Practice Makes Perfect

I’ve said many many many times that the doctor makes their practice and that it doesn’t matter if you work with one, with three, or for a DSO: the doctor sets the tone. Period. I would even venture a guess that this is true for non-dental offices as well but I’ll stick to what I know best for now.  Recently I read an article from Modern RDH discussing why private practice dental offices were a preferred work atmosphere (over group practices).  I was genuinely disappointed in the article for several reasons: first, it listed only two benefits for private practice over group practice – paid office vacations and hefty incentives; second, there was also no definition of group practice which makes it difficult to determine what venue is actually being discussed; and finally, it addressed mostly superficial work environment “benefits”.

For the purposes of this article, private practice refers to any office that has a dentist as the sole proprietor with no more than two office locations; group practice refers to any office that has up to three dentists as proprietors regardless of locations; and a DSO (dental service organization) is any office that has outsourced human resources in an attempt to provide clinicians the opportunity to focus on clinical practice (this is also called “corporate” dentistry but that term is a misnomer).

In full disclosure, I have been happily employed by a DSO in Indiana for nearly ten years.  Through my involvement in the state dental hygiene association, I maintain healthy relationships with dental hygienists that work in private practice, education, public health, etc. and through previous employment I maintain healthy relationships with dentists and specialists that are not affiliated with my DSO employer.  In the last five years I have also been employed as a didactic and clinical instructor in a dental hygiene program and as a continuing education speaker.

I decided to dive a little deeper and here is what I found:

What’s loved about private and group practice:

  • Longer appointment times: a large majority of my peers schedule their hygiene recare appointments for 60+/- minutes giving them ample time to treat the patient in their chair.
    • This also helps with another key item to love –> less fatigue: mental, physical, emotional … longer appointment times = fewer patients in a day.
  • Flexible hours: looking for work-life balance? Right here. Only want to work part-time? Excellent.  Like having weekends/holidays off? Check.  There are hygienists that like working in two or three practices or enjoy irregular work schedules – and private practice definitely has that.
    • This is also a benefit if all you want to do is “clean teeth and go home” – you don’t have to get any more involved in the office than the patients.
  • Long-term patients: Before I graduated from dental hygiene school, I went to the same dental hygienists and dentist for 15 years.  Her name is Wendy and we’re now colleagues.  There are many reasons for this in to be more common in private practice over the alternative practice models and I consider it a benefit.*
  • (Group) Multiple dentists.  The benefits to having more than one DDS to learn from and work with are invaluable when looking to create long-term partnerships. My top three in this category:
    • Interprofesional collaboration and accountability
    • Leadership personalities and team expectations
    • Second opinion patient options

What’s loved about DSO

  • Guaranteed hours: I have real-life adult bills. Student loans. A car payment. More student loans. Mortgage. Children. Etc.  What’s the point of college if you can’t earn any money with your very specific degree?  I was hired for 32-40 hour work weeks – and that’s what I get.
  • Community: Although participation in ADHA and IDHA provide me with networking and community, if I wasn’t a member (who are we kidding that will never happen 🙂 but if it did), I imagine my DSO colleagues would be my go-to community for questions.  For the longest part of my career, I worked as a single dental hygiene provider and I needed other clinicians.  The DSO is one way to do just that.
  • Autonomy: Modern RDH did mention this but I think it warrants a slightly deeper look – specific to dental hygiene treatment planning – while we cannot diagnose, many of my DDS colleagues look to their DH for hygiene treatment planning.  This level of autonomy and collaboration during the patient appointment helps prevent my least favorite chair side activity: bloody prophies 😦
  • Career Advancement: Did you know that in Indiana 96% of the over 5,000 dental hygienists work clinically? 96%!  Want to know why?  There aren’t any other options.  Yes we have DH educators, researchers, entrepreneurs, etc. but 4% isn’t a large enough % and some of these options may require additional education.  Moving up in a company that already recognizes your value may be a welcome reprieve for a dental hygienist wanting to transition out of clinical practice.
  • Benefits: free CE (that you get to keep), insurance, PTO, 401K, etc.  The workforce in dentistry is changing. A significant number of new graduate dental hygienists are non-traditional or second-career graduates.  Some of the benefits that non-DSO practices offer are not a priority to these student or their traditional student peers.  For me, I went a year without health insurance and am now the subscriber for my family of 4 because my husband’s employer is employee only.  These benefits were important to me as a traditional student and are important to me as a wife and mother.

What’s not to love about both:

  • Dental hygienists not able to work to the top of their license.
    • We are LICENSED professionals and in most settings we are under direct supervision to perform job duties we have proven many times we are capable of doing.  While I fully respect my DDS, their education, and the very healthy employer-employee relationship we have, we both agree they have many hygienists employed that are more than capable of treating patients without direct supervision or prior authorization for services.
  • The ideology that dental hygiene therapy is expendable – even by some of our DDS colleagues.
    • Pain management, dental hygiene therapy, restorative.  Why are there any exceptions to this?
  • The inability of dental hygienists to diagnose.  See above 🙂
  • Career burnout. Sometimes, as much as I love clinical practice – I do not want to scale/polish/floss another tooth.  Ever.  Again.
    • Did you know that in Indiana 96% of the over 5,000 dental hygienists work clinically? 96%! Want to know why?  There aren’t any other options.  Yes we have DH educators, researchers, entrepreneurs, etc. but sadly, they only represent 4%.  96:4 isn’t a large enough distribution of dental hygienists in Indiana.  Expanding scope of practice, exploring alternative practice or non-traditional settings, and pushing to have dental therapy a higher priority are hopefully on their way here.

One thing is certain: I can’t disagree with the conclusion of the Modern RDH article: Know your worth.

As a dental hygienist, you are a LICENSED dental practitioner and an ESSENTIAL primary care provider in the health care delivery system.  As health care changes, dentistry progresses, working to the top of our license will become a reality and not a dream.  It won’t matter if it’s private, group, or DSO practice – because at the end of the day, we can talk about flexibility, benefits, hours, etc. – those things pale in comparison to finally providing access to dental hygiene care for all patients when we are truly able to know our worth.

Dental hygiene associations are working on these issues that hygienists face daily – but they need your help.  And your membership.  It’s not easier than ever to maintain your membership, stay in the know, and be part of the movement to help hygienists recognize their worth.  You can become a member here: quarterly dues are roughly $75: and membership gets you FREE continuing education at your local dental hygiene meetings (as well as other benefits).

What do you love about your practice setting? If it were up to you, what would you change? Let me know in the comments!

Here is an excellent article from the ADA on group practice definitions:  http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0214_2.ashx

Here is the original article from Modern Hygienist:  http://www.dentalproductsreport.com/hygiene/article/you-choose-private-or-group-practice?page=0,0

 

*That’s not to say that in group/DSO practices patients don’t stick around!! We’ll touch on this again in a later blog 🙂

 

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