Editor — Where Have All the Assistants Gone?

Kerry K. Carney, DDS, CDE

First, a blanket apology to Pete Seeger for commandeering and altering the title of the best antiwar ballad ever written. Seeger sang a story of generations lost in the flower of their youth to the graveyards of war. This variation on the ballad’s title reflects the storyteller’s slow unfolding of a new world, a sad recognition that times have changed. The world we live and practice in is not the same as it was in 1955 when Seeger’s song was published.

Three years ago, I started hearing colleagues complain about how hard it was to find dental assisting staff. It was hard not to feel a little smug about having a good, reliable complement of staff members. This was, of course, hubris; the only constant is change.

In my mind, staffing issues were simply a problem for those who did not treat their staff well or did not pay them a reasonable wage or were somehow unreasonable in their employment demands. When we lost a longtime dental assistant, we were frog-marched into the new reality. We tried to make our practice stand out to lure applicants. Our ads got us very few responses. The few applicants we interviewed used us to leverage other employment offers. We found ourselves joining the chorus: Where have all the assistants gone?

Urban hipsterfication was making it difficult to impossible for entry-level employees like dental assistants to find affordable housing in the cities. But the affordable housing crisis was not the sole cause of the dwindling numbers of job applicants. The applicant pool for dental assisting positions is just not the same as it was in 1955.

When Dr. C. Edmund Kells hired Malvina Cueria in 1885, she became The flexibility and the easy-in, easy-out employment that characterizes the digital economy may have contributed to the reduction in candidates that previously supplied the dental field. recognized as the first staff member hired as a dental assistant. In those days, dental assistants were also known as “ladies in attendance.” One of their primary duties was to act as chaperones and facilitate the treatment of female patients without the need for the presence of a male relative.

Now dental assistants fulfill a much greater role and are an integral part of our professional team. When a longtime dedicated member of the dental team leaves for any reason – change of family demands, change of living circumstances, change of career goals, etc., it can be very traumatic to the practice, the patients and the remaining staff. It can feel like a death in the family. But life moves on and the practice has to seek a replacement for the missing staff person. In the past, there were many experienced applicants and many inexperienced but motivated and reliable applicants eager to join the dental team. Today, not so much.

In 2017, the CDA House of Delegates voted to establish a taskforce to investigate the problem articulated by a number of dental society components: Where have all the assistants gone? Some of their findings follow.

The decline in applicants for entrylevel positions is not restricted to the field of dentistry. There are many economic influences on the entry- and mid-level job markets that have resulted in a reduced applicant pool. Technology companies may be perceived as offering a better or higher paying career than dental assisting. Employment environments have changed. The numbers of individuals working from home or working remotely have been on a dramatic and continuous rise since the 1990s. The flexibility and the easy-in, easy-out employment that characterizes the digital economy may have contributed to the reduction in candidates that previously supplied the dental field. There are jobs now that simply did not exist in the past. Whoever heard of a barista before Starbucks?

Dental office hours may also be a problem. Many offices see the majority of their appointment requests for times after school. Working these hours can make child rearing difficult for the employee.

The costs of dental assisting training programs may be deterring new candidates from entering the field. Training programs range from $1,000 to $16,000 in tuition and from nine months to two years in duration. Though financial aid may be available, the prospect of taking on educational debt may be a significant barrier to prospective candidates.

Several schools reported in a survey that they had seen a decrease in enrollment over the last few years. They also reported an increase in students who were not prepared to be successful in the educational process or in the dental assisting field, citing tardiness and absenteeism as concerns. They also reported that high-performing students were recruited directly into hygiene programs.

The taskforce pointed out that the dwindling number of assistant applicants meant human resource companies that perform the service of locating and hiring employees added dental assisting to their portfolio. These services are bundled with other HR services and the sticker shock for the hiring dentist can be significant.

The final recommendations of the taskforce focused on: workforce development, defining a career pipeline, facilitating licensure portability, streamlining resources at CDA Practice Support, improving knowledge of the dentist’s role in the employer-employee relationship, communicating the importance of nonsalary support for assistants and developing the dentist’s crucial conversations skills. Dentists have to change and adapt to the new employment environment.

But let me tell you what finally worked for us. We contacted all the local assisting programs and offered to provide extern training opportunities for their students. Our very first extern impressed us all. She has joined our team, and we hope we will not have to do this again for another 17 years. But in the meantime, we will be promoting the career of dental assisting to everyone who will listen. It is a great chance to have a little personal impact on the supply of dental assistants for dentists in the future. Explaining the emotional and financial benefits our hands-on field of medicine can offer may broaden the horizon of employment opportunities for those interested in a new career. And if we do not let others know how rewarding the oral health care field can be, when will they ever learn? When will they ever learn? (Sorry again, Pete.)