The Hygiene Shortage

Transcript performed by A.I. Please excuse the typos.

00:00
looks like for dental hygiene enrollment there was a dip, a significant dip in 2020, there was a significant dip in 2022. The hygiene wages have gone up dramatically over the last five years.

00:16
This is Dental All-Stars, where we bring you the best in dentistry on marketing, management and training.

00:24
Welcome to Dental All Stars. I’m Alex Nottingham, founder and CEO of All Star Dental Academy. And with me is Rachel Wall, the president, the founder, the consultant extraordinaire of hygiene, inspired hygiene. Cause we’re thinking I have hygiene on my brain. Cause we’re to talk about hygiene shortage. Is it real? So we have inspired hygiene’s Rachel Wall. Welcome. Thank you. Thank you for having me again. Yeah. It’s good to be back. Yes. You’re.

00:52
You’re a staple of All-Straight General Academy. Thank you. We love you and what you stand for and your company-inspired hygiene. this is a big issue. Shortages. I hear so often, I don’t have a hygienist, I can’t find a hygienist. We have a hiring service at All-Straight General Academy. And that’s probably our biggest request is help me find hygiene. And we find every position in the office, but hygiene is the toughest to find.

01:22
Um, the golden goose, whatever, uh, out there. So what is going on with, with hygiene and just to kind of set the tone here, uh, we’re just gonna have a discussion and talk about what we think is going on. I know you have some numbers, but there’s a lot happening, uh, with respect to that. So give me a bit of a, of a background that this let’s just talk about it. What’s going on, man.

01:51
So this has been a challenge for the dental industry, you know, for the last five years. I think that the pandemic actually brought this to a head, brought a lot of things to a head, right? It just amplified, you know, it amplified in dental practices where there was great communication. The communication just got better for the most part. You know, you probably remember we had practices where the dentist was like giving, you know, every other day was an update.

02:21
to the team, like, here’s what’s going on. And they were all pitching in together. And in practices where the communication was very poor, it was almost non-existent. You know, the door’s shut, nobody heard from anybody. It’s like, do I still have a job? What’s going on? So there were, during that time, a number of dental professionals that retired that left the industry. There were some that left for a while and then came back once they felt like the environment was, you know, one that they wanted to be a part of again.

02:50
And what we’ve seen in talking to, you know, practices all over the country is that the good news is that there are a lot of practices that have a very stable hygiene department, despite maybe some turnover and shake up over the last few years. Things are in a lot of practices are seeming to stabilize, but they’ve had real challenge and we’ll share, know, Alex, you chime in, but

03:20
just want to share some observations of what we’re seeing around this. And also, as we know, because of supply and demand, the hygiene wages have gone up dramatically over the last five years. And some of that needed to be reset. of those, know, that increase was necessary and was something that was long overdue. Some of it has gotten to an extreme level. And hey, I’m all about if the value is there,

03:49
then the compensation should be there to match it. And so I think the conversation a lot of times where it gets a little sticky on all sides of the table, all right with the dental professionals, is the value that’s being delivered by the individual and by the practice to the team. Is it matching the compensation or is it an even trade-off? So a lot to kind of unpack there.

04:18
I don’t know, where do you wanna start, Alex? Well, I always have to start with the problem, right? And kind of what we’re seeing. So we know it’s a problem. I mean, and just kind of illustrating what the issue is, what’s also making it worse. I mean, I have a lot of dentists that are, they’re doing their own hygiene because they can’t find a hygienist. And so I think the question we were considering is, is it real?

04:45
That is our hygiene shortage. the statistics bear that there is. So we can, you can share some statistics in a moment. And then the other issue is what can we do about it? How can we mitigate it? Because of the other area that you were talking about, we’re both talking about is office culture and, and training. It helps, right? That will be one, one area we can talk about. It doesn’t mean it’s your

05:13
only solution, because I have a practice that’s just in a really bad location. And she’s amazing and she invests in her team, but just can’t get a hygienist that wants to live there. That’s another situation. let’s start then first with the data. What is some of the data that you see? Again, it’s not all encompassing, but it’s interesting to start. my source for the data is CODA, which is the committee on dental accreditation. So this is the committee that

05:42
that gives accreditation to dental schools and dental auxiliary schools. And so you’re gonna link to this in the show notes for anybody that wants to go and peruse that. There’s a lot of data there. It looks like for dental hygiene enrollment, there was a dip, a significant dip in 2020. There was a significant dip in 2022. The good news is it looks like it’s increasing. There are some dental hygiene programs that have

06:12
increased seats, we’ll say, for lack of better term, in the program. I know there are some dentists that are doing some grassroots efforts to expand or add additional hygiene schools in some states. And there are lot of different solutions flying around. So I would encourage dig into some of that COTA data. Look at some of the ADA Health Policy Institute data as well on hiring.

06:41
Um, it does look like, uh, the, respondents are saying it’s slightly less difficult to hire hygienists than it was about a year ago. So that’s good news. Um, and then I would say also, you know, things like the dental post, um, you know, salary survey, uh, we saw that in over the last couple of years, it says a third of dental hygienists are planning to retire in the next six years. So that’s frustrating. Now what I don’t know.

07:10
is do we have the same number of licensed hygienists as we had before? But what I’m observing is a lot of hygienists are working fewer hours than they did prior to the pandemic. So if they were working four days, maybe they’re working three days now. The other thing I will say is, when I graduated dental hygiene school in 1991, you either worked clinically or you taught. There really were not a lot of other options.

07:38
It was very rare to have hygienists in other options unless it was public health, which I consider clinical. But now, you know, we, I was just talking with the director of sales for Vivartis and he’s like, yeah, we’ve hired, I don’t know how many, 15 sales, you know, associates and a good number of those are hygienists. You know, there are hygienists that are doing any number of things in and out of the industry from remote, you know,

08:06
administrative services to teaching, to consulting, like all of these different things are a lot more opportunities for hygienists outside of the clinical realm now than they were in the past. Which means to me to satisfy the clinical need, you need to graduate more hygienists. The other thing that’s happening is increased popularity of the Dental Compact Act, which is a compact

08:35
you’re an attorney, you can explain this better than I can. But essentially, it’s a compact that multiple states join. And the states, if they get enough states in there, which I think they’re up to 15 now, that this compact can become a reality where hygienists wouldn’t have to be licensed individually in every state. They could move from one state to another of those states that are in that compact. And so I think that’s going to create

09:03
flexibility for hygienists. Hopefully it increases the recruiting pool for dental practices. I would think that would be the case. And then the other thing that’s happening that I’m not crazy about, but hey, dentists are business owners and business owners are going to find solutions to their business problems. And so I do believe that there are some states that are considering changing licensing requirements for hygienists.

09:33
and changing the requirement for high Gens to be graduates of an accredited program. So just keep an eye out for those types of things. mean, there, I don’t know, I think there’s a lot of variables on levels of education in that type of program because the programs that have been in that method in the past really rely heavily on the dentists for the education in the clinical practice. So that’s kind of where we are.

10:01
And then the question is, is there truly a shortage? I will tell you, you know, like you said, anecdotally, we’re talking about this in the pre-show is, we talked to practices all over the country and I know for a fact, many of them have a very healthy culture and they’re having a very difficult time finding hygienists. Even with that, Yeah. So that says that, you know, that’s the control variable, that the fact that those good practices are still having it. Do you find…

10:31
I mean, I don’t if it’s obvious, but that those that have a worse culture are having a harder time than those that do have a better culture. So does culture and training help? Yeah. Oh, absolutely. I believe it does help. But then you’ve got to educate your pool that of what you’re doing. so I would say, um, yes, it helps. I came across this, uh, quote by James clear that I used in a program I taught last week. And it says the world is big, but industries are small.

11:00
And essentially the quality of your work will become known and your reputation is everything. So whether that is a practice that, you know, is, it has a toxic work environment or that is an individual provider that is out there in the community, you know, temping at multiple practices and not bringing their best or, you know, having an attitude that’s not one of teamwork, that’s going to get around.

11:29
And, you know, those things do get around our dental communities and are small. And so, yes, I think absolutely those things impact ability to hire and hire ability. And then I think training and investing in the team and culture absolutely makes a difference. But here’s the thing is potential team members are not just going to know that you’re working on that. And so it would be good for us to talk about some ways that practices can get that message out.

12:00
I like that. Also, I’ve heard that there’s temp agencies with hygiene and that some hygienists prefer that to be involved with the temp agency. So whereas like, cause again, like you said before, there were only two options and there’s multitude of options that they do work less, just temp. I don’t have to deal with the practice and all of that. And they can do where that goes. that’s out there as well. So if, if you were to kind of build.

12:30
Um, you know, a framework to, um, to help, what would you, what will be some of the steps or that would, um, you know, this is, listen, got inspired hygiene, got also dental Academy. What can we do to help, uh, them find a hygienist? Yep. I would say first step is communicate with your team that you currently have. So really sit down and.

12:58
identify what you’re doing well as a practice, why they stay in your practice, what do they love about the culture, what could be improved about the culture and communication so that you’re building a strong foundation for which to bring in new team members. Okay. That makes sense. Yeah. I would say if you have that great culture and you have a really tight knit team, share that. You know, it amazes me still

13:25
You know, in 2025, when I go on to a practice as facial social media or Facebook, and I just see stock images one after another, right? Or there’s no, there’s not been a post. I have come across some, what appear to be very progressive practices and they haven’t posted since 2021. So you, it’s necessary to market for team now as much as it is to market for patients. And I know.

13:53
Yeah, I know that All-Star believes that and you guys have an incredible hiring program and yet, you know, if there’s no, if the practice has no presence in the community from a staffing standpoint, it makes that job a lot harder, right? Yeah, I like what you said. To build on what you’re saying, social media is incredible. I don’t think that social media is like the only way to attract like patients.

14:20
but I think social media can hurt you if you don’t have a presence. Because a lot of people communicate that way and it’s almost like saying we’re not for sale, we’re not open, we’re not taking patients. And also if we’re looking to attract great talent, I mean, that’s at the end of the day what we’re doing. How do we attract great talent? One of them is dental assistants. In the numbers you were showing me, which was really interesting earlier, actually dental assistants were seeing a shortage there too.

14:48
They may not be as difficult of an issue because you can get them accredited quicker or there are ways you can utilize people work around it. But hygiene seems to be more of the problem. I think, so talk about our hiring service. definitely would, because I think what happens is that offices, it’s like anything in a recipe. If you skip a step, it doesn’t work well. so…

15:11
You know, we have to say, are the principles that work? And you follow those principles and it’s hard to stick with principles. is when, when you’re nervous or you’re, that’s great, whatever it is, just try not to have you get in the way, realize your limitations. Like for me, my patience is sometimes an issue. And so I work on, uh, being more patient or having people coach me on that, but it is a weakness. You watch that. So I say like our hiring service is a great tactic and, and.

15:40
One of the barriers to that is, why am gonna pay somebody to help me? I’ll do it myself. Well, is that the best use of your time? Are you most skilled in doing that? Same thing with coaching from our end, right, Rachel, with yourself and our coaches is like, it’s asking for help and putting, look at it about putting a team around you that can help you, right? So I think that’s number one. Or not number one, part of what you’re saying, get your payment order. Now, with that, what we found with our hiring service, and we’re proud of this, that sometimes we don’t even hire.

16:09
the hygienist, they find it from within. So we start the process and we put it out there and they post it on social media, we encourage them, we post it on different job forums, but we also encourage the team. And then sometimes the team knows somebody and they find, somebody just walks in, wanna, that’s fine, we don’t care if we get it, as long as we get the ball moving. We don’t need credit, we just want it done and they’re happy. So the point is that I think what you’re insinuating is

16:38
If we can galvanize our team, they know people. It looks like a place you want to be. And I’ll leave you with this as well as a foundation. You have to pay people enough where money is not an issue. So if you start, uh, trying to negotiate, mean, you don’t want to be strong armed because you need a hygienist, but what the pay is you pay them well. And then you got to be, and then how do you keep them? How did they stay is by having a great culture.

17:07
and so on, but I think it’s a great point on social media. People you want, and again, we’re talking about hygiene, but you want people that wanna be there, and it’s part of something greater than yourself. And so illustrate that by posting photos of maybe you did a give back day as a team, right? You did a free dental day, or you went and volunteered as a team at the food bank.

17:33
You know, you have lunch. was a beautiful day. Like today was a gorgeous day in Charlotte in February and everybody, you know, sitting outside having lunch. Take a picture, show that your team loves to be together and do things. Um, you know, highlight your technology, show that you have current practices and that, you know, when you do training, take pictures, post that when your coach comes in, know, share those things so that you’re illustrating, you’re painting the picture for someone from the outside of what it feels like to be part of your team.

18:03
and then have a specific shout out on your specific post on your social media. We’d love to have someone else join our team. Like we’re looking for a business team member or we’re looking for a hygienist. Like don’t be afraid to post that on social media. You never know. We had a client whose one of their patients niece was a hygienist and wanted to move to the area. And so they hired somebody that way.

18:29
know, have a friend in your work. never know. They share things and things just kind of get out there. So, yes, I think first and foremost, focus on communication relationships and really being willing to have the tough conversation of what what is the team feel is great with the culture and what is not so great and then intentionally work on those things and allow them to see you working on those things. I think.

18:54
Another thing, and we have a document on our website that’s free on inspiredhygiene.com under free resource guide. It’s called 17 tips to attracting a hygienist. So that’s a good guide to have too, is be flexible, be flexible and willing to do job share. So I think we all have to recognize that today in 2025 is different than it was in 2015 or 2020.

19:23
We have to accept the changes that have come in our businesses and our communities, and then just figure out the best way to apply these changes and embrace them. So, you you may not have a five day a week hygienist. You might have two hygienists that are willing to job share and each work two days. And if they both seem like they’re fantastic fit, then why not embrace that? You know, it is absolutely possible to train,

19:52
and empower and have part-time team members that when they’re there, they’re giving 110 % and they are fully supportive of your practice and your, and your processes and philosophy. So I would say be flexible. That’s another one. That’s a really good one. That’s very good. Cause I mean, this is always, you want to take an inventory of yourself. What am I doing where I’m not, I’m creating an unnecessary barrier.

20:20
to be part of the practice, right? And that’s great one. love definitely thinking outside the box. So job share, love it. That’s a good one. And intentional barriers, things that you might not think of, like if you’re not able to work four days, please do not apply. Well, you just, mean, I’ve seen that on ads. So you’ve just eliminated a lot of people. You brought up team members that are working for staffing companies.

20:48
And yes, this is absolutely happening. I have to think that some hygienists, maybe not all of them, but some of them will get tired of that all the time and want to kind of find a home practice, you would hope. However, there likely are, and I actually did this for three years when I worked at the dental school at UNC is I worked as a long-term temporary. And so I was there four days a week, but

21:17
because of, you know, I was in my twenties and I wanted to be able to travel, I would kind of plan my schedule and then I’d take two weeks off. And I didn’t get paid, but for me, at that point in my life, I didn’t have, you know, responsibilities other than my job. And so now we’re seeing that style kind of come to play with some of the staffing companies that are offering benefits, that are offering, you know, the team members are full-time or they are employees, W-2 employees of these staffing agencies.

21:45
And I think that there’s ways that in dentistry, you know, we’re going to have to develop a mindset and ways to work with that and to see that as an advantage and to maybe figure out ways around that because, know, the hygienist has traditionally been such a key piece of the relationships in the practice because they see patients so often and spend so much time there that

22:11
if you can develop a relationship and have a really great place for even some of these, you know, temps to come in that maybe you can develop a long-term relationship and maybe you say, Hey, I respect the fact that you want to have this flexibility. What can we do to have this be a regular place that you’d like to visit? You know? And I mean, that’s kind of the best of both worlds for the hygienist. So how can you make that the best of both worlds for the practice as well? You know, can you

22:41
Um, maybe adjust your schedule to where you have, uh, days that are more conducive for a lot of hygiene appointments, right? So doctors may be not doing as big of cases and maybe you, you know, structure your schedules so that the days that the doctor’s doing big cases, aren’t hygiene, there’s no hygiene patients there at all. Um, you know, so there’s, there’s different ways I think we’re going to have to learn to work with this and work within our new normal. I love it. I love it. That’s,

23:11
pretty helpful. All right, so those are the steps that we kind of talked about in terms of how to find and keep, I’m just gonna apply to any company in terms of, so we talked about making sure you have a proper baseline, that you have a great culture, that you find out why people wanna be there or not. We were talking about hiring, you can use it.

23:41
a service, All-Star is one of them, also posting on social media. then, know, galvanizing your team to help find, you talked about flexibility as well, which I think is key. Oh, I like threes. Was there a fourth one? Culture, flexibility.

24:03
I mean, there’s probably 10. There’s probably a whole ton, but I like to simplify everything. I think flexibility is a good umbrella around, you know, job share and also hygiene scheduling models. Again, we touched on that a bit, but, know, consider assisted hygiene, consider, you know, was talking to one practice that’s in a remote resort type area. And so we talked about, she’s like, we’re coming up with all these different ideas.

24:33
of having like a hygiene day. I’ve seen this done in some of our client practices in the past for a pedo, where they just have a pedo day and they do it a couple times a year, like summer and over Christmas break. And it’s all hands on deck. You know, they have the hygienist and assistants working together. They get a lot of patients in. You could have once a week. This practice in particular practice had been searching for a hygienist for about six months. She has redone her ad to make it super attractive. She set up like

25:02
a really great living space for somebody. Like she’s just doing everything she can to recruit. They have a great culture and she’s just having a really hard time because it’s not a heavily populated area. It’s lovely, but it’s not somewhere where a lot of people can afford to live and you know, that kind of thing. So they’re going to do, we talked about them doing a day a week of everybody’s seeing hygiene, including doctor, and everybody’s working with an assistant. So you have a hygienist and an assistant.

25:29
Another hygienist plus an assistant, doctor plus an assistant, and you’ve got six rooms. So the doctor is doing hygiene too? Yeah. Yeah. Yeah. And that’s what I wanted to ask you is that I’m seeing that some dentists or dentists are doing hygiene. Is that a workable model in the interim? Could you get like also associates that will do that? how can you utilize dentists to?

25:55
I think, I think it is a viable solution in the interim. I will tell you, I, I don’t, and, and this may be a limiting belief for me, but I don’t see how that could be ideal long-term, but there are some dentists that have no hygienists and they like it, you know, and it’s working for them. mean, anything can work. I think Alex that you hit the nail on the head with that comment is, uh, if

26:22
If you’re in an area where you’re having a lot of guest hygienists coming in and you don’t have a, you know, that hygiene team that’s there every day, day in and day out, the responsibility really lies heavily on the doctor and the rest of the team to build that relationship. So what I have found is that the dentists that do hygiene, they have found some good positive side effects. Like they really get to know the patient quite well. And I will say this, one of the areas, and this is a whole nother topic that

26:49
we help a lot of practices get off insurance or less reliance on insurance. If you’re not reliant on insurance, let’s say you’re at a network, then you have a potential to spend more time with the patient. You could do hygiene and you may, you might end up with the numbers saying, if I’m not giving insurance 40%, I can spend a little longer, do the hygiene in the interim, right? Cause I can spend more time.

27:17
My hourly production goes up and then look I mean you’re building or poor you’re the dentist right there Hey, we can fix we can do the crown we can do the tilling whatever it is right then and there that could be something again It’s not ideal, but I right what you said we have to adapt in the different spaces and find You know what it is that we can make that work and that certainly is a recommendation that we bring up anytime we see a practice that’s heavy and network and they’re booked out six months and

27:46
You know, they’ve had a hard time finding a hygienist and they’re ready to kind of release some of those things. I would say the flip side is also true that if you’re out of network, then you likely have room to pay hygienists a little bit more than if you’re in network because you can point that profitability point easier. And, and I will say, you know, from a profitability standpoint, I mean, again, that’s a whole nother concept or her another podcast that we’ve probably already talked. I feel like we’ve talked about that before. We’ve got to talk to it again.

28:14
Yeah, is and absolutely is possible for hygiene to be profitable. Now there are some extreme examples. But in general, yes, it is still possible even at the compensation level that a lot of hygienists are at now. So I think the I think kind of circling back with all this is, yes, I believe there is a shortage. It could be regional, it may not be as significant in in certain areas, which is true.

28:44
Yeah, absolutely. And also it is necessary for dental leaders to make sure that their practice is attractive and a great place to retain team members and just to work for everybody’s sake. Because when there is tension and friction, patients feel it, team feels it, and it just doesn’t allow you to do your best work. So I think the key thing is we’ve all got to work together, right?

29:13
division and friction does not, you know, that tension does not serve anybody well. So the more we can, we can come to have some, really healthy and respectful conversations about things, except some of the new normal, but also stand firm in your clinical standards and work together. I think we will, we will get through this and we’ll, find a new way of, you know, being the best that we can be. That’s a

29:42
Beautiful podcast. Well said from the hygienist of hygienists, Rachel Wall. Thank you. President and founder and CEO of inspired hygiene. Thank you for being on our show. We’ll have you many, many other times. love having you. All right. So for those who want to learn more, would direct them to inspired hygiene.com. You have coaching, have online training, peri or bootcamp, a number of great programs for anybody that is interested anything hygiene.

30:11
Make sure you have Rachel Wall’s company inspired hygiene on your speed dial and you check her out. I’ll put that in the show notes as well. Thank you for joining us, Rachel. I appreciate it. thank you. And thank you to your team for all you do and support our industry. It’s amazing. So, I appreciate you. You’re welcome. Remember everyone to follow us on Apple Podcasts, Spotify, YouTube, social media. We talk about social media as well. Get episodes as they are released, share with your friends, and until next time, go out there and be an All-Star.

30:44
We hope you enjoyed this episode of Dental All-Stars. Visit us online at AllStarDentalAcademy.com.