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Salary vs. commission: Which boosts your bottom line?

June 21, 2022
Is earning commission as opposed to being paid a set salary the right move for you? There are pros and cons to both.

“I earn more working three days on a commission than five days on an hourly wage.” What a dream, right? This is true for many dental hygienists, but it doesn’t happen without understanding the many variables involved. While an hourly rate can provide a sense of income security, working for commission has the potential to increase your flexibility and maximize your earnings.

What variables should you ask about when considering a commission or salary wage in dental hygiene? There are many pros and cons to each choice. Here are six questions to ask employers so that you can negotiate fairly and competitively.

1. What is your commission percentage, and what is the comparable hourly rate?

This is the most obvious question, and this percentage affects the next questions so you can determine whether it’s worth moving from hourly to commission or accepting a commission rate in general. To find general statistics on dental hygiene remuneration, visit jobseeker sites such as payscale.com to review your offer compared to national averages. Generally, you should be aiming for 30%–40% of your daily production in a straight commission structure.

For example, if you work eight-hour days four days a week with a consistent patient base, and you conduct $1,200 worth of business each day at 35% commission, you earn approximately $420 per day, $1,680 per week. A commission percentage requires an understanding of the office, the patients, and the recall protocols. You might consider an hourly rate if you’re new to a practice.

2. Are the appointment books consistent?

A commission means that no patients = no earnings. Are the appointment books consistent enough to make up for the cancellations and lulls when the practice isn’t as productive? When I say consistent, look for at least 80% of your day to be filled with 60-minute appointments, and be sure there are no more than two gaps per day maximum. It is also essential to track downtime and it’s a good idea to ask what protocols are in place when there are cancellations, and what is done to keep downtime to a minimum.

Don’t be afraid to ask what the books currently look like. If you mainly see an overflow of patients, there may not be enough patients to fill your book. Who manages the schedule? Remember, dentistry is a business, so in this scenario, the owner may offer a commission package as your books may not be consistent. I would get a guaranteed base pay amount to secure yourself a minimum wage or agree on an hourly rate and renegotiate at your performance review. Federal law requires that nonexempt employees, which includes most dental hygienists, to be paid at least minimum wage for hours worked. Hours worked include all the time during which an employee is on duty, including clinic upkeep and assisting the front office with scheduling.

Related reading

Dental hygiene duties when paid by commission: The job description is often too vague
Common questions when developing a commission-based compensation plan for dental hygienists

3. Is this a new appointment schedule or is it taking over an existing one?

Another variable may be clinicians who have been with the office for years and have seen most of the patients. This can impact how your appointment book grows and how long it takes to fill the days you’re contracted to work. If you’re taking over an existing consistent appointment book, this may work better for you than a commission structure. Also, for straight commission to be effective, the dentist must place importance on preventive work, and a periodontal program must be in place. If neither are in place and your goal is to build it, an hourly rate may be more appropriate.

4. What payment methods are available?

A hygienist’s salary can be paid as straight commission, a combination of salary and commission, a fixed annual salary, or daily/hourly rate. Each has its advantages and disadvantages. Salaried hygienists often receive sick leave and paid vacations whereas straight commission arrangements may not have any benefits. However, if the forecasted commission wage outweighs the offered hourly rate, you may think it’s worth it. You should carefully evaluate a combination of commission and salary: can you live on the base pay alone? Does your dentist value preventive treatment? Commission wages require consistent patient flow so if the dentist does not value this, patients often don’t either. If you have an assistant, this can free up your time for you to see more patients, which means more production and commissions.

5. What are the benefits?

Benefits should be negotiated just like an hourly rate or commission percentage. Aside from benefits enforced by law, these may be continuing education, production bonuses, free dental, parking, paid vacation time, sick leave, health insurance, or retirement benefits. For example, if an employer is negotiating a lower commission wage, I recommend negotiating benefits to compensate until you can ask for a pay raise at your performance review. Of course, each situation will affect how someone views a benefits package, so negotiate for the benefits you value the most.

6. Is there any flexibility?

Working on commission allows you to work your career around your lifestyle. Prove to your boss that you’re productive and taking initiatives in your earning potential. Whether you need a late start to drop off your child at school or prefer to work part time, working on commission allows this flexibility more than an hourly rate depending on how productive you are.

Fulfillment in dental hygiene requires a plan that offers job security, as well as flexibility to adapt to life changes, personal goals, and interests. Many leave the profession because of burnout and stress, family responsibilities, or to pursue new interests. Challenging yourself by finding ways to advance your professional development and compensation packages has the potential to lead to great career satisfaction. 

About the Author

Emma Cubis, BoH

Emma Cubis, BoH, is an oral health therapist based in Melbourne, Australia, with more than nine years of experience. A graduate from the University of Melbourne with a bachelor of oral health, Emma educates individuals beyond the dental clinic about oral health and its connection to overall wellness through her social media platforms @emmatalksteeth. In addition to being a practicing OHT, she is the founder and host of the Talk Dental to Me podcast. Contact her at [email protected].