Paying more for less

Sept. 1, 1998
Who came up with the salary figures for the chart example, "Who`s on staff?" in the article, "The Pension Plan" in your March 1998 issue? Based on a four-day, 36-hour work-week average, you have the RDH making approximately $18/hour and the dental auxiliaries making less than $10/hour. I want to know where on the face of this planet are you able to find employees to work for those salaries?

Who came up with the salary figures for the chart example, "Who`s on staff?" in the article, "The Pension Plan" in your March 1998 issue? Based on a four-day, 36-hour work-week average, you have the RDH making approximately $18/hour and the dental auxiliaries making less than $10/hour. I want to know where on the face of this planet are you able to find employees to work for those salaries?

My spouse is a solo practitioner in Denver with two full-time employees (DA and patient-care coordinator) and a part-time hygienist. Last November, the hygienist who had been with us for over nine years, retired. After a two-month search, we decided to hire a new grad from a two-year community college program, as she was the only person available. This individual was 21 and we were able to talk her into coming to work for us by paying her a starting salary of $28/hour! She lasted six weeks in our office before deciding to move back home with her parents.

We hired a respectable dental placement service we had used successfully in the past to find us a hygienist. Four months, and $750 later, we not only do not have a permanent hygienist, we haven`t had one candidate to interview! Our placement agent could find no one from three area schools or the one in a neighboring city who didn`t have a job commitment prior to graduation.

When our patient-care coordinator informed us five weeks ago that she would be moving, we immediately called the agency to find out about available candidates to fill her spot. We were told the dearth of applicants is so bad that they wouldn`t even contract with us to find someone. So we set out advertising on our own.

We have interviewed more than 20 people for this position, and the only qualified candidate we could find would not leave her current position unless we paid her $21/hour to start. We did not feel our practice could afford that salary, especially in light of the fact that we are paying $36/hour to a temp agency to staff us with a hygienist one to two days a week.

Over half of our "educated and experienced" applicants required a calculator, or were unable to answer this application question: If Mr. Jones` treatment fee is $120 for today and he receives a 10 percent senior discount, what is his total charge for today`s services? These same people have been through a nine-16-month associate degree/private tech school program and are being told by these schools to expect $12/hour to start? When I ask experienced placement personnel, I am told that my expectations are very much within reason, but these salaries are not.

One can only raise treatment fees to compensate so much. We raised fees twice in the past year for an overall average of 11 percent and on par with other fee-for-service practices in our area. Our overhead is up 33 percent in the first six months of this year, and this is almost entirely due to employee salaries. Both production and collection are up by 26 percent, but the doctor`s salary has gone up only 22 percent. (His gross salary last year was $112K, as opposed to the $134K in your example!)

After 10 years of private practice with a well-managed overhead, we have experienced incredible employee turn-over and base salary increases in the past two years. Everyone is having to pay more for less-competent and experienced people. My spouse has been told by current and almost all past employees that he is great to work for. But he is ready to throw in the towel with frustration and sighs watching his younger colleagues emerge from dental school unable to make even hygiene wages after eight years of schooling and mountains of debt.

Our reputable dental employment agency can only console us with the "bottom-has-to-drop-out soon" adage. They also implore us (dentists) to "do something to stem this tide ... you are the only ones who can." How?

We look forward to your reply to our question and an explanation for the salary figures used in this article.

Name withheld

Brian Hufford responds: Your frustration with staff salaries is evident. Quite simply, the salaries listed in the chart are meant to illustrate a point about the differences in retirement plans and should not be used as the "gospel" for the fees you should be earning or paying your staff. Generally, we use the numbers at the lowest end of the wages we see to represent staff salaries in examples such as this. Otherwise, some dentists become concerned that publication of "normal" wages will drive up salaries in those areas where lesser salaries still are acceptable. The dentist`s salary of $134,000 in our example is not inflated. In fact, the dental clients we work with (most of whom study practice management with Pride Institute to ensure systems are in place to support optimum patient care, production, and collection) actually average salaries of $143,774, with additional noncash compensation (pension and fringe benefits) of $29,360. As a rule of thumb, the dentist`s salary should be a minimum of 25 percent of production, after all expenses have been paid.

Based on the issues you address, there appear to be several key items on which to focus.

First, congratulations on your statement that your practice is fee-for-service. Your struggle with salaries would only increase if you were overly involved in third-party insurance or managed-care plans.

Second, you are tracking some numbers in your practice - overhead, production, collection - which is important. As you know, the numbers tell the story, and there are many more besides these that need to be monitored on a regular basis to assure the practice is hitting its goals.

Third, don`t be so quick to assume you have to hire employees who are fully trained. Fully trained by whom? It is far better to hire someone with the right attitude and willingness. The ability will follow with proper training by you for the way you want it done in your practice. It sounds as if the qualified applicants weren`t really that qualified anyway, so why not look outside of dentistry for the right match? Obviously, a licensed hygienist or an expanded-duties chairside assistant require professional schooling, but appointment coordinators, financial administrators, and patient-care coordinators can be recruited from many other professions and be trained. You`re too busy to train? Get yourself some reputable practice-management advice. There are books, tapes, and classes available from business schools for the dentist and staff, such as Pride Institute.

Finally, tell your husband not to throw in the towel. Finding good employees takes time and effort - for all industries. Don`t be so quick to rely on expensive employment agencies - they can be OK in a pinch, but it is far better to advertise and interview accordingly. Regarding the hygiene shortage, the tables will turn. Indiana is one positive example where there is now beginning to be an abundance of hygienists. Several years ago, the Indiana Dental Association decided to mandate more hygiene classes. The result is more graduates who are finding that (in certain counties in particular) there suddenly are not so many job openings. And guess what? Hygiene salaries are coming down. I am pleased to see that you have sent a copy of your letter to the ADA and your state dental society. Perhaps the representative in your state will adapt the same "fix it" attitude that Indiana did. In the meantime, with your permission, I`d like to put you in touch with one of our clients in your area whose successful practice, pension funding, and lifestyle have surpassed his goals. We find that networking with other local dentists who are positive and successful can present solutions to even the toughest problems. Good luck.

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