Click here to enlarge imageSince reducing hygienists’ wages is impractical, doctors need to organize and manage their hygiene departments smarter. The six management actions to hygiene success are:
- Creating a hygiene profit center and empowering the hygienist with profit and loss responsibility.
- Tying hygienist compensation to profitability.
- Delegating hygiene scheduling control to the hygienist and using a computer to record procedures and schedule appointments.
- Providing each hygienist with a clinical/administrative assistant.
- Designating two treatment rooms for each hygienist to enhance productivity.
- Having the hygienist or assistant educate every patient for three to five minutes using electronic imaging (e.g., intraoral video cameras, digital still cameras).
Hygienists should be responsible for their own business areas. After all, they are highly trained and well compensated. Thus they should be viewed as partners in the practice and paid accordingly. Hygienists, like doctors, should be paid for what they do, and should not be paid for what they don’t do. The hygiene profit center matches hygiene production with expenses, and hygienists should receive a share of the profits based on performance. Production includes recall visits, deep scaling, root planing, sealants, and electronic imaging tours and X-rays, but excludes the doctor’s exam fee.
Hygienists who are paid on commission are generally happier, perform better, make more money than their salaried counterparts, and take ownership responsibility. On the other hand, hygienists who prefer an hourly wage or salary should find work at a dental practice that is willing to pay $74 an hour, as calculated in Figure 2. If you’re comfortable paying $74 an hour for a provider, perhaps you’d be better off hiring another dentist to do hygiene, amalgams, and other procedures. Practices that pay hygienists $74 an hour based on clinical work actually performed operate using a 1970s business model that assumes lower labor costs and minimal OSHA requirements.
Computer technology using point-of-treatment workstations and electronic appointment scheduling makes delegating possible. A hygienist (or assistant) who uses a chairside workstation can key in procedures performed in less than 30 seconds. She also can schedule the next hygiene visit in the electronic appointment book in less than a minute.
This approach gives her control over her schedule, reduces data-entry errors and omissions, and, surprisingly, lowers failed appointment rates. The patient appreciates the clinical necessity of the next appointment because the hygienist makes the appointment directly and motivates the patient to keep it. Hygienists who use point-of-treatment workstations say that they have more than enough time to perform these two simple tasks.
Equally important is that the receptionist, who used to enter procedures and schedule appointments, has more time to pay close attention to the doctor’s schedule, fill last minute openings, and collect money. In a typical one-doctor, one-hygienist practice - where 50 percent of patient visits are for hygiene - a receptionist has at least two extra hours a day to spend on high priority activities.
The production of a hygienist with an assistant and two treatment rooms could equal that of two hygienists with no assistants. Patients receive the same quality care and the department operates more efficiently. Data from a time and motion study presented in Figure 2 shows how an assistant, whose hourly rate is less than 50 percent of the hygienist’s rate, dramatically improves the department’s profitability.