2.16.07 - Issue # 258 Forward This Newsletter To A Colleague
Hygiene Salaries
McKenzie Case Study
Justifiable Treatment

What’s Your Hygienist Worth?
by Sally McKenzie CEO
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Your hygienist should be a key producer in your practice. She/he is a primary link between you and your patients. She/he is potentially the most influential person in your office when it comes to encouraging patients to pursue treatment. How much should you pay your hygienist? How much can you afford to pay her/him? You want to be fair. You want your patients to have the best care your practice can deliver. You also want to protect your overhead costs.

Obviously, the hygienist’s salary can have a significant impact on the practice’s bottom line. Too much and you’ll quickly tip beyond the 22% benchmark for staff salaries (excluding the doctor), too little and she/he will likely be a “short-timer” in your practice and you’re scrambling to fill the void.

While individual practice salaries are influenced by a number of factors, hygiene salaries should not exceed 33% of the hygienist’s production. Moreover, pay should never be increased without first conducting a salary review. The Salary Review is a clear and simple mathematical tool you can access immediately to determine exactly how much more money you’ll need to collect each month to cover a pay increase. It ensures that you are making an informed decision when it comes to salary increases.

Additionally, when considering salaries and pay increases, it’s helpful to have some idea what the going rate is for hygienists in your state and region.  The January issue of RDH Magazine includes the results of the publication’s most recent hygienist salary survey. 

Most hygienists responding to the survey work in general dentistry practices. While responses were received from all 50 states and the District of Columbia, those states that provided the majority of responses are listed below. Of those, California has the highest median hourly rate while Florida, Pennsylvania, and New York have the lowest. However, of the states submitting fewer than 20 responses, Alabama appears to have the lowest median hourly rate at $20. And hourly income does appear to be influenced somewhat by whether the practice is in a metropolitan or rural area.

  • Ranking by state
    Statewide median hourly rate:
  • California $44
  • Washington $42
  • Maryland $37
  • Colorado $37
  • Arizona $37
  • New Jersey $37
  • Virginia $36
  • Connecticut $35
  • Massachusetts $35
  • Illinois $35
  • Minnesota $33
  • Texas $33
  • Georgia $32
  • North Carolina $32
  • Missouri $30
  • Michigan $29
  • Ohio $29
  • Wisconsin $29
  • New York $28
  • Pennsylvania $28
  • Florida $28

In addition to hourly rates, some hygienists indicated that they receive a percentage of their production. Others noted that they receive bonuses based on whether the practice achieves it’s monthly goal. Some hygienists receive additional compensation for taking X-rays, selling products, perio treatment, prophies, sealants, etc. Others receive additional compensation based on their collections. Still others indicated that they are on straight commission and are paid anywhere from 33% to 55% of production. 

In addition to considering appropriate compensation for this key player on your team, consider other steps your practice can take to ensure the hygiene department is a full contributor to total practice success:

  • Insist on periodontal assessment. One-third of hygiene production should be in interceptive periodontal therapy. Require the hygienist to measure the total number of dollars produced in the 4,000 code and divide it by their total production.
  • Review hygiene production each month during the team’s monthly meeting.
  • Customize the time per patient based on patient need, not on a standard one-hour allocation for each patient.
  • Provide hygiene hours in the evening if patients are requesting late appointments.
  • Expect the hygienist to use the intra-oral camera, so patients can see the condition of their mouths every six months..
  • Expect the hygienist to review previously proposed treatments for the patients and reinforce the doctor’s recommended treatment plan.
  • Expect the hygienist to speak positively about the doctor’s professional abilities, recent continuing education courses, or specific cases (without referring to specific patients) that have been particularly impressive.
  • Expect the hygienist to educate the patient, not only on oral hygiene, but also on practice services.

For information on the RDH Salary and Benefits Survey, visit www.rdhmag.com.

Interested in speaking to Sally about your practice concerns? Email her at sallymck@mckenziemgmt.com.

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Nancy Caudill
Senior Consultant
McKenzie Management
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Bragging Rights!

A McKenzie Management Case Study

Dr. Charlotte Hill - Case Study #213

For those of us that have “been around a while”…we remember the days when the only ad you had in the yellow pages was a one-liner for your name and telephone number.  You hung out your shingle and “they would come”…just like Field of Dreams.

Dr. Hill called McKenzie Management because she was concerned about the lack of growth in her practice.  Overhead continued to climb but not her collections.  Not a good sign in any business.

When I visited with Dr. Hill, here is what I noted about her practice:

  • 20 year old practice
  • Same location
  • Same number of hygiene days per week since the first year in practice (3 days a week)
  • Office remodeled within past 5 years
  • # of New Patients had steadily declined for the past 3 years….from 20 a month to currently 12 a month.
  • Net collections were also steadily declining at a rate of 10% per year for the past 5 years.
  • The town she practiced in was growing rapidly

COMMENTS:

The average solo-practice needs about 20 new patients (patients that have comprehensive exams and are seen by the hygienist) per month to grow and prosper.  This is assuming that they are losing about 10% per month to attrition.

A 20-year old practice that has not increased the number of hygiene days is NOT growing. It is actually declining in the number of “active” patients.  If you recall from one of my previous articles a hygienist is only capable of seeing so many patients per day.  If you do the math, you will soon see that if a practice has been seeing 20 new patients per month over a 20-year period, the practice must be losing the same number of patients.  Otherwise, the practice would need additional hygiene  days to accommodate the growing number of active patients.

Over a period of time, as the number of new patients decline, the opportunity to perform restorative dentistry also declines.  If 50% of your production is coming from restorative dentistry that is diagnosed in hygiene and 50% is coming from new patients, at some point you will eventually “mine” all the restorative work within your current patient base and you will need to depend on newly diagnosed treatment from your new patients.  If the number of new patients declines, so does your production/collections.

RECOMMENDATIONS:

As I spent time with Dr. Hill, I soon realized that the practice was doing no internal marketing, let alone external marketing.  For the first 10 years of the practice, it wasn’t necessary.  She was seeing all the new patients that she could manage.  However, as the town grew and more dentists starting coming to the area, the competition increased.  Younger dentists were coming in with aggressive marketing campaigns.  How dare they advertise in the yellow pages!  And offer free services…what is that all about?

It is a new world out there.  Dr. Hill accepted the fact that marketing was necessary to increase her active patient base and to “keep” her existing patient base.  Along with a demographic study that McKenzie Management provides to all of our clients, here are some ideas that I suggested to her:

  • Celebrate patients’ birthdays during the week of their appointment.  Have a little “token” with a balloon attached, ready for them at the reception desk.  Not only do you get recognition from the birthday patient, but the other patients will ask and you can say that your practice enjoys recognizing your patients’ birthdays in a small way.
  • Always send a hand-written note from the doctor to all new patients thanking them for choosing your practice.  It MUST be handwritten from YOU!
  • Take before and after photos for your cosmetic patients.  Frame the “after” photo and mail it to their office.
  • Send a handwritten “thank-you” note for  new patient referrals.
  • Call patients after certain difficult procedures.  I know you “used” to do this but why did you stop?
  • Have a website with downloadable forms, directions to the office, information about you and the staff, etc.  Direct all new patients to visit your website for additional information.
  • Be as “high-tech” as you can afford.  Patients like to know that their dentist is “cutting edge”.
  • Use a Professional Marketing Company that specializes in Dentistry.  McKenzie Management recommends Intelligent Dental Marketing.

CONCLUSIONS:

The time has come for dental practices to be proactive in attracting new patients.  There is nothing better than a new patient from a satisfied existing patient.  ASK for referrals from your good patients.  “Mrs. Jones, you are such a pleasure to work with.  I wish all my patients were as nice as you.  If you have friends who are looking for a new dental home, we sure would love to have them here.”   Obviously, this is most effective if delivered by you.  Your team members also have relationships with the patients and can deliver this message.

Recently, I visited a local restaurant for dinner.  The food was average but the staff was knowledgeable and extremely accommodating.  I felt as though they wanted to make me happy.  The next day I received a telephone call from my waiter (they had my phone number from my reservation) thanking me for visiting their restaurant and invited me back again.  I WAS IMPRESSED!  Guess how many people I have told about this restaurant?  How many restaurants have you eaten in and received a telephone call the next day thanking you for your business! 

This is the type of service we must provide to our dental patients as we compete for patients.  Many patients don’t know the difference between good dentistry and poor dentistry.  If they did, we wouldn’t see patients walking around with Chiclets on their front teeth!  But they do recognize customer service and will stay or leave depending on the service they receive from you.

Start marketing to your patients by doing little things that make a big impact on them, and cause them to talk about you to their friends.  Give them a reason to brag about you and your team…they want to!

If you would like more information on how McKenzie's Practice Enrichment Programs can help you IMPLEMENT proven strategies….. email info@mckenziemgmt.com.

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Belle DuCharme CDPMA
Instructor/Consultant
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Is Your Dental Treatment Justifiable?

“4.c.1 Meaning of “Justifiable” from the American Dental Association’s Principals of Ethics and Code of Professional Conduct—revised 10-06

“Patients are dependent on the expertise of dentists to know their oral health status.  Therefore, when informing a patient of the status of his or her oral health, the dentist should exercise care that the comments made are truthful, informed and justifiable.  This may involve consultation with the previous treating dentist(s), in accordance with applicable law, to determine under what circumstances and conditions the treatment was performed.   Difference of opinion as to preferred treatment should not be communicated to the patient in a manner, which would unjustly imply mistreatment.  There will necessarily be cases where it will be difficult to determine whether the comments made are justifiable.  Therefore, this section is phrased to address the discretion of dentists and advises against unknowing or unjustifiable disparaging statements against another dentist. However, it should be noted that, where comments are made which are not supportable and therefore unjustifiable, such comments can be the basis for the institution of a disciplinary proceeding against the dentist making such statements”

Working with client Dr. Goodfloss (not his name), he received a call from an upset patient stating that “I have reported Dr. Goodfloss to my dental insurance company so that I can get my money back because Dr. Badbreath (patient’s new dentist) said that Dr. Goodfloss did not place a crown on tooth #3, but the insurance paid him for it three years ago.  Dr. Badbreath needs to be paid for his new crown, so please give us our money back!”  The patient was told that we would need to research the information and return the call within the next hour.  It would have been professional of Dr. Badbreath to call to consult with Dr. Goodfloss before the patient’s frantic call was received.

Upon examination of the record and the lab slip, it was determined that a cast porcelain onlay was placed on tooth #3 three years ago.  The patient’s insurance company had paid the contracted amount for the onlay (a crown had not been billed).  The patient had not returned to Dr. Goodfloss in the last three years so there was no record after that as to the condition of the onlay.  A copy of the lab slip, x-rays, chart notes and statement of account were sent to the patient so that he could communicate the information to Dr. Badbreath.  Dr. Goodfloss never received a call from Dr. Badbreath.  The patient was put in the middle and the entire situation was preventable.  Dr. Goodfloss had accurate records with supporting data.

Accurate documentation of patient records is of utmost importance.  The entries need to be detailed including all anesthetics (dosage), description of treatment on each tooth, materials, shades, cement types, labs used, x-rays, photos, patient comments.  Copies of lab slips need to be scanned or placed in records.  Charting existing restorations routinely on every new patient will give you the base to work from for creating a new treatment plan.  Charting these existing restorations should not be done solely from x-rays that a patient brings to you from another practice because they may have had some work after the x-rays were taken and some restorations are hard to distinguish in the x-ray and need visual viewing to make an accurate observation.  Notes on the patient’s experience with past dental care should be documented along with the patient’s primary reason for seeking care in your practice. Meticulous noting of periodontal conditions with charting that includes BOP, recession, mobility, gingival attachment etc is important especially if you embark on a course of periodontal therapy that was not diagnosed at a previous dental practice. 

When requesting records from the patient’s previous dentist I recommend x-rays, perio chart and clinical notes (if the patient has received any major treatment) are sent.  If there were record that the patient was seeing a specialist for any condition, I would also request records or a current report from the specialist as to the condition of the patient prior to their arrival in your office.  Checking insurance history with the insurance company helps determine if a claim was filed on a proposed course of treatment in the past.

Does this seem like a lot of work?  When you consider the possible consequences of inaccurate records… I think not. 

I hear over and over again how difficult it is to find formally trained dental personnel for front office positions.  This “gatekeeper” job is the most important for the growth and maintenance of the systems of your practice.  This person is the last team member to view clinical information and is your check and balance for accuracy of insurance claims, treatment planning, communication with labs etc.  If he/she does not have the knowledge to complete these tasks you are asking for chaos, incomplete or inaccurate records and claim filing, billing problems, scheduling errors and patient attrition.

Stop the madness and sign up today for our Advanced Business Training for Dentists and Office Managers

For more information on McKenzie's Advanced Training for Dentists and Office Managers, email training@mckenziemgmt.com, call `1-877-777-6151 or visit our web-site at http://www.mckenziemgmt.com/

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