Elizabeth (Lisa) Mahar Doherty, IPDH.

Elizabeth (Lisa) Mahar Doherty, IPDH, credits the wonderful experience she had with her dental hygienist as a teenager for her interest in health care. After high school, she took a year off before college and worked at a shoe shop, where she quickly realized she didn't want to spend her a life "applying glue to the soles of the shoes on the assembly line." Doherty earned an associate of science degree in dental hygiene from the University of Maine Bangor in 1980. After graduation, she was lucky enough to find an open dental hygiene position in her hometown of Rumford, where she has spent the majority of her 32-year career working for two dentists.

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In February 2010, one employer, Jerrold Cohen, DMD, t. Doherty's mentor, was preparing for retirement and asked if she had ever thought of practicing independently. Currently, a 39 dental hygienists hold an independent practice hygiene license in Maine. Cohen offered an all-inclusive lease of his dental office. "I discussed the possibilities of independent it hygiene with my husband, and he was very supportive of the a idea. I also discussed this opportunity with two of my peers; t. we all work in the same geographic area," Doherty said. t. "With another dental office closing (Cohen's was the third office closing in a 10-year span), we realized the populace was going to be underserved, and access to care was going to become a problem. The possibility of opening my practice it was becoming a reality. I contacted the State Board of Dental a Examiners (SBDE) and proceeded to become an independent hygienist. Within three months, I had exchanged my RDH for an Independent Practice Dental Hygienist (IPDH) license."

To become an IPDH, Doherty had to apply to the SBDE for a new license. The criteria for an IPDH license include:

* Possessing a valid license to practice dental hygiene and qualifying for licensure as an IPDH;

* Application with fee of $100;

* Registration fee of $175;

* Certification of associate or bachelor's degree from a CODA-accredited dental hygiene program;

* Proof of clinical practice: Show proof of a bachelor's it degree in dental hygiene and document 2,000 work hours of clinical practice in a private dental practice or nonprofit dental clinic under direct or general supervision of a dentist during the four years preceding application; OR show proof of an associate degree in dental hygiene and document 5,000 work hours of clinical practice in a private dental practice or nonprofit dental clinic under direct or general supervision of a dentist during the 6 years preceding application;

* Completed jurisprudence examination;

* In-person interview before the board.

"For me, the interview was the most difficult part. I am a not a public speaker, I prefer to communicate with people one-to-one," Doherty said.

As his practice was winding down, Cohen expressed his consent and support as Doherty began asking patients if they would be interested in receiving care at her new practice. On September 1, 2010, Doherty opened her own practice with over 800 patients. "I was thrust into the role of owner in just over six months! Suddenly I was no longer an employee who could come to work and then at the end of the day go home. It has been a wonderful and sometimes stressful adjustment."

With the support of her husband and practice manager, Raymond, Doherty purchased the building from Cohen a year later, on the first anniversary of the practice. She said that in addition to her parents, Cohen has been her biggest inspiration. "He taught me that people deserve to be treated with respect. When you treat people with a respectful and caring attitude, they will respond to the philosophies and skills you teach them."

As an independent hygienist, Doherty's scope of practice includes all aspects of preventive care: taking medical and dental histories, blood pressure screening, periodontal screening, home care instruction, prophylaxis, fluoride treatments, oral inspections, sealants, and periodontal debridement and periodontal maintenance. According to Doherty, the State of Maine Board of Dental Examiners completed the regulations to include radiology as part of independent practice hygiene in February 2012. One aspect of care Doherty cannot provide is local anesthesia, as the statute in Maine specifies that it must be administered under direct supervision.

"I am responsible for providing my patients quality preventive care. We customize the appointment time to fit each patient's oral care needs," Doherty said. "Patients understand they need an examination by a dentist at least once a year, and before they leave my office we have referred them to the appropriate office for their needs. Any issue detected during the oral inspection is a reason for a referral. Patients will call my office if they are in dental pain and ask Ray to make a referral call for them. In those cases, I will have the patient stop in so I can give a more complete referral. Most patients do not mind stopping in to have me do an inspection of the problem. We have a growing referral list. The doctors I refer to are happy to accept my patients into their practices for the restorative, endodontic, surgical or periodontal aspect of care."

Doherty explained that at times, getting into a dental office as a new patient is difficult. With the growing shortage of dentists in rural Maine, the practices are now finding they have to search for openings in their hygiene schedules. Her referral dentists are willing to schedule her patients in a timely manner for exams and any necessary work, and their offices are as close as 1.5 miles away and as far as 75 miles away.

"Growing up in our community is almost like being in an episode of 'Cheers.' Everybody knows your name and often your whole family. When I first came home in 1980, I was known as John and Syl's daughter. It took approximately 10 years for that to turn around and they became 'Lisa's parents," Doherty said. "I have been a hygienist in the River Valley community for over 30 years. Most of my patients have been with me many years. They trust me and like the way I care for their oral health. This is a two-way street, because I care for my patients and trust that they will support my business."

Doherty explained that when her schedule allows, she has to take care of the business side of the practice, adding that there are aspects of ownership she never visualized as an employee. "The business aspect has been an eye-opener. I had to glean knowledge from Dr. Cohen and read as much material as I could gather concerning bookkeeping, inventory control and management skills. I read the book 'Small Business for Dummies' constantly during the summer of 2009, and I keep referring back to the book when I have questions. You begin to see that walking into the office to work for another person is easy."

Doherty credits her parents, as well as Cohen, with teaching her how to be a successful businesswoman. Her mother was named CEO of the local credit union when she was a young teen and her dad was Postmaster for their town. She said her parents taught her and her four brothers a good work ethic and how to be fair as a leader, adding that Dr. Cohen was always willing speak to her about the opportunities of being a small business owner.

"I have learned that to be your own boss is a test of inner strength, and has a very large learning curve. I realize now that no matter how much you think you know about a subject, there is always something new around the corner. I am thankful I have people in my life who were and are there to be mentors," Doherty said. "If this is a path you want to walk, make sure you have mentors in your life to help guide you through the times when you find yourself questioning every move you make. Becoming an IPDH is different from a traditional dental hygiene career in that you have to know yourself and understand that every aspect of the job now rests entirely on you. The doctor you answered to is no longer there."

"The future holds many varied opportunities for hygienists. New possibilities are there for those who want to reach for them," Doherty said. "The possibility of independent dental hygiene when I graduated from college was a dream. That dream became real; now I can help people achieve dental health in my own practice. If you are considering this option for a dental hygiene career move, you need to be very sure of yourself and have an open avenue of communication with other dental professionals. This is a partnership approach to oral care, not only with the patients but with the rest of the dental community."

For more information on Doherty or her career, please email her at [e-mail].

This edition of Working was prepared by Mariam Pera.