Dental Hyigienists and Dentists: Financial Considerations

Turning a Profit on Your Dental Hygienist Investment
Editorial by Jim Du Molin

Once again, I’m putting my capitalist hat on and analyzing the economics of dental hygienists. (I started by discussing the economic aspects, and last week I talked about how you can turn a profit.) The dentist needs to begin by preparing an operatory for a hygienist, then actually hiring one. Done properly, the dentist will then start earning a healthy chunk of passive income. At this point, many hygienists may view the dentist as a fat capitalist who is getting rich off the sweat of their labor. They fail to recognize the cost of capital and risk.

As a capitalist, your risk is the cost of equipping the hygiene operatory. If you have to add a staff member in administration to schedule hygiene, that cost would also have to be considered.

In our example, we’ll assume that your cost is a $554-per-month loan payment on equipment for the hygiene operatory. When we subtract this cost from the previous increase in profit, the net return is $5,799 per month, or about ten times your risk. As the number of hygiene days per month increases, your return on investment continues to grow. And that’s what American Capitalism is all about.

Profit on Hygiene Investment

Number of hygiene days per month 4 8 12
Profit on hygiene production* $1,169 $2,338 $3,506
Profit on dentist’s production* $5,184 $5,184 $5,184
Less: capital investment – $554 – $554 – $554
Total Net Profit per Month $5,799 $6,968 $8,136
* before indirect overhead costs

If you’ve got comments on the economics of hiring hygienists, feel free to post them below!

Alternative Providers of Dental Care (Survey Video)

Alternative providers and dentists: dental survey videoAlternative providers are playing an increasing role in dentistry, with more and more states expanding the roles of alternative or mid-level dental providers.

In our survey, half of dentist respondents said they are concerned about the level of care alternative dental providers can provide. In addition, over half believe that there should be fewer alternative providers than there already are.

On the other hand, 22% of dentists in this survey feel good about mid-level oral health providers and believe that alternative providers increase access to dental care.

Jim Du Molin and Julie Frey discuss what dentists think about dentistry, dental hygienists, and alternative providers:

“There’s no real need for more of these non-dentist providers,” said a Nevada dentist. “If patients and dental insurance valued dental care with proper payment for services, they could use the existing infrastructure of dental availability.”

“We need MORE alternative dental providers to meet the needs of our population. This is the only way we will be able to meet present and future underserved,” said a Connecticut endodontist.

“We’ll need them when there is a public health system to employ them,” said an Illinois Dentist. “Otherwise, dental insurance companies and entrepreneurial dentists will employ them and use them to crush our ability to make a living in private practices.”

Do you have any further thoughts on alternative providers of dentistry and dental care?

What Dentists Have to Say About Dental Hygiene Clinics (video)

What Dentists Have to Say About Dental Hygiene Clinics (video)Across the U.S., lawmakers are approving the licensing of independent dental practice hygienists in states where it appears that the public needs greater access to dental care.

But independent dental hygiene clinics are a controversial approach to dental care.

Dental hygienists may love the idea, but dentists just aren’t sold on the concept.

The Wealthy Dentist decided to conduct a survey to ask dentists if they’ve ever seen a successful, private, independent dental hygiene clinic.

One New York prosthodontist wrote, “Bad for the public, good for hygienists. How much are we willing to give up? We are health care providers — not just a good business model!”

To hear what other dentists had to say about dental hygiene clinics, Click on Play to watch the following short video —

What are your thoughts on dental hygiene clinics? Do you believe that they can be a success?

Dentists Cut Hours of Dental Hygienists

Dental hygienistsOne dentist in three has cut their dental hygienist working hours, with the slow economy leaving less demand for dental hygiene services.

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

Dentist Faces Unexpected Challenges in Hiring Dental Hygienists

How Do You Attract Practitioners to Under-Served Areas?

Watch the Video

Luring hygienists to a practice in rural Maine has proved challenging. Though there’s been a lot of interest in the ads they’ve posted, very few candidates are actually interested in the “downeast lifestyle” that Machias, Maine, offers.

Recruiting Hygienists from Across the StateBuilding Machias Dental

So the Sparagas decided to try another hygienist recruitment strategy – and it’s proven to be surprisingly controversial. For $35, the State Bureau of Records gave them a mailing list of all licensed health care providers in the state of Maine.

Interestingly, roughly a third of the listed RDHs used their current office as their personal mailing address. As a result, the Sparagas received a few irate letters from dentists questioning the moral and ethical appropriateness of soliciting their hygienists. As one doctor wrote,

I feel compelled to write you today with a serious concern we have regarding a mailing each of our hygienists received from you (at our office address no less!) inviting them to join your team at Machias Dental.

Our reaction to this solicitation initially was to laugh at it, though as I thought more about it, my feelings went from amusement to outrage to bewilderment. This is not the way we “do things” in Maine, so where was this coming from? I know your reputation and the reputation of your practice is outstanding, so I’m confused as to why this type of mailing would make its way to our office. I can only assume this was an oversight mistake on your part. I suppose this can happen. But did hygienists at other dental offices in the state also receive this letter? I certainly hope not!

Please either respond to this email or call me to discuss this matter further. I would like to put my mind at ease that the collegial culture Maine dentists have traditionally enjoyed is not on the decline! I look forward to hearing from you soon.

The Doctor Defends His Strategy

Dr. Sparaga’s response was both diplomatic and sympathetic.

Thank you for your concerns about our recent mailing to all the hygienists in the state in our quest for a new hire. I’m sorry if you have taken this personally and it has offended you.

As we all know, it is most difficult to attract qualified personnel to live here, and we’ve resorted to a mass mailing to Maine RDH’s seeking someone looking for a change not only in jobs, but in lifestyle. With a practice in an underserved rural area, we do not have the luxury of putting an ad in the local paper, hoping to attract a provider, someone looking for a change.

The state considers the lists of practitioners, medical and dental, as public information, rather than personal. With the dental manpower shortage in the rural areas, the state bureau of records is most willing to give out the list of all their medical and dental personnel especially if it helps remedy the maldistribution of manpower toward these areas. I would suppose when considering the current access to care issue, it might be considered unethical to restrict such information. For whatever reason, it would appear that many of the RDH’s listed their dental office of employ as their contact address, instead of their personal residence. We could not tell whether these addresses were of their home or office. And of course, I assume that these healthcare professionals will judge for themselves whether our offer of new horizons is offensive to them. I would propose that the offer might mean more to them than a concern for collegiality amongst us dentists.

Thank you for understanding that a mass mailing was the only way we could reach out to Maine’s RDH’s and supply more healthcare manpower to this underserved area.

But in addition to the angry letters, they also received several excellent replies from remarkable candidates. The Sparagas are happily interviewing those RDHs now.

Jim Du Molin’s Two Cents

I am squarely on Dr. Sparaga’s side. There’s nothing wrong with a doctor who is looking to hire hygienist taking a state mailing list and sending out a letter. It is clear to me that there are no ethical issues here. The state mailing list is public information, and I’m not going to fault Dr. Sparaga for using all the resources available to him.

Registered dental hygienists are a scare resource. Given the realities of supply and demand, that means there will be competition for RDHs. If you’re a dentist and you need a hygienists, you will do whatever you can and pay whatever you need to in order to find a hygienist. It’s easier for dentists to raise their prices than function without a hygienist.

In addition, there are lots of reasons why RDHs (or anyone) might switch jobs. No matter how great a job is, sometimes people need a change of scenery. People are going to do what’s in their own self-interest. If you want loyalty, get a dog!

So to the doctor who complained, I would say, “If you’re taking care of your hygienists, then you have nothing to worry about.”

What do you think? Post your comments!


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