The competency battle between dentists and dental hygienists has risen to new heights now the latter are being trained to independently make diagnoses and perform simple dental operations. Although the new-style dental hygienists are considered welcome additions to their practices, dentists are loathe to yield more authority. As a result, the intended reshuffling of duties has gone far less well than intended. This is the conclusion of PhD research conducted by the Groningen dental hygiene lecturer Katarina Jerkovic, for which she will be awarded a PhD by the University of Groningen on 5 April 2012.
Jerkovic sees this development as symptomatic for the entire healthcare sector, where by now in many disciplines healthcare practitioners trained at universities of applied sciences are expected to take over duties from colleagues with a research university degree.
Over twelve years ago the proposal was first floated to expand the dental hygienists’ training programme and shift more duties from the dentists to them. This would leave the dentist more time to attend to more complex affairs. The decision anticipated a shortage of dentists as a result of the ageing population. The four-year Dental Hygiene degree programme began in 2002; earlier this had been a two-year programme, later extended to a three-year one. Since 2006, some 100 to 150 new-style dental hygienists have graduated every year. They are allowed to do the twice-yearly check-ups, drill and fill small cavities, and independently make the related diagnoses.
Dentists, however, find it difficult to relinquish their authority, Jerkovic finds: ‘Although they appreciate the leeway created for them when they have a dental hygienist in their practice, they do want to keep the decision-making in their own hands. This means that the dental hygienists have less to do than they have been trained for. To an extent this is a result of the fact that they have taken over a job from an old-style colleague who never did such work. Dental hygienists also often have multiple jobs which means that they have little time to concern themselves with new duties alongside their primary ones in prevention and treatment of gum disorders.’
Jerkovic’s research also shows that new-style dental hygienists have lower job satisfaction the their predecessors. ‘The new-style dental hygienists experience less autonomy and more role conflict in their jobs, which can be explained by the current manner in which duties are divided between dentists and dental hygienists.’ Jerkovic expects that matters will change now that patients are allowed to visit a dental hygienist without a referral from the dentist. This does, however, require patients being acquainted with the possibility to do so, otherwise they will continue to visit their dentist for matters dental hygienists could deal with.
What is happening in the relationship between dentists and dental hygienists is also occurring in other parts of the medical world, Jerkovic says. This is why it is very important to monitor how this model is fairing. Jerkovic: ‘The new division of duties is symptomatic for the entire healthcare sector. Take, for instance, ophthalmologists and opticians, doctors and nurses. The academically trained doctors from research universities are confronted by healthcare practitioners trained at universities of applied sciences who are able to take over many of their regular duties. This can only be considered to be a good thing and fits government policy of providing people with a fitting level of training a suitable set of duties. Where dentistry is concerned, the Netherlands are leading the way in the world. There is nothing to indicate that this results in the academically trained doctors being supplanted. They can in fact profit if they are prepared to share some of their duties with their colleagues from another educational background.’
Katarina Jerkovic-Cosic (Bosnia, 1976) graduated as an old-style dental hygienist at the Hanzehogeschool Groningen, currently known as the Hanze University of Applied Sciences, Groningen. She gained her Master’s degree in Epidemiology at the University of Amsterdam. She has worked as lecturer in the Dental Hygiene degree programme since 2000, and since 2002 has been a researcher with the Transparent Healthcare department at Hanze University, while also working at the Centre for Dentistry and Dental Hygiene of the University Medical Center Groningen. She will receive her PhD from the Faculty of Economics and Business at the University of Groningen, where she was supervised by professor of Business Studies, Prof. A.M. Sorge, and professor of Rehabilitation Medicine, Prof. C.P. van der Schans. Her thesis is entitled ‘The relation between profession development and job (re)design. The case of dental hygiene in the Netherlands’.
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