Howard Speaks by Howard Farran, DDS, MBA, MAGD
Publisher, DentalTown Magazine

Last month the online survey at www.DentalTown.com was on hygiene-related issues. Over 1,000 Townies took the poll. One of the questions asked, One of the survey questions asked “How long do you schedule for a regular cleaning?” Fifteen percent said 30 minutes, 25% said 40 minutes, 21% said 50 minutes, and 39% schedule a full hour. At my Today’s Dental Practice in Phoenix, AZ, we schedule a full hour for a hygiene check.

Do you think your hygiene department is profitable? An overwhelming 77% said yes, while 23% said no. My dad always told me that God gave us two eyes so you could keep one eye on the customer and the other eye on cost. From over a decade of lecturing and talking to dentists, I seriously doubt the majority of dentists have systems in place to accurately track their hygiene overhead.

Does your hygienist sell merchandise such as toothpaste and mouthwash? Forty-two percent said yes, while 58% said no. We dabble in this a little but not enough to write home about.

What percentage of your patients receive a regular cleaning every six months? Six percent said 20%, 18% said 40%, 39% said 60%, 35% said 80%, and 2% said 100%. Can you believe that two out every 100 dentists said every single patient is on active recare? They either have perfect dental practices with perfect patients, or they are completely insane. You be the judge!

How do you pay your hygienist? Thirty-three percent said salary, 8% said commission, 17% said base salary + incentives, and 42% said hourly. I paid my hygienist 35% of production from 1987 to 2000. I have always paid my dentist associates 25% of production. The dentists have a lab bill that runs between 7% and 10%, which the registered dental hygienists do not have. So I added the 10% lab bill to the doctors 25% and that is how I arrived at paying my hygienist 35% of production.

I discontinued paying hygienists on production in 2000 and I think it works better to pay them hourly. The reason is variance. If dentists have their morning schedule fall apart, they can come back after lunch and do a bridge and make goal for the day. If dentists have a cancellation they can fill that time in with an emergency patient. Dentists have a very high production variance. Most emergency patients are either:

A broken tooth needing $1,018 worth of treatment in an hour
0140 - Emergency Exam - $55
0220 - Periapical - $19
0270 - Bitewing - $15
2950 - Buildup - $175
2752 - Porcelain to Noble Metal - $754

Or a toothache needing $1,723 worth of treatment in an hour and a half.
0140 - Emergency Exam - $55
0220 - Periapical - $19
0270 - Bitewing - $15
2950 - Buildup - $175
2752 - Porcelain to Noble Metal - $754
3330 - 3 Canal Molar endodontics - $705

Now with registered dental hygienists, it’s a completely different story. If their schedule falls apart it was always a bad day. When the hygienist had a super great day they never said thank you. And if their schedule fell apart with no shows, cancellations, or reschedules, their attitude would fall apart as fast as their schedule did. Having a high staff turnover is not good. One day I had a hygienist leave me who had been with me for 6 years. Her name was Donna and it broke my heart. She did not like the stress of not knowing what her paycheck would be. It finally hit me after a decade–if a hygienist has a patient no show, how do they make up for that? A cleaning, exam and bitewings is about the same money as a quadrant of root planning and curettage.

1110 - Routine Prophy Case Type I - $70
0274 - 4 Bitewings - $41
0120 - Periodic Oral Exam - $39
Total - $150
4341 - Case Type II/A - $94
4341 - Case Type II/B - $122
4341 - Case Type III - $200

Hygienists have a very small production variance. If a patient doesn’t show, the hygienists lose. If every patient shows, they win. I now pay all hygienists hourly, $32 an hour, which is the going rate in Phoenix, and now their attitude is awesome. This is why we call our Today’s Dental practice–Prototype #1, because our business model and our dentistry are always changing. Where do we find all the great information to make changes? On www.DentalTown.com! We now have over 13,000 registered dentists, hygienists, receptionists, assistants, lab techs, consultants, and hopefully YOU!