The Dental Hygiene Shortages & The Challenges Within

Episode #629 with Katrina Sanders

There isn't a shortage of hygienists. There's something else in short supply. Back to share her provocative thoughts, Kirk Behrendt brings back Katrina Sanders, The Dental WINEgenist, to explain the factors that contributed to this “shortage”, common barriers and pain points hygienists experience, and ways for you to navigate these challenges. Invest in the people who carry and represent your practice! To learn how, listen to Episode 629 of The Best Practices Show!

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Links Mentioned in This Episode:

Register for Katrina’s next Disease Prevention & Wine Tasting course (October 5-6, 2023)

Learn more about Katrina’s wine

Main Takeaways:

It’s not hygienists that are in short supply — it’s dentists who value them.

Know what your hygienists truly want from you and your practice.

Understand your hygienists’ pain points and create solutions.

Evaluate whether you're attracting the hygienists you want.

Offer new hygienists more than just a sign-on bonus.

Quotes:

“One interesting trend that I still don't understand today is around how dentistry looks at who the employable hygienists are. It seems as though you're not considered an “employable hygienist” until you have two years of experience. Well, that's really hard. Right? Because it's like, how am I supposed to get experience if nobody is going to hire me because I'm a brand-new grad fresh out of hygiene school?” (5:14—5:37)

“I had this viral post go out. I posted this a few months ago and I said, ‘Just a heads up, there's no shortage of employable hygienists. We are there. We have the skills. We've gone to hygiene school. We've passed the boards. We have the licensure — we're there. We are licensed and we are ready to work. There's no shortage of hygienists. There's a shortage of appreciation of what hygienists bring.’ And so, inside of that, it makes it a lot easier if I show up every day and I'm in a toxic environment, or I'm being treated like garbage, or the skills that I spent all of this time not just going to school but getting continuing education credits for, that all of that is being squandered inside of, ‘Just do what's on the Dentrix appointment book column for today,’ well, you know what? Opening that Etsy store where I'm making stickers and bookmarks and making the same amount of money working from home sounds really yummy and juicy right now for me.” (6:07—7:03)

“Hygienists, for a long time, have not felt the level or layer of importance around the value and worth of what it is they bring to their practice. As a hygienist, I am consistently told — I will go into practices. I see them all the time where their morning huddle begins with, ‘Here's what Katrina produced yesterday.’ That's a hard pill for me to swallow because what you're doing is you are quantifying, ‘This is the value of what you brought to our practice yesterday. Here's how much money you brought in.’ What you're not talking about is the patient who cried in my arms because she's going through a divorce and she's scared, and she's looking to me not only as her healthcare provider but as somebody who cares about her as a human being. What you're not taking into consideration is the patient who maybe did want to start scaling and root planing today but couldn't because they had to pick up their special needs son from school. And so, as a human, instead of driving home the bottom line of the business of the practice, I'm treating my patients from a humanistic standpoint.” (7:09—8:25)

“It really moved into this model where hygienists were seen as, ‘Here's how much production you're bringing into the practice, so here's the value of what you bring.’ It has created this really toxic narrative where hygienists truly only believe that what they bring to the practice is around money. Hence, where you start to see the sign-on bonuses and the, ‘Here's how much I'm going to pay you.’ It really started to create that narrative. And it's interesting because I've asked hygienists, ‘Has your doctor ever asked you, what do you need in order to remain happy here in this practice? Is that a question?’ That's where we have to start changing that narrative.” (8:26—9:11)

“You have a provider, or a series of providers, who are showing up every day, clocking in, putting on your branded scrubs, representing you, the core values of your practice. They are the mid-level provider of the practice. They are gathering, at a minimum, a dental hygiene co-diagnosis. They're taking intraoral photos. They're taking radiographs. They are single-handedly maintaining open relationships with the patients who trust you and have to come in every three, four, or six months — and you can't prioritize a chunk of time to sit down with that person and to make sure that they're happy. And here's the thing. Doctors will say, ‘I'm giving them everything.’ Well, that's everything to you. What do they want?” (12:07—12:53)

“I find, as many times as I ask a hygienist, ‘Has your doctor ever asked you,’ or not even doctor, has your practice owner, whomever that may be, ‘Has your practice owner asked you, what do you need?’ or, ‘What can I offer you? What are your professional goals? What are your clinical goals? How can I support that?’ Are these the conversations you're having? Or is it, your doctor is so afraid, we're in this fear base where it's like, ‘Here's how much more money I'll pay you if you continue to stay and don't go to the practice across the street’? So, the first piece I'll say is, the fear brain, the scarcity mindset, goes, ‘I don't have any more money to pay these people. I'm doing my best. I'm giving them everything.’ That's the fear, the scarcity mindset. The love is, ‘These individuals are representing me. They are bringing their clinical excellence every day.’” (12:57—13:49)

“One major piece that I don't think practice owners fully understand is, as much as they are working because they own the practice, and if we close a bunch of porcelain crowns, or cosmetic work, or whatever that may be, that they as the business owner are going to benefit from the bottom line of what that is. What I don't know if they fully understand is that you also have team members who are dying to pee but don't so that they can bring that next patient back on time. They are starving. Their stomachs are growling in their patient's ears because they are just dying for a handful of almonds. And they're not going to do it because they're going to make sure that they bring your patient back. They are going to wipe down all of the pieces of equipment in the operatory. At the end of the day, they're going to take the trash out. They're going to make sure that their instruments are wiped down. They are going to help you by anesthetizing that patient when you're running behind. These are people who really do care about you, about your patient population, about your practice.” (13:50—14:46)

“The fear base is, ‘Oh, they only want more money, and they only want this, and they only want that.’ The love space, I think, really carves open the space to have a conversation about, ‘What does this look like? What does your dream practice look like? What does your dream job look like? What does your dream patient experience look like? How can I help facilitate that for you? Because here's the thing. When you facilitate that for your hygienist, what you're doing is you are facilitating clinical excellence for your patient population. Does that not matter to a practice owner? Of course, it does, because clinical excellence gives clinical outcomes. And clinical outcomes mean you have a happy patient population. That's marketing you simply cannot pay for.” (17:02—17:45)

“Are you a magnet attracting people in which their motivator or their core values are perhaps not in alignment with what you want?” (18:57—19:07)

“Let's say you don't have a hygienist or a hygiene team, and you're putting ads out there because you want to bring in a hygienist or hygiene team into your practice, and [your mindset is], ‘Nobody in my town wants to work. You don't understand.’ Well, take a look at what bait you're putting on that fishing hook before you're throwing it out there.” (19:54—20:12)

“If you're saying things like, ‘We pay the top amount of money. We give bonuses,’ what you're going to attract is a hygienist in which money is their motivator. So, there's where that fear base — if you're a practice where you can't pay top-dollar, you can't just throw a $10,000 sign-on bonus or whatever that might be, if you can't do that, what can you offer? What can you offer to a hygienist? Are you a practice where you, as the doctor, are going to support your hygienist when they sit down and they say, ‘I'm concerned about this area. I want Dr. Jones to come in and take a look at this. Dr. Jones, come on in,’ and Dr. Jones says, ‘Wow, Katrina. Thank you so much for pointing that out. That was excellent.’ That may be a terrific motivator for somebody. Do you offer continuing dental education as a team? Do you create opportunities for your hygiene team to select the products, the equipment, the protocols that they're using? What type of an experience is a clinician going to have inside of your practice?” (20:30—21:41)

“If you can't think of anything that gets you excited to write about in an ad, then I think we found the problem. You know what I mean? I promised we're going to get provocative here, so here it is. Start getting creative. Think about other ways to help people.” (21:42—22:01)

“If you can't write about something that you're excited about, that makes people get excited to potentially be a member of your team, then we've got some work to do in what that culture looks like in your practice, what you are offering to a team to help them understand the value and worth of what it is they bring to your organization.” (22:43—23:02)

“There are four major reasons, barriers, challenges, or pain points that nearly every hygienist — definitely in the country. I won't say around the world, but I'll say, at a minimum, in the country — will say or call out as major pain points or challenges that interrupt them or get in the way of them being able to do the level of care they want to. My first inclination or thought, if I'm a practice owner or doctor and I want to either attract a hygienist or I want my hygienist to be happier, I'm going to look at these four things and I'm going to think, what are ways that I can really trap or corral those four pain points into different segments so that I can start addressing how those things are showing up for my hygienist? If I can solve those four major barriers, then I am a delightful, wonderful, joyful place to work, and I'm going to be able to be a wonderful attractant for future clinicians to want to come and work with me . . . Those four barriers are time, fear, lack of support, and cost.” (24:40—25:54)

“Time is a big [pain point for hygienists]. I want you to start thinking, for practices where it's, ‘This is as much as I can pay my hygienist,’ can we get creative with time? So, this was interesting. There's a research study that was done by the American Dental Hygienists Association that looked at how often dental hygienists take and record blood pressure readings on their patients. In this research study, the most frequent reason why dental hygienists do not take blood pressure and record — which, by the way, this is starting to become a standardized protocol in dental practices across the United States. The most frequently cited reason why hygienists do not do this is because of insufficient time and minimal value given to this procedure by their employers. So, let's put the doctor hat on. Let's put the practice owner hat on. ‘I'm giving them everything they want. I bought them the little wrist cuff thing. I don't know what else they want.’ Well, we might need more...