In a recent blog post, “Does the market really want college educated dental hygienists?”, I mentioned in a side note that Alabama dental hygienists earn the lowest wages in the United States. The implication of that side note was that the existence of the Alabama Dental Hygiene Program (a one year program) is one of the factors that most likely lowers dental hygiene wages in that state (Note: All the other 49 states require a college degree to become a dental hygienist). Why do I believe that? The ADHP program makes becoming a dental hygienist easier (not easy, but easier). It logically follows, in my mind, that if you make something easier to obtain then you will get more of it. If the supply of hygienists goes up, relative to the demand, then wages will come down over time. It’s the law of supply and demand that none of us can avoid. I received a lot of feedback from Alabama hygienists who didn’t agree with my implication at all. They claimed that the low cost of living and the low cost of dentistry in Alabama are the real factors that explain the lower wages, not the ADHP program and the supply of hygienists. This blog post is my attempt to determine what factors are actually, or most likely, affecting wages. The chart below lists all the states that have a lower cost of living than Alabama, the median hourly wages of those states, and numerous factors that may, or may not be, affecting dental hygiene wages.
| Lowest cost of living | Median hourly wage (2009) | Average cost of prophy | Average cost of SRP | Population per hygienist | Hygienist to Dentist ratio | Average dental spending per capita | Gender pay gap (%) |
|---|---|---|---|---|---|---|---|
| Kentucky (1st) | $26.77 | $56 | $741 | 2282 | .78 | $249 | 80% |
| Arkansas (2nd) | $30.61 | $66 | $794 | 2522 | .96 | $273 | 78% |
| Oklahoma (3rd) | $29.14 | $66 | $794 | 2262 | .87 | $316 | 73% |
| Louisiana (4th) | $27.04 | $66 | $794 | 2885 | .74 | $251 | 65% |
| West Virginia (5th) | $22.22 | $73 | $864 | 1473 | 1.41 | $280 | 70% |
| Mississippi (6th) | $23.63 | $56 | $741 | 1970 | 1.16 | $223 | 77% |
| Alabama (7th) | $20.66 | $56 | $741 | 1264 | 1.69 | $257 | 73% |
Based on the data presented in the chart, the cost of living and the cost of dentistry factors do not explain the differences in wages. The average dental spending per capita also seems to be a non-factor. I included gender pay gap information only because one Alabama dental hygienist mentioned it as a possible factor, but as you can see, it too is not really a factor. The only factor that really jumps out is the relative supply of dental hygienists in Alabama. You can look at it from the population perspective or you can look at it from the hygienist to dentist ratio perspective, but either way, it tells the same story. Alabama has way more hygienists! Is the ADHP program at least partly responsible for this high supply of hygienists? Most likely.
Are there other factors that were not mentioned that are driving wages down? Maybe. For example, wages tend to be lower in rural areas, so if Alabama has a higher ratio of rural areas compared to the other states, then that may be a factor. Are the sources I referenced flawed? Maybe, but I don’t think so, but they are definitely not perfect. For example, I would have preferred only 2014 data, but it was not readily available. Some information is from 2009, some from 2012 and some from 2014. Whether you agree or disagree with my analysis, I would love to hear your feedback.
Mark Frias, RDH
Links
https://www.dentaloptimizer.com/dental-cost-calculator/
http://www.cnbc.com/2014/06/24/americas-cheapest-states-to-live-in-2014.html
http://www.dentalcareerguide.com/dental-hygienist/salary.html
http://kff.org/other/state-indicator/health-spending-per-capita-by-service/
https://simple.m.wikipedia.org/wiki/List_of_U.S._states_by_population
http://www.aauw.org/resource/gender-pay-gap-by-state-and-congressional-district/
Mark,
I would just like to say no matter the data, all though I am glad you took the time to show the stats, I am very happy you addressed this comment that I saw as well. I was deplored at the post and almost went on a rampage, but then thought… How would that make me look? Definitely not college educated, so let’s see how we can, together, prove that yes indeed the market does in fact “need” (who cares about want) college educated dental hygienists!
Thank you for your blog and efforts Mark!
Dear Mark, after reading your last blog post (in which you insinuated that I was “possibly” endangering my patients with my insubstantial education) I wrote a page of nastiness that I decided would not benefit me to post. At this time, I decided to mention only a few points that you may want to consider in your next post degrading my education and abilities, as well as my pay standard (that my own stupidity accounts for). First, the APHP program is a very intensive 1 year program that compresses 2 years of classes into one. We learn the same material, have the same tests as 2 year programs, but finish with quadruple the experience as most degreed programs (although I am also a college graduate). Our program is now (and has been for several years) been overseen by CITA, and I received a regional license (the same that other states accept, and test through). Although I think your info is probably dated, I’m sure that in some areas, $20 an hour is normal pay for a hygienist, but I have seen similar pay scales on FB sites across the nation. What you also need to understand is that I make $30 an hour as an assistant (with my 20 years experience) and could work anywhere I choose for more (or at least equal to) as a hygienist. I would greatly appreciate you gathering more information before you print another such derogatory blog (although I’m sure the feedback you received from your first post convinced you to continue along this route?). You do a disservice to hard-working hygienists everywhere.
Hi Marci,
I think you misread a few things. I actually support the ADHP Program. The questions I posed at the end of my previous blog were not all things I believe. Many were questions I’ve heard many times from other hygienists. I asked the questions only to spark conversation. I disagree with your statement that your 1 year program is equal to a typical 2 year program when it comes to the classroom. My 2 year program was also very intense and I would argue it was a 4 year program squeezed into 2 years. You are probably correct to say that you received more hands training/experience than I did. You stated you received a regional license. My understanding is that only states issue licenses. Do you mean regional exam? Do any other states accept the ADHP education for licensure? Yes, wages are going down, or at least not rising, across the nation, but I don’t think that affects the point of the blog post. You said, “I think your info is probably dated”. Yes, it is. The wage rates are from 2009, which I mentioned, and I also mentioned why the data is less than ideal. I think I made that pretty clear in the post. The other info is from 2012 and 2014.
Yes, other states have accepted Alabama’s licensure. I believe there are 43 states that are associated with CITA. I work with 2 hygienists that have a national license (both ADHP students). I don’t believe the license hanging on their wall is fake. The CITA regional exam is just one step away from a national license and full accreditation. And on another point, if you knew your info was dated, why did you use it? Is the point just to create an argument? Alabama hygienists are well aware of opinions about our program. But if you haven’t been through it, you really don’t know how hard it is, do you? Extremely difficult to give an opinion about something you have absolutely no experience in whatsoever. And I’m very glad that you support the ADHP program. Your comments/blog posts reflect otherwise. Maybe you should spend more time/research on how to improve oral health and forward dentistry and perio disease into the forefront of healthcare..
Marci,
You seem to be conflating the terms license and exam. Yes, CITA is one of a hand full of regional board exams, but it’s not a license. Only states issues licenses. The CITA provided exam(s) is only one requirement for a state license. So yes, CITA is associated with other states, but the question is do other state boards who issue actual licenses accept the ADHP Program for the educational requirement when issuing licenses based on credentials for hygienists who are already licensed in other states? I just checked the websites of the states around Alabama. Some don’t provide the information, but Tennessee and Georgia do and they do not accept the ADHP Program. You must be a graduate of a CODA accredited dental hygiene program in those states. Can you point to a state that does accept the ADHP Program when applying for a license based on credentials? When you say “national license” I’m assuming you mean the national board exam? But according to the ADA, only those who have graduated from a CODA accredited program can take that exam. I don’t see the ADHP program on that list. Some of the info I used is not as up to date as I would have preferred, but IMO it’s still valuable. I don’t blog to create arguments. I blog to share what I’m interested in. You said, “But if you haven’t been through it, you really don’t know how hard it is, do you? Extremely difficult to give an opinion about something you have absolutely no experience in whatsoever”. Couldn’t I say the same thing about you not having experienced a CODA accredited 2 year program, but yet you claim the two are equal.
I am sure you’re 100% correct, that’s why only CODA hygienists are real hygienists, Mark. As I mentioned previously, I also have a degree, not just a state issued license. And just because you are uninformed about the transferability of Alabama’s license, does not mean that it doesn’t occur. I am fully aware of the difference between a license and an exam, as you are well aware of the point I was making of the fact that many other states use CITA for their exams, and the testing is no different for our state. I am sure you could spend a little extra time on gathering accurate up-to-date information to report, instead of inaccuracies that back up opinions. I choose to not continue the conversation on other points in your reply. They are not worth the time it takes me to type. Personally, I would love to see more attention given to lifting this profession (and each other) up.
I work and teach dental hygiene in Alabama. You are correct that APHP candidates cannot be licensed in other states as their education is not recognized. They are not allowed to take the DHNBE. I was only in the last ten years that regional testing agencies like CITA and CRDTS included Alabama in their exam coverage. The facts are: APHP students attend lecture one week per month for twelve months. CODA accredited entry-level programs attend lecture 3-5 days per WEEK for 2-3 years; my students get a whopping 900 clinical hours of instruction in their two years of clinic courses (the first year is just general education and introductory classes) while I have never, in a decade of private practice, seen a Dentist actually sit with his APHP student and correct her scaling/probing/exploring technique and guide her through patient education/OHI/nutritional counseling etc.; dentists at the UAB School of Dentistry (where the APHP program lives) are taught by BSDH Dental Hygienists, not preceptors for good reason; currently, the UAB Hospital of Dentistry (attached to the host of the APHP) will not employ hygienists without at least an associate level degree. I’ve dealt with a great many APHP dental hygienists (some were my classmates that wanted their degree, some I worked with and watched go through the process) and not one of them had to take Biochemistry and Nutrition in the APHP program, not to mention the psychology courses, the histology courses, the community health projects, and I could list about 145 more credit hours of formal education. Do I think that some of the APHP have the technical skills needed to see your generally healthy patient, yes. Do I think that Marci is correct in insinuating that her education is on par with mine or my students’, no. Do I think that she is endangering her patient? I will not say that, but I would love to sit chair side with her and see if she is using the most current ADA and ADHA recognized techniques and practice models.
The CITA administers 2 exams in Alabama, the Regional Exam and the Alabama exam. Candidates who sit for the regional exam must be graduates of CODA accredited programs. ADHP students sit for the Alabama exam and can only obtain a license in Alabama. I keep hearing about these ADHP graduates who are able to obtain licenses in other states, however, there are no statistics to show evidence of this. I do know personally of one ADHP graduate who was able to obtain a license in another state due to a gray area in the state practice act. Since then, the state practice act in that state has been revised to state that only graduates of CODA accredited programs can obtain a license. ADHP students do not receive the same education as students of an accredited program. They receive about 160 hours of academic education, compared to 1000 hours in an accredited program. Yes, they may do more prophies in their sponsoring dental offices, but there are no standards for clinical training. The training is totally dependent upon the individual dentist. I have personally worked in many offices where ADHP students are trained and the training consisted of one day observing a hygienist in the office (who is also ADHP trained) , then the next day they have a full schedule of patients who have no idea they are being treated by a trainee. In accredited programs, students attend at least 130 hours of preclinical training before they ever touch a real patient. The preclinical training is based on strict accreditation standards. When the students enter clinic, instructors are there to supervise and check every aspect of patient treatment and the public is aware they are being treated by a student. Quite the opposite with students being trained by individual dentists in a private office. Many times the dentist instructs the employees not to tell the public that they are being treated by a student and the patient gets charged the same amount as they would if they were being treated by a licensed hygienist. How does this protect the public?
Hi! I graduated recently from the ADHP. You are correct that our education program is not accredited, but they are trying to get accredited. Every state is different in what they allow as their educational requirement. We have had many girls move out of state and have petitioned the state boards to grant them a license and were granted one. They had to show their years of experience and taken the state in question’s license exam. Not every state of course but there are more coming to realize that since we are taking a regional exam, the same as the girls graduating with an associates degree are taking, and are passing! If our quality of education isn’t up to par then we wouldn’t be passing. The girl’s (and few guys) now have to do over 200 prophylactic procedure. Also, another reason Alabama has lower wages is because hygienists have less liability here. We are not allowed to give injections and can only practice under supervision, both of which were in place before the ADHP.
As to the statement about ADHP hygienists making the same as one with an associates degree, yes. We do the same work often times more so why shouldn’t we? We have to start has assistants, therefore were are cross trained in multiple areas and trust me, we are used in multiple areas. On any given day, I can go from Scaling and Root Planning to extractions, to pouring up a model, to a crown prep and making the temporary. I have met several hygienists who have their associates degree but have no idea about assisting. So I ask you, should a hygienist who has an associates make more just because she has that degree but can do less in the office than a hygienist who can provide hygiene and assisting services?
Hi Haleigh, You made great points and I agree with everything you said except for one thing. You said every state is different in what they allow as their educational requirement, but I think it’s the exact opposite. The vast majority, if not all states, require that the applicant complete a CODA accredited program which is basically a two or four year degree so it’s a pretty standard requirement. The CODA requirements are very standard, so it’s basically the same across the board. As far as pay goes hygienists should get paid whatever the market is willing to pay regardless of what education they have.