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Hygiene Students: DSO 101

By Heartland Dental

Whether you've recently graduated from dental hygiene school or are contemplating a change in your full-time career, the landscape offers a multitude of opportunities. However, while you may see many job postings available, it can be difficult to determine if a DSO or private practice is a right fit for you and your career goals.

Donita Keller, a campus recruiting coordinator at Heartland Dental, shared her transformative journey and the evolution of her perspective on DSOs. Once a hard-and-fast DSO skeptic, Donita's candid account traces her professional path, transitioning from a practicing hygienist to a role as a clinical hygiene teacher, and ultimately emerging as an advocate for hygienists exploring careers within the realm of DSOs. Read how an encounter with a job advertisement changed her perspective and set her on a course towards a meaningful career shift.


Can you share your personal journey from being a clinical teacher in a hygiene school to becoming a campus recruiter for Heartland Dental?

Donita Keller: It was a whirlwind journey. I have been a hygienist for over 23 years and a clinical hygiene instructor for seven years. My husband took a travel nurse job, which made it difficult for me to practice hygiene in states that I was not licensed. During this period, a friend unexpectedly sent me a job advertisement for Heartland Dental. My initial reaction was skepticism because I had heard mixed opinions about corporate dentistry. But as I looked into the job posting, I found it intriguing and a chance for personal and professional growth. Throughout the interview process, I became increasingly excited about the opportunities offered.

What really turned my head to Heartland was an article I found by Dr. Rick Workman. He mentioned that he founded Heartland Dental because pursuing his passion for dentistry came with working 55 hours a week on patient care and an additional 30 hours on the business side of operations and that he knew “there had to be a better way.” This resonated with me, as I had seen many doctors and hygienists throughout my career who could have benefited from a more balanced approach. When I read that, I knew I wanted to be a part of Heartland Dental.

What did you tell your students about working at a DSO when you were a clinical teacher?

Donita Keller: When I was a student, I remember my instructors cautioning us to stay away from corporate dentistry. Looking back, I don't think they shared this advice from experience; it was likely something they had been told. In fact, I don't recall any of my instructors ever working at a DSO!

When my students would come to me asking my advice, I shared the same misconception. "Stay away from corporate.” "They’re all money driven," "they don't care about you," "you don't have a voice," “no opportunity for quality patient care." I believed this because I didn't know any better and hadn’t experienced anything different.

Last year, I had the opportunity to return to my school in my current role as campus team member. In fact, I gave a presentation to a class I first met as freshmen, and now they are seniors! When I first met them, I told them to stay away from DSOs. But when I returned with actual experience working with a DSO I was able to share a very different POV.

What is the culture like at Heartland Dental for dental hygienists, and how does it differ from your initial expectations or concerns about DSOs?

Donita Keller: Once I started working for Heartland Dental, I delved into the company's culture, attended trainings and events. It wasn’t long before my perception changed, and I realized how wrong I was about the barriers associated with DSOs.

Our culture places a significant emphasis on the doctor-hygiene partnership. In my prior private practice experience, there was often limited interaction with the doctor concerning patient care. Another thing that lacked in my previous offices was teamwork. It seemed the office was not on the same page. We never had regular meetings or morning huddles. In my opinion this is crucial not only for the team but for patient care. At Heartland, there are synergy meetings and strong connections between doctors and hygienists. Respecting hygienists is deeply rooted in the company’s culture. This is something I wasn’t expecting. Hygienists' voices are genuinely heard and respected here, which wasn't always the case in private practices where I've worked.

I also know a common fear about DSOs is that hygienists will be thrown into an office without guidance or professional development opportunities, but that isn’t the case at Heartland. Heartland Dental provides mentorship, which is invaluable. There is always someone to lean on because the company is committed to providing its team members with the tools to succeed. And no matter where you are in your professional journey, you are never alone. If you have a difficult case that you want to discuss with your mentor or even get general advice you can reach out anytime.

Many hygiene students may be concerned about their autonomy and the quality of patient care when working at a DSO. Can you shed light on how Heartland Dental supports its hygienists?

Donita Keller: It is a common misconception that providers have no clinical autonomy. I was always told that at DSOs, you were forced to practice in one way and that true high-quality patient care was not a priority. I quickly came to realize that this is not the case. At Heartland Dental our hygienists are treated as providers because that is what they are. Our hygienists are in charge of their schedule. They know to offer optimal patient care it may require more time and adjust their schedules accordingly.

When I joined Heartland Dental, I saw the company's commitment to providing hygienists with the resources they need, including state-of-the-art equipment and technology. In contrast, I've worked at private practices where we had to buy instruments from eBay! I thought DSOs limited clinical freedom when in reality by taking care of the non-clinical business side of things it enhances our freedom to do what we went to school for, taking care of our patients.

Supported hygienists are also strongly encouraged to develop their skills beyond clinical with impactful opportunities that help bolster their leadership skills. One example is the Company’s unique Communications Class that helps multiply personal and team effectiveness by strengthening the communications among teams and with patients.

Communication plays a very significant role in the relationship between hygienists and patients. Hygienists are responsible for explaining why treatments are recommended and for educating patients about how proper oral hygiene. However, in hygiene school, we spend a lot of time teaching clinical skills and not necessarily communication skills. That’s what is so priceless about Heartland Dental. They understand the pivotal role hygienists play in helping our patients understand “the why” behind treatments.

As someone who has experienced both clinical dental hygiene and education, what insights can you provide to dental hygiene students uncertain about pursuing a career with a DSO?

Donita Keller: Keep an open mind. Not all DSOs are created equal which is the same for private practice offices. Here are a few things I would like them to remember:

  • Prioritize what's important to you. Many private practices cannot offer what Heartland Dental provides, such as numerous benefits for you and your family. A vast amount of continuing education training, the latest in technology, etc. The resources available here are invaluable, and they contribute to personal and professional growth in the operatory as well as outside.
  • All dental offices are a business. Patient care is number one, but every office has overhead. Someone should be watching what is coming in and going out. And please don’t assume because a bonus structure is in place that it means it’s all about money. Our CEO Pat Bauer says, “do the right thing for the right reasons.” If you are providing optimal patient care and doing the right thing for the right reason, your production will show. And isn’t it nice to be recognized for doing what we should be doing anyway?
  • Remember that every office is different. Shadow an office so you can have a look into their culture. Know what questions to ask and remember you are interviewing them as well.

A career as a dental hygienist is very rewarding. Choose a company or office where you will have a strong future and have what you need to grow your skills. Keep an open mind, educate yourself and don’t worry about others’ opinions on your career choice. Do what is best for you.

Tags: Dental Support Organization, Careers In the Dental Industry, Dental Hygienist, DSO