Let’s face it: the industry of dental hygiene is more than saving smiles one tooth at a time. While we’re highly trained to meet the oral and systemic needs of our patients, we also encounter immense stress from various aspects of our careers. These stressors often lead to hygiene burnout.

As resilient providers with the desire to soundly and ethically provide for our patients, it’s important that we remind ourselves of the good work we are called and compelled to do. I often am reminded of that work when I read a copy of the Dental Hygiene Oath, as it demonstrates the immense responsibility we have as providers.

The truth remains, however, that despite our greatest efforts, hygiene burnout exists. Most commonly, of note, burnout exists due to workplace stressors. I know every hygienist LOVES the back-breaking work they do over a patient who arrived 20 minutes late to a front desk whose ambivalence over adhering to a schedule is perfectly paired with a doctor’s reticent attitude over your co-diagnosis or an overzealous employee handbook (eye roll).

Many hygienists believe that choosing to work in a private office helps avoid several workplace stressors. In turn, many new graduates seek work in corporate dentistry because of its incredible benefits. This article addresses the differences in workplace satisfaction between corporate dentistry and private practice. Spoiler alert: both have their benefits and their areas that need improvement.

Disclaimer: This article is constructed to provide generalizations about corporate vs. private practice workplace settings. It’s in no way intended to offend or articulate specific speculations with regards to various work settings. This author works in both corporate and private establishments and appreciates both for their many strengths.

Employee benefits

As many would suspect, corporate dentistry shines when it comes to employee benefits. Due to the number of employees utilizing benefits, often medical and dental benefits are more inexpensive with improved options for health spending accounts.

In addition, corporate dental allows for excellent 401k contributions, lucrative paid time off options, and excellent bonus structures for the production-minded hygienist. I have also found that corporate dental practices have a greater pool of hygienists to pull from whenever I wanted to utilize my PTO, thus making scheduling of a vacation easier on my guilty conscience.

Nevertheless, privately owned dental practices can either provide the minimum as it pertains to employee benefits or they can offer additional benefits based on the doctor’s preference. For example, I worked in a private practice in which the doctor reimbursed for a monthly gym membership. He believed greatly in the value of personal wellness and wanted to pass this on to his staff. Additionally, this doctor wanted to reward employees who contributed heavily to their 401k accounts and made greater matching contributions based on the percentages added to their retirement plans.

Unfortunately, the trend of private dentists providing excellent benefits to their teams has diminished over the years. While many doctors do still support their staff, there’s an increased understanding among the dental hygiene community that the benefits and support have evolved over the years. So, congrats to you, fabulous RDH, whose doctor takes the whole office on an annual cruise and treats everyone to massages every Friday; you nailed an awesome office. Stick with it, and know that you are incredibly lucky.

Bonus structure

While hygienists hate the idea that dentistry is a healthcare BUSINESS, we love the idea of receiving a bonus for our hard-earned production. It only makes sense; we’ve always been the bread and butter of the dental practice and our ability to maintain patients within the practice makes us an incredible asset to the BUSINESS of dentistry. With great work comes great reward (or something like that, right?).

In my employment experience, I have found that the integration of a bonus structure within a corporate establishment is standard, but often means a reduction in base salary. For instance, most corporate offices I’ve worked for reduce base salary by about 30 percent but promise a great reward for the productive hygienist. Of note, these structures promise the hygienist will make a bonus of a percentage of production over his or her daily goal.

For example, a hygienist who produces $2,000 with a goal of $1,000 will receive a base salary plus an additional $300 for the day. In theory, this is an incredible way to dig yourself out of that hygiene school debt; however, this structure has many flaws. Namely, a patient clientele comprised of largely Health Maintenance Organization (HMO) insurance plans or worse —$29 specials can compromise the daily production earned for the hygienist.

While this information certainly is disheartening, I have had excellent luck with not only meeting my production goal but exceeding it well above what was expected of me. Here’s my secret: I diagnose what the patient needs, I explain to the patient why he or she needs it, and I deliver the service. I understand this may sound basic, but I’ve found that many hygienists who know too much about the insurance plan of the patient hold back on treatment recommendations instead of encouraging adjunctive services or products for the management of gingivitis, periodontal disease, sensitivity, whitening, decay, elevated cancer risk, etc.

In contrast, many private dental practices either don’t offer a bonus structure at all or provide varying options with regards to a bonus opportunity for dental hygienists. I worked for an office in which I earned 1 % of all earnings from the doctor’s chair. It encouraged me to be proactive with co-diagnosis and use my caries detecting skills (hygienists have those, right?) to guide the doctor during his examination. The idea is that I’ve been in this person’s mouth for an hour and the doctor has only five minutes to do an exam, so who’s more familiar with the mouth? But what’s the con? An overly conservative doctor whose explorer clearly sticks directly under that failing PFM but wants to “watch” at this time (give me a break).

Another common private practice bonus structure is the office goal approach. I worked in a private office where I received $25 per day that the office (two RDHs and doctor) exceeded goal. I believe I cashed in my $25 bonus once every three months. What was the issue? Overzealous goals that, in no way, reflected the ability of the staff, number of operatories, or excessive cancellations due to inattentive front office staff.

Finally, I’ve had the pleasure of working for offices that simply offered a slightly higher hourly salary with the expectation that I would be a patient advocate and be an active member in the co-diagnosis process. Quite frankly, this experienced RDH appreciates this tactic best, but to each his own. You deserve to be appreciated for your hard work, my darling RDH colleague.

Professional development

As much as we all loved dental hygiene school, it certainly was a relief to turn in those poorly fitting scrubs with your school logo on them or, as some of my previous students did, burn their old syllabi in a giant bonfire surrounded by hopeful future RDHS. What we forgot about, however, was the lifelong journey we would embark on when it comes to personal and professional development.

While many dental hygienists see professional development simply as the acquirement of the necessary continuing education credits to attain a license, many dental offices see professional development as much more. As our state and national associations continue to lobby for expanded functions and duties for the dental hygienist, it’s imperative that we prepare ourselves to answer the call to action. Many dental offices provide excellent incentives for attaining advanced certifications in local anesthesia, N₂O, laser and/or restorative functions as they understand the value this adds to their practice.

Additionally, several offices, both private and corporate, permit an allowance for continuing education coursework. In fact, as a faculty member, I utilized employee benefits for tuition reimbursement to aid in the attainment of my master’s degree. The financial benefits were wonderful but knowing that I had the support of my company with regards to my development was invaluable, as I knew it meant they encouraged and supported my professional growth.

Corporate dental practices often facilitate their own training based on the corporate-wide need for continued education in various clinical or administrative parameters. However, I’m familiar with one corporation, in particular, that supports its hygiene staff with travel and specific laser training that aligns with its business model. This is a great way for hygienists to review their clinical and treatment planning techniques while receiving continuing education coursework.

Finally, many corporate and private dental practices enroll their staff in local study clubs, which allow for comprehensive, unbiased, and evidence-based presentations to further guide or facilitate office-wide development.

As a student of life, I love any and every opportunity to grow and develop. There are so many amazing ways that teams can attain continuing education or develop via team-building opportunities!

Employee relations

The other day, as I was scarfing down a bite of a granola bar, I realized something. I was replying to a text from my boyfriend who was asking “Did you get lunch today?” An awkward Snapchat photo of me posing with my KIND bar and grabbing a piece of gum on the way out of the staff room concluded my “lunch break.” This nearly daily occurrence is a beautiful cocktail of my corporate banking boyfriend not understanding the late patients, the “I scheduled this re-eval over your lunch hour, is that okay?” or simply the pile of clinical notes and dirty instruments needing catch up over the lunch hour.

It was then that I realized a major difference between corporate and private practice.

In many states, lunch breaks are REQUIRED after a certain number of work hours have been completed. Corporate offices require the employee to clock out and take their much-earned lunch hour while many private offices toe this legal line to great extent. Lunch hours are simply one example. I have often found that corporate offices adhere strongly to granting of overtime, earned sick time and state-regulated breaks, to name a few.

This strong adherence can be a help and a hindrance to the employee. I recall a personal day I took as PTO while faculty with a dental hygiene program. I ignored emails, phone calls and text messages from colleagues all day in an effort to enjoy my personal day. At 5 p.m., my boss advised me that my PTO day was done and that I needed to get back to work.

Corporate offices, in many ways, do provide advantages in employee relations. Their ability to provide a human resources individual or department ensures (or should ensure) an unbiased moderator during stressful office occurrences. Their employee handbooks are typically verbose in all areas of employee matters, which ensures protection of both the employee and the corporation.

However, as we know all too well, dentistry is a humanistic business. We are people who treat people, and often empathetic people don’t wish to feel like a corporate number. It’s in those moments that I appreciate my private offices for the personalized birthday card, understanding when I need to leave early for my dog’s vet appointment, or respect when I’m not feeling well but am still working to produce while battling the plaque of 2018. For many of us, it’s the little moments of understanding or kindness that mean more than having a full hour to eat a 500-calorie Lean Cuisine meal while making awkward small talk in the staff room.

Conclusion

At the end of our stressful, exhausting hygiene days, we simply want to feel that we’ve made a difference. For many of us, this means a sense of accomplishment with treating immense disease among our patients. For others, it means exceeding a production goal. And still, for others, it may mean connecting with a stubborn patient, brightening up someone’s day, or simply not losing it on their coworkers.

Whatever drives you to do and consistently be your very best, I hope you’ve found it in your place of work. If your current place of employment doesn’t allow the fabulous talents you have within to shine, you have my immense support in finding another employer who will challenge, encourage, and provide for you.

From one hygienist to another: you’re good enough, you’re smart enough, and doggonit, patients like you!