We know the pandemic has had a profound impact on the dental profession. Hygiene, in particular, has been hit hard, with a number of hygienists seeing it as a sign to change careers.
The resulting labour market has seen dentists jumping over each other, pushing salaries ever higher to make sure they had someone—anyone—available to treat their patients.
Perhaps many of you might be surprised to hear that this is not the first time we have seen huge increases in hygienist salaries. We may have to go back in time a couple of decades, but I recall some hygienists making more than some dentists back in the 1990’s!
Hygiene colleges could not turn out new grads fast enough!
Eventually, everyone learned how great the salaries were and enrolment in college hygiene programs boomed. This resulted in more hygienists in the labour pool, which created downward pressure on salaries.
At the end of the day, dentists not only survived that experience—they thrived!
This time, we may have to factor in that the Great Resignation has produced labour shortages across the board. So many people are re-evaluating how “work” fit into their lives that this labour shortage could last longer than what we experienced in the 90’s.
Then again, who knows for sure. Nobody has the crystal ball that will answer all questions!
Perhaps it is this concern that is leading some dentists to choose to go without a hygienist. Some are even doing their own hygiene.
Many dentists have told me they won’t replace any lost team members until salaries come back down. They feel they can manage until then. Others say they will never replace their hygiene team. Instead, they will do the work themselves as they believe they are more profitable doing so.
Now, I have not seen the actual numbers of any dentist who is claiming their practice is making more money without a hygienist. However, when it comes to such a claim, I will plead that I am from Missouri…show me.
Perhaps some dentists will show me financial statements that support their claim of higher profitability. If that were the case, I would still have to ask if their hygiene was truly living up to its full potential. If not, and you managed to address that issue, would your practice still be more profitable down a hygienist (or two)?
To consider your hygiene potential, start by determining the number of active patients you have in your practice. Then, let’s assume a perfect world where every active patient shows up twice a year for their regular hygiene appointment.
Assuming 1,200 active patients needing one hour per hygiene appointment, that is 2,400 hours of hygiene needed.
Now let’s assume 30% of those patients are on a Perio-maintenance schedule that requires 3 visits per year. That is 360 patients needing an extra hour of hygiene, so we are now at 2,760 hours.
If even 10% of your total patient base needs 4 visits per year to meet their needs, that is another 120 hours of hygiene, bringing us up to 2,880 total hours.
So, the first question you have to ask is are you willing to provide 2,880 hours of hygiene per year? Would you be able to do that and still have time to do the dentistry you love?
More importantly, if you are not prepared to do that much hygiene, will patient care be compromised? Will your patient relationships be compromised? How do you account for these issues when analyzing your profitability?
Still, we will just focus on the hygiene math for the moment. And since I like to keep my math simple, let’s assume your average hygiene appointment bills $200.00 per hour. With our 2,880 hours of hygiene time, the potential annual revenue would be $576,000.00.
When you subtract hygiene salaries and variable costs for providing hygiene services, are you making money? Even with higher salaries and increased supply costs, are you making money?
In reality, we know there will be missed appointments. And while you may save on supply costs when that happens, you may still have to pay for labour.
So, let’s assume our hygiene patients only show up 70% of the time. That would be 2,016 hours and $403,200.00 in revenue based on our example.
When you look at those potential numbers, are you still certain you are making more without a hygienist?
I have a hard time thinking that there are many offices making more money without a hygienist. The potential for compromised care is too great, as is the potential for weakening your patient relationships if you cannot provide the required amount of hygiene.
There are still valid questions about providing increases to keep your team today and wondering how to deal with things should salaries trend downward in a year or two. You could then be stuck with salaries well above the market rates.
As much as that may not be a desirable outcome, is it better than compromising patient care or going crazy keeping up with your own hygiene?
Sometimes the best solution may not be what you want it to be. But when you can find a top-notch team member, it may be worthwhile to do what is necessary to keep them.