Howard Speaks: The Hygienist's Challenge: Bring Value or Vanish by Dr. Howard Farran

Dentaltown Magazine

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

Is your hygiene department an outdated horse-and-buggy model, or is it a virtuous value creator?

The benefit of traveling around the globe lecturing is I’ve seen the world’s only three publicly traded dental offices, and done Dentistry Uncensored with Howard Farran podcasts with executives from each of them:

1300 Smiles, in Australia: I talked with founder Dr. Darrell Holmes in Podcast No. 850, “Optimize Your Dental Practices.”

Pacific Smiles Group, also in Australia: My conversation with co-founder Dr. Alex Abrahams was Podcast No. 841, “Structural Organization.”

Q&M Dental, in Singapore: Podcast No. 373 was my Q&A with co-founder Dr. Raymond Ang.

What’s interesting about all three is they have the same business model—and none of them has a hygiene department. Those guys ask me, “How do you do that in America? You pay a hygienist $40 an hour to do a $55 cleaning in a building that has 65 percent overhead. How does that even work? That’s why you’re not profitable.”

What killed hygiene? It wasn’t the dentist, and it wasn’t the hygienist—we aren’t doing anything “wrong.” Blame insurance reimbursements!

The typical fee for a cleaning is so low that in markets around the world—including Singapore and Australia—dentists are getting rid of their hygienists and doing the work themselves. It makes me crazy when an insurance company pays only $55 for a cleaning but their CEO claims, “We pay 100 percent of preventive dentistry, because we really want to prevent disease.” Dude, if you really want to prevent disease, you’ve got to give dentists more than $55 for a cleaning. I mean, it costs $60 in major cities to get your hair cut nowadays, and stylists aren’t required to have a four-year college degree!

The importance of virtuous value creators
Nowadays, the only way a hygiene department works is if the hygienists are virtuous value creators. Your hygienists brush and floss their teeth every morning and every night, and probably use an electric toothbrush instead of a manual one. Are they conveying those virtuous values to your patients, or do they spend that time talking about how their deadbeat spouse left a towel on the bathroom floor, and how crazy their 2-year-old is acting lately?

The word doctor comes from the Latin word docere, meaning “to teach”—and even though hygienists don’t have DDS degrees, they can still teach patients about what’s going on in their mouths and instill values. “I’m a hygienist. If this was my tooth, this is what I would do. If my gums were bleeding like this, this is what I would do. If I had your situation, I would not manually brush my teeth. I would go to an electric toothbrush. I would get a water flosser.”

Your hygienist should be taking out the intraoral camera, looking at each single tooth and telling patients whether she sees any possible issues that the dentist will want to discuss further.

Are your hygienists conveying and educating? If hygienists stay in the mindset that their job entails only mechanically removing tartar and staying in policy, here’s what’s going to happen: They’re in danger of being not just replaced but eliminated—the human equivalent of a Blockbuster Video.

Office Highlights

What a practice without hygienists looks like
Here’s what the three publicly traded companies overseas are thinking:

“In America, they pay a hygienist $40 to do a $55 cleaning. You don’t have to be a hygienist to set up the room, and you don’t have to be a hygienist to usher the patient from the waiting room to an operatory; a dental assistant can do that.

“Before the $40/hour hygienist starts scaling, she brings in a $20/hour dental assistant to record the numbers. After she’s done scaling, the rest of the appointment—polishing, flossing, fluoride treatment, writing up the notes, dismissing the patient, cleaning and flipping the room for the next patient—could be done by the assistant.”

These publicly traded companies have done away with hygienists. Dental assistants set up the room and seat the patients; the doctors come in and measure the gums while the assistants record the scores. Then, while the doctors are scaling, they start in the upper right and go all the way around—examining and diagnosing every tooth, with the intraoral camera, the scaling and the exam. It’s often about the same amount of time a dentist would spend on a hygiene check anyway.

But today in America, most of those duties are still done by the hygienists, who also need to get you to do a hygiene check. They often wait five minutes for you to get free and do your five-minute exam—that’s 10 minutes, more than 16 percent of an hourlong appointment.

In conclusion …
The “old days” of how the hygiene department worked in the 1970s and ’80s will still work today only if hygienists are helping pay the bills by transferring their values of what they would or wouldn’t want done to their own teeth and gums. The patients will listen to these virtuous values and spend their money accordingly to have teeth just like the hygienists.


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