By Anne Guignon, RDH, MPH, CSP
When Irene Newman became the first dental hygienist, it was highly unlikely that she ever considered owning her own equipment, much less her own business. The dental hygiene profession, as first conceived, was a service profession that focused on delivering early, regular preventive care to school children in Connecticut. While we still serve patients and provide preventive and therapeutic services, the landscape has changed dramatically, especially over the last 25 years.
Depending on the state statutes, dental hygienists can now own their own businesses, provide care outside of the four walls of a traditional dental office using portable and mobile dental equipment, and purchase their own equipment and supplies for use in more traditional settings.
The academic world has changed as well. Years ago students were issued instrument kits that contained a variety of hand instruments and a typodont. Schools supplied all other equipment and supplies, a model that most hygienists expected as employees in a clinical practice setting. Until a decade ago, most hygienists assumed the dentist employer would provide everything.
In the academic world, today's instrument kits have evolved to contain not only hand instruments, but also slow-speed handpieces, magnification loupes and headlights, ultrasonic dental scalers and inserts, and, in one program, the student's saddle stool. This cost shifting trend started as a way to contain the financial outlay incurred by the academic program. But soon many schools recognized students who owned their own equipment took better care of their tools and more fully appreciated business costs. The students were also more prepared to enter nontraditional work settings where having your own equipment is a significant benefit.
Who can own equipment?
Unless a particular state has an unusual set of statutes, there is no reason for a dental hygienist not to own their own equipment. Hygienists who have their own independent or collaborative practices, or have who are qualified to provide care in a more independent setting due to specific licensure or credentialing systems, purchase their own equipment and supplies all of the time.
Employees can also own their own equipment. There is a misconception that equipment ownership automatically makes a dental hygienist a contractor, not an employee. But equipment ownership is only one of many tests that must be met to be a contractor. According to the Internal Revenue Service, you're still an employee if your dentist employer sets the hours, controls the scheduling, determines the physical workspace, provides the treatment room, and supplies the patients.
Reasons to own equipment
A growing number of dental hygienists are choosing to purchase their own equipment. New graduates are more at ease with this process, but a growing number of seasoned clinicians are investing in clinical equipment and supplies. Factors that compel a clinician to make purchases include:
• Getting exactly what you want
• What works well in your hands to reducing the aches and pains that come from working with equipment that does not fit the body.
If the equipment is yours, it is easy to recreate a healthy workspace environment if you work in more than one office or it's time to relocate. In addition, many clinicians are choosing to take a more active role in their future, rather than letting an office budget determine what they work with on a daily basis. Some find begging for equipment distasteful and professionally demeaning.
Equipment ownership sends a clear signal that you are a committed professional willing to invest in your future. Many doctors are impressed with this approach, and clinicians are often able to secure a job in a competitive environment or even negotiate a more robust compensation package.
The purchasing process
There are many ways to achieve your goals, and taking the plunge into owning your own equipment is one way to increase control over your clinical environment. Some hygienists create an annual budget for equipment purchases, acquiring new equipment every year. Others, who are venturing into providing clinical services using mobile or portable equipment, may make multiple purchases in a shorter period of time.
It is important to select a company that is familiar with the dental hygiene services and procedures that we can provide in a particular state. Companies that sell directly to dental hygienists are often aware of equipment options that are designed to help us achieve our goals. Ask for bundled pricing if purchasing more than one piece of equipment.
Purchasing brand new equipment offers the advantage of a full warranty and eliminates any concerns about the maintenance or repair history, but the price tag will be higher than acquiring pre-owned equipment. Used or refurbished equipment may be more affordable initially, but the original manufacturer's warranty is rarely transferrable.
Regardless of how the purchase is made, keep all original receipts. Make sure your name is on each receipt and that they are marked as paid. For insurance purposes, or when claiming a tax deduction, it is smart to photograph each piece of equipment, record all serial numbers, and make duplicate copies, which should be stored in an office site location in case of a theft, fire, flood, or other natural disaster. Records like this also come in handy in case there is some dispute over ownership in an office.
A business-like approach
Some clinicians negotiate for equipment instead of a raise. While this may seem attractive to all parties, outline the terms in a written agreement that documents exact ownership and the length of time that is covered by swapping equipment for a raise. Without a memorandum of understanding, a worker could be forfeiting a potential raise for an undetermined amount of time.
Others have agreed to co-owning equipment with a doctor. This approach is fine as long as a cordial relationship is in place. But what happens if a clinician chooses to move to another practice or out of state, the original doctor gets sick or passes away, or the practice gets sold to another doctor or a corporation? None of these scenarios are far-fetched, and all are fraught with problems if equipment is co-owned.
Typically, dental hygienists who choose to purchase their own equipment feel a sense of pride in investing in their own physical well-being and the future of their careers. Often, their enthusiasm is met with skepticism or a cold shoulder by dental hygiene colleagues, especially if they are working in the same clinical practice. In rare cases, some doctors come to expect their hygienists to provide equipment and supplies.
Get equipment ownership agreements in writing, thus avoiding unpleasant miscommunications or misunderstandings. An agreement should include a detailed explanation of the following:
• Who can use the equipment?
• Who covers the cost of disposable consumables?
• Who determines if repairs should be made?
• How are repair costs covered?
• Who pays for maintenance or upgrades?
Hygienists who have chosen the ownership pathway know all too well that it is not the norm, and research shows that currently around 10% of all clinicians make some or many purchases on their own. But the numbers are growing. Hygienists who own their own equipment feel a sense of pride in how they are taking control of the future of their dental hygiene careers and their own physical well being. RDH
Your colleagues' thoughts about equipment
1. Is it worth it to own your own equipment
"I constantly encourage hygiene students to invest in themselves and stress the importance of ergonomics. while I was temping I really enjoyed knowing I had my own ultrasonic to use." - Dee Vecchione, RDH, Ohio
"Be proactive in your career to invest in yourself. It is narrow-minded and shortsighted to think that a dental hygienist does not have a choice in equipment. Above all have ownership of your career and play it safe with ergonomic strategies." -Lana Crawford, RDH, BS, Texas
"When I moved to Oregon several years ago, my goal was to develop a mobile dental hygiene business. I had to purchase my own sterilizer and hand instruments just to get started. Over time, I've added more portable equipment to provide a wider range of services to more diverse population. Equipment purchases are a fact of life for those of us who have chosen to practice outside of a traditional dental office." -Kyle Issacs, RDH, BS, Oregon
2. Would you recommend this as a career strategy? If so, why
"I had my first pair of loupes delivered to the office address on purpose, and, boy, did I ever get the reaction that I wanted. The revelation of my purchasing power hit me. Suddenly, my input into product purchases were respected. There was no stopping me at that point! I suddenly realized that I did not have to stay in a stale, stagnant office because of the high-tech ultrasonic. I purchased my own unit and my own inserts. That opened up a new world to me. I realized that I could go practice anywhere." -Cindy Purdy, RDH, BSDH, CEAS, Colorado
"Owning your own equipment is very important for career longevity and is especially important if you are not a permanent employee in the practice. Most employers do not see the importance of ergonomics to our overall health." -Jenn Collins, RDH, California
"It is important to take ourselves seriously as professionals and bring the best options for us into our work. It diminishes our own worth when we say, 'I really want that, but my boss won't buy it for me.'" -Kathy Bassett, RDH, MEd, Washington state
3. Any pitfalls to ownership
"The only disadvantage is if there are other hygienists present in the office who did not do the same thing. It can cause ill feelings and undue stress in the workplace." -Lynn Southerland, RDH, BS, Texas
"One has to be ready for the unexpected when practicing mobile dental hygiene. It's important to know how portable equipment works and be prepared to replace a fuse or a battery out in the field." -Kyle Issacs, RDH, BS, Oregon
4. How do you handle jealousy from another hygienist or coworker
"I handle coworker jealously by focusing on my job and ignoring their immaturity. If the jealously continues and gets in the way of my job, I discuss the matter with my employer." -Jenn Collins, RDH, California
"Held my head up high and let the gossip continue. It did increase my stress, but it reflected negatively on the other hygienist. The dentists always came to me to discuss cases and talk shop because they knew I was serious about my career (not job) and could count on me to do the best service to the patient." -Lynn Southerland, RDH, BS, Texas
"I don't make apologies for taking good care of myself professionally. We all make a good salary and can take tax advantages for equipment for our jobs. It's a point of view-investing in yourself. I find it personally more enriching than hair color and acrylic nails." -Kathy Bassett, RDH, MEd, Washington state
5. Any office ground rules that should be followed/implemented
"It should be documented somewhere in the office exactly what is yours-just for the record." -Lana Crawford, RDH, BS, Texas
"Equipment I paid for and take care of the upkeep is not for open use. If others want to use it, it needs to be a business arrangement with provisions for upkeep, proper use, and liability for damage." -Kathy Bassett, RDH, MEd, Washington state
6. Do you think ownership has helped hygienists find or retain a position
"Over the years, dentists have told me that they are impressed by hygienists having some of their own equipment." -Lana Crawford, RDH, BS, Texas
My work with clients in a nursing home or at community centers would not be possible if I did not own my own equipment. -Kyle Issacs, RDH, BS, Oregon
Claiming an income tax deduction
While any equipment or supply expense can be deducted, the Internal Revenue Service has specific guidelines for deductions. Expenses can only be deducted if the user does not get reimbursement from their dentist employer or another party. For example, if your dentist chooses to reimburse you for the cost of your new saddle, then they are entitled to the deduction. In addition, deductions can only be made by filing a long income tax form with the appropriate documentation, and deductions must reach a certain threshold before they can be taken.
Hygienists in California who hold the RDHAP license or special extended care permits in states such as Oregon and Washington are in a position to own and operate their own businesses, making them eligible to deduct business expenses under schedule C.
As in all business matters involving taxes, consult a tax specialist regarding your individual tax deduction eligibilities and potential liabilities.
ANNE NUGENT GUIGNON, RDH, MPH, CSP, provides popular programs, including topics on biofilms, power driven scaling, ergonomics, hypersensitivity, and remineralization. Recipient of the 2004 Mentor of the Year Award and the 2009 ADHA Irene Newman Award, Anne has practiced clinical dental hygiene in Houston since 1971, and can be contacted at [email protected].