Dental Associates vs. Hygienists: Who’s More Profitable?

Examine the Bottom Line When Considering a Hygienist and/or Associate
Editorial by Jim Du Molin

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

Provider: — Hygienists — Associate
Mary Tim Goal Equiv.
(Commission) (Salary) (Per op)
Production $700 $700 $962 $1,176
Collections (96%) 672 672 924 1,129
Less…variable costs (9%) – 63 – 63 – 87 – 106
…commission (41%) – 288 n/a – 482
…salary n/a – 288 – 313 n/a
…employer taxes (10%) – 29 – 29 – 31 – 48
Profit $292 $292 $493 $493

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

Collections 96%
Less: variable costs – 9%
Less: commission – 41%
Less: payroll taxes – 10%
Profit 36%

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.

Hygiene Clinics: Without Dentists, Hygienists Have No Profit

In this survey, we asked dentists if they had ever seen a successful, private, independent dental hygiene clinic. Only 2% said they knew of a successful one.

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?

Dental Hygienists’ Compensation (video)

Hygienist pay ratesDentists report the average dental hygienist base hourly pay is $36 an hour, starting at under $20 an hour and extending past $50 an 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 hygienistsDentists: What do you pay your dental hygienists?

Dental Management Decision: How To Pay Your Dental Hygienist (video)

Dental hygienist payment videoMost dentists (81%) paying their dental hygienists a base hourly wage. Only 19% say their dental hygienist payment includes commission.

“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

Dental Care: Are Mid-Level Practitioners a Threat to Dentists?

Dental Care: Are Mid-Level Practitioners a Threat to Dentists?Can mid-level dentist practitioners give the same quality of dental care as a dentist?

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

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