Revitalizing a career: Hygienist assumes a more active role on the business side of practice to recharge career aspirations

Sept. 28, 2015
Hygienist assumes a more active role on the business side of practice to recharge career aspirations

BY Lauren M. Cherico, RDH

I had been a hygienist for 14 years when I took a job working in the second office of my career. I was interviewed by and hired for the position by the receptionist/office manager, Mary. She and I had become friends in the six months we had worked together.

One day, Mary suddenly left the practice. I managed to remain in the office for another 18 months even though I knew I needed a drastic change. I had always exuded unwavering passion and excitement for my work. This was true even while I was in school. The excitement was natural and sincere and while it truly never left me, I was now bored with my position. I occasionally felt some stimulation or spark, which typically came from a challenging case and elicited a creative response on my part.


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I found myself frustrated with the dentist/hygienist dynamic I was experiencing, but it seemed to be the same everywhere. I hadn't received a raise in almost 10 years. I wasn't a valued asset to a dental office as I hoped I'd be. I was underpaid and felt underappreciated. Things weren't right, and it was my fault. What was I doing wrong? More importantly, how was I going to align myself with what I wanted?

Much to my surprise, one day the phone rang. It was Mary. "Hi, Lauren. You've probably been wondering where I went. I'm working in a beautiful, high-tech office in Pennsylvania, and guess what? We need a hygienist. I told the dentist and his wife that you are the best I've ever worked with. I would love it if you would come and meet them!"

As soon as we hung up, I picked the phone back up and dialed the number Mary had given me and scheduled an interview.

At that time, I was living in a townhome in Delaware with my two daughters and basically raising them alone. Even though their father was involved with them, he never supported me. The distance from my home to my existing job was 30 minutes, which made it difficult to handle things that came up with my daughters, with home, etc. I was excited to learn the new office was only 15 minutes from my house. That was a major plus!

The day of the interview, I walked in and instantly fell in love with the place. The entrance to the office was vintage and nostalgic. The décor was beautiful and the ambience warm and welcoming. It even had a working wood-burning fireplace. I felt like I had just walked into a close friend's home. My first impression was this could be my "dental home" for a long time to come!

The back of the office had the most sophisticated equipment I'd ever seen or had the opportunity to work with before. It was also very charming. The office was clean, neat, and organized down to every nook and cranny. Even the sterilization area was perfect. I was not surprised to learn the building was a historical landmark registered by the township.

Even the arrangement between the dentist owner and another dentist was unique. The owner treated patients Tuesday through Thursday and some Fridays. On Mondays he worked as a clinical instructor at the University of Pennsylvania. This meant his office was not used on Mondays, so he rented it out to another dentist. This man had a second office he worked at the other days of the week. Between the two dentists, I was offered full-time hours five days a week.

The caveat was that the position might only be temporary. The current hygienist was on maternity leave and was undecided about returning to work after taking six months off. But that didn't matter to me. I was willing to take a chance to become part of something that excited me, even if it would only last for six short months.

This is where things got interesting. I had decided that I wanted $38 per hour due to the lack of proper compensation for all my prior years of hard work. I estimated this would catch me up to current-day salary and wages. Well, the dentist had something else in mind.

Much to my surprise, I was offered a commission formula that was comprised of 33% of all hygiene procedures, including X‐rays that were generated from my operatory. I would also receive 25% of all exam fees in exchange for my ability to encourage and facilitate preliminary restorative treatment plans. I would be paid upon production, not collections. Collections were another person's job according to my potential new bosses. I did not even know such a thing existed, but it intrigued me!

The owner dentist was a unique businessman and innovative thinker. His current hygienist was being paid based on a similar, but more modest, version of the formula. He believed that his hygienist should be paid exactly as he was paid. That meant I would be paid only if there was a patient in the chair. I asked him to approximate a dollar per hour amount of the current hygienist's earnings so I had a frame of reference. The number he quoted was well within the pay range I was looking for.

He did not offer paid vacation. His train of thought was he didn't get paid when he was on vacation, so why should the hygienist get paid for being off? He did, however, offer medical insurance and dental work at no cost. In exchange for my dental work, I would provide hygiene services to his family. There were also 401(k) and profit-sharing plans, and continuing education and uniform allowances. I mentioned that if I took the position, I would need medical insurance for my daughters as I had agreed to be legally responsible for this during my divorce proceedings. The dentist agreed to my request.

This was a dream job, and hygiene nirvana all rolled into one! It was way better than I could ever have wildly imagined! I left the interview elated, and I felt the job had to be mine. One week later, I received the phone call! I got the job by default; no one else had applied.

Traditional, but state of the art

Soon after I started seeing patients, I learned that the doctor's wife had just become involved in the practice because it was financially broke. There was a lot of expensive equipment and not enough revenue. It was then I realized they really needed me, just as I needed them. I could see the path in front of me and I was eager to start.

The doctor's wife had a strong character. She had prior office and business management experience, and her skills were polished. She was an invaluable asset. She helped the office adopt the adage we lived by: "Old-fashioned service, state-of-the-art technology."

The first step in getting the office back on track was a weekend continuing education course presented by a prominent dental consulting firm. I was instructed to use an intraoral camera and of course all other diagnostic procedures to achieve my goal of encouraging and facilitating preliminary restorative treatment plans.

When we arrived back at the office, I began implementing all of the strategies I had learned. I picked them up quickly. The system was working and I was working hard. Since the inception of the new system, the dental hygiene department production almost tripled within the first six months. With this increase, I could no longer manage the patients on my own.

The schedule was bursting at the seams! It was time for a second hygienist to join us part‐time, and the position could quickly grow into full‐time hours if the person was interested. In that first year, the office as a whole made almost $1 million. This was incredible considering that when we started the office was in debt.

Foundation of practice

Over the next several years, an evolution took place. Each year, I raised my level of performance by incorporating strategies that worked as well as new technologies. This was no longer just the doctor's business. I was running my business within the dentist's business, and I took this very seriously.

The value that I created for myself was integral to the foundation of the practice. I was willing to work harder than the doctor and afford him the option to work as little or as much as he wanted. He also had the luxury of doing the kind of dentistry he preferred, which was full-mouth and quadrant cases. I had become instrumental in facilitating preliminary restorative treatment plans, just as I had agreed to.

Not only was I working in my business during production hours, I found myself working on my business during nonproduction hours, which is when I did all of the administrative activities that are the responsibilities of an owner.

Sometimes I would be there for two or three hours after everyone else went home. I spent this much time for two reasons. In the beginning it was an overwhelming amount of work. It's too difficult to convey here all of the things I did to achieve my goal. It was really important to me to balance the relationship between me and my patients so they knew the worth of what they were paying for. My hygiene visits were oftentimes pricey after adding in augmented services to their visits. I needed to create a wow effect.

My intention was to be the dental hygiene version of the Four Seasons Hotel or Nordstrom's Department Store. To give you an idea of what this work resulted in, I had a patient travel from England every three years to see me. I had a patient who lived in Florida for six months a year, and, while in Florida, she flew up every two months. There was a patient with Sjogren's syndrome with whom I had done extensive work. She had to cancel one time in all the years I treated her and did so a few days in advance. The next time I saw her, she brought me flowers as an apology.

It was always about the patients. They knew that they were especially cared for and they were willing to pay for that level of service. This hard work created a value for myself that was unprecedented and undeniable. It spoke for itself. Also, reflected in my work was the impeccable health of my patients' mouths the entire time I was with them.

In 10 years, I had an explosion of advancement and development both professionally and personally. I couldn't imagine a more visionary and rewarding experience. My salary and compensation reflected my work. It was steadily among the top 5% to 10% in the country for years.

Mary eventually left the practice. She and her husband moved south to warmer weather. As I said my final goodbye and thank you to her, I couldn't help wonder where I would have been if she hadn't called me that day. While I haven't seen or spoken to Mary since, her decision to pick up the phone and call me changed my life forever for the better. It's fascinating how one small gesture can accomplish something so powerful. RDH

Lauren M. Cherico, RDH, is a new author and 29-year veteran of clinical dental hygiene, of which she is still enthusiastically practicing. Chairside hygiene has been her sole focus throughout her career. Lauren currently resides in Delaware and has practiced in both Delaware and Pennsylvania.