The Dental Hygienist Shortage: What Hygienists Want, Why They Leave, and What to Do About It

By LeAnna McClendon Chevernak, Blue Sea Dental Director of Hygiene

The Dental Hygiene job market has a new normal

As we all know, the COVID pandemic created a shortage of Dental Hygienists that has transformed hiring and retention strategies for dental practices.

Dental Hygiene is now a seller’s market where buyers compete aggressively for a very limited pool of talent. To attract the best candidates, practices are offering higher salaries, better benefits, and even sign-on bonuses. For the Hygienist who is not entirely satisfied in their current position, the siren song of these new incentives could make them consider a move. For those who are satisfied, thinking they aren’t receiving fair pay, benefits, and bonuses compared to newer staff could drive them to seek a new position.

It is very likely that these relatively new labor market conditions are here to stay, at least for the foreseeable future. Any dental office or group that wants to maintain a strong Hygiene department needs a strategy for hiring, developing, and retaining good Dental Hygienists.

For our group, the strategy begins with understanding why some Hygienists leave the field and why others stay. Our group understands that compensation is only one element of creating a work environment that will attract and retain the best Dental Hygienists.

Even before the pandemic, dental hygiene had a high burnout rate

Dental Hygiene has always had a high burn-out rate. The average Hygienist spends only seven years in practice. Some reasons:

1. Many Dental Hygienists go into the field unaware of and unprepared for the physical and emotional demands of the job.  Prospective Hygienists observe only experienced Hygienists – who make a difficult job look easy. Attracted to the field by the high pay and flexible hours, many are unpleasantly surprised at the reality of day-to-day practice.
2. Dental Hygiene is extremely hard on the back, neck, arms, and hands. The repetitive, precise movements required take a heavy toll on the body even though they don’t appear strenuous.
3. Dealing with anxious or difficult patients is emotionally draining. Many Hygienists become burned out by the mental and emotional toll the job takes on them.
4. The Hygiene role is frequently undervalued by patients, colleagues, and even sometimes dentists.

Why did so many Hygienists leave dentistry during the pandemic?

Everyone in dentistry knows that a substantial number of hygienists left dentistry during COVID. What we don’t know is where they went. And why. I don’t have all the answers but here are some scenarios that played out based on my personal connections in the field:

1. Older Hygienists decided to retire during COVID. Considering the burn-out factors of the job and COVID’s greater danger to older people this is not surprising.
2. With no childcare and schools operating remotely during COVID, some Hygienists with young and school-aged children decided to just stay home with their children. Because these parents often worked only part-time, income was not as much of a motivating factor for returning to work.
3. Some Hygienists left clinical practice for teaching.
4. The work at home bandwagon appealed so strongly to some hygienists that they found jobs outside of dentistry that allow remote work.

Some good news: for some Hygienists, COVID renewed their passion for dentistry

Although some people burn out on Dental Hygiene, others stick with it, sometimes for decades. What differentiates the ones who stay from the ones who burn out?

1. They develop self-care habits to manage the mental and physical strains that lead to burn out.
2. They love working with people.
3. They love the hands-on nature of Dental Hygiene
4. They are passionate about oral health.
5. They know they are on the front line of overall health.

Hygienists with this mindset recognized that in a post-COVID world, their work is more important than ever. Because of the link between oral health and heart health, they understood their role in protecting their patients from serious COVID complications by helping protect their heart health. They returned to practice with renewed commitment to being on the front line of good overall health.

What do Hygienists want you to understand?

The dental practice can’t prevent the physical strain of being a Hygienist. It can’t prevent the emotional strain of difficult or anxious patients. Those are part of the job and it’s on the Hygienist to learn to deal with them. But there are attitudes and behaviors that lead to burn-out that the practice can control.

1. Dental Hygienists get very frustrated when there is no understanding of and appreciation for their training and expertise. It is bad enough that so many patients have no idea that the Hygienist has specialized training, education, and expertise about oral health. When we face that role undervaluation from our co-workers, and sometimes even from the dentist, some resentment is inevitable.
2. A good Hygienist is passionate about health care and their role in helping patients have not just good oral health but overall health. They view themselves as a health care provider. The Hygienist is often the one who spots the first signs of more serious conditions that originate in the mouth. For a Hygienist with this mindset, it is difficult to stay in a practice where they are viewed as a little more than a tooth polisher.
3. Too often dentists ignore the observations and recommendations of the Hygienist. The ideal situation is one in which the Dentist and Hygienist work together with a spirit of mutual respect and appreciation. A practice with that approach rarely has a turnover problem with its Dental Hygiene team.
4. Hygienists are frequently not recognized as revenue-producers. Unlike other roles that support the dentist and add to production costs, the Hygienist provides directly billable services. If Hygienists are asked to clock out if there is a no show or hears whispers from coworkers that they get paid for “standing around doing nothing†they know they are not recognized as a provider.

How to cultivate and maintain a Hygiene-friendly practice

Our dental group was very fortunate because nearly all our Hygienists returned to work after the COVID shutdown. In fact, most of them are still working with us today. For this enviable situation, we credit our group’s approach to managing Hygiene. The following are ways in which our group maintains a Hygiene-Friendly practice model.

1. Our Hygiene Director (me) is an experienced Hygienist. I work closely with the Hygienists at our offices to make sure they have what they need to excel in their job. As “one of them†I represent our Hygiene teams to leadership with the perspective of someone who fully understands their role, its challenges, and their concerns.
2. Leadership seeks out and listens to the Hygiene Team’s input. As we prepared to return to the office after the COVID shutdown, our Hygienists worried about COVID exposure via aerosols. Several were afraid to come back to work. Leadership was open to our ideas about how to ensure team and patient safety. Based on our input and without any hesitation or push back, the group made a significant financial outlay for extra oral aerosol suction machines in all locations.
3. We provide the tools Hygienists need to provide superior treatment. Our group does not skimp on materials or supplies. Instruments are kept in good condition. Requests for materials and supplies are not questioned or denied. During the pandemic, our group made sure appropriate PPE was readily available and in good supply.
4. We offer professional development opportunities. We bring speakers in, sponsor attendance at industry events and conventions, and do internal training.  Our Hygienists aren’t just told to exceed patient expectations, they are given the tools to do so. We believe investing in individual team members is the best insurance we have against losing them to a competitor.
5. We recognize Hygienists as highly trained health care providers who bring revenue to the practice. Their observations and opinions are valued and appreciated by the dentists. They have a high degree of autonomy in their practice.
6. In our dental group, all roles are important, all individual contributions are valuable, and all team members are expected to treat each other with respect and consideration. This applies to team members at every level.
7. With that basis of mutual respect, we cultivate a positive work environment. We value having fun at work and celebrating whenever we can. Like any other group, we encounter bumps along the way, but we work together to maintain a happy workplace.
8. We offer competitive compensation, but we also know it’s not all about the money. In addition to professional development, team fun activities, and quality materials and equipment, we offer a benefits package and other “extras†that we believe are superior to most of our competitors.
9. We keep an eye on the other side of the fence. We are interested in what our competitors are offering, how they treat their teams, and how we compare. We want to avoid losing a valuable team member because the grass looked greener elsewhere.

Our group is growing so we know that we will have an ongoing need to recruit Hygienists. We are ready to meet the challenge. We will continue to listen to our current Hygiene team, adjust and adapt to changing market conditions, and most importantly, offer a professional environment where we hope a Dental Hygienist can thrive.