world and their patients that they were capable of much more than cleaning teeth.

In most practices, in fact, it is still the dental assistant who is tapped to pick up the slack when someone is out for the day or if some peripheral task crops up during the course of routine duties. This individual is often selected as the most convenient “gap filler” to deal with those issues other team members are too busy or too important or too high on the hierarchical totem pole to handle. A sort of inferiority complex that makes it difficult for practices to recruit and keep exceptional people often taints the position.

What this means for dental practitioners and their practices is an unacceptable and dangerous obstacle to growth and productivity. It is a situation that is conducive to staff turnover, which is time-consuming and costly in any business. Dentists who recognize this also need to recognize that the antidote is to reassess the function and purpose of the dental assistants already in their practices, as well as those men and women who are enrolled in dental assisting programs and planning to enter the job market.

To do this effectively requires an objective review of what assistants are trained and educated to do. Qualified and competent dental assistants possess skills and knowledge of great value to patient care. They perform a variety of clinical duties, provide chairside assistance to the doctor, communicate with patients about home care and post-op instructions, maintain operatory equipment and inventory, and must do all of this with strict attention to OSHA requirements. Because assistants have primary contact with patients, they also develop relationships with patients that further the practice mission and goals. Frequently, it is the dental assistant who provides the reassurance and comfort that patients want and need before, during, and after a complex session in the operatory. In this alone, they are an invaluable asset to internal marketing.

Specific dental assisting skills cover a wide range of knowledge and expertise. The scope of these skills is enormous and this, indeed, may be the very reason the assistant is perceived and utilized as the practice jack-of-all-trades. The physical requirements alone are daunting. The position involves extended periods of standing, walking, stooping, and bending. Consider as well the manual dexterity required for participation in four-handed or six-handed dentistry, which also demands excellent eye-hand coordination, depth perception, ocular focus, close vision, color vision, and peripheral vision.

Dental assisting also requires radiographic proficiency, familiarity with laboratory procedures, and a broad knowledge of oral pathology, microbiology, pharmacology, and pain control. The truly effective dental assistant is well-versed in endodontic and orthodontic procedures, anatomy and physiology, medical and dental terminology, cosmetic dentistry, and ethical and legal issues relevant to the dental profession. He or she works with a wide range of complex technology, instruments, and devices that must be scrupulously maintained, understood, sterilized, and kept in good working order before, during, and after every operatory procedure. Consider, for example, the attention to detail required to master the diverse functions related to the intraoral camera, the laser, sedation, creating and fitting impressions, and digital radiography while simultaneously attending to the minutiae of cotton swabs, tongue depressors, and other “trivial” items that are indispensable but barely noticed - unless they are not at the right place at the right time. Add to this the tasks related to accurate recordkeeping and communication skills that must accommodate the needs of children as well as adults, and you are looking at an individual whose multiple skills and multifaceted range of knowledge is truly remarkable.

Ironically, it is this diversity in job functions and job components that make the dental assistant a prime target when something unusual or tedious and disagreeable must be performed in the practice. In some respects, the dental assistant can be analogized to those “trivial” tools of the trade - a sort of human cotton swab that is barely noticed unless it is not there.

Just as ironically, it is the excellent dental assistant’s most noteworthy characteristic that creates and nurtures this jack-of-all-trades impression. That characteristic is an almost innate adaptability - an incredible talent that most experienced dental assistants have honed and perfected. This adaptability quotient manifests itself in the ability to adjust to circumstances and exhibit grace under fire, cope effectively with schedule changes and equipment malfunction, and communicate with poise and aplomb with distressed patients, obnoxious sales representatives, or laboratory technicians - knowledgeably, professionally, and persuasively. Like a chameleon, the dental assistant is able to change from green to orange and back to green as needed.

This instinct for survival in a sometimes hostile terrain is nearly imperceptible and seldom appreciated until it goes missing through attrition, lack of appreciation, lack of proper remuneration, or demands that exceed human endurance and dignity. Unfortunately, too many dental practices fail to grasp that chameleons do more than change color. In a threatening environment, a chameleon exhibits a rather neat trick. If a predator or a careless but well-meaning human snatches at its tail, the chameleon has no problem shedding that tail and scurrying to safer ground, knowing that the tail (and all it implies) can be regenerated elsewhere. Without the proper motivation, appreciation, and respect, your own chameleon may do the same.

Cynthia McKane-Wagester, RDH, MBA, a practicing hygienist, is president of McKane & Associates, a full-service management consulting firm. She is the author of “Dental Hygiene: The Pulse of the Practice,” a book on the business of hygiene. McKane-Wagester is co-founder and director of the Chesapeake Institute for Dental Studies, an educational enterprise that promotes teamwork through the integration of clinical excellence with business principles. She can be reached at [email protected] or at (800) 341-1244.