When I graduated from dental hygiene school over 15 years ago, I thought I would spend my entire career in clinical patient care. My passion was working one on one with patients, creating a relationship of trust by educating them, encouraging them, and supporting them in their dental health. Over the last few years my entire mindset has shifted and instead of having passion for what I get to do and how I get to impact people, I find myself depressed at the current reality and the future of my profession.
I am not alone. The fire is close to being BURNT OUT, with no changes being made in sight. The chase of the all mighty dollar and the influx of private practices selling out to corporate dental offices, patients are more like cattle being pushed through as nothing more than a $ sign. The daily fights with dental insurance companies to cover obvious needed treatment care, only to be met with DENIED….please provide additional information, when your initial claim was sent with X-rays, intra oral photos, diagnosis, charting and everything but a blood sample that clearly shows the need for it. Add to that the unrealistic perception of what dental hygiene actually encompasses and the lack of respect from Dentists all over the US towards dental hygienist has me currently questioning the career I have felt called to.
All of this happening day in and day out has taken its toll on not only my body but my mindset too. I probably should try not to care so much, it‘s just a job….. right? The problem with that thought process is that when it becomes just a job, that would make me less invested in each one of my patients. Frankly, I can’t do that. I genuinely want to help every one of them, I want them to not only understand what is going on in their mouth but how that impacts their entire body. I want them to realize why waiting and putting off treatment can be detrimental to their goals in the long run.
1. Corporate Dental Offices vs Private Practice.
First, I would like to preface with just because an office is privately owned doesn’t necessarily mean they provide quality dental work. Same goes for corporate. Here is what I have personally seen with the increase in corporate offices in the dental industry. This is strictly my opinion….. after all it is my blog. LOL.
Corporate offices are owned by investment corporations, meaning that their end goal is strictly monetary. In these practices dentists & hygienists often get commission based on sales of the products and the treatment they provide. The more services they provide the more money they make. Often times this leads to unnecessary treatment being done and then due to limited time constraints often leads to rushed, poor quality work resulting in sub par patient care. They are often times "IN NETWORK" with multiple insurances and offer subscription programs like “FREE WHITENING FOR LIFE” or “XRAYS, CLEANINGS & EXAM FOR ONLY $99”and they have late hours and weekend appointments to be able to treat a lot of patients. These practices also usually have 4+ dentists working there, along with multitude of different specialists so that everything done can be kept in house. These leads to higher production and higher monetary earning power.
Patients think because an office is ”IN-NETWORK” than they must provide quality work. The problem is most patients have no idea what quality work actually looks like, and at what cost IN NETWORK can come at. Patients assume if at the end of their appointment it ”looks pretty” to the naked eye and "doesn’t hurt", it’s good work. Also there is a lot of bait and switch to just get patients in the chair. In corporate dental offices, the dental hygienist can expect to see double the amount of patients, a typical private practice would see in the same amount of time. This means shortened cleaning appointments, assisted hygiene ( a dental assistant will usually take the x-rays and sometimes polish and floss the patient and the hygienist comes in literally to just provide the cleaning.) How do you create a level of trust or a bond with someone when you have 15-20 min to clean what takes me 45 min-1hour to do a thorough job of charting, educating, cleaning etc. This not only does a number on the body and lead to higher rates of burnout, but often times just because a hygienist is seeing double the patients doesnt mean they are getting paid double.
2. Dental Insurance Companies - AKA The Joker
I hope I can say this clear enough for the people in the back, dental insurance is a DISCOUNT program. They do not cover claims like medical insurance and their payout to dental providers who are IN NETWORK are extremely low. Which is why most private practices are forced to go OUT OF NETWORK, just to be able to keep their doors open. The people who are approving or denying these claims are often times do not even have a dental background. Add to that a x-ray is 2 dimensional image of a 3 dimensional object. It does not tell the whole story.
Recently I had a patient come into my practice. It had been many year since his last cleaning and he had heavy tarter present EVERYWHERE. Let me give you a quick peak into dental education. When you stick a dental probe into the gum tissue to measure for bone loss and the probe hits tarter before it reaches the bottom of the pocket, the depth you get will not be accurate. Often times I will re probe at the end of the cleaning to get accurate pocket depths. This cleaning ended up taking me over 2.5 hours due to the tenacity of the tarter and I was running extremly behind on my next patient who had already been moved down. Due to my time constraint I opted to re probe when the patient returned in 6 weeks for his follow up appointment, only he never returned and rescheduled multiple times. In that time his insurance has now denied the claim and I have sent multiple appeals.
" Fun Fact.... It is NOT the responsibility of the provider to make sure your claims are covered. The agreement is between you and your insurance company. We send appeals on your behalf as a courtesy. It is our responsibility to submit accurate claims with correct codes and diagnosis."
The patient is now upset because what he thought would be covered, his insurance denied....... side note we provide estimated cost of treatments PRIOR to you receiving your treatment. We NEVER guarantee that your insurance will pay that it is only a guesstimate based off of the information your insurance provider gives us. Truthfully I don't blame him but regardless if it's a covered procedure it would not change my standard of care.
3. WHAT'S WORTH THE FIGHT?
In 2020 with the pandemic, the dental hygiene field saw it's greatest loss with dental hygienist all over the country leaving the clinical setting in mass numbers. The demands of Covid, patient care and maintaining self preservation many hygienists no longer felt it was worth it. Due to this shortage, the hygienists remaining in the clinical setting re evaluated their worth and started demanding higher wages to keep up with the ever increasing patient numbers they were now having to see. In fairness where most jobs often times get yearly raises or evaluations, I often find myself having to beg for a raise and prove my worth. In years passed I had one employer offer me a 25 cent raise on my hourly wage....... 25 CENTS!!!! That was a punch in the gut, especially because I feel I am 110 % employee. I arrive early, stay late, am a team player, take initiative and rarely call in. My production numbers are high and my patient retention is 98%, yet somehow even with employers appreciating my hard work it is never showed monetarily.
Instead of paying hygiensits their worth, many dentists decided to cut corners and start having their dental assistants clean teeth. Besides the fact that 1) this is illegal 2) unethical and 3) morally wrong........ the person who LEAST benefits from the arrangement is the patient. Dental Hygiene is not one of those things you can bring a person in off the street and train on demand. My 4 year education was grueling not to mention the 2 state board licensing exams I had to pass to prove I was proficient to work on people. After all you are paying for a dental hygienist knowledge and expertise, would you know if your provider was licensed or not ? I keep a copy of my license on display in my operatory as required by state law for patients to see, but in 15 years i have never had a patient actually ask to see it. We have become a society that assumes if you work in a certain setting you must be a licensed professional and that is just not the case. This goes for the medical field as well.
I say all this to bring to the attention patients, a world they have probably never thought twice about. Some people still have the mentality that "I just clean teeth" and that couldn't be farther from the truth. Yes, I clean teeth, but I also assess your current dental health status, look for signs of infection, correlate your medical history to your current dental state and educate you about where those intersect. While I too want to make sure everything "looks pretty" in your mouth it is what's below the surface I also want to make sure is healthy and there are no underlying issues or causes for concerns you are possibly unaware of.