Speaking Softly and Still Being Heard: Advice on Advocating for Yourself in a Professional Setting

By Kelly Schroeder, RDH, MS

Like many of you, becoming a health care professional, specifically a dental hygienist, was a dream job for me. The small-town practice I worked for really cared about their employees, patients, and the community. For many years as a clinical dental hygienist, I felt I had found my purpose.

I loved my job and my patients, but like every good love story, there was a dark side.

It didn’t take long for me to realize the standard of care I learned in dental hygiene school did not always match with office logistics and business constraints. Have you heard the phrase, “school is ideal not real”? Although, we performed oral health assessments, clinicians (dentists and dental hygienists) often felt pressured by patient expectations, insurance benefits, and office administrators to recommend a minimum care treatment plan — prophylaxis and brushing and flossing instruction — regardless of the oral health diagnosis. There was concern among co-workers that the cost and time commitment of a periodontal treatment plan would scare patients away. However, without the right treatment plan to mitigate oral disease, a patient’s oral health was at risk.

It finally dawned on me that we were overlooking the multifactorial components of patient’s whole health. This is when I knew I wanted to do more with oral health care delivery and felt compelled to be part of the process for change. Taking a leap of faith that there would be a place for me, I continued my education, earning a master’s degree in dental hygiene public health with a focus on research.

While working on my thesis project, I needed assistance with community oral health outreach and decided to contact my local professional association. Becoming involved with my professional association created a whole new perspective for me on the important role oral health professionals have in advocating for themselves and patients. It also provided networking opportunities and a chance to be involved in legislation. Once I learned the skills on how to advocate for community and professional concerns, it became easier to advocate for patients and myself.

I also realized at that point that I wasn’t alone.

People get this feeling of dissatisfaction and have a lack of fulfillment in their profession for a lot of different reasons. It’s not always an ethical dilemma about patient care and feeling the need to change industry standards. Research shows that long work hours, unfair pay, unrealistic expectations, and negative work culture can all contribute to work dissatisfaction and the desire to leave your job or sadly, your profession.

Instead of leaving your profession, what if you were able to advocate for yourself, co-workers, and patients (customers) to improve conditions and create lasting policy change? In a time when burnout is becoming more pervasive in all corners of the health system — something that can be harmful to both practices and patients — I wanted to learn more.

Why Don’t We Advocate for Ourselves?

So why don’t we advocate for ourselves? Mostly because it feels uncomfortable and we might fail, not be supported, or worse, lose our jobs. Don’t you hate the feeling of sweaty armpits and a dry throat when you need to speak up in uncomfortable situations? Although the nervous feeling seems like torture, living in a chronic state of frustration isn’t good for you either.

It’s never easy but advocating for yourself or others can be less difficult when you feel passionately about something. In his TED Talk, which has been viewed more than 7 million times, social psychologist Adam Galinsky, PhD, says that when feeling strongly about something and especially if you are advocating for others, changes in body language and tone of voice convey passion, increase credibility, and improve your chances of creating lasting change. Galinsky explains that if we are going to speak up and want others to listen, we need to feel confident in our convictions and we need to be prepared.

Drawing on his talk and other research, I’ve identified four advocacy actions to take if you want to create change for yourself and others.

1. Identify the problem and know what you want. We are most likely to see change if we clearly define the problem. Be sure to look at the issue through different perspectives to truly understand the scope of the problem and learn how it may affect others. Know what you want to see in place of the current situation.
2. Develop your case. Gather credible research on the topic from industry leaders such as the American Dental Association (ADA), the American Dental Hygienists’ Association, the Occupational Safety and Health Administration (OSHA) standards, the Centers for Disease Control and Prevention (CDC), or other reputable sources. This is the time to gain allies who are willing and able to have calm, rational, and positive discussions about the problem and potential solutions.
3. Propose a solution. Offer solutions that are flexible and reasonable. Offering more than one solution to a problem and being flexible lowers the defenses of decision makers and makes it more likely for you to get a resolution to the problem.
4. Know when it is time to let it go or walk away. One of my current co-workers uses the phrase “it’s not a hill I am willing to die on.” Is the topic at hand an issue you are willing to fight for until the bitter end? If it is, then you may need to cast a wider net to bring in new allies, learn more about the topic, and create novel solutions. Sometimes, it is necessary to let a particular situation rest until there are new policies in place or new information is available. A recent CareQuest Institute blog post on license portability is a good example of situation when advocacy efforts take time. ADA and ADHA are expecting a license portability contract between participating states to come into effect in the Spring of 2023.

Advocacy Advice from Two Dental Hygiene Leaders

In discussions with other dental hygienists who are now in leadership roles, common themes emerged that aligned with Galinsky’s advice on advocacy: identifying the problem, knowing what you want, gaining allies, finding solutions, and knowing when to walk away.

• Sharity Ludwig, EPDH, MS, director of Alternative Care Models at Advantage Dental Oral Health Center and affiliated practices, shared her perspective on advocacy: “I hadn’t thought of it as personal advocacy, but I do advocate when it is needed for others.” Ludwig explained that she has been very fortunate to work with dentists who have empowered and mentored her and were advocates for improving the oral health of patients. “The office I worked for was providing patient centered risk-based care 20 years ago, moving beyond traditional care,” she said. “I enjoy providing population- based care.” She further explained that the dental hygiene laws in Oregon, where she is licensed, allows dental hygienists to work to their full scope of practice. “In addition, I have had the opportunity to work with dentists that supported team-based care,” she said. “They empowered and mentored the care team, which I was a part of, to work at the top of our license.”

Ludwig’s experience could be like yours — you may already have the advocacy tools you need in your environment to be successful, which benefits both patients and employers. But sometimes it can be helpful to look beyond the walls of your practice.

• After being a clinical dental hygienist for 19 years, Tameka Lee, MPA, RDH, BSDH, experienced job dissatisfaction in 2019 when additional job requirements were becoming difficult to manage. To help gain new perspective and create allies, she rejoined her professional association to reconnect with “her hygiene bubble.” She realized that she needed to advocate for herself and that she could also help other dental hygienists advocate for themselves. During the COVID-19 safer-at-home order, Lee began Empower RDH, a company that focuses on leadership, productivity, and the patient experience. Lee realized that part of the reason she was no longer enjoying her job was because she “had been stagnant (in her career) for so long” and decided to advance her education with a master’s degree in public administration. She uses her advocacy skills and new degree as a dental contract manager. She recommends four actions for hygienists to advocate for themselves:

1. Knowing your worth and your value.
2. Have a good partnership with the dentist.
3. Find a dentist who will allow you to work to your full scope of practice.
4. When possible, spend time temping or job-shadowing different offices to learn office culture and values.

The need to advocate for oneself and for others is going to happen at some point during a professional career if you are to grow. Sometimes we are perfectly happy in our personal and professional lives but overtime, small inequities may start to creep in. When these inequities are affecting your conscience and quality of life, it might be time to get out the advocacy toolbox and develop a plan for change, improvement, and growth. You may be surprised at how many other people, including your employer, will benefit from your willingness to speak up and help create solutions.