Dental Hygienists: Are we reaching a tipping point?

Dental hygienists compensation vs. productivity

Dental Staff ProductionInfographic

Are we reaching a tipping point for dental hygienists?

The more I work in different offices, the more I am seeing a trend of hygienists paid so well that they struggle to reach their goals. This seems to set up a vicious cycle.

The Vicious Cycle of Dental Hygienists Production vs. Compensation

The hygienist is paid $28 – $34/hour.

She spends 1 hour per patient.

Depending upon the PPO plan of the patient, the office is paid $45 – $55 for the cleaning plus any xrays they’re allowed to take and the $24 periodic exam goes to the dentist’s production.

The hygienist has to take xrays plus try to sell whitening or recommend other dental treatment the patient needs – to both increase production and provide the expected dental care the patient expects.

The hygienist feels overwhelmingly rushed. She never feels she gets enough time to really clean the teeth well as she was taught in school.

At the end of the month, the dentist compares the hygienist compensation and her production, she sees 45% – 55% and knows that is just not working.

The upshot is that the hygienist feels the dentist expects too much in too little time, while the dentist sees that the hygienist is substantially overpaid for their production! So, how does this problem get fixed?

How to Manage your Dental Hygienists Productivity

Supply and Demand

I receive an application almost every single week from a new hygienist graduate looking for work. As more and more hygienists graduate, the supply increases and they will accept a more reasonable rate of pay – one that allows them to meet their production goals and feel good about their day’s work.

Pay on Production

I’ve never been a fan of this approach, but the more I’m seeing we’re in the middle of a vicious cycle with hygienists compensation, I’m considering this option. A quick way to put your hygienist’s compensation in proper proportion to their production seems to be to pay your hygienist say, 35% of their production. If you make this change from a salaried $30/hour hygienist and start the next month paying 35% of production, you need to be prepared for your hygienist to quit. If you’re seeing the increased supply like I am, you may be more comfortable taking that risk.

I enjoy working with hygienists – their level of professionalism and knowledge makes them a significant strength in a practice as staff naturally look to them for clinical answers and leadership. At the same time, I believe we’re reaching a tipping point where a lower pay rate would actually increase the hygienist’s job satisfaction because she would be celebrated for contributing to the office, rather than dragging down the profitability.

Managing dental hygienist compensation vs production is just one way to run a successful dental practice. If you’re interested in new ideas on running a dental practice, please subscribe to my weekly blog. One of the biggest challenges to managing a dental practice is managing dental insurance. With dental insurance handled, then dental marketing for new patients becomes a primary focus. In today’s day of online reviews, handling patient complaints well is essential. As your practice grows, hiring dental staff becomes more important. With 16+ years of dental practice management experience, I’m open to your questions to help you run a successful dental office.

Feel free to email me.

AUTHOR: Jill Nesbitt
jill@dentalpracticecoaching.com
47 Comments
  • Linda millard

    I’m interested to learn more about how to factored the numbers? If the hygienist generates a yearly total of at least 120,000 (not considering all the work she sold for the dentist) and is paid 50000 a year with no benefits, no 401K, no medical insurance, minimal if any paid vacation. How is paying the hygienist less going to make the numbers work and increase job satisfaction?

    June 3, 2014
    • katie

      amen!

      June 3, 2014
    • Linda,
      Thanks for your comment. Looking at the numbers you mention, if a hygienist receives $50,000 in total compensation and the benchmark is 33% (which I use but it’s definitely on the high side), then your production goal is $151,515.

      For practicing hygienists already earning a significant income, I don’t believe a dentist can reduce an employee’s compensation without risking that person walking out the door. My goal with the numbers is to give a guideline for evaluating the financial performance alone of a practicing hygienist. And, the same guideline for the hygienist to feel that she is providing a strong level of production to cover her compensation level.

      Thanks again for reading and taking your time to share your thoughts. I appreciate it.

      Jill

      June 3, 2014
  • Sherri

    I would love to go back to production pay!
    35% of what I produce would be reasonable
    BUT exams fees should be counted on the RDH’s
    production in my opinion. I’m not saying that
    because I’m an RDH I’m saying that because
    a good RDH DOES the exam and the Dr. only
    Really has to confirm the rdhs findings. I made
    WAY more money on production than on hourly
    and I work in the same office. Thanks to a consultant
    we rdhs were put hourly and I lost about 15% of my income

    June 3, 2014
    • Sherri,

      Thanks for your very interesting comment! I completely understand your feeling about the exam piece – and I agree with your opinion that good hygienists are doing the exam and the DDS confirms the findings. Unfortunately, I think the exams going to the dentist’s production are the new benchmark – although I’ve worked with a dentist who counted the exam towards the RDH production – and in fact, if she ended up doing a filling in the RDH room, she gave that filling production to the RDH as well!

      I’m sorry to hear your pay rate was cut by moving to hourly rather than production – nobody likes less money (which may sound ironic since I happened to write the article above), but I wonder if you could use your production success to continue to provide feedback to your doc to make sure he/she knows how you are performing? Perhaps your dentist really looks at numbers each end of month, but I wonder if you created a one pager and touched base with him/her each month – and you tracked year to date also – if you’re consistently producing better than the 33% or 30% or 28% comparables in the industry, perhaps there are other benefits you could receive?

      Just a thought.

      Thanks so much for reading and taking the time to share your experience.

      Jill

      June 3, 2014
  • Jennifer Lackey

    Just curious if you have sacrificed your pay for the betterment of your practice’s profitibilry? Has it made you feel more “satisfied”??

    June 3, 2014
    • katie

      amen!

      June 3, 2014
    • Jennifer,

      Ouch. Sounds like I upset you. I apologize.

      My goal with this article was to use numbers to measure a hygienist’s financial performance from a business perspective. Especially in the face of increased supply.

      Thanks for reading and taking your time to comment.

      Jill

      June 3, 2014
      • Sandra

        No, it sounds like you are trying to justify lowering hygiene salaries period. (Gosh, who DO they make so much money? All they do is polish teeth!!!”

        June 3, 2014
        • Sandra,

          Thanks for adding your thoughts.

          I am not in control of hygiene salaries. I have never recommended to anyone to reduce a hygienist’s pay.

          I do believe that when the supply of dental hygienists increases beyond the work available, hygienist salaries will go down. I have no idea when (or even if) that will happen, but that’s why I titled this article with the question.

          Thanks again for your time spent reading & contributing.

          Jill

          June 4, 2014
  • Carmen

    This Seems to be way off as far as production goes. I work for production and we produce quite a few thousand in 1-2 days. This is with taking HMO insurances that only cover 54 per cleaning/exam/X-rays at more then 30 min a patient. I believe hygienist are not over paid as far as I am concerned. They are an important part of a team. It’s not just what hygiene produces but what they can coding nose and help the dentist treatment plan for patients. This article is far from accurate.

    June 3, 2014
    • Carmen,

      Thanks for your comment. Sounds like you’re already being paid a % of production and that’s working well for you.

      I’m sorry if I came across as saying that hygienists across the board are overpaid – that was not my intent. I hoped to share some numbers so that both the dentist and the hygienist could have a benchmark to use in evaluating performance.

      Thanks again for reading.

      Jill

      June 3, 2014
  • Eva

    Really?

    June 3, 2014
  • Amanda

    Dear Jill,

    While I can appreciate the concerns of dentists over profitability of the hygiene department, I’m a little taken aback at some of the suggestions in your article.

    First, I disagree with some of the numerical assessments you’ve made. As a hygienist of 11 years, my daily average production is $1000-1200. My average daily goal is $1100/day. Production from my chair comes from dental prophylaxis, xrays, periodontal treatments, adjunctive therapies, sealants, fluoride, and products. In a 45-50 minute appointment, I am responsible for:

    Update/Review Medical Hx
    Blood Pressure
    xrays/or full periodontal charting (alternating)
    Restorative review/screening
    intraoral pictures
    intra/extra oral pathology/abnormality screening
    Scaling, polishing,flossing
    adjunctive therapies as needed (arestin,fluoride,sealants)
    assist with Dr exam (of which I get no production)
    present treatment needs/answer questions when necessary
    make next appointment
    complete all charting notes
    dismiss patient
    turn over room

    According to national provider norms, I should be making 33% of my production, however, at my previous office, I made well below this standard. Conservatively, according to this standard, I would make appx $330/day, which would equal roughly $42/hr. I was being compensated $30/hr with no benefits, no insurance, no PTO. I paid my own licensing fees, uniforms, ce’s, and felt like my potential was not recognized or valued. The dentist was not concerned with the quality of care I provided, nor did he care about the quality of care his patients received. Patients were merely numbers.

    Now, having said all of that, I do understand that dentists are running a business, and that I am an employee. If they are going to pay a hygienist as a provider, then they should do so at the 33% rate, even as you suggested. However, anything less than 33% should have benefits/bonus opportunity to equal 33%.

    Fortunately, I now have an amazing working relationship with a dentist that fully respects the profession of dental hygiene, my education, and the role the hygienist plays in the success of a practice, beyond “just cleaning teeth”.
    He pays me $34/hr (still way below 33%), but I also receive 2 weeks PTO, paid holidays, uniform allowance, CE allowance, health insurance, and 401K, AND I have a bonus system! Because he values me as a provider and helps me reach my potential, I’ve increased hygiene production in his practice in 2013 by over $50,000 from year 2012, and I’m projected to have a $70,000 increase in 2014 over 2012. He also regularly lets me know how much my role in hygiene has increased HIS production. By discussing treatment needs with patients in hygiene, they are more likely to schedule for treatment. And he VALUES that! He cares about his patients receiving a high quality of care and truly wants to see his patients keep their teeth for a lifetime. And its frankly exciting to be a part of a practice that changes lives.

    I LOVE being a hygienist. I love the interaction with the patients, the team concept in dentistry, and being a go-to source for the patients when they have questions. I also cherish the relationship between the dentist and I.

    I sincerely pray that the direction of dentistry doesn’t continue down the trend you’ve suggested and promoted. A hygiene-friendly consultant will ultimately be the most successful. I have no problem being paid as a provider, nor do I have a problem with dentistry being a business and the practicality that entails.

    You’ve heard that phrase “you get what you pay for”? That applies to employees as well. If dentists want a professional, ethical, well educated team, they need to be willing to pay accordingly.

    Would you pay a police sgt the same salary as a security guard and expect the same level of ethics and professionalism?

    Sincerely,

    Amanda, RDH

    June 3, 2014
    • Amanda,

      Thanks so much for taking the time to write such a thorough comment. I really appreciate it!

      In fact, we’re agreed on so many topics, I’m not sure why my article has you “taken aback” on anything? I also follow the 33% benchmark (although I’ve been told this is on the high side) and so I would agree with you that if you’re producing at the level to put your compensation in balance then you deserve your pay and benefits.

      One area where we disagree is what the future compensation of hygienists may bring. When I see the incredible volume of hygienists looking for work – and I see this in multiple states – this is telling me that the supply of dental hygienists is increasing. The law of supply & demand states that once the supply increases, prices will go down – in this case the compensation level of dental hygienists. I’m not saying that any hygienist deserves to be paid less, I am observing the increased supply and making an inference that when more hygienists are looking for work, they will be willing to accept a lower rate of pay – and eventually, this lower rate will become the new norm.

      I also may be wrong. Its happened before. 😉

      So, thanks again for reading and taking the time to write. Very kind of you.

      Jill

      June 3, 2014
  • Kathy

    So who wrote the rule of 35% & not higher for the DH? Sadly, health care is run on these types of business models. When I went to hygiene school we were taught to do what was in the best interest of our patients. It’s this mentality of downgrading DHs that will drive them to pursue independent practice. I found this article to be completely offensive.

    June 3, 2014
    • Kathy,

      Thank you for your comment. I’m sorry you were offended by my writing – as you can see from my other responses, that was not my intention.

      I have no idea who officially wrote the benchmark %’s we use in dentistry – or in healthcare for that matter. I’m sure its something that has evolved over time. You’re right in that it is a shame that we just can’t all focus exclusively on patient care and that the business of dentistry would all turn out alright.

      I did not intend to ‘downgrade hygienists’ by suggesting their compensation may be reduced – its not an opinion on the value of a hygienist, its an observation based on how many hygienists are applying to dental practices looking for work. I’ve been absolutely amazed at the number of resumes dentists are receiving.

      Regarding independent practice, I wonder if there are any hygienists who own their own practice now and what benchmark numbers they use? That would be very interesting.

      Thanks for your time spent reading dental blogs (even the ones you find offensive) and for sharing your thoughts.

      Jill

      June 3, 2014
  • Angela Hodges

    While your heart is in the right place, you have forgotten other attributes that your hygienist contributes to the practice. She/he builds rapport with patients that brings referrals to the practice ad well as protects the dentists from law suits. Besides selling dentistry as a person the patients may trust more than the dentist who spends 2 to 5 min. In the patients mouth. The whole dentist office benefits ad the production on the dentist schedule stays full. This is part of a hygienist production that does not get proper acknowledgement of for their contribution. Hygienists also while in a patients mouth will find work that needs to be done that the dentist missed during his examination. So while you are trying to rationalize your means of decreasing your hygienists pay you may want to consider these attributes in your decision making.

    June 3, 2014
    • Angela,

      You’re absolutely right.

      In fact, one office I worked in for a number of years created a bonus system in order to reward hygienists for doing just as you said. That system took a mountain of effort to measure – both on the RDH part and on mine, but we all felt it was worthwhile.

      Thanks for reading & sharing your 2 cents worth.

      Jill

      June 3, 2014
  • Lovey Tillotson

    Jill,
    OMG !!!!!! After reading that I just shook my head and said, ” SHE SOLD OUT !!! and she SOLD US OUT TOO.” your article states:
    “tipping point where a lower pay rate would actually increase the hygienist’s job satisfaction because she would be celebrated for contributing to the office, rather than dragging down the profitability.”

    Where do I start? Dental Hygiene school tuition is NOT cheap, having a BS is not cheap, if you want a professional, educated, knowledgeable person in your office it will cost more. Similar to when you buy a sweater in Neiman Marcus vs./ Target. You get what you pay for. If a Dr. just wants a tooth scraping drone to avoid ” dragging down his/her profitability” then they will pay less for that. Unbelievable article you wrote………. I’ve been a RDH for 22 years, and I’ve never heard one of us being “satisfied” by not being paid what we are worth. We all know that 75 % of the restorative work comes out of the Hygiene Op. I’m wondering, when you say “dragging down the profitability” do you mean cutting into the Dr.’s pay check so they can continue to make the trips to France ( leaving the back office assistants unemployed ie: NO SALARY ), and drive the $150,000.0 cars, Pay all their Nannies./House Keepers,/ Drivers. I see the dental office becoming institutionalized. It’s all about how much is each new patient worth, how can we make our office a 2.6 million dollar office in one year. It’s all disguised under the black veil of ” we’re doing it all for our patients.”

    I just read your credentials, so typical yet not surprising, you’re not a hygienist, nor a dental assistant. You’re paid by the dentist to make them more money. Have you invested anything other then ” profitability driven ideas” into the dental culture? It seems to me that the RDH is frequently being picked on by others who ( haven’t invested the time, effort and finance into their careers ) are not hygienist. Unbelievable.

    On another note, my feeling on time spent vs./ salary, the Dr. pays for our loyal ,undivided time spent /on call/ available hours in their office (ie: lawyers, psychologist, anesthesiologist, pretty much every educated trained professional follows the same rule) . If the RDH is there in the office for 8 hrs. she/he should be paid for their time.
    Thanks for your time,
    Lovey T.

    June 3, 2014
    • Lovey,

      I’m cheering you on! One of my favorite things about consulting is that I get to choose my clients. So far my clients have come to me facing massive financial needs – embezzlement & medical issues in the COO. We stare down the face of tens of thousands of unpaid bills and my job is to manage the business side of the practice so that all the fabulous, hard working, caring staff get to keep their jobs.

      I agree & empathize with your frustration about the “feel” of dentistry today – seeming to focus on “money, money, money”, so let me tantalize you with the future I believe is headed our way.

      First of all, dental insurance is changing the business of dentistry – its drastically reducing the profitability of most offices. In fact, the ADA has an excellent (if not happy & positive) article on their website sharing that we’re looking at a “New Normal” of lower income across the entire field – and that’s not going away in the foreseeable future.

      Next, we’re watching healthcare become government run right now. And, as our government has oversight on everything, they’re starting to oversee the healthcare outcomes of their healthcare expenses. This is showing up with Medicare not paying for readmission of heart attack patients to hospitals. Although I guarantee hospitals aren’t happy about their drop in compensation, they are very motivated to align their healthcare outcomes in order to avoid a non-reimbursed expense.

      So, what happens to dentistry when we follow healthcare? Dentists who align their practices with healthcare outcomes will make the most money. I hope this leads to a win-win-win. A win for the dentist who earns more money by doing good, a win for the employer (or government) who pays for the insurance because their expenses are in proportion to the health of their population, and finally, a win for the patients who receive this level of care.

      If these changes come to pass (I’ve been told that you at 22 years and me at 17, won’t be practicing then, but we can always hope) then I think there’s a happy home for the business staff like me as well as the clinical team members – not as opposites against each other, but with interests aligned, putting patient care first.

      Thanks so much for your time this evening. I appreciate your reading my article and sharing your thoughts. Best to you!

      Jill

      June 3, 2014
  • Jamie, RDH

    Not only are the numbers of this article inaccurate, the ridiculous view of ” a lower pay rate would actually increase the hygienist’s job satisfaction because she would be celebrated for contributing to the office, rather than dragging down the profitability.” is not only offensive to the hard-working hygienist, but suggests that paying ANY employee (in this case, a RDH) a rate they deserve means their employer resents them for it. I don’t know what practice you’ve worked for, but this is certainly not the standard for all in the dental profession.

    June 3, 2014
    • Jamie,

      Thanks for your comment. I apologize for offending you with my article.

      It may seem ridiculous now to say that a lower pay rate would increase satisfaction, but my observation that two things are happening at the same time that will drive down the compensation level of hygienists:
      1. High volumes of hygienists are looking for work
      2. Existing hygienists are paid on average, 50% more than the rest of the staff

      I am not intending to disparage any hard-working hygienist, but to share my observations. When I think again about the sentence I wrote that you quoted, I believe that to be the case in the future. Right now, I observe hygienists that are not meeting the benchmark of 33% and they feel stressed. I imagine (and since I’m guessing at the future of economics, its just my imagination), that if a hygienist was paid less, it would be easier to meet their benchmark goal – and then they would feel great (and earn a bonus perhaps besides?).

      As I mentioned before, I may be wrong.

      Thanks for taking the time to read and comment.

      Jill

      June 3, 2014
      • amanda

        Jill,

        Your comment above about hygienists making 50%more than other staff….hygienists are also the only other college graduates in the office. Thats like saying “the charge nurse shouldnt make so much since the CNA’s make so much less”
        Arent you comparing apples to oranges there?

        Clearly, youve hit a nerve with many RDH’s and maybe could have worded your article a little better.

        Dentists in our area are also flooding the market, yet they all still raised their fees 3% at the beginning of the year.

        The article comes across as a bit of an attack on our profession…which many of us paid tens of thousands and spent 4 years to obtain.

        I dont know where you are, but almost every dentist here has hygiene production at $1000 or more per day, yet they compensate the hygienist at around 25%

        You stated you frequently work with struggling practices, but yet you never stated that fact in your article and generalized all hygienists.

        You are in the business of practice consulting, and yet you are making a classic mistake of pinning on role against another (whether you meant to or not).

        June 3, 2014
        • Amanda,

          Thanks for your follow up comments.

          I’m sorry you see my article as an attack on the profession. I wrote nothing disparaging hygienists – not one negative comment about performance, attitude, education, contribution, etc. As you can see with my response to each and every comment (I only deleted 2 comments sent to me that were personally nasty) I have no ill will against hygienists.

          You’re definitely seeing a different world than I am from a hygienist productivity standpoint. But that would make sense, right? When a dentist is struggling financially, they (hopefully) reach out for help.

          Thanks for your time.
          Jill

          June 4, 2014
  • Sarah

    This is like saying the pizza boy gets paid per pizza and makes extra if a costumer adds pepperoni… As an office manager I realize that your goal is to decrease costs much as possible but the hygiene department is not the place. I can’t count the practices I’ve worked that the patient couldn’t pick he dentist out of a line up. Rdh’s on the whole are the heart of the practice. Amanda summed up a day in the life but forgot to mention taking out the trash, sweeping the floors, and the other long list of duties that we do to earn our compensation.

    June 3, 2014
    • Sarah,

      Thanks for your comment.

      I agree with you regarding the hygienist being the heart of the practice. I’ve worked with some fine hygienists whose patients follow them no matter where they go.

      Thanks for taking the time to read & share your thoughts.

      Jill

      June 3, 2014
  • Liss

    “you need to be prepared for your hygienist to quit. If you’re seeing the increased supply like I am, you may be more comfortable taking that risk.”

    You might lose an employee who gets along w/ your other employees, who is loved by your patients, who works his/her tail off for you in every aspect of the office, who went to college for upwards of 3 years, who is an integral part of the office, who eases your exams not to mention your day, who produces far more than he/she’s paid daily, but there’s TONS of them now, so whatever. Let the door hit em on the way out. 15 will be lined up tomorrow, and you can offer them WAY less than what they’re worth because they’re desperate. Take advantage of them, obviously, you’d be stupid not to.

    That may be good business sense, but it’s sickening. You might be a wonderful business woman, but I’d hate to be your child, your employee, or anyone in your personal life. Ruthlessness isn’t a cute personality trait in a man or a woman, my friend.

    June 3, 2014
    • Liss,

      Thanks for your comment. I’ll agree with you that the law of supply and and demand can be terribly ruthless. It just isn’t fair when an entire group of people (for example, lawyers in the past 5 years) can’t find work because there isn’t enough demand for their services. (Perhaps you’ve heard how certain law schools were sued because the graduates realized after they were $100,000 in school debt that there weren’t enough jobs and felt the university misrepresented their career prospects.) I was pointing out what I am beginning to observe regarding hygienists following a similar path.

      I will disagree with you when you turn and charge me personally with being ruthless. I have never let an experienced hygienist go with the plan to hire a new graduate in order to save money. And seriously, you would disparage me in relation to my children?

      I published your comment because the first two paragraphs describe, in raw emotion, what it would feel like if the supply for hygienists continues to increase.

      Thanks for your comment.
      Jill

      June 4, 2014
  • Michelle

    As dental hygienists, we are worth so much more than what you suggest. Dentistry to me is more than the bottom line. It’s helping people even when they don’t appreciate it. It’s having your boss’ back. It’s working through pain. It’s finding pathology on your patient and worrying that it could be cancerous. I could go on and on. I don’t expect you to believe that I am worth what I am paid because you don’t know me. However, my patients and my boss would all disagree with your opinion. That’s what counts.

    June 3, 2014
    • Michelle,

      Thanks for your comment. I agree with everything you said – except your suggestion that somehow we disagree. I believe all caring, team-oriented, patient-focused dental staff feel the same way you do – I know I do.

      I think the confusion here is opinion vs. observation. In my opinion, I want all the wonderful intangibles of great staff to also be in the proper financial balance – and if a hygienist is missing her production goal, then I want to help her to achieve it. In my observation, as the supply of dental hygienists increases, compensation will decrease – this has nothing to do with my opinion of what a hygienist is worth because one person doesn’t control supply and demand.

      Thanks for your time & sharing your opinions.

      Jill

      June 4, 2014
  • lisa

    Just wondering why you do not consider why a prophylaxis only usually cost 55.00? A preventive cleaning only done twice a year is less on what people spend on their toe nails and hair during the year. The downgrading of the teeth and gums is so frustrating to me. Cost should be adjusted accordingly even if it’s not paid at 100 percent. That’s where the problem is. If a hygienist does a good job like any other professional she should be paid for her time and knowledge. Sounds like there should be some better marketing skills taught to dentists and staff alike to diagnose and treat from needs and not what is thought to be in the pocketbook. Instilling value in one’s teeth is more important than hair and nails (coming from a hygienist) due to the fact we use them for mastication and social hierarchy. Maintenance is a key factor for preventing expensive dental cost. I see your math, and completely agree we should not be eating the practice (which I really cannot fathom a dentist allowing that) but there are other solutions than making us sales people in general and that’s believing in what we do is important and getting paid for it. I’m sure you feel the same about your profession.

    June 3, 2014
    • Lisa,

      Great questions! I also have wondered how some women will pay $150 for a quarterly cut & color, but switch dentists because their insurance won’t pay for it?! I think that the wonder of dental insurance in the 60’s has turned around to bite us.

      Agree with you on the need to improve diagnosis, treatment planning and case acceptance to break through and improve the mindset regarding teeth.

      Thank you for agreeing that a hygienist (or any staff person) shouldn’t put a burden on the practice. Your comment about not imagining any dentist allowing that just shows how different the views of our profession can exist – I have only run into one dentist whose hygienists are in the proper balance!

      I also like your comment about finding other solutions to show the value in our work in order to be paid for it. I think this is a challenge our entire profession is facing.

      Thank you for your thoughts.
      Jill

      June 4, 2014
  • Leigh

    Well I AM a hygienist AND I am married to the dentist so I can see things from both sides. We try to treat our hygienists well and offer benefits besides descent pay. However, we are running a business….and we don’t have expensive cars, maids, nannies, or any of the other ridiculous things mentioned earlier. BUT, if we did it would not be the business of our employees. Dentist spend 8 yrs in school compared to the two we spend. Running an office is expensive and any smart business person is going to try to be as productive as they possibly can….same as you would do if you could have your own practice. Now, there is my 2 cents worth from a hygienist and office manager. Thanks for the interesting article giving us all something to think about Jill!

    June 3, 2014
    • Leigh,

      Thanks for your unique perspective!

      I appreciate your comments.

      Jill

      June 4, 2014
  • amanda

    Might i just add…did it ever occur to you that hygienists are stressed because they are having their patient time cut, their duties expanded, their pay cut, dentists dont want to hire hygienists full time and pay them benefits so they often are working multiple part time jobs, they are asked to increase production with no incentive, and frankly…they have to defend their profession constantly to people like you, and other consultants, who treat them as though their 4 year degree means nothing. THAT, is what stresses them. I can tell you this…if you want to see how to hurt the dental practice, attack the hygienist.

    June 3, 2014
    • Amanda,

      Yes – I hear the same thing from other hygienists. Lots and lots of stress.

      Another option that professionals have when faced with a difficult situation is to take in the new information (even if it’s bad news, like a possible increase in supply) and then to use your education, talent and intelligence to figure out a solution moving forward. This is exactly what I think Lisa was getting across. This is not an easy challenge – and just because things are a certain way, doesn’t mean we understand why they are that way.

      Thanks again.
      Jill

      June 4, 2014
  • Bridget

    I have been employed in the dental field for almost 20 years. First an office manager, then a dental assistant, and now as a dental hygienist. I have seen consultants come into offices and make wonderful suggestions and greatly improve a practice. However, I have also seen consultants come in and ruin a practice. With that being said, I strongly disagree with your article. I do agree that most hygienists would walk out when offered less pay. However, you did not even address what would happen to the practice with a less experienced hygienist. Nothing against recent dental hygiene graduates, but don’t most professions get an increased rate of pay for experience? I am certain nurses and other medical professions do. Dentistry is a field that definitely benefits with experienced employees. I know that a less experienced hygienist will not be able to contribute to the dentist’s production as much as an experienced one would. I feel fairly certain that most dentists would agree with me on that. I am personally very happy with the way I am compensated at my current office. However, if I were to make 33% production only, I would be happy with that too. That is because I am a very productive hygienist, and strive daily to do the best for my patients while making the most production possible. To me its a win/win for the office and the patient. Also, you failed to mention who is responsible for maintaining the hygiene schedule. In some practices, it can be impossible to meet production goals because of scheduling issues. Lastly, you mentioned changes in healthcare and insurance companies. While I agree that we must stay well informed of changes in healthcare policies and dental insurance companies, it is not their guidelines that should be used to recommend treatment to patients. Because, lord knows that the government healthcare system nor insurance companies have the patient’s best interest in mind.

    June 3, 2014
    • Bridget,

      Thanks for your thoughts! I agree with you that in most professions, including hygiene, that higher pay exists for experience – and for the really excellent hygienists, compensation is never a problem because they are great with patients and production follows.

      Good point also on who is responsible for the schedule and how important that is to be managed well.

      Finally, while I agree with you wholeheartedly that insurance companies do not have the patient’s best interest in mind, my reference to government involvement with healthcare was to show an alignment between improved healthcare outcomes and financial profitability – as every experienced hygienist knows, there is no such alignment in dentistry right now. If you want to make more money as a dental practice, then you must provide more treatment – aka cut more teeth. The economic drivers I described with Medicare paint an entirely different scenario – a future where dentists who help maintain the health of their patients are paid more would move us into a completely different world.

      When the government/employers stand to make more money because they spend less on dental repairs thanks to measuring healthcare outcomes, now the businesses do well, the dentists focused on preventive care do well and the patients do well. The ADA is trying to be the one to create these guidelines – Google “Dental Quality Alliance” and you see the research going into measurable dental health outcomes. This was my point with bringing up government/employers – certainly not that we should expect insurance companies to think in terms of patient care and provide any helpful measures.

      Thanks again for your comments.
      Jill

      June 4, 2014
  • LeeAnne

    While I definitely see your point, I do have another angle for you. I’m a dental hygienist, paid quite higher than what you suggest here , and, like your article suggests, I sometimes just miss my production goal. When I mention this as a concern to my dentist, he assures me that even though I miss my goal at times, he readily admits that the majority of what is scheduled on his schedule is due in large part to my findings during the prophy.

    I’ve only been at my current office not even 6 months yet, and just today there was a crown scheduled on my boss’ schedule that had been treatment planned for seven years. Seven years! And you know what the patient told the office manager? The reason he scheduled finally was because I explained to him why he needed it. He understood, because I took the time to explain it in a way that was effective to him.

    So while I will whole heartedly agree that reimbursements from dental insurance companies are complete crap, I think lowering a hygienists’ salary (especially a good one) is entering dangerous territory. Like my dad always said, “you’re going to get what you pay for.”

    June 3, 2014
    • LeeAnne,

      Sounds like you have some excellent communication skills. Congrats!

      In fear of sounding a bit like a broken record, I want to say that I am not recommending paying a hygienist less than a competitive wage. I have never recommended this to any dentist. I am saying that I am observing a high volume of hygienists looking for work and I am starting to wonder if we are at the start of a tipping point that will result in a lower compensation for hygienists.

      I think its great that your dentist gives you credit for the treatment you motivate. As I have written in other responses, I established a system to track this for each hygienist and we established a bonus to reward hygienists such as yourself.

      Thanks for sharing your thoughts here.
      Jill

      June 4, 2014
  • Carol

    I think the biggest mistake in hygiene is only looking at what is produced in the hygiene chair. Until you start to figure in the crowns, whitening, and everything that is produced that comes from the marketing your hygienist is doing, hygiene will always be undervalued, and you will always wonder why your practice isn’t as successful as you would like it to be. It is not a competition, it is a collaboration that makes an office successful.

    June 4, 2014
    • Carol,

      I completely agree.

      Wouldn’t it be great if the dental practice software made it easy to give “credit” to the hygienist who motivated restorative treatment so that this value could be calculated?

      And, after all these responses, may I say how much I appreciate your thought of “collaboration” as well?

      Thanks for your comments.

      Jill

      June 4, 2014
  • Carol

    One more thought. Why does the exam go to the dentist? It was generated out of the hygiene schedule. Doing that creates creates a zero sum game for the hygienist. Isn’t the hygienist doing all the assessments that contribute to the exam? Updating the medical hx, probing, hard tissue eval (including demin, caries, other defects), risk assessment, oral cancer screening, salivary function and much more. All these and more are outlined in the Standards for Clinical Dental Hygiene Practice. It’s all in what you value.

    June 4, 2014
  • Eva

    How about instead of cutting our pay…Drs ban together and refuse to accept a PPO, HMO or any other plan who does not pay for what a top notch provider deems necessary for standard of care tx. Give the RDH time to recognize and educate rather than filling the chair every thirty min and I can promise everyone involved will be happier.

    June 4, 2014
    • Eva,

      Oh how I wish that were true. Personally, in the group I managed for 16 years, we tried this approach and failed. We did everything we could think of – we marketed, we talked with patients, even with my MBA and massive effort from the entire multi-specialty group – you know what happened? Year over year we lost patients – hundreds and hundreds of patients. The PPOs just started taking over. We had dozens of teachers as patients in our small town – and we all knew each other. And yet, these teachers would request their records, tell us how sorry they were to leave us, but they “had to follow their insurance”.

      But we hung on – the owner of this beautiful small town, award-winning multi-specialty group grew up in this town and he started his practice there in 1970. He put all three of his kids through that public school and he had personally taken care of these folks for dental emergencies 24/7. And still, the teachers and administrators left to follow their insurance. It was truly heart-breaking.

      Eventually, we felt we had no choice – at our height we had over 10,000 patients and by the time we signed up for our first PPO plan in 2007 we were down to 7,000. We felt we owed it to our staff to make the tough business decision required in order to fill the schedule – and avoid cutting any staff positions.

      Sadly, this story is not unique. I have talked with many dentists who experienced similar challenges – and these dentists are employing staff and helping people. I believe that there is room in this dental profession for both clinical and business staff and sometimes, even when we do band together, we just can’t fight the economics. That’s why I want to write articles about how to manage the business side of dentistry because I want dentists to have successful, strong, profitable practices – businesses that can employ quality staff, pay competitive wages, care for patients and make a difference in their communities.

      Thank you so much for your comments – for everyone’s comments here.
      Jill

      June 4, 2014
  • C. Smith dds

    I can understand how hard it can be to see an article that seems to limit RDH income. I’m afraid most of the hygienist that responded don’t see what’s happening around them today. In Ohio a chairside can be trained in months in coronal polishing. In my office a chairside , trained to assist a hygienist makes her more productive. Now is the time for hygienists to find ways to make their practices more economically successful. Most practices try to hold staff salaries to 28%. When you pay a hygienist more than this salary justifies, it comes out of the pockets of the rest of the staff.

    June 4, 2014