Why a Two-Tier Hygiene Salary May Work Best
As the CEO of your dental practice, there’s a lot you need to think about to ensure you run a successful, profitable business – including how much you compensate your staff. Most dentists pay all of their team members as employees, with guaranteed hourly wages. This is fine if you’re talking about a non-producing team member, but it really isn’t the best method for hygiene salaries. This guaranteed wage gives hygienists no motivation to increase productivity, and because of that their salary often soars well beyond 33% of their production. And when your hygiene salaries go above that 33% benchmark, your overhead goes up while your revenues go down.
With this system, your hygienists get paid while sitting in team meetings or attending continuing education courses, when they are clearly not producing. Associates don’t get paid to sit in meetings or CE, so why should hygiene?
Some dentists pay their hygienists straight commission, but this can lead to trouble if you have a hygienist willing to sacrifice quality for quantity to up his or her earnings. This scenario is pretty rare, but it isn’t the only pitfall that comes with straight commission. It’s a pay structure that most hygienists don’t like. They want the security of knowing how much they’ll bring in each pay period, and many just aren’t willing to consider a commission based salary.
So how can you develop a payment structure that is fair to both the hygiene team and the practice? I recommend implementing a two-tier system. I truly believe this is the best system, and is one that benefits both the practice and the hygienist.
In this system, you pay hygienists a guaranteed base plus commission. For example, if your hygienist Susie works 10 days a month at $300 a day, she earns $3,000 a month. So she needs to produce $9,000 a month to meet her goal. Let’s say she produced $10,000 last month. With the two-tier structure, you can pay her commission of 15-33% on the $1,000 she brought in over her monthly goal.
This extra incentive gives Susie motivation to produce more than three times her salary, which results in a boost in your practice productivity numbers and your bottom line. This system also makes figuring out raises relatively simple. If your hygienist earns a pay bump, her raise would be based on a percentage increase on the commission, as long as it’s less than the 33% maximum.
If you pay Susie straight commission, she basically gets a raise every time you implement a fee increase, whether she’s earned it or not. What if she just isn’t performing to your expectations? Maybe she comes in late every day, or leaves her instruments for someone else to clean up. With the commission system, she gets more money with every fee increase despite her performance, sending mixed messages and giving her no reason to improve performance.
Then there’s the problem of the long-time hygienist who asks you to raise her commission to more than 33%. This loyal employee has been with you for years, and the patients love her. You really can’t risk losing her to another practice, so you give in and increase her commission rate. Your hygienist is happy, but your practice suffers.
Remember, you’re not in business to lose money. This is why it’s best to implement a payment structure, like guaranteed base plus commission, which rewards hygienists for good performance without hurting the practice in the process.
Keeping Salary Under Control
• You have a long-term hygienist who you pay top dollar. This hygienist gets a raise every year no matter what, so performance never improves.
• Hygiene is under-producing because your fees are too low or the hygienists take too long on each patient for the service provided and fee charged.
• Hygienists are under-producing because they only perform basic prophys and the practice has no periodontal therapy program.
• The practice has more days of hygiene per week than it has patients to fill them.
• Your practice has a high cancellation and no-show rate because you rely on pre-appointing six months out.
• No one is accountable for keeping the schedule booked or for following up on past due patients.
If any of these scenarios are playing out in your practice, it may be time for you to not only look at how you compensate your hygienists, but also have a professional analysis of your hygiene department. Cleaning up your salary/production ratio is a good start, and if you implement a two-tier payment structure, it will lead to a more profitable practice with hygienists who are motivated to increase production and boost your bottom line.
For a complimentary base-line hygiene assessment go here: http://www.mckenziemgmt.com/cons-hygieneassessment.php
For additional information on this topic and more, visit my blog: The Lighter Side
Interested in speaking to me about your practice concerns? Email firstname.lastname@example.org
Understanding the Most Important Practice System
It’s always interesting when I go into an office and ask the hygienists to explain their recall system, or ask if they know how their recall system works. The answer depends on whether or not the office actually has a recall person who is responsible for working the system. Many give me a blank stare and say, “Well, when we have open time the recall person tries to call patients who are overdue for their cleaning appointment.”
After hearing this response, I am not surprised to find that the office has a high number of cancelations, open time and no-shows in their schedule. After all, how can a practice expect patients to be compliant to something they have never been educated about, if the entire team (including the doctor) doesn’t even know how the recall system works?
If there have been recent changes to your recall system, or if existing patients have not been completely educated, the hygienist should be going over these details with every patient in the chair. It does not take long. This can be done at any time during the hygiene appointment, and will be briefly repeated when the patient places their address on the recall card.
There are many different options for patient communication available. Some offices are not only utilizing an individual recall person in their office, but are also using an outside source to help reduce the amount of time spent confirming patients for their appointments. What you have set up for your individual practice will make a difference in how the recall system works. This is a very unique system in every office.
I will briefly review one recall scenario – of course this verbiage will need to be customized based on your individual system.
“For your next appointment reminder, we have many options you may choose from. First we will be sending out a reminder notice. This will either remind you to come in for a specific appointment time and date, or it will be a reminder that you are due for your hygiene appointment. If you are confident of your future schedule and you need a specific time or day, you may want to go ahead and set up your next appointment to secure your preferred date. However, if you do not know what your schedule will look like in several months, you may not want to set up your next appointment just yet. We do ask for at least 48 hours advance notice to change an already scheduled appointment.
If you set up your appointment today, you will receive a postcard, email, text, and/or phone call to remind you of your appointment. We will also make contact with you approximately two weeks prior to your appointment. If you prefer that we use just one way of contacting you, we can always set up your account to reflect that. Some people like to have every form of communication, and some prefer just a text or email reminder.
There may be additional information provided during this educational time with the patient, but this gives you an idea. There are many things implied and not actually said by the hygienist during this synopsis:
1. The patient is educated about your recall system.
If you and your team are not taking the time to inform patients about your recall system, you may be missing a very important part of patient education that many offices do not consider. This can cost your office a high price in the form of open time in the hygiene schedule.
Interested in improving your hygiene department? Email email@example.com and ask us about our 1-Day Hygiene Training Program or call 877-777-6151
Leadership Lessons to Consider
Life informs many abstract guidelines for us to follow as we trudge down our paths, attempting to simplify our journeys for optimal success. Leadership is a bit of an abstract concept, which has many definitions and applications. Generally for dentists, the concept of leadership does not readily resonate with being a dentist. Being a dentist is typically thought of in terms of one’s ability to take care of people by way of their mouths. Leadership is generally thought of in terms of well-known figureheads throughout history, such as presidents, military generals, or CEOs. What about the “front-line” leaders? What about all the people who manage others in small businesses or medical practices? Are they not leaders? Are they not intending to persuade others through positive influence toward a common goal?
In thinking about the ways in which you are a leader, here are five leadership lessons tested by time and practiced daily by leaders at all levels, public or private. Think about which ones fit for you, which you already do well, and which ones might need some development. At the very least, reading this article, and ones like it, will give you a leg up, but integrating this information into the way you run your practice and how you interact with your staff and patients, will really give you an advantage.
1. Diverse teams generate better ideas. You have heard that ‘similarity breeds liking,’ ‘great minds think alike’, ‘birds of a feather…”, etc., but how does feeling good due to innate similarities manifest in star team performance? When it comes to a team functioning together, it does not, necessarily… Creativity necessitates different points of view, and sometimes this results in tension between individuals. Outside-the-box thinking requires fresh perspectives and change-willingness. Keeping at the vanguard of dental care necessitates being abreast of current knowledge and requires constant development as team. Having a well-oiled machine is one thing, but make sure your team is heterogeneous enough to keep the practice a little on the edge. This will provide a unique service to your patients, and will keep you and your team stimulated and engaged.
2. To lead you need to let go. If you are a roll-up-your-sleeves and get the work done kind of dentist, you may be doing all the work! Make sure to surround yourself with competent professionals to whom you can delegate and not have to worry about whether they complete the task or not. Your role should be specialized – something no one else can do – and your staff’s role should be to do everything else. No one appreciates a micromanager, in addition to the fact that micromanaging is not the same as leading. Leading successfully actually allows you to focus on what you do best, which will bring about even better results!
3. Meet resistance head-on. Whether it is internal resistance to accepting your leadership responsibilities or external pressures acting to keep you too busy on other things to worry about what kind of leader you are, you must meet the resistance head-on. When we don’t confront resistance, it remains, and can even become stronger due to the psychological feedback mechanism that says: “If I’m not confronting that obstacle, it must either be because it is too difficult or I am not equipped.” If you are caught in this unhelpful thought process, things only become harder; not easier. If, however, you would like to alter this process, remember: You are the Leader!, and therefore the responsible person to go head-to-head with the difficulty.
4. Without strategy, change is merely substitution, not transformation. There may be things you want to change in your practice, and as the leader, you may be considering them, or are already involved in making those changes. However, make sure you have a solid strategy, which can be plotted 5 and 10 years out. Leaders who have their eye several years ahead are much better able to make decisions about what to do in response to today’s stressors. These leaders also end up seeming much more successful and therefore command a more loyal followership. Be the change you want to see; don’t get lost in the maze of reactivity. Make your practice’s future your professional as well as your personal goal.
Trust yourself. This involves the ability to know your strengths well enough that they allow you to navigate your practice issues successfully. This requires you to know your natural talents, capabilities, and skill-sets, as well as strengths you’ve learned or developed along the way. If you do not have a clear picture of what you bring to the table, as a dentist, as a leader, and as a person, consider professional leadership coaching to assist you in creating or building upon the foundation for launching you into effective leadership.
Dr. Gale provides coaching and training to enhance leadership skills, interpersonal communications and team building. If you would like to learn more, contact him at firstname.lastname@example.org
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