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2.15.08 Issue #310 Forward This Newsletter To A Colleague

Hygiene Salaries How Does Your Practice Rate?
by Sally McKenzie CEO
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It’s that time of year again; time to see how your practice fares on the salary survey. RDH Magazine’s annual hygiene salary survey results were recently released. For some practices, dentists can breathe a sigh of relief – they are right on track with averages. For others, you may find that the results pour emotional gasoline on an already raging wage war in your office.

Of the top 15 states listed, 13 of those reported that 40% or more of the hygienists surveyed do not believe they receive raises in “fair intervals.” Yet in 12 of those states 50% or more of the respondents had received a raise within the past year. We’ll talk about “fair” in a minute. First, here’s how hourly wages break down in the top 15 states:

  • California $46.53
  • Washington $42.52
  • Illinois $36.85
  • Massachusetts $36.24
  • Oregon $36.13
  • Texas $33.84
  • North Carolina $31.36
  • Ohio $25.03
  • Tennessee $31.16
  • New York $30.65
  • Michigan $28.95
  • Wisconsin $29.28
  • Florida $29.09
  • Pennsylvania $28.13
  • Virginia $35.41

Now, let’s talk about “fair.” Obviously, what one employee perceives as fair pay could spell overhead disaster for a practice. Similarly, a dentist’s idea of a “reasonable employee wage” can keep the staff revolving door spinning. Certainly, compensation is one of the most emotional and challenging issues practices face, which is why it requires clearly defined guidelines. I recommend the following “Raise Rules.”

Rule #1 - Don’t increase anyone’s salary until you conduct a Salary Review. This mathematical tool enables practices to quickly and clearly determine how much of a raise they can afford while keeping total salary overhead in line with the industry.

Rule # 2 - Raises must be based on individual ability or achievement. This is the most effective compensation system because it is contingent upon demonstrated results. Moreover, it enables every team member to understand that individual job success equates to practice success, which equates to increased compensation.

Rule # 3 - Employee salaries should account for no more than 22% of your total overhead, not including doctor’s compensation or benefits, which will run an additional 3%-5%. For example, if your staff salaries for January were $14,300 and your average monthly collections are $65,000, you are within the recommended industry range of 19%-22% of monthly collections. However, you would be at the top of that recommended range.

Rule # 4 – Spell out exactly how the compensation system works in the practice, what is available, what formulas are used, what it takes to earn more money, and how much more an employee can earn in that position. Employees must understand how compensation is established – including benefits, bonuses, special perks, and their role in influencing their pay. If the employee does not understand the fundamental elements of compensation, whatever the doctor dishes out will never be “fair.”

Rule #5 - Pay close attention to hygiene compensation. If hygiene salaries are beyond 33% of production, consider paying the hygienist on a commission basis of 33%. If a hygienist is making $300/day, production needs to be three times her salary or $900 at a minimum. This is not the responsibility of the hygienist but the person responsible for scheduling the hygienist.

Another option would be to pay a guaranteed base wage plus commission. For example, if the hygienist works10 days a month and makes $300/day her monthly earnings are $3000. She must produce $9,000. If she produces $10,000 for the month the doctor could pay her commission of 15-33% on the $1,000 over her monthly goal. Next year, if her performance warrants a raise, she would get a percentage increase on the commission, provided it’s less than 33%, which is the maximum.

Don’t let the dollars slip through during non-production time. The hygienist should be paid 50% of her production salary for staff meetings, continuing education, and other non-production activity. But don’t spring it on the individual. Ideally, this should be spelled out during the hiring process. If not, you’re going to have to invest some time in staff education.

For starters, give staff a general overview of the financial picture of the practice to help them understand the real costs of operating a dental office. Unless overhead and expenses are clearly explained employees won’t get it. Consequently, they fill in what they don’t know with their perceptions – “Dr. is a miserly scrooge because I’m just sure the practice is raking in millions and we get a paltry 2% pay raise.” Team members must be given the opportunity to understand the raise rules and especially what influences them.

For information on the RDH Salary and Benefits Survey, visit

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Angie Stone RDH
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Why Should I Have Consulting for My Hygiene Department?

“Why should I have hygiene practice consulting? My hygienist already knows how to clean teeth. That is what she went to school for.” Does this sound like something you have heard from colleagues or have had this thought yourself? 

 While it is true that dental hygienists go to school for either two or four years to obtain a degree, they do not learn about the business of dentistry.  Hygiene school is no different, in this respect, than dental school. Dental schools main focus is on the mechanics of dentistry.  During a survey, when dentists were asked if they thought business knowledge would have been helpful to them when beginning their practices, an overwhelming number responded with a resounding, “yes”.  Consequently, many dentists felt that if these classes would have been a requirement, they would not have been taken seriously.

 Many respondents reported seeking this type of training after graduation, through continuing education courses, once they realized they had no skill in this area.  Many dentists relayed that they were not comfortable in the role of being a business owner and they would rather do dentistry and not worry about the other responsibilities. In order to work in an environment that entails only dentistry, dentists would need to seek out a position in a large dental corporation where management duties are left to corporate policies.

Without a formal business education in dental management, dentists will often hit roadblocks to practice success and not know which way to turn.  

 If graduating dental hygiene students were polled regarding what knowledge they had of practice production goals, patient retention percentages, insurance coding, etc., the general response would be that they had little to no knowledge. Required hygiene classes seldom if ever discuss which insurance codes  to use and how one missed appointment everyday can result in thousands of dollars lost over the course of a year.

 Hygiene students are not taught that hygiene production should be 33% of total practice production in order for the practice to be profitable.  As a result, there are many lost opportunities in the hygiene department.  Unless the hygienist seeks out this kind of continuing education on her/his own, there is no learning process.

 The Hygiene Practice Enrichment Program provides education in the business area of dental hygiene, as well as addressing key clinical issues that will help increase production and patient compliance. This program is geared to educate the hygiene team, along with the rest of the team, on the importance of a sound recall system, the development of the system, and the implementation of the system. During a three to four day program, the team is taught how to reduce the number of openings per day in the schedule, how to increase production, and how to develop a relationship with patients that will leave them excited about returning for their next visit!

 What if there is turn over in the hygiene department?  How does a practice replace a hygienist with another who will fit in with regards to practice theories and manner of treatment?  These issues are also discussed and solutions are taught during the hygiene practice enrichment program. 

Hygiene protocols are developed to streamline hygiene procedures and calibrate hygiene providers.  Protocol is essential in the event of the loss of a team member.  If all protocols are written, the event of incorporating a new team member becomes an easy task. If the applicant does not agree with the protocol, it can save time and money because this person is not hired.  The search can continue until the right candidate is found. Development of a protocol is an investment in the future of the dental hygiene department and can make many issues that arise easier to handle.

Interested in knowing more about how to improve your hygiene department?

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Dr. Nancy Haller
Dentist Coach
McKenzie Management
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Are You Disciplining Employees Effectively?

People are human. Mistakes happen. No matter how skilled, savvy, or well-intentioned, your team is bound to slip-up at one point or another.

It’s normal to feel uncomfortable with discipline situations because dentists are not trained to deal with the sensitive interpersonal dynamics involved in changing unacceptable employee behavior. There is a temptation to avoid conflict. But face it – a poor employee isn't going to get better unless she/he is made aware that there is a need to improve. By concentrating on the desired results rather than the employee's perceived shortcomings, you can improve the chances of a positive outcome.

The challenge is to use mistakes to impart knowledge, to expand skills, and to develop heightened awareness. Unfortunately for many, the word discipline is frequently misunderstood as it conjures up negative images and knee-jerk reactions....memories of being grounded and privileges denied.

The root of discipline is disciple…a student. To discipline means to teach. Discipline is to correct more than to punish behavior. If you want employees to be productive, you have to create a disciplined, teaching environment. Discipline is really a part of overall performance management.

Research indicates that perceived fairness is the key to effective employee discipline. It results in positive attitudes and behavior when it is perceived as being applied in a fair manner. Raise your employees’ responsibility, promote accountability, and enhance learning.

1. Review your personnel manual. Every dental practice needs sound, straight-forward policies as well as clear and concise job descriptions. Failure to do so leaves your employment-related practices vulnerable to challenges, grievances and possibly lawsuits, particularly if you are inconsistent in how you apply your policies and your pay structure/system. Of course, be sure to communicate rules regularly to employees.

2. Prepare. Only in a true emergency should you act without thorough planning. Do your homework. Research the situation until you have verified what the facts are and know that action is necessary. Anticipate how the employee will respond. Practice what you are going to say and in what sequence. Know your own communication style, how you are perceived, and how you will react in the event of a challenge or emotional outburst. The emphasis is on coaching the employee to do better. Knowing what you intend to cover in a face-to-face meeting, and sticking to the agenda, is much easier if you have planned in advance.

3.  Have a conversation with your employee. Ensure confidentiality. Discipline should never happen in front of others. Remember the purpose is to teach not embarrass. Identify the problem as you understand it. Be brief but specific. Then offer the employee an opportunity to present their side of an incident. There may be a factor you didn't know about that will help the two of you to solve a problem jointly. Refusing to listen just builds resentment and makes improvement difficult. Be fair to the employee. Consider his or her side of the story and any evidence submitted. Never criticize the individual, but rather focus on the actual behavior.

4. Stay focused on work related issues. You should act as promptly as possible while the incident is fresh, but you need to make sure you’ve got the facts. Parties may also need a little time to cool down. The conversation must be business-based to be appropriate.  Also, avoid addressing more than one or two concerns at a time. If necessary, schedule another meeting.

5. Document. There often is a misunderstanding about what and when to document. All disciplinary infractions should be recorded in some form. For minor, first-time offenses, write a note as a reminder that it is not formal. The employee need not know about this, and it does not require formal entry into a personnel file. If the problem reoccurs or if it is a serious offense, be sure to formalize the process by having the employee sign the document.

6. Follow-up. Know how you will monitor the situation. Discipline normally follows a series of defined, documented steps of increasing severity. The usual sequence is verbal warning, written warning(s), suspension or layoff without pay, and discharge. Only the most serious offenses require immediate discharge, but after careful investigation and documentation. Always confront an employee whenever there seems to be a discipline problem. You can learn to give feedback well. You must practice to improve your skill level – and be willing to be uncomfortable while you are learning. The goal is to help your employees achieve the overriding mission – to be successful in their careers and in your office!

Questions or problems with your employees? Contact Dr. Haller at

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