Trends in Hygiene Education

Author: Heidi Arndt RDH, BSDH– – CEO – Enhanced Hygiene

The past 10 years have brought many changes to dental hygiene supply & demand with the growth of dental hygiene schools all over the country. With that, the compensation of dental hygiene has also seen some big changes.

I went to dental hygiene school in Minnesota in the late 90’s. At the time of my graduation there were only 7 schools in Minnesota, and only 1 of which that was offering a 4-year degree. Now there are over 10 dental hygiene schools in the state and some are graduating 2 classes/year of graduates. Needless to say, Minnesota (urban) is saturated with dental hygienist, as are many other cities and states across the country.

The saturation of dental hygienists has also caused some changes in the compensation landscape for dental hygiene. And, in my opinion the changes are not so bad. As long as you are committed to practicing to the top of our license and training, which we should be doing anyway…right?

According the recent RDH magazines survey, the per hour pay is still the most popular form of compensation for dental hygienists, however this form of pay has seen a slight decrease in the areas where there is a heavy supply of dental hygienists.

The dental hygienists that were reporting pay increases in 2011-2012 were part of a commission type structure of pay, which is the pay structure that is picking up popularity in dental practice and groups throughout the country.

However, The question remains, how should you compensate your hygienist?  There are several schools of thought ranging from hourly rates, to base plus commission, or full commission.  There are benefits and challenges inherent in each method.  Your selections of compensation plans should be based on find the most balanced method for your practice, keeping in mind profitability, competitive rates, and personal incentive needs for the dental hygiene team.  And, no matter the method,  

the focus of patient care is the highest priority!

COMMISSION: I have seen a lot of success with the commission style compensation. For the hygienists, the practice and the patient care that is delivered.

Commission pay is best calculated from the Adjusted Gross Revenue or the Collections number. Using this, I have seen commission percentage ranges from 24-38%. And the percentage, depends heavily on your mix of business (insurance, write offs, etc.) Commission paid from the UCR of gross revenue can is an easy calculation for the hygiene team, but depending on your collections and mix of business; it can cause fluctuations on your profit margin.

There is no doubt the commission structure provides an ‘incentive” for the hygiene team. Yet, it is often met with a lot of resistance from the hygiene team. Why? Because of the unknown, the change, and the fear of how it will affect their personal finances. And, this is completely understandable.  

Before, implementing a commission style pay the dental group needs to set a strong foundation of protocols, systems and support for the dental hygiene team. These measures will help ensure success for the hygiene team. Not only that, the management needs to be prepared for all of the questions and concerns the hygiene team will have.

And by all means, NEVER implement a commission style pay as a punishment or as a result of frustrations with your hygiene team performance.

Instead, reward your high performing team with a piece of the pie. Allow them to take a piece of the production they bring to the practice!

**Also, be sure to check on your states labor laws about commission style pay for your hygiene team. There is some language that you need to be aware of before implementing this type of plan.

BASE PAY + Commission: The base pay, plus commission plan is a good

compromise to the straight commission plan. The base pay is provided to the hygienists as a per hour or a per day compensation. This rate should be set well below the standard pay rate for hygiene, so an incentive can be easily built in. Production above this amount will be paid as a percentage of the adjusted revenue (collections) they produce. 

This plan takes some modeling in order to find the right base and commission based on your geography and mix of services.

BASE PAY + Incentive: The other plan that has some popularity is the base pay plus incentive. It is much like the base pay, plus commission but it is set up slightly different. The dental hygienists will be paid their standard hourly rate up to a set daily production goal. Once the hygienist exceeds their daily goal, they receive either another $1-2 per hour, or they get a % of the over-age.

Although this plan sounds nice, it is cumbersome to calculate and understand for the entire team.

What’s the RATIO?: As a general rule of thumb, dental groups will allocate about one-third of hygiene production for compensation.  This includes gross salary, tax match and all benefits.   This should be what you what your outcome to look like when modeling your compensation plan.


WHAT YOU SHOULD EXPECT: I have heard dentist say that all the good hygienists are already taken!  While that’s not true, it can seem that way when it comes to creating a strong working relationship with your hygienist.  Dental groups should expect high performance from highly compensated hygienists, and the truly great hygienists know this.The mark of a true dental hygiene professional is possessing a proactive nature, being held accountable, and demonstrating an eagerness to contribute.  This goes both ways… doctors should educate themselves to the expanding role of the hygienist and learn ways to open the lines of communications.  Building an appropriate compensation package is a foundational step in creating an outstanding, long-term relationship with your hygiene team.

The BOTTOM LINE: There are several hygiene compensation plans out there today, and the all have their perks and a downside. The plan you select for your hygienists needs to be one that you are confident in, and happy with the outcome of patient care and financial outcome for them and your group.

After helping over 13 dental groups implement commission style plans, I can tell you this…keep it simple for everyone- simple for the hygiene team to understand, and simple for your accounting staff and managers to calculate.

Be clear and transparent about the plan, and help them understand the benefit to the patient, to them and to the business.