Julie Whiteley, BS, RDH
In a perfect world, all employers would have a regular performance review system in place, and this would include the opportunity for pay increases. The reality is that there are practices that do not have an annual review process. In some cases, conversations such as these may never take place unless there is a problem.
When it comes to raises, according to the 2017 RDH eVillage Annual Salary Survey, 31% of respondents reported receiving an increase within the past year. Seventeen percent of respondents reported not having an increase in more than five years.1 These situations have the potential to leave employees feeling devalued, underappreciated, and underpaid. This can lead to decreased performance and commitment and can increase the turnover rate, which affects patient satisfaction and comfort.
Let’s start with a few facts. There are two types of pay raises. Merit increases are those based on performance. Cost of living raises are given to keep wages reasonable based on increasing living expenses and inflation. The US Department of Labor Bureau of Labor Statistics publishes information on the annual cost of living change. Neither type of pay raise is mandated for private employers by the Fair Labor Standards Act (FLSA).2 You may be thinking, “Well, they aren’t mandated, my employer doesn’t have a process in place, and I haven’t been offered what I feel is an earned increase, so what can I do?”
If you are in a situation such as this, it likely may be up to you to initiate the process. These conversations can make us feel on edge and may be difficult for a variety of reasons. The most obvious may be fear of rejection or being made to feel uncomfortable or retaliated against for even asking.
We must have confidence in our worth and advocate for what we feel we deserve. We need to approach our employers from a place of preparedness and come with facts. This is not an emotional conversation, but a business one. Ask yourself why you deserve an increase and relate this back to how you contribute to the success of the practice. The reality is that others (including those who are responsible for determining what we earn) don’t always know what we do. I recently had a conversation with a hygienist who was approached by a former employer who shared with her that he had no idea how much she did and how much value she added to his practice until she was gone.
With that being said, here are some dos and don’ts to consider when preparing your best case and to give you food for thought about areas you may want to invest in going forward.
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Do: find an appropriate time
Timing might not be everything, but it sure helps. It’s not advisable to approach someone on the fly and expect a good dialogue. Instead, request a meeting and consider a time of the day when you’ll catch your employer at their best and when they’ll have time to talk without interruptions.
Also consider timing with respect to what is happening in the practice. Timing could be less than optimal if there were a recent big expense, particularly an unexpected one. For example, a major plumbing issue occurred in one office right about the time I was planning on asking for a review and increase. I decided to postpone the conversation for a few months, and it was the right choice. If you were just told in a staff meeting that the practice has plateaued or declined, it may not be good timing on your part to ask for an increase. That time may, however, be an opportunity to set the wheels in motion by being proactive and bringing forth ideas to help the practice grow. Asking what you can do to help could be a wise move for the future.
Consider what you have done over the previous three to six months. If you have taken on additional responsibilities or had great production numbers, it might be an optimal time to bring that information forward and make your request.
Do: know your numbers
I understand that the subject of numbers can result in feelings of resentment and frustration. We are health-care providers and not salespeople. I believe this last statement wholeheartedly and do not support overtreatment. I do, however, believe we owe it to our patients to address disease and risk factors and help guide our patients to the most optimal care. We also have a duty to create value in our appointments in order to help patients understand that hygiene visits are not “just a cleaning.” When we do this, we have patients who are more committed to showing up for appointments and accepting the recommended treatment.
In order for a hygienist to earn a competitive rate, the business needs to be able to cover it. Industry standards suggest practice owners set salaries at a rate of no more than 22% of collections. We cannot turn a blind eye to how our hygiene departments factor into that equation. I covered this topic at length in the November 2018 issue of RDH magazine.3
Do some research on the going rate for RDHs in your area. Pay rates should be competitive, based on experience, performance, and contributions. There are several online sources available, including the US Department of Labor, Bureau of Labor Statistics. You may find other sites specific to your state that break it down by town. It is also helpful to consider practices of similar size and scope of practice. This information may be harder to gather, but I have found talking to colleagues or networking through my professional association to be most helpful to establish a baseline.
It is also important to understand the concept of total compensation, which is the combined value of pay rate along with benefits. If you are in a practice where you receive benefits such as assistance with CE, paid vacation time, health insurance, inclusion in a retirement savings plan, etc., your hourly rate may be less than someone who receives no benefits and is paid only for hours worked.
Know some basics about your production numbers. Track your production over a period of at least one quarter (three months). Your gross earnings should be approximately one third of that number.
It’s important to also understand how much of what you produced was actually collected, as this impacts the salary budget. The more insurance companies your office is in network with, the less will be collected.
I also recommend tracking your production by procedure. Is your day filled with prophies and occasional bitewings, or are you performing perio procedures, taking full series of x-rays where indicated, placing sealants, recommending adult fluoride where needed, etc.? Another industry rule of thumb is that perio procedures (those D codes that begin with the number 4) should account for approximately 30% of your hygiene production. When we consider the prevalence of periodontal disease, this number is not unreasonable. Even if you are not at 30%, if you can show that the number is going up based on your contributions, that is fantastic and should be included in your discussion.
Another great thing to track is your role in guiding patients toward needed restorative treatment. We all know that a good amount of restorative work is generated from the hygiene room. Show where and how you have directly impacted that number. Do you take the time to address potential issues with the patient and then bring those issues to the doctor’s attention at the exam? Are you taking photos to help educate patients on potential problems? Are you following up on unscheduled treatment at each recare and helping guide patients to treatment? A quick and easy way to do this is manually tracking on a day-to-day basis. Use a copy of your daily schedule to indicate treatment booked.
Also be aware of your downtime percentage. Downtime specifically refers to time you were available for patients (do not include lunch or work meetings), but did not have a patient. Here’s how you calculate this. One hour is typically broken down in the office schedule into either 10- or 15-minute units of time. If you are in a 10-minute office, there are 6 units of time in an hour. If you work 40 hours per week in this office, you have 240 units of time available each week (6 units x 40 hours). In an office with 15-minute units of time, you have 4 units per hour. If you work 40 hours per week in this office, you have 160 units of time available each week (4 units x 40 hours).
In order to get the percentage, divide the number of nonpatient time units you had over a period of time by the total number of units you were available over that same period. (The larger number goes into the smaller number to give you a decimal. Move the decimal two places to the right to give you a percentage number.) Industry standards indicate that downtime should be less than 5%.
Also consider what you do during downtime if you are on the clock. Work that keeps the hygiene department running smoothly and efficiently is important. Sharpening instruments is one area. Another is familiarization with recall and short notice protocols and offering assistance when needed in other departments. Knowing where the holes are coming from and adding to the solution can create value and decrease downtime.
Do: highlight other areas of contribution where you add value to the practice
If you have taken on additional responsibilities and/or are cross-trained in other areas that help the office, be sure to showcase what you have done and how it has made an impact. If you can cite examples that show commitment, teamwork, quality care, and patient satisfaction, have that information ready. Other considerations might include:
• Making recommendations and showing an interest in the success of the practice
• New patient and patient retention initiatives
• Cost-saving initiatives
• Implementing protocol, systems, or practices that improve the office
Do: know your plan if the answer is no, or not right now
Ask what it is you can do to be considered in the future. It is best to set specific, measurable goals together and determine an appropriate time period for reevaluation. In the case where you may be at the top of the pay range for your office or your area, you may want to try to negotiate for other types of compensation. Perhaps a lump sum bonus, reimbursement for continuing education courses, a production-based bonus system, uniform allowance, or some paid days off are a few examples. It is always advisable to have any agreed-upon terms in writing for both parties’ sakes.
If it’s a case where you feel that it’s simply not going to happen and it is becoming a sticking point for you, you may want to consider other options. The grass may not always be greener, but you won’t know until you do some research and some exploring. Just do so confidentially until you are sure. You don’t want to put yourself in a position where your employer questions your intentions. They may make the decision for you. Also, keep in mind that there may be other elements of your current position that may not be part of your next opportunity. Consider the value of having the proper amount of time for patient care, a short commute, a fantastic team, etc. Sometimes a few dollars aren’t worth giving that up for an environment that may not suit you.
Do: portray yourself in a positive and professional manner
Professionally stating your case is a better tactic than going in as if you were preparing to enter a boxing ring. Similarly, have your facts in order and present them in a concise way. If you run down a long laundry list of tasks versus highlighting where you’ve made impact, you run the risk of losing your audience. Present yourself calmly and professionally, even if the conversation isn’t going the way you’d hoped.
Don’t: use length of service as a basis for a raise
Do not use length of service, or what I prefer to call “time in chair,” as a basis for your request. Loyalty is a wonderful thing, and continuity of care versus a revolving door approach to hygiene staff is important, but may not make a compelling enough case for an increase. This also applies to asking for a raise based on time since the last increase. This is a business conversation and should be approached as such. The conversation should focus on how you have made an impact.
Don’t: use what you know or believe other staff members are making to pitch your case
A conversation like this often puts your employer on the defensive and can stir the dreaded pot of office drama. Instead of highlighting your wonderful contributions as a valued team member, you could appear petty and entitled.
Don’t: bring your personal financial issues into the conversation
This may be what is propelling you to ask, but is not the responsibility of your employer. The conversation must be based on your value to the business versus personal need.
Threats and ultimatums rarely end well and it is unlikely you will get what you ask for. Worse, you may be out of a job as well.
The bottom line is that these conversations can be hard, but we owe it to ourselves to be our own advocates. We also owe it to our employers to show them what we do and what we are worth, and give them a chance to respond to our request to have our rate reevaluated before we simply leave for what may or may not be greener pastures. Further, it’s important to have periodic conversations with our employers to discuss performance and expectations on a regular basis (at least annually). These conversations are a benefit to both employees and employers and can create a positive impact for both parties.
Please note that this article is for general informational purposes only and is not providing legal advice. You should contact an attorney or your state labor board to obtain advice with respect to an issue or problem.
1. Hartley M. 2017 RDH eVillage Annual Salary Survey, part 3: Raises for part-time vs. full-time dental hygienists. DentistryIQ website. https://www.dentistryiq.com/articles/2017/11/2017-rdh-evillage-annual-salary-survey-part-3-how-part-time-vs-full-time-dental-hygienists-fare-with-raises.html. Published November 16, 2017.
2. Questions and answers about the Fair Labor Standards Act (FLSA). United States Department of Labor website. https://www.dol.gov/whd/flsa/faq.htm.
3. Whiteley J. Compassion & production: Can they coexist? RDH magazine website. https://www.rdhmag.com/articles/print/volume-38/issue-11/content/compassion-production-can-they-coexist.html. Published November 1, 2018.
Julie Whiteley, BS, RDH, is certified in human resources. She holds degrees in business administration and dental hygiene and has worked extensively in both fields. She is on the faculty of Massachusetts College of Pharmacy and Health Sciences University in Boston. Julie bridges her knowledge and experience from business, clinical hygiene, and teaching to deliver information and programs that enhance dental practices. Contact her at [email protected].