Hurdles and Challenges that take us from Pioneers to Successful Business Owners

By: Lori Lawrence   R.D.H. 

I am writing to you to talk about the transition from being a ‘pioneer’ to being an owner of a successful Independent dental hygiene clinic in Ontario.

Those of us that have ventured out with our self-initiation have had many hurdles to overcome. The legislation was changed in September 2007; that is over 3 years now and yes we have broken down many walls put before us but we still face some challenges that I would like to discuss with you today. 

Of course the obvious one would be the ODA and the CDA, most of their membership see entrepreneurial dental hygienists’ as a threat to their own practices. We hear time and time again complaints from our clients who have been told that they will not “receive the same quality service from their dentist if they have their teeth cleaned at an independent dental hygienist office”. Or even though they have continued with their regular DDS for all their diagnostic and restorative needs, they are charged over and above the normal fees because they have chosen to have their teeth cleaned by their “favorite RDH” who has been cleaning their teeth for years and years but has recently opened her own practice. The most outrageous one of all is that clients are out and out refused their regular dental treatment because they have had their teeth cleaned at one of our offices. 

How do we overcome this challenge? I spend a lot of time trying to get the word out to the public and to fellow dental professionals that we are not ‘the competition’We are regulated under the ‘Dental Hygiene Act 1991’ and are authorized to perform the act of scaling teeth and root planing including curetting surrounding tissue. We represent another oral health profession that is working collaboratively within our health care system to maintain the oral health of our clients who seek our services. I now have many DDS’s that I can refer to and trust that the client will return to my office for their dental hygiene appointments. 

 Our second biggest challenge is “Dental Insurances”.  Although most insurance companies accept independent dental hygiene services, NOT ALL DO!  It is vital that we check with each and every client that their insurance will cover our services. Here the problem lies with the ‘employer’ they are the ones that are responsible to make sure that our services are written into their policies so that their employees will have coverage for an independent dental hygienist. Along with that hurdle, we also face the fact that the insurance companies have not yet uploaded the Dental Hygiene Fee Guide into their data base. This introduces a range of many problems for us. We are still having to “snail mail” our insurance claim forms, once they arrive, an employee of the insurance company must open the mail and manually convert our dental hygiene codes into dental codes. Many errors occur with this process because the person doing the conversions is not well versed in the dental lingo and frequently “get it wrong”. Last year one of my clients called and asked why I billed for an “implant” even though the claim was for 3 units of scaling and root planing!  That is how serious this problem is. Keep in mind every claim form that we have a problem with gets delayed with the payment to the client. Sometimes a client can wait 6-8 weeks for payment……that is a serious issue because some would just say “I’m going back to my dentist where they can bill me electronically and I won’t have this grief”. The electronic system is being tested in Ontario currently, but once again the insurance companies are going to have to spend a lot of money updating their data bases which so far they have been reluctant to do. So far only “Green Shield” is participating in the ‘pilot’ program, the problem is, currently very few Green Shield policies cover the services of an Independent dental hygienist. 

How do we overcome this challenge? Relentless letter writing and endless phone calls every time there is a problem. Every day we are on the phone to an insurance company trying to fix the system. Currently I am also in discussions with employers and insurance brokers that can affect changes at the policy level. 

Our third challenge is “local anesthetic” and “radiographs”. The local anesthetic challenge has been eliminated by the introduction of 2 great products, Cetacaine and Oraquix. Both of these products allow an RDH to deliver sufficient local anesthetic for subgingival root planing without any discomfort to the client. Radiographs on the other hand are a much bigger challenge. In order for the Healing Arts Radiation Protection Act (HARP) to be changed the HARP Commission needs to lobby the government to make the necessary changes to the law. The only problem is, as of last year the government disbanded the “HARP” commission and to date there is no talk of setting up a new commission. Sadly it will be a while yet before we ever see any changes in the law to allow us the ability to take radiographs without a written order.

How do we overcome this challenge?  We have invited and hosted our MP and MPP to our clinic in order to show them a) that we exist and b) that they need to understand the importance of radiographs and how it can improve the services we provide to our clients. Hopefully someday they will be sitting in the legislature and faced with a vote on the HARP Act, at which time they will think back at being in our office and vote a resounding “YES”.

 Our fourth challenge would be one that most of you haven’t thought of. It is our own profession. Yes some of our own colleagues seemed to be a bit miffed at us independents. Sad but true! There is still that ‘fear’ that some RDH’s have about associating with an ‘independent’. How many RDH’s support their own profession by going to have their teeth cleaned at a colleague’s office? Probably not many because there is still that ‘fear’ of what will my boss think?

How do we overcome this challenge?   This is where “Unity Day” can play such a huge role in bringing us all together as ONE. We all have the same education, the same skills, and the same passion to help our clients. We need to rekindle that passion amongst ourselves. Stand tall, shoulder to shoulder, whether we work in a nursing home, or in a traditional dental office, or with public health or in our own independent clinics…be proud that we are all PROFESSIONAL REGISTERED DENTAL HYGIENISTS!

 We as pioneers have been busy paving the way for anyone else who wants to join in the journey. There are lot fewer bumps in the road now than there was 3 years ago. We will continue to strive to make the road as smooth as possible so that we can ALL be SUCCESSFUL in our endeavors.

There is nothing in this world better than being your own boss. You decide how long you need for each client, you decide what instruments you are going to use and what supplies you like best, and the greatest of all, you decide what the best treatment plan is for your clients. And you go home with a clean conscience every day!  “You are OFF the Clock”

Smiles Always,

Lori 

Lori Lawrence   R.D.H.

 Smile Sensations