Dental Hygiene Compensation

Oct. 1, 2006
What You Can Do To Improve Yours!

What You Can Do To Improve Yours!

Having had the advantage of training hygienists nationally and internationally for 14 years, I have seen firsthand their salary ranges, the types of practices they work in, and what types of clinicians they are. This article will explore different types of compensation, the many ways hygienists are paid, what dentists are looking for in a well-paid hygienist, and what hygienists can do to improve their compensation.

There is a false assumption that when hygienists obtain their license they qualify for a certain level of compensation. There should definitely be a minimum entry-level salary considered for new graduates, and this is based on geography as well as supply and demand. Compensation in this case is usually a flat daily or hourly rate and typically ranges from $20 to $30 an hour. In some densely populated, high-demand areas this hourly rate may be even higher. There is usually a probation period of between three and six months before benefits are offered. This type of compensation is very common for an entry-level dental hygienist and is a great way for a clinician to gain the experience needed to take him or her to the next level of earning potential.

Over the last few years, I have noticed an encouraging trend. Many people are entering dental hygiene as a second career. The first career for many was nursing or education. These hygienists are typically mature and have hands-on experience working with different types of people in a professional capacity. In this situation a higher entry-level salary should be considered based on their work experience.

Another false assumption is that many years of hygiene experience will afford one a higher compensation than a clinician with fewer years of experience. Compensation for the experienced hygienist takes into consideration many factors: the experience of the hygienist, the type of practice(s) the hygienist has worked in, the amount and source of continuing education the hygienist has pursued, longevity with previous employers, productivity level of the hygienist or hygiene department, and the hygienist’s contribution to the restorative and esthetic case acceptance and profitability of the practice. The hygienist’s talents in leadership, mentoring, and external and internal marketing are also taken into consideration. These qualities are most likely found in an experienced clinician, but this is not always the case.

Most dentists are looking for a hygienist who is excited about dentistry and is a team player, whether or not he or she is a new graduate or has years of experience. Dentists want an individual who can assist in increasing case acceptance of restorative/esthetic procedures as well as focus on the periodontal health of the patients. Dentists want hygienists who understand the business of dentistry, can maintain a profitable hygiene department, and contribute to the leadership and mentoring of the entire team. This type of hygienist is becoming more common, but it takes some years of experience and dedication to continuing education beyond the required amount.

Compensation comes in many packages. Commission is the least popular form of compensation. Usually paid at about 30 percent, the hygienist is often not offered benefits. Another type of compensation is the flat daily/hourly rate. The hygienist is usually part time (one or two days per week) and is paid this daily rate with no benefits and virtually no strings attached, with the exception of attending team meetings from time to time. The only requirement is the clinician must show up to treat patients. This is typical of a hygienist who wants to minimize his or her level of commitment and involvement in any specific dental practice. This compensation also works great for temporary, fill-in, or pregnancy-leave opportunities. Only a very special clinician can go from office to office and match the tone of the patients and practice. I have great respect for hygienists who provide this service for offices across the country. They are usually well paid. Their compensation ranges from $35 to $45 per hour. Some areas have a great demand for substitute hygienists, and the hourly rate fluctuates. In this scenario the hygienist is responsible for taxes, disability insurance, and any other state or federal requirements. This arrangement is very attractive to many clinicians, especially those who want to work part time.

Compensation on a daily rate is also common with full-time (four to five days per week) or part-time (two to three days per week) permanent hygienists. These hygienists typically earn a high per-hour or daily rate without benefits, which is why the doctor can pay the high rate. This often becomes a point of contention when a hygienist leaves a practice where compensation is based on a daily rate and goes to work for a dentist where the daily rate is lower but benefits are included. The clinician needs to carefully consider the dollar value of the benefit package and the tax benefits or tax obligations if applicable. Often the dentist will bring the hygienist on for a short probationary period, usually three months, to see if he or she is a match with the team. Benefits are offered after the probationary period.

The most common benefits include vacation (two weeks) and holiday pay (usually the four big ones) after three years of employment. A few offices increase vacation to three weeks after four years and stay at three weeks for the duration of employment. This benefit is huge and should be highly prized by the hygienist. Not many employees who are in a highly productive type of employment like dental hygiene get full pay when they are not producing. Additional benefits typically include a medical insurance premium, uniforms, and an in-office dental benefit. I’m glad to report that many dentists provide CE as part of their compensation, and this is a huge benefit. In some cases the value of CE could be as high as several thousand dollars per year.

The necessity of continuing education cannot be downplayed. Recently I heard a hygienist who was returning to the profession after a 20-year absence say, “Nothing much has changed.” I must admit I was surprised and concerned that a clinician would think that after a 20-year absence there was “nothing much” new to understand about the disease process and technology. In my travels, I have come across hygienists who have not changed much about the way they practice after 30 years. They are doing the same things they have always done. Those of you who participate in continuing education will find both of these situations alarming. The value of continuing education for the refinement of clinical skills and the building of business and leadership skills should be top priority for every hygienist.

How can a hygienist increase his or her earning potential? There are many opportunities. First, the minimum required hours of CE should be just that, a minimum. Looking into additional venues that provide continuing education for hygienists should be the first step, and the second step should be to budget for these out of one’s personal income. Many dentists will assist with the cost of CE. Remember, if you never ask the answer is always no.

There are many venues available. RDH Under One Roof is one you should be familiar with. RDH UOR is held annually in different locations around the country. I am very excited to see the high number of hygienists who attend and who travel clear across the country to do so. There are many training institutes as well. The Nash Institute, the Las Vegas Institute (LVI), American Academy for Dental Practice Administrators (AADPA), and The JP Institute are just a few. Many hygienists believe they must attend these venues with a doctor. This is not required. I have come across many hygienists who enroll themselves in these classes for their own professional career development. The JP Institute in particular offers hands-on Mastership Curriculum Certification training designed specifically for all dental team members who wish to advance their clinical, communication, and business skills.

I would also recommend some sales training for the clinician who wants to advance his or her career and earning potential. Although dentistry is a health-care occupation, a sale occurs when a patient pays for services. Many patients take advantage of optional treatment and procedures that the auxiliary must be prepared to sell. I was taught nothing in school about the communication process between a patient and clinician that can lead to successful case closure. Since increasing the case acceptance of restorative and esthetic dentistry is a primary responsibility of the dental hygienist, it is vital to know how to present treatment, quote fees, and get good case acceptance.

I have found that the reason many hygienists shy away from discussions about money or treatment presentation is lack of training. If this applies to you, seek some additional education in these areas. Most dentists expect the hygienist to be supportive and proactive when it comes to restorative or esthetic treatment plans.

To reward an exceptional hygienist, many dentists use a profit-sharing or piece-of-the-pie protocol. These clinicians commonly receive a lower daily rate but have the opportunity to receive thousands of dollars in additional income. A hygienist I know in Texas recently began her profit sharing after a three-month probation period with a check for $1,000. She quickly discovered that if she were willing to invest in the practice and meet the expectations of the team and doctor, she would be rewarded accordingly.

Sometimes it is difficult to make sense out of this type of compensation, especially if it appears that someone is making a lower daily rate than a colleague. However, when examined over the long haul, hygienists who are paid this way make a greater income than those on a flat daily rate. Let me give an example of how this works. The hygienist is paid $250 a day and works 16 days a month. The practice has a bottom line of $65,000. This month the practice does $75,000. The team members share according to the number of days each worked. Four team members share $2,000, assuming they all worked the same number of days, and the hygienist earns two additional days of salary ($500) for which she did not work. If this trend continued over the course of the year, the hygienist would earn an additional $6,000. These profit-sharing plans come in all sorts of packages. Let me encourage you to do the math, and do all that you can do to increase your earning potential.

Here’s a question I hear often. What if continuing education involves days normally worked for the regular salary, but the doctor is paying for CE and has made team attendance mandatory? Should a hygienist be paid for this time, and if so at what rate? This is a much-argued point between the dentist and hygienist. I have suggested a compromise that works very well. First, the hygienist must consider that CE is being provided, all of the arrangements have been made, and all that he/she must do is participate. Since the hygienist is normally a producer and will not be producing during the CE class, he/she should be offered the same hourly rate as the highest paid clinical assistant or administrative personnel. In some cases even that rate needs to be negotiated, but I find it ranges between $12 and $20 per hour. If travel is involved, the doctor is probably paying for the travel and meals, and there is no compensation for the travel time. Participation in CE at this level is very important from a “team player” perspective.

The business-savvy hygienist must know what it takes to run the hygiene department in terms of dollars and cents. Formerly, the hygienist was typically expected to produce three times his or her salary. Now with the increases in technology and the cost of equipment, the hygienist can produce four times his or her daily salary. This will ensure that the hygienist covers all expenses incurred in the delivery of the highest standard of care possible through his or her production. The business-savvy hygienist also tracks his/her restorative/esthetic case acceptance contribution to the practice. If you are not tracking what you produce, you cannot show what you are doing in your department, and you will be unable to justify any type of increase in salary.

From a leadership perspective, the hygienist is the second most educated person in the dental office and can have a direct influence over the team. I often hear complaints from team members about hygienists who arrive too late or leave too soon, “hang out” during downtime, and leave their instruments for someone else to deal with. This gives the impression that the hygienist does not consider the team’s workload. An effort should be taken to pitch in to do whatever duties in whatever capacity are needed. Since a leader empowers by example, this sets a standard of excellence for the rest of the team.

Additionally, the business-savvy hygienist will remember internal and external marketing. Asking for referrals from existing patients whom you would like to duplicate in your practice is an easy source of internal marketing. Anytime a patient says thank you, the reply could be something like, “You are very welcome, and I’d like to thank you for being such a great patient. We would love to have more patients like you. If you know anyone who might be looking for a dentist, please give them our card.”

Kimberly Miller, RDH, BSDH, is a Senior Consultant with The JP Institute. The JP Institute offers continuing education training for the entire dental team. JP specializes in analyzing and refining practice philosophies, business systems, hands-on implementation of clinical skills, technology and product integration. Call The JP Institute for information on their Mastership Certification Courses, Dental Spa Product Line, and In-office Consulting Services at (800) 946-4944 or visit