Becker's Dental + DSO Review

26 BECKER'S DENTAL + DSO REVIEW // VOL. 2022 NO. 2 THOUGHT LEADERSHIP Concerns about safety in clinical practice remain, especially among inexperienced hygienists who simply haven't practiced long enough. This gap can create a space where demand for compensation packages exceeds the income earning potential of hygienists. The employee/ employer relationship can also remain fragile when hygienists have expecta- tions regarding PPE or infection control that exceed what might currently be mandated, such as requiring a negative pressure room, to see patients at all. Jason Hirsch, DMD. Dr. J Pediatric Den- tistry (Royal Palm Beach, Fla.): The giant DSO/PE idea adds layers of manage- ment that requires a lot of capital in the form of revenues. Revenues come from procedures. One of the biggest sources of procedure revenue is from hygiene. If there are less RDHs, then there are less revenues. There is just not enough cap- ital being deployed to retain RDHs, and that is why the dual problem of retention and recruitment of the same position is occurring. Experienced RDHs leave be- cause they are not being paid for their experience, likely having to upsell a lot of nonsense, and they don't want to see double the volume of patients; and new RDHs are aware of the market disloca- tion and are likely asking for way above their starting range, except they don't have the experience to see as many pa- tients per day to make the ends meet. The bottom line is the economics are just not aligned now. Something has/ had to give. When interest rates rise we are going to see even more basic eco- nomic problems that this profession never dealt with before. This profession believed it was the field of dreams. Then private equity got involved. We shall see. Jason Korkus, DDS. Sonrisa Family Dental (Chicago): Dentistry has become a very high cost business to operate. With in- creased government regulation through higher taxation, there is only so much a dental operation can support as far as wages for hygiene and staff. There was a constant fear among the support staff that COVID-19 would be a continuing factor in dental practices, so they decided to migrate away from patient care. Other op- portunities were afforded to them in other industries that allowed them to work from home. The decision for these support staff to return to the dental office was hindered due to the wages and the supplemental benefits that an office can afford. We have had inflation of dental costs, COVID-19 and options for a more ac- commodating working environment for hygienists. Recently, the Illinois State Dental Society helped push through legislation that will allow expanded func- tions for dental assistants. This will help in the short time, but let's be hopeful that there will be a push for reasonable wag- es in all facets of healthcare that will allow a larger presence again for hygienists. Rick Mars, DDS. Dental Care Group (Aventura, Fla.): The pandemic, DSOs and insurance compensation are just a few reasons why a dental hygienist might wake up in the morning and say, "This is not what I signed up for." That being said, the question bears asking, which hygienists are leaving the work- force? I am proud to say that in our group practice, all eight of our hygienists have maintained their full-time employment at the Dental Care Group, and this is not by accident. I believe employers must be intentional in what they do to main- tain their teams, especially with key team members, which includes our hygienists. This is done by addressing concerns and being dynamic in the way we practice dentistry to accommodate the needs and concerns of our team members. In the recruitment of new hygienists, hiring the right people who fit your model and strong compensation packages are two of the keys for overcoming the current recruitment challenges. Kai Weng, DDS. Dental Designs of Mary- land (White Marsh): The primary drivers for the hygienist exodus are on-going child care issues and lingering hesitancy about the safety of our profession in re- lation to COVID-19. Schools have only re- cently begun to relax their protocols, and for many hygienists with the option of staying home, it is often a more predict- able route when children are being sent home or entire classes forced to go virtu- al at unpredictable intervals when there is a positive COVID-19 test. There is also still hesitancy as to how safe the aerosol-lad- en dental environment is in regards to contracting COVID-19 and possibly bringing it home. I've spoken to many hygienists that are caretakers of elderly family members, and this is a major con- cern. Until COVID-19 becomes accepted as endemic or highly treatable, these will continue to be issues facing dentistry. Challenges with hiring at this point pri- marily have to do with supply and de- mand. Private equity-backed DSOs are able to offer more competitive pay and benefits, and effectively treat hygiene as a loss leader, whereas private practices do not have the same luxury. Over time I predict hygienists prioritizing highest pay will end up in DSOs, and hygienists looking for work-life balance and quality of care will gravitate toward private or group practice. In the meantime, the lack of hygienists is a problem that affects all strata of the dental business. Barry Lyon, DDS. Dental Director at Dental Care Alliance (Sarasota, Fla.): I believe we do not realize, nor appreci- ate, just how hard our dental hygienists work. Considering the toll repetitive mo- tion takes on the hands of a hygienist over 10 to 20 years, and the unrelenting presence of the COVID-19 pandemic, it isn't hard to see that a moment is often reached where the decision is made to call it a career. Dentistry, like all other sectors of the economy, is dealing with staffing short- ages. For many dental hygienists, there comes a tipping point where the manu- ally arduous tasks of daily work, coupled with required intimate patient contact during a deadly pandemic, leads to the decision to retire from hygiene practice. No wonder dentists often search for months without receiving a bite on their recruiting efforts. Rick Singel, DDS. (Cincinnati): We den- tists are absolutely stumped by the dis- appearance of this work force. Never expected it! The only things I can think of are that federal and state money are keeping them afloat for right now. Sec- ondly, they may have wanted a career change and the pandemic downtime gave them the opportunity. But no doubt, it has created an emergency for the den- tal profession. I myself have been work- ing shorthanded for the past months. n

• Cover