A case study of employment in the middle of Tennessee
by Susan B. Solomon, RDH, MA
In late 2012, Tennessee's Fifth District of the American Dental Hygienists' Association conducted its employment survey of the hygienists who are registered in the district -- a project undertaken every two years since 1990. The struggling economy provided an incentive for taking a closer look at the local hygienists' work conditions.
The Fifth District, otherwise known as Nashville Area Dental Hygienists' Society, cuts a swath north to south from Kentucky to Alabama through the middle of the state. The district includes 12 counties, and the cities of Nashville, Franklin, Columbia, Dickson, Hendersonville, and Lawrenceburg. These counties include rural, suburban, and metropolitan areas, displaying disparate economic conditions.
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In many ways, the careers and experiences of Fifth District hygienists reflect what is happening around the country, and provides a good case study for the current economy. The survey questions about the general economy in Tennessee show a clear picture of hygiene work shortage.
Of the approximately 1,169 hygienists registered in the Fifth District during the 2012 survey, 115 or approximately 10% of the district responded. While not quite 10% of the district's hygienists are ADHA members, members represented 42% of the respondents. Even though less than half of the respondents are ADHA members, 99% feel that ADHA and the Tennessee Dental Hygienists' Association represent them.
To get an accurate picture of the income of Fifth District hygienists, both the hourly rates and the number and value of benefits must be taken into consideration. For example, there is always a great variety in the number of paid vacation days, holidays, and retirement plans (see Figure 1). Some dental hygienists whose hourly rate is below average have a significant number of benefits. Some bonuses may be reflected in the hourly rates and some are listed as benefits, as the hygienists were asked if they received a salary plus a regular bonus, and were later asked if they received annual, Christmas, or occasional bonuses. The amount of a bonus can also vary greatly. And of course, there are many intangibles that cannot even be quantified.
Recent Decline in RDH Income
From 1990 until 2008, the average hourly rates for Fifth District dental hygienists had increased. 2010 was the first year since the surveys started that the average hourly rate was actually less than the prior study. In 2008, it was noted that it was "a year in which the U.S. and world economies faltered. How the changes in the U.S. economy will effect our occupation in our location may be seen in our next survey in 2010." The downturn in the economy did affect the Fifth District hygienists in 2010. Rather than continuing upward, average reported hourly rates dropped 26 cents from 2008 to 2010. This trend has continued with the average hourly rate reported by the hygienists in the 2012 survey dropping another 45 cents per hour.
The average hourly rates for the last four surveys were:
- 2006 $32.66
- 2008 $33.66
- 2010 $33.40
- 2012 $32.95
Perhaps another indication of the employment challenges facing dental hygienists in this area is the modest increase in the number of hygienists who report working in multiple practices. In 2008 and 2010, 16% of the respondents worked in multiple offices; the number has now grown to 19%. This perhaps is the start of a trend of dental hygienists trying to fill out their work schedules by taking on a number of part-time positions in lieu of being able to obtain full-time employment. This also reflects the challenges that dentistry in general is facing.
Because of the current job shortage, many workers in different sectors are experiencing employment insecurity. The Fifth District survey also indicates that Tennessee dental hygienists also experience some vulnerability; 42% of the respondents said the downturn in the economy affected their income. Fewer practices offer retirement plans, so hygienists are also challenged to make plans for their retirement. Both the opening of new schools and the reduction in the demand for dental hygiene services have added to employment challenges.
Nevertheless, the Bureau of Labor Statistics (BLS) projects that the employment of dental hygienists is expected to grow by 38% from 2010 to 2020, much faster than the average for all occupations. Likewise, US News and World Report continues to recommend dental hygiene, rating it as #10 in the 100 Best Jobs in 2013. Reconciling the recent decline in income and shortage of dental hygiene positions with the rosy picture painted by US News and World Report and BLS statistics is challenging.
Helping to understand this discrepancy is the fact that new dental hygienists under age 30, or those practicing for one to three years, report lower hourly rates. Hygienists who have been working four to six years have higher rates, and the group working 20 or more years has the highest reported hourly rates. The newer hygienists competing for fewer jobs have skewed the average hourly rate downward. Hopefully, more doors will open in public health with the creation of advanced dental hygiene therapists, and the economy will continue to improve so that the current tenuous outlook for hygienists will abate.
Type of compensation
Along with stagnating wages, there has been a shift in the payment agreement from salaried to hourly agreements.
There is a significant change in the number of respondents who receive pay by the hour over the past six years:
- 2006 15%
- 2008 28%
- 2010 50%
- 2012 55%
Likewise, there is a significantly lower percentage of respondents receiving salary, or salary plus commission or bonus received on a regular basis.
In 2012, less than half of the respondents are being compensated by salary, or salary plus regular bonus:
- 2006 74%
- 2008 62%
- 2010 48%
- 2012 42%
Comparing some of the most common benefits also shows a decline in the Fifth District's economic situation. Fewer respondents received paid holidays and paid vacation days since 2008. Also, fewer hygienists receive retirement plans. The most significant change is the number of hygienists receiving paid vacation. In 2008, almost all hygienists received this benefit; in 2012 it was slightly over half.
Percentage receiving paid vacation:
- 2008 93%
- 2010 61%
- 2012 53%
Percentage receiving paid holidays:
- 2008 90%
- 2010 67%
- 2012 59%
Percentage provided retirement plan:
- 2008 61%
- 2010 45%
- 2012 34%
Private Practice vs. Corporate Practice
In recent years, a growth of corporate dental practices has occurred (Castle, Embassy, and Aspen, for example). Private dental practices may be incorporated, but are local practices with fewer office locations. In 2010 the survey included a category for large corporate practices to see if there is a difference in the status of hygienists working for them.
The hygienists who work at the corporate practices are treated consistently; most of them are paid hourly wages. In comparison, 51% of noncorporate dental hygienists are paid with some type of salary agreement or commission. Most of the corporate dental hygienists are offered medical insurance (90%), with 50% of them using their practices' medical insurance. They are given slightly fewer holidays, vacation days, and personal or well days than overall. Also, more corporate practices offer employees retirement plans with a small corporate contribution.
Another measurable difference between corporate and private practice is the average number of patients seen per day. In both 2010 and 2012, the normal patient load reported for hygienists who work in private practice is seven to nine patients per day. In both survey years, hygienists who work in corporate practices tended to see more patients each day (see Figure 2).
A final observation about the survey would be that 93% of the respondents support the creation of an advanced dental hygiene practitioners. RDH
Other key statistics from 2012 TDHA Fifth District Employment Survey Report
- Hygienists in the district: 1,169
- The educational backgrounds of those participating in the survey: associate's degree, 58%; bachelor's degree, 39%; and master's/doctorate, 3%
- 69% were married or living with a partner; 17% were no longer married or living with a partner; and 14% never married
- Number of dependents: 47% reported no dependents; 39% reported one or two dependents; and 14% reported three or more dependents
- 34% work 33 to 40 hours a week; 34% work 25 to 32 hours a week; 16% work one to 16 hours a week; 11% work 17 to 24 hours a week; and 5% work more than 40 hours a week
- Average number of patients per day: 61% treat seven to nine patients a day; 18% treat 10 to 12 patients; 11% treat one to six patients a day; and 7% treat more than 12 patients a day
- Compensation type at current workplace: 55% receive an hourly rate; 35% receive a salary; 7% receive salary plus commission or "consistent" bonus; and 2% are on straight commission
- Uniforms are provided to 42% of dental hygienists, and a uniform allowance is provided to 8%
- ADHA dues are paid by 8% of employers
- 42% say the economic downturn decreased their income as a dental hygienists
- 32% say the economic downturn decreased the number of hours worked
- 30% would like to work more hours
- 22% are currently seeking employment
Susan B. Solomon, RDH, MA, has a bachelor's degree from Douglass College, a master's in history from Yale University, and an associate's degree in dental hygiene from Meharry Medical College/TSU. She has practiced dental hygiene in the Nashville, Tenn., area for over 25 years, is a member of ADHA, and the Tennessee Academy of Dental Hygiene. She can be contacted at [email protected]. The author gratefully acknowledges Sue K. Bessner and McKenzie Smith at the American Dental Hygienists' Association for their assistance with the survey referred to in this article.
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