Julian Perez, Chief Legal Officer, dentalcorp; Nicola Deall, Chief People Officer, dentalcorp
The sky is blue; what goes up must come down, and if you are a dentist practicing in North America, finding and retaining adequate personnel is a struggle. Enough has been written about the shortages of dental assistants and dental hygienists. The scary job-opening-to-job-candidate statistics, the Great Resignation, and the demographic sea change brought on by retiring boomers are common knowledge. But a related phenomenon—one that is just as prevalent—has garnered far less attention: the accelerating use of temporary workers in dental offices to support the shift of team members wanting more flexibility in the way they work. This article addresses the benefits and risks of using this growing portion of the labor pool and offers tips for making the most out of casual, traveling, and temporary oral healthcare workers.
1. Why “safety first” is a good approach to relying on temporary workers in dentistry
Regardless of the kind of contract you have in place, temporary workers are entitled to the same protections under occupational health and safety legislation as full-time or part-time team members. Furthermore, temporary workers should, at least at a basic level, understand their rights and duties before commencing work in a dental office. Ensuring this occurs often requires three-way collaboration between the workers, the employers at temporary agencies, and host employers. Indeed, there is a joint responsibility to make sure temps understand what will be expected of them and arrive prepared to work safely at the clinic. For management of the dental office, providing a targeted and effective orientation will go a long way towards mitigating risks and ensuring success. Such “mini-onboardings” should not be tick-the-box exercises. “Workers who are new to a workplace are up to three times more likely to be injured on the job, especially in the first month, than at any other time.”1
We know the practice of dentistry to be a relatively safe activity; nevertheless, hazards exist, including myriad sharp instruments, biological waste, toxic chemicals, and radiation-emitting devices. Although placement agencies share responsibility for ensuring a worker is qualified for the relevant tasks, once the worker crosses the threshold into the dental office, the dentist and their team take responsibility for the safety of the working environment, both physical and mental. Beyond an appropriate orientation and confirmation of qualifications, dental office managers should explain any unusual or latent safety concerns. In the same vein, dentists and office managers should encourage temps to communicate freely if they identify a potential threat to their or someone else’s safety: “some temp workers may have a different cultural outlook on safety or might hesitate to speak up to people in authority.”2
2. Don’t be casual about casual employees’ contracts and methods of payment
Another consideration when contracting temporary workers is how to classify them for payroll, EI, and tax purposes. One question that needs to be considered is whether such workers are self-employed (i.e.independent contractors), contractors paid through an agency by invoice, or employees. The decision needs to be carefully considered at the outset, and if the relationship with the worker changes over time—as it often does—the initial determination may need to be revisited. For example, a dental hygienist may start off as an independent contractor and, over time, turn into an employee. If the professional relationship transforms in that way, it will require the employer to update their payroll records. While the line between contractor and employee can be blurry, a person’s employment status affects not only their income tax status but also their contributions for Employment Insurance and the Canada Pension Plan. Failure to get this right can have serious consequences: “An employer who fails to deduct the required CPP contributions or EI premiums has to pay both the employer's share and the employee's share of any contributions and premiums owing, plus penalties and interest.”3 Moreover, “the fines and penalties may be quite substantial when Revenue Canada decides that an arrangement said to be a contract for service is actually a traditional employment relationship.”4 HR professionals and employment lawyers can help determine the appropriate status for workers, temporary or otherwise, and the CRA will also proactively adjudicate such decisions upon request by an employer.
It is important to note that some temp workers have different expectations of being paid and often expect immediate payment or faster payment than your usual pay cycle. And it shouldn’t need to be stated, but paying temporary or casual employees, even for trial shifts, in gift cards is not compliant with employer obligations and should not be done.
3. When hiring temporary workers, quality patient care should be at the centre
How temporary workers are integrated into a clinic can have implications for clinical outcomes. While research in dentistry is scarce, some studies have shown that “temporary staff members working in a hospital's fast-paced emergency department (ED) are twice as likely as permanent employees to be involved in medication errors that harm patients.”5 Studies outside of healthcare have also linked contingent workers to increased rates of accidents.6 And of course, when accidents are more likely to occur, liability becomes more probable. To reap the rewards of temporary team members without all the potential headaches, being systematic about where, when, and how such casual workers are deployed is vital.
Another way we need to ensure we keep patients safe is by checking the identity and registration of temp employees. There have been known cases of fraudulent and unregistered Hygienists working as temps as a result of poor compliance processes in practices.
Whether temporary workers or float pools are used to fill staffing holes, dentists and office managers must keep their commitment to patient safety squarely in focus. Beyond the administrative measures mentioned above, this may also require matching the available skill mix of the visiting workers with the specific needs of the clinic’s patients. Not all dental offices are the same, and a temporary worker who succeeds in one office may not be a good fit elsewhere. Despite many schools increasing the number of students training to work in the dental industry, temps will remain a reality until supply levels of qualified dental industry workers are able to meet demand. Managing temps in a compliant and safe way will remain a core part of running a dental business for the foreseeable future, and it is important to get it right. Our job is to ensure effective communication, education, and onboarding processes so that we deliver on our responsibility to provide safe patient care.
[1] Temporary help workers, agencies and host employers, https://www.ontario.ca/page/temporary-help-workers-agencies-and-host-employers, last viewed on November 16, 2022.
[2] Protecting temp workers, https://www.safetyandhealthmagazine.com/articles/18095-protecting-temp-workers, last accessed on November 16, 2022.
[3] Employee or Self-employed? From: Canada Revenue Agency https://www.canada.ca/en/revenue-agency/services/forms-publications/publications/rc4110/employee-self-employed.html, last visited November 16, 2022.
[4] Self-Employed vs. Employee Status, The Canadian Dental Hygienists Association, https://www.cdha.ca/cdha/Career_folder/A_Career_in_Dental_Hygiene/CDHA/Career/Career_in_Dental_Hygiene/Self-Employed_Vs_Employee.aspx, last accessed on November 16, 2022.
[5] Temporary staff can boost liability risk, November 2011, https://www.reliasmedia.com/articles/132561-temporary-staff-can-boost-liability-risk, last visited November 17, 2022, citing Pham JC, Andrawis M, Shore AD, et al. Are temporary staff associated with more severe emergency department medication errors? J Healthc Qual 2011; 33:9-18.
[6] Quinlan M, Mayhew C, Bohle P. The global expansion of precarious employment, work disorganization, and consequences for occupational health: a review of recent research. Int J Health Serv. 2001;31(2):335–414.