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Thursday Troubleshooter: Does this commission-only RDH have a prayer for a raise?

Jan. 19, 2017
This dental hygienist has done her homework and knows her area. She is paid on commission only, but believes the percentage she receives is too low. Does she have a chance at receiving a raise?

Do you have a tough issue in your dental office that you would like addressed? Each week the experts on Team Troubleshooter will tackle those issues and provide you with answers. Send questions to [email protected].

QUESTION: I’ve been and RDH for 30 years in Topeka, Kansas. The job market for hygienists is flooded, and moving to another office because I’m not happy is not an option; there are very few job openings. With that being said, I work solely on 30% commission. I'm meeting with the doctor this week to discuss raising my percentage to 33%. He has never paid his hygienists any other way. He's been in practice for 27 years. I've been in this office for five years. I lost my last job of 15 years due to the doctor retiring and the new doctor ridding his office of original staff. I work 3.5 days per week with no benefits. I've contacted our local dental board and hygiene association. They couldn't really tell me anything because no one pays strictly on commission. I then contacted the ADHA and they thought my percentage was low. What they told me was that 33% is more current. What are your thoughts?

First, let me say I empathize with your situation. Hygienists are critical to a practice’s success. In fact, the hygiene department is the gateway for the majority of doctor production. That said, how to adequately compensate team members is one of the toughest questions a practice owner must grapple with.

For hygienists, Levin Group teaches our clients to use one of the three main compensation methods.

  1. Salary – An annual wage that’s agreed upon by the hygienist and the practice.
  2. Salary Plus Commission – A base salary that can be supplemented by commission when specific production goals are met.
  3. Commission – The hygienist’s pay is based solely on the number of patients seen.

There are advantages and disadvantages to each of these methods.

In a salary-only arrangement, the advantage is that the hygienist knows exactly what her annual compensation will be and can plan accordingly. This creates a high level of financial security and comfort. The disadvantage is that there’s little or no motivation to increase practice production (and hygiene compensation) by improving performance. Some individuals are highly motivated regardless of how they are compensated, while others excel when they have the opportunity to increase their salary based on improved performance.

The second option is my personal favorite. Levin Group recommends a base salary representing approximately 70% of the desired hygienist compensation with a commission program. If the hygienist performs in a superior manner, she can exceed the projected compensation. The advantage of this method is that the hygienist will have financial security knowing that 70% of her wage is guaranteed, but still have the incentive for achieving additional compensation based on a certain level of production.

The third option compensates the hygienist strictly based on performance. For some hygienists, this can very positive. It empowers them to work efficiently and provide care to more patients. However, there are drawbacks. Under this system, patients can be viewed as little more than numbers because the hygienist is pushing so hard to increase her compensation. Customer service and quality of care may take a backseat to the hygienist’s salary goals.

Regarding the specific question of whether 30% or 33% commission is satisfactory, it largely depends on where you live, the supply of hygienists, and the demand for hygiene services. From what you’ve indicated, there’s an abundance of hygienists in your area. Despite this, I believe you should still ask for a higher commission. Before you do so, I would recommend that you build a compelling case for why you deserve a raise. Some of the things you may want to mention include your experience, your commitment to patients, your efficiency, your attention to detail, your positive relationship with patients, your dedication to the practice, your ability to identify potential treatment, and your case presentation skills.

Coming into this salary discussion well-prepared will give you the best shot at persuading the practice owner that you deserve a raise. Be professional, marshal your facts, and make your case. You’re in a tough situation. There’s a good chance, based on what you’ve said, the doctor won’t agree to a raise. But if you don’t ask, you’ll never know. I wish you the best.

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