This question is being raised in the Northwest where a Washington state dental practitioner bill passed through the Senate Health Committee.  The Senate version of this legislation moves out of committee and can potentially be considered by the full Senate.

If this bill passes in the Senate, Washington will be the next U.S. state to adopt a mid-level dental provider model to create both dental hygiene practitioners and dental practitioners, who will be supervised (offsite) by a dentist.

These practitioners will be allowed to provide various levels of dental care “pursuant to a written practice plan with a dentist.”

Dental hygiene practitioners would expand the scope of practice of the state’s hygienists, who can now place fillings after a dentist has done the prep work. They would receive specialized training to do extractions, handle medical emergencies, and administer some drugs.

Dental practitioners would be permitted to do everything that hygienists can do except scaling and cleanings. They could also do restorations, administer anesthesia, and extract primary teeth as well as loose permanent teeth (+3 to +4 mobility).

Both types of practitioners could work with offsite supervision if approved by their supervising dentist, but neither could do dental crowns, bridges, or complicated procedures. (Dr Bicuspid)

The Washington Academy of General Dentistry and the Washington State Dental Association oppose this bill siting, “insufficient training for diagnosis and a lack of direct supervision.”

What are your thoughts on mid-level dentist practitioners? Are they bad for dentistry?

For more: Washington Lawmakers Mull Dental Therapist Bills

“Hygienists are a critical aspect of any practice,” said one prosthodontist who pays on commission.

“My hygienists make quite a bit of money on commission," offered another dentist. "They sell sealants, fluoride, Arrestin, perio med, not to mention dental crowns, Invisalign, etc."

"Hourly wages are unfair; the dentist takes all the risk," said a pediatric dentist. "I continually have to remind my hygienists to utilize downtime constructively for something other than ‘dusting’ their workspaces. But in past when I paid on commission, I tended to lose my dental hygiene staff during downtime."

Read more: Dental Hygienists Get Paid by the Hour

“They get paid too much for what little they do,” complained a New York orthodontist paying his dental hygienist $27 per hour.

Another dentist – one paying $55 an hour – disagreed about the value of dental hygiene. "She's worth every penny. She makes me a fortune."

Read more about dental hygienists – Dentists: What do you pay your dental hygienists?

Another 11% have reduced the number of dental hygienists they employ, and 5% have cut compensation.

“Hygiene is the fuel that feeds the fire," said a California dentist.

How much hygienists are paid is an important dental management decision. "Upon doing a practice analysis, we found we overpaid our hygienist by $13,000," said one dentist. "We paid more in hourly plus benefits than we collected!"

“Our hygienist was paid salary and now she is paid hourly," said one doctor. Offered another, “Instead of any raises, we put our hygienists on a bonus system based on achieving a minimum daily production."

Here’s more of what dentists had to say on hygienists and tooth cleaning appointments:

• "Hygiene at our office, which has a dentist and a prosthodontist, has remained strong throughout this economy. We are very thankful." (Ohio prosthodontist)
• “We have not cut hours, but we have worked very hard at activating past due patients, with good success.” (General dentist)
• “We have at least two cancellations in hygiene daily. Most tell us to reschedule their dental cleaning later into the year. Other simply say they are not coming.” (Bermuda dentist)
• “Hygiene is the one aspect of the practice that hasn't shown lower numbers. I'm glad we instituted a good recall systems several years ago.” (Pennsylvania dentist)
• “We are seeing more no-shows, and some people are wanting to wait a year instead of 6 months for their next dentist cleaning.” (Dental hygenist)
• "If things slow down more, I will cut my dental hygentist days or time and do the dental hygiene myself.” (New York dentist)
• “They have to take on more responsibility.” (Massachusetts dentist)
• “We have a very periodontal oriented office. A lot of our patients are switching themselves to twice a year for teeth cleaning. They only want what the dental insurance will cover.” (Utah dental office worker)
• “The gross receipts were down about 1% last year, but the profits were slightly up.” (Pennsylvania dentist)

Read more about dental practice management: Dental Hygienists – How the Recession Affects the Dentist

While dentists want to promote access to dental care, most doubt that an unsupervised visit to the dental hygienist is the right answer.

Read more: Dentists Not Enthusiastic About Dental Hygiene Clinics

Location is highly correlated with hourly base pay, with urban California hygienists being paid twice as much as their rural Southern counterparts.

Read more: How much dental hygienists get paid

Four out of five dentist report paying hygienists a base hourly wage.

Only 19% say their hygienists are paid on commission.

Read more: Paying Dental Hygiene Staff Not a Dentist’s Most Fun Job

But why is that? We found that 76% of dentists think it’s not a profitable business model, whereas 22% think hygiene practitioners’ hands are tied by state laws.

Dental hygiene clinics seem to fail, because dental hygienists need dentists and dental practices to be most profitable. At least, that's what our dentist respondents seemed to think…

• "Dental hygiene clinics are bad for the public, good for hygienists. How much more are we willing to give up? We are health care providers. not just a good business model!" (New York prosthodontist)
• "Financially, I don’t see how it could pay for itself." (California dentist)
• "The whole concept is flawed. They cannot diagnose and read X-rays, and this will definitely lower the standard of care. It will also make it cost more since the doc will have to charge more to do dental exams." (Connecticut dentist)
• "Will they subcontract a DDS to come in to do exams at $200 an hour?"(Alaska dental office manager)
• "A hygienist is an invaluable team member due to close and continuous communication, which is not able to happen in remote hygiene settings." (California dentist)

Read more: Are Successful Dental Hygiene Clinics a Myth?

Dr. Jim Sparaga is constructing a new dental facility in rural Maine. He’s going to need some dental hygienists for his expanded practice, but finding them has proven more difficult than expected. He came up with a great recruiting strategy – but a few Maine dentists were less than thrilled.

Learn more by watching the video below. Or, if you prefer the written word, you can read Jim’s editorial about the difficulty of recruiting dental hygienists.

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Have you ever wondered what your real profit is on your hygienists or dental associates? Have you ever wondered whether a hygienist can be more profitable to you than an associate? If you have an extra operatory available, would it be more profitable to hire a dental associate or another hygienist?

In last week’s column, I explained how you can earn a profit of $493 per day from a hygienist who produces $962. How much would an associate have to produce to yield the same profit? Here again, the Comparative Value Analysis is helpful.

Comparative Value of One Day’s Production

Let’s assume that you would pay the dental associate 41% of his or her production. (In reality, we normally recommend that the associate be paid a percentage of his collections. However, we will keep things simple here.)

Further assume that the associate would pay his or her own lab fees and assistant, and that you would not have to add any front desk staff to handle the associate’s patients and scheduling.

Your net profit rate on the associate would be as follows:

Net Profit Rate on Associate

The associate would have to produce $1,176 per operatory used to give you the same profit as a hygienist. If the dental associate used two operatories, he or she would have to produce $2,352 per day to be as profitable as hygiene would be in those same operatories.

In our experience, it is easier to bring hygiene production up to $960 per day than it is to find a dental associate capable of consistently producing $1,176 in each operatory, or $2,352 in two operatories. Also, the associate must have a sufficient flow of patients to make this production level possible.

When structuring both hygiene and associate compensation, we advise that you compare what the hygienist or associate is earning on the relationship, compared to what the senior dentist is earning. The relative compensation levels should reflect a fair distribution based on the parties’ investments of time, energy, and financial risk.

For help in increasing hygiene production, a key element to increasing doctor profitability, contact J.P. Consultants or Advance Hygiene Concepts.