When I consult with dentists on the pay rates that hygienists are being offered in their area, I usually hear two things:
- “I can’t post a job at that pay range; it’s more than what my current hygienist is making.”
- “How can offices afford this? Dental insurances don’t even reimburse that much for a recare appointment.”
But here’s the thing: It doesn’t matter how amazing you and your practice are. If your pay rate on a job posting is lower than all the other hygiene posts in the area, you’re not getting applicants. And if you’re paying your current hygienist less than other offices nearby, you might, unfortunately, find yourself without one soon.
Now, I’m not saying, “Just throw more money at it; that’ll fix everything,” but we need to think outside the box to stay staffed in this tough and expensive market. Many consultants will say that hygiene pay needs to be 30% of your hygienes columns production. But with dental insurance that can be near impossible to do with the rising hygiene pay rates.
What you should focus on is making your hygiene column more profitable for the practice as a whole and compensating your hygienist based on that, rather than just the 30% of their production. With that being said this article has two goals:
- Help you make your hygiene program more robust to ensure your patients are getting the best oral care possible.
- Help you find additional money in your hygiene program to bring your hygienists pay rate up market value without breaking the bank.
#1 Think of your hygienist as a providers not a producer
In February 2020, hygienists in California were happily making $47/hour. By the end of the year, however, they were asking for $65/hour. I reached out to my clients and dental consultants to see how they were handling this significant increase, as these rates were clearly beyond the typical 30-35% production range we were used to in the hygiene column.
One common response from my clients was that they shifted their focus away from their hygienist being a primary producer. Instead, hygiene appointments became part of the lead nurture process to feed the doctor’s production. They justified the higher cost by viewing their hygienist as a key part of their marketing process and budget.
Think about it: Hygienists are the front line driving patient flow. The experience patients have with them often determines whether they move forward with treatment. In many cases, hygienists form the strongest relationships with patients. Personally, I love my dentist, but I LOVE my hygienist. When I refer people to the office, it’s because of her.
For skeptics, let me share a story. I have a client in Irvine, CA whose hygienists requested a raise. They switched to assisted hygiene and reduced appointment times to 30 minutes. The result? The doctor’s production went down, as co-diagnosing fell by the wayside, and long-time patients left the practice. While hygiene production technically improved, overall practice revenue suffered. They returned to 1-hour appointments, kept the pay increase, and the practice stabilized.
I know this approach is bold, so I’ve also gathered additional strategies to maximize your hygiene profitability.
#2 Set and Track Production Goals
My friends Michelle and Tina over at Staff Driven Dental Consulting offered this suggestion: set goals for production originating from the hygiene column—not just from what the hygienist performs like prophys and SRPs, but also production referred to the doctor’s column.
This includes:
- Reviewing pending treatment and scheduling patients
- Whitening
- Night guards
- Arestin
- Identifying “fractures” or “dark spots” for the doctor to diagnose
This goal is reviewed daily in the morning huddle. It’s up to the hygienist to follow up and ensure treatments are completed and discussed at future appointments.
This is an excellent way to assess your hygienist’s overall contribution to the practice. Even if their pay exceeds 30% of their hygiene production, you can still assign a tangible dollar value to their impact on the practice’s total production.
#3 Hygiene Philosophy Meetings
Sharyn Weiss at Weiss Practice Enhancement encourages her clients to hold hygiene philosophy meetings to ensure that hygienists and dentists are aligned.
Ideally, if hygienists see the same number of patients, their production should be consistent. However, variations occur due to subjective treatment decisions. To align everyone, the doctor reviews all potential scenarios and outlines expected outcomes. For example, if a patient complains of tooth sensitivity, the doctor must perform an exam, even if unscheduled.
This approach:
- Ensures consistent patient care across hygienists
- Provides superior care by addressing issues promptly
- Holds the team accountable with clear expectations
- Likely increases doctor production
Training and consistency are key, and the payoff is well worth the effort.
#4 Increase Your Patients Visits
This one came from my personal hygienist: Encourage your hygienist to increase the frequency of patients’ recare appointments. For instance, I complained once to my hygienist about how one of my teeth felt fuzzy. No matter what I did, I couldn’t get rid of that fuzzy feeling. She explained, “Yes, teeth 5, 6, 7, and 22 through 26 build up plaque quickly on you. Let’s switch you to four-month recare appointments instead of six.” Now, I’m paying for two extra recare appointments out of pocket each year.
This not only improves my (the patient’s) oral health but also increases profitability by scheduling additional visits that may be paid out-of-pocket. Small adjustments like this can significantly boost your hygiene schedule’s productivity while delivering personalized care to your patients.
#5 Have a Soft Tissue Management and Smile Analysis
Michelle Massotto, Lead Coach at Staff Driven Dental says it’s crucial for your practice’s success to have a Soft Tissue Management System in place.
The team at Staff Driven also shared that their clients’ hygienists conduct a “Smile Analysis Survey” at every recare appointment. This involves 8 to 10 questions designed to uncover patient concerns, allowing hygienists to offer suggestions to improve their smiles.
They’ve generously agreed to share their Smile Analysis form as a tool for your hygiene department – simply email [email protected] and she will send it your way!
#6 Have an arsenal of products and procedures
Equip your hygienists with an arsenal of products and procedures to offer patients when necessary. The most profitable hygiene practices empower their teams to provide optimal care with tools like:
- Oral Cancer Screenings
- PerioPaste
- Electric Toothbrushes
- Specialty Paste
- Anti-sensitivity Agents
- Antimicrobial Medicaments
- Fluoride Treatments
Don’t enforce quotas. These are meant to be used when your hygienists identify a true need, helping both your patients and your practice thrive.
#7 Shake up the Schedule
We discussed how shortened hygiene appointments can lead to a decrease in doctor production. However, many patients don’t require an hour-long appointment. For those straightforward cleanings without pending treatments, consider scheduling 45-minute hygiene appointments. Reserve hour-long appointments for new patients, those with pending treatments, or cases needing extra care.
You might operate with 45-minute appointments on two days a week and hour-long appointments on three days, or vice versa, depending on patient needs. Just ensure your hygienist has a dedicated assistant during the shorter appointment days.
#8 New Patient Exams Go on Doctors Schedule
Credit goes to Michelle and Tina at Staff Driven Dental for this idea as well. In their clients’ practices, new patients are placed on the doctor’s schedule rather than the hygienist’s.
When scheduling the new patient, the front office team informs them that the doctor will conduct an exam and evaluate their needs. They mention that they’ll try to do the cleaning the same day, but in some rare cases, it may not be possible. This allows for proper perio diagnosis and scheduling while keeping hygiene production optimized by removing longer new patient exams from the hygienist’s schedule.
Michelle says “This also allows sufficient time for the doctor to spend with all new patients building the three most important things with a new patient: Their trust, Certainty, and likingness of the doctor personally and the practice as a whole.”
#9 Hire the Right Hygienist
It’s no secret how difficult it is to find a hygienist in today’s dental field.
The key to success is writing a compelling job advertisement and getting it in front of as many hygienists as possible. DirectDental can help with this by distributing your job post across all major job boards and offering additional services to extend your reach.
Once you receive applicants, finding the right person is essential.
Sharyn suggests looking for hygienists motivated by a passion for helping others, not just the paycheck. While it may feel like most are driven by money, many entered the field because they genuinely care about dentistry and patient care. Focus on finding those ones.
Michelle and Tina recommend paying attention to how candidates communicate with patients during cleanings. Hygienists who discuss areas of concern and offer solutions are likely passionate about oral health. These are the applicants who will integrate well into any hygiene program and provide excellent patient care.
#10 Review Bonus
Patient reviews play a huge role in attracting new patients to your practice. Increase both hygiene and doctor production by boosting your reviews. One way to do this is by offering a small bonus whenever a hygienist receives a 5-star review that mentions their name. You could even extend this incentive to your entire team, which could result in a significant increase in reviews and new patients.
I understand that these ideas may feel daunting and might not work for everyone, but it’s crucial to think creatively about the costs of employing dental professionals in today’s market. By increasing your hygienist’s production or tracking their overall financial contribution to the practice, you can better afford them as their rates continue to rise.
Other ways to keep your hygienist happy
I took some time to interview some hygienists that left the field to get insight into what offices can do to keep their hygienists happy. Here is what I found.
Invest in tools and systems to keep their backs healthy
Whenever I ask hygienists why they left the operatory, the number one answer is often related to back pain.
Hygiene is a physically demanding job, so consider investing in ergonomic chairs and tools that make cleanings easier. Support your hygienist by giving them time to stretch between patients, and maybe even assist with chiropractic costs or treat them to a monthly massage. Sharing recommended workout videos can also show your commitment to their well-being.
Offer them the flexibility they need and want
Again, hygiene is not easy, and we are seeing hygienists cut back on the number of hours they work each week to take care of themselves. So rather than looking for a full-time hygienist, post your job with the hours you see hygiene patients and welcome anyone to apply if they can work one or more of those days.
If you consider running some days with 45-minute appointments, you might increase the pay for those days while shortening the hours worked. Instead of 8 to 5, your hygienist could work from 8 to 2:30, while their pay remains almost equivalent to a full day. Just make sure you work with your HR company to stay compliant with your state’s labor laws.
Make them feel included
Another reason people have left the field is that they feel like outsiders in their practice. The dentist, assistants, and front office staff all get mini breaks throughout the day and gather together for a quick laugh, while your hygienist is often trapped in their operatory. Consider training your assistant on something they could do for hygiene patients, allowing the hygienist to take a mini break and hang out with the team for a few minutes. Alternatively, have a dedicated lunch break where you treat everyone to lunch, giving everyone a chance to socialize for a few minutes each week. Anything to make them feel included will help.
The Misunderstood Value of Benefits
Sharyn at Weiss Practice Enhancement had this to say about hygiene pay and benefits. “When employees complain that they’re underpaid compared to their peers, it’s often because they’re focusing only on their hourly salary without including the value of their benefits. Sit with your hygienist and provide dollar figures for every benefit you offer. Make sure you include benefits most employees ignore – like their holiday “bonuses,” free uniforms, free CE, licensure renewal, dental treatment, social security, and retirement. When the monetary value of these benefits are added to the hourly salary, many hygienists realize that actually they’re already receiving a generous compensation package.
If an applicant requests a higher salary than you budgeted, use their request as part of the interviewing process and see if you can negotiate a more reasonable salary.
- How did you arrive at this salary level?
- Does this amount include the value of benefits? (As we mentioned, most employees don’t understand benefit packages or their value.)
- What benefits are most important to you?
- My current employees with this job title make $XX when benefits are factored in. Given this information, would $XX be acceptable to you?
- As a business owner, I want you to be able to live comfortably in our community and also provide a salary that matches your skills and your contribution to my practice. Since your requested salary is higher than what my current team makes, what specifically will you do
- to justify this amount? How will you increase our production / collection /efficiency so that the practice can afford you?”
Sharyn offers a fantastic tool called the Dental Wage Planner to help you calculate your employees’ full compensation package. As a bonus for reading this article, it’s free! To get yours, email her at [email protected].
Final Thoughts
Finding hygienists is increasingly difficult and costly, but by maximizing their impact on both hygiene and doctor production, practices can afford to offer more competitive pay. This approach not only helps retain talented hygienists but also ensures they are bringing in more revenue to cover rising salary demands. By tracking a hygienist’s contribution to the overall production, you can confidently justify higher wages.
A big thank you to Sharyn, Michelle, and Tina for sharing their invaluable insights for this piece and for their ongoing willingness to contribute their knowledge to me and my readers.
Smiles,
Holli Perez
DirectDental
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