"Hygienist Practitioners"

[mike3kgt]

This Hygiene Practitioner program keeps gaining momentum.

http://www.adha.org/news/11032005-adhp.htm

While it does not even begin to imply ratification, senators just do not understand that allowing a hygienist to perform a pulpotomy would be a BAD idea.

Just let them stick to scraping plaque off of teeth.

-Mike

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[aphistis]

Dental hygiene, as a profession, seems to be spending a lot of time & energy on developing this delusion that hygiene deserves somehow to be independent of dentistry. Exactly what they're basing this on, I haven't figured out yet, but judging from the ADHA website it appears that the oppresion of proletariat hygienists by the bourgeoisie dentist swine is the gravest injustice alive in the world today.

Hygienists are invaluable for providing preventive & other services in the dental office setting, but only under appropriate supervision. The ADHA can gripe & moan about "advanced dental hygiene practitioners" all it wants; in the meantime, I'll continue trusting my health to doctorates, not associate's degrees.

 

[drhobie7]

OK, I'm gonna say it and maybe I'll get some crap for it, but I don't care. Hygienists are grossly overpaid. In many parts of southern CA they get $400-500/day! That's the starting salary for many general dentists! They don't even need a college degree. It's a 2 year associate degree. I'd say pulling $100,000 a year for only doing 2 years after high school is pretty damn good.

Expanding their scope of practice into clinical decision making is dangerous.

 

[eddyRDH]

OK, I'm gonna say it and maybe I'll get some crap for it, but I don't care. Hygienists are grossly overpaid. In many parts of southern CA they get $400-500/day! That's the starting salary for many general dentists! They don't even need a college degree. It's a 2 year associate degree. I'd say pulling $100,000 a year for only doing 2 years after high school is pretty damn good.

Expanding their scope of practice into clinical decision making is dangerous.

I am an RDH going to DDS, and we are not grossly overpaid! Think about what you are saying...... Where I work I am paid salary $240 per day ( $30 per hour in VA) , prophys are $58, exam $42, fluoride $26, 4 bitewings $42, pano $79, perio: $175 per quad. My pt load averages 11-12 pt per day. If I am doing perio, it goes to 8-9 patients. But overall, we are "producers" ! We help make dental practices very successful. Yes, you are a DDS, but you can't run the practice by yourself. Every one, dental assistant , front desk and RDH's play a very critical role.

Your assistant- will probably spend more time with the pt than you
Your Front desk- they are the first that is seen by patients
Your RDH- pt will been seeing them 2 x year or more if perio pt

And by the way.... not all RDH's are 2 yr grads. I have a 4 year degree, B.S. in Dental Hygiene. Also, for two year programs (they are a rip off) it is actually 3 yrs of schooling. The first year is just prereq's (Micro, anatomy,chemistry and so on). Then they have to apply to DH school which is 2 yrs!!!

In my class, 200 people applied, 40 were accepted and 22 graduated. What happened to the rest? 1 dropped out at will, the others were failed or were held back 1 yr. As you can see, our schooling is not a walk in the park!

Don't forget........... we have grueling national boards, clinical boards and state exams to pass!!!!!


I have worked for many doctors. I have seen practices gross over 1 million per year. They are the ones who realize that there staff is very "key" to success.

Dental Hygiene is not an easy job. In under 45 min we have to:

Review med hx
Take BP/pulse
Perio probe 32 teeth with 6 readings per tooth
scaling( coronal and sub)
do oral health care instructions- explaining what is periodontal disease, how they can prevent it, demo places they are missing with brush,floss, waterpik etc.
polish
fluoride

Plaque scrapers? I think not. Try a pt with generalized moderate periodontitis and gen heavy sub and supra calc. with heavy stain.

 

[aphistis]

I am an RDH going to DDS, and we are not grossly overpaid! Think about what you are saying...... Where I work I am paid salary $240 per day ( $30 per hour in VA) , prophys are $58, exam $42, fluoride $26, 4 bitewings $42, pano $79, perio: $175 per quad. My pt load averages 11-12 pt per day. If I am doing perio, it goes to 8-9 patients. But overall, we are "producers" ! We help make dental practices very successful. Yes, you are a DDS, but you can't run the practice by yourself. Every one, dental assistant , front desk and RDH's play a very critical role.

Your assistant- will probably spend more time with the pt than you
Your Front desk- they are the first that is seen by patients
Your RDH- pt will been seeing them 2 x year or more if perio pt

All true enough.

And by the way.... not all RDH's are 2 yr grads. I have a 4 year degree, B.S. in Dental Hygiene. Also, for two year programs (they are a rip off) it is actually 3 yrs of schooling. The first year is just prereq's (Micro, anatomy,chemistry and so on). Then they have to apply to DH school which is 2 yrs!!!

DH programs awarding bachelor's degrees are significantly in the minority. Further, I never said anything about "2-year grads"; I referred to associate's degree programs which, like it or not, is what the significant majority of DH curricula are.

In my class, 200 people applied, 40 were accepted and 22 graduated. What happened to the rest? 1 dropped out at will, the others were failed or were held back 1 yr. As you can see, our schooling is not a walk in the park!

I'm not going to open up a debate over who's smarter than whom (MOD NOTE: if anyone else does, this thread will be closed in a heartbeat), but here and throughout your post, you make the significant--and seriously flawed--assumption that all DDS & DH students are equally intelligent, and that academic struggle is purely a function of curriculum, rather than reflecting both rigor of curriculum and academic ability of students. I had to successfully finish 112 credit hours of graduate-level coursework to complete first & second years. I don't know specifics on IUSD's hygiene program, but associate's degree programs are typically ~60 hours of undergraduate classes. Like it or not, that's a 2:1 imbalance, and that's even before the undergrad/post-grad discrepancy widens the gap even further.

Now, before you jump on me for belittling your profession, I'm not saying anywhere in this post that hygiene is unimportant or its training is insignificant. What I am saying, and there's plenty of objective data supporting the position, is that the two professions are not identical, they are not interchangeable, and they are not equally trained to diagnose & treat. Dentistry is the top-level provider of oral health care, & hygiene is a valuable, but adjunct, support profession.

Put another way, if every hygienist on earth disappeared this afternoon, every patient in a given practice could still be treated by the employing dentists; if every dentist disappeared, however, everyone except SRP & maintenance patients would be completely SOL.

Don't forget........... we have grueling national boards, clinical boards and state exams to pass!!!!!

This is another appearance of the flawed premise I mentioned above. In case nobody has mentioned this, we have to do all that too.

I have worked for many doctors. I have seen practices gross over 1 million per year. They are the ones who realize that there staff is very "key" to success.

Dental Hygiene is not an easy job. In under 45 min we have to:

Review med hx
Take BP/pulse
Perio probe 32 teeth with 6 readings per tooth
scaling( coronal and sub)
do oral health care instructions- explaining what is periodontal disease, how they can prevent it, demo places they are missing with brush,floss, waterpik etc.
polish
fluoride

Like I said, you'll get no arguments from me on any of this.

Plaque scrapers? I think not. Try a pt with generalized moderate periodontitis and gen heavy sub and supra calc. with heavy stain.

You & other hygienists across the nation aren't just "plaque scrapers," not by a wide margin.

But, by equally wide a margin, you're not doctors either (yet, in your case ). I find it both highly disingenuous & deplorably unethical that hygiene as a profession is trying to legislate itself into something it objectively is not, and is not even close to being. It's doing a tremendous disservice to patients, and it's for nothing more significant than professional chest-beating.

 

[groundhog]

I'm thinking folks are getting upset over nothing here. I'm betting economics would keep the status quo in tact no matter what politiicans might do in regards to authorizing changes in the scopes of practice of oral health care providers. In the vast majority of cases, the dentist/hygienist/assistant under one roof concept is the most efficient means to deliver comprehensive oral health care services. In the thinly populated rural areas, the dentist/assistant model might likley be the more efficeint model to deliver those same services. Now, in some harsh habitat sparsley populated areas ( where no dentist chooses to set up practice) a hygienist/assistant model might make sense if one buys into the notion that some care is better than no care. However, I don't invision many RDH's opting to enter into that type of practice unless they happened to have family roots in such an area or were motivated by a missionary zeal.

 

[Dr.BadVibes]

I just wanted to pose a question and see what you guys/gals thought. Would it be beneficial to give hygenist's authority to do more unsupervised procedures only if it were within designated underserved areas (e.g. Alaska)?

 

[LSR1979]

I just wanted to pose a question and see what you guys/gals thought. Would it be beneficial to give hygenist's authority to do more unsupervised procedures only if it were within designated underserved areas (e.g. Alaska)?

In horribly underserved areas, this would be fine as long as it stayed within certain geographic perameters. However, this would be the biggest can of worms you could ever open. Pretty soon chicks in NYC would be griping about wanting to do their own restorative work, extracting 3rds, doing ortho and even RCT. Not because its in the best interest of their patients, but in the best interest of their bank account. Overall it would be lighting a fire that would be impossible to put out = Disaster.

 

[DrJeff]

In horribly underserved areas, this would be fine as long as it stayed within certain geographic perameters. However, this would be the biggest can of worms you could ever open. Pretty soon chicks in NYC would be griping about wanting to do their own restorative work, extracting 3rds, doing ortho and even RCT. Not because its in the best interest of their patients, but in the best interest of their bank account. Overall it would be lighting a fire that would be impossible to put out = Disaster.

This scenario may be happening sooner than you think

 

[aphistis]

I'm thinking folks are getting upset over nothing here. I'm betting economics would keep the status quo in tact no matter what politiicans might do in regards to authorizing changes in the scopes of practice of oral health care providers. In the vast majority of cases, the dentist/hygienist/assistant under one roof concept is the most efficient means to deliver comprehensive oral health care services. In the thinly populated rural areas, the dentist/assistant model might likley be the more efficeint model to deliver those same services. Now, in some harsh habitat sparsley populated areas ( where no dentist chooses to set up practice) a hygienist/assistant model might make sense if one buys into the notion that some care is better than no care. However, I don't invision many RDH's opting to enter into that type of practice unless they happened to have family roots in such an area or were motivated by a missionary zeal.

None of this addresses the fundamental problem--hygiene's professional organization working tirelessly to sweet-talk its way into a position its members have absolutely no business occupying.

 

[Stanford Fencer]

I'm seeing a trend, and while I have no point to make, I just think that the observation is very interesting.

Since I'm studying for the GRE's, let me throw in an analogy here.

OMFS in Californialastic surgeons
Nurse Anesthetist: Anesthesiologist
RDH: Dentists

I'm not saying the situation exactly parallels each other, but the uncomfortable threat that the latter feels towards the former is evident and vocal. The former group, on the other hand, is doing a tremendous job lobbying for their cause.

This kind of turf war actually has been the norm, not the exception, for health care professions/groups in the US. In gaining greater autonomy in one field, often times there is encroachment into practice areas belonging to already-established groups.

If one reads what plastic surgeons are saying about OMFS wanting to practice cosmetic surgery in California, it sounds remarkably similar to the arguments against RDH in expansion of practice scope.

 

[Rube]

I'm seeing a trend, and while I have no point to make, I just think that the observation is very interesting.

Since I'm studying for the GRE's, let me throw in an analogy here.

OMFS in Californialastic surgeons
Nurse Anesthetist: Anesthesiologist
RDH: Dentists

I'm not saying the situation exactly parallels each other, but the uncomfortable threat that the latter feels towards the former is evident and vocal. The former group, on the other hand, is doing a tremendous job lobbying for their cause.

This kind of turf war actually has been the norm, not the exception, for health care professions/groups in the US. In gaining greater autonomy in one field, often times there is encroachment into practice areas belonging to already-established groups.

If one reads what plastic surgeons are saying about OMFS wanting to practice cosmetic surgery in California, it sounds remarkably similar to the arguments against RDH in expansion of practice scope.

Its a war. A competition for resources. This happens as you rightfully point out in every profession. This is where you make sure you join the ADA. The ADA has been an exceptionally good professional association. Dentistry has thrived whereas medicine has withered. Remember men who wanted to support a family and get wealthy went into dentistry. That's the model that built this profession.

 

[aphistis]

I'm seeing a trend, and while I have no point to make, I just think that the observation is very interesting.

Since I'm studying for the GRE's, let me throw in an analogy here.

OMFS in Californialastic surgeons
Nurse Anesthetist: Anesthesiologist
RDH: Dentists

I'm not saying the situation exactly parallels each other, but the uncomfortable threat that the latter feels towards the former is evident and vocal. The former group, on the other hand, is doing a tremendous job lobbying for their cause.

This kind of turf war actually has been the norm, not the exception, for health care professions/groups in the US. In gaining greater autonomy in one field, often times there is encroachment into practice areas belonging to already-established groups.

If one reads what plastic surgeons are saying about OMFS wanting to practice cosmetic surgery in California, it sounds remarkably similar to the arguments against RDH in expansion of practice scope.

Definitely. The obvious solution (maybe that's why it has no chance of succeeding) would be to determine a profession's scope of practice via some really, really outlandish method, something outrageous like looking at what they're trained to do.

 

[drhobie7]

I'm seeing a trend, and while I have no point to make, I just think that the observation is very interesting.

Since I'm studying for the GRE's, let me throw in an analogy here.

OMFS in Californialastic surgeons
Nurse Anesthetist: Anesthesiologist
RDH: Dentists

I'm not saying the situation exactly parallels each other, but the uncomfortable threat that the latter feels towards the former is evident and vocal. The former group, on the other hand, is doing a tremendous job lobbying for their cause.

This kind of turf war actually has been the norm, not the exception, for health care professions/groups in the US. In gaining greater autonomy in one field, often times there is encroachment into practice areas belonging to already-established groups.

If one reads what plastic surgeons are saying about OMFS wanting to practice cosmetic surgery in California, it sounds remarkably similar to the arguments against RDH in expansion of practice scope.

This analogy is so far off it strains the definition of analogy ( ), (but you mentioned this). OMS and Plastics are both surgeons specializing in craniofacial reconstruction with many of the same clinical capabilities. Nurse anesthetists have undergone extra training in anesthesiology (and isn't there still a floating anesthesiologist among the ORs for intubation and extubation?). Hygienists...well are simply hygienists. Their scope of practice is determined by their education. If they want to do more they can go to college and then do dental school.

I'm standing by my original statement: hygienists are grossly overpaid (in southern CA) and allowing them clinical autonomy and expanded scope of practice is dangerous for patients and the dental profession. If they want to do additional training so they can cut preps and do endo, guess what? The curriculum is already there! It's called dental school.

 

[drhobie7]

I just wanted to pose a question and see what you guys/gals thought. Would it be beneficial to give hygenist's authority to do more unsupervised procedures only if it were within designated underserved areas (e.g. Alaska)?

As mentioned, this is a slippery slope. All greased up and ready.

 

[Stanford Fencer]

This analogy is so far off it strains the definition of analogy ( ), (but you mentioned this). OMS and Plastics are both surgeons specializing in craniofacial reconstruction with many of the same clinical capabilities. Nurse anesthetists have undergone extra training in anesthesiology (and isn't there still a floating anesthesiologist among the ORs for intubation and extubation?). Hygienists...well are simply hygienists. Their scope of practice is determined by their education. If they want to do more they can go to college and then do dental school.

I'm standing by my original statement: hygienists are grossly overpaid (in southern CA) and allowing them clinical autonomy and expanded scope of practice is dangerous for patients and the dental profession. If they want to do additional training so they can cut preps and do endo, guess what? The curriculum is already there! It's called dental school.

Neither OMFS nor plastics are 'specialists' in craniofacial reconstruction. To be considered as such, fellowship training ensuing OMFS or plastics residency is required.

I'm not comparing 'facts' here in building these analogies. If that were the case, we'd not need to talk about RDH doing procedures such as RCT or extractions. They should not be doing it. I'm alluding to the fact that they are lobbying, and lobbying effectively, as a group, to encroach upon an already established group.

Lastly, I am impressed with how unified the dental profession is, with regards to ADA memberships. In fact, I read that the year OMFS attempted to pass SB 1336, CDA contributed the same, if not slightly more, towards lobbying efforts, as the CMA. Considering that there are 89,153 physicians in the state, and 28,215 dentists in the state, that's outstanding (esp. if you factor in that many physicians have higher income)

 

[12YearOldKid]

This is absolutely crazy. Many states are considering a mandatory residency for dental grads because 4 yrs of college plus four years of dental school is not enough to adequately prepare a new dentist for private practice.

And now we are considering LESS education. Many of the hygiene students at my school have a chip on their shoulder and like to point out that they even "learn to do fillings". (Which is a 1 day hands on session with dentiforms.) There are 3 hygienists in my class and everybody thought they were going to be light years ahead of everyone else. But the only advantage they had was exhausted after the first month of dental anatomy and the first few perio lectures. They are going to be good dentists but they weren't ready to practice dentistry and I wouldn't even let any of them near me with a handpiece today (we are 3rd years.)

Yea, hygienists could be trained to do dentistry - if we added about 3 years and 6 months to the curriculum. But if you are going to do that why not just send them to dental school? DUH.

I agree with the slippery slope comment. It starts out with "JUST" fillings. But, really a class 2 composite with a deep box is one of the hardest fricking things to do well in dentistry. So if hygienists can do that, why not an easy crown prep... or some endo... or some extractions... laying their own flaps for perio procedures. The politicians see this as the solution to the imagined "healthcare provider shortage." But why are these new hygiene practitioners going to go to places the dentists wouldn't? In fact, most of them are girls and are going to be LESS likely to want to go to these rural areas where the main activities are hunting, fishing, and drinking. And are they going to charge less for procedures? No, not a chance.

The ADA has done a poor job of nipping this thing in the bud and now anything they do makes dentists come off as greedy protectionists. This is a lose, lose for the dental profession and the public.

 

[Demeter]

I was surprised to find out that in CO you can have a Hygiene private practice. This is virtually independent from the Dentist office except that a Dentist has to sponser you; meaning is willing to provide emergency dental care to their patients.

 

[12YearOldKid]

I was surprised to find out that in CO you can have a Hygiene private practice. This is virtually independent from the Dentist office except that a Dentist has to sponser you; meaning is willing to provide emergency dental care to their patients.

And the fact that there are practically ZERO independent hygienists out there is proof of the fact that hygienists are overpaid in many areas of the country. There is no way an independent hygiene office could afford to pay their hygienists what a dental office can.

 

[Slash]

The quality of student that gets into hygiene school is poor compared to the quality of student the gets into dental school. If hygienists want to do more procedures I suggest they take the required science classes and apply to dental school. 80% of them won't be able to cut it. I swear, everyone these days wants to be the chief and nobody wants to be the Indians.

 

[superchris147]

I am an RDH going to DDS, and we are not grossly overpaid! Think about what you are saying...... Where I work I am paid salary $240 per day ( $30 per hour in VA) , prophys are $58, exam $42, fluoride $26, 4 bitewings $42, pano $79, perio: $175 per quad. My pt load averages 11-12 pt per day. If I am doing perio, it goes to 8-9 patients. But overall, we are "producers" ! We help make dental practices very successful. Yes, you are a DDS, but you can't run the practice by yourself. Every one, dental assistant , front desk and RDH's play a very critical role.

Your assistant- will probably spend more time with the pt than you
Your Front desk- they are the first that is seen by patients
Your RDH- pt will been seeing them 2 x year or more if perio pt

And by the way.... not all RDH's are 2 yr grads. I have a 4 year degree, B.S. in Dental Hygiene. Also, for two year programs (they are a rip off) it is actually 3 yrs of schooling. The first year is just prereq's (Micro, anatomy,chemistry and so on). Then they have to apply to DH school which is 2 yrs!!!

In my class, 200 people applied, 40 were accepted and 22 graduated. What happened to the rest? 1 dropped out at will, the others were failed or were held back 1 yr. As you can see, our schooling is not a walk in the park!

Don't forget........... we have grueling national boards, clinical boards and state exams to pass!!!!!


I have worked for many doctors. I have seen practices gross over 1 million per year. They are the ones who realize that there staff is very "key" to success.

Dental Hygiene is not an easy job. In under 45 min we have to:

Review med hx
Take BP/pulse
Perio probe 32 teeth with 6 readings per tooth
scaling( coronal and sub)
do oral health care instructions- explaining what is periodontal disease, how they can prevent it, demo places they are missing with brush,floss, waterpik etc.
polish
fluoride

Plaque scrapers? I think not. Try a pt with generalized moderate periodontitis and gen heavy sub and supra calc. with heavy stain.

damn, someone is feeling a little inadequate.

i'm sure the schooling is very hard to become a hygenist and its tough and blah blah but so is dental school and so is medical school. the bottom line is, you should be allowed to do things that you have been trained to do by FORMAL EDUCATION. hygenists that are trained to do fillings, crowns, endo, etc are called DENTISTS.

Your argument of "yeah you're a DDS but your whole office is key" is an incredibly poor argument for hygenists making more money. Every successful dentist knows that keeping his staff happy is important for production. But if every hygenist decided to quit dentists could just do the hygeine themselves and be fine. they would probably make less money but they would be fine. if you just have a hygenist you're going to have problems that they are not going to understand how to take care of. if hygeine was such a big money maker then dentists would just do it themselves.

I think that letting hygenists do those kinds of things in underserved areas is BS. You'll end up giving poor/rural people poor oral health care. If you're argument is something better than nothing then I guess its ok, but its not the answer.


BTW, if you couldn't do this in 45 minutes

Dental Hygiene is not an easy job. In under 45 min we have to:

Review med hx
Take BP/pulse
Perio probe 32 teeth with 6 readings per tooth
scaling( coronal and sub)
do oral health care instructions- explaining what is periodontal disease, how they can prevent it, demo places they are missing with brush,floss, waterpik etc.
polish
fluoride

then i definately don't think you should be making an argument for being paid more

shazaam

 

[superchris147]

this is off topic but i was getting my hair cut at supercuts like two weeks ago and the girl cutting my hair asked me what i did and i said i was in dental school. she told me that her friend just recently finished hygeine school and i told her that i thought it was a very good profession and asked how her friend liked it and she said "she hates it, she says she does 95% of the work while the dentist just sits there and makes all the money doing nothing" so then i said "sounds like your friend wasn't smart enough to get her doctorate degree" nothing further was said and . . .



i now have a mullet

 

[Bifid Uvula]

this is off topic but i was getting my hair cut at supercuts like two weeks ago and the girl cutting my hair asked me what i did and i said i was in dental school. she told me that her friend just recently finished hygeine school and i told her that i thought it was a very good profession and asked how her friend liked it and she said "she hates it, she says she does 95% of the work while the dentist just sits there and makes all the money doing nothing" so then i said "sounds like your friend wasn't smart enough to get her doctorate degree" nothing further was said and . . .



i now have a mullet

and one less ear

 

[Dr.BadVibes]

In horribly underserved areas, this would be fine as long as it stayed within certain geographic perameters. However, this would be the biggest can of worms you could ever open. Pretty soon chicks in NYC would be griping about wanting to do their own restorative work, extracting 3rds, doing ortho and even RCT. Not because its in the best interest of their patients, but in the best interest of their bank account. Overall it would be lighting a fire that would be impossible to put out = Disaster.

The reason I posed the question was because there are many underserved areas out there, and no matter what incentives you give dentists, they just wont go there. For example, Alaska and Maine have very attractive loan repayment programs if you practice in those states for a specific amount of time, but no one goes because no one wants to live there.

However, if someone else can be trained to do simple dental procedures and increase the oral health for people in these underserved areas, than I think its a viable option and not one that should be looked down upon.

 

[groundhog]

I'll say again there is too much worry about this issue. It begins to smell of greed (which hurts the real and just cause of insuring that the public is provided the safest and best oral health care). The outcomes I gave above was even assumming the existance of a completely unregulated free market (which would not be the case even if scopes of practice were expanded). Society is sophsiticated today. How many amongst those who regularly see a dentist today would suddenly choose to refer themselves and family members to an RDH instead of a dentist for future health care needs? I would bet not many. Geeze, we even have scads of bored suburban "mommies" these days trying every scheme in the book to manuver their precious darlings into pedo (which is why it is becomming a real money maker specialty). Another related example of the public's inclinations in this area is that folks overwhelmingly opt for medical insurance plans which let them self refer to specialists rather than having to go through a primary care physician/physican assistant/nurse practitioner gate keeper when given the choice.

Now on to the rest of the market that might be up for grabs. A good example here here would be a medicaid patient based practice. A lot of folks shy away from such a practice for both economic and patient relation reasons. But a few of the smarter business DDS/DMD types have learned how to make such a practice highly profitable and emotionally rewarding. The trick is to do high volume excellent work with no down time. In order to to that, you have to have a highly skilled staff of hygienists/assistants supported by a front office that is manned by folks possesssing excellent scheduling, ordering, and people skills. The DDS/DMD concentrates on the treatment planning and the surgery. The hygienists/assistants do the rest of the work with oversight by the DDS/DMD. The front office keeps the appointments book full each day, maintains a just in time inventory of supplies, and really knows how to smooze lower income folks by making each one feel special and valued ( a trick used by the preachers who head up those highly successful mega churches). This system is the most cost effective comprehensive care model given a large high volume low income patient load. A stand alone RDH/assistant model cannot beat it.

 

[12YearOldKid]

I'll say again there is too much worry about this issue. It begins to smell of greed (which hurts the real and just cause of insuring that the public is provided the safest and best oral health care).

It is attitudes like yours that allows these things to happen. These issues need to be addressed early on. Please don't take this as a personal attack, but how exactly are you involved in the dental field, anyway? Just curious.

 

[bsmcga0]

stating that you are vital to the profitability of the business does not necessarily demand that you make more money. The dentist takes all the risks associated with running the business, if the office fails the dentists has huge loans to pay off, while the hygienist can go across the street and work for another dentist, debt free.
You should note that hygienists are making more money than most people with four year degrees, many who are salary workers that work 50 hours a week for a salary based on a 40 hour work week.
I did a paper on employees stealing from the dentist they work for, and the common theme was that the office belonged to everyone, however the loan is only in one name

for a real life example: my friend is an electrician, he makes about $20/hr, but when he works the company bills for $65/hr. The owner of his company make more money than most dentists, so why is he not entilted to more money? and he did go to a two year trade school full time

 

[drhobie7]

Neither OMFS nor plastics are 'specialists' in craniofacial reconstruction.

I'm guessing you've never watched an oral and maxillofacial surgeon reassemble someone's fractured skull. Fellowships be damned. But that's beside the point. Yeah you made a good point about lobbying, but failed to mention the lobbying of the OMS is justified whereas the hygienist is not.

 

[drhobie7]

Society is sophsiticated today. How many amongst those who regularly see a dentist today would suddenly choose to refer themselves and family members to an RDH instead of a dentist for future health care needs? I would bet not many.

Society may be sophisticated but that doesn't mean people's knowledge about dentistry is sophisticated. I can easily see how people would go to a 'hygiene practice' for their biannual prophys. Maybe instead of paying $90 per prophy they would only pay $50. It's not too hard to see how hygienists could then become a referral base for general dentists.

I'll admit it, hygiene is a cash cow for general dental practices. Of course I don't want them running their own hygiene practices. However, I also don't want them to have clinical autonomy or a broader scope of practice because it will certainly result in more incidences of bad dentistry, which hurts everyone involved in the profession.

 

[Bifid Uvula]

You've got to be kidding me! I value the hygiene profession and most hygienists, but don't dare elevate it to something its not. Just for kicks, I'll pick out some of your arguments....

1) Of course hygienists are grossly overpaid considering their job requirements. Hygienists are being paid more than many nurses who have much much much much MUCH more difficult and demanding jobs. Most nurses deal with life and death, medications, IV's, EKG's, etc etc...

2)I agree that hygienists are producers and can help make practices very successful financially. If I practiced general dentistry I too would pay my hygienist to handle that crap. But don't kid yourself. The truth is, your job is disposable. There are plenty of dentists making good money, working easy schedules, and doing their own hygiene work.

3) Congrats on getting a BS degree... as far as the job is concerned, you don't do anything more with a BS degree than you do with an associates. I guess the only argument is teaching in a hygiene program.

4)what on earth do those stats have to do with your education not being a walk in the park? Compare those to some statistics in my class. 800 + applied, 100 were accepted. 1 was Lesbian, 10 played basketball,5 were psychologically unstable, 70% were alcoholics, 12 were Morman (talk about screwing up the grading curve), 2 were black, and EACH AND EVERY ONE OF THEM had to take WAY MORE GRUELING: DAT entrance exams, spend thousands of dollars on applications and interviews, More coursework and courseload than you could ever phathom, National Boards, Regional Boards, and incur a ton more debt than your hygiene program. So as you can see, it clearly wasn't a walk in the park either.

5)Dentistry is not an easy job as well my dear.... Heaven forbid you should be able to accomplish the BP/Med Hx/Dental Hx/ Prophy and Charting in 45 minutes. I know some patients need additonal time to scale away 20 years of not brushing their teeth... I'm realistic, I know you may need a few more appointments on some patients. So what is the big deal? That's why we do quadrant scaling.

6) I treat patients with heavy subginival calculus and periodontal disease every day. I do something that all your scaling in the world will never do for the perio patients. I not only treat them, I cure them of periodontal disease. I extract those nasty puppies. wahlah... no more periodontal disease. Ohhh my, less work for u.... sorry.

The bottom line is, an Associates degree is not, and will never be equivalent to that of a doctoral-level degree. The true fact of the matter is that patient safety is the issue here. Patients need to be treated

As a hygienist, you cannot Analyze, Diagnose, and Treat the patient the same way that someone with 6-12 years more training can. Its impossible. At the end of the day patients want a doctor to diagnose them and deal with the major things. If you want to be able to do that... then suck it up and do what the rest of us did. Study for DAT's, Apply, Go to Dental School, Pass your classes, National and Regional Boards and then do as you please. No special favors.

 

[mike3kgt]

Plaque scrapers? I think not. Try a pt with generalized moderate periodontitis and gen heavy sub and supra calc. with heavy stain.

When I made the original statement, I do not mean it to come across like hygienists only scrape plaque all day. They provide a valuable role in the dental office. Now providing services outside the office may or may not work, hygiene has to always understand that anything perio disease is plaque related.

Whatever you look at it, gingivitis case - plaque scraping. periodontitis case - calculus scraping. It's the nature of the etiology. simple.

Now granted, I do not wish to undermine the education. I believe becoming proficient at perio work is not easy but then again, who said a class II prep and composite was? A pulpotomy is not the most difficult thing to do, but imagine the risks of the procedure? I also do not believe hygienists are "stupid or uneducated" rather, it's a demanding education.

Expanding scope of practice is always dangerous. I love surgery, but I don't know if I would want my OMFS performing a boob job on my girlfriend. Nor do I want my optomotrist performing lasik or my hygienist giving me an injection or filling.

A professor at out school states that you could train a monkey to ideal prep an ideal tooth, but could you train the same monkey to collect diagnostic data, treatment plan, prep the tooth, prepare for any consequences pre,peri,post op? What happens if that "ideal" lesion turns into something huge?

Now is the hygiene practitioner push by 1% of the members of the hygiene association? But then again, those are usually the loudest 1%.

-Mike

 

[Dr. Pedo]

Bottom-line: RDHs have absolutely no business and more importantly no education to be doing any irreversible procedures. If they want to place some fluoride varnish and perhaps a sealant great----they have an education comparable to that level of treatment. Anything other than scaling/prophies, F-,sealants, polishing amalgams, and brushing/flossing is simply out of their educational abilities.

You want to do dental procedures that are irreversible or learn how to diagnosis; I know a way-----GO TO DENTAL SCHOOL AND GET YOUR DOCTORATE DEGREE.

 

[Bifid Uvula]

Expanding scope of practice is always dangerous. I love surgery, but I don't know if I would want my OMFS performing a boob job on my girlfriend.
-Mike

Admit it dude, of course you would love it if ur girlfriend got a boob-job

 

[txdent2be2007]

Right now I'm listening (intently, as indicated by my typing on this post!) to an RDH lecture to us on their roles in the care of geriatric patients. She's saying that here in Texas hygienists can work on patients in a nursing facility without these patients being first seen by a dentist. I want to ask her how many of these old folks develop SBE after her care, or where she trained in pharmacology so she could prescribe minocycline, ketoconazole, or any of the other drugs recommends to the caretakers at the nursing homes.

I'd say we're less in control of this issue than we think. Hygienists aren't pushing for extended privileges in outer Alaska; they're thirsty for more money and independence right here in our backyards!

 

[aphistis]

Right now I'm listening (intently, as indicated by my typing on this post!) to an RDH lecture to us on their roles in the care of geriatric patients. She's saying that here in Texas hygienists can work on patients in a nursing facility without these patients being first seen by a dentist. I want to ask her how many of these old folks develop SBE after her care, or where she trained in pharmacology so she could prescribe minocycline, ketoconazole, or any of the other drugs recommends to the caretakers at the nursing homes.

I'd say we're less in control of this issue than we think. Hygienists aren't pushing for extended privileges in outer Alaska; they're thirsty for more money and independence right here in our backyards!

Maybe your class is already doing this, but I think it'd be worth seeing her response if you pinned her to the wall on some of those questions and not let her duck out with a wimpy "that's not in the scope of this lecture" excuse.

 

[gryffindor]

The reason I posed the question was because there are many underserved areas out there, and no matter what incentives you give dentists, they just wont go there. For example, Alaska and Maine have very attractive loan repayment programs if you practice in those states for a specific amount of time, but no one goes because no one wants to live there.

However, if someone else can be trained to do simple dental procedures and increase the oral health for people in these underserved areas, than I think its a viable option and not one that should be looked down upon.

Badvibes, if a dentist can't be convinced to live in Alaska or Maine for loan repayment, why would anyone else want to go there and do any dental procedures? Whoever said this is opening up a can of worms is right.

 

[esclavo]

CLASSIFIED ADD: HYGIENIST Come work in my practice where you could expand your scope of practice. Learn to start I.V.'s (go to phlebotomy school-payed for) You can practice all those "technical" blocks on my awake patients so when I come back I can "treat" the perio disease with you. I could teach you to chin and control the airway. When the calculus is flying all over the place under the grip of my specialized perio instrument {33 ash (nice ASH!)} you can collect it. This method of "scaling and root planing" has 100% results. No "maintenance" just pure treatment. You only have to smile and converse with the patient for a few seconds until the 5 of versed kicks in. No more asking about useless meaningless questions about their life that you know your not interested in....
Call 1-800-NIC-EASH

 

[txdent2be2007]

Maybe your class is already doing this, but I think it'd be worth seeing her response if you pinned her to the wall on some of those questions and not let her duck out with a wimpy "that's not in the scope of this lecture" excuse.

Done; I asked her in front of the class how she managed patients who need SBE prophylaxis and how she can prescribe minocycline for perio tx without a doctorate...she quickly cleared this up by saying everything she prescribes must be done by a DDS/DMD, either over the phone or by fax.

A major time saver these exta-smart hygienists are...can't imagine how many patients have complicated medical histories in a nursing home, each of whose care must be authorized by a licensed dentist. I sure don't want to be on the phone all day baby-sitting.

I like Esclavo's idea...how about establishing a dedicated training program for these super-hygienists? I'll donate toward the first scholarship: The SDN Award for Excellence in Patient Mismanagement!

 

[2thclnr]

Hello future dentists!! I am currently pre-dental and cannot wait to become a dentist. I currently am a hygienist, was an assistant and "prophy tech" in the Air Force, and I feel I need to chime in. The ADHA is crazy, as a hygienist I would not want the responsibility of someone's life in my hands , as I do not have the required degree. The only reason I belong to this organization is to keep dental assistants from cleaning teeth , as I know my education far exceeds theirs - and I know your education far exceeds mine.

I just do not want you to think that our education is substandard. I believe I am very educated. A hygenist is valuable in many ways. My ability to converse with patients about any dental procedure is seen as valuable to my dentist. We are like a tag team and back each other up.

Also I do not want you to start hating hygienists as a collective, which is the feeling I am getting . We are not all that bad. Yeah, I like money, so my dentist makes me work for it with commission and bonuses. I work hard, make patients happy, and make sure the production goal is met or exceeded.
The right hygienist will help you build your practice, the wrong one will send patients away. I have many patients run to me for cleanings and stay because of my light, but thorough, touch. I love this profession, that is why I want to learn more.

 

[drhobie7]

Also I do not want you to start hating hygienists as a collective, which is the feeling I am getting

I love hygienists. As long as they don't touch my highspeed or alter my treatment plans.

 

[TucsonDDS]

I don't even think that hygienists would make a substantial more amount of money from opening their own practice. So they charge 75 instead of 95 for a prophy. They manage to get 5 or 6 patients a day so lets say $450/day so what is that, $9000/month. Now you have overhead to pay for. Rent for a tiny little place for a small waiting room and a chair will be probably 1000/month. The loan repayment for the $50K loan you took out for working capital and the money to buy the chair and secure the lease is what $600/month. Now you are down to only $7400 a month and still have monthly bills to pay. Phone, electric, water, sewer for a couple of hundred a month. Oh yeah, continued monthly expenses like insurance, both malpractice and on the practice for another $150/month. Sure they could live on the $7000/month that is left but unfortuneately they forgot to buy any supplies to actually scrape the tarter. Prophy angles and other necessities, maintaining your instruments, even toilet paper and light bulbs are going to add up, really quick. So now you are down to $5500 a month, thats not so bad, after all you are your own boss. Oh crap, no health insurance, $600-$700 a month for the family. And retirement, can't afford it now that we are down to only $4800/month, before corporate taxes of 40%. Now we are down to a whopping $3000/month for a grand total of $36000/year assuming: you work 5 days a week every week, can find 1300 patients to keep you busy (5 per day), and do all of your own scheduleing, cleaning and accounting. That comes out to roughly $144/day. But hey, no boss. Or you can work for a dentist, take home 200-250/day, have a nice retirement plan, have health insurance, actually take 3 or 4 weeks of vacation, not have to call and cancel your 6 patients if your kid is sick and never have to worry about the number of people walking throught the door looking for cheap dental care. And we all know what the types of patients that are only after the best deal.

I am not saying that RDH's don't provide a very crutial role in dental care or that their schooling a walk in the park but any RDH that wants to open their own clinic has got to be stupid if they are in it for the money.

I don't think that dentists make a whole lot of money off of hygiene, I do think that they make a killing off of procedures that the patient would not have known that they needed if they didn't come in for a hygiene appointment. And hygienists would have to refer out the majority of those procedures anyways.

I don't think that we have to worry about hygienist working on their own. The reason why it works for Nurse Practitioners is the sheer number of patients which just isn't possible when you need to spend 45 minutes doing quality work on your patients.

 

[2thclnr]

I would never open my own hygiene practice - too much of a headache. Staffing issues, too much estrogen-- and I am a chick --, overhead, blah blah blah. I like to go in and ask the dentist questions, get his point of view, before treating a patient who is medically compromised.
But there is money to be made on the dentist's side due to the hygienist's suggestions. (Yeah I know this has nothing to do with the topic - just would like to share this) I had a lady in my chair who wanted my smile. I told her that I was not going to rip out my teeth and hand them to her - she laughed--but I did suggest veneers, at least 6 of them to make them look great!! She had no money, was depressed and never smiled. She said she wasn't sure. I told her a smile cures all. When you have the smile of your dreams, you smile more, which makes you happy. She agreed.
2 months later she came back into the office SMILING !! She got a higher paying job, a new truck and no longer takes depression meds. Now I realize that this seems crazy, but it works!! I sold, she bought, dr happy, patient really really happy, more referrals for office. Just remember - you guys make a difference in peoples lives!! Did I mention I love dentistry? hehe

 

[TucsonDDS]

I would never open my own hygiene practice - too much of a headache. Staffing issues, too much estrogen-- and I am a chick --, overhead, blah blah blah. I like to go in and ask the dentist questions, get his point of view, before treating a patient who is medically compromised.
But there is money to be made on the dentist's side due to the hygienist's suggestions. (Yeah I know this has nothing to do with the topic - just would like to share this) I had a lady in my chair who wanted my smile. I told her that I was not going to rip out my teeth and hand them to her - she laughed--but I did suggest veneers, at least 6 of them to make them look great!! She had no money, was depressed and never smiled. She said she wasn't sure. I told her a smile cures all. When you have the smile of your dreams, you smile more, which makes you happy. She agreed.
2 months later she came back into the office SMILING !! She got a higher paying job, a new truck and no longer takes depression meds. Now I realize that this seems crazy, but it works!! I sold, she bought, dr happy, patient really really happy, more referrals for office. Just remember - you guys make a difference in peoples lives!! Did I mention I love dentistry? hehe

That is the exact reason why dentists make money and RDH's get paid well. Teamwork is extremely important in a small business like a dental office.

 

[Dr. Pedo]

I would never open my own hygiene practice - too much of a headache. Staffing issues, too much estrogen-- and I am a chick --, overhead, blah blah blah. I like to go in and ask the dentist questions, get his point of view, before treating a patient who is medically compromised.
But there is money to be made on the dentist's side due to the hygienist's suggestions. (Yeah I know this has nothing to do with the topic - just would like to share this) I had a lady in my chair who wanted my smile. I told her that I was not going to rip out my teeth and hand them to her - she laughed--but I did suggest veneers, at least 6 of them to make them look great!! She had no money, was depressed and never smiled. She said she wasn't sure. I told her a smile cures all. When you have the smile of your dreams, you smile more, which makes you happy. She agreed.
2 months later she came back into the office SMILING !! She got a higher paying job, a new truck and no longer takes depression meds. Now I realize that this seems crazy, but it works!! I sold, she bought, dr happy, patient really really happy, more referrals for office. Just remember - you guys make a difference in peoples lives!! Did I mention I love dentistry? hehe

I know a dds that gives his RDHs a cut of the tx they suggest and pt accepts. Man do those RDHs make bank----one in particular makes roughly 60k a year

 

[ItsGavinC]

In horribly underserved areas, this would be fine as long as it stayed within certain geographic perameters. However, this would be the biggest can of worms you could ever open. Pretty soon chicks in NYC would be griping about wanting to do their own restorative work, extracting 3rds, doing ortho and even RCT. Not because its in the best interest of their patients, but in the best interest of their bank account. Overall it would be lighting a fire that would be impossible to put out = Disaster.

Tribes in Alaska already have this going, and those practitioners are attempting to expand to Native American tribes in the lower 48. From there it's a hop-skip-and-jump into your neighborhood.

I think it's a terrible idea and doesn't do much of anything to improve access to care.

 

[ItsGavinC]

I am not saying that RDH's don't provide a very crutial role in dental care or that their schooling a walk in the park but any RDH that wants to open their own clinic has got to be stupid if they are in it for the money.

Excellent post. We've had a few threads about this same topic in the past couple of years, and that was the general concensus that has always been reached.

The hygiene alone wouldn't cover enough to pay the overhead for the building space and utilities.

 

[MsPurtell]

I agree with you Mike. They just simply aren't dentists. If they want independence and to do the job of a dentist they should go to dental school.

This Hygiene Practitioner program keeps gaining momentum.

http://www.adha.org/news/11032005-adhp.htm

While it does not even begin to imply ratification, senators just do not understand that allowing a hygienist to perform a pulpotomy would be a BAD idea.

Just let them stick to scraping plaque off of teeth.

-Mike

 

[DrJeff]

I know a dds that gives his RDHs a cut of the tx they suggest and pt accepts. Man do those RDHs make bank----one in particular makes roughly 60k a year

I know of 3 RDH's that bank over 60K a year total compensation(wages, retirement, medical, + CE), and those are just the 3 full timers(full time being basically 32 hrs a week) in my office. Essentially mine are paid so that their total compensation is 1/3 of their gross production.

Your hygiene department of your practice can be a huge addition to your bottom line with not only gross prodctions from the prophy, films, fluoride tx's, perio tx, bleaching etc, but also in the added patient information that gets accomplished when you're not in the room. Believe me it's real nice when I walk into the operatory for my exam and ask the patient how they're doing and THEY tell me that they need a crown on a tooth beacuse my hygienst has explained to them about how the BOF (Big 'ol Filling) is failing and needs replacement

As I've alluded to before you'll pay a good hygenist alot of $$, and they'll be worth every penny and then some back to you.

Now if you get me started about a hygenist with a couple of years of "extra" training being able to comfortably and competantly handle all aspects of basica restoration and potentially exodontia, I say you better be able to preform those duties upto the standards of a specialist as we dentists are!

 

[LegendDMD]

My school was giving FLu shots during lunch. There was 2 lines. One line was the flu shots given by the nurse, the other was given by an MD. The nurse had to steal people from the MD's line because she had no patients. Just goes to show you the mentality that people have. Even though giving a flu shot is a SIMPLE procedure, people would rather have it done by an MD. Just a train of thought.

 

[kerrydds06]

Now if you get me started about a hygenist with a couple of years of "extra" training being able to comfortably and competantly handle all aspects of basica restoration and potentially exodontia, I say you better be able to preform those duties upto the standards of a specialist as we dentists are!

I can smell the lawsuits lined up already. The defense will have a tough time getting "experts" to defend them WHEN (not if), WHEN they screw up.