There are a few states where hygienists can operate independently; it seems like California might be one of them. One stipulation though is that the patient MUST have proof of a a dental exam in the last year. And the odds are pretty good that patients got their "cleaning" when they went in for an exam.
I would think long and hard before setting off down that road. In my opinion independent hygiene just isn't a viable business model. Think of all the costs involved. Your wife is probably making ~$35-40/hr right now, but if you take into account the portion of her taxes which is now payed by her employer and any benefits she recieves this number is probably ~$50/hour. The number I have seen for breaking down an operatory correctly according to OSHA standards is ~$30/patient. You have the cost of a building which I imagine will be pretty high in CA especially if you are in SoCal. Let's say a small place in the mall (you will need a high exposure location; since this is an unusual service people will not actively seek you out) runs ~$15,000/month including utilities - I think I am being overly optimistic here. Figure in another $50-75,000 initially to build out the location and get it stocked and equipped. This will run you around $700/month on a 10 yr. note. Unless your wife plans on working overtime you will have to hire someone to take care of the front office stuff for ~$30,000/year. But remember you are the employer now - the actual cost with taxes and benefits will be ~$40,000/yr.
I'm sure I am missing lots of little stuff here but let's say this covers everything. Assuming you wife hires another hygienist as an employee, both work 20 days/month and see 10 patients/hygienist/day (probably more than she sees now) you are going to need to charge:
$600/day for sterilization/OSHA costs
$800/day for the 2 hygienists' earnings
$167/day for front office staff
$35/day to cover the cost of your initial setup
$750/day to cover the cost of rent and utilities
Total: $2352/day = $118/patient
That better be one heck of a cleaning!!!!
If she had no employee and assuming the same fixed costs, she would have to charge $165/patient !!!!
Remember, this assumes no increase in her wages but with increased responsibilities. Also, without a dentist she will not be seeing many of the more lucrative SC/RP because as a hygienist she won't be able to administer anesthesia or prescribe the need for such a procedure. The main reason someone would come to a place like this is if they thought they were going to get a deal; this means that somehow you've got to be able to offer a prophy for significantly less than what a dentist charges and do about a zillion of them a day.
I could be way off with my numbers here, but it's something to think about. I would also ask this question over at DentalTown.com. You might actually find a hygienist who is doing this already. Good Luck with whatever you decide.
