Thursday Troubleshooter: Dental team struggling to provide decent care with 15-minute appointments
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QUESTION: I’ve been an RDH for almost 40 years, and I’ve worked in both private practices and corporate offices. The office I’m in now schedules four hygiene patients every hour. Every single person gets 15-minute appointments regardless of their issues, such as periodontal disease, disabilities, smoking, etc. That 15 minutes includes patient exams and x-rays, which are taken in another room at a different time, so we don't have to wait on exams or take x-rays. But often the exam is one or more hours behind schedule.
The office calls this scheduling "double hygiene," so the schedule is for two hygienists. Unfortunately, on days where there is only one hygienist scheduled, the times are not much better. We wind up seeing 25 patients a day with no lunch break, and we run at least an hour over every day. I realize it sounds ridiculous, but what can we do? Is there an industry standard for how many patients the hygienists can reasonably see in a day? I might add that we have no assistants to help us and we do our own instruments and set ups.
The stress is unbearable, not to mention that I have workplace neck and hand problems. Please help us!
ANSWER FROM JAMIE COLLINS, RDH, founder of MyDentalEducator.com:
First of all, congrats on 40 years! You have seen so much happen in the world of dentistry. You’ve seen how patient care has changed for better and for worse.
The schedule you describe is ridiculous and does not provide an opportunity for optimal patient care, among other concerns, such as the risk of liability from missed diagnoses. The simple fact is that you don’t have time to do all that’s needed. Almost all hygienists I know would agree this is an unattainable expectation to address concerns and provide thorough treatment.
Ergonomically my back and neck cry in sympathy for you. The wear and tear on your body working in those conditions and with that stress will quickly lead to burnout. A lunch break should be a time to recharge and rest your mind and body. You are mandated by law to receive a daily lunch break. That being said, in dentistry there are times when breaks do not happen, however, this should be the exception, not the standard.
I once worked in an office that decided to do double hygiene. When a new office manager took over, her misconception about how a hygiene schedule should be organized did not realistically work. I tried to discuss this with her and was told, “Just do your best.” It went against my philosophy of doing something right or not doing it at all.
I took my concerns to the doctor with the other hygienist, who was also struggling, and together we expressed our concerns and need for change. I believe there is sometimes discord in practices when the front office staff has never worked clinically and does not understand the flow of a practice. Just because there’s a space in the schedule does not mean there’s a clinician available to provide treatment.
Besides bringing your concerns to the dentist’s attention, present your reasons and solutions. The reality is that patients often leave a practice if they must wait on a provider who is running an hour behind or if they feel rushed through their appointments. This also leads to patients devaluing the treatment that they do receive. People value their time and become frustrated when they must wait time and time again. How would the dentist feel if he or she was rushed to complete a crown prep or fillings?
I encourage you to organize a meeting with the front office staff and the dentist to discuss the schedule and together find a solution that works for all parties involved. If the doctor and manager are not open to considering changes, it might be time to take care of you and look for a practice that is more aligned with the way you want to practice. Good luck!
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