Seven months ago I was freaking out...
But let me share the back story first.
(If you don't want to know the back story, then just scroll down to Top Concerns for Dental Hygienists in Corporate Dentistry)
It was November 2022.
I was working about 12 hours a week as a Hygienist in a private practice that I loved. At that point, I had been there for 8.5 years. When I had my 2nd child in June of 2021, I decided I would no longer be working anything over 15 hours a week so that I could be at home with my two daughters as much as possible, while also building my mentorship business of "The Awakened Hygienist".
Life was moving along and my family was happy.
Then I got a text from our landlords that they were putting the house up for sale.
The cabin in the woods that we were so cozy in, and had been for 3.5 years, along with our current reality that we were living, was swooped out from under me. We were living in Northern Arizona in the Prescott National Forest; a highly desired area that people from all over were moving to. We knew the cabin would sell fast!
And it did. In fact, two days was all it took. It was Thanksgiving.
There we were... me homeschooling my 10 year old and taking care of my 1 year old, working extremely part time in private practice, building my mentorship business on the side, and my husband supporting us on his very limited salary.
To be straight, I am the bread winner if we are comparing hourly wages in our household. I know some of you hygienists reading this right now are too.
The day I received the text that the cabin was going up on the market, I cried all morning because of fear.
Fear of where we would be living next; fear of how we were going to pay our bills because our rent was so cheap for the area; fear of losing time building The Awakened Hygienist, fear of how I was going to continue to homeschool, fear of daycare and missing out with my 1 year old, fear of the loss of stability and security I so desparately always feel that I need... fear of the unknown; and on and on. I was in a spiral.
That afternoon (of the day we learned that our landlords were selling) I went in to my practice for the measly 3 hours a day that I worked with puffy eyes and a broken heart, and I explained to another hygienist what was happening.
Then she said these words to me...
"You're a freaking hygienist, just work more hours and you'll be fine."
Epiphany! Ha! It had been so long since I worked a standard 32 hour work week that I forgot that was an option!
(and just like that, unconsciously I fastened the Golden Handcuffs.)
When I came home that evening, I spoke with my husband and informed him that I was going to find another practice to work more hours and we were buying a house and getting out of the renters market.
The next step to take was figuring out where I was going to go. I absolutely loved my private practice so I knew I wanted to stay there, I just needed to change my schedule there to fit another office into my life.
Then I remembered...
There was a local dentist that I was acquainted with, and he had been trying to get me to come work with him at a corporate office that was in our small town. Consistently I had been turning up my nose and shaming corporate dentistry; not because of personal experience but because of what I had heard about it. I'm too "seasoned" of a hygienist to accept corporate dentistry views.
But, desperate times call for desparate measures.... I needed a job and I needed it fast!
AND this corporate office was offering a $5000 SIGN ON BONUS.
I made a call, set up an interview, expressed my values and work ethics to the office manager, filled out the endless amount of paperwork online and signed my mental health away...
Errr... I mean, signed my 6 month contract in order to receive that bonus money.
December 5th was my first day of work.
It was a good day. I knew the hygienist working there from years ago. She had been an assistant at another private practice we worked at together, but now she was a hygienist working for corporate so it couldn't be that bad there, right?!
Wrong...
As days turned into weeks, my values and work ethics as a dental hygienist were being challenged on the daily.
At first it was confusing to me because before accepting this job I specifically reviewed this particular corporation's
- "tag line"
- mission statement
- vision and company brand promise
- and core values!
However, I found myself having to consistently stand my ground as a healthcare provider and professional. The office manager, who has no business or hygiene background experience, wanted to tell me how my schedule should be, and what I should be able to do in that time frame. She expressed that she is doing us hygienists a favor by not requiring us to clock out if a patient doesn't show, but that our regional/district manager is wanting her to make sure we do!
This is when I realized I had been and was being gaslighted...
Remember when I said I was working with a hygienist I knew from another office where she had been an assistant?
What I learned is that this hygienist was a new hygienist, only 1 year in the profession. She started working in corporate dentistry when she received her degree. That corporate business work culture was all she knew as a hygienist...
and this is where my concern started with corporate dentistry.
TOP CONCERNS for Dental Hygienists in Corporate Dentistry
This list is NOT complete. In fact, in editing this article right now, I had to decide to remove some points because it would be too much info to digest in one reading. This list is the most obvious for those of us who have worked in corporate dentistry, and is more of a red flags list for those considering it. So here we go.
- Corporate Dentistry is profit driven, only. The focus is on your daily profit after insurance write-offs and deductions; not if patients are being cared for in the appropriate ways they need, and not if patients scheduled with the DDS for treatment they needed after you educated them. Its a business, run by business minded people, focused on financial success. The higher your profits, the more praise you receive. This leads me to #2.
- Corporate Dentistry is highly competitive. In the company I was employed, we received emails called "Stack and Rank". It you profited the company what they believe you should be producing, your name was marked in green that included your daily production after all deductions. This excel sheet varied from green at the top followed with yellow and ending in red, listing all hygienists in our district, hence "Stack and Rank". Personally, I am not a competitive person, so this list did nothing for me. I barely looked at it because I just did not care. But the goal behind it is to create a competitive environment amongst the producers (DDSs & RDHs) in the company.
- Corporate Dentistry lacks teamwork among the staff. Most RDHs feel burned out and overwhelmed due to the lack of help. Even if you're lucky to have a hygiene assistant for assisted hygiene (yes that's right, some hygienists are working 2 columns with no assistant), beyond question they will be pulled to doctor's side, up front, or somwhere else, absent any thought to the fact that you need them. In fact, your needs are not considered at all.
- Corporate Dentistry does not understand Labor Laws (or they do but don't care). Many of us RDHs have been told to clock out when a patient does not show for their appointment or for a last minute cancellation. This is illegal, and I refuse to do so and explain why (although I shouldn't have to and neither should you). The problem doesn't end there though. Apparently, some RDHs have had hours removed from their time clock without knowing. Reasons have included the above, but also because if you are setting up your rooms, going through your charts or writing in your chart notes, that is not actively producing profits which means you shouldn't be getting paid in their eyes. So keep track of all your hours!!!
- Corporate Dentistry possesses an assembly-line mentality. Assisted hygiene is the keystone to profits in Corporate Dentistry. You are a "teeth-cleaner". Its all about the hustle of bouncing from one room to the next, performing dental hygiene in the minimum amounts of time they can give to you! You get approximately 20-30 minutes to provide oral health care to your patients from start to finish, along with doing some of the front office duties. It doesn't matter if your patient is 8 yrs old or 80; it doesn't matter if they are a child prophy or a periodontal maintainence, it doesn't matter if the patient spent 15 minutes updating their medical history, you get the same time even if you say differently.
- Corporate Dentistry breeds the hustle work culture. You've heard the message, "work smarter not harder"... its the opposite in corporate. "Work hard, and harder, until you have let us use you all up", is more their motto.
- Corporate Dentistry lacks real communication. In private practice, you have direct access to the owner, who mainly tends to be the DDS. There is a huge disconnect in communication in corporate because you have too many levels and people between you and the CEOs. HR exists, but doesn't really do much of anything, and this is based on direct experience. I witnessed an HR nightmare, and the dental assistant with the very valid complaint continually was passed around unresolved. As far as communication with patients, there is just no time, literally.
- Corporate Dentistry lacks human connection. Because of the hustle work culture, there is no time to connect with your patients or with the staff. If A.I. becomes dental hygienists, Corporate Dentistry will be the first to buy them all up. Mark my words. They already treat RDHs as robots.
- Corporate Dentistry accepts unethical behaviors. Substandard care is common because of the lack of proper time given to the providers both RDHs and DDSs. When hygienists have 2 columns filled with a third column for probing doctor's new patients, and dentists have up to 4 columns filled, substandard care isn't just a probability, its inevitable. Scope of practice challenges is another issue, specifically with dental assistants. Misdiagnosed, underdiagnosed, or over diagnosed treatment happens when DDSs are replacing DDSs, and profits are leading the company.
- Corporate Dentistry has a high turn over. Currently the corporation I just left when my contract ended, has over 300 job openings in 8 different states that they serve. Instead of consistently training new people over and over, wouldn't understanding the issues the current employees are experiencing be a better way to do business? It seems obvious to most of us, but lacks concern for corporate. When the system is broken, you fix it, you don't keep doing the same thing over and over and expect anything better to happen.
So how is corporate dentistry in business then?
Are there positives to working in Corporate Dentistry? Yes. Benefits.
We can't deny that the benefits a major corporation can offer employees is superior to a majority of private practices. Most private practices do not offer any medical benefits. Some do not offer a 401K/IRA/Profit Sharing. A good amount of private practices don't pay for our CEs. Many can not offer holiday pay, and lots won't pay the hourly wage you can make with a corporation. These are the perks to being in corporate. (There are exceptions in private practices of course; I am speaking in general here.)
I would also like to insert here that all of this is through my own personal experience.
Do all hygienists that work in corporate dentistry experience what I experienced?
Well, that answer has a few possibilities...
1. No they don't.
2. They are willing to tolerate the B.S.
3. They can't tolerate the B.S. but do so anyway, and are living a professional life that is stressed out, burned out, and overwhelmed...
Because let's face it, corporate dentistry is all over the country, which means we are keeping this business structure alive and well by working for them.
To solve a problem we need to find the root cause.
So the problem is rooted in what we accept as tolerable and reasonable.
It's time to lock arms with each other. It's time to uphold our boundaries, individually and collectively as a profession. Its time to move out of this corporate culture to one that is patient centered and professionally balanced. Its time.
And that is for another article.
