The Problem with Guaranteed Hygiene Salaries

By Sally McKenzie, CEO

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To many dentists, it just makes sense to pay their hygienist a guaranteed salary. They receive an hourly wage just like any other employee, which in theory seems like the best set up. Both dentist and hygienist know what to expect each month, and everyone is happy.

The problem? Your hygienist is a producer. If she knows she’s going to get the same paycheck no matter what, she really doesn’t have much motivation to up her production numbers. She can’t grow her income, so she’ll continue to perform the same. And if she knows they’ll be a raise thrown in every year regardless of her performance, she’ll be even more content to stick with the status quo.

I suggest you consider to start treating your hygienist like an associate, who typically earn between 30 and 35 percent of what they produce. If they produce more, they earn more, which of course motivates them to improve. Would you ever ask your associates to grab the recall list and start making phone calls in their downtime? Of course not. You want them producing. The same should be true of your hygienist.

How guaranteed hygiene salaries hurt your practice

Many dentists pay their hygienists a guaranteed salary because they want to keep them happy. Most employees prefer to know exactly how much they’re going to make each month, after all. But if the hygienist is falling short of production goals and still taking home the same paycheck, it’s eating into your bottom line and damaging your practice. When your hygienist’s salary goes beyond the 33 percent of production benchmark, you’re dealing with high overhead costs and all the trouble they bring rather than enjoying practice success.

So what are some reasons your hygienist isn’t meeting production goals? It could be because the Scheduling Coordinator isn’t trained to schedule her to produce three times her salary, or that you have a non-existent recall system, which means no one is accountable for scheduling hygiene patients. If these systems are weak, your hygienist will fall short of production goals more often than not. The result? You lose money, yet still need to pay your hygienist the same wage. Can you see how that might do some financial damage to a practice? Yes, it’s not the hygienist’s fault, but the practice still suffers, and so does the rest of the team.

What about paying hygienists straight commission?

This is another system dentists like to use, but I don’t recommend it either. Remember when I said employees like to know how much money they’re going to get in their paycheck? That number will be different every time if their salary is based on straight commission—which could make them a bit uneasy. One month of low production might put them in a financial bind.

You also have to keep in mind some hygienists might be willing to sacrifice quality for quantity if they know it means more money in their pocket. Fortunately this is rare, but it’s not something you can ignore. When hygienists focus on quantity, they’re not providing patients with an exceptional experience and top-notch care. Patients notice the difference and aren’t as happy as they once were, and might even be prompted to start looking for a new dental home.

Why you should consider a two-tier system

If you’re not going to pay hygienists a straight salary or base their earnings on commission, how exactly should you pay them? I suggest a guaranteed base plus commission. I believe this is the best option for dentists and their hygienists. Knowing they’ll always receive that base pay makes them feel financially secure, but the opportunity to make more motivates them to excel. They now have a reason to focus on improving their productivity because the more they produce the more they earn, which also translates into higher revenues for the practice. It’s a win/win.

Get your hygienist excited about the potential earnings

When you first talk with your hygienist about the new system, you might get some push back. People don’t usually like change, and this is a big one. Take the time to explain why it’s beneficial to everyone involved. Make sure she understands how it works and how she can earn more. Let her know how important her contributions are to practice success, and that you want to reward her for her efforts. It might take some time, but she’ll soon understand how the new system benefits her, and she’ll be ready to make some changes so she can start earning more.

While it’s likely something you’ve done for years, paying your hygienist a guaranteed salary isn’t doing her or your practice any favors. She has no extra earning potential and as a result no motivation to improve—putting both her and the practice in a rut. Switching to a two-tier system that allows your hygienist to earn more will give her the push she needs to increase her productivity numbers. She’ll finally have an opportunity to grow, giving her more job satisfaction and a little extra pep in her step. You’ll find that means increased production and revenues for your practice.

Next Thursday: The two-tier hygiene salary: Why it's best for your practice Share this Newsletter

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