21 votes

The San Francisco Bay Area shortage of dental hygienists

14 comments

  1. [8]
    skybrian
    Link
    From the article: … … … … … … I don’t think this article explained very well why this career is less attractive than it used to be. Perhaps it hasn’t changed that much, but nursing pays better?

    From the article:

    Today, the field […] faces a shrinking workforce, especially in the Bay Area, where there is only one hygienist for every 2.5 dentists, though most practices function best with three to four hygienists per dentist. Even high wages can’t stem an outflow caused by a lack of support, an unsustainable workload, and policies that are straining the industry.

    Between 2019 and 2023, the number of registered dental hygienists in seven Bay Area counties fell 8.6% from 3,262 to 2,980, even as the number of licenses statewide increased by 426, according to the California Department of Consumer Affairs.

    The shortage has driven up compensation. Registered dental hygienists in the Bay Area earn an average hourly wage of about $69 or $142,751 annually for full-time work, according to Revelio Labs. Even a three-day workweek pays well above the region’s median annual earnings. But many hygienists work part time and receive no benefits.

    Unlike other roles in healthcare with similar educational requirements, like nurses, many hygienists do not benefit from employer-sponsored health insurance, sick leave, and retirement accounts.

    Nationally, women make up 94% of registered dental hygienists but only 38.8% of dentists, according to the Bureau of Labor Statistics (opens in new tab), reflecting the history of male dentists recruiting their wives and daughters to clean patients’ teeth throughout the early and mid-20th century. Part-time schedules are crucial to manage the physical demands of a job in which carpal tunnel and repetitive strain injuries are commonplace.

    Facing chronic vacancies, some states are letting lower-paid dental assistants take on tasks once reserved for hygienists. Model legislation from the conservative think tank American Legislative Exchange Council and the American Dental Association has opened the door to expanded assistant duties.

    California dentists have begun hiring associate dentists to do preventive care.

    “[A hygienist] frees up my schedule to do dentistry and deliver better care, but numbers-wise, I just can’t make it work,” says Travis Smith, a dentist who opened an office in San Francisco this year. “Since the shortage is so profound, the salary demands of a per diem hygienist is going to be more than an associate dentist.”

    Some 60% of dentists polled (opens in new tab) by the ADA in 2022, the latest data on record, reported that their rates were stagnant (opens in new tab), and 25% said their rates had decreased over the previous year. Consolidation in the insurance industry has weakened small providers’ negotiating power, and there’s a lack of regulation in dental insurance compared with medical insurance.

    Given that backdrop, it’s no surprise that some hygienists have pivoted to nursing. “In nursing, you have the union, you have the support, you have the hospitals that can work for you,” Markopoulos said. “There are more options for nurses, and they have the benefits and retirement.”

    I don’t think this article explained very well why this career is less attractive than it used to be. Perhaps it hasn’t changed that much, but nursing pays better?

    7 votes
    1. [6]
      fefellama
      Link Parent
      This seems like yet another problem that could be mostly mitigated or completely eradicated by universal healthcare and better labor practices/protections.

      Unlike other roles in healthcare with similar educational requirements, like nurses, many hygienists do not benefit from employer-sponsored health insurance, sick leave, and retirement accounts.

      “Some hygienists are seen as divas or prima donnas just for asking for fair hours or better instruments or more time with their patients,” Katie said.

      This seems like yet another problem that could be mostly mitigated or completely eradicated by universal healthcare and better labor practices/protections.

      16 votes
      1. [5]
        DefinitelyNotAFae
        Link Parent
        The "family business" aspect of many dentist practices has a big impact on this too. I'm not going to claim being a family member working for them is a great experience, especially in such an...

        The "family business" aspect of many dentist practices has a big impact on this too. I'm not going to claim being a family member working for them is a great experience, especially in such an imbalance of power as that between hygienist and DDM. But also having been a random person working for a family owned dept store, the pay sucked, the benefits weren't great (my mom worked there at one point too) and the people in charge were always micromanaging things. I could have made more money at Walmart.

        Doctors offices aren't run like family businesses these days and it seems like the dental profession is having to reckon with hygienists being professionals themselves, not replaceable or obligated

        (Which is to say I agree with your solutions just with some specific things going on in this industry)

        13 votes
        1. [2]
          vord
          Link Parent
          My dentist in NJ is amazing. They are fully staffed, have a full care system that lets you interact completely via text, including chatting with technician/front desk for scheduling. The facility...

          My dentist in NJ is amazing. They are fully staffed, have a full care system that lets you interact completely via text, including chatting with technician/front desk for scheduling.

          The facility has it centered around the hygenists: The workspace is entirely theirs, they don't move around during visits except to take a break while the dentist steps in. They can handle scheduling/rescheduling as part of the the appointment, making it easier for patients to have a preferred hygenist.

          It's the epitome of 'empower the employee' and it seems to be working. I don't think I've seen more than 2 face changes in 4 years, in a junior role.

          7 votes
          1. skybrian
            Link Parent
            I also have a general impression that hygienists at the dentist we go to are treated well. They don't seem to have much turnover. But it seems unlikely that they would complain to the patients.

            I also have a general impression that hygienists at the dentist we go to are treated well. They don't seem to have much turnover. But it seems unlikely that they would complain to the patients.

            3 votes
        2. [2]
          jredd23
          Link Parent
          I can't imagine the pay is great and given how expensive that area of the world it is, can't be easy to live near by. The fun part of being affluent but have no teeth cause you got nobody to help...

          I can't imagine the pay is great and given how expensive that area of the world it is, can't be easy to live near by. The fun part of being affluent but have no teeth cause you got nobody to help DDS, fair exchange IMO.

          4 votes
          1. DefinitelyNotAFae
            Link Parent
            In which case, they're going to have to pay more and treat hygienists better. Family businesses just have not been pleasant to work for IME, and perhaps dentists also need to pivot to a medical...

            In which case, they're going to have to pay more and treat hygienists better. Family businesses just have not been pleasant to work for IME, and perhaps dentists also need to pivot to a medical practice model that isn't just 4 brothers with DMDs whose father and uncles were also DMDs (why does that mean Doctor of Dental Medicine, titles are weird)

            6 votes
    2. CannibalisticApple
      Link Parent
      The lack of benefits alone seems like a perfectly valid reason for it to be declining. Benefits like health insurance and retirement are more crucial than ever right now, and it sounds like...

      The lack of benefits alone seems like a perfectly valid reason for it to be declining. Benefits like health insurance and retirement are more crucial than ever right now, and it sounds like insurance companies aren't keen to cover part-time roles of any sort without raising rates. The lack of insurance is especially bad since the article mentions some having to pay out of pocket for physical therapy relating to pain from doing their jobs, so that cuts into the paycheck.

      Combine that with potential personality clashes and cliquey environments, which can be particularly bad in smaller environments like dental practices, and it's understandable people change fields. Some people might stick out bad environments for the benefits, but it sounds like even good practices are likely struggling due to simple economic factors.

      5 votes
  2. [3]
    vord
    Link
    For a simple why, look into the next tier of enshittified gig economy platforms. An Uber-style "independent contractors" platform for nursing and hygenisists: Gale "Let's them work how they want"...

    For a simple why, look into the next tier of enshittified gig economy platforms. An Uber-style "independent contractors" platform for nursing and hygenisists: Gale

    "Let's them work how they want" is business code for "undermine nursing unions and murder any semblance of stability."

    4 votes
    1. [2]
      skybrian
      Link Parent
      Dental hygienists are not nurses so that link doesn't seem directly relevant? Dentists and hygienists don't seem to be mentioned. But I wonder if there any similar companies for hygienists? People...

      Dental hygienists are not nurses so that link doesn't seem directly relevant? Dentists and hygienists don't seem to be mentioned. But I wonder if there any similar companies for hygienists?

      People in this very topic are explaining how working for family businesses isn't necessarily better. Though, perhaps some of them do treat hygienists well? It's going to vary depending on who owns the business.

      From a brief search, it looks like hygienists haven't historically been unionized, but they do have professional associations that do advocacy.

      2 votes
      1. DefinitelyNotAFae
        Link Parent
        Sure, some of them certainly do. The article highlighted the family business practice history of dentistry which led to my reply to someone's broader statement highlighting one facet of the...

        People in this very topic are explaining how working for family businesses isn't necessarily better. Though, perhaps some of them do treat hygienists well? It's going to vary depending on who owns the business.

        Sure, some of them certainly do. The article highlighted the family business practice history of dentistry which led to my reply to someone's broader statement highlighting one facet of the situation. But overall, regardless, they're not being treated well enough to maintain their staffing. I personally suspect the history of family practices contributes to that.

        But maybe the damage has been done and no matter how good the benefits and pay now there's just not enough interest in the field due to the historical treatment of hygienists regardless of the type of practice.

        As far as I can tell, I'm the only "people" complaining about working for family businesses.

        2 votes
  3. [3]
    Earhart_Light
    Link
    Since there's such a huge market demand, the "part time" status (for a significant percentage at least) is likely a deliberate policy by the dental office to avoid having to pay benefits. There...

    But many hygienists work part time and receive no benefits.

    Since there's such a huge market demand, the "part time" status (for a significant percentage at least) is likely a deliberate policy by the dental office to avoid having to pay benefits. There are so many jobs that just ever so coincidentally work out to 34 hours per week :/

    4 votes
    1. skybrian
      Link Parent
      I'm not sure that part-time is always bad. Nowadays it's common to have couples where both people work. But a well-paying part-time job might work out pretty well for some families, when the...

      I'm not sure that part-time is always bad. Nowadays it's common to have couples where both people work. But a well-paying part-time job might work out pretty well for some families, when the spouse can get healthcare for the family?

      Also, from the article, it sounds like it would be pretty physically demanding to work full time?

      And it sounds like being part-time isn't new, but maybe there are fewer people nowadays where this sort of arrangement works for them.

      5 votes
    2. R3qn65
      Link Parent
      I'm certain that this is true in some offices, but it doesn't make much sense for offices desperately trying to hire new hygenicists for the business to remain viable. (And honestly doesn't really...

      Since there's such a huge market demand, the "part time" status (for a significant percentage at least) is likely a deliberate policy by the dental office to avoid having to pay benefits. There are so many jobs that just ever so coincidentally work out to 34 hours per week :/

      I'm certain that this is true in some offices, but it doesn't make much sense for offices desperately trying to hire new hygenicists for the business to remain viable. (And honestly doesn't really make sense in a market for which there's a demand for hygienicists.) For example, one dentist was quoted as saying that he's started having to try to hire assistant dentists to do hygiene work. There's just no way that would be the choice over offering full-time hours and benefits to a hygenicist.

      The 34 hours a week thing is more for like fast food jobs where the supply of workers outstrips the demand.

      3 votes