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THE EDITOR'S CORNER

The Orthodontic Staff Shortage

The Orthodontic Staff Shortage

Over the last 22 years, I have had the great good fortuneto work with some of the best assistants in the world.I actually count my current staff as friends and familymore than I consider them employees. There is nothingthat eases the day-to-day burden of running a busy practicemore than having efficient team members who arenot only professional at what they do, but have a greattime doing it. Still, I must admit that I have occasionallyhad to tolerate assistants who made me wonder what Ihad done in my previous lives to deserve such torment.Either they were technically incompetent, or their interpersonalskills were better suited for a boxing ring thanfor an orthodontic office.

Other practitioners have apparently experiencedsome of the same concerns. In an informal poll I conductedof about 20 orthodontists, the problem they citedmore than any other was that of staff management. Surprisingly,though, the biggest staff issue reported in myinformal survey was not managing conflict, but findinggood employees in the first place. It seems that we are inthe throes of a genuine shortage--especially of RegisteredDental Assistants. In outlying rural areas such asRidgecrest, California, or Roswell, New Mexico, it isalmost impossible to find a reasonably competent orthodonticassistant. I know of one orthodontist who shutdown a satellite office in a remote area simply because hecould not find anyone to staff it and his home-officeemployees refused to travel.

Orthodontic practices pioneered the expanded roleof clinical staff in patient care. Although the dictionarydefines an assistant as a "helper", and the Latin base ofthe word means "bystander", that certainly does notapply to orthodontic assistants. Unlike staff members inother areas of dentistry, an RDA can legally handle manydetails of the patient's appointment, under the directsupervision of the doctor. Not only does this allow theorthodontist to see more patients per day, but it alsomakes orthodontics the most desirable field in dentistryin which to work.

So where are all the RDAs? It is clear thatmany young people no longer consider dentalassisting to be an exciting new field or a careerpath with advancement possibilities. The perceptionis that jobs in computers and business offermore opportunities (with or without a collegeeducation). Furthermore, there is more money tobe made in those occupations, once a person hasgained some experience. While the importanceof a high-quality staff has long been recognizedby orthodontists, many are limited in their abilityto pay wages competitive with other fields.Therefore, most RDAs who stay in orthodonticshave supplemental income from parents orspouses. In addition, the small number of employeesin most practices makes it fiscallyimpossible to offer the benefits that might beavailable in larger companies. Perks such as continuingeducation are not highly valued by youngpeople, leaving practitioners to wonder why theyspend the money when "no one seems to care".Family influence has also made a difference.Even though we consistently see informationpublished in the media about the increasing needfor medical and dental staff, the health-care industryis 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 bytheir parents from going into dental assisting.

Adding to orthodontists' distress is theproblem that RDA training does not provideenough specific information about the specialty.A newly graduated RDA cannot step into anorthodontic practice and give oral-hygieneinstructions, change elastomeric ligatures, removearchwires, or pick out a particular nickeltitanium or stainless steel wire from the supply. Ifthese skills were already present in the new hire,the staff member would be more valuable andproductive from the start. Orthodontic tasksshould be added to the state RDA practicalexams, and an orthodontic course should bemade available at the conclusion of general RDAtraining. Such an added program should not belengthy, however, because the new licensee isalways anxious to go out and begin earningmoney in the field. Orthodontists, perhapsthrough their regional study groups, could alsounderwrite periodic off-site training days so theircurrent staff and new hires could gain the necessaryknowledge faster. Even though each practicehas its particular techniques and procedures,there is still much that can be standardized in aformal program before training is completed inthe office.

We all know the joys of working in theorthodontic profession, but we need more toolsso we can recruit good people into orthodonticassisting, train those people to function at a highlevel of proficiency, and retain them in a mutuallyrewarding working relationship. There are noquick fixes to the assistant shortage. The twomajor obstacles are economics and training. It'stime for some new approaches.

ACKNOWLEDGMENT: I would like to thank Ellen Grady for hersignificant contribution to this month's column.

ROBERT G. KEIM, DDS, EDD, PHD

Editor, JCO

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