Selling Dentistry

July 31, 2009
Responses to RDH eVillage survey indicate that hygienists who work for bonuses or commissions have been pressured to become more aggressive in "selling."

Many dental hygienists (38%) who rely on production figures for all or part of their compensation have faced an increased emphasis on their production during the past 12 months, according to the results of a survey in the June issue of RDH eVillage. On the other hand, hygienists who just earn a salary have "not felt added pressure to aggressively sell preventive or operative services or products" (69%).

An emphasis on increased production touches nerves. An Alabama hygienist wrote, "We should not have to sell dentistry! It's ridiculous, to say the least. My boss tells everyone who comes in that they need new fillings or crowns because their fillings don't look good! Crap like that. He is a con! His license should be taken!"

An Arizona hygienist added, "When the production numbers are the driving force of the practice, it lowers morale among the office staff and makes the doctor seem greedy rather than concerned with the patients' welfare."

A California hygienist, though, wonders if the office is too passive with its approach. "He is so concerned about not appearing to sell to patients that sometimes I think patients would be better served if we did have the convenience of providing fluoride toothpastes, gels, and electric brushes, rather than writing a script for them to get it at the pharmacy or sending them out to a retail store. That said; we have a very successful practice with very educated and financially secure patients. We cater to a very sophisticated base, so the dentist is doing something right!"
Overall, 208 hygienists participated in the RDH eVillage survey. The results also offer a peek at the types of compensation offered to dental hygienists:

&bull: 59% said they earn a salary or hourly wage that is not based on "production or sale of services or products."

• 29% said they work in offices where a bonus program is based on production and/or sale of products.

&bull: 7% indicated that they work for commission only, which is based on production.

• 5% work in multiple work settings that have established various compensation policies.

Hygienists who do produce to earn a salary plus bonuses or are on straight commission said production goals were set "without input from me" (76%).

"I am constantly talked to about production, and told to remedy the situation," said a Wisconsin hygienist. "I am talked to and pressured in front of all staff."

A New York hygienist, though, commented, "The goal set is fair and the products are beneficial to the patients so I don't feel like a salesperson."

A Nevada hygienist added, "The bonuses we receive are based on total production of the practice. The production number is at the discretion of our employer, but he is very generous. The total office staff benefit from our employer's generosity. The bonuses are not part of our employment package. We all work together to provide the best care for our patients while trying to keep our costs down by being efficient without shortchanging the patients."

The final question asked, "If you could share one suggestion for your employer about this topic, what would it be?" RDH eVillage shares some of those comments below.

&bull: "Be realistic to what is happening in the whole country, not just what is happening to your numbers. Be careful how you treat staff. You might end up with no success, because many times those who are on the staff can reach the patient."

&bull: "If you put your patient first, the production numbers will come, and your patients will feel cared for and want to come to you whether you are the cheapest or not."

&bull: "Do not expect your hygienist to hard sell any procedures. Rather, let the hygienist persuade patients to do procedures that are in their best interest, whether it is for healthier mouths, confident smiles, or upgrading worn fillings."

&bull: "I don't feel like any suggestions would do any good. My doctor is going to do what he wants so I am not going to waste my breath."

&bull: "Yes, we are aware that there is not a tooth fairy who leaves our checks under our pillows at the end of the week. If you don't make money, we don't make money, so we have a vested interest in your success."

&bull: "Providing good dental care, education, and products in an environment that tells patients you care about them and their health will reap the financial rewards you seek. It also will not compromise your values."

&bull: "Tell me I am important to the practice and not just a money maker for you. Knowing I am appreciated is more than just the dollar amount I am paid."

&bull: "I quit my job and retired, due to these pressures. Thankfully, I was able to retire early and collect social security and work as a sub to keep my head above water. I met production goals daily. But I didn't feel good about my job, couldn't respect my employer, and couldn't live with it anymore. I would never work in another office where these pressures are applied. Unfortunately, it seems dentistry has become greedier for the dollar (for the doctor!), and much less oriented to the service to the patient. The patient is clueless when these pressures are applied. I felt like I was lying. Now I can sleep at night."