RDH Insight: Understanding the Dental Hygienist Shortage

Facing staffing issues in hiring and maintaining registered dental hygienists for your practice? Hear directly from an experienced RDH on possible causes and successful solutions.

By Sharon Boyd, MA, RDH

It's estimated that nearly 40% of dentists in the United States are actively trying to recruit a dental hygienist for their practice. Yet, in polls by the American Dental Association (ADA), nearly half of all hygiene positions are going unfilled in some of the nation's largest cities.

Why Dental Hygienists Are Leaving Clinical Hygiene

Many dental hygienists left clinical practice during the COVID-19 shutdowns. Some reasons include eliminating aerosol-producing equipment, physical fatigue, and pressure from office management to maintain strict scheduling requirements even while hand scaling and taking additional time to disinfect rooms between patients. In addition, many may have clashed with their doctors and practice managers over COVID-19 constraints for one reason or another.

With the added stress of working through a pandemic, many hygienists consequently hit "burnout" simultaneously. Some retired from hygiene completely, others sought higher-paying temp jobs, and some took pay cuts to change careers or follow other endeavors. Even then, others chose to stay home with their families after navigating the finances of making it through a pandemic without their typical salary. Finally, with concerns over virtual learning, childcare, and a work-life balance, some hygienists left the profession altogether due to lacking family or employer support.

Changing Safety Concerns for Clinicians

As healthcare professionals, many hygienists have expressed concern about their safety and their families' health while working close to potentially infectious patients, even with PPE measures in place. That, combined with inconsistencies with quarantining and isolating, keeping family members home, and distancing from other sick individuals, has caused undue stress on many hygienists nationwide.

The ADA advised that dentists follow the CDC's recommendations for infection control. Yet, many practice standards were left up to independent dental office management, causing inconsistencies across most cities and states, as most were dependent on the personal opinions and beliefs of each practice owner or manager. As a result, countless hygienists felt their concerns went unaddressed or not considered at all while making these decisions—combined with scheduling adjustments—adding fuel to the fire and increasing frustrations industry-wide.

Salaries: A Case of Supply and Demand

Aside from patient care practices and time constraints in a post-COVID world, other factors contributing to hygienist hiring and retention include the overall culture of the practice, benefits, work-life balance, and compensation. With temping positions currently paying anywhere from $15-20 an hour or more than typical dental hygiene salaries a few years ago, the flexibility and monetary benefits are a win-win for hygienists who are not yet ready to commit to one set office on a full-time basis. In fact, it's becoming increasingly common for hygienists to hold a part-time clinical job in an "anchor office" and use their remaining free days to temp at other practices in the meantime.

In some parts of the country, hygienists earn as much as $100,000-$129,000 annually. Yet, polls show that nearly half of the dental practices nationwide have hygiene salaries hovering around $70,000 annually. Because the hourly pay for a temping hygienist can easily be as high as $90 per hour, it makes it more challenging to compete for those practices looking to hire an RDH permanently at a much lower pay rate. 

How Canada is Tackling the Issue

The United States is one of many countries struggling with a dental staffing shortage. As a result, Canada has added several dental professionals to a special immigration program to fill the industry's vacancies. Dental hygienists and dental therapists—a type of mid-level dental practitioner found in Canada, Australia, and the UK—were among the 16 jobs added to the program.

What Can Dentists and Dental Office Managers Do to Help?

  • Address wage disparities of clinical hygiene positions in their community
  • Onboard hygienists as a co-provider and include them in decision-making related to appointment length, infection control practices, and office safety standards
  • Improve work-life balance for dental hygienists by making vacation, family, and sick leave more accessible, partnering with a temp agency to fill roles when needed
  • Maintain mutual respect between office management and hygienists related to office policies and patient care practices
  • Allow current hygienists to voice their concerns and create a written plan to meet those issues within a set timeframe
  • If decreasing reimbursement rates interfere with the ability to offer competitive salaries to hygienists or any dental staff, consider developing an in-office membership plan or transitioning to a cash-pay practice instead
  • Re-think employment benefits and sign-on perks to incentivize new hires

On a Personal Note

As someone who works with dental industry leaders around the country, I am consistently met with conflicting opinions about the dental hygienist shortage on both sides of the issue. Finding a middle ground between dentists, dental office managers, and hygienists is a narrow rope to walk.

Regardless of where a dental practice is located, it's possible to successfully hire and retain quality hygiene providers by being open-minded and considerate of the concerns dental hygienists face. However, until changes are made across the industry, hiring and retaining dental hygienists will likely remain a hot-button issue for several more years.

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Sharon Boyd, MA, RDH — Sharon has over 20 years of experience in the dental industry and is the founder of DentaSpeak, LLC. In addition to being a registered hygienist, she serves as a full-time patient education professional with a special interest in strategic dental communications. She often works as a liaison between practitioners and patients, bridging the gap between care needs and patient concerns. Sharon is an Ironman, band mom, and enjoys volunteering at her family's church.

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