Occasionally, at the end of a procedure, a patient will compliment my assistant and me for our work as a team and how well choreographed we are. Not being one to take compliments properly, I might tell the patient that, although both of us are below average, we’ve learned to fake it well after 15 years together. It usually earns a chuckle form the patient and a kick in the shin from my assistant, but kidding aside, it reveals how important it is for us to work with familiar, well-trained people.

Of course, our staff needs time off; perhaps they take vacations, maternity leave, or mysteriously disappear. Their absence is missed, and everybody in the office scrambles to fill the void. While technical elements of a dental procedure shouldn’t change much from one person to the next, it’s amazing how much more taxing the same task becomes when a new person is introduced. Unfortunately, filling the void of a missing staff member has become tougher than ever.

The improvement in the economy has increased busyness for dentists, along with a corresponding demand for auxiliaries. As a result, the pool of assistants, hygienists, and front desk staff has become alarmingly slim. With the unemployment rate dropping, many of those who are still unemployed are the unemployable. Consequently, practices struggle for both short-term and long-term help. 

For short-term replacements, staffing agencies often fail to find a suitable fill-in. Low supply and high demand allow agencies to command hefty prices for increasingly questionable talent. I’ve paid good money for temporary assistants to ruin or lose equipment, blow their nose in front of patients, and sometimes not even show up. I’ve paid even more for temporary hygienists to butcher tissue, tell patients about their love lives, and scold me at the end of the day because they don’t like the practice software I use. After all that trouble, I kowtow to the mighty temp agency, write them a generous check, and tell myself I will never let another staff member have a day off.

Hiring for the long term offers its own set of problems. With dental assistants, the quality of training varies so greatly from one school to the next that dentists have to be especially careful about who they hire. Many of the public schools, as well as some of the for-profit schools will graduate students who have a decent grasp of the basics. Sadly, some of these for-profit schools provide such a crummy and expensive education that students are getting ripped off. Some charge close to $20,000, then graduate an assistant who is barely more skilled than when they enrolled.

Fortunately, hygiene schools are accredited, but we still encounter similar supply-and-demand problems. In Seattle, some freshly graduated hygienists are asking for hourly wages in the mid-to-high $50s. Meanwhile, some insurance plans have decreased prophy reimbursement to almost the same level. This creates a mess for the whole market. Dentists switch to a 30-minute prophy schedule to cover costs, the patient gets substandard care, and the hygienist burns out. Even the insurance companies lose, paying more to cover the higher costs of repairing a poorly maintained patient. Nobody wins.

This dilemma offers the opportunity for organized dentistry to improve the undersized and underqualified pool of dental auxiliaries. It’s time to act by opening up new hygiene and assisting schools, and enlarging the ones already operating. 

On the assisting front, we need to use our relationships in Olympia to start policing the private schools. Students deserve to receive a suitable education no matter what school they attend. Locally, we need to encourage the development and expansion of assisting programs at reputable vocational schools.

Similarly, a push to expand the dental hygiene workforce will benefit everyone. Just as dental schools and residencies help deliver care to the underserved, so will growth of hygiene schools. Nearly a million people live in Snohomish and Skagit counties, but they have no hygiene programs, while Eastern Washington has three. Our state has seen significant population growth and a significant influx of dentists arriving from all over the country, so the state needs more hygienists to keep the workforce in balance. Patients, dentists, and staff all will be better off for it.

Organized dentistry must lead the charge, but help will be needed from leaders of our schools and government, as well. If we don’t push the matter, nobody will do it for us. Fortunately, this idea should be able to sell itself. It’s an opportunity for local leaders and politicians to bring a valuable asset to their communities. Once implemented, dental offices will enjoy more highly qualified hygienists and assistants so we can deliver our best care to our patients, and I can once again let my staff take a day off.

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The views expressed in all WSDA publications are those of the individual authors and do not necessarily reflect the official positions or policies of the WSDA.