The last 20 months or so have put into havoc all the things we had previously taken for granted. Everywhere you look there is a ‘help wanted sign,’ new cars in certain areas are being sold 20% over sticker price (1), and stores cannot keep up with the much needed new washer, dryer, or refrigerator for purchase. Restaurants close early and some have gone out of business altogether. We have all noticed grocery prices climbing every month and see empty shelves due to shipping delays.
Containers are sitting in ports still holding halloween costumes and there aren’t enough truck drivers for their very late distribution. The new normal involves employees who are overworked, consider themselves underpaid, and suffer from burnout and emotional exhaustion. This severe underemployment and its effects in the United States has been named the “great reshuffle (2).” As many of us know, the “great reshuffle” has not spared the community of dental professionals.
An indeed.com search (November 5, 2021) shows that in my area alone (western suburb of Chicago), there are 2243 jobs available for a receptionist (in a 25 mile radius), 571 jobs available for a Dental Assistant, and 308 jobs open for dental hygienists. As we move forward, attempting to provide our patients with the care they are used to, with the readily available appointments that they need, we fall short searching for administrators, dental assistants, and especially missing our hygienists.
And thus, we have began to ask ourselves as providers and as business owners: What has happened to create such a shortage of hygienists? Where have they all gone? And… most importantly, what will it take to bring them back? I have had to engage my mind differently in thoroughly examining this question, shedding the skin of a practice owner and dentist to really study and evaluate the voices of a contemporary RDH, emphasis on contemporary.
I have put forth a tremendous amout of effort and research, and continue to do so, to create a presentation that is as unbiased as possible. The intent of this ongoing exploration and writing is to begin a conversation, a vital conversation, that needs to take place between the dentist and hygienist, community-wide.
It is my belief that we will only have a chance of bringing our beloved co-provider back, if this dialogue takes place.
Numbers don’t lie
According to the US Bureau of labor statistics for the year 2020, there are 139,200 (3) dentists and 206,100 Dental Hygienists (4) in the United States. That’s a ratio of 2:3, dentist to RDH. In 2019, 7311 hygienists graduated for RDH school and 6350 Dentists graduated, which leaves us to a closer ratio of 1:1 (5). Further examining the statistics, I have found that in the last 10 year schools have increased graduates from RDH programs by 7.8%, yet DDS programs have upped their graduates by 37%.
So, the question begs: is there a shortage of hygienists or have dental schools created an overpopulation of dentists? Have we, truthfully, failed to train enough hygienists to support the patients presenting into dental offices? And if either one is the case, why have we just caught this discrepancy at the heels of the pandemic?
Are they really leaving?
To top the discrepancy in the ratio between the dentist and the RDH, is it possible that the shortage of hygienists has been exasperated by the pause that the pandemic has brought? Is it possible that in the months since March 2020, we have reopened our clinic doors to find that we are under-supported in our hygiene department? Is it really true that we’ve come to a point where RDHs are leaving our profession in harrowing numbers? And then, more questions arise: why are they leaving? What will this mean for dentistry?
What will this mean for our patients? Will the shortage that we are currently experiencing create a change for the model of a contemporary dental practice? I don’t know that I can answer all of these questions, but I can certainly scratch the surface on a few. Much of my information has been pointedly suggested to me in my research on social media and some through person to person conversations with my peers, dentists, and RDH’s alike.
Why did they leave?
The 12 weeks of quarantine was unfamiliar, unexpected, and unprecedented. But what it did leave was time for all of us to think. It’s put front and center what we view as important and non-negotiable. This method of evaluating our journey was no different for the contemporary hygienists.
Just like the rest of us, they have found their own irrefutable truths and have chosen to lay out their lives in a way that reduces stress and maintains joy. Apparently, their new lives and their new joys laid outside the dental office. Quite possibly, this has been a turning point which has brought about this change, this hardship in our dental offices.
In all of the communication I have received from hygienists who have left the operatory, or ones who are planning to leave the operatory, the number one reason, by far and with adamant emphasis, was a toxic work environment present in the dental office. Complaints of being unfavorably and unfairly labeled as divas, of being disregarded, disrespected, and discouraged filled almost every private message I received.
And as much as that disclosure ruffled my own feathers, as a practicing dentist, apparently I had failed to consider the veracity of that statement. I had never considered that to be a widely held possibility. In a study by J. N. Petit, et al published in International Journal of Dental Hygiene, this past August, 21% of participants experienced workplace bullying in clinical practice. 2.9% of them experienced it on a daily basis (6).
This study along with others presented information that a toxic work environment, as felt by the hygienist, is neither a myth nor a misrepresentation, it is supported in data.
Other reasons topping the list for leaving the profession have been a lack of benefits, including medical insurance, retirement plans, paid time off, and inflexibility of schedule prohibiting taking an active role as a parent. Lack of growth within the profession was also listed and burnout related to the lack of compliance and respect coming from patients. Many hygienists suffered from body aches and injury related to the profession, which was mentioned repeatedly.
It is also important to point out that the additional benefits distributed during the pandemic in a form of unemployment bonus or child credits have had little to do with RDH’s not returning to work, I was warned by one of my sources. Once again, the average wage of an RDH, as stated by the US Bureau of Labor, is $37.06 per hour or $77,090 per year (4) (this wage, however, appears to be a inaccurate and misrepresentation of the current environment).
The average distribution of a unemployment check with the Pandemic Unemployment Assistance hovered around $1000 per week, making it about $25 an hour (7). It’s also important to mention that as of September 5, 2021 (8) the additional unemployment benefit has been removed; currently the average unemployment benefit is about $300 a week (7), depending on the state, or $7.50 an hour. Financially, there was and is little to no benefit for the RDH to stay home simply for the government subsidy, and this also has to be understood.
More importantly, even if there was hesitation in maintaining that statement’s truth, since September 4, 2021 there has not been an increase in hygienists returning to work.
Amassing all the reasons listed above in concert with having the time during quarantine to consider what really matters in life, the contemporary RDH had decided to leave the field, either temporarily, or quite possibly for good. If this doesn’t change and the shortage of hygienists continues, our patients won’t be given adequate care and dentists won’t be adequately alleviated of their duties in providing care for restorative patients.
It is likely that existing patients will have to wait longer for recall appointments and new patients will have a hard finding a new dental home.
What is front and center in this conversation is that fact that we hang on to an outdated model of a dentist being financially, educationally, and skillfully elevated and separated from his or her support team, which was ingrained in us over the past several decades. Do we fail to see the teamwork that goes into providing care to our patients? Do we underestimate the strengths of those who surround us and possibly overestimate our own value? Do we think of ourselves as the provider, as opposed to a co-provider in a team with a hygienist?
Two things will happen if this conversation isn’t forthright: the model of practice as we know it will need to change, putting the health of our patients on the line, and the role of dentist will be redefined as we will need to incorporate maintenance and periodontal patients into our production schedule, reducing our profitability and productivity.
As providers, practitioners, and business owners, we must begin to pay close attention and take effort to imagine ourselves in the shoes of another, even if it isn’t a task that places itself easily onto your plate of daily actives. We ought to consider if we, as providers, have become so determined, so focused on our own practice and business growth, that we have left the mid level providers out of the equation?
Have we been so busy in dealing with the hardship bought on by the pandemic, in sourcing PPE, applying for PPP, and managing an overload of overdue patient that we have become unaware of the newly redefined needs of RDH’s? Are we willing to be open for an opportunity to treat the hygienist as the mid-level providers they are, as co-practitioners? Can we see their own role in a different light and through a different lens?
And if we can, the question still stands…
Will that be enough?
- Petit JN, Boyd LD, Vineyard J, Dominick C. A survey of the prevalence and predictors of workplace bullying towards the dental hygienist. Int J Dent Hyg. 2021 Aug;19(3):332-339.