Union Upset About Elimination of Periodontal Hygiene Classification

The organization’s 17 periodontal hygienists are still at work, but earning less -- and may not be able to take care of their longtime patients
About 70 people showed up last week at Kaiser Permanente headquarters in Northeast Portland to protest its decision to eliminate the periodontal hygienist classification from its union contract -- a move that, when it was initially proposed in April, prompted outcry from the Oregon Federation of Nurses and Health Professionals, which represents dental hygienists and other healthcare workers throughout the Kaiser system.
Previously, 17 of Kaiser's 125 dental hygienists were classified as periodontal hygienists, who specialize in treating long-term severe gum disease. 
The periodontal hygienist job code was eliminated Oct. 31 and now all dental hygienists at Kaiser are considered general hygienists. That means a pay cut for those who previously specialized in periodontal care -- $5,000 to $6,000 per year, or $2.54 per hour -- and also that patients with chronic gum disease may not be scheduled with the hygienists they saw before. 
Organizer Jeff Carr said the union was not consulted about the decision prior to its announcement, placing Kaiser in violation of its contract with the union.
Demonstrators included OHNHP rank and file as well as people representing the International Electrical Workers Union, the Service Employees International Union and Jobs With Justice.
Prior to the demonstration, representatives from both Kaiser and OHNHP spent 11 hours negotiating with a federal mediator to resolve the dispute, and the next step is likely "final and binding arbitration. We never say never," Carr said. "We hope they'll come to their senses." 
"I'm starting to get a lot of general hygiene patients," said Jackie Farlinger-King, a Kaiser hygienist who used to take periodontal appointments primarily.
In April, when the union first learned that Kaiser was planning on cutting the position, Farlinger-King said she was concerned about the continuity of care for her patients with gum disease.
"My concern is that my long-term patients won't be able to get in to see me."
According to the Centers for Disease Control and Prevention, half of US adults over 30 have some degree of periodontal disease, but prevalence is higher among seniors, who make up the bulk of these  patients: 70 percent of seniors have some degree of gum disease, and 23 percent have severe gum disease.
Carr said the next step is going to binding arbitration in December, though he hopes Kaiser executives will change their minds and reinstate the position.
"We're going to arbitration to say, 'You can't just do this,' and we believe we will prevail," Carr said.
"Kaiser has done things better than other canned dental plans," Carr said, and its membership numbers have grown in recent years as a result. Currently, Kaiser operates 16 dental clinics in Oregon and Washington and has 200,000 members on its dental plan. But, he said, reducing access to specialized care could turn patients off and drive them to other plans.
Kaiser did not respond to a request for comment in time for this story's deadline.
UPDATE: After this story posted on 11/19, Kaiser submitted the following statement. 
"Kaiser Permanente Northwest has been in discussions with Oregon Foundation of Nurses and Health Professionals (OFNHP) about consolidating the functions of our dental hygienists to enhance service delivery for all our members. This enables us to provide our members the full spectrum of dental care by combining two classes of dental hygienists into one and utilizing the entire range of skills and training for every one of our hygienists.
"Across the industry, dental hygienists are trained in school to perform both dental and periodontal hygiene care services. However, at Kaiser Permanente Northwest, we have 17 hygienists who perform only periodontal hygiene care services, and 125 hygienists who perform the full scope of dental hygiene care services, including periodontal hygiene care. Broadening the scope of care services performed by both groups allows all of our hygienists to provide dental and periodontal hygiene services, to the fullest extent of their schooling and licensure.
"We are supporting our valued hygienists during the transition period with training that will maximize the existing periodontal care skill set all hygienists are taught as part of their formal training.
"Periodontal disease is one of the most prolific dental diseases. It is often unrecognized or under treated. We depend on the vigilant surveillance capability of all our hygienists to ensure our member dental needs are quickly recognized and treated. 
"We continue to reach out to OFNHP on efforts to transform care to improve quality and efficiency and are confident that union members will work with us to achieve our shared goal of patient-centered care.
"Since beginning in 1974 with one office, the Kaiser Permanente Dental Care Program has grown to 17 dental offices that serve more than 200,000 members in the Portland-Vancouver metro area, Longview, and Salem. It is now one of the largest group-practice dental programs in the country.
"In early 2012, we became the first in the Northwest – and third in the nation – to attain dental home accreditation for all 17 of our dental offices."
Christen can be reached at [email protected].
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