Paying our profession forward.
I recently returned from a short vacation getaway at St. Simons Island, where the beaches can stretch out for hundreds of yards at low tide. Being an avid nature lover, I enjoyed watching the seabirds and dolphins, especially early in the morning before the crowds move in. After rising early one morning and heading from our condo to the beach, I observed a one-legged seagull landing ever so cautiously on the sand after flying above the ocean surface. He seemed quite confident despite his physical limitation and even though he was clearly disadvantaged, he stood tall.
This was an 'aha' moment for me, and it comes at a time when our profession is struggling to survive tough economic times. Like many of my colleagues who practice part-time, I'm often frustrated for a number of reasons. Even though I have the ability to provide outstanding service to my patients, my ability is not always appreciated, and I am sometimes treated with disrespect by well-meaning employers. I observe dentists working with new equipment and instruments, and I watch as they page though catalogs and order what they need to provide a superior service. Many practicing RDHs, on the other hand, work in second-rate operatories, often with old chairs, unsatisfactory ultrasonic units, inserts and left-over instruments. Some of my colleagues will suggest that we purchase our own equipment and instruments, and I would agree that this makes sense for independent contractors, but not for employees. Like the one-legged seagull, we sit tall and do our best under the circumstances, but we remain frustrated and sometimes feel unfulfilled.
If we look at our profession on the whole and compare it to a one-legged seagull, it is indeed restricted in some states. In my home state of Georgia, for example, there are too many dental hygiene programs, and many talented clinicians cannot find work.
OK, enough of the gloom and doom. As I travel around the U.S., I can't help but notice an energy force in our profession that is paying us forward in spite of the many obstacles that stand in our way. Where did this expression come from anyway? 'Pay it forward' is an expression that was first introduced in the 2000 movie Pay It Forward, in which a young man named Trevor McKinney tackles an intriguing social studies assignment: he is told to think of a way to change the world and put the new initiative into action. Trevor conjures up a notion to repay-forward good deeds to new people. Trevor is the troubled child of an alcoholic mother and an abusive but absent father, and his idea of repaying a favor forward instead of back caught on and spread to an ever-widening circle of strangers.
How can we continue to propel (pay) our young profession forward in new ways that might just catch on? Here's an idea for us to ponder anew, and it's tied to self-regulation, our ADHP initiative and ways to facilitate direct access to preventive care.
America is screaming for better access to health care, and it's no secret to us that a healthy oral cavity is an essential part of overall health and well-being. As one of the fastest-growing professions in the U.S. that is far surpassing the growth of the dental profession, our services can be better utilized if tied to walk-in medical clinics. There's a new walk-in health care model called the Mayo Express Care that serves as a model new delivery system providing treatment for acute conditions that require prompt treatment. Bingo! Doesn't this sound like the perfect fit for an ADHP? Isn't it also a perfect fit for the RDH? I can see it now--caregivers are integrated members of a primary care team that includes RDHs, nurse practitioners, physician assistants and primary care physicians. While other providers offer treatment for minor illnesses like allergies, colds, ear and skin infections, vaccines and blood glucose testing, RDHs will provide preventive oral health services including tests for dental caries or periodontal disease risk and oral cancer screening. Prices for primary care services like topical fluoride treatments and sealants might be posted on the wall, similar to ones in oil changing or nail salons, and patients may be able to food shop or enjoy a meal while waiting for a walk-in appointment.
Convenient care clinics (CCCs) are primary health care clinics located in retail stores, supermarkets and pharmacies that treat routine family illnesses and provide preventive care services. What better way to increase access to basic oral preventive services and minimally invasive restorative services for consumers who have trouble accessing traditional oral health care providers?
I like to think of CCCs as a consumer-driven movement. Consumers will drive hours of operation and the walk-in nature of appointments, and it may well be that preventive oral health care services by RDHs in some areas will be best delivered in a retail environment. Consumers will appreciate convenient access to an RDH, and they might just begin to grasp the significance of oral/systemic risks.
I recently spoke to Edie Gibson, RDH, BSDHc, who works unsupervised in Crested Butte, Colo. Edie owns/operates a dental hygiene spa called About Face. For her, and many like her, having autonomy allows her to deliver patient-centered, need-specific oral health care instead of production- and time-driven care with an unrealistic, overloaded daily schedule. Edie said it best: "I know my clients come first, not production goals tied to bonus schemes or the doctor's production needs. My assessments are valued by my clients, and they recognize them as true needs-based assessment. My clients continually thank me for an unbiased opinion on their oral condition. When they see their DDS, they already understand their condition/needs, they have accepted treatment and trust the DDS and his team completely!
"If dentists/establishment could shift their perceptions on independent practice and see that we are an asset and not a threat, and that we are their best referral source for building their business (and not "stealing" clients), then we have a fighting chance of moving our profession out of the dark ages!"
In paying forward our services to the community at large, let's lobby to join a primary care team and forever change the outdated and ineffective practice models that include supervision. Direct access to the community necessitates unsupervised practice in all settings for licensed RDHs.
P.S. This letter is dedicated to children like 12-year-old Deamonte Driver who died needlessly from a dental abscess that spread to his brain. RDHs can pay it forward to prevent oral infections, one child or adult at a time.
Lynne H. Slim, RDH, MS