Hygiene Slum

March 1, 2010
Dear Dianne, Since my children are very young, I choose not to work regularly in one office.

by Dianne Glasscoe Watterson, RDH, BS, MBA
[email protected]

Dear Dianne,
Since my children are very young, I choose not to work regularly in one office. I work for a temporary agency, and I love the flexibility of being able to choose when I work. Temping helps me keep my skills up and brings in a little extra money. Plus, I love interacting with patients and providing hygiene care.

However, there are two recurring problems I have in the temping world. The first problem is that the doctor often hands me a check at the end of the day without taking out any taxes. While I like the extra money, I know it will hurt us at tax time. The second problem is that some offices have terribly inadequate, dull instruments. In one office, there were only a couple of anterior sickles, four posterior curettes, a leaky cavitron, and a schedule full of 30–minute adult prophies. I nearly panicked!

Can you give me some advice on how to ensure that when I accept a temporary assignment, there will be usable instruments, and pay with the appropriate taxes withheld? Just sign me,
One of your devoted readers

Dear One,

I smiled when I read your post. It brought back memories of my temping days when my children were young. For about five years I temped in a four–county area around my home. The temping experience gave me valuable insight into many different practice environments. Some of my experiences were delightful, and some were downright traumatic.

One office was very upscale with a beautiful building and stunning décor. I just knew everything would be first class. Unfortunately, the hygiene operatory could be best described as a slum with a drawer full of old, rusted, broken instruments, a manual–lift chair, and no cavitron. At first, I couldn't believe my eyes! My initial thought was that surely there were some better instruments somewhere, possibly the autoclave. No such luck! The only thing that saved me that day was that I had brought along two sets of my own instruments. At the end of the day, the doctor asked if everything went okay. Without being too demonstrative, I informed the doctor that he desperately needed some new instruments and a power scaler. I also told him that as much as I enjoyed meeting him and treating his patients, I would be unable to come back without the right armamentarium. Then he asked me if I would make a quick list of what was needed. He assured me he would order whatever was needed. I wondered if his reluctance to properly equip and supply his hygiene department was responsible for his former hygienist's departure. Actually, this doctor did follow through with purchasing instruments and a power scaler, and I temped for him many times over the years.

It is prudent for you to have two very good complete sets of instruments to take with you if you temp, because you never know if there will be adequate, sharp instruments. You and I both know that we cannot deliver high quality care without the right tools. Whatever you purchase is tax deductible.

I also learned through temping that although there might be an adequate number of instruments, they might not be sharp. I have temped in offices where there was not one sharp curette in the building. I came prepared with my sharpening armamentarium, which consisted of my Shofu® friction–grip sharpening stone, and my Designs for Vision magnification. I would ask the assistant to lend me a high–speed handpiece. With good light and magnification, I could see the dull edge and erase it with just a few light strokes of the handpiece. Using this method, I could sharpen several sets in just a few minutes. (For an instructional CD on this sharpening technique, go to www.professionaldentalmgmt.com.)

Concerning withholding taxes on pay for temporary services, you need to establish up front that you would like taxes withheld. Otherwise, you could be held responsible for a significant amount of unpaid tax at tax time. Many employers of temporary hygienists would prefer to withhold no taxes, because this saves them from paying the employer's portion of Social Security and Medicare (FICA), which amounts to 7.65% of wages. (The total is 15.3%, half of which is paid by the employee.) However, the whole idea of whether to withhold taxes or not should be based on the employment status of the person providing the service. I remember one doctor telling me that he didn't need to withhold taxes because I was considered an “independent contractor.” Since I was not a regular employee in his office, I figured he was correct. Actually, he was incorrect.

The general employment status rule is that an individual is an independent contractor if the employer has the right to control or direct only the result of the work and not the means and methods of accomplishing the result. Under common–law rules, anyone who performs services for an employer is an employee if the employer can control what will be done and how it will be done. This is so even when the employee is given freedom of action. What matters is that the employer has the right to control the details of how the services are performed.

An employee is generally subject to the business' instructions about when, where, and how to work. All of the following are examples of types of instructions about how to do work:

  • When and where to do the work
  • What tools or equipment to use
  • What workers to hire or to assist with the work
  • Where to purchase supplies and services
  • What work must be performed by a specified individual
  • What order or sequence to follow

As you can see, temporary hygienists are subject to all these controls.

Now, if you work with a staffing agency, you're considered a “leased employee” and fall under different guidelines. The staffing agency has the right to control and direct the worker's services for the subscriber, including the right to discharge or reassign the worker. The staffing agency hires the workers, controls the payment of their wages, provides them with unemployment insurance and other benefits, and is the employer for employment tax purposes.

The doctor pays the staffing agency directly.

Although there are some aspects of independent contractor status that would relate to dental hygienists doing temporary work, the preponderance of criteria shows that temporary dental hygienists are employees, and as such, should be subjected to all regular withholding taxes.

One other thought I want to share is if a doctor does not withhold taxes, he or she must furnish you a 1099 form at the end of the year. This form is used to report payments to nonemployees. If the employer does not report payments to you, he or she could be held liable for taxes and penalties later.

I hope you continue to enjoy the temping experience. Just be sure you state up front that you want all the appropriate taxes withheld from your pay, and take a couple of good sets of instruments along for emergency back–up.
Best wishes, Dianne

Dianne Glasscoe Watterson, 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 Watterson for speaking or consulting, call (301) 874–5240 or e–mail [email protected]. Visit her Web site at www.professionaldentalmgmt.com.