1906 Rdh Gui P1

Working as temporary : The good, the bad, and the ugly

Temping is big business. It is a great way of life for many, anathema for some, and a headache-generating experience for others. Temping, also called subbing, offers diversity and unique challenges, and it is quite different than practicing in the same dental office every day. Some people are really cut out for working as a temp, and others would rather trim something out of their budgets than challenge their comfort zones and spend a moment in an unfamiliar office.

While this article is focused on working as a temp, much of the information can be used when accessing any job opportunity. So even if temping is not part of your professional plan, it’s not a bad idea to have an understanding of the process. Life circumstances can change in an instant, and temping could be your new normal sometime in the future.

The good

Hygienists who thrive in this environment are adaptable, find challenges exciting, and love the lack of monotony. Every office and every team are different, and some clinicians just like a change of scenery. The good, ethical, fun offices are great places to work. There are two obvious benefits that come from working as a substitute: the boost to your income and the flexibility and control over when you actually practice. You only have to accept the positions you want.

Since there is no one universal way to provide patient care, subbing is an opportunity to gain a wealth of information. You can learn about different home-care products, ways to treat patients, communication techniques, or even a new software system.

Every office has favorite systems and different equipment setups. Subbing can be like taking a mini-CE course. No, you won’t get credits, but you will learn a lot. And if you’re lucky enough to temp in an office where the dentist or other team members are natural-born educators, think about how much you can learn from being around people who love what they do and are willing to share what they know. Experience is a powerful teacher.

Working as a temp is a wonderful way to network. It’s a great way to “test-drive” a practice. You can spend a day or two, or even more, to ensure the practice philosophy and dynamics are consistent with your professional goals and ethics. Temping is like dating. Most offices are on their best behavior, so take advantage of being appreciated. You’re much less likely to be drawn into office drama if you are not a permanent staff member. If the fit is not right, just smile, but don’t accept another assignment at a toxic office.

But what if the chemistry is really good? What if you walk away feeling appreciated and knowing that you provided quality clinical care? And what if your subbing job leads to an offer for a permanent position, a referral to a great practice, or you become the go-to requested temp in a practice that you love? When temping is good, it is really good.

The bad

Hygienists often complain that they are expected to provide care using broken, dull, or worn-out instruments. Some offices do not have ultrasonic scalers, or not enough inserts or tips. Others complain about insufficient appointment times or being double booked. A 40-minute schedule full of adults is going to be really stressful for a clinician who has always had one hour for a patient.

Some offices don’t let patients know their regular or favorite hygienist will not be providing their care. This puts the temp in a very awkward position. It’s not fun to spend the entire day hearing “Where’s Suzy?” or “But Janie always cleans my teeth,” or “Ashley never hurts me,” or worse yet, “Brittany doesn’t do it this way.” The stress can get even worse if you realize you’re temping in an office where the norm was a chat-and-polish appointment. Now you’re struggling with years of deposits. It can be very uncomfortable if the previous hygienist just got fired or quit unexpectedly. Many people don’t like change and seeing a new hygienist without warning does not help the day run smoothly.

There are times substitute hygienists just want to run and hide. Dental practices each have different office protocols and policies. Most temps are not experts at every dental office computer system. If we’re smart enough to make it through dental hygiene school, we’re smart enough to learn a new system, but we’re not going to be proficient in an hour or two.

Other issues that can crop up include questionable diagnostics, suspect billing practices, and problematic infection control protocols. As hygienists, we are allowed to create a dental hygiene diagnosis, but we are smart and understand that one or two bleeding points or one or two 4-mm probing depths does not support the recommendation for four quadrants of scaling and root planing. We also have eyes and ears and have seen administrative staff up-code a procedure that increases the fee or down-code so the fee will be covered by a benefit plan. Coding must match the diagnosis. It is fraud to veer from this standard. We understand infection control procedures, so expecting a temporary hygienist to reuse a saliva ejector or not autoclave an ultrasonic tip is not OK.

Sadly, not all temporary positions are good, and by the same token, there are hygienists who are simply filling in just to get a paycheck. They are warm bodies going through the motions and giving a bad name to those who really care. It’s a nightmare to temp in a poorly run office where the staff is unsupportive and the doctor is annoyed to have to pay a fee to a dental staffing agency for your services. If an office is in a bind and hires a temporary hygienist, there is no reason for the staff to be snippy. Temps are just trying to do their jobs and trying to take care of patients in the practice.

The ugly

This is where the conversation gets really hard. It is important to know your rights and understand the state laws that govern your license to practice. When dental hygienists are treated unfairly, they often say “But the doctor said I had to,” or “The office manager insisted,” or “This is the way they’ve always done it in this office.” Rather than relying on a hearsay comment, take time to read the law and familiarize yourself with state and federal regulations. Nine resources are listed at the end of this article. The documents are easy to read.

The US Department of Labor (DOL) has ruled that dental hygienists are employees in all but a very few distinct circumstances. Most states require a dental hygienist to work under the supervision of a dentist to practice dental hygiene.1 This is a licensure requirement and it creates an employer-employee relationship. Dental hygienists must be classified as employees, not independent contractors or what is also termed a contract worker.2,3 Working as a contractor puts our license and that of the dentist in jeopardy.

Some people think a temporary or substitute worker can be classified as an independent contractor. If the dentist controls the location where the work is performed, the specific hours the work is done, supplies the equipment to perform the work, provides the patients who will receive the treatment, and collects payment for services rendered, this is an employer-employee relationship. We simply do not meet the legal definition for independent contractor put forth by the Internal Revenue Service, the federal Department of Labor, or individual state labor boards or workforce commissions.2,3

This has become a very contentious issue. Hygienists who work as temporaries are often misclassified as contractors by individual dental offices. Referral agencies often inform dental hygienists that they are considered independent contractors and state that classification status of temporary workers is up to the dental office. True staffing agencies hire dental hygienists as employees, who then agree to work at specific locations for certain time periods. The staffing agency pays the necessary federal and state taxes and issues the dental hygienist a W-2 form at the end of the year. This employer-employee arrangement complies with federal and state laws.2-4

While misclassification may not seem to be a big deal, especially if this only happens a couple of times a year,5 misclassification of an employee is not legal. According to the US Department of Labor, common industry practice does not excuse misclassification. Misclassification shifts the burden to the worker, who is now responsible for paying all of the Federal Insurance Contributions Act (FICA) and Medicare taxes. Unemployment compensation and worker compensation issues are handled on the state level, but misclassified workers are not covered and therefore have no recourse if their jobs are terminated or they get injured on the job. When workers are misclassified, businesses benefit financially. It is estimated that misclassification saves a business around 30% by eliminating the cost of matching taxes and not paying taxes that cover employee benefits mandated by individual state labor boards and the DOL. Misclassification is a serious issue, and many businesses are now paying hefty fines and penalties for not complying with federal and state laws.

Hygienists all over the country are being told to clock out, come in late, or leave early—another sticky point. The DOL Fair Labor Standards Act applies to employees. Employees, such as dental hygienists, are “engaged to wait,” a term that indicates a person is actually working and therefore is entitled to compensation. Waiting for a patient to arrive is part of our jobs and is considered work that is entitled to compensation. Being required to clock out between patients for short periods of time is not legal.6,7

Another complication arises when a worker is told to clock out in advance. Essentially, the worker must be notified of the change in the schedule well in advance, not an hour ahead of a change. In addition, there must be sufficient time for the worker to leave the premises and use the time as his or her own. If the worker is required to stay on the premises, this play is illegal.6,7 Sadly, offices use these excuses, which are often illegal, to cut the hygienist’s hours.

Working interviews can get complicated. If a worker performs services on a patient who is paying for the services, the worker must be paid standard wages. If the work is performed on the dentist or an employee, the law requires the worker to be paid for the time, but sadly, it is not illegal to pay the interviewees minimum wage. And some practices refuse to pay the worker under the guise that the clinical time is an interview, not a working agreement. It is illegal not to pay people for working time.

Getting paid can get sticky. Since it is illegal for a hygienist to be classified as a contractor, the employer must take out taxes.8 Employees are required to fill out a W-4. Consider sending the form in advance, just to be safe, and arrive with a backup copy and the IRS information that outlines the employee versus contractor rules. Many temps expect to receive a check at the end of the work shift. While this ensures you will get paid, it is important to understand the office’s payroll protocol may require a check be issued on a specified payroll date. Either arrange to pick up the check, make arrangements for a direct deposit into your bank account, or ask to have the payment mailed. It’s a good idea to supply the office with a self-addressed stamped envelope.

Never, ever accept cash payments. Document all payments. It’s easy to take a photo of every pay stub and every check. Send the image to yourself via email or text. What if the check bounces? This happens, and again, it can be ugly. It is best to remain calm and ask for a replacement check in addition to reimbursement for insufficient funds fees imposed by your financial institution. Unless there is a written agreement specifying the exact payment date, a dentist or agency is free to issue a check on their regular payroll date. If there is a discrepancy in wages or hours, or payments get delayed beyond the payroll date, contact the dental office or agency first. If there is no reasonable resolution, contact the state labor board.

It will be much more difficult for a practice to play fast and loose with your wages when you are an informed worker. And you will be doing practice owners a big favor if they truly do not understand the enormity of misclassification and toying with other worker rights. The IRS and state labor boards are taking a very dim view of worker abuses and they are sharing information. The fines and penalties are enormous and can even include jail terms.

Keep calm and enjoy the opportunity to learn

Like anything else in life, each one of us has control over the final outcome. If a practice is not to your liking, for whatever reason, you don’t have to go back. You have the right to choose how and where you work. Temping or subbing can have many benefits, including helping you refine your work philosophy. Consider it a postgraduate learning experience in which you’re getting paid to learn while providing patient care.


1. American Dental Hygienists’ Association. Dental Hygiene Act Overview: Permitted Functions and Supervision Levels by State. https://www.adha.org/resources-docs/7511_Permitted_Services_Supervision_Levels_by_State.pdf. Revised January 2019. Accessed March 4, 2019.

2. Internal Revenue Service. Independent Contractor or Employee? Publication 1779 (Rev. 3-2012) Catalog Number 16134. https://www.irs.gov/pub/irs-pdf/p1779.pdf. Accessed March 1, 2019.

3. US Department of Labor Wage and Hour Division. Know Your Rights: Misclassification as an Independent Contractor. YouTube. https://www.youtube.com/watch?v=BTUkKFYBdrU&feature=youtu.be. Published September 29, 2017. Accessed March 1, 2019.

4. US Department of Labor Wage and Hour Division. Get the facts on misclassification under the fair labor standards act. Are you an employee or a contractor? https://www.dol.gov/whd/workers/Misclassification/misclassification-facts.pdf. Accessed March 1, 2019.

5. Fact Sheet 13: Employment relationship under the Fair Labor Standards Act (FLSA). US Department of Labor Wage and Hour Division website. https://www.dol.gov/whd/regs/compliance/whdfs13.htm. Accessed March 1, 2019.

6. Fact Sheet #22: Hours worked under the Fair Labor Standards Act (FLSA). US Department of Labor Wage and Hour Division website. https://www.dol.gov/whd/regs/compliance/whdfs22.htm. Accessed March 1, 2019.

7. Fact Sheet #53 – The health care industry and hours worked. US Department of Labor Wage and Hour Division website. https://www.dol.gov/whd/regs/compliance/whdfs53.htm. Accessed March 1, 2019.

8. Fact Sheet #21: Recordkeeping requirements under the Fair Labor Standards Act (FLSA). US Department of Labor Wage and Hour Division website. https://www.dol.gov/whd/regs/compliance/whdfs21.htm. Accessed March 1, 2019.

9. North Carolina State Board of Dental Examiners. Employee Classification. North Carolina State Board of Dental Examiners E-Forum. http://ncdentalboard.org/PDF/Jan%20-%20March%202018.pdf. Published January 2018. Accessed March 10, 2019.

A snapshot of the Tar Heel State

On December 31, 2017, the North Carolina Employee Fair Classification Act went into effect. Since that time, all North Carolina occupational licensing agencies are required to collect information about misclassification for any license renewal and any new licensure application. Dentistry was not singled out. The new law applies to all worker licenses. North Carolina’s state motto is “Esse quam videri,” which means that it is better to be something instead of pretending to be something. Kudos to the Tar Heel State for sticking to their motto.

Dental professionals must certify that they understand the North Carolina Industrial Commission’s employee misclassification statement regarding independent contractor status. In addition, applicants and licensees must report if they have been investigated for employee misclassification within the past three years. According to the North Carolina Dental Board, “this new law is to serve notice to all licensed professionals that the Department of Revenue is serious about catching those who avoid tax liabilities by misclassifying employees as independent contractors.”9 This proactive reporting addresses the misclassification issue in a very direct manner. Professional licenses are being held up until matters are cleared up by the state department of labor.

Some may be tempted to not answer these new licensure questions, but making false statements can be considered perjury, thus putting one’s license at risk. To further support the importance of misclassification, the North Carolina State Dental Practice Act clearly states that a dental hygienist must practice under the direct supervision of a dentist. There is further clarification for those working in a public health setting, an educational institution, or in a facility such as a nursing home. But clearly, most dental hygienists practicing in this state are working in traditional practice settings.

Reading a state practice act is hardly a leisure-time activity, but here are four key statements that come into play with this discussion:

  • A dental hygienist may practice only under the supervision of one or more licensed dentists.
  • The board can take disciplinary measures if the applicant “has engaged in any act or acts of fraud, deceit or misrepresentation in obtaining or attempting to obtain a license or the renewal thereof.”
  • A dental hygienist shall not establish or operate a separate care facility that exclusively renders dental hygiene services.
  • Every state requires licensees to be knowledgeable of the law. A hygienist who accepts a clinical assignment in North Carolina as an independent contractor has just put his or her license in jeopardy.