Are you raise worthy?

Oct. 22, 2009
Exciting dental hygiene skills are necessary to ask for a raise if you’re planning on staying in the current position.

by Shirley Gutkowski, RDH, BSDH, FACE

There are two parts to the mystery known as the resume. Writing a resume with the exciting things you’ve been doing as a clinical dental hygienist can’t be easy if all you’re doing is scrapeology. There won’t have anything to put on the resume to make you stand out. Exciting dental hygiene skills are necessary to ask for a raise if you’re planning on staying in the current position.

In order to ask for a raise, the business owner will want to know what’s in it for him or her. Coming to work with a cold or knowing the filing system isn’t really good enough.

The reality is that in this market bringing something to the table besides attendance numbers and knowing how to run the autoclave is essential. Know your numbers.

Find out how much you produce in an hour, a day, a week, and a month. Without those numbers, you won’t really know your value to the business. If there’s no easy way to find out, start keeping track of them yourself. Learn how to use Microsoft Excel to keep track of each procedure and what the fee for that procedure is.

The next number to know is the per hour income. The income in business owner’s terms includes FICA, benefits for vacation, IRA matches, and uniforms — anything possible that you could be paying for and are not because the business pays for it.

The hourly wage with benefits could be more or less than one-third of that production number. No one seems to know where the 30% comes from, but it is currently the number consultants are using to determine the value for dental hygienists.

If the hourly production is less than two-thirds of what you’re making (including your benefits) don’t ask for a raise. Formulate a plan of how you’re going to increase your monetary benefit to the practice. There are a number of low stress ways to achieve this balance. Increasing the number of xrays for the sake of increased production is not an answer, neither is shortening up patient chair time.

Take a look at the practice acts, are you doing everything you’re legally allowed to do, and are you billing appropriately for it?

Things that are too often missed are:

  • Full mouth series of X-rays (every three years, especially on diabetics)
  • Panoramic X-rays
  • 50% of patient base on perio recall or treatment
  • Locally delivered antibiotics
  • Home and/or office fluoride
  • Home remineralization pastes
  • Sealants on adults with xerostomia or hyposalivary function
  • Using diagnostic aids to find problems before they become big problems. Examples are the intraoral camera, DIAGNOdent, Spectra dental laser, Dentsply's Cari-Screen, and TekScan's T-scan
  • Saliva testing
  • Plaque testing
  • Step testing
  • Oral cancer screening and brush testing
  • Mouth guards
  • Orofacial myology

If you’re not probing every patient every time, you’ll never find the kind of periodontal disease numbers you should be finding. There are also a number of aids to use for accurately diagnosing periodontal disease and caries, all with dollar figures involved.

Look for cases the doctor can do and track them as well. Ortho, or full mouth rehabs, perhaps it’s time to start looking at sleep apnea, or get trained in myofacial therapy to increase your worth to the practice.

I believe I hear some negativity! The rabble rises up in revolt, “We won’t do treatment that isn’t needed!” Face it, people don’t work for free. And providing services for free isn’t logical either. Which is not the same as doing unnecessary treatment or diagnostics. A person with no enamel lesions and no reason for concern wouldn’t need a strep culture. A person with new decay and no saliva evaluation or strep test is undertreated.

If it’s too expensive for patients to pay for four quadrants of perio therapy, suggest that the fee be reduced and make up the difference in volume. Now we’re talking! Do that for a prescribed amount of time until such time you become comfortable to bring the fee back up again.

Read up on processes, or philosophies, or simply look for things! It’s nearly impossible to find a tiny sesame seed size spot on the lateral boarder on the far side of the tongue when you’re talking about someone’s vacation. That small spot could be a dysplasia on its way to cancer. Making a friend is not as important as finding that spot and treating it.

Once production is up around the one-third, two-thirds split, suddenly treatment recommendations come more easily. Perhaps it’s time to do a little shuffling. Maybe you don’t want to see the Class I patients any longer. They don’t present you with enough of a challenge. Finding work is fun and more importantly brings benefits to the patient. Think while doing the exam: if this patient is my mother, I love my mother, and dentistry is free, what would I recommend?

Use that technique when discussing findings with patients. Use it as an opening. Soon saying it aloud will be unnecessary. Eventually just thinking it will make it easy to be recommending veneers for patients who need them, braces for patients who need them, sleep studies for patients who need them and on and on.

Language is a part of this whole package too. Anyone who has read the book "Tipping Point" or "Buyology" knows scary language doesn’t rmotivate people. In the 1980s, we were introduced to the term hemorrhage as an alternative for bleeding on probing. It sounded scary. Patients were supposed to be motivated by it.

If the word hemorrhage doesn’t work coming from your mouth, use the term “little bleeding” and do something about it. Set up a mindset of zero tolerance for bleeding. A website,, supports that. There are plenty of places on the Internet where dentists who support more aggressive treatment of periodontal disease have mountains of evidence to share with a dentist employer.

Now that an increased number of services has been identified, find a way to keep track of them. Most office software can track this for you, if you put it into the computer. If you don’t put the effort into entering the data into the computer, the computer cannot print reports.

Talk this part over with the support staff too. Explain why reports are necessary for the dental hygiene department. Make sure you agree on what goes into your production and what goes into the dentist’s. Incorporating new things into the practice can benefit everyone. Keeping track makes certain the ideals are in the forefront.

If it’s not possible for the support team to track the data, a little computer for the hygiene department is the answer. Even laptop notebook computers have come down dramatically in price. A small, nine-inch screen computer with very few bells and whistles can run under $500. Use Microsoft Excel, or find a free version of spreadsheet software on the Internet and download it onto the computer. Start entering the treatment provided as well as the treatment that the dentist didn’t need to recommend. This is also a good place to store information about treatment that was not accepted and the reason. This is a heck of a report to show at a meeting with the employer.

Once you have a tracking system, use it for a length of time. See what the data is showing you. Would it be interesting if you were a practice owner? If you owned a practice, would you give that hygienist a raise? That’s the language of the business owner. Even if the dentist has a very poor business sense, they will understand dollars and cents.

If you’re not working as the only oral health care provider, avoid comparisons with other hygienists at all costs. If you can’t be on the same page and work together, take it upon yourself to run your own practice. Don’t overdo. There is plenty to do without overdoing anything.

Numbers and attitude make a practice owner feel like giving a raise. Grouchiness and competitiveness are not conducive to practice harmony. Your practice is all you. It’s really fun. Read and implement, you’re sure to set reachable goals then achieve them.

For useful resources, check out the Career Development Center at Friends of Hu-Friedy by clicking here.

Shirley Gutkowski, RDH, BSDH, FACE is an International speaker and writer. Look for her new book The Purple Guide: Developing Your Paper Persona co-authored with Heidi Emmerling, RDH, PhD coming in the fall. Look for news at