Ten years ago, I picked up my license, walked out of my employer’s office midday, and never looked back. I don’t regret it. What I do regret is not noticing the red flags sooner. Working in a toxic office is not something that every hygienist will encounter in their careers, but many will. So, here is a discussion of some things to be on the lookout for when interviewing at a prospective practice.
Appointment Times
Before taking a position, it is always a good idea to ask to look at the practice’s patient schedule. Be sure to view several days, weeks, and even months if you can. Look for things like big gaps in the schedule, as well as how long between appointments patients are scheduled, and how many last-minute add-ins there are. And, of course, be sure to look for how much time is given for each type of appointment.
Are prophylaxis appointments 30 minutes? An hour? How about nonsurgical periodontal therapy/SRP? Are hygienists asked to do two (or even four) quads of nonsurgical periodontal therapy in the same time as a prophy? Looking at what is expected ahead of time can be very helpful in avoiding a stressful situation later. If the appointment times are short, find out if the office plans to have a hygiene assistant working alongside you.
If there are multiple gaps (not just an occasional cancellation), ask what would be expected of you during that downtime. Will you be asked to clean/stock the operatory? Will that be time for you to prepare for the next day, or sharpen your instruments? Will you be asked to cold-call patients to schedule their next hygiene visit? Will you be asked to clock out and not be paid for that time?
Asking dental hygienists to clock out between patients is in violation of the Fair Labor Standards Act (FLSA). The U.S. Department of Labor is very clear on this point, but many dental offices still try to enforce this practice.
If a hygienist has a patient cancel or no-show to an appointment, they are considered to be “engaged to wait,” according to the FLSA. This is defined as any time that an employee is waiting for work to do under the normal parameters of the position. An example of this would be a receptionist waiting for a patient to arrive or for the phone to ring. Therefore, they should be considered on duty and paid for the time.
Mis-scheduled Patients
Sometimes it happens that a patient gets put on the schedule for a routine prophylaxis but should have been scheduled for a periodontal maintenance procedure or SRP. It happens; no scheduling department is perfect. That said, if it starts to look like a regular occurrence, something might be amiss.
Always ask about scheduling practices when interviewing at an office. Is the front desk asked to verify via the patent record what the next visit should be, or do they rely on the patients to tell them? Some practices rely on patients to tell them what to schedule to avoid putting anyone on hold.
Another thing to watch out for with scheduling is the use of the full-mouth debridement (D4355). How often does it pop up on the schedule? Is it being used as an additional SRP appointment? Is this being utilized as a way to bill out for “more than just a prophy,” or is it indicative of a practice that is simply not current on CDT changes in coding and practice standards?
Some offices may not be aware that there are newer CDT codes for treating patients with gingivitis (D4346). This code is to be used when scaling “in the presence of generalized moderate or severe gingival inflammation.” The ADA offers a very clear decision tree (scroll to second page of document) that can help clinicians know what code is most appropriate for the type of cleaning being done.
Culture
The most important thing when interviewing at an office is to keep your eyes and ears open. Watch the front desk as well as the clinical staff as they interact with patients. If they seem overly rushed or indifferent to patient needs, that may be a sign of something wrong with the overall culture of the office. Essentially, watch how people in the office treat each other. Do they say “good morning” as they come into work, or offer to help others before they leave?
Ask why they are hiring. Sometimes it’s as simple as the practice is growing and in need of another RDH. Other times, you find out there are personality conflicts (that may persist when you join the staff). Listen for professionalism in the doctor/office manager’s answers. If you hear a lot of personal opinions of their previous employees, you may want to think twice about signing up for the job. Remember, an interview is for you as much as it is for them.
Look around the office. Usually, an interview includes an office tour. How organized are the operatories? Do things appear to be well-stocked?
I hate to say it, but I once interviewed in an office that was out of paper towels. Crazy, right? I don’t know how they planned to accomplish appropriate handwashing, but they did not seem too concerned. This made me think about the possibility of larger infection control issues that could arise were I to accept a position there. So, when a job was offered, I politely declined.
Production
Another thing to watch for on that initial office tour is numbers. How prominent is the office culture are production goals? Every practice has them, and they are a necessity. Still, does it seem like the prominent focus? I like to ask a potential office about their production tracking and find out ahead of time what the expectations regarding production will be for me as a hygienist in the practice.
Will product sales be a major part of the job? Some offices expect that every patient should leave having purchased a dental product of some sort, while others take the approach that patients should be offered products purely based on their oral health care needs.
Ultimately, there is a perfect office out there for everyone. Finding it is the tough part, and sometimes hygienists end up in offices that are not the right fit for them at all. Keeping a sharp eye out for potential problems during the interview process can, hopefully, help avoid having to quit later. No one wants to leave a job, so be proactive when going out on interviews.
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References
- Wages and the Fair Labor Standards Act. U.S. Department of Labor: Wage and Hour Division. https://www.dol.gov/agencies/whd/flsa
- ADA Guide to Reporting D4346. The American Dental Association Guide to Reporting D4346. American Dental Association. Version 4. 2018 July 11. https://www.ada.org/~/media/ADA/Publications/Files/D4346EducationGuidelines_V4_2018Jul06.pdf?la=en
