The great equalizer

Oct. 1, 2003
One thing that often bothers hygienists is how poorly they're treated by employers and patients, particularly when it comes to comparing one hygienist to another.

By Shirley Gutkowski

One thing that often bothers hygienists is how poorly they're treated by employers and patients, particularly when it comes to comparing one hygienist to another. Dental hygienists complain about salaries, compensation packages, and how much they put into their profession compared to their hygiene co-workers.

There isn't a hygienist alive that hasn't accepted a position, only to find that the preceding hygienist had reshaped the instruments with improper sharpening, also evidenced by the boulders of calculus visible on the radiographs. Working with one of these hygienists is very distracting.

Every time one of his or her patients is on your schedule, you know you'll be working extra hard. You'll remove deep black calculus that's been there for ages, talk to them about teeth lightening for the first time, explain the ramifications of bleeding on probing, explain the benefits of cast restorations over amalgams, bring out the camera for the first time, use a pre-op rinse for the first time, or place a temporary filling in a broken tooth.

You bring in scientific articles, contribute to staff meetings, have an X-ray ready for the doctor, and then you find yourself treating all of the perio cases in the practice because the other hygienist doesn't want to, and your compensation packages are identical.

What happens to the compensation package when that hygienist, who does only prophies, has been with the practice two years longer than you? Obviously, she has seniority. Obviously, she has more vacation time. Obviously, she gets more per hour or per day than the newest employee. Obviously, you're working harder and producing more than she is, and she's not up to par in her clinical skills. How frustrating is all this? Since I'm asking questions, how is the doctor supposed to know about this chasm between the abilities and work ethics of the hygienists? Does this mean the doctor has to do something about it? If the doctor wants to keep the second hygienist and values his hygiene department, he just might act.

The best way to make the situation equal is to pay the hygienists on commission or on production. Using this method, the hygienist is paid a certain percentage of the actual fee for a procedure. This is better for the hygienist and the office. It seems that many dental hygienists are scared to work with this type of compensation package. Their fear is that, suddenly, their integrity will fly out the window. They will start taking X-rays on people who don't need them. They'll start doing periodontal therapy on patients who don't need it.


Any oral health-care provider who would compromise his or her integrity in this way is rancid to the core. Most are not. Continuing to do the procedures indicated will net the motivated hygienist a nice paycheck and force the lackadaisical hygienist to get on the stick.

A good friend of mine said, "I treat every patient as if they were my Mom and as if dentistry was free."

There is no better way to treat our patients/clients. That simple sentence implies respect and a full range of dental hygiene and dental services. It implies that no patient will walk out of the treatment room with active disease unless they want to, because they will be fully informed. If a fluoride treatment is indicated, it will be applied. If a patient presents with symptoms that resemble an abscessed tooth, an X-ray will be taken, not to pad a paycheck or make ends meet, but because it is good dental hygiene practice.

Hygienists often panic when they consider the downside of working on commission, citing the no-show rate at their office. There are two other problems associated with working on commission — an unmotivated or hostile front office staff, and a doctor who thinks periodontal disease is treated with a toothbrush. If the schedule coordinator or the person who makes appointments is incompetent or feels the power of making or breaking the dental hygienist's paycheck, then problems are inevitable.

Working together in this venture can be rewarding for all. A token of appreciation to the scheduler on a particularly productive day is a good way to keep the schedule full, or some kind of incentive package could also be arranged.

Paychecks for the exceptionally motivated oral health-care provider can easily become bigger by working on this compensation model, and with the services she normally provides. What can and often does happen is that the doctor may be alarmed by the size of the dental hygienist's paycheck. The hygienist might make more than an associate dentist.

If handled properly, this method can prove to the doctor/owner that someone not working on commission or not producing their capacity is a drain on the financial health of the practice. Here's an example.

Harold Hygienist is making $25 per hour working 32 hours per week. He produces $6,000 per month. Harold brings home 53 percent of the dollars he generates for the dental practice. This does not include vacation and other benefits. He may be doing prophies all day every day. Whatever he's doing isn't all that he could be doing.

Heidi Hygienist works on commission, and earns 30 percent of her daily production. If she produced $6,000 in the same 128 hours per month like Harold, she'd bring home $1,800 compared to Harold's $3,200. If she produced $12,000 by providing essential dental hygiene procedures, her gross check would be $3,600. In other words, if Heidi provides services and treatments over and above Harold, even though he's been with the doctor longer, she's getting paid what she is worth to the practice.

The ordinary percentage paid to someone working on commission is all over the place. Most consultants, though, seem to agree that between 30 to 35 percent is fair. A hygienist making 30 percent may get paid holidays, but someone who earns a higher percentage may get no benefits.

To see if it's worthwhile, dig up the production numbers and multiply the total production by 30 percent. If you're frustrated with the parity between hygienists at your office, being paid on commission may take the sting out of it.

Shirley Gutkowski, RDH, BSDH, has been a full time practicing dental hygienist in Madison, Wis., since 1986. Ms. Gutkowski is published in print and on Internet sites, and speaks to groups through Cross Links Presentations. She can be contacted at [email protected].