Hygienists of the future

[Dr_Oh_DMD]

Do you think it is possible that one day hygienists could become independent from the dentists? I was talking with my dentist today and he said that this it is quite possible some day hygienists would be able to operate on their own - do their own billing (for cleanings/ x-ray/ prophylactics) and simply refer all dental work to the dentist. Just imagine a hygienist office on every corner ? like the ?cleaners?. Do you see this happening and if it happens what impact do you think it will have on us ? the dentists? Could this be something positive or not? I would really appreciate what some practicing dentists think of this.

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[larryt]

Possible ! Those dental hygienist are working real hard to get that come true.

If I can't attend dental this coming Fall, I will finish my dental hygiene program next year. I'm planning to open my own dental office and hire dentists to work for me.

 

[UBTom]

There are a state or two that already allow hygienists to open their own offices independent of dentists... I don't remember which.. I vaguely remember either Arkansas or Alabama as one of them, not sure though.

Personally I think it's more effective and efficient to have the hygienist as part of a dental practice so a patient can get everything done under one roof. The hygienist after all depends on the dentist for recall patients and the dentist depends on the hygienist to find developing problems in recall patients so that the problem can be intercepted in a timely manner.

to Larry: (grin) There is only one little problem with your plan... As far as I'm aware, all the states bar anyone who is not a dentist from owning a dental practice (except in the case of widows or widowers of recently-deceased dentists, who must sell the practice within a certain number of months).

 

[NonTradMed]

Originally posted by UBTom
There are a state or two that already allow hygienists to open their own offices independent of dentists... I don't remember which.. I vaguely remember either Arkansas or Alabama as one of them, not sure though.

Personally I think it's more effective and efficient to have the hygienist as part of a dental practice so a patient can get everything done under one roof. The hygienist after all depends on the dentist for recall patients and the dentist depends on the hygienist to find developing problems in recall patients so that the problem can be intercepted in a timely manner.

to Larry: (grin) There is only one little problem with your plan... As far as I'm aware, all the states bar anyone who is not a dentist from owning a dental practice (except in the case of widows or widowers of recently-deceased dentists, who must sell the practice within a certain number of months).

Interesting.....I did not know that.....why do you think that is, UBTom? I was always under the impression anyone can open up a healthcare clinic as long as they staff it with the correct personnels. Is this stipulation also applicable to other health care providers as well?

 

[lmgonza2]

There are a couple of problems I see with such a scenario...but i'm sleepy so i'll limit to the most obvious. Hygenists are not trained, to my knowledge, to diagnose oral health abnormalities, decay, ...etc.

Unless the hygenist is trained to do this...it would seem that you would need the dentist to make a decision regarding proper treatment.

Having said that, I think Colorado allows hygienist to operate without a dentist.

 

[UBTom]

to NonTradMed:

Non-dentist individuals are not allowed to own dental practices because it creates a conflict of interest-- Who should make recommendations and approve decisions (aside from the patient) in regard to appropriate dental treatment, someone who is not educated in the field, or someone who is? The ADA and state dental associations have been very successful in lobbying legislatures to allow dentists such autonomy and protect them from encroachment, for which I am glad since I will be a full-fledged dental professional in a couple of months.

I don't know what the situation is like in other health professions though.

 

[larryt]

Originally posted by UBTom


to Larry: (grin) There is only one little problem with your plan... As far as I'm aware, all the states bar anyone who is not a dentist from owning a dental practice (except in the case of widows or widowers of recently-deceased dentists, who must sell the practice within a certain number of months).

There is a way to do it legally ... using federal law.

 

[larryt]

Originally posted by lmgonza2
Hygenists are not trained, to my knowledge, to diagnose oral health abnormalities, decay, ...etc.

We are trained to look for it every single day but can't make any final diagnosis under state law.

 

[UBTom]

Originally posted by larryt
There is a way to do it legally ... using federal law.

Definitely not where you are, Larry... Check item #14 at the Texas State Board of Dental Examiners website FAQ:

http://www.tsbde.state.tx.us/legalFAQ.htm#14

"14: Can a non-dentist own a dental practice?

Answer: No, you must be a licensed Texas dentist to own a dental practice."

As far as I'm aware, there aren't any Federal statutes that overrides such state regs... Yet. And hopefully there never will be. Thank goodness for the ADA and state dental associations.

 

[larryt]

That law applys only for individual owned dental practice. I will not go that way. Ever think of dental chain such as Castle dental, southern dental ? They're incorporated.

 

[larryt]

Of course, every business has its own risk. It is depending on your strategy, management and policy. I still have lots to learn from many of my mentors.

 

[larryt]

Originally posted by UBTom
Incorporation does not allow you to skirt licensure issues, Larry.

Dentists can incorporate... That's how Castle Dental came about-- It was originally a Texas dental practice owned by one Dr. Jack H. Castle, DDS. Southern Dental Associates is incorporated by a Texas-licensed dentist too if you check their public records.

I doubt Texas law will allow you to incorporate a DMSO there if you don't already have a DDS license.

As long as I have 1 DDS on my board of director with an advisory role, there is no problem to incoporate.

 

[UBTom]

Larry, I don't think that would work. Incorporation does not allow you to skirt licensure issues.

Dentists can incorporate... That's how Castle Dental came about-- It was originally a Texas dental practice owned by one Dr. Jack H. Castle, DDS. Southern Dental Associates is incorporated by a Texas-licensed dentist too if you check their public records.

I doubt Texas law will allow you to incorporate a DMSO there if you don't have a DDS license.

Here's Subchapter F, Section 108.70 of the TSBDE rules on licensure:

Rule 108.70 Improper Influence on Professional Judgment
(a) For the purposes of this rule, the term dentist shall include the following:
(1) a dentist licensed by the State Board of Dental Examiners;
(2) a professional corporation wholly owned by one or more dentists;
(3) other entities that provide dental services and are owned by one or more dentists.

(b) Any dentist entering into any contract, partnership or other agreement or arrangement which allows any person other than a dentist any one or more of the following rights, powers or authorities shall be presumed to have violated the provisions of the Dental Practice Act, Section 251.003 regarding controlling, attempting to control, influencing, attempting to influence or otherwise interfering with the exercise of a dentist's independent professional judgment regarding the diagnosis or treatment of any dental disease, disorder or physical condition:

If you don't have a DDS license, you would NOT fulfill item #2 or #3, even if you have one DDS sitting on your corporate board in only an advisory role.

You should contact the TSBDE if you have any doubts about this.

(Post consolidated with the previous one.)

 

[Dr.BadVibes]

Damn Tom...you're on fire! ANyways, given Larryt's past post history, he is always full of $hit, and just keeps on talking!

 

[gryffindor]

Originally posted by lmgonza2
Having said that, I think Colorado allows hygienist to operate without a dentist.

Colorado was the first state I thought of while reading this discussion so I agree, I think they are the state where hygienists have their own practice.

 

[larryt]

Originally posted by UBTom
Larry, I don't think that would work. Incorporation does not allow you to skirt licensure issues.

Dentists can incorporate... That's how Castle Dental came about-- It was originally a Texas dental practice owned by one Dr. Jack H. Castle, DDS. Southern Dental Associates is incorporated by a Texas-licensed dentist too if you check their public records.

I doubt Texas law will allow you to incorporate a DMSO there if you don't have a DDS license.

Here's Subchapter F, Section 108.70 of the TSBDE rules on licensure:

Rule 108.70 Improper Influence on Professional Judgment
(a) For the purposes of this rule, the term dentist shall include the following:
(1) a dentist licensed by the State Board of Dental Examiners;
(2) a professional corporation wholly owned by one or more dentists;
(3) other entities that provide dental services and are owned by one or more dentists.

(b) Any dentist entering into any contract, partnership or other agreement or arrangement which allows any person other than a dentist any one or more of the following rights, powers or authorities shall be presumed to have violated the provisions of the Dental Practice Act, Section 251.003 regarding controlling, attempting to control, influencing, attempting to influence or otherwise interfering with the exercise of a dentist's independent professional judgment regarding the diagnosis or treatment of any dental disease, disorder or physical condition:

If you don't have a DDS license, you would NOT fulfill item #2 or #3, even if you have one DDS sitting on your corporate board in only an advisory role.

You should contact the TSBDE if you have any doubts about this.

(Post consolidated with the previous one.)

I guess I have to call out my bro in Dallas to be my partner then. There is still a way out.

 

[larryt]

Originally posted by UBTom
Larry, I don't think that would work. Incorporation does not allow you to skirt licensure issues.

Dentists can incorporate... That's how Castle Dental came about-- It was originally a Texas dental practice owned by one Dr. Jack H. Castle, DDS. Southern Dental Associates is incorporated by a Texas-licensed dentist too if you check their public records.

(2) a professional corporation wholly owned by one or more dentists;
(3) other entities that provide dental services and are owned by one or more dentists.

There is also a loophole somewhere in Texas's law that I haven't figured out yet. Who own Castle Dental ? It is a public traded company, so the investors (including myself with 500 shares) are the ones owning it. Well, so Castle isn't WHOLLY owned by one or more dentists. It is still in business today.

By the way Tom, thanx for pointing that laws out for me. I have to do more research about this anyway.

 

[larryt]

There ain't no loophole

Here is my research:

If I incorporate my business under Professional Corporation Act or Professional Association Act, then I do need a DDS license to operate. Most dental offices are incorporated under this. That why you always see the words P.C. in most dentist's business cards.

If I incorporate under Business Corporation Act, I don't need a DDS license to operate the dental services.

Hope I am interpreting the laws right. I will ask my lawer friends next week about this.

 

[Dr.BadVibes]

Larryt just keeps on talkin eh! Lemme guess...you fought in the GUlf War...took out a whole platoon, won the medal of honour, while writing you're thesis for your physics pHD which later on won you the NObel Prize in Physics!

So after making all these claims, and having Tom shut you up, you FINALLY admit that you need to do "more research on this topic".....Hope you've learned your lesson about talking bull$hit to impress people and look all cool and intelligent without knowing what you're talking about first...

First you tell us that you extract and prep teeth in your dental office, and then you tell us that you are gonna open your own dental office and hire dentists....all of this without even being in dental school! Doing too many drugs there buddy?

If you are gonna try and boost your ego with ******ed claims, at least make them believable!! By the way, did I tell you guys that in my spare time, I built myself my own private jet, and Ill be going around the world in a week!

Tom...Good Job for shutting this guy down....he really needed it!!

Hope he's not still doing extractions on his family members!!

 

[larryt]

Tom did mention about the law regarding the professional corporation law (which I had no idea about). I talked about business corporation law . This was a reason I had to do a research to make sure that we were on the same page.

 

[larryt]

Originally posted by avingupta
Larryt just keeps on talkin eh! Lemme guess...you fought in the GUlf War...took out a whole platoon, won the medal of honour, while writing you're thesis for your physics pHD which later on won you the NObel Prize in Physics!

First you tell us that you extract and prep teeth in your dental office, and then you tell us that you are gonna open your own dental office and hire dentists....all of this without even being in dental school! Doing too many drugs there buddy?

If you are gonna try and boost your ego with ******ed claims, at least make them believable!! By the way, did I tell you guys that in my spare time, I built myself my own private jet, and Ill be going around the world in a week!

I'm about to tell people about this stories too, but you took my credit.

 

[Dr.BadVibes]

I'm about to tell people about this stories too, but you took my credit

With all your accomplishments, I would assume that you would know proper grammar!

 

[larryt]

Thanx to AA , I did accomplish lots of things in life without any proper English.

 

[DrJeff]

In the near future atleast it won't happen widescale. I know that many, many hygenists love to say that they'd go out on their own and practice independently, but then the cold, hrad reality of business sets in quickly(and I know I read that this has been the case in Colorado). The hygenists while practicing in the Docs office take for granted things like the rent on the building, the cost of the chairs, x-ray equipment, instruments and supplies, how much work is involved with billing and collecting, confirmining and providing healthcare insurance for employees. Suddenly they need another employee or 2 to do all the background things and the headaches mount.

All these things away from patient education and scaling, while they don't seem like a big deal in an office thats set up to handle them already(the doc's office) becomes the factor that ultimately has led to many of the independent hygenists to close their doors and go back with a doc.

Now I am a huge proponent of getting hygenist the leagl abilty to give anesthesia(and not just infiltration). Realistically many, many hygenists are already inserting instruments 10 or so millimeters in certain places and also administering subgingival medicaments.

 

[drPheta]

Originally posted by DrJeff
In the near future atleast it won't happen widescale. I know that many, many hygenists love to say that they'd go out on their own and practice independently, but then the cold, hrad reality of business sets in quickly(and I know I read that this has been the case in Colorado). The hygenists while practicing in the Docs office take for granted things like the rent on the building, the cost of the chairs, x-ray equipment, instruments and supplies, how much work is involved with billing and collecting, confirmining and providing healthcare insurance for employees. Suddenly they need another employee or 2 to do all the background things and the headaches mount.

All these things away from patient education and scaling, while they don't seem like a big deal in an office thats set up to handle them already(the doc's office) becomes the factor that ultimately has led to many of the independent hygenists to close their doors and go back with a doc.

DrJeff, I was thinking the same exact thing. Beyond that, the convenience and efficiencty (not to mention the overall health benefits) of having the hygienist and dentist in the same place make me wonder why hygienists feel the need to move independently.

I also think their liability over the patient would skyrocket if they were to move independently. Under the dentists employment, they can piggyback off the dentists' provided insurance and benefit from the dentists' supervision. It's like driving a car without airbags or ABS. Sure, you can do it, but your insurance company knows it's better to have them.

This idea sure can happen, but why should it? From the patient benefit perspective alone it's apparent this shouldn't need to happen. Factor in the overall cost of two separate entities, and you make the current situation look golden.

 

[larryt]

Why did hygienists want to start the movement ? I guess it was part of dentists' faults. Many of them were not appreciated by their bosses regarding of their training and education. Many of them were treated only as "teeth cleaning's person".

Paycheck isn't a factor that make your hygienist happy. You should let them actively involve into your patients' exam, diagnosis and treatment. Work with them as a team member or associate.

In an ideal dental workplace environment:
. patient is seated by floor coordinator or dental assistant
. dental assistant then gives listerine rinse and takes x-rays
. hygienist steps over and reviews health history, intra/extra oral
exam, dental accessesment and recommend the diagnosis and
treatment for both dental and hygiene treatment on the chart.
. dentist then goes over the suspected areas and reviews the
treatment recommendations by hygienist and adds his own
if applicable then signs the chart
. dental treatment is performed by the dentist
. hygiene treatment is performed by the hygienist
. patient is discharged.

Remember, all hygienist are trained well enough to recommend most of the dental and hygiene diagnosis and treatment plan. Most dentists do not take advantage of their hygienist's training and knowledge. Well, the hygienists are also upset about this too.

Just my few thoughts after attending the texas hygienists convention couple weeks ago.

 

[ItsGavinC]

Larry, you probably make some good points. What I do know is that ALL smart dentists do exactly what you just wrote. Whatever their motivations for doing so, they are aware that there is less work invovled on their part, the hygienists are happier, they are seeing a greater number of patients, and the office is therefore generating much more $.

 

[larryt]

Originally posted by ItsGavinC
Larry, you probably make some good points. What I do know is that ALL smart dentists do exactly what you just wrote. Whatever their motivations for doing so, they are aware that there is less work invovled on their part, the hygienists are happier, they are seeing a greater number of patients, and the office is therefore generating much more $.

Nah.. It isn't "smart" .... I'm thinking of "business sense"....

 

[DrJeff]

Originally posted by larryt
Why did hygienists want to start the movement ? I guess it was part of dentists' faults. Many of them were not appreciated by their bosses regarding of their training and education. Many of them were treated only as "teeth cleaning's person".

Paycheck isn't a factor that make your hygienist happy. You should let them actively involve into your patients' exam, diagnosis and treatment. Work with them as a team member or associate.

In an ideal dental workplace environment:
. patient is seated by floor coordinator or dental assistant
. dental assistant then gives listerine rinse and takes x-rays
. hygienist steps over and reviews health history, intra/extra oral
exam, dental accessesment and recommend the diagnosis and
treatment for both dental and hygiene treatment on the chart.
. dentist then goes over the suspected areas and reviews the
treatment recommendations by hygienist and adds his own
if applicable then signs the chart
. dental treatment is performed by the dentist
. hygiene treatment is performed by the hygienist
. patient is discharged.

Remember, all hygienist are trained well enough to recommend most of the dental and hygiene diagnosis and treatment plan. Most dentists do not take advantage of their hygienist's training and knowledge. Well, the hygienists are also upset about this too.

Just my few thoughts after attending the texas hygienists convention couple weeks ago.

In my practice, more often than not, all I'll be doing when I come into the hygenist's operatory is to "rubber stamp" the findings/reccomendations that they've made in the last 45-50 minutes that they've spent with the patient. Sure I look at all the oral tissues/the radiographs/ and each and every tooth, but basically if my hygenists have it written down on the post it notes they use to put notes on before chart entry, then 98% of the time I going to reccomend it.

The main point in my post above wasn't a respect issue(and for all the students out there going into the GP world, if you don't respect the judgement/opinion of you're hygenists, then #1 you'll be looking for alot of hygenists, and #2 you'll be loosing out on alot of potential $$)but a business issue, in that many hygenists out there may not realize exactly how much it takes to open/run/ maintain a practice. For example, if the total overhead of my office is at 62.5% than it would likely be higher for a hygiene only practice. Here's why, proportionally you need the same things, a chair, auxillary staff(and you will as a hygiene only practice), and equipment. In my bigger office, sure the total overhead is higher, but proportioanlly per room it would be similiar to a hygiene only practice. Now heer's the kicker, in a hygiene only practice, each room may be able to bill $125-$150/hour. In my bigger office, not only do my hygiene rooms bill that, but my Doc's ops bill (if my front desk is scheduling correctly) $400 or so an hour. This keeps my overhead where its at. In the proportional hygiene setting, that overhead will be higher since you don't have that extra room income that way.

It's the same reason why its easier to buy-out or associate and buy-into a practice than start from scratch, its more econimical that way.

 

[groundhog]

DrJeff hit the bullseye. Business economics wins out. My gut feeling is that the RDH separatists represent just a small fraction of their peer group. People tend to go into a line of work based upon what they perceive will be the working conditions associated with that occupation. I suspect most prospects who persue a RDH career are very comfortable with the idea of becomming a team member in a dental office that is headed by a dentist (headed is not even the best word in one sense--licensing statutes place certain responsibilites on the dentist and others on the hygienist respectively and that is just the way it is).

The RDH separtists try to make hay with the politicians by claiming to be able to provide a solution to the underserved population delimma that confronts some regions of the nation. I think that arguement is a bit lame because I doubt that much of an econimc incentive would exist for RDH's to serve the underserved if such an economic incentive does not exist for dentists. I just don't see hoards of RDH's suddenly bolting their associations with dental practices in order to open up RDH practices in underserved areas.

 

[booshwa]

I think its legal in San Fransisco for a hygientist to have their own practice.

Wait, did I say legal...I meant that the mayor will probably let you do it.

 

[ShawnOne]

Originally posted by groundhog
I think that arguement is a bit lame because I doubt that much of an econimc incentive would exist for RDH's to serve the underserved if such an economic incentive does not exist for dentists.

Just playing devils advocate here.

Maybe there simply isnt enough dentists graduating per year to force dentists into this underserved, probably rural, areas. I have heard places in Nevada, for example, simply dont have enough dentists for the population. No dentist, no RDH.

What if a few RDH's got together and opened a shared (group) office? Share the overhead and provide a much needed service. You dont think they could make it?

 

[aphistis]

Originally posted by booshwa
I think its legal in San Fransisco for a hygientist to have their own practice.

Wait, did I say legal...I meant that the mayor will probably let you do it.

Jackpot! We have a winner, folks.

 

[larryt]

Originally posted by ShawnOne
Just playing devils advocate here.

Maybe there simply isnt enough dentists graduating per year to force dentists into this underserved, probably rural, areas. I have heard places in Nevada, for example, simply dont have enough dentists for the population. No dentist, no RDH.

What if a few RDH's got together and opened a shared (group) office? Share the overhead and provide a much needed service. You dont think they could make it?

Shaw.. you hit right on the target. There is widespread shortage of dentists in low income and rural areas just for the basic dental cares. This is a golden opportunity for RDHs to start lobbying. As DrJeff wrote, RDHs sure will have lots of problems when starting their businesses. In my opinion, majority of them in the first wave would fail miserably and only fews would survive and success. Those with success businesses will be the role models for the following waves. Is this the concept of revolution ? RDHs across the country are eyeing on colorado and other state (forgot which one) and waiting. Those 2 states are the hotbed testing site for them.

 

[sxr71]

Originally posted by ShawnOne
Just playing devils advocate here.

Maybe there simply isnt enough dentists graduating per year to force dentists into this underserved, probably rural, areas. I have heard places in Nevada, for example, simply dont have enough dentists for the population. No dentist, no RDH.

What if a few RDH's got together and opened a shared (group) office? Share the overhead and provide a much needed service. You dont think they could make it?

I think it is possible to run it sucessfully if it runs as a big operation. In all honesty though I think an MBA is more of an asset that a RDH license for the scale that you would need for it to work. So you'd need an experienced hygienist with an MBA who is just going to focus on setting up the business and hiring more hygienists. This is in sharp contrast to the way a dental practice which can be financially feasible with just one dentist and a couple of asisstants and hygienists (although I don't think that's the most efficient solution even for dentists).

For all you know it's going to a dentist or even a couple of dentists together that finance such an operation and hire an experieced RDH to manage the place and use the hygienist's office as a feeder to their practice.

 

[ShawnOne]

I dont think it would take a MBA degree.

In my opinion, MBA degrees are for people trying to work up a corporate ladder and need credentials.

What is needed for this RDH business to work is a business savvy 'go-getter', lots of capital, and a little luck. Look at all the major players who started these tech/net companies.

 

[sxr71]

Well, I think the two sources for funding in this case are dentists or banks. A dentist might provide funds to a hygienist he or she trusts, but a bank is going to want to see a good business plan before they cough up the cash. I think you'd need to run fairly large operation to realize those savings on overhead.

But I think I agree with you that these operations don't need to be that large as to require an MBA with the training to set up accounting with the appropriate checks and balances, human resources, organizational structure, policies etc. I suppose a good hygienist with a good deal of experience under their belt will do the job nicely.

 

[ShawnOne]

I also wanted to add another thing..

It seems like many dentists are against RDHs becoming independant mainly becuase they are afraid. They are afraid the RDHs might leave their office and it will end up costing the dentist lost money.

I think this 'fear' might be a little shortsighted. If RDH's start branching out, it could very well raise overall oral health awareness. If that happens, people be more likely to see a dentist AND they would keep their teeth longer.

So in the long run, I think it would benefit both RDHs and dentists alike.

any thoughts on this?

 

[sxr71]

Originally posted by ShawnOne
I also wanted to add another thing..

It seems like many dentists are against RDHs becoming independant mainly becuase they are afraid. They are afraid the RDHs might leave their office and it will end up costing the dentist lost money.

I think this 'fear' might be a little shortsighted. If RDH's start branching out, it could very well raise overall oral health awareness. If that happens, people be more likely to see a dentist AND they would keep their teeth longer.

So in the long run, I think it would benefit both RDHs and dentists alike.

any thoughts on this?

I actually agree with this. There are too many people not getting the care they need. Instead of coming to us for extractions, maybe we can save their teeth if they see someone earlier. These independent RDH clinics would become feeders for the care we can provide.

I just think that the economics would require a reasonably large scale to keep prices down for customers. I think we need offices with 10-15 RDHs, and the ability to pay for advertising and competitive pricing to see this happen. Ideally it would become like seeing a stylist to get your hair cut or styled, but instead of doing it every month you go every 6 months. Another thing that would work is larger centrally managed chain that has an office with 4-5 RDHs in every major shopping center in a city. That way the advertising can help the entire chain. This requires a complete rethink of how things are currently done and it sounds just like the thing one might propose during an entrepreneurship class in business school. It is going to take a lot of work and talent to get there.

However the way I see things working is not the only way it could work. It might actually be feasible for smaller independent clinics to be economically feasible. In fact it might be best if a couple of small clincs are established by enterprising RDHs and then later consoldated via partnership. Then they could adopt the best practices of each individual practice.

 

[ShawnOne]

I am not so much concerned about a feasible business model. The free market (if that ever happens) would figure that out by itself.

My point was if there was more people on the front lines, helping maintain and encourage oral health, this could help our profession in the long run.

These independent RDH clinics would become feeders for the care we can provide.

That sums my thoughts exactly.

 

[sxr71]

Well, I really hope it happens. As for the business mechanics, I think those are important considerations. As Dr. Jeff pointed in his post about the situation in Colorado, the current paradigm of opening up RDH offices structured like dental offices isn't working very well.

Someone will need to step in a create a better structure, but while I agree that eventually market forces will get it to work, we can help jump start things with either financing or knowledge.

EDIT: Then again we don't really want hardnosed business types invading our space like they did in medicine.

 

[Dr.SpongeBobDDS]

I tend to disagree with ShawnOne. I feel that too many people would feel that just going to get their "cleanings" was sufficient dental care for the year. The ability to "just get a cleaning' without the need for pesky x-rays and proper clinical examination, would simply serve to perpetutate the only-fix-when-it-hurts mentality that dominates so much of America.

But the hygienist can identify problems and refer, you say. Wrong. At the risk of sounding elitist, a hygienist just isn't qualified to do a proper exam. Yes, a hygienist with experience can do a bangup job of finding a lot of problems, but it doesn't compare to the training of the dentist. We don't go through nearly a friggin' decade of school just to learn the mechanics of our profession; any good carpenter could be taught to do pretty decent, basic dentistry in a 2 yr. evening trade school program; it is the diagnosis and treatment planning that really make us doctors.

Hygienists are not qualified to diagnose and refer which is what independent practice assumes of them. And if they are given that right, what is the point of our schooling and profession, anyway? Are we, after all, just tooth mechanics? I say, no.

Another issue is: what is the hygienist's motivation to refer: No one is checking her work, she makes no money from the referral, and assumes no liability for failure to diagnose. The real temptation would be to give everyone a clean bill of health, keep 'em happy and schedule 'em for recall in another six months.

Hygienists are valuable and important members of the dental team, but they are auxilliaries and should remain as such. This would be akin to giving LPN nurses permission to open up shop for routine immunizations and check-ups. Just a bad idea all-around. The public deserves the expertise of a well-trained and educated doctor.

 

[DrJeff]

Not bad ideas, however the one big limiting factor is that there just aren't enough hygenists as it is already, which means that many times what would cause a hygenist to leave a practice (respect issues/$$ issues/or personality issues) can be smoothed over by raises. This puts the hygenist is a strong position where they can command a big market price, because we as dentists want to have them in our offices.

As it would likely be perceived, and group hygenist only practice would likely acquire the mass view of a "discount" cleaning, since the mass populations opinion would be no doctor present = no expensive doctors fees to pay. Now to get thatbig hygenist only practice, you'd have to entice many of a limited valuable commodity(the hygenist) and get them to likely take a pay cut (perceived lower no doctor fees) over to the bidding war over themselves that they can command while shopping around the private practice market. Remember, people altruism will get them so far, but it won't pay their mortgage each month.

 

[larryt]

Originally posted by Dr.SpongeBobDDS


Hygienists are not qualified to diagnose and refer which is what independent practice assumes of them. And if they are given that right, what is the point of our schooling and profession, anyway? Are we, after all, just tooth mechanics? I say, no.

I disagree with you on this ? have you ever gone to dental hygiene program ? Do you know about their training ?

Dr Jeff, (I may get this wrong, so please correct me). There ain't many oral diseases that general dentists can diagnose from looking to oral tissues and X-rays anyway. I can list them all here. All of those can also be identified by RDHs. There rest of other problems are spotted by RDHs and refer to the dentist. The dentist then orders biopsy, culture, blood test .... before finalize the diagnosis.

I don't mean that RDHs are equal to the dentists. They are the forerunners and make the dentist's life a little bit easier in term of patient's basic dental care.

 

[aphistis]

Originally posted by larryt
There ain't many oral diseases that general dentists can diagnose from looking to oral tissues and X-rays anyway. I can list them all here.

Time to head to the plate, slugger. Let's see your comprehensive list.

 

[Dr.SpongeBobDDS]

LarryBoy, I didn't mean to offend you or denigrate your schooling. I just think you are confusing two very different concepts. Recognizing a disease is NOT diagnosis. My grandmother who is a nurse can recognize mumps, measles, chicken pox, streep throat, thrush, heart murmurs you name it. What she cannot do is diagnose; this is a legal right bestowed upon someone with extensive training in their area of expertise.

Currently, hygienists cannot diagnose; they can give the dentist a heads up on which areas to examine closely; they can reinforce the need for treatment by mentioning problems to the patient before the doctor sees them - but they cannot diagnose.

A diagnosis should be made by a doctor. I'm not saying hygienists don't get good training, but you will see when you get to dental school, how incredibly rigorous the training of the dentist is. We take two classes with the hygienist. These are introductory level classes and barely scrape the surface of what the dental students will learn in future classes. For the hygienists, though, this is their only exposure to the material. These two courses also happen to be the easiest courses in the dental curriculum; dental students don't even study for them. Yet the hygienists are constantly stressing about these classes because they are some of the hardest in their program.

Let me stress, I am not trying to say that dentists are smarter or better or superior in any way. I am just saying that the education levels are an order of magnitude apart in intensity and I don't think it is appropriate to grant professional independence and the right to diagnose to a person with a 2 yr. Jr. College/Trade School degree.

I know you are going to be upset by this post, but please know that it was not my intent to offend you or be inflammatory in any way. I respect the job that hygienists do and will treat the hygienists in my practice as peers and equals. But there is already a program in place for hygienists who want to diagnose and treat disease in their own offices; it is called dental school.

Just calling 'em how I see 'em. Bob

 

[larryt]

Bob.. nah.. this is a healthy discussion thread. I don't get offend on anyone on this forum. By the way, I misunderstood your earlier post. Of course, only doctor can diagnose the disease. I don't like the idea of giving RDHs the right to diagnose the oral condition also. But I do support the idea of profession independent for them to ease the shortage of dentist in those low income and underserved areas. My whole point is that RDHs are capable of identify the problem beyond the gum tissue and refer to dentist for further exam, diagnose and treatment.

 

[DrJeff]

Originally posted by larryt

Dr Jeff, (I may get this wrong, so please correct me). There ain't many oral diseases that general dentists can diagnose from looking to oral tissues and X-rays anyway. I can list them all here. All of those can also be identified by RDHs. There rest of other problems are spotted by RDHs and refer to the dentist. The dentist then orders biopsy, culture, blood test .... before finalize the diagnosis.

After quickly thinking about the numbers and types of diseases that we diagnose and pick up via the intra oral and radiographic exams, I came up with roughly 50 different diseases (from AIDS to zygomatic arch fractures - literally from A to Z )

My hygenists will pick up on about 85 to 90% of the pathologic processes that I'll pick up on my examination. It's the more obscure, often more severe diseases that seperate my diagnostic skills from that of my hygenists(both of them are 10+ years of experience, top grads from Boston area 4 year bachelors based programs). In the past year, I can think of the following biggies that my diagnostic skills picked up that were above that of my hygenists. A case of Acute Myelogenous Leukemia, a case of Gastroesophagael reflux, a case of Osteomyelitis, and a case of Eagle's Syndrome. They've picked up numerous cancer cases, drug abuse cases, and a couple of cases of diabetes.

Some of the temporary hygenists that I've seen don't have quite the diagnostci skills that my crew has(Of course I'm being 100% objective and unbiased here )

 

[larryt]

Originally posted by DrJeff
A case of Acute Myelogenous Leukemia,

When you mentioned AML, I was brought back a bad memory 8 yrs ago. I worked in the small hospital just outside of houston on the second week after graduation. One nite, We got the patient in with 250,000 WBC on CBC with flu-like symptoms in summer time. I had a chilling feeling in my head when checking his blood smears. I took the report and ran to ER doc and also helped those doc and nurses with language interpretation for this patient. I did built a special friendship with this man for the next 3 days. He died on the fourth day with me next to him. This man had no family member in this country. I did able to contact his wife and children months later and passed them his notes.

 

[preludexl]

Originally posted by larryt
Bob.. nah.. this is a healthy discussion thread. I don't get offend on anyone on this forum. By the way, I misunderstood your earlier post. Of course, only doctor can diagnose the disease. I don't like the idea of giving RDHs the right to diagnose the oral condition also. But I do support the idea of profession independent for them to ease the shortage of dentist in those low income and underserved areas. My whole point is that RDHs are capable of identify the problem beyond the gum tissue and refer to dentist for further exam, diagnose and treatment.

Take a page from the medical establishment before you make such bold statements. Ask an anesthesiologist about nurse anesthetists, ask a GP about physicians assistants, ask an opthamalogists about optometrists lobbying for the right to do minor eye surgery. You are opening a can of worms. If a hygenists wants to do what a dentist can do, go back to school and become a dentist. Pure and simple. Why dont pre-dents just all become hygenists and still be able to do what dentists do? You give a little and soon that little will be too little, and more becomes too much.