Dental apocalypse? The dentist’s role in team education and team building

March 31, 2011
Today, several states are contemplating granting hygienists licenses to open their own hygiene practices without any supervision from or affiliation with a dentist. Dr. Charles Samaras asks, "Is anybody actually thinking of our patients?"

By Charles D. Samaras, DMD, FACD, FICD

Today, several states are contemplating granting hygienists licenses to open their own hygiene practices without any supervision from or affiliation with a dentist. Even more incredible is the Minnesota legislature discussing a pending bill that would allow hygienists to perform extractions and dental fillings without the presence of a dentist.

These examples remind us of when we heard in the news someone doing something incredibly stupid and we said, “What were they thinking?” Is anybody actually thinking of our patients?

The rationale is that hygienists would be able to treat the underserved. How do you perform ANY treatment without a diagnosis? How do you perform any procedure without the proper education and training? To me, treating a patient without a diagnosis gives true meaning to “underserved.” Performing a procedure on a patient without the proper training is malfeasance. As I have stated many times, dentistry is about treating people, not fixing teeth! It is also about providing clinical excellence and excellence of service to every patient, every visit, every procedure.

Simply stated, patients deserve our best. Is this our best? How can it possibly be in the best interest of patients? I believe dentists have to take some responsibility for not only the current state of affairs, but also for the future direction of dentistry and dental education of the dental team. Without direct involvement in education, I believe patients will not be the beneficiaries of the excellence they deserve.

The apocalypse
The word apocalypse leads one to think of a cataclysmic event. I believe this will be true for patients if the proposals mentioned above come to fruition. However, the true meaning of apocalypse in Greek means an unveiling or revelation. The revelation for dentists is that we have squandered our opportunity to demand excellence from team members and abrogated our responsibility to educate them. In part, it is because we were never taught any practice management during our dental education. We never learned to create a dental team and inspire team members through leadership and education to be the best they can be for the benefit of patients and the practice.

In essence, we did not value the impact great team members have with respect to patient service. What is even more troubling is that we dentists did not hold ourselves responsible for setting high standards for team members, and holding team members accountable for maintaining those high standards. All too often we have accepted the “warm body” mentality for filling a vacant team position because we felt we needed someone to get by and thought a warm body was better than nothing.

However, how does a warm body benefit the patient or practice? Does the person provide clinical excellence or excellence of service? Or is the person simply putting forth minimum effort, punching a time clock, and collecting a paycheck? Are these mediocre team members really part of the team and practice? The answer is obvious. The truth is that many experienced dentists have been able to have a pretty good career, even with a mediocre team, because it was what patients were used to. Many older patients remember going to the dentist when there was only the dentist, a receptionist, and a “helper.” Many dentists have grossly underestimated the value of well trained, service oriented team members.

Today’s 21st century dental practice team must be more than just ancillary help. Mediocrity will not suffice in the future. Today’s dental patients are much more educated about dentistry. In fact, they are becoming dental consumers. These patients change everything! Due to increasing overhead, rising prices for materials and technology, and skyrocketing increases in salaries and benefits, successful practices will be directly related to patient benefit and patient service. This will be especially true for new dentists who are starting practices with excessive debt from their educations. For them, there will truly be a revelation. They will require team members who are dedicated to providing dental services for the benefit of patients. By patient benefit, I mean the provision of excellence. The only way to provide excellence is to demand excellence from our dental teams and ourselves.

The only way to achieve excellent dental team members is to be directly involved in their education, training, and vision. This training must involve not only their dental education, but also their training in being part of a dental business as well as practice. Successful businesses are about great product and great service. Successful dental practices are about dentists and team members/business partners working together to provide excellence. We must also demand excellence from each other and be held accountable if we do not meet expectations. The only way to hold ourselves and our teams accountable is for all of us to be part of the business. Dentists should heed the words of the immortal Gerry Glanville — “This is the NFL, which stands for Not For Long.” No more salaries for a mediocre performance. As the practice goes, so does the sharing of the profits. It is my belief that without a shared vision, education, accountability, compensation based on performance, and a stake in the practice, team members will never be part of the team and patients will not receive the best treatment.

I also believe this is part of the reason we have before us the two situations I mentioned in the first two paragraphs. If these two propositions come to fruition, the revelation will become the connotation of the apocalypse for our patients.

The solution
The solution to this state of affairs is simple, but not easy. It is not easy because change is difficult and uncomfortable. However, there must be fundamental change by all parties. If the best interest of dental patients is to be treated by dental teams with the highest standards and accountability, there must be a fundamental change in the way we educate our dental providers. There must also be change in the way we create, inspire, direct, valuate, and compensate our dental team members. The first step is for dentists to become leaders in dental team education, because for too long we have abrogated not only our responsibility but also our opportunity to provide direction, guidance, and real world experience in the education of hygienists, assistants, and managers.

The education of these dental team professionals has been riddled with politics, mistrust, and animosity toward dentists, with an “us vs. them” mentality. In truth, some animosity is justified. We did not consider the value of team members because if we did, we would have worked in concert with them instead of dismissing them as “ancillary personnel.” We should have stated the case for including not only our dental knowledge, but also our mutual goals of excellence in patient service. We could have gained the respect necessary for optimum education and practice excellence.

At this point I feel strongly that we dentists should demand to be part of this process. How else can dental team members develop any sense of team without direct input from the leader of that team? How can they learn about the vision of a dental practice without input from practicing dentists? How can they develop the high practice standard that not only has to be met but maintained? Is that not the only way dentists can demand excellent team members? I am not implying that current team education is not at a high standard. I’m saying it can be better with education from real practice experience and guidance. Real education must simulate real life. I believe that dental team members want vision and leadership from the leaders of the practice. Therefore, the time for politics, mistrust and animosity must come to an end! The benefit to the patient, the practice, and dentistry is paramount.

The second change is the necessity to educate dental students and all dental team members together, not separately. How can we ever expect all of us to work together for a common goal and mutual vision if we do not learn together? Learning together not only facilitates a common vision and purpose, it fosters mutual appreciation and respect and promotes a team effort for the ultimate goal — the benefit to the patient and the practice. The education process must continue through the years of the practice if the entire team is to remain focused on the provision of excellence for our patients. For the existing dental team that is past the initial institutional dental education period, the dentist must take the leadership role in continuing education. In the future, I recommend insisting that team members progress in their education as dental providers. In other words, certified dental assistant degrees should be a prerequisite for certified dental hygienists. How else would they be able to inform and educate our dental patients about dentistry? They must be knowledgeable in more than hygiene.

The same holds true for our certified dental assistants. They must be part of the patient education process. Another consideration is for our dental managers to have a degree and working experience as a dental assistant. I believe these people make the best managers. Managers must have a command of dentistry, not just office work. This type of highly trained, multitasking, and motivated dental team is paramount for the patient experience of excellence.

Finally, we cannot continue the present system of financial remuneration of dental team members by the hour or fixed salary. This system only fosters mediocrity. Now, I know there are many team members who work hard and are dedicated to patient care. However, there are too many team members who are “mailing it in.” These are the warm bodies I mentioned. They do not contribute to excellence in any way. In fact, they prohibit it, and they detract from the really great team members. Paying by the hour or base salary only enables this to continue, and in some cases proliferate throughout the entire team.

Dentists and great team members must develop the “NFL” mantra, but not for long if you are not the best! If you are the best, then you should be financially compensated. That is why dentists must rethink how team members are financially compensated. I think great teams should have a stake in the business. Yes, they must have a base compensation, however, if the practice is providing excellence and is financially rewarded for that excellence, then team members should share in the revenues. There is not a single way to share the rewards. Each practice can devise their own system. But I believe it is the only way to attract and maintain the best team members in dentistry.

In addition, team members will demand other team members to commit to excellence because their success is interdependent. Clinical excellence and excellent patient service are accomplished only when a team functions as a team. Having a stake in the financial and professional success of a practice will empower winning teams to win! Now, imagine if we can instill this attitude to all dental care providers during the institutional education degree process.

Fundamental change is required if a dental apocalypse is to be averted. Our population cannot fall victim to any dentistry or service that is not excellent in every way. The revelation is that dentists must not only take an active role in the education of dental team members, they must demand to be part of the process. They must demand that all dental care providers be educated together to promote the mutual appreciation and respect necessary to provide excellence for patients. Change is also necessary in how dentists value their dental teams. Team members must evolve from a staff of workers to a team of professional business partners dedicated to practice excellence.

However, change is difficult and uncomfortable. But, as I learned for Linda Miles, “If you do not change you will not grow!” If we do not grow, dentistry will truly find itself in an apocalyptic situation.

Charles D. Samaras, DMD, FACD, FICD, practices in 21st Century Practice Solutions. He can be reached at