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First job

Hello all,

Just some background info first. I’m a male hygienist class of ’14. I didn’t get licensed until this year due to some financial constraints (hospitalized for pneumonia). I applied to jobs everyday for a week until I got a call from a dentist to set up an interview. The interview went ok and I was asked for a working interview. The pay was going to be less than I had asked for but I understand being a new grad and inexperienced.

Working interview went ok for the most part. A few quirks about the office but I attributed that to being new. Doctor asked me to come in for 3 more working interviews (M,TH,F). I accepted the position and started working part time until a week later and I received a call from the dentist. She wanted to offer me full time with benefits since she was having trouble finding another part timer for Tues Wed. I couldn’t believe my luck. I accepted and started working 5 days a week.

Some background on the office. Been around since 2005. Accepts Medicaid, private insurance, and ffs. 3 rooms for operative, 2 hygiene rooms, 1 overflow room.

The honeymoon feeling waned quickly as I found out more about the office. For one, recall patients and new patients are allotted the same amount of time with the hygienist (45 minutes). New patients are frequently late getting in my chair because of the paperwork. My classmates have told me that in their offices, new patients meet the dentist first before a prophy or radiographs are prescribed. At my office, if the new patient is “healthy” then their 45 minutes includes the med hx review, 4 BWX, 2 anterior PA’s, a PAN, prophy and comprehensive exam with the dentist. I feel like I have to become some sort of super hero to accomplish this without the OM and dentist on my case about staying on time.

Secondly, there is high staff turnover. In the 2 months I’ve been there, I have seen 4 new assistants. Apparently I’m the 3rd or 4th new hygienist in 4 months. The OM, one front desk, and lead assistant have all taken a month off at a time after having confrontations with the dentist, who can be quite abrasive even in front of patients. Our newest assistant has been hired for full time but after a week was asking us if we knew any other places hiring.

Thirdly, the instruments we have are apparently all bought used on eBay, according to our other hygienist who has been here 11 years. Our ultrasonics are on their last legs. Mine broke about a week ago and we haven’t been able to replace it. We often have two or three of the same instrument in a hygiene pack because they are so dull with nothing left to sharpen that we hope another instrument has an edge.

Fourthly, after any 4341, she checks my work. She wants us to get every last piece even in pockets 6mm+. We don’t usually refer out to periodontists and try to do it all here (yes even with 8-9mm+ pocketing).

Finally, we hygienists have the duty of calling and confirming patients 2 weeks out and 3 days out. We also have to clean the bathrooms, parking lots, etc. The OM implemented a new checklist that if we don’t complete all these tasks, we may not go to lunch or leave for the day.

I am starting to feel anxious everyday going to work. I have lost my appetite and stopped working out. There a days where I am on the verge of tears because of how crazy the schedule gets or how afraid I am of the doctor (she yelled at me one time down the hall to stay on schedule). I want to leave but I feel like I should just be happy to have a full-time job (or any job for that matter).

I want to be happy and successful in hygiene like all my hygiene sisters I graduated with but the stress has made me feel like a failure.

Any advice?

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1 Answer

It breaks my heart to read what you are going through. Sadly enough, I have been in your situation with my first permanent position out of school just like you. While you want to be grateful to not only have a job, but a full-time job, the bad far outweighs the good here.
45 minutes for all patients: No matter how seasoned you are, this simply isn’t enough time especially for new patients. The ADHA did a breakdown of a periodontal maintenance appointment (See page 8, table V: http://jdh.adha.org/content/88/2/87.full.pdf+html).
The time needed ranges from one hour and five minutes to one hour and 43 minutes, with an average of one hour and 24 minutes needed. Some doctors think squeezing more patients into the day increases production, but I would argue it actually does the opposite. If the hygienist does not have the time to explain the need for treatment and conduct thorough education, the office’s bottom line will suffer.
Furthermore, the doctor could be setting themselves up for a malpractice suit. A rushed hygienist can lead to a less thorough medical history, failure to detect oral pathology such as periodontal disease and oral cancer, injury to the patient, less-than-thorough chart notes (which are legal documents), and this list could go on. Patients notice when their care is being hurried through and isn’t thorough. This hurts patient retention and referral rates. For a doctor, what steps would they cut out of a crown prep if their appointment times were shortened? No steps can be left out, right? The same logic applies to hygiene appointments. Additionally, how would the quality of care suffer if a doctor’s time with patients were shortened? The length of appointment times is just as important for a hygienist as they are for a doctor.
Beyond giving sub-par treatment to a patient, stressing your body out to provide treatment this quickly wears on your body. Ergonomics tend to go out the door when you are rushed. This can lead to musculo-skeletal injuries and in turn shorten your career. Not to mention what it is doing to you emotionally.
The most efficient offices I’ve worked at have the first appointment with a new patient with the doctor. It makes financial sense because a dental assistant can take all radiographs and help with the comprehensive exam. Once the periodontal condition is diagnosed, then the patient is scheduled with the hygienist, for the appropriate amount of time. Legally, it makes more sense too because in most states a doctor must diagnose for a hygienist to treat.
High staff turnover: Huge red flag. Not much explanation is needed for this one!
Abrasive attitude of the dentist: Everyone has “off” days, but they certainly shouldn’t be every day. Mutual respect between dentist and staff is an absolute must. A dental office should be a team environment where everyone works together in a smooth, efficient, respectful way. If there are several confrontations happening without any effort to make the office a team and make situations better, it’s a toxic environment. Further, chairside manner is a biggie. No boss should demean staff in front of a patient.
Instruments: If the doctor needed a new high-speed handpiece, carver, or bur, they’d buy it with no question because they need it to do their job. Hygiene instruments are the same. Stainless steel instruments need to be replaced every nine to 18 months, and sometimes even more frequently depending on the number of set-ups, difficulty and amount of patients seen, among other factors. For a hygienist to provide the highest standard of care to their (and the doctor’s) patients, you need equipment that’s up to par. Without proper instruments, you aren’t only doing a disservice to the patient, but it takes a toll on your body. Again, this is literally shortening your career if you don’t have adequate instruments.
Not to mention you are working harder, not smarter — and ultimately, time is money. You need to be allowed to work efficiently. Another analogy: If a computer was out of date or not working properly the doctor would replace it – it’s a business expense. The same goes for hygiene equipment and instruments. Hygienists should bring in on average one third of the office’s total revenue. Not to mention that an estimated 50-80 percent of the doctor’s treatment (restorative) is generated through hygiene exams. You must be allowed to do your job properly because you do produce for your office and add to the bottom line. Your doctor must provide you with the instruments and equipment you need, just as the doctor does for themselves.
Using poor quality, re-tipped, and/or old instruments can lead to breakage. If an instrument breaks in a patients’ gingiva or even worse if they swallow it, the doctor is going to have big problems.
Not referring when necessary: This is neglect. Hygiene instruments are only efficient to about 6 mm. Beyond that, a referral needs to be made. If a patient’s tissue heals around calculus it can lead to a perio abscess. This could then lead to tooth loss, which again, a patient can take legal action against the doctor.
Extra duties: Helping out when there’s time is one thing. However doing the front office or office manager’s job is another. Why would the doctor be paying someone to do a job then have other people do it for them? Especially when you have your own job to do!? This is simply poor business practice. Further, the office manager isn’t the boss, the doctor is. It sounds like the office manager is overstepping their role.
I very highly suggest you start looking for another office and move on. The fact that you are anxious and it’s effecting you mentally and physically simply isn’t worth it. Don’t wait until you regret going into hygiene, become burnt out, or ruin your body to find a better office. You must work in an office that shares you same patient care standard, period. This office doesn’t seem to meet that and you need to sleep at night knowing you provided the best patient care you could, period. Every office has their quirks, but your concerns are more than quirks, they are red flags.
However, do take this as a learning experience. Now you know what to look for and ask about when finding your “forever” office. How long are appointments (prophy, PM, SRP, etc.)? Who are new patients seen by first, doctor or hygienist? How often are new instruments provided? Why did the last hygienist leave? How long has the office manager, dental assistant(s), hygienist(s) been with your office? What is the protocol for referring?
Lastly, you are not a failure. You recognized there is a problem and are seeking advice. Failures don’t do that! I wish so much for you to be happy. A new office can make all the difference and you deserve that! I wish you the very best of luck!

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