Tuesday, October 27, 2015

Dental Hygienists Struggle In Corporate Dentistry

Deborah Lynn Malone StewartDeborah Stewart is a dental hygienist, author, mentor, office manager, coach, consultant, and popular speaker for dental hygiene schools. She holds degrees in dental hygiene, organizational behavior and coaching as well as an MBA. She is author of the 2014 book Perspectives on Dentistry: An Insider’s Guide to the Professional Business of Dental Hygiene (available here).

Deborah passionately promotes collaboration, ethical standards, and high achievement in both hygienists and the dental industry she loves. A proud member of The Daughters of the Republic of Texas, she is also an historian and a civic and community advocate. 

What Do Dental Hygienists Do to be Employed?
by Deborah Stewart

North Texas, the area where I live, was once roamed by Frank and Jesse James, and home to one of the top ten feuds in American history. The Lee-Peacock Feud was a continuation of the Civil War. North Texas was very prosperous with cotton agricultural growth after the Civil War, so a feud developed whether North Texas would continue to have slaves. Fighting a Civil War apparently was not enough for the additional 200 lives that were killed in the feud. 

To say North Texans are a bit hard headed is an understatement.  

One hundred fifty years later, North Texas dental hygienists are fighting another war. Striving to maintain respect for their profession, they fight the battles of what preventive dental hygiene services are to be performed and how they are to work in dental offices. Faced with very few options, what allies do dental hygienists develop in this fight to stay employed? 

What is obvious is disrespect and disregard for the dental hygiene profession by Texas dentists. This behavior by dentists provided a growth opportunity for corporate dentistry business models.  

You don’t have to have multiple offices and a logo to become corporate dentistry, you just have to have a mindset of disrespect. Texas dentists began disrespecting the profession of dental hygiene in the 1980s when the Texas Dental Association (TDA) decided that the Texas Dental Hygiene Association (TDHA) needed to have their own convention.

Since then, the industry has progressed to a corporate way of thinking that now thrives in North Texas. The “dental business” has a checklist for employment of dental hygienists.

Those items include: 

       1)  Businesses will set minimum production dollars per day 

       2)  “CREATE URGENCY” to pressure patients/parents to consent to procedures immediately

        3) Identify 3 patients that need SRP each day 

        4) Use intraoral camera to identify 3 patients per day that need dentistry with $1200-1900 per day. 

        5) All patients seven years and up need an orthodontic appointment    

        6) All patients 14-20 years of age need a wisdom tooth evaluation 

        7) All patients requiring Scaling and Root Planing (SRP) need to be referred to in-house Periodontist 

        8) Call 5 people per day to come into the clinic for treatment

        9) Clean the bathroom 

       10) No employment benefits with longevity  

       11) Hiring through temporary employment agencies; having no intention of providing full-time employment 

       12) Abusive employment policies.

Does anyone think this list of job duties is appropriate?  

I worked as a dental hygienist for twenty years and then as an oral surgery office manager for twenty years. Never once did the dentist or oral surgeon require me to create urgency with the patient to perform dental work, but in 2009, I witnessed a change in the weather.

Every year, the employment conditions for employees became worse and if any one of us were faced with the above checklist as a young dental hygienist that needed a job, then you would make the decision to conform like the form of  slavery after the Civil War in North Texas.

In all the years of working, even as a supervisor of others, I was never required to clean nor did I require my team to clean the bathroom. If dental hygienists are relegated to just being a subservient that “sets up” the patients for the dentist to oversell unnecessary dentistry, then they will never reach full potential nor ever be considered a member of the team much less a colleague. In fact, no one will reach full potential, not even the dentist. What has caused these poor work conditions to develop? 

I am concerned with the adversarial role that the Texas Dental Association has developed with the Texas Dental Hygienists Association.  My initial experience  after graduation with both TDA and TDHA was very positive with meetings held together where hygienists and dentists studied together as colleagues.  I loved  being a delegate to the TDHA meetings when the TDA and TDHA conducted meetings together in San Antonio at the State convention in May, but then the TDA decided that the TDHA needed to have their own convention.

Therefore, the TDHA convention moved to San Marcus. That decision, in my opinion, created a weakness for corporate dentistry thinking to pit dentist and dental hygienist against each other. Since 1980s we have trained thousands of dental hygienists and dentists to not work together when they need to work together in private practice to be a viable business model. Labor laws and employee taxes are being exploited by Texas dentists, and the ruling that allowed dental assistants to coronal polish has not increased jobs for dental hygienists.

Additional, the idea of preceptorship—where people are trained in the office—has serious implications for the public. Training has obviously gone underground with two people arrested in North Texas area for practicing dentistry without a license. Serious problems require allies, and the TDA and TDHA must work together with the Texas State Board.

The culture of dentistry needs a massive overhaul.  

Two bills were introduced to Texas legislature this past session concerning expanding scope of practice for dental hygienists. Bills 1409 and 1940 were kept
in committee because the TDA “asked” dentists to contribute one million dollars in PAC money with the sole purpose to keep these bills in committee so they would die. 

The Senators and Representatives that sponsored the bills tried everything in their power to get these bills out of committee and identified the TDA as the organization that was defeating their efforts. Politics of a “bully nature” doesn’t set well with this seventh generation Texan. Does anyone think this behavior is appropriate leadership by the TDA?  

That amount of money would be better utilized to provide advanced training on dental procedures or study the tremendous amount of Medicaid fraud that is rampant in dentistry.  Medicaid fraud has become a very lucrative business model for dentists and investors. 

Does the TDA just overlook the fraud problem? How does the TDHA counter balance the massive amounts of PAC money to reason with TDA concerning bills which have been approved in other states for over thirty years?  

Local Anesthesia and expanded duties by dental hygienists have been successfully integrated into the other forty-nine states with schools of dental hygiene, so why not Texas? 

As with all great wars, a battle plan is prepared and allies are engaged. The Lee-Peacock feud ended with an intervention of the United States Calvary. Texas began to see positive changes in the 1890s—thirty years after the Civil War.  

Each dentist and dental hygienist has to make the decision if we are going work with the above checklist.    

This is not the dental checklist nor opportunities that I want to pass on to the next generation of dental hygienists and dentists who are presently being educated at our twenty-two schools of dental hygiene and three schools of dentistry.  

Providing quality dental care to the citizens of Texas needs committed leadership with dedicated and ethical dentists and dental hygienists respectfully working together.  

It is also a time for equally respectful leadership provided by the TDA and TDHA; which supports the Standards Of Care of the Texas State Board of Dental Examiners.