Dr Phillip Palmer, September 2005 - “How do you calculate the contribution a Hygienist can make to your practice?”

Prime consultants must get asked a question like this from a dentist at least once a week. In recent years, with several new training schools and institutions for hygienists opening up, more and more dentists are weighing up the pros and cons of hiring a hygienist. 

Dentists understand that as business people (in the dentistry business), they can’t afford to make decisions that will result in drains on our financial resources. But how can we isolate and analyse a hygienist’s contribution to profitability when:
- so many hygiene overhead items like rent, administrative staff time, billing and equipment costs are shared with the restorative side of a practice and
- Not all of our hygienist’s contributions to practice profitability and well-being are easily measured.

Let’s look at some of the hygienist’s contributions to the practice: 

1. The Hygienist’s production.
The first contribution is also the most obvious – the Hygienist’s production. Hygiene production should include items like:

• Scale and polish, including most preventive procedures(saliva testing, topical application of fluoride)
• X-rays
• Root planing
• Whitening (take home kits)
• Mouthguards

A solid and mature practice should be able to reach targets of more than $1500 per day per hygienist without much problem. For a hygienist working a 4.5 day week, 45 weeks a year, a gross production of over $300,000 should be achievable. Unfortunately, that doesn’t mean that all hygienists get those sorts of targets. Most remain in the $600-$900 per day range until they learn the proper protocols.

In a well-run practice, the dental hygiene department will:

• Provide 25-33% of the annual practice production.
• Have an enrolment or involvement of 98% of the patients in the practice.
• Have 33% of its production going to the hygienist as wages.

When dentists add a hygienist to their practice it should be (and usually is) an independently cash flow positive exercise from day one. It should never be a ‘breakeven’ situation, or a loss leader, to employ a hygienist. However, in addition to direct practice revenues, a Hygienist contributes to the profitability of the practice in several other indirect ways.

2. Shift of procedures
The biggest contribution a Hygienist makes to the profitability of the practice doesn’t come from the production generated by the hygienist (considerable through this may be) but by the amount of dentist’s time that is freed up by the presence of the hygienist. A dentist spending a large percentage of his or her time doing scaling, polishing and oral hygiene instruction is a waste of resources (the dentist’s hands and brain) that could more profitably be utilised elsewhere.

Shifting these procedures to a Hygienist means that the Dentist becomes available to do procedures that are more sophisticated, more remunerative and for many dentists more satisfying (Crown and Bridge work, etc). The impact this shift of procedures can make on the profitability of the practice is enormous.

3. Aid in the communication to patients of their needed treatment.
How much do your hygienists contribute to this process? When you enter the hygiene room and greet the patient, do you ask the hygienist, ‘What have you found?’ If so, the hygienist should brief you on the following items:

• Any concerns the patient has.
• The patient’s periodontal situation.
• Other needs/ wants the patient may have (such as crown-and-bridge and cosmetics).

If not, you are missing a terrific opportunity. Obviously, you have to be the diagnostician in the practice, but the hygienist can really help by showing the patients likely conditions that will need attention and explaining likely remedies.

As we’ve seen in countless practices, the hygienist’s interactive involvement with the dentist in ascertaining patients’ needs and wants builds the credibility and value of the Hygienist in the patient’s eyes and results simultaneously in increased treatment acceptance and increased participation the practices’ active maintenance programme. 

4. The second opinion
Hygienists have more time with your patients than anyone else in the practice and as a result patients often develop a very special relationship with them. Patients see the hygienist as a concerned “third-party” and will often become a ‘second opinion’ for patients to use as a sounding board for considered dentistry thus further contributing to case acceptance for the practice. 

5. The dentist’s workspace
Lastly, but by no means least importantly, having a hygienist means that usually by the time we dentists see the patients they have pink, healthy gums, clean mouths and are motivated to keep them that way. I can’t tell you what a pleasure it is. I doubt there are many dentists who given the choice between working regularly on mouths that are dirty, inflamed, smelly, and diseased, or working in a clean dry field, free of disease process, would prefer to have the former.

Make no mistake; a successful dental hygiene programme occurs where dental hygienists and dentists treat each other as ‘partners’ in providing optimum care to patients. If you allow this attitude to permeate, hygiene will become the heart of the practice helping pump life-blood (patients and treatment plans) to all areas of the practice and help boost the health (case acceptance and increased revenues) of the practice as a whole. 

Aren’t we lucky that in this wonderful profession, hygienists - so long a feature of dentistry around the world - are at last being provided in sufficient numbers in this country.

[Published Australasian Dentist, Spring 2005]