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6 considerations for negotiating the position you need—on the terms you decide

July 21, 2021
It can be tricky to get everything you want in a new job. But you won't get it if you don't ask. That's where the art of negotiating comes in. What have you got to lose?

It’s no secret the pandemic has created a nationwide shortage of dental hygienists; by December 2020, an estimated 8% of hygienists in the US had left the field.1 Those of us entering the job market, therefore, are uniquely poised for wonderful career opportunities. But what specific terms should we negotiate? What makes for a “good” job offer?

Unfortunately, many practices fail to adjust employment terms appropriately after hiring, but by being proactive in negotiations prior to being hired, we can avoid regretting the terms after accepting a position. These six essential considerations are based on major drivers that cause hygienists to quit. If we address these before being hired, we can obtain employment that remains satisfactory for the long haul.

1. Basic pay and employment structure

It's important to first develop a clear understanding of the general expectations of the job. This includes days and hours, pay structure (hourly or production models), and benefits included such as vacation, holidays paid, health or disability insurance contributions, continuing education provisions, 401(k) availability, and more. This is the starting point for negotiations; too frequently, though, this is also the end of the discussion for an interviewee, leading to long-term regret and dissatisfaction with employment terms. The remaining items will focus on frequentlyoverlooked essentials that commonly lead to employee turnover.

2. Other increases

Many interviewees fail to inquire about other types of increases, including bonuses, profitsharing, scheduled evaluations, and raises. These can, however, really make or break a job offer. They can also be used as to negotiate terms when more traditional benefits (such as health insurance or 401(k)s, are not available. Unfortunately, many practices engage in very inconsistent evaluations and raises. Consider asking for a guaranteed (in writing) yearly raise in an amount you feel is reasonable and appropriate for the long term. Ultimately, this is one of the main reasons many hygienists leave employers, so it’s worth addressing this issue up front.

3. Consistent hours

Although this could fall under the category of basic employment terms, here it is separate to emphasize its importance for clinicians. Sadly, many practices cut hours so quickly, send hygienists home without notice, or ask them to clock out while waiting for the next patient. While this article won’t go into details and legalities of all those scenarios, it will stress the importance of knowing your rights and boundaries for these occurrences. Each clinician should specify a minimum number of hours weekly they expect to work  (excluding holidays, PTO, etc.). Again, though this is not common practice, it can provide assurance that your financial needs are met each week. So often, hygienists suffer when the practice can’t keep a full schedule, though this is usually beyond our control and depends on many other factors. If this continues for long periods, it can compel us to leave for a practice with more patients. Reasonable employers will understand our need for consistent and reliable employment.

 4. Periodontal protocols

While some dentists do mostly defer to hygienists’ assessments, it's not always the case. This is also a major reason hygienists leave practices. Therefore, always “probe” for information on the customary periodontal protocols in the practice. Practices may follow a written manual or a consultant’s suggestions, or the dentist may personally probe and diagnose each new patient. Some practices do not even perform scaling and root planing (SRP), instead referring patients out for this treatment.

Knowing these details ahead of time gives the hygienist a sense of the periodontal health and outlook for the patient demographic, as well as the day-to-day balance of prophies to disease therapies. Don’t shy away from specific questions; ask what percentage of patients are periodontally treated, how often the gingivitis code is used, if SRP and laser therapies are performed, what stages of periodontitis are directly referred to periodontists, and the like. If there are specific areas you personally value in a perio program, such as subgingival antibiotics or irrigation products to send home, be sure to discuss this before being hired, as well.

5. Armamentarium

It cannot be overstated that hygienists are at physical risk from poor ergonomics or improper instrumentation. Thus, well-maintained instruments are a necessity. However, most hygienists do not address this when they’re hired; furthermore, countless offices fail to proactively maintain a healthy working environment for their hygienists in this way. As clinicians, we absolutely can assert ourselves in this area.

Any office that is unwilling to organize proper instrument care and replacement is arguably suspect; consider asking for a consistent monthly or total yearly budget for hygiene instruments and maintenance such as sharpening. This may not be a common practice yet, but in times of provider shortage, we should address this long-term health and safety risk. Also, ask if the other equipment in the office if fully functional; lagging computers, finicky x-ray sensors or extraoral cameras, or other time-sinks can cause constant work stress, especially in accelerated or assisted-hygiene departments.

6. Department flow

Even if all the other terms above are acceptable, perhaps the most notable and crippling issue for many hygienists is the day-to-day flow of the schedule. Again, this is a huge reason hygienists seek new practices. Therefore, ask about the schedule in detail, not just how long a prophy is. We need to know if we will have assistants for hygiene, if new-patient appointments include time for a prophy (and what is expected for the first appointment if the patient is periodontally involved). Even more importantly, ask how often you will be double booked or if you are running more than one column daily, as well as how often patients are “squeezed in” to shorter appointments.

Though this list certainly does not include all items to consider, it serves as a strong foundation for negotiations. Undoubtedly we all differ in our priorities for employment, but as individuals (and as a professional group) we should work to ensure acceptable treatment as health-care providers. Good luck in your own search. You’re worth the terms you want!


1. Gurenlian JR, Morrissey R, Estrich CG, et al. Employment patterns of dental hygienists in the United States during the COVID-19 pandemic. J Dent Hyg. 2021;95(1):17-24. 

Michelle MacLean, RDH,is a full-time clinical hygienist in a general practice near Lawrenceville, Georgia. She has created and implemented practice protocols compliant with the 2017 World Workshop on Periodontal Diseases and Conditions. She is also a real estate investor and is in real estate school. She is married with a five -year-old daughter, and is in the process of opening her home to children in need of foster care. MacLean can be reached at upwardcentalc[email protected].