What caused 'a perfect storm' for dental hygienists and what can be done to solve it: Dr. William Simon

A sense of unappreciation, COVID-19 and a lack of training programs are all contributing factors to the ongoing shortage of dental hygienists in the industry, according to William Simon, DMD.

Dr. Simon is the owner of City Smiles and Sonrisa Urbana, both in Chicago. He is also a member of the Board of Trustees for the Illinois State Dental Society. He spoke with Becker's about the workforce shortages, potential solutions and when the industry could see improvements.

Question: What can you say about the current dental hygienist workforce shortage?

Dr. William Simon: A lot of things play into it and I would say at this point, it really is a perfect storm for the dental hygiene profession, as far as dentists' ability to attract hygienists to their practices. 

I'm a dentist who has a lot of appreciation for my team. I think that you might find that dentistry historically has not always positioned themselves that way. It took a long time for dental practices to get to a point where the team was recognized to be an integral part of the provision of the care. There are a number of hygienists out there that in some ways don't feel as if they are looked at by the practice owners as a contributor to the level that they might like to be looked at. In some cases, dental hygienists feel they are just a machine that's pumping out dental hygiene. There are still offices out there where the dentists are not utilizing dental hygienists, or perhaps they don't truly employ them to the extent that they could, in other words, expanding their functions and allowing them to give input into the way that the care is provided. And I think that would go a long way also toward making a dental hygiene career more attractive. 

In my practice, we lean on our hygiene team very heavily for much more than simply to provide the actual clinical care physically. It goes well beyond. When COVID-19 hit, many hygienists actually were furloughed at that point. And it sent a couple messages. One message maybe was, "We're not going to  pay you through this pandemic. We're just going to  furlough you. You're not that critical to our operations." So I think that might have opened up some eyes. And I would also say that perhaps some of the late career hygienists may have just said, "That's it, I'm done. I've had enough. I only had a few years left in my career and to come back in the midst of all of this with all the PPE and the potential risk, it's just not worth it to me anymore." 

Another thing that is important to look at is that a lot of dental hygienists historically are women. Many women have spouses who are often the primary wage earner in the relationship and as a result, they're the ones providing healthcare insurance. So it's a lot easier potentially for somebody to leave a job when they don't have to worry whether or not they're going to  be losing health benefits. 

I think another thing that came out of this was that some of the hygienists maybe were stuck in a situation they really didn't have that much excitement about. Maybe they felt they were in some kind of a rut, and then all of a sudden they're furloughed for three months, four months or whatever it might have been. They got a chance to see life without their profession and to see, "Hey, maybe I really don't want to necessarily go back to that." If there were people on the edge of feeling good about their job, that gave them an opportunity to see things from outside looking in, instead of inside looking out, and gave them an opportunity to make decisions to change.

I don't think that we're seeing enough graduates in dental hygiene programs. I'm not that deeply familiar with all of the ways that hygiene programs are being offered throughout our country. I know what's happening here in Illinois, and what we're seeing is that we're not graduating enough minority hygienists who would go and serve in minority areas. One of the areas where dental hygiene staffing struggles exist are in areas where there's not a good mix of the minority groups that are coming out of the schools. Generally speaking, just like any dentist coming out of dental school, the preference is to typically go into an urban area or a suburban area, and not many dentists coming out of dental school want to go into rural practices. I think that also potentially holds true for dental hygiene.

Q: Do you think the increasing presence of larger group practices is making it harder for smaller practices to attract talent?

WS: Yes, potentially. There's always this push-pull between independent practice and corporate entities, where the corporate entities may be in a position to offer higher wages. They may be in a position to offer even a signing bonus. I know they offer signing bonuses for dentists and they also may be in a position to offer more benefits than an independent dental practice would, especially a single-doctor practice or a single-location practice. So there's always going to  be this push-pull for a dental hygienist or even a new doctor to say, "Well, where do I want to go? Do I want to go into a DSO-type organization where I can get myself a decent wage, solid employment, maybe a signing bonus, good benefits, et cetera?" Probably the technology is going to be at the top of the game, but oftentimes in those settings, the culture is at issue.

I don't want to generalize across all DSOs or all large group practices, but often the motivations of those entities can be such that the culture of the practice is affected negatively. When you're in a practice, all of us healthcare providers, whether you're a dental hygienist or a dentist, we all got into this to help people. Sometimes when you get into an operation that doesn't have that as their primary mission, and instead has the bottom line driving the operation, that can create some issues with values, culture, et cetera. So I think that's something that certainly impacts the hiring of a dental hygienist.

Q: What needs to be done to alleviate the workforce shortages?

WS: There needs to be a very active effort put forward by dentistry. It used to be that this would be the effort put forth by organized dentistry. When I say organized dentistry, I'm talking about the American Dental Association [and] state dental societies. In the past, those were the organizations that impacted the profession most because the corporate entities didn't exist. In my eyes, that's one of the biggest benefits of organized dentistry, is having an association of dentists in place where you can try to impact change, or introduce new things to the practice of dentistry, but in the corporate environment, it doesn't seem that there's as much of that going on necessarily. So in my opinion, the answer is for dental societies to create programs early on. We need to engage young people early on in their education to promote the benefits of being in the profession of dentistry and the things that can come out of them choosing that profession. It gets to a place where we need to have programs in as early as grammar school, and certainly into the high schools, where the career opportunities that are being presented include these options for dental hygiene, to the point where more young people would make a decision to join that workforce.

Q: When do you see the workforce shortages improving?

WS: I really don't have the answer on that. I think understanding that answer requires a very deep look into the metrics of the dental profession as a whole and how it compares to the need, and how that then compares to the number of hygienists that are graduating annually across the country, and then seeing how the dental hygiene program availability meets that need. There's so many factors; [it's] a very complex issue. It might not all be simply that young people aren't attracted to the profession. It might be that we have an inadequate supply of programs to train the people. So I don't have those answers. If I were to guess, I would think that this is probably going to  smooth over in the next year or two. I think a lot of it had to do with the pandemic. Anytime you get yourself in a position where your routine operations are virtually upended, it then opens people's eyes to what the reality of things are and then forces people to think about change and what can be done compared to the routine that was going on previously. It's kind of like making lemonade out of the lemons, so to speak. Over time, our profession is going to respond to this. It might take a little while, but I think we'll see an elevated education of young people to be more attracted to dental hygiene, and we'll see more programs developed for them to be educated. I can't put a timeframe on it, but I think we'll see it happen.

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