3 Proven Strategies to Solve the Hygienist Crisis

By Wesley W. Lyon II, CPA, CFP®

For the past few years, an overwhelming complaint across the entire dental industry has been that owners can’t find hygienists. According to the American Dental Association Health Policy Institute, the industry lost almost 10,000 hygienists between 2020 and 2023, or almost 5% of the workforce.(1) Meanwhile, according to the U.S. Bureau of Labor Statistics, the employment of dental hygienists is projected to increase by 9% over the next decade.(2) Since this shortage is unlikely to solve itself overnight, make sure to implement these three strategies to attract and maintain top talent.

Cultivate a Strong Company Culture

Put simply, your employees must enjoy coming to work. To accomplish this, you must get rid of the bad employees and reward the good ones. I generally group employees into three categories — A, B and C employees. A-level employees are all-stars that can’t be persuaded to misbehave or slack off. They are hardworking and loyal by nature. C-level employees are the opposite, constantly trying to pull one over on you and hoping to bring everyone else down with them. B employees are in the middle and will follow the strongest lead. In order to mitigate having a disastrous culture, eliminate all C employees quickly, because they are the main source of disruption in your office.

Once you have all A and B employees, be sure to reward them not only with money, but also with random acts of kindness. For example, I work with a dentist who will sporadically send his staff to happy hour. Rather than forcing his employees to hang out with him, this dentist discovered it was best to call the bar and pay the tab, allowing the employees to enjoy time with each other. These acts of kindness should always be random, as once something becomes a regular occurrence, the staff will view it as an entitlement program.

Lastly, empower your employees! Many leave due to a lack of job satisfaction. For hygienists, do you have protocols for how to handle obvious treatment needs? While the hygienist certainly shouldn’t be responsible for recommending treatment, being on the same page can both empower your hygienists and increase your conversion rate. For example, if there is a crack in the tooth, does the hygienist point it out? Do they explain the next steps and provide some comfort? Having standard procedures and a gameplan for the hygienist to help educate your patients will make them feel more valuable while also ensuring the patient understands the need for treatment.

Offer Competitive Compensation and Benefits

Many dentists are shocked and caught off guard by employees receiving offers to work elsewhere for substantially more money. With a lack of hygienists and increased demand, this should come as no shock. The problem many dentists don’t see coming is that by having one employee successfully negotiate a higher wage, the remainder threaten to leave one by one until wages are increased. It’s best to get competitive from the start. The Bureau of Labor Statistics website (bls.gov) is a great place to find wage ranges by area.

The option of corporate dentistry has also provided hygienists with an array of benefits should they switch jobs. Private practice owners must compete here as well. Offering a retirement plan is great, but the real key is health insurance, followed by paid time off. Be sure to communicate these benefits each year by providing an annual pay statement, showing their effective hourly wage including benefits.

Implement a Production-Based Bonus System

Lastly, we need to encourage hygienists to produce more in order to cover these additional expenses. Based on consulting with hundreds of dentists over the past few years, I have found most hygienists are hesitant to return to pre-COVID protocols of 50-minute appointment intervals for routine cleanings, instead choosing to enjoy more free time on the clock. In order to turn profits around, hygiene appointment times need to return to pre-pandemic lengths, and the urgency to fill cancellations needs to increase. Rather than threatening hygienists, try a production-based bonus system instead.

This bonus system will pay the hygienists a percentage of any production over their daily baseline. For example, if a hygienist’s baseline production is $1,100 per day, but he or she produces $1,300 per day, the bonus would be based on the $200 increase. Often, dentists will pay 30% of this increase as a bonus.

The key is to ensure the baseline is set correctly. If one of your hygienists is currently producing only $600 per day, you cannot simply create a bonus of 30% of anything above $600. Instead, you need to calculate the baseline based on three times daily wages, since the industry standard for hygiene pay is one-third of net production. For example, if a hygienist is paid $46 per hour, the baseline production figure would be $46 multiplied by 8 hours, multiplied by three to ensure that wages are equal to one-third of net production. In our example, this would set the baseline at $1,104 per day.

To pay the bonus, I recommend calculating the differences quarterly, rather than daily. Let’s assume this hygienist worked 40 days in a quarter. He or she would have a total baseline production of $1,104 × 40, or $44,240. If the hygienist’s true net production was $52,500, then the bonus would be equal to 30% of the difference ($52,500 - $44,240 = $10,260), or $3,078. This is the equivalent of an additional $9.62 per hour.

The hygiene shortage is unlikely to solve itself anytime soon. While implementing these strategies is always easier said than done, dentists who take these to heart will have an easier time maintaining staff, recruiting replacements, and increasing production and collections. With the current shortages in the market, I recommend dentists be proactive rather than reactive, at least until we see some staffing relief.

Wesley W. Lyon II, CPA, CFP, is president and CEO of McGill and Lyon Dental Advisors. For more information on his firm’s comprehensive tax and business planning services for dentists and specialists, contact Danielle Fitzgerald at 877.306.9780, or email consulting@mcgillhillgroup.com. To comment on this article, email impact@agd.org.

References

1. “Wage and Job Count Dashboard.” American Dental Association Health Policy Institute, ada.org/resources/research/health-policy-institute/wage-and-job-count-dashboard. Accessed 7 Oct. 2024.

2. “Dental Hygienists: Occupational Outlook Handbook.” U.S. Bureau of Labor Statistics, 29 Aug. 2024, bls.gov/ooh/healthcare/dental-hygienists.htm. Accessed 7 Oct. 2024.