Several motivating experiences over the past few months have prompted me to write this column. I have been asked by some individuals and groups to help defend the proposed expansion of the role of dental assistants and hygienists in their various geographic locations. This subject was one of considerable controversy and debate in the past, but it has been relatively dormant in recent years. Perhaps the surplus of dentists 10 or 15 years ago lowered interest in having dental staff members perform more clinical functions. In my opinion, there now is revived interest in increasing the responsibilities of dental staff members. The subject always generates active discussion among dentists and has been known to cause significant disagreement. This article includes my views on the advantages and disadvantages of expanding the role of dental staff members based on more than 40 years of experience in clinical practice, teaching and research.
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ARGUMENTS AGAINST EXPANDING THE ROLE OF DENTAL STAFF MEMBERS
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The proposed delegated tasks are too difficult for staff members to accomplish.
Some dentists feel that tasks proposed for delegation are too difficult to assign to people less educated than dentists. A good example of such a task is delivery of local anesthetic by dental hygienists. Numerous states have legalized the performance of this responsibility by dental hygienists. Have the dentists in these states experienced problems with this delegated duty? Not by my observation. I have found that most dental practitioners who delegate this task agree that properly educated dental hygienists can perform local anesthetic delivery with great skill, increasing practice efficiency and improving patient care. My contention is that regardless of their educational background, properly trained dental assistants, hygienists and technicians can perform relatively difficult clinical responsibilities well.
When responsibilities are delegated to staff members, they will "take over" the profession and reduce the role of dentists.
Has this happened in states that have very liberal dental practice acts? I had the opportunity and responsibility of being one of the people who contributed to the writing of a liberalized dental practice act for the state of Colorado more than 20 years ago. This practice act is still one of the most liberal in the United States. Have dental staff members taken over the profession in Colorado? No. In fact, the people in charge of administering the act have controlled the profession very well.
In general, this act allows staff members to perform procedures as controversial as placement of amalgam and resin-based composites in tooth preparations made by dentists, and it has been a success. Some practitioners in Colorado use their staff members to the limit of the practice act, while others have staff members perform only the most routine, conventional tasks.
When staff members are educated and paid well and fairly for their contributions to the practice, they are very satisfied to be members of the dental team. One of the major keys to successful delegation of responsibilities to staff members must be a highly effective state professional regulatory agency, with significant professional help in policing the practice act.
Patients will not accept staff members’ performing clinical procedures usually accomplished by dentists.
For many years, I have used expanded-duty dental assistants, hygienists and technicians to the full limit of the law in the respective states in which I have lived. Contrary to some beliefs, most patients enjoy and prefer a team effort, rather than having the dentist perform all of the treatment procedures.
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ARGUMENTS FOR EXPANDING THE ROLE OF DENTAL STAFF MEMBERS
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I would like each person reading this column to review the following advantages of expanding the role of dental staff members. If any reader has legitimate arguments against these points, I would be pleased to learn of them. The following points are related to my own experience of many years conversing with thousands of dentists in every one of the United States.
Patients benefit from expanding the role of dental staff members.
Staff members do not have the high overhead of dental practitioners. Most staff members are paid a reasonable salary for their efforts in the practice, but they do not have the hundreds-of-dollars-per-hour overhead that dentists do. As a result, staff members can perform a specific task for much less cost to the practice and the patient than can a dentist. A very good example of this concept—which, I should note, is illegal in some states—is the clinical construction of provisional restorations. If a qualified staff member makes the provisional restorations in a 30-minute period, the cost to the practice is about $10 for his or her salary plus the overhead for use of the operatory. If a dentist makes the same provisional restorations in the 30-minute period, the cost to the practice ranges from $100 to $500, based on the range of overhead present in U.S. dental practices.
When staff members are educated and paid well and fairly for their contributions to the practice, they are very satisfied to be members of the dental team.
I have yet to hear a legitimate rebuttal to this concept. However, as recently as the night before this writing, I received a letter from a practitioner in a state in which this task appears to be illegal, stating that she is being examined by the state dental board for disobeying this law in her state. On what logical basis can such restrictive laws be based? The savings in overhead created by delegating this and numerous other tasks should be passed on to patients, thereby lowering the cost of accomplishing dental therapy and allowing more patients to afford adequate dentistry.
Dental staff members benefit from expanding their role in the dental practice.
Savings for less expensive dental therapy also can be passed on in higher salaries for the dental staff. When staff members receive higher salaries, they are more satisfied with their positions, and it is likely they will stay in the profession on a more permanent basis.
Additionally, staff members have greater job satisfaction, because they consider themselves to be professionals who are valuable to their respective practices. It has been my experience that expanded-function dental assistants, hygienists and technicians who have become accustomed to working in broader roles than the conventional ones are satisfied and highly productive in their positions, and they find it difficult to return to only conventional responsibilities.
Dental practices benefit from expanding the role of dental staff members.
It cannot be denied that practices using expanded-function staff members are more productive than those practices not using staff on an expanded basis. As a result of this increased activity, the dental team gains more experience. The potential result of this increased experience is higher-quality dental therapy. The increased activity also produces more gross income to practices, and it is logical that some of this increased gross income can result in higher net income for practitioners.
Some of my additional beliefs about and experiences regarding the importance of expanding the functions of dental staff members can be reviewed in past JADA issues.1–4
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SUMMARY AND CONCLUSIONS
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It is my opinion that expanding the role of properly educated dental assistants, hygienists and technicians creates a situation that benefits dental patients, staff members, dental practices and dentists’ net income. I contend that conservative dental practice acts that limit the potential responsibilities of educated dental staff members should be critically analyzed and expanded to allow this valuable concept to be incorporated into dental practices.
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ARGUMENTS AGAINST EXPANDING THE...
ARGUMENTS FOR EXPANDING THE...
