How One DSO Manages the Hygienist Shortage and Maintains Production

Written by: Michael W. Davis, DDS
hygienist shortage


The current staffing shortage of registered dental hygienists represents a national challenge. Numbers of suggestions have been proffered to alleviate this hygienist shortage.

Some advice from the American Dental Association (ADA) focuses on enhanced hiring efforts. Others point toward innovative technologies to mitigate staffing problems.

The California Dental Association makes a case for elevated salaries, bonuses, and benefit packages.

hygienist shortage

How One DSO Manages the Hygienist Shortage and Maintains Production

Practice management expert, Roger Levin, proffers a multipronged approach.

Dr. Maggie Augustyn presents novel humanistic attitudes in attracting superb hygienists with her highly unique methodology.

One particular dental support organization (DSO) recently distributed a policy letter for all employed dentists and hygienists to read and sign, at this past holiday season. The document is presented here as it was given to their company’s professional personnel. DSO company name and logos have been redacted. Cited names of company officers, directors and personnel have been redacted or reduced to initials for anonymity. Any run-on sentences, typographical errors, grammatical mistakes, etc. read exactly as printed by the DSO’s president, in this formal policy statement.

One is recommended to read the following DSO internal policy letter from the perspectives of ethics, legality, compliance with a state dental practice act, respect for the doctor/patient relationship, third party interference into patient healthcare, and dollar production trumping patient welfare.

Readers may decide for themselves if this presentation of DSO policy is constructive and beneficial to alleviating our dental hygienist shortage.


Hello Doctors, Happy Holidays to You and your family!

Regarding your having hygienists:

We are delighted to have a hygienist work for you if you feel you need a hygienist to work with you in your dental practice.

Our opinion: Hygienists and having a hygienist work with you in your office… is a luxury not a necessity in the practice of dentistry.

When we hire a hygienist to work for you, we have expectations. We assume you will fully support and refer patients to your hygienist to ensure your hygienist will produce… a minimum of $850 every day… that your hygienist works for you.

For instance, if your hygienist works 20 days per month, your hygienist is expected to produce a minimum of $17,000 in that month (20 days $850 per day).

So long as you are supporting your hygienist and refer her/him an average of $850 per day which is easy to achieve, you may always have a hygienist or a second hygienist to support you.

We have offices that have two hygienists working for one doctor!

  1. D. RDH (name redacted), our Clinical Director of Hygiene and Perio is happy to discuss with you our expectations and help you establish effective hygiene business processes and protocol to ensure that your hygienist produces a minimum of $850 a day.

When you have a hygienist work for you. At the end of every month, S. D. RDH will calculate whether your hygienist produced our minimum daily requirement ($850/day) and you will be emailed your hygienist’s monthly production results.

In the event your hygienist produces less than an average $850 per day, your hygienist may be transferred to another general dentist who will do whatever it takes to support their hygienist in-order to produce our minimum daily requirement to employ a hygienist.

Again, if you feel you need a hygienist (or more than one)… we are happy to hire hygienists to work for you, but you must take ownership of your hygienist’s success and support them by referring hygiene and periodontal procedures to them to ensure their success on a monthly basis.

We’d like you to know:

Dr. J.N. (name redacted), a GP who has worked with us for 15 plus years does not have a hygienist… does not want a hygienist… and has a 3rd RDA (registered dental assistant) perform XXXXX (redacted initials of state dental board) allowable procedures- coronal polishings on his patient’s (sic) teeth.

Dr. N., performs all other periodontal procedures on his patients and refers any patients in need to a periodontist.

Dr. N. produces consistently month-over-month well over $85,000 a month and often well over $100,000 a month and has done so for many years, practicing dentistry without the support of a hygienist.

And, I’d like you to know that this month (*November 2022) I have not had a hygienist work with me and I’m on track to produce more than $100K.

All the best,

  1. L., DDS President

Please reach out to S.D. RDH, Clinical Director of Hygiene and Perio if you’d like to visit with her.

hygienist shortage


Practice affiliation for doctors and hygienists is increasing within the DSO industry. Prior to the COVID-19 pandemic, numbers of dental hygienists faced bleak prospects for desirable employment.

Post-pandemic, many hygienists left their profession, as part of what many term “The Great Resignation.” Others continue to search in vain for what is today called a “Unicorn Dental Office.”

Hygienists increasingly ask themselves and each other, is it possible today to find an opening in a dental office which operates ethically and in the best interest of patients and staff?

Yes, help wanted offerings are rife for dental hygienists. However, is money enough to compensate for a potentially toxic work environment?

The ADA’s Health Policy Institute, American Dental Hygienists’ Association, et. al. found in an comprehensive 2022 study that the leading reason for hygienists voluntarily leaving their field (42.9%) was workplace culture (e.g. poor leadership, toxic environment) and not insufficient income (26.6%).


The more pertinent question may be, can an ethical patient-focused practice survive in today’s dental industry climate? The economical principle of Gresham’s Law mandates that bad money always drives out good, if unregulated. The same applies to bad practices in the dental profession driving out good, if unregulated.

Without serious efforts towards oversight and especially enforcement of violations to ethics and statutes, few hygienists will desire work, much less a career in an all-too-common unhealthy employment environment.

The above DSO professional employee document may resolve the company’s immediate problems. Unfortunately, it exemplifies a deeper crisis within the dental profession. If that troubling trend is not recognized, addressed, and resolved very soon, our beloved profession will rightly be viewed by the public as tantamount to the sales of timeshare condos and boiler-room penny stock traders.


Dr. Michael W. Davis practices general dentistry in Santa Fe, NM. He also provides attorney clients with legal expert witness work and consultation. Davis also currently chairs the Santa Fe District Dental Society Peer Review Committee. He can be reached at