Dentaltown July 2021 - 67

to expect maximum effort without reward?
Yet this disincentivizing form of aversion
therapy describes today's dominant dental
compensation system.
To create a superior structure, we took
our hygienist's W-2 taxable income for the
preceding year and divided it by her total
production to establish the past percentage
of compensation. For example, assume your
hygienist's salary for 2020 was $60,000 and
her production was $180,000. The future
compensation percentage would be 33% of
production ($60,000/$180,000 = 33%), so
she would receive 33 cents of every dollar she
produces. (Because an RDH can't control
collections, I always paid on production.)
Because a W-2 includes all paid benefits
including sick leave, paid vacations and
continuing education compensation, they
are automatically contained within this percentage.
Separate payment or recordkeeping
is no longer required.
Some hygienists may prefer that benefits
remain separate. This simplifies adjustments:
Simply remove the benefits from last year's
W-2 total, recalculate the compensation
ratio, and subsidies can be reimbursed as
they had in the past. (Your accountant, who
already has the necessary information, can
handle this.) This system rewards effort
when calculated with or without benefits.
Now, the more diligently and effectively our
hygienist works, the greater her rewards,
just like me.
Hygiene profit center
Central to some RDH-dentist disputes
is the small to nonexistent profitability of
many hygiene departments. We must improve
this to satisfy the dentist and the hygienist.
Our 25% productivity increase requires a
minimally higher overhead. Most expenses,
such as equipment, rent, insurance, utilities
and other staff salaries, remain unchanged.
The net is reduced only by the hygienist's
salary increase and a few pennies for supplies.
Requesting a salary enhancement without
growing hygiene production is akin to asking
dentists to reduce their paychecks to fund a
hygienist's raise. Refusing a salary increase
can leave the hygienist feeling frustrated and
powerless, but dentists may suffer lingering
resentment regarding their reduced pay
should the request be granted. However, our
enhanced profits resulted in my enthusiastic
support and commitment to the hygienist
and her department. Nota bene: The more
she makes, the more profitable the practice.
It is in the dentist's best interest to maximize
hygiene salary.
All employees, including janitorial,
must realize that their economic fate and
personal happiness remain inextricably
linked to overall office success. Mutual
profitability enhances everyone's pay and
allows for improved work environments.
In these ultracompetitive times, dentists
must become savvy businesspeople who
comprehend this foundational truth of
free enterprise: Increased incentives yield
amplified efforts that result in higher profits.
Creating an office leader
Most dental staff members are honorable,
hardworking people. However,
I've found that the vast majority aren't
self-starters; they do as they're told. Seasoned
professionals realize how rare and delightful
it is when a teammate takes ownership and
fully buys into one's practice. I was delighted
to have even one such individual at any given
time, until this system created opportunities
for well-educated, hard-working hygienists
to control their destinies. Once hygienists
became respected leaders, I only had to
stay out of their way.
Future projects they might spearhead
among many other practice-enhancing,
profit-building strategies include: implementing
or enhancing a soft-tissue management
system; establishing a hygiene-controlled
tooth-whitening program; creating an
in-office dispensary for electric brushes
and fluoride supplements; or developing a
halitosis center. Each project improves patient
service while increasing hygiene production
(and compensation), thus creating a sense of
control and personal power vital to health
and happiness.
Expanded hygiene
Let's dream big! Expanded hygiene,
featuring two dedicated rooms and a fulltime
hygiene assistant, is the next logically
progressive step to explosive hygiene and
practice growth. Space limitations prohibit
a detailed discussion of the topic, but let's
consider the benefits such a system provides.
The hygienist's chairside:
* Performs room setups
and breakdowns.
* Sterilizes instruments.
* Seats and dismisses patients.
* Reviews medical histories.
* Takes needed X-rays and images.
* Polishes, flosses, and administers
fluoride (state law allowing).
* Reviews oral hygiene (including aids
suggested by dentist or hygienist).
* Schedules recare exams.
* Assists with pocket charting,
sealant placement and
periodontal treatment.
An assistant performing all these fatiguing,
low-productive tasks allows an RDH
to treat 12 patients daily instead of the
standard eight. With expanded hygiene,
quality of care improves as each patient
receives 80 minutes of staff attention where
before, only 60 minutes were available. (Two
staff members, each working eight-hour
days, create 16 total hours for 12 patients,
or 80 minutes per patient.)
Expanded hygiene also enhances practice
income in two primary ways. First,
seeing a dozen patients daily rather than
eight creates an additional 50% increase in
hygiene production, above and beyond the
25% garnered by switching to commission
compensation. Second, the added care
diagnosed from 20 supplementary weekly
examinations (four per day for five days)
or 1,000 per year (20 per week for 50
weeks) further enhances revenue and may
singlehandedly eliminate the dreaded
business problem.
The hygienist is less weary at day's end
when freed from many tedious and tiring
tasks; she is allowed to focus on the unique
skills her training and license permit,
just like me. Before beginning expanded
hygiene, each of my hygienists worried
she'd become a " scaling machine. " After
a week, none wanted to work without an
assistant, just like me.
Implementing the above changes results
in hygienists, dentists and patients being
better served and rewarded. A triumvirate
triumph is essential because if the needs
of all parties aren't met, none will achieve
lasting fulfillment. But by intelligently
working together, we all become more! n
dentaltown.com \\ JULY 2021 67
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Dentaltown July 2021

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