Over the last 22 years, I have had the great good fortune to work with some of the best assistants in the world. I actually count my current staff as friends and family more than I consider them employees. There is nothing that eases the day-to-day burden of running a busy practice more than having efficient team members who are not only professional at what they do, but have a great time doing it. Still, I must admit that I have occasionally had to tolerate assistants who made me wonder what I had done in my previous lives to deserve such torment. Either they were technically incompetent, or their interpersonal skills were better suited for a boxing ring than for an orthodontic office.
Other practitioners have apparently experienced some of the same concerns. In an informal poll I conducted of about 20 orthodontists, the problem they cited more than any other was that of staff management. Surprisingly, though, the biggest staff issue reported in my informal survey was not managing conflict, but finding good employees in the first place. It seems that we are in the throes of a genuine shortage--especially of Registered Dental Assistants. In outlying rural areas such as Ridgecrest, California, or Roswell, New Mexico, it is almost impossible to find a reasonably competent orthodontic assistant. I know of one orthodontist who shutdown a satellite office in a remote area simply because he could not find anyone to staff it and his home-office employees refused to travel.
Similar articles from the archive:
- THE EDITOR'S CORNER Stretching the Limits of Delegation January 2002
- THE EDITOR'S CORNER Investing in a Sure Thing December 2000
- THE EDITOR'S CORNER Where Are the Assistants? December 1998
Orthodontic practices pioneered the expanded role of clinical staff in patient care. Although the dictionary defines an assistant as a "helper", and the Latin base of the word means "bystander", that certainly does not apply to orthodontic assistants. Unlike staff members in other areas of dentistry, an RDA can legally handle many details of the patient's appointment, under the direct supervision of the doctor. Not only does this allow the orthodontist to see more patients per day, but it also makes orthodontics the most desirable field in dentistry in which to work.
So where are all the RDAs? It is clear that many young people no longer consider dental assisting to be an exciting new field or a career path with advancement possibilities. The perception is that jobs in computers and business offer more opportunities (with or without a college education). Furthermore, there is more money to be made in those occupations, once a person has gained some experience. While the importance of a high-quality staff has long been recognized by orthodontists, many are limited in their ability to pay wages competitive with other fields. Therefore, most RDAs who stay in orthodontics have supplemental income from parents or spouses. In addition, the small number of employees in most practices makes it fiscally impossible to offer the benefits that might be available in larger companies. Perks such as continuing education are not highly valued by young people, leaving practitioners to wonder why they spend the money when "no one seems to care". Family influence has also made a difference. Even though we consistently see information published in the media about the increasing need for medical and dental staff, the health-care industry is still perceived as offering hard work, low pay, little advancement, lack of appreciation, and some risk of exposure to injury or disease. It's no wonder young people are discouraged by their parents from going into dental assisting.
Adding to orthodontists' distress is the problem that RDA training does not provide enough specific information about the specialty. A newly graduated RDA cannot step into an orthodontic practice and give oral-hygiene instructions, change elastomeric ligatures, remove archwires, or pick out a particular nickel titanium or stainless steel wire from the supply. If these skills were already present in the new hire, the staff member would be more valuable and productive from the start. Orthodontic tasks should be added to the state RDA practical exams, and an orthodontic course should be made available at the conclusion of general RDA training. Such an added program should not be lengthy, however, because the new licensee is always anxious to go out and begin earning money in the field. Orthodontists, perhaps through their regional study groups, could also underwrite periodic off-site training days so their current staff and new hires could gain the necessary knowledge faster. Even though each practice has its particular techniques and procedures, there is still much that can be standardized in a formal program before training is completed in the office.
We all know the joys of working in the orthodontic profession, but we need more tools so we can recruit good people into orthodontic assisting, train those people to function at a high level of proficiency, and retain them in a mutually rewarding working relationship. There are no quick fixes to the assistant shortage. The two major obstacles are economics and training. It's time for some new approaches.
ACKNOWLEDGMENT: I would like to thank Ellen Grady for her significant contribution to this month's column.
RGK