Workers all over the country are now in a stronger position to negotiate employee agreements, creating a stronger, more equitable work/life balance. While COVID accelerated some dramatic shifts, changes in the workplace started taking place about 10 years ago with the rise of the gig economy. Decades ago, potential employees were given an offer, and very little negotiation ever took place regarding duties, pay, or benefits. Many considered it a badge of honor to remain with the same firm until retirement.
Now the world is upside down. For the first time in over 25 years, there is an abundance of practice opportunities where we can be paid fairly and respected for our contributions to the business. The glut in the marketplace is gone, and we are freer than ever to find a dental home that meshes with our personal needs and practice philosophy. It’s not about being greedy, but rather a time to closely examine fair employment practices.
Taking an active role in your future
Set the stage for success. Take an active role in what you bring to a practice and consider how your contributions help the practice prosper. Being paid fairly and correctly is critical, and if there is not a good philosophical fit between you and the practice owner, it could be time to move on.
While change is intoxicating to some, and threatening to others, keep your head on straight and don’t assume anything. It is time for dental hygienists to adopt an ownership mentality about our professional careers.
If you are contemplating moving to a new practice, there are several important considerations. These principles apply to permanent positions as well as short-term assignments. Whether you are working as a hygienist du jour, or have found your forever home, understand what you are agreeing to when you accept employment. Here are seven strategies that ensure a smooth transition.
1. Understand tax and labor laws
Reading practice acts can be a real snoozer, but understanding the basics prevents a lot of heartache. Most state practice acts say a dental hygienists must work under the supervision of a dentist licensed in the state. This supervision requirement means dental hygienists are employees according to IRS worker classifications. Clinical dental hygienists must be paid as employees.
Related: Understanding the complexity of employment law and worker rights
Employees are not independent contractors. Fill out IRS W4 form and submit it to the doctor or office manager to ensure taxes are paid correctly. The dental office must send all employees a W2 form at the end of the year that details all wages and taxes paid over the last 12 months.
Federal Department of Labor (DOL) statutes are different from the tax laws, but impact hygienists as well. The DOL focuses on fair wages and workplace conditions. State labor boards protect employee rights and enforce both federal and state statutes. Independent contractors are not employees. When misclassified, workers miss out on important protections such as required overtime pay. They may be forced to work off the clock. They may be denied fair pay for mandatory meetings, unemployment benefits, worker compensation if injured on the job, or protection for nursing mothers.
2. Don’t sign anything until…
Read all terms and conditions for any employment offer or agreement. The same advice applies to any agreement with an employment agency or staffing service. These are legal documents. It is critical to understand the terms. If you don’t understand a provision or don’t agree with an aspect in the agreement, ask for an explanation. Don’t sign on the dotted line until the information is clear. It’s a huge red flag if someone pressures you to sign a document or says “It’s only paperwork.”
3. Request the employee manual
Employee handbooks are all over the map. Some are outdated, others are written like an encyclopedia, and some practices don’t even have one. Employee handbooks, also called manuals, are critical for a well-run business. If properly constructed, a current and detailed manual spells out the rules of the road. It can be a life-saver when there is confusion or drama over an office policy or an employee behavior. A qualified human resources expert can assist a practice in either developing or updating a manual to support workplace fairness and equality. Employee handbooks need to adhere to and comply with state and local laws. Neither the IRS nor DOL consider ignorance of the law when it comes to noncompliance. And workers can’t sign away their rights.
4. Ask for what you want
Topics such as worker classification, wage rates, hours and days, scheduling practices, and required breaks need to be ironed out in advance. Nothing is more demoralizing than finding out a certain benefit, such as a paid holiday, is not covered in your agreement. Until you sign on the dotted line, nothing is set in stone.
Employers are not mind readers. If you need or want a particular accommodation or benefit, have a discussion. The answer can’t be yes if you don’t ask for what you need or want. Eliminate the emotion from your request. Be prepared to negotiate and back up requests with facts. If the practice does not offer benefits such as paid holidays, health insurance, paid time off, uniform reimbursement to all full-time employees, then benefits can’t be offered to just one person. In addition, many dental hygienists are part-time employees, so may not meet the hours threshold to receive benefits. There are practices that prorate the benefit packages for part-time employees. If so, these details will be spelled out in the office manual.
If benefits are not available for whatever reason, why not get creative and negotiate a perk that is beneficial to you? The conversation can go like this: “Okay, since I am a part-time employee and don’t get PTO other than paid holidays that fall on my regularly scheduled workday, would you consider providing support for me to attend the annual RDH Under One Roof Conference, or providing a specific CE budget, or increasing my hourly rate by an extra dollar or two?”
Keep in mind that very few dentists and dental hygienists have business backgrounds. Our education focused on health-care matters, not human resources. Employers who value their employees will put effort into creating a harmonious plan.
5. Don’t assume anything
Get all agreements in writing—even if it is for one day of work. A simple email prevents disappointment. Spell out your exact requirements in all written communications. If you expect a full day’s pay, require a 24-hour notice to cancel a guest assignment, expect an hour lunch break, or need time to pump breast milk, add the specifics to the agreement. Inform the practice if you are bringing your own equipment or if you require a specific type of personal protective equipment. Make sure everyone agrees to the details.
Make it easy for the practice to pay you properly and on time. Provide the dental practice with all necessary documents in advance. Send electronic copies of a completed W4 form, your license, CPR certification, and any direct deposit information. Consider bringing a self-addressed, stamped envelope if your wages are being paid on the regular payroll day.
If you are a permanent employee, study the office manual. Know your responsibilities in addition to what you are entitled to as a worker. Every office is different.
It is dangerous to assume anything. If you choose to use your own equipment, such as a saddle stool or power-driven scaler, have a chat in advance regarding expectations. It is critical to have a written agreement that covers who can use the equipment, who pays for any repairs, and who covers the cost of any consumable products that are necessary to work with the equipment.
6. How to decline an opportunity
If you choose to decline a permanent position or not accept a short-term assignment in a particular practice, keep things simple. If the fit is not good, then trying to make things work typically backfires. If you don’t like the diagnostic protocols, the scheduling practices, or the office vibe, do yourself a favor and decline. You do not owe the practice an explanation. It is not your office, and unless the doctor or office manager really wants input, leave the suggestions up to a practice management consultant or human resources expert. Just move on.
If you choose to decline a position over worker misclassification issues, this can be a perfect opportunity to provide accurate information. The conversation can go like this: “Dr. Wonderful, I would love to work with you, but I can’t accept your offer. The 1099 status places your dental practice in a compromised position with several governmental agencies. The state practice act requires that dental hygienists be supervised workers. According to the IRS, supervised workers are employees. Both the federal DOL and state labor boards classify dental hygienists as nonexempt employees. Typically, malpractice and liability plans cover employees, not the work of an independent contractor. So, while I thank you for your offer, I don’t want to put your practice at risk of violating legal statutes and possibly paying fines or interest to the IRS or a state labor board. If you are open to providing employee wages via payroll, let’s continue this discussion.”
Some offices will not reverse their position on the 1099 issue. That is a business decision on their end. But given the current worker shortage, a dentist may choose to comply with the various laws to bring you on board. This is an example of why and how negotiations can work.
Related: Can my employer require me to take a longer lunch break?
7. Moving on
Change is hard for many people. Fear of the unknown keeps people stuck in environments that do not support growth or happiness. Some stay because of money or benefits; others resist because of close patient attachments. There are good patients everywhere, so staying for the patients rarely makes a bad situation better.
If you feel an urge to move on, spend a moment or two considering what you could have done differently to make your current situation work. It is wise to create a list of what you personally need or want in a professional relationship. Knowing what makes you thrive will help you find a better match as you move forward. Learn what you can from your past experiences, and start exploring your options.
You are not married to the dental practice. Even clinicians, reluctant to change, are finding practices where they are getting appropriate wages and benefits and now feel valued and appreciated. The growth in job opportunities in the clinical world is a welcome and unexpected benefit from the last 18 months. Today, there are more good jobs than ever. If you need a change, now is a great time to act.
Editor's note: This article appeared in the December 2021 print edition of RDH.
