Author Rachel Wall, RDH, BS
Hygiene compensation has always been a hot topic. In light of current hygiene staffing challenges, it has become a critical element in securing and retaining hygienists. In addition to incentivizing hygienists, for a compensation model to be sustainable, it must provide structure to ensure the hygiene department remains a profitable part of the dental practice.
For the last 20 years at IH, we’ve contributed to the development of healthy hygiene compensation plans for hundreds of practices. One of my dental CPA friends recently reminded me of this piece I did a few years ago and these principles still hold true.
A long standing industry benchmark for hygiene profitability is that hygiene production should be at least 3 times the total hygiene compensation and that hygiene produces 25-30% of total practice production. Of course there are variables that affect this such as insurance participation and doctor procedure mix. In this article, we will explore several hygiene compensation models that dental practices use to incentivize their hygienists and a few pros and cons of each model.
- Hourly Pay Model
The hourly pay model is the most straightforward compensation model for dental hygienists. Hygienists are paid a set hourly wage for the hours they work. With this model, we often see a team bonus in place that provides an equal distribution of additional income for team members based on hours worked.
Pros: This model is easy to administer and provides a predictable income for hygienists.
Cons: It may not incentivize hygienists to work more efficiently or improve protocols and systems to improve patient care. Hygienists may come to expect regular pay raises regardless of performance.
- Commission-Based Model
The commission-based model ties hygienist compensation to the amount of revenue they generate for the practice. Hygienists are paid a percentage of the revenue they generate, which can incentivize them to work more efficiently and provide better patient care through higher level services and adjuncts. This model can calculate pay based on individual or group performance.
Pros: Hygienists can see a direct relationship to their performance and their income. When based on net production, the model ensures hygiene is producing at the desired level compared to compensation.
Cons: This model can be difficult to administer, and hygienists may feel pressure to upsell unnecessary treatments to increase their commission. Also, when there are no patients on the schedule, there may
- Hourly Plus Commission Model
The hourly plus commission model combines the predictability of an hourly pay model with the incentives of a commission-based model. Hygienists are paid a set base hourly rate and can earn additional commission based on the revenue they generate compared to their base pay. This model can incentivize hygienists to work more efficiently and provide better patient care while still providing a predictable income.
Pros: Hygienists have a stable base income to count on while the opportunity to earn more once they reach a certain production level. The practice owner can determine what percentage of the hygienist’s compensation is hourly vs commission and ensure the first profitability point is reached before the commission starts.
Cons: This model requires careful math and clear communication between practice administrators and hygienists to make sure the hygienist knows how their commision is calculated and which procedures count toward their production goals.
Changing your dental hygiene compensation model
Over nearly 20 years, Inspired Hygiene has worked with numerous practice owners to elevate dental hygiene services, systems and hygiene profitability. When our clients ask us for help with restructuring dental hygiene compensation, we are eager to help because we’ve seen this touchy situation result in a successful transition when a few key components are implemented simultaneously.
1-Create a compensation plan that is easy for the hygienists to understand and have very clear communication around expectations, fears and concerns from all parties. Have a transparent method for reporting production and commission on the agreed upon timeline (monthly, quarterly).
2-Incorporate very specific clinical and communication training and coaching to give hygienists the confidence, knowledge and skills to implement clinical services and increase patient acceptance.
3-Map out a plan for the hygienists to reach the goals they set for their compensation. Use sample schedules to run different scenarios for hitting their goal and arm them with the proper equipment and products to achieve clinical outcomes that elevate patient health and profitability.
In the vast majority of practices, both employee and employer desire a dental hygiene compensation model that is fair and supports ethical clinical behavior as well as creating an income growth plan for both the practice and the providers. It’s important to consider the impact of the model on the hygienists’ attitudes and effectiveness in meeting compensation benchmarks.
No matter the model you choose, clear communication of expectations and the system for compensation is critical. We recommend a written agreement between employer and employee to
A few points you’ll want to be very clear on are:
- The threshold at which commission on production will begin
- The percentage of production that will be shared
- Duties expected of the hygienist during open time on the schedule
- Expectations of team work and support of the productivity of the entire practice
- Clinical protocols that must be honored
In conclusion, the right hygiene compensation model will depend on the practice goals and philosophy and the hygienists willingness to see it as a growth opportunity. By choosing the right hygiene compensation model, dental practices can incentivize their hygienists to provide better patient care, ensure the profitability of the hygiene department, and adapt in an ever-changing industry.
Check out this article and video interview I did with Patient Prism founder, Amol Nirgudkar.
Are you interested in learning how Inspired Hygiene can help your dental practice? Use this link to Book Your Discovery Meeting.