Th 235097

Crunching the numbers

Jan. 1, 2007
Dear Dianne, After working 17 years in the same practice, the doctor and his wife (who is the office manager) are making disturbing remarks about my salary.

Dear Dianne,

After working 17 years in the same practice, the doctor and his wife (who is the office manager) are making disturbing remarks about my salary. Apparently, the wife read somewhere that hygienists should not make more than 30 percent of their production. I’ve never read that anywhere! I can’t find any information about this, so I was wondering if you could shed some light on this topic.
Worried in Massachusetts

Dear Worried,

I have to wonder what is provoking the sudden spotlight on your wages. Is your production down? Do you monitor your production? Is the front desk having problems keeping your schedule full?

The 30 percent idea actually should read 30 to 35 percent, depending on what is included. The industry standard is that the hygienist should make in wages about 33 percent or one third of her production, and also should produce about one third of the total production. I don’t know where this came from, but I can tell you from practical experience that it varies widely. I’ve met hygienists who make anywhere from 20 to 54 percent of their actual production.

In fact, many hygienists don’t have a clue what their salary/production ratio is, because they have never monitored their numbers. For example, if your production is $15,000 for June and your salary is $4,000, that is $4,000/$15,000 = 26.6 percent or, rounded up, 27 percent.

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However, industry standards can’t always be taken as relevant to every practice situation. For example, if the doctor performs a large number of cosmetic/elective, implant, or other high production dental procedures, it is doubtful that the hygiene department will produce one third of the total production. Another “skewing” factor is when hygiene fees are low compared to restorative fees. Some doctors try to keep hygiene fees low because they think patients will complain if they raise them. They might choose to raise restorative/surgical fees by 4 percent and preventive fees by only 2 percent. So if a doctor keeps hygiene fees low in comparison to restorative fees, it is unfair to expect hygiene to produce the “industry standard” of one third of total production.

The number of hygienists and days of hygiene are important in the big picture. A practice with three full-time hygienists and one doctor should easily produce one third or more of total production in hygiene. However, a practice with only one hygienist (who might be only part time) will not achieve the industry standard, unless the doctor’s production is correspondingly low.

One more factor that can greatly influence hygiene production is the number of periodontal procedures that are performed. Again, the industry standard is that periodontal procedures should account for about 33 percent of total hygiene production. However, many practices see their total periodontal segment of hygiene production as much lower than 33 percent, especially if they do not have a strong new patient flow. Some hygienists are not accustomed to assessing periodontal status, mainly because they are pressed for time and do not have anyone to record periodontal chartings. (Every adult patient should have a six-point probing that is recorded once per year.)

Dental practices are businesses that are subject to the same ups and downs in the business cycle as other businesses. When dental practices see a high demand for their services, schedules are full and owners/employees feel secure. When demand falls, as is often the case during a weak economy, schedules are hard to keep full and downtime becomes an issue. When people struggle to pay for housing, transportation, food, and medical care, dental care becomes secondary and is often delayed until more discretionary money is available. Based on many of my client’s practices, I think we’re seeing a glimpse of that now.

I believe it is easy for hygienists to retreat to the safety of their own operatory, to go in each day and do their job, and not give production numbers a second thought.

Further, I think some hygienists would rather not know their numbers. They delude themselves by thinking that those numbers don’t really apply to them, and that as long as they show up and do what’s on the schedule, they’ve fulfilled their responsibility. They take no responsibility for the success or failure of their department.

In my opinion, the value any employee brings to a practice is expressed in his/her willingness to work consistently toward the good of the practice, and that includes promoting the doctor’s dentistry and bringing in new patients. For a practice to be healthy financially, everyone should do his or her part. It’s not all about money, but let’s be honest. None of us work for our health.

I don’t know how much of the practice production, collections, or overhead information your doctor shares, but many dental practices have notoriously high overhead. I’ve consulted in practices where the doctor didn’t take home much more that the hygienist after all the bills were paid. I like to see overhead at about 65 percent or less, but I’ve seen overheads in the 70 to 80 percent range. Overhead expenses are all those practice expenses that have to be paid, such as staff salaries (24 percent or less and does not include the doctor), lab fees (10 percent), dental supplies (6 to 8 percent), telephone, office expense, repairs, utilities, etc.

Here is a sample practice monitor to use each day that can give you hard data about your production. “Units of downtime” refers to the total number of open units (either 10- or 15-minute units; 10-minute increments have six units in one hour). At the end of the month, this can be converted to hours.

I’ve dealt with staff members who felt they deserved a raise, yet were already making more than 50 percent of their production. In those circumstances, a staff member should demonstrate that she or he is at least willing to show an interest in the success of the business and do what it takes to get production up to par. A hygienist who contributes mightily to the success of the practice by promoting the doctor’s dentistry and being productive is certainly worth more than a hygienist who does only the minimum to get by.

I’m all for everyone in the office making good wages. And I believe, according to my friend Linda Miles, that “Above-average doctors have above-average practices, do above-average dentistry, have above-average staff members, pay above-average wages, and charge above-average fees.” That says it all!
Best wishes, Dianne

Dianne D. Glasscoe, RDH, BS, is a professional speaker, writer, and consultant to dental practices across the United States. She is CEO of Professional Dental Management, based in Frederick, Md. To contact Glasscoe for speaking or consulting, call (301) 874-5240 or e-mail [email protected]. Visit her Web site at