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Net Promoter Score (NPS) the new ‘percentage of collections’: How to compensate employee dentists

Dec. 16, 2019
Compensating employee dentists with a percentage of their collections is great for employer dentists but bad for patients, explains Dr. Marc Schlenoff, since it prioritizes quantity over quality. Here are ideas for how to handle compensation.

Employer dentists typically compensate their employee dentists with a percentage of their collections. This model is great for employer dentists but bad for patients, since it prioritizes quantity over quality. It’s also bad for employee dentists, particularly those who are just starting their careers. These young practitioners went into dentistry to help people. But the way most of them are compensated is not directly tied to quality care. In fact, it can be at odds with it.

Student debt exacerbates the problem. According to the American Student Dental Association, the average dental school graduate was $278,000 in debt before finding their first job.¹ That’s a frightening number when, according to PayScale, that first job will only pay about $118,000 per year.² The situation is particularly grim in the New York area. The cost-of-living-adjusted annual income for dentists in New York is $138,526, the fifth lowest in the country.³ Also, local dental schools produce more than 600 graduates per year, many of whom remain in the area and compete for a limited number of positions. 

Are the least qualified dentists performing the most dentistry to get themselves out of debt and keep their hard-won jobs? The incentive is there. Indeed, patients are sometimes steered toward procedures that are not necessary, which hurt them financially and erode their trust in the profession. This is a problem situation all around. How did we get here, and how can we change it? 

For dentists of my generation (I’m a 1981 graduate), debt was not an issue like it is today. As a result, the traditional compensation model did not bear down on us like it does on the current generation. But the system we’ve long been used to is broken. At Tend, where I am the head of clinical development, we see a path forward. 

Tend pays dentists a competitive base salary, not a percentage of collections, plus a bonus based on patient satisfaction. This bonus is measured by a net promoter score and other common clinical and experience metrics. If you’re a Tend dentist, we want your patients to trust you, and we believe that if they do, they will ultimately accept the care they need. We don’t want you to push care that’s excessive or outside of patients’ comfort zones. We want your interests and your patient’s interests to be aligned. 

This is a win-win for patients and providers. It creates a healthy work environment that allows dentists to be comfortable with the way they develop treatment plans, knowing that their pay is not linked to how much they produce. It also prioritizes patient quality of care and happiness, which reframes the dental experience for everyone. 


  1. Dental student debt. American Student Dental Association website. https://www.asdanet.org/index/get-involved/advocate/issues-and-legislative-priorities/Dental-Student-Debt. Accessed November 18, 2019. 
  1. Average entry-level dentist salary. PayScale website. https://www.payscale.com/research/US/Job=Dentist/Salary/add53175/Entry-LevelAccessed November 18, 2019.
  1. Stebbins S. Dentists generally earn a high salary, but here are the best states to practice in. USA Today website. https://www.usatoday.com/story/money/2019/11/04/dentist-jobs-best-and-worst-states/40478783/. Published November 4, 2019. Accessed November 18, 2019.

Marc Schlenoff, DDS, FAGD, is head of clinical development at Tend, the dental brand that brings a hospitality mindset to oral health. Prior to Tend, Dr. Schlenoff was the Director of Advanced Education in General Dentistry and Assistant Professor of Prosthodontics at Columbia University College of Dental Medicine. He has over 30 years of experience in private practice, and oversees all aspects of Tend’s clinical work.