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Getting paid what youre worth

June 1, 1998
When you go on a job interview, immediately asking what you will be paid is almost taboo. Many times salary is not even brought up until a second interview. However, that is one of the most important questions to think about. After all, would you work for free? Would you leave a job you love for more money? How much money would it take to get you to stay at a job you hate?

Believing in yourself is a big first step toward achieving greater reward.

Tami Farmer, RDH

When you go on a job interview, immediately asking what you will be paid is almost taboo. Many times salary is not even brought up until a second interview. However, that is one of the most important questions to think about. After all, would you work for free? Would you leave a job you love for more money? How much money would it take to get you to stay at a job you hate?

There are several factors to take into consideration when trying to determine what to expect salary-wise. These include experience, education, productivity and market demand. More experience does not necessarily mean more compensation. In fact, a new graduate likely will earn just as much or more than a hygienist who has been practicing for several years. For example, a hygienist who has been working for several years probably has not received raises that elevate her to the current pay scale. A new graduate knows what the current pay scale is and will expect to get it. Also, new graduates are up-to-date on the latest dental trends. An older hygienist may not be as up-to-date on new ideas, even with attending continuing education courses.

Education does not seem to greatly influence salary. Hygienists with associate degrees in private practice get paid about the same as hygienists with bachelor`s or master`s degrees in private practice. From the dentist`s standpoint, you are just as much of an asset to them no matter what kind of hygiene degree you have.

Productivity should be highly looked upon. The more of the dentist`s income you produce, the more you should be paid.

Market demand ultimately determines the going hygiene pay rate. Cities have more dentists, which means that more hygienists will be needed, and, therefore, the dentists in big cities are going to pay far more to get the hygienists to drive to the cities.

Geographic location can be another important factor. The unemployment rate for hygienists is low and employment is free of geographic limitations. After all, there are dentists just about everywhere. However, the farther south you go, the lower the salary rates seem to be. This would be due to the lower cost of living. If should be noted that the Southeast has more hygienists working on commission than any other region. The farther west you go, the higher the hygiene salaries. So, if you want to make a really high salary, move to Los Angeles or San Francisco. Also, the farther you are from a hygiene school, the more you are going to make because there will not be an overabundance of hygienists looking for jobs.

To be compensated for your productivity, the dentist must see you as a great asset to the practice. In a recent ADA survey, 40 percent of dentists do not even employ a hygienist. There are several reasons for this. Many older dentists still do prophys themselves. Some resent sharing the power position with a hygienist. Others claim that they can`t find a hygienist due to a short supply. Still others do not want to pay high hygiene salaries or simply have a very small practice. Dentists who do not employ a hygienist fail to see how not employing one can be a bad business decision.

Increasing productivity

Hygiene productivity should be roughly 30 percent of office production. Dentistry is a business. The more profit a hygienist can create for the business, the greater the returns will be. These returns also can pay off in other ways, including better equipment, higher quality materials and, most importantly, more salary and benefits.

There are several ways for a hygienist to increase office production. Most have nothing to do with actual hygiene delivery because success in dentistry is 15 percent technical and 85 percent people skills. Very often, the hygienist, not the dentist, will be seen first by a patient and for a longer period of time. If a patient can trust the hygienist, there often is an 85 percent return rate. The patient has got to like you. Once trust is gained, the hygienist can convince the patient why it is important to return and complete treatment, and educate him or her on the necessity of continued, regular dental care. The three Ws should be explained to all patients - why they need to come back, what will be done at each appointment and when they need to return.

Soft-tissue management programs also have to be incorporated into successful hygiene performance (see related chart). Perio prophys and quadrant scaling maximize the skills of the hygienist and are paid at much higher rates than the routine prophys. There still are dental offices out there that will charge out all prophys as routine prophys, and nothing else. To have production, you have to have patients. Make sure there is an effective recall system in place to assure that you have patients who will be there on a routine basis to generate income. Make sure the patients are confirmed. Set penalties for cancelled and no-show appointments and make sure the patient is aware of the penalty when they make an appointment. Have a list of patients who can come on short notice to fill cancellations. Patients also are likely to return when home-care products - toothbrushes, toothpaste, floss - are dispensed at the prophy appointment. Patients will feel they are getting more for their money if they get something to take home.

Hygienists also need to be happy with themselves and their jobs to please the patients as well as the dentists who employ them. Why should the dentist pay a good salary to a hygienist who acts like she would rather be anywhere, any day, other than in the practice treating patients? Hygienists must see themselves as doing more than "cleaning teeth." They need to continue to grow personally and professionally. They must see their jobs as interesting and rewarding, and feel that they are being compensated appropriately.

A hygienist also needs to prove that she is a valuable team member in the dental practice. The hygienist, who only cares about herself and leaves at the end of the day as soon as her job is done, will not be seen as a true team player. Hygienists should review their charts before the day begins, make notes about the patients in their charts to differentiate between them, decide on the best approach for each patient and then discuss the patients with the dentist. When the hygienist doesn`t have a patient, she should be checking with all the other office employees to see if she can assist with anything.

Employee or independent contractor?

There are two ways a dental hygienist can be classified: independent contractor or employee. The independent contractor hygienist should not be confused with the independent practice hygienist in Washington and Colorado. Independent contracting is an IRS classification of a business arrangement between the hygienist and dentist. State practice acts do not prohibit it. The relationship of employer and employee exists when "a person for whom services are performed has the right to control and direct the individual who performs the services, not only as to the result to be accomplished by the work, but also as to the details and means by which that result is accomplished." An independent contractor (self-employed) is an individual "subject to control and direction of another person merely as to the results to be accomplished by the work and not as to the means and methods for accomplishing the results."

Independent contractors often are paid by the job or patient treated, set their own hours, may lease an operatory, set their own fees, are responsible for billing and collection from patients and assume loss for uncollected fees. They adhere to the dental supervision and settings as mandated by the state practice laws while providing their services to the patients of the particular dentist. Hygienists, who are paid strictly on commission, are similar to independent contractors. Employees usually are paid by the hour or day, have their hours and place for working set by another and rely on another to do the fee-setting, billing and collecting.

The tax responsibilities for independent contractors and employee hygienists also are different. Independent contractors have no taxes withheld from their paychecks. The hy-gienist must pay federal and state income tax quarterly on an estimated basis. So-cial Security is paid by the hy-gienists according to a percentage of their gross income. Unemployment and workmen`s compensation are not applicable. Hygienists should purchase their own disability insurance. The IRS does state that it is illegal for a dentist to arbitrarily assign the title of "independent contractor" to an employee. For employees, employers withhold the federal and state income tax while the hygienist and dentist pay Social Security taxes. Employers pay a percentage to state and federal government for unemployment tax. Employers also pay workmen`s comp, the amount and percentage differing with each state.

Four basic payment methods

A hygienist`s salary is paid as a fixed annual salary, straight commission, a combination of salary and commission or by daily/hourly rates. Each method has advantages and disadvantages.

With a straight salary, paid vacations and sick leave usually are included. This can provide financial security. However, it may not be as rewarding. There may be less incentive to fill broken appointments and to maintain a good patient-return rate.

Hygienists who receive a combination of salary and commission should consider a couple of things. First, they should be able to live on the base-salary part alone and use the commission as an incentive for financial reward. The dentist also must place a high value on preventive treatment (see table 1) for the arrangement to work. A hygiene assistant can be beneficial to a hygienist on any sort of commission. Without a hygiene assistant, the hygienist might see 10 patients a day, for example. Having a hygiene assistant can allow the hygienist to see about one-third more patients a day, especially when she works out of more than one operatory. With more than one operatory, the hygiene assistant can be doing things that will save the hygienist time, such as taking X-rays, cleaning rooms, sterilizing instruments and assisting the dentist in the actual exam. This will free up time for the hygienist, allowing more patients to be seen for more production and bigger commissions.

Straight commission usually is paid at 30-40 percent of a hygienist`s daily production. Some dentists pay as much as 50 percent of daily production. To determine if commission would benefit you, determine your daily base salary times three. Now figure out what your average daily production is. Subtract your base salary times three from your average daily production. Figure out what 30-40 percent of that figure is and add this to your current daily pay. This figure will be what you would be paid if you get about 33 percent commission from your daily production. So, if you were paid on a daily rate of $160, you would need to regularly produce $480 before considering commission. Produce $600 in a day and you would be paid $198 at 33 percent commission.

For straight commission to work, perio programs must be incorporated into the practice (see table 1). You will make more commission off a $100 fee per each quad prophy than a $50 routine prophy. Many hygienists on commission do not receive the commission from perio prophys until the insurance companies have paid. Therefore, it may be important for you to follow up on the insurance claims because insurance companies usually are not in a big hurry to pay out.

Hygienists who work on straight commission usually will have more freedom in setting their hours and off days. However, in order for it to work, the practice must be well established with a good base of patients. Hygienists on commission usually do not receive paid vacations. They also may resent the patient who breaks an appointment and may fail to appoint them for another recall. Some may lower the quality of their work to squeeze in as many patients as possible.

Most hygienists still are being paid on an hourly, daily rate. Some can set their own hours. They may or may not receive benefits.


Benefits should be looked at almost as closely as salary. Legally required benefits include Social Security, workmen`s compensation, unemployment insurance and, in some states, disability insurance. Top benefits include paid vacations, sick days, health insurance, continuing education, uniform allowance, production bonus, free dental and parking. Unlike big companies, though, most dentists are small, private business owners who cannot or do not offer benefits. Hygienists are more likely to receive benefits if a school system, public-health agency, state agency or the federal government employs them. Hygienists who work for government health agencies can expect the same benefits and holidays that all other government workers receive. Hygienists working for a large group dental practice, one with over 15 employees, are likely to receive benefits.

Personal situations may effect how some hygienists view a benefit package. Some hygienists receive health insurance through a spouse or would rather get paid more and skip any benefits. Although benefit dollars cannot be spent directly, they are just as important as salary dollars. Full-time employees are more likely to receive benefits than part-timers. Some dentists may even be hiring part-time employees to avoid having to pay benefits.

A good benefit package is equal to about 27 percent of gross salary. Imagine you are a full-time employee earning $120 a day. Sample benefits are two-week, paid vacation ($1,200), five sick days ($600), health insurance ($136 a month), continuing education ($400), uniform allowance ($50 a monthly), downtown parking ($3 a day), production bonus ($219 a month) and free dental care ($220). That`s a benefits package totaling $8,100. That would be 27 percent of a $30,000 salary. Sadly, most dentists just do not see benefits as something they can offer to their employees. Since they are hard to come by, a good benefits package can increase employee loyalty.

Asking for a raise

You deserve to be paid what you are worth. After all, you are selling your expertise, skills and professionalism to the dentist. If you don`t bring up salary negotiation, your employer probably won`t either. Going about asking for a raise should not be as hard as you might imagine. Pick a good time to talk with the dentist, probably at the end of the day when you are less likely to be interrupted. Know exactly what your compensation is through salary and benefits. Be prepared to list your accomplishments and achievements at the office. Show how your performance has surpassed expectations. Have a legitimate proposal prepared. Do not ask for anything outrageous and know what the going rate is for hygienists in your area. Explain what you know and understand about the practice. Justify the raise. Mention ways you have helped increase production and efficiency in the office. Have your production totals handy. Are there any benefits you currently are getting that you could do without in order to have more salary? Discuss whether certain job aspects will change because of the raise. Maybe there are better ways you can fully utilize your technical and professional skills. Most importantly, be calm and listen to everything the dentist has to say.

Studies have shown that your chances of getting a yearly pay raise are greater when you stay at your present practice than when you change practices. This may explain why the turnover rate among dental hygienists is declining. When you change practices, odds are your pay will have little to do with how many years of previous experience you have.

There are other ways to advance in the hygiene profession. One way to make more is to move to a large, more prestigious office. Also, dental manufacturers and insurance companies hire dental hygienists, as do dental consulting firms. If you have a higher degree, consider a change to teaching, administration or research. Most college professors earn between $19,200 and $48,000. You also are more likely to get benefits working for dental manufacturers, insurance companies, consulting firms or educational institutions.

The demand for dental hygienists is expected to increase. So will the wages they earn. The Department of Labor forecasts a 41 percent growth in the dental hygiene field through the year 2005. Several factors are expected to come into play. The population will have a growing awareness of the importance of good oral hygiene. A rise in personal income will allow the population to spend more on dental care. The liberalization of dental insurance plans and benefits will make dentistry available to a broader range of people.

As you can see, the first step in achieving the perfect salary is to believe in yourself. The more motivated and productive you are, the greater you can be rewarded. For hygiene is not about just "cleaning teeth" and getting paid for it, it is about being the best you can be and achieving that financial goal in the process.

Tami Farmer, RDH, has worked for group and private-practice dentists for 10 years in Atlanta and surrounding areas. A graduate of the Medical College of Georgia, she currently writes and practices in Rome, Ga.

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