continued from pg. 24
do their diligence and get a hygiene degree. My
question is who empowered assistants to make
job decisions that affect their coworkers without
management being involved? This brings me to
the second problem of definitive job descriptions.
Every staff member should have a job description. And yes, someone has to be in charge of
laundry, just like someone has to be in charge of
managing the schedule or collecting money. If
management decides that hygienists will be paid
on straight commission, laundry is not one of
their duties. It is a peripheral task not related to
direct patient care. Sterilization is a necessary
part of patient care, but it is peripheral to direct
patient care. Setting up trays in advance increases
office efficiency, but it is not part of direct patient
care. All these tasks have to be part of someone’s
The whole idea of commission-based pay for
hygienists is primarily so that dentists don’t have
to compensate hygienists when they don’t have
a patient in the chair. Hygienists working on
straight commission are not being paid to do
anything outside of direct chairside duties.
Sometimes, assistants (who are typically paid
hourly) do not understand that concept. Management can’t “have their cake and eat it too,” which
is the case when they expect straight commissioned hygienists to perform peripheral duties. It
is simply not legal to expect people to perform
work with no expectation of compensation.
However, just to show you how people think,
I was once approached by a hygienist who related
to me that she was being paid by straight commission. She further stated that she did not feel
she should be asked to perform periodontal charting, because it was not something she could bill
separately. What?! I told her that periodontal
charting is a part of direct patient care, and even
though she cannot “unbundle” that task, it is her
job to see that it gets done. It is just as important,
if not more so, than scraping calculus off teeth.
The third problem is related to OSHA stan-
dards. Laundry is one of those subjects that seem
to generate lots of opinions. For information, I
consulted my friend and colleague, Noel Kelsch,
RDHAP, who writes the infection control column
for RDH magazine. According to Noel, scrubs
function as a uniform and are supposed to be
covered by a lab jacket or gown that covers the
wrists, neck, and knees. Lab jackets and gowns
are PPE and are required to be furnished and
laundered by the employer. Dental personnel that
do not wear lab jackets or gowns are exposing
their arms and lap area to aerosols from a variety
of sources. No jacket or gown means no PPE,
which means the employer is in violation of the
blood-borne pathogens standard by having em-
ployees launder exposed garments on their own.
If your jacket does not cover your knees, your
employer should not require you to launder your
own garments. (See PPE requirements at osha.
gov and search “PPE general requirements
1910.132. Also, search Blood Borne Pathogens
As you might guess, straight commission is
not my favorite way for compensating hygienists
for many reasons. First, I believe straight commission creates a temptation to upcode or inflate
treatment that a few hygienists will act upon in
order to increase production. Second, it is inevitable that on some days the schedule will fall
apart, and the hygienist will see very little take-home pay. That’s definitely a downer for a hygienist
with bills to pay. Third, the team concept will
suffer, which is precisely what is happening in
your office. As jealousy builds, the office work
environment can become toxic. The solution is
clear job descriptions and firm leadership.
It would not be difficult for your office to figure
out a fair and equitable base plus commission for
hygienists. That way, hygienists can be paid to
help out with the myriad of peripheral duties
without compromising their commission.
In an office as large as yours, I recommend the
position of office administrator (OA). This person
should be in charge of making sure that everyone
has a clear job description. The OA would also
be in charge of human resources and ensure that
no labor violations are occurring. A good OA will
handle disputes like this with a generous helping
of tact, fairness, and respect for all parties.
All the best,
continued from pg. 34
improved optical clarity and headlamps with an
edge-to-edge uniform lighting option. Beware of
companies that claim superior optics and lighting
for bargain-basement pricing.
Other things to consider are the size of your
head, the position of your ears, the shape of your
nose, and the length of your eyelashes. Your frame
selection should fit your head size. A small frame
will not work for a large male head, and conversely,
a large frame will not fit a user with a small face.
Most people’s ears are not positioned at the same
height on their head. Adjustable temple arms
allow the loupes to be custom fitted to ear height,
which results in a view through the optical center
of the oculars. Adjustable nose pads not only
improve comfort, but help keep the loupes posi-
tioned correctly on your nose and increase the
distance between the optics and the tips of the
eyelashes. Those with long lashes know how an-
noying it is to clean mascara streaks off the oculars
Headlights have become increasingly popular.
Many clinicians feel their headlight is more important than magnification. Like any other commodity, headlights are all over the place, and the
internet is full of sites that sell cheap headlights.
I purchased one just for the sake of comparison.
Don’t waste your money. It would be just as effective to duct-tape a mini flashlight from a dollar
store to your eyewear. Serious headlights are not
cheap and are available either cordless or with a
cable that attaches to a battery pack. There are
advantages to both designs.
Three key features to consider are the brightness, color, and clarity of the spot; the power
system; and the electrical safety of the charging
system. Look for a clean, even spot. Fuzzy spotlights can lead to eye fatigue. High-end headlights
have spots that are blue-light compliant, and
come with charging systems that follow Underwriters’ Laboratories safety standards.
When it comes to alternative or saddle seating,
“butt testing” should be your deciding factor. What
works for your work buddy who’s as thin as a
toothpick may not work for you. It’s not a matter
of right or wrong; it is simply a matter of what seat
pan design, tilt adjustment, and cylinder height
will keep your spine comfortable in a neutral
position. As much as I would love to embrace all
saddle styles, only one configuration works well
for my torso. Before you shell out the dollars for
a seating option, make a plan. You can try a colleague’s saddle, ask a dealer to bring in different
styles, or if you have the opportunity, try different
styles at a convention. Padding or foam are also
a personal preference.
Gloves and uniforms that fit correctly are important. Most of us have encountered situations
where we’ve had to wear the wrong glove. If you’re
like me, my focus shifts away from providing clinical care when my gloves aren’t comfortable.
Gloves are a barrier and need to fit like a second