Howard Speaks: Why Are You Resisting Change? by Dr. Howard Farran

Dentaltown Magazine

by Howard Farran, DDS, MBA, publisher, Dentaltown magazine

Do you support hygienists opening their own hygiene clinics? A Townie asked this question in a poll on the Practice Management & Administrative forum on Dentaltown in early June, and more than 500 people posted their opinions in the first 10 days.

To me, that question is just another way to ask, “Do you support direct access?” So far, the majority of Townies say no. I don’t understand these colleagues!

A hundred years ago, dentistry was just about pulling teeth; everybody ended up with sepsis and people were exclaiming how “healthy” they were only after they’d had all their teeth pulled. Back then, dentists thought hygienists were a threat to their profession.

That opinion only started to change when people started asking, “Do I want to see my children in dentures, if that could be prevented?” In 1977, Dr. Bob Barkley was still trying to convert dentists to champion preventive dentistry and dental education. He was on his way to another speaking engagement when he was killed in a small-plane accident.

Controlling the narrative

Today, most dentists apparently are OK with dental hygienists practicing their work only as long as they’re toiling under that dentist’s thumb.

Meanwhile, the typical dentist doesn’t even make money on cleanings, because insurance reimbursements don’t pay enough to cover a $40-an-hour employee plus overhead—especially if there’s downtime between hygiene patients. Imagine being able to use that chair for higher-dollar procedures like emergency dentistry or root canals, and not paying your hygienists $40 an hour because they’re doing the cleanings at their own place!

Many dentists don’t like that idea, because for them it’s all about more money, more power, more control of their dentistry.

It’s a selfish mindset

I’ve been traveling for speaking engagements for 30 years now, and in states like Colorado and Maine, dentists who come up to me after a meeting love the fact that hygienists can set up their own spaces. The hygienists are often in towns with fewer than a thousand people, which keeps dental care accessible and affordable to rural residents, and have set up a chair in a parlor or something to perform cleanings. Most don’t take or bill for X-rays; they’re focused on cleanings and if they see anything that concerns them, they write a referral slip to the general dentist, just as general dentists do to specialists like endodontists and orthodontists.

I’m embarrassed that more than 60% of Townies don’t want to give them that right! It reminds me of back when dentists tried to control whitening—which went to the U.S. Supreme Court in 2015, when dentists in North Carolina tried to regulate who could perform whitening services. “We didn’t invent it, and it used to be sold over the counter, but we want to be the only people who can legally do this.” (They got overruled.)

It also reminds me that only a few months ago, dentists were raring to shut down businesses like Smile Direct Club because their dentists weren’t always on site; they were practicing teledentistry. All these state dental associations were coming out with loaded barrels, but when the COVID-19 pandemic hit, suddenly those same dentists loved teledentistry—because it had become convenient for them.

Our footing needs to go back to what’s best for the patient, not what’s best for your paycheck.



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