Written by Janice B. Cary, RDH Sunday, 29 February 2004 19:00
It’s staff review time again, and while you have been busy trying to understand how to give raises and still keep your practice within manageable financial limits, your hygienist has been cruising the Internet to discover what hygienists all over the nation are being paid. Chances are good that you are short on information and feeling pressured. Management consultants are in conflict over the best compensation solutions because each practice is unique. Guidelines have been established that can help, and a consistent approach to the review process is advised.
LET’S LOOK AT THE HYGIENE SIDE FIRST
You know without my telling you that your hygienist is a special member of your office team. Not only can he or she produce revenue, but he or she also can forge relationships with your patients that bind them to your practice and allow them to become major referral sources, enabling your practice to grow far beyond what you can do alone. By combining clinical skill, communication excellence, and professionalism, hygienists serve patients’ expressed and unexpressed needs. The alliance that is forged by a good hygienist who is also a good listener and observer keeps patients in your network, allowing them to become healthy and accepting of your treatment recommendations.
MEASURABLES VS. IMMEASURABLES
Patient loyalty to you and the practice has been established with a positive patient relationship built over time and a great clinical skill set, all offering themselves up for review. Your hygienist has financial goals in mind, some idea of the “going rate,” and most likely is not aware of your practice overhead and the ratio attached to hygiene production. Hygiene training programs do not generally have a management or business curriculum as part of the course work.
- Weekly salary based on hours usually worked (hourly rate listed) ... $;
- Paid vacation days at same rate of compensation as if worked ... $;
- Paid sick days if used or not used paid at same rate as if worked ... $;
- Medical insurance (annual amount) ... $;
- Uniform allowance (annual amount) ... $;
- Continuing education allowance ... $;
- Profit sharing estimate ... $;
- Holiday bonus ... $;
- Total available package ... $.
Included in the explanation is a sentence that shows the total increase in salary, in dollars and as a percentage. Thus, the employee has a clear picture of both the annual increase amount and the total compensation figure. The discussion begins with this presentation and clearly outlines all facets of the compensation issue. Both you and the hygienist are on the same page all the time. Questions can be answered and potentials discussed for both personal and professional growth. The paperwork becomes the vehicle for each subsequent yearly review, and if items are deleted or added, they can be discussed at that time.
DOLLAR OR PERCENTAGE INCREASE?
The rule of thumb that still holds in most situations is based on percentages. And frankly, it doesn’t matter whether you have 1 or more hygienists on staff. As long as the compensation is 30% to 33% of revenue produced, the formula works. By the way, this is a good time to remind your hygienist that there are times when the numbers do not add up and you pay for unproductive time. Establish a protocol for which staff member makes the phone call when a patient does not keep an appointment. (Usually, the person without the patient makes the call.) Decide if or how you compensate your hygienist for “working” recall, sending cards, and making calls to keep the schedule full. Do you reward the hygienist who assists you with an emergency patient, staying late and taking x-rays without being asked? This is the time to be proactive and discuss situations that happened during the past year. If improvements are needed, ask for cooperation. If you are reminded of “extras” done by your hygienist, say “thank you.”
BONUS AND INCENTIVE SYSTEMS
Increasing salaries by bonus systems can be difficult to track, tough to promote, and a team-breaker if not handled well. Having said all that, full-team bonus rewards are helpful if instantly given when due. Bonus systems based on hygiene performance alone do not always produce the desired results unless your full staff benefits from goal attainment. With a large staff, bonus goals need to be established clearly and maintained during the reward cycle (12 months, 6 months, special time frame such as just before the holidays), and considerations need to be established for end-of-year situations and insurance reimbursements/write-offs.
DOCTOR’S POINT OF VIEW
So, we’ve covered what the hygienist would like, and we know what the accountants generally recognize as reasonable. How would you as the doctor/owner/ manager/administrator like to reduce your stress over the salary debate? Here’s one person’s opinion. A client of mine is a doctor in Pennsylvania who is a partner in a newly developed, state-of-the-art group practice sharing 10,000 computerized square feet with in-house endodontics, orthodontics, pediatric dentistry (still searching for an oral surgeon), etc, and who has told me that there is “no amount of compensation that can reward an employee for the unmeasurables in making the practice a success.” Terry has said on more than one occasion that the “fit” must be right for both the employer and the employee. And further, he said, a staff member who works “for the money” will never be the right one. Of course, compensation must be competitive with the area and benefits reasonable, but at the end of the day, if your hygienist wants to leave on time and doesn’t help others out the door, then you need to start over. A highly compensated hygienist who is not happy with the practice or the doctor should be helped to leave. Patients are quick to pick up on the dissatisfaction. Hygienists are people who are happiest in rewarding relationships. They try hard to please everyone, and what it is that binds them to your practice can be very subtle.
THE LAST SIDE
Your first order of business is to form a plan and develop a vision of your practice as you want it to become. People who set attainable goals and write them down have a much better chance of succeeding. The act of aligning your conscious and subconscious thoughts, and being clear about what you want, can and does produce results. Secondly, at your next dental meeting, talk with your peers about successes and failures in their practices. Discover how they found and rewarded their best employees. Develop mentors from practitioners who have “seen it all.” Find out what they did to keep staff in place and happy for 5, 10, 15 years, and more. The discovery you will make is that you have to love what you do and attract others who feel the same way.
- Silverman S Jr. Demographics and occurrence of oral and pharyngeal cancers. The outcomes, the trends, the challenge. J Am Dent Assoc. 2001;132(suppl):7s-11s.
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