On May 5th an article was published called “The real deal about dental hygienists.” Linda Ma, a dentist in Arizona, had the courage to email the author and explained how she felt about hygienists. One statement Ma made was that if a hygienist’s patients don’t show up for appointments it is because they did not build their own customer base and that any hygienist can pick up the phone and call patients.
In many offices the office manager and/or receptionists will not allow a hygienist to do this even if a hygienist offers to help to prevent openings in the hygiene schedule. The front desk does not want the dentist to know they are not confirming appointments so they tell the hygienist they can get it done even if a hygienist offers to help. Linda Ma DMD also blamed the hygienists for having poor financial management if they were unable to pay their bills due to hygiene patients not showing up and being told to clock out by the dentist.
Dr. Ma agreed to answer questions sent through email for a story about her on Examiner. She was born in Pennsylvania and her parents were Vietnamese refugees and came to the United States with no money. Ma said that all of her schooling was in Philadelphia. If she wasn’t a dentist she said she would be working in finance or interior design. She and her husband have a practice together in Tempe, Arizona. Ma wrote that she had student loan debt and invested 20 years of her life and money in dentistry and said that none of the team members had done that.
Dental hygienists in the United States usually have invested at least three years in going to college to become hygienists (unless they live in Alabama). Many hygienists graduate from a dental hygiene program with a large amount of student loan debt to pay back. Dental assistants usually attend dental assisting school now and most are also in debt when they leave assisting programs. Many office managers have bachelor’s degrees which come with a large amount of student loan debt to pay back starting six months after they graduate. Linda Ma may not being hiring personnel strapped with student loan debt but most young hygienists, dental assistants and baccalaureate degree holders have debt to pay back after school. There are many hygienists, assistants and front desk staff who also say they feel they have invested years into a practice and into dentistry even though Linda Ma may not be hearing that from her staff.
Here are the questions Dentist Ma answered:
1. Where were you born and where did you grow up?
I was born at Penn State College, Pennsylvania and I was raised in Philadelphia. My parents were Vietnamese refugees from the Vietnam war.
2. What did your parents do for a living and do you have brothers and sisters?
My father was a teacher and sold real estate on the side and my mom was a housewife. I have one younger brother and one younger sister.
3. Do you have children and pets?
I have a four-year-old daughter and two dogs.
4. Where did you go to high school, college and dental school?
I went to Central high school, Temple University, and Temple School of Dentistry. All in Philadelphia.
5. How long have you been a dentist?
I graduated dental school in 2004 so I’ve been a dentist for 11 years
6. Do you have your own office or do you work for a corporation that owns many dental offices?
I have my own office which I share with my husband. Our office is called Smile Innovations.
7. If you had not gone to dental school and become a dentist what job would you want to do aside from being a dentist?
A career in finance or interior designer.
8. Do you have a hygienist?
9. What kinds of benefits does the hygienist have in your office? (retirement plan, healthcare insurance, paid continuing education etc.)
We currently do not have any benefits for our staff besides free dental care. I personally train my team.
10. How many employees work at your dental office and what jobs do they do?
We have three employees, front office, assistant, and a floater. We are still working on our team. Everyone shares responsibility.
11.If your hygienist is bringing in clients does the hygienist take them when they leave, or even get a bonus on that production?
No, I asked my hygienist if she would like to be paid on production and she does not want to be paid that way. I have given all my hygienists the opportunity to be better and all of them have chosen to give me an excuse on why they can’t. I tracked all my patients because I do all the marketing so I know where the patients are coming from. The hygienists do not bring in patients but they help contribute to lose patients. I had a consultant run hygiene’s numbers, and less than 3% follow-up for 3 month re-calls for scaling and root planing, not to mention that most of her patients were prophies when stats says that more than 50% of people have periodontal disease, and only 3% was treated at my office.
12. Do you clock in and out for patients, only collecting a paycheck for the hours you have patients?
My husband and I pay ourselves a $52,000 salary, which is way below what we pay our hygienist. We do not clock in and out but I can say that I have spent over 80 hours on my practice a week, invested over 20 yrs of my life and money, which none of my team members do. Both my husband and I graduated with a $250,000 student loan each, so between the two of us that is $500,000 in expenses which the hygienist does not share with me.
13. Who is to maintain the dental hygiene instruments and room if your hygienist is not paid for this?
Everyone in my office helps the hygienist maintain her hygiene room including myself.
14. Do assistants and front desk personnel clock out if there are no patients in the office?
No staff members clock out when there are no patients, but when the hygienist doesn’t have a patient I expect her to call her patients to make sure her schedule is booked for the following days. She also clocks in a half an hour earlier to prepare for her day. And she does get paid for all those hours. When we go on vacation the office is still open, I give the hygienist the opportunity to open her own schedule
15. Which staff position creates production?
Every team member creates production. The top producing production is the dentist the second is a hygienist and everyone is expected to help promote Invisalign, whitenings, toothbrushes, Botox and laser dentistry. Hygienists are very entitled, and other team members resent them. I have had about 4 hygienist in the last ten years, and I from my perspective, they only help themselves, not their patients or their team members.
16. Where have you gone on vacation?
I have been to many countries; Thailand, Vietnam, Japan, Indonesia, Germany, France, Mexico and Canada. Most major US cities; Seattle, San Francisco, San Jose, Orange County, Los Angeles, Las Vegas, Salt Lake City, Colorado, Houston, Austin, Dallas, New Orleans, Miami, Orlando, Charlotte, Washington DC, New York City, Boston, Atlantic City, St.Louis, Chicago, Trenton and probably a few more cities that I don’t remember their names of.
17. What kind of car do you drive?
I drive a 2001 RX 300 Lexus.
18. What is your favorite thing about doing dentistry?
People, when they have a great result. I enjoy training my team and educating my patients to become better. Our goal is for patients to look good,feel good,and be healthy.
19. What is your least favorite thing about working in dentistry?
People. Well actually management, when team members don’t take responsibility or when patients don’t take responsibility.
20. Do you have a fish tank in your office?
I do not have a fish tank but I do have a waterfall that I designed into my office that goes from ceiling to floor.
21. What do you do for fun when you are not working as a dentist?
I like baking and decorating. Shopping is another fun thing for me. But my favorite by far is spending time with my daughter.
22. Do you go to church?
No but I am Buddhist. I practice karma. I try to be fair with my team and my patients.
23. Have you ever been to Wisconsin or Illinois? If you have been to either state tell me about it.
I have been in Chicago and in Champaign, Illinois. One of my good friends is the head chef to popular restaurant in Chicago. I visited Millennium Park, Navy pier, the Magnificent Mile. I’m a fan of the deep dish pizza. I am a vegetarian so I didn’t try the popular Chicago dogs. I have been to the food festival and went on an architectural tour. Chicago is one of my favorite cities.
24. Have you heard of Vermin Supreme? He is running for President on a mandatory tooth brushing platform and a free pony for all Americans. What do you think about that?
I don’t really watch TV or pay attention to the news because I focus more on reading and surrounding myself with people but I did Google him and watched his video. I feel that the media these days are more negative than informative, and I choose not to participate. I do not involve myself with drama or gossip. Whatever I can contribute to the world is more important to me then listening to other people’s judgments and complaints. I try my best to create a positive atmosphere and help those that need my help.
25. What would you think if your office joined a Union?
What kind of union would we join? In Philadelphia there are labor unions and these unions were created for equal opportunity but the result was not equal opportunity. It is like communism in Vietnam where the poor took from the rich so the power was exchanged and nothing changed. The injustice was reversed. Nothing was fair. Hence why my parents fled Vietnam. They lost everything because they were educated and they came to the U.S. penniless. I am grateful for everything I have, and strive to be a better person daily. I try not to complain, and be as compassionate human. I would not join a union, but I can educate people to change and help other and better themselves.
I tell my staff the grass isn’t greener on the other side. Stop looking at someone else’s grass and water and care for your own grass and then you’ll have your own green grass. – Linda Ma DMD May 12, 2015
Linda Ma sent some correspondence to the author that she had received after her email was posted at the bottom of the article “The real deal about dental hygienists.” Here is what she sent to the author:
“From Chris Crannie Zimmerman
Hello Dr Ma, I noticed your response to an article on hygienists clocking out when patients cancelled. I appreciate your response but really wanted to share another perspective. I have been a hygienist for 23 years and now I am the practice manager of an office that had very low morale.
The environment was toxic and everyone was so discouraged. Our boss pays very well, pays bonuses for monthly goals and offers a nice benefit package. The team was battling negativity for feeling unappreciated and my boss was frustrated. I slowly changed things around, but still working on things. We had a few people we had to let go because they were very negative. We have met goal 7 of the 9 months I have been there. It is proven the most productive employees are happy employees.
You stated that hygienists blame the dentist when patients cancel and that isn’t the case. There are times when patients cancel and there has to be a strong policy in place with proper verbiage to try to prevent cancellations and place value on appointments. It isn’t anyone’s “fault” but everyone needs to work together to keep the schedule full and when there is down time. Everyone should pull together to keep the schedule full. As a former hygienist, it was nice to have occasional down time to sharpen instruments, stock, clean and work on reactivation lists. The biggest thing is team work. I don’t feel any employer should pay staff to sit around and do nothing but if they are willing to work then by all means they should be paid their agreed upon wage to do so.
I’ve done this for many years and I have worked in a lot of different environments and I feel strongly that if dentists can grasp this they will change the dental field back into the wonderful career field it used to be. Place value in your team, respect them and they will help you achieve the success that you desire. Statistics show that patients trust the front office staff overall and next is the hygienists and then assistants and lastly the dentist (they love you but still feel you are out for their money) so build that team that has unquestionable faith and respect in their boss and that will carry over to the patients.
I am passionate about the dental field and about helping dental practices become the best place they can be, where the dentists trust their staff and the team loves to come to work. I hope you receive this with the encouragement and hope that it is sent with. Not many can afford to have their wage cut daily because of cancellations of patients. I wish you well in your practice it looks like you have a beautiful practice. Best of wishes and if I could help in any way I would be happy to Smiling face with smiling eyes
Dr. Linda Ma’s response:
I agree with you on team work, but the article didn’t discuss team work or responsibility and accountability. From my perspective as a dentist, I treat everyone well. I know my patients, love and care for them. I have practiced for over ten years and see how many hygienist do not impact their patients lives, therefore they have no patients. Cancellations can be minimized, and if no one on the team takes responsibility, then yes, there will be no patients. When my husband and I started our practice, our hygiene schedule was full, and as we handed off our patients to the hygiene department, we had less patients. When we speak about negativity, hygienist are equally as negative and non productive. Most dentist are not brave enough to fire those hygienist and staff members who do not contribute to their and their patients lives. If the hygienist feels the situation is unfair, there are plenty of fair jobs for them if they are willing to work hard and follow their passion like yourself. Each individual creates their own destiny. I feel that the article didn’t give insight to how many hygienist do not play fair on the team, and have an expectation or entitlement attitude. For example, the blog stated how dentists go on vacation and doesn’t pay the team. She forgot to mention that the dentist doesn’t get paid either, and has made every Investment in their solo practice. The hygienist can pay for her own vacation making $60,000 plus a year. Or the fact that her $40 per hour is not enough when you have more than 2 cancellations in a day, which makes her pay $53.33/hr. How about how she complained about being subcontracted or commission based. If you are commission based and hit your goals, you should make more money and become a value to the office. I think what should be published is how many hygienist don’t hit their goals and how they don’t affect their patients lives and how truly valuable they are to the dental office, not how horrible it is to be a dental hygienist working for a solo practitioner with no management experience. The whole article was pretty negative, and I feel that it gives more fire for dentists and patients not to appreciate the hygienist. We always love our hygienist, but when the hygienist has a bad attitude, I do not expect the dentist she works for or the patients she sees will value her.
I couldn’t agree more. One of the staff we let go was a hygienist that had a horrible attitude and spoke negatively to the patients about the dentist. Patients liked her because she was full of drama but didn’t diagnose perio and most of her patients ended up needing RPS. I had a lot of spoiled staff members that got upset with the dentist because he would roll his eyes out of frustration. Getting rid of two negative Nellies- changed the team. Thank you for responding and I do feel a lot of dentists get a bad rap for lazy entitled staff. Again I wish you well! Sounds like you have a great outlook for your practice. Smiling face with open mouth and smiling eyes
Sent from my iPhone”
Author’s response to Dentist Ma after seeing this email:
“Thanks for sharing this. How are you doing on the questions I sent to you?
I do agree that some hygienists ask some weird questions and make patients very uncomfortable. Some hygienists don’t talk to patients at all. I was temping at an office where the hygienist would have made me uncomfortable as a patient. We could hear her in the next room grilling the patient about why she didn’t like her job etc. It was uncomfortable for me and the patient I had in my chair at the time felt uncomfortable listening to it as well. The receptionist at that office was very domineering and hard to get along with making it a deadly duo for any other hygienist coming in and probably many of their patients. The receptionist alone would make me look elsewhere for a dental practice if I was a patient there. The hygienist was nicer but was under pressure to talk with patients so she asked them extremely personal questions that everyone could hear. Then there are the hygienists who are like some hair stylists. They talk to other staff members during the patient’s appointment but not to the patient very much. I may do a story on hygienists I have run across while temping and how that would make a patient uncomfortable in the future. Thanks for the ideas.
I may share this in the story I do about you.
This is the email Linda Ma DMD sent to Ann Day about her article “The real deal about dental hygienists” that resulted in the article above :
“I was unable to post this response to your article Hi, I am Dr Linda Ma DMD from Arizona, and I do not agree with your article. Dental hygienist who don’t have a full schedule is because they do not build their own customer base, and depend on everyone else. They are the highest paid in the office besides the dentist, and expect to get paid for not keeping their patients. When a dentist owner has a failed appointment, he does not get paid, plus he has to pay for everyone else and then more aka; insurance, rent, supplies, utilities. Hygiene patients are supposed to be on a 6month schedule and if the hygiene does not have a solid schedule, it is not the dentist’s fault. Any hygienist can pick up the phone and call their patient. Hygiene can also promote themselves in the office through word of mouth. There are openings because the hygiene does not promote dental health or a commitment. If the hygienist has financial problems, it is not due to the dentist, it is due to their lack of poor financial management. Hygiene’s role is to help the doctor and patients. I have yet seen in this article where hygiene appreciates the doctor or their patients.” -email@example.com
Dentist Linda Ma shared her viewpoints about hygienists in that she thinks hygienists feel “entitled” which may be true for many dentists in the United States. Many hygienists say they feel their pay is being cut any which way possible by dentists. The email Dentist Ma shared from a hygienist who is now the office manager is interesting because the author named Cris Crannie Zimmerman never stated why she stopped working as a dental hygienist and is now an office manager. It might be for some of the same reasons that were listed in the story “The real deal about dental hygienists.” It would be interesting to hear from Cris Crannie Zimmerman the real reasons she started being an office manager instead of a hygienist. If any of Dentist Linda Ma’s past four dental hygienists care to give their take on Ma’s statements of hygienists being entitled or why they left her practice please contact the author using the email button above. Many hygienists are interested in hearing about that.
Update 5/13/15 Author was contacted by Cris Crannie Zimmerman. Here is what she sent:
I am responding since Dr Ma chose to post the private message that I sent to her. I chose to keep it between her and I, out of respect for my fellow hygienists and for Dr Ma. Since Dr Ma chose to put my private message out there . I feel I need to say a few things for the rest of your readers. I’m thankful one of my wonderful fellow hygienists that knows me from a hygiene page, let me know my private message was on here. So feel free to post this in response. I would have done it directly on the article but I apparently set up an account at some time and don’t know my password.
Firstly, to the one that attempted to question me about doing my job as an office manager “by allowing a hygienist to get by without diagnosing perio.” Apparently she missed that I said I hired in and got rid of a few people. Obviously, I had to work there long enough to see that this was going on and she was gone within 2 months of my hire date. (This was one of the reasons I private messaged for that hygienists sake.)
Secondly, I belong to a hygiene site on Facebook that stays clear of hygienists like her. That is, hygienists that jump to negative conclusions and attack each other as if I wasn’t doing my job. This leads me to the question you asked me about why I stopped doing hygiene. The thought process that started me in that direction was herniated discs in my neck. I love dentistry though and it’s all I have ever known or wanted to do since I was in the 6th grade. I started thinking about how things have changed so much since I first started in dentistry. I loved my patients and did all that could to provide the optimum standard of care and most of them became like family to me. Things in dentistry have changed a lot. Hygienists, like the one mentioned above, began attacking each other for whatever reasons instead of coming alongside and being team players. I’m not sure if it became a competition with others or that they felt they were better?
I tried to do all that I could with the team at the office I work for to try to help each of them change their perspective so that they could become the team we needed. I implemented a perio program to make sure patients were being properly diagnosed. Out of 10 girls, two chose different paths. I’m passionate about making the office a better work environment for the staff, patients and dentists. I have found that some dentists are receptive to it while others may have to find out the hard way. That has been the same with the staff.
As I told Dr Ma, it’s proven that the most productive employees are happy ones. We have one incredible team where I currently work, and I can’t tell you how much It brings my heart joy to know that I have helped this to happen. The staff and the Dr. tell me often that I have made such a huge difference. We have made bonus 8 out of 9 months that I have been there ( this month being our largest yet). My heart is to be able to do this in many practices. My goal is to go into dental office coaching.”. – Cris Crannie Zimmerman 5/13/15