independent dental hygienist...

[DrToof]

Which States allow dental hygienists to independently practice without a dentist on site? Are hygienist allowed to open and run their own clinic? How does it affect dentists and the public? Any information is much appreciated.

---

Members don't see this ad.

 

[12YearOldKid]

The only state I know of is Colorado and it hasn't had much effect. It is common for hygienists to be paid way out of line with regards to what they actually produce for the practice. The thinking is that the value of an RDH isn't so much in what she produces, but in what she allows the dentist to do by freeing up his schedule.

Basically, a hygienist in a dentist's office can make more and work less than a hygienist running her own place.

 

[12YearOldKid]

Now somebody is going to come in here and tell you that RDH's in an office should only be paid a third of production, but that (in my opinion) is usually grossly miscalculated by consultants and doctors.

Many offices will include x-rays and exams in the hygiene production figure which is where they screw up. First of all, the hygienist doesn't do the exam. Second, the patient isn't paying $75 for somebody to click the button 16 times and take a full mouth series; they are paying $75 for the dentist to interpret the films and render a diagnosis.

An independent hygienist can't legally interpret films or examine patients so their sole production is from cleanings and product sales. Makes it hard to compete with the salaries dentists are willing to pay - not to mention the added headaches of running a business.

 

[DrJeff]

Now somebody is going to come in here and tell you that RDH's in an office should only be paid a third of production, but that (in my opinion) is usually grossly miscalculated by consultants and doctors.

Many offices will include x-rays and exams in the hygiene production figure which is where they screw up. First of all, the hygienist doesn't do the exam. Second, the patient isn't paying $75 for somebody to click the button 16 times and take a full mouth series; they are paying $75 for the dentist to interpret the films and render a diagnosis.

An independent hygienist can't legally interpret films or examine patients so their sole production is from cleanings and product sales. Makes it hard to compete with the salaries dentists are willing to pay - not to mention the added headaches of running a business.

As much as you may bemoan this answer, if you have a good crew of hygenists working for you, you WILL rely on their diagnostic interpretations ALOT. Once you've seen what a hygenist that works for you can and can't do, both clinically and diagnostically, it will often greatly affect how you'll do your patient exam. I'm fortunate enough to have 4 hygenists that work in my practice who have very good diagnostic skills, to the point where when I walk into the room to do the exam after my hygenists have done the cleaning/applicable films 90%+ of the time what i will reccommend to my patients is what my hygenists have identified clincially and/or radiographically and noted on a small post-it note on top of the patients chart for me to look at. I'll look at any films taken that day, rarely finding anything that my hygenists missed(often they've noted a few incipient interproximal lesions that I'll just try and remineralize rather than restore), and then take a intra-oral look, once again rarely will I see something that I want to do something about that my hygenists haven't already noted. A little small talk with the patient, and very often less than 2 minutes after I walk into my hygenists operatory, the patient is on their way to the front desk. For 2 minutes of my time, my hygenist has billed (if bite wings were taken) a little over $200(and yes my exam fee is included in that number)😀

There is a certain amount of confidence/trust that you need to have your hygenists earn before you can do this, and not every hygenist has these skills. The last time we hired a new hygenist, instead of 2 minutes of operatory time for a patient check, it would be 5 or so minutes for the 1st few months until I learned what the diagnostic/clinical strengths weakness of my new hygenist was.

As for hygiene compensation, well 33% is the general rule of thumb as noted, and unless your fees are too low, or your expenses too high, it is a win-win situation where you'll make $$, and your hygenist will be well compensate. Since their pay is basically production driven, they'll tend to be quite pro-active about keeping their schedules full and are aware that the more they produce, the more they'll make. Basically they determine their salary. Additionally, a good hygenist with a good patient rapport will often have the patient prepared and wanting to have any needed treatment done before you step into the room👍

I can't stress enough that to be successful in this field you need a good TEAM. And that also means that you're a part of the team, so if you put yourself on too high of a pedestal, you'll see some unhappy team dynamcis which can really make your professional life much more difficult than it needs be😱

 

[12YearOldKid]

Oh, I agree completely that hygienists can see caries on x-rays - a good assistant too. It's not that hard once you know what to look for and two sets of eyes are better than one.

I was pointing out that LEGALLY they can't render a diagnosis from the x-ray which is what the patient pays for. So even though hygienists are often paid for radiographs (and sometimes exams) by dentists, really it's not their production and that income is not available to the independent hygienists.

BTW, Dr. Jeff. Thanks for spending time on here to provide a voice of experience. It truly is appreciated.

 

[Lesley]

As much as you may bemoan this answer, if you have a good crew of hygenists working for you, you WILL rely on their diagnostic interpretations ALOT.

Everything you say is 100% correct. It is nice to walk into the room, review the x-rays, review the exam that the hygienist has prepared, do my exam and take both into consideration. It is team work. A good team makes life easier. We prefer to pay hourly, though.

Happy New Year.

 

[SuperC]

Mex-e-co!
-C

 

[DrJeff]

As much as you may bemoan this answer, if you have a good crew of hygenists working for you, you WILL rely on their diagnostic interpretations ALOT.

Everything you say is 100% correct. It is nice to walk into the room, review the x-rays, review the exam that the hygienist has prepared, do my exam and take both into consideration. It is team work. A good team makes life easier. We prefer to pay hourly, though.

Happy New Year.

We pay hourly also, we just have quarterly reviews where if needed(and it seems to be needed about 95% of the time), my partner and I give bonuses to our hygenists to bring their compensation upto 33%. The caveat is that before bonuses are handed out, we show our hygenists how much $$ we contribute towards their medical, retirement, uniform allowance, and CE stipend, and then factor all that into the 33% number. This quarter is going to be interesting since mid December we recieved a new fee schedule from United Healthcare where they upped their prophy UCR fee by $13 , so I'm guessing that during reviews at the end of March we'll be writing out bigger bonus checks than usual. I foresee a very happy hygiene department in my future 😉 😀

 

[groundhog]

Dr Jeff knows how to run a business. Take care of the help and they take care of you. That does not mean that you might not have to thin out a bad apple now and then, but even that will be rare if you do a good job on your selection process. I've been around long enough to watch very successful small businesses go bust in about five to ten years when short sighted greedy kids take over for the old man and start driving out the good help with their penny wise pound foolish "squeeze blood from the turnip" personnel policies.

 

[diastema1]

Which States allow dental hygienists to independently practice without a dentist on site? Are hygienist allowed to open and run their own clinic? How does it affect dentists and the public? Any information is much appreciated.[/quote

As I understand, independent Hygenist also works at California, they must get their certification in Local Anesthetics Techs through a bi-annual testing center (School of Dentistry), get in touch with Cal. Dental Board, after you get certified, the Hygenist advertises with a few Drs. and the Doctors will send patients with the Diagnosis and treatment planning ready to be followed by the hygenist, including the Xrays. Hygenist does the scaling and takes the post-op Xrays and sends it back to the dortors office. 😱
The advantage is that doctors have more office space translated into more productive capabilities to treat multiple and faster quantities of patients without having to get a Hygiene Scheduler Organizer that has to make calls in order to keep the production high, mainly this doctors are the ones that works with PPO, Medicare and HMO plans, which means "lots of work and low pay" just like a fast food business, quantity makes the different!... quality is not mandatory and "WALLA" mediocre dentistry work is done... ...But. But. But, the hygenists did a great Job...😀

 

[Lesley]

We pay hourly also, we just have quarterly reviews where if needed(and it seems to be needed about 95% of the time), my partner and I give bonuses to our hygenists to bring their compensation upto 33%. The caveat is that before bonuses are handed out, we show our hygenists how much $$ we contribute towards their medical, retirement, uniform allowance, and CE stipend, and then factor all that into the 33% number. This quarter is going to be interesting since mid December we recieved a new fee schedule from United Healthcare where they upped their prophy UCR fee by $13 , so I'm guessing that during reviews at the end of March we'll be writing out bigger bonus checks than usual. I foresee a very happy hygiene department in my future 😉 😀

We review once a year, not quarterly. It just works out better for us that way. I always add up employee perks, insurance, retirement, uniform allowance, vacation time, CE, recalculate and inform all our employees of their "true" hourly wage at review. I give raises at this time too. Going on 23 years at this practice alone, I find repeatedly, that most employees, regardless of perks, focus on their base hourly wage and how many hours are available for them to work. I like to be very competitive in the base hourly wage area, before calculating in all the perks. Even before the perks, my employees are making above average hourly wage, certainly no less. I can't give them any more hours than our office schedule permits. We have been down that road. Hygiene, I have found, has a natural ceiling when it comes to the hours needed for each practice. You can try to grow it, but you have to be willing to possibly increase the size of your office, add more operatories, more overhead, participate in more plans, more discounting, do more exams while working on your own patients, interrupting the work you are trying to accomplish and has the potential for more canceled/broken appointments. For us, it was not an efficient proposition. We have found the ideal number of hours for our office, and it has been pretty consistant over the years. We've only had employees leave, and not often, because of pregnancy, marriage, moving or very occasionally dismissal. Due to dismissal, maybe only 2-3 employees over our 22+ years at our office. None of our employee's income is related to a percentage of their production. This system works well for us and may be a little easier to keep track of. I'm glad yours, slightly different, works for you.👍

Living and learning every day!~

 

[DrJeff]

We review once a year, not quarterly. It just works out better for us that way. I always add up employee perks, insurance, retirement, uniform allowance, vacation time, CE, recalculate and inform all our employees of their "true" hourly wage at review. I give raises at this time too. Going on 23 years at this practice alone, I find repeatedly, that most employees, regardless of perks, focus on their base hourly wage and how many hours are available for them to work. I like to be very competitive in the base hourly wage area, before calculating in all the perks. Even before the perks, my employees are making above average hourly wage, certainly no less. I can't give them any more hours than our office schedule permits. We have been down that road. Hygiene, I have found, has a natural ceiling when it comes to the hours needed for each practice. You can try to grow it, but you have to be willing to possibly increase the size of your office, add more operatories, more overhead, participate in more plans, more discounting, do more exams while working on your own patients, interrupting the work you are trying to accomplish and has the potential for more canceled/broken appointments. For us, it was not an efficient proposition. We have found the ideal number of hours for our office, and it has been pretty consistant over the years. We've only had employees leave, and not often, because of pregnancy, marriage, moving or very occasionally dismissal. Due to dismissal, maybe only 2-3 employees over our 22+ years at our office. None of our employee's income is related to a percentage of their production. This system works well for us and may be a little easier to keep track of. I'm glad yours, slightly different, works for you.👍

Living and learning every day!~

Lesley, don't you just enjoy trying to explain the concept of "true hourly wage" vs. dollars per hour to employees sometime🙄 😉 With a couple of my hygenists who've been working for the practice for well over a decade, the way we do our retirement plan is through a profit sharing program where the amount that we contribute to their retirement funds is over $10,000 a year😱 , so when we show them their true hourly wage vs. their dollars per hour they'll very often see a difference of $8 to $10 per hour, and subconsciuosly you can almost see the dollar signs lighting up in their eyes saying to themselves "if I took no benefits and all cash, look at what I'd be making!"🙄

Isn't it fun being the boss sometimes😉

We just went through loosing a hygenist a few months ago due to moving away to follow her spouse, and my partner and I took a great deal of pride when she told us that one of the hardest things on her about the move was leaving our office, since she never felt so at home, or comfortable (or appreciated for that matter) as in my office. It was nice to hear that as an employer, even if it meant we were loosing a very good hygenist.

 

[Lesley]

so when we show them their true hourly wage vs. their dollars per hour they'll very often see a difference of $8 to $10 per hour, and subconsciuosly you can almost see the dollar signs lighting up in their eyes saying to themselves "if I took no benefits and all cash, look at what I'd be making!"🙄

Unfortunately, employees often remember what you tell them about for a minute. The "base hourly wage" seems to be a very big, mental stumbling block for many employees. I've just given up trying to fight it.

We do a Simple IRA, so our match, consistantly at 3%, is not nearly the amount of a profit sharing plan. But when you consider that either match is a based on gross income and the health insurance benefit is a pre-tax deduction, they are both are very valuable. All benefits add up, it's annoying to have to remind anyone of it. Employees can certainly do the math if they think they are shorted in any way, but it doesn't work the other way round.😉


It's ashame about your hygienist. Not everyone will be that appreciative.