Chasing unicorns: Finding the perfect hygienist-doctor fit

It's nearly impossible to join a dental community chat or attend a conference without hearing discussions about the dental hygiene crisis. Hygienists express feelings of being overworked, undervalued, and burned out, while dentists voice frustrations about being taken advantage of or held hostage by what they feel are demanding hygienists. This divide breaks my heart.

Having spent more than 20 years as a dental hygienist and now working as a dental practice coach, I have a unique perspective. I've been on both sides of the chair, experiencing the rewards and challenges of clinical work, and now, guiding practices through these difficult times. I've been fortunate to work in practices where being a dental hygienist was not only fulfilling but deeply rewarding. I love this profession and believe it offers incredible opportunities. And now I wonder—how did we get to this point?

The dental profession is undoubtedly in the midst of a hygiene hiring crisis. There’s a growing chasm between dental hygienists and dentists that must be bridged for the betterment of the entire profession. When I coach dental practices, I look at issues that arise by trying to understand the root of the issue. It’s hard to solve an issue as big as this; however, if we solve the problem at the root we may just be able to make progress.

The dental hygienists’ voice

Dental hygienists are leaving the profession or turning to temping in alarming numbers, driven by a deep sense of frustration and exhaustion. Common reasons expressed are:

• Feeling undervalued by their teams.
• Being treated as cogs in a machine rather than vital contributors to patient care.
• Being restricted by rigid, unforgiving schedules that leave little room for balance, forcing them to choose between their career and personal life. 
• Insufficient time to provide the quality care they’re so passionate about.
• Struggling to obtain basic tools and resources, compromising their ability to do their job well. 

To make matters worse, stagnant wages and inadequate benefits fail to keep pace with the rising cost of living, leaving them feeling unappreciated and underpaid. For many, the only way to reclaim control over their professional lives is to leave traditional roles and seek temp work, where they can find the flexibility and respect that’s been sorely lacking, or they can transition away from dental hygiene altogether. This exodus is a cry for help, signaling that the profession must change or risk losing its most dedicated and skilled practitioners.

The other side of the coin: The challenge for dental practice owners

Dentists are caught in a heartbreaking struggle, trapped between the financial pressures of a fractured system and the needs of their valued hygienists. With their restrictive fee structures and relentless write-offs, insurance contracts drain the lifeblood from practices, leaving dentists fighting to keep their doors open while providing quality care. Additionally, practice costs have risen, making overhead soar, especially if a practice is limited by contractual fee agreements that don’t allow them to collect more. 

As a dental practice coach who works with some amazing private practice owners, I can attest that they desperately want to meet the demands of hygienists—offering fair wages, benefits, and the tools needed for quality care—but the harsh reality is that the numbers just don’t add up in many offices.

As they watch, their teams dwindle and they’re unable to maintain a fully staffed practice, and the stress and guilt mount knowing that patient care is slipping through the cracks. Dentists are left feeling powerless, burdened by the impossible task of balancing financial survival with the growing expectations of their hygiene teams, all while the profession they’ve dedicated their lives to unravels.

How do we solve this problem at the root?

For dental hygienists who feel disillusioned, it's crucial not to give up hope but to actively search for that unicorn office—a place where your values and needs are met. Start by asking these questions in interviews: 

• What is the practice’s philosophy on patient care? 
• What are your core values and how are they displayed each day?
• Tell me about the practice purpose or mission, and where you are going.
• How involved are hygienists and the team in decision-making?
• What flexibility in working hours do you offer to support work-life balance?
• How much time is allocated for each appointment? 
• How often is hygiene equipment evaluated for quality and maintenance?
• What is my total compensation package? (This is much more valuable than an hourly wage alone.)

Remember that as a valued member of the team, you need to balance your ambition with humility. Being truly humble in your interview can go a long way. Show your openness to growth and development with these questions:

• How can I help support the practice purpose/mission?
• I know it can take time to learn a new practice, so how will you share feedback with me?
• It’s important for me to support your dentistry, so will there be learning opportunities for me to understand your treatment planning philosophy?
• What does the team want most in their next hygienist?

Remember that the interview is the potential beginning of your working relationship, and it should be a respectful conversation that helps you and the dentist determine if there is alignment that can grow into something constructive and rewarding.

For dentists who feel frustrated and held hostage by the growing demands of dental hygienists, rather than leaning into your frustration and developing a bias against all dental hygienists, focus on finding the right hygienist for you and your practice. To attract and retain unicorn dental hygienists, practice owners should focus on creating a supportive and respectful work environment where hygienists feel genuinely valued. 

Create your unique employment proposition to include:

• Flexible hours to promote work-life balance 
• The necessary tools and equipment for quality patient care
• Customized schedule templates that meet production needs and allow for ample time to serve patient needs
• Continuing education allotments to help hygienists develop and support patients and the practice purpose
• Competitive pay and creative benefits options 

Remember that a dental hygienist can be a trusted colleague and partner in caring for patients for the lifetime of your practice. In any partnership, it’s important to have consistent and respectful communication. One tip for dentists is to regularly seek and act on feedback from hygienists. This small step can have a huge impact on helping build a culture of continuous improvement.

Additionally, managing financial constraints can create more freedom to provide for the needs of dental hygienists, such as:

• Optimizing efficiency to improve productivity and reduce burnout
• Negotiating better insurance fee schedules
• Reducing your insurance contract participation. More dentists are finding freedom in moving toward a fee-for-service model.
• Implementing fee analyses annually to ensure your office fees are competitive
• Marketing to and scheduling more cash-paying patients
• Working with a dental practice coach to help you see the gaps in profitability
  
  

The path forward is clear

Making a difference in the future of our profession is up to the dental hygienists and dentists working together to build a bridge. Let’s not view these challenges as “us vs. them,” but rather as a shared industry issue that demands our collective effort. The real opportunity lies in coming together, understanding each other's perspectives, and working side by side to forge solutions.

Both hygienists and practice owners have the power to drive positive change. We all must be willing to look beyond ourselves and remember that we’re all in dentistry to best serve patients, and we cannot do that if we’re at odds with each other.

Roy T. Bennett said, “The more you feed your mind with positive thoughts, the more you can attract great things into your life.”¹ To truly bridge this gap between the unicorn office and the unicorn hygienist, you must steer away from the negative narrative creeping into our profession and believe it can be better.

Hygienists, continue your search for the practice that aligns with your values and career goals. Practice owners, reflect deeply on how you can transform your practice into a place where top talent thrives. Together, we can overcome obstacles and build a future where both parties feel valued and fulfilled!

Editor's note: This article appeared in the October 2024 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.

Reference

1. Bennett RT. The Light in the Heart. Roy Bennett. February 26, 2016.