Why some dentists don't hire hygienists

Hygienists can increase the productivity of a dental practice. Even so, only about one-third of dentists employ them, according to a new study in the Journal of the American Dental Association.

So why doesn't every dentist hire a hygienist?

Dentists who work full time, employ more administrative personnel, and have more operatories, longer appointments, and more income from private payors are more likely to employ hygienists, according to the study (JADA, August 2009, Vol. 140:8, pp. 1027-1035).

Previous studies have not reported on why some dentists do not hire hygienists, study author Nadereh Pourat, Ph.D., an associate professor at the University of California, Los Angeles (UCLA) School of Public Health, told DrBicuspid.com.

In fact, studies that describe the characteristics of dentists who employ hygienists and their reasons for doing so are limited, and most do not include dentists practicing in the U.S., she noted.

One exception is the ADA's 2007 Survey of Dental Practice. Among other things, that report found that more than 76% of independent general practitioners and more than 26% of independent specialists in the U.S. employed full- or part-time hygienists in 2006, and that specialists are less likely to hire hygienists as most specialty areas do not require their assistance.

Logistic regression analysis

For the JADA study, Pourat used data from the 3,599 dentists who responded to the 2003 California Dental Survey, a statewide random mail survey of dentists in private practice. As part of that survey, which was conducted by Pourat and colleagues from the UCLA Center for Health Policy Research, a follow-up survey was sent to a random sample of 500 dentists from the initial survey who did not employ hygienists to find out why.

The survey instruments were based on ADA's dental practice and workforce surveys, and included many similar questions, according to Pourat.

For the JADA study, she used logistic regression analysis to assess factors associated with dentists' employment of hygienists, such as their personal, practice, population, productivity, and patient care characteristics. She also assessed characteristics of dentists who did not employ hygienists.

Pourat found that the most common reasons for not employing hygienists were personal choice (73%), not being busy enough (49%), and business costs of employing a hygienist (42%). In addition, most dentists (77%) not employing a hygienist reported having no plans to hire one in the future.

Other findings included the following:

• Asian Americans, specialists in areas other than pediatrics, and graduates of dental schools outside the U.S. were significantly less likely to employ hygienists than Caucasian dentists, general dentists, and U.S. dental school graduates.
• Dentists who were associates or contractors and working full time were more likely to employ hygienists than those in solo practice and those working part time.
• Dentists who reported that they were not busy enough were less likely to employ hygienists than those who were busy or overworked.
• More administrative personnel, more operatories, and higher salaries for dental assistants were associated with an increased likelihood of practices employing hygienists.
• Dentists who reported a larger mean percentage of their income as derived from public payors were less likely to employ hygienists than were those who derived a larger mean percentage of their income from private insurance.

"Dentists who employ hygienists appear to be established in their practices [and] have larger and busier practices and more resources," Pourat told DrBicuspid.com. "These dentists spend less time on preventive care personally, presumably because they can delegate those tasks to their hygienists."

As for why some dentists choose not to add a hygienist to their practice, those with lower incomes can opt to provide the preventive care themselves, she noted. Others prefer to hire newly graduated dentists rather than hygienists, since the former can provider a broader range of care. Some practice in areas with a much higher level of need for restorative care and less demand for preventive care, so they feel they do not need to employ a hygienist.

The current economic recession could also be affecting hiring practices, Pourat added.

"Loss of employment-based insurance could lead to delays in visiting the dentist, which means less demand for dental and hygiene work," she said. As a result, those dentists who do not have great demand for their services may choose to let their hygienists go or not hire one at all.

"In employing hygienists, dentists consider preferences, practice income, and patient demand, among other factors," Pourat concluded in the study. "Hiring a hygienist increases a dental practice's patient capacity, yet not all dentists can or choose to do so. Policies aimed at increasing dental workforce capacity must take into account dentists' characteristics and preferences."

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