Compensating hygienists

I have three very good dental hygienists in my practice. Over the years, I’ve always paid them a daily rate; however ...

by Dianne Glasscoe Watterson, MBA

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Dear Dianne,

I have three very good dental hygienists in my practice. Over the years, I’ve always paid them a daily rate; however, I’m wondering if a different method of compensation might be better, such as commission-based pay. What is your recommended method of compensation for hygienists?
Dr. Bill

Dear Dr. Bill,

There are three ways hygienists are compensated: (1) daily or hourly rate, (2) base pay plus commission, and (3) straight commission. The daily or hourly rate is still used by many practices, primarily because of its simplicity. However, if downtime is problematic, doctors get antsy when they count the costs of paying a hygienist who is not producing.

My favorite method of compensation for hygienists is a base pay plus commission. Using this method, each hygienist is compensated for his/her individual efforts and not the efforts of the group.

The base pay is to ensure some compensation in case the day falls apart, but when there is a great production day, the hygienist would have the opportunity to earn more. The commission amount is generally 25% to 30% of the excess of the production goal.

For example, say your daily goal was set at $900. If a hygienist produces $1,000, the excess is $100. 100 x 30% = $30. So, for that day, the compensation would be the base plus $30. The commission is a good incentive to push a little harder. Some hygienists are motivated by it; some are not. I still like having the base because hygienists are employees and cannot prevent the occasional low production day when the schedule falls apart.

Hygienists paid strictly on commission are happy only if their schedule is kept full, which puts pressure on the business assistants. I have seen commission-based pay cause rifts, and I have also seen full commission pay turn hygienists into production “monsters.” Hygienists may be tempted to sacrifice quality for quantity in an effort to keep production rolling.

If they ever get a taste of a big production pay check, they may feel demoralized if they are not able to maintain the same high level of production for every pay period. You and I both know there are ups and downs with commission-based pay.

Another problem with commission-based pay is that there is no incentive for hygienists to do anything other than clinical hygiene. It is unreasonable, even illegal, to expect staff members to work without expectation of compensation.

The team concept can suffer, as hygienists on straight commission are not compensated for residual duties, such as sterilization, laundry, calling patients, and assisting other coworkers. In one situation, the doctor expected his commission-based hygienist to come in on her day off and fill her schedule without compensation. She filed a complaint with her local labor board and won a sizable settlement.

By law, staff members have to be compensated when they are expected to perform residual duties. It can be at a different rate, but compensation must be provided all the same.

The value a hygienist brings to a practice should be a function of both her direct and indirect production. If the hygienist is an adept communicator and has the ability to help patients understand and accept needed restorative recommendations, her value increases many times over. Does your hygienist have an intraoral camera? Does your hygienist understand your desires regarding promoting restorative/esthetic dentistry? Are your hygienists willing learners and promoters of your practice? These are important considerations above and beyond the hygienist’s raw production numbers.

Dianne Glasscoe Watterson, MBA, is a consultant, speaker, and author. She helps good practices become better through practical on-site consulting. Her book, Manage Your Practice Well, is available for purchase at For consulting or speaking inquiries, contact Dianne at or call her at (301) 874-5240.

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