Episode #401: How Do I Compensate My Hygienist? with Drs. Groth, Ritter & Lillis

  You need to hire a hygienist, but they're in short supply. And the ones who apply ask for outlandish salaries! So, what do you do? Do you pay incoming hygienists more and create animosity? Do you raise everyone’s salaries and have high overhead? Or do you just choose to go without hiring? For some insight to help you navigate this dilemma, Kirk Behrendt brings in The Big Three, Dr. Kevin Groth, Dr. Rob Ritter, and Dr. Pat Lillis for ways to fairly compensate your hygienists without losing your mind. For their best practices on finding, hiring, and keeping the best hygienists, listen to Episode 401 of The Best Practices Show!

Main Takeaways:

• Take emotion out of compensation decisions.
• Use metrics to determine your hygienists’ salaries.
• Consider giving all your hygienists the same salary.
• Quality hygienists exist — you just need to be patient.
• Hygienists are not more important than everyone else.
• Empower your team to be the best they can be.

Quotes:

• “Right now, we hear it all over the country, it’s supply and demand for hygienists to work in your practice. I know there aren't enough hygienists. Either they left the profession, didn't come back, or they're coming back and asking for some of the most unbelievable salaries that I've ever heard in my career. And then, dentists are struggling on how to compensate them.” (10:23—10:43)
• “It’s an interesting thing with hygienists. Let's just start it there. I think we’d all agree with that, it’s very interesting. Because remember, they're taught in hygiene schools that they don't work for the dentist, they work with the dentist. They are that mid-level provider. And they want to be compensated because they typically have more education than our clinical assistants or our administrative team. Yet, I don't make emotion-based decisions on how we compensate our hygienists. I don't — I won't. I will not go down that path.” (10:49—11:18)
• “When it comes to hygienists, here’s what I do that's pretty simple. I know what I charge for a hygiene prophy for an hour. I take that number times eight — because that's how many patients they're going to see in an hour on a typical day, not including the new patients, not including the scaling and root planings — and then I take 30% of that, and that's what they can make for the day as a starting salary.” (11:49—12:14)
• “Most general practices run somewhere between 60% and 70% of overhead. That's what it costs them for overhead. So, I'm not going to compensate them more than that because my overhead is somewhere between 60% and 70%, in most general practices.” (12:18—12:33)
• “I've got two ways for [hygienists] to make legitimate bonus money that will increase their hourly rate on things that they do. So, we do a bare-ass minimum, a BAM, and I know how much they need to generate for the day. So, in a general practice, let's just say it’s $1,000. They need to do $1,000 for the day as a BAM. What I do is I give them 10% of anything over $1,000. So, if they did $1,500 for the day — and they get everything, whether they sell a toothbrush or a whitening kit or a fluoride treatment, whatever they sell. I don't care if they sell it. And I know we’re not supposed to use the word “sell” by the practice management consultants, but that's what they're doing. They're marketing, they're selling, whatever you want to call it. So, if the difference is $500, they get 10% of that, $50, and you amortize that out over eight hours, how much is that? That's an extra $4 or $5 an hour on top of their initial amount of money that they're going to get.” (12:46—13:41)
• “The second compensation is, when I go in the room and I diagnose a unit, a crown, an onlay, a veneer, an implant, they get 1% of whatever is done. So, if I do a crown, and we just say it’s $1,000, they get an extra $10. If I do two crowns I diagnose, they get an extra $20. You amortize that out, it’s an extra $2 an hour to their salary. So, all of a sudden, they're making a very good per-hour wage.” (13:42—14:11)
• “I have four hygienists, four days a week. So, big hygiene. Their salary is exactly the same. I have one hygienist that's been with me for eight years. I have two hygienists that have been with me for two, two-and-a-half, and one that's been with me for like three-and-a-half. I don't care how long you've been with me. Just because you've been with me — that's great. That means that you're doing a great job. I appreciate you and value you, what you're doing in the practice and for my patients. But I'm not giving you a salary based upon longevity. That's great, but that doesn't mean much to me. It’s based upon performance.” (17:51—18:30)
• “The other thing we all need to recognize is that hygienists talk amongst themselves. And so, what I don't want to set up is one hygienist making $40 an hour, another hygienist making $45 an hour, and another one $50 an hour, because then there's animosity between them. And then, you've got this constant stream of them coming in, one comes in, ‘Well, this one’s making $45. This one’s making $50.’ It just becomes a logistical and emotional nightmare for the dentist having to deal with a structure that really wasn't, to me, thought out well to begin with. They're all the same to me. They all have the same value to me. They all have the same value to the patient. So, if that's the case, I'm going to treat them exactly the same. Because my feeling is, if one of them is not performing the way the other three are, you're not going to work for me anymore. And so, we just make it simple.” (18:32—19:23)
• “I have a hygienist who’s my longest employee. I think she’s worked with me for six years. She and I worked together in two offices, both mine and another office. And when I took over my uncle’s practice, she came right up to me and said, ‘Hey, I want to work with you full-time.’ And, to me, that was the best compliment because it wasn't about money. It wasn't about benefits. It was, ‘I value you as my employer, and you take care of me.’ So, it doesn't matter what you're being paid. Ultimately, that will get to a certain level. But it’s what you do, the intangible benefits. I talk to her every day. I care about her. I do the things that really go above and beyond what was being done at the other practice.” (20:22—21:08)
• “I need another hygienist. I also don't like the fact that any type of new hire right now is going to probably ask more than what I'm paying my current team. And then, now, you're in this conundrum like, ‘Well, now, do I raise up everybody to that level and now my overhead’s going uncontrollably high?’ Or do I feel guilty, the fact that this new hire is coming in and I'm paying them more than the people that have been with me for X number of years, where I'm loyal to them and they’ve been loyal to me? So, I think maybe using that as a leverage point and saying, ‘Hey, let's just restructure this so it’s fair for everybody.’” (21:29—22:01)
• “There are certain times in offices where hygienists feel like, ‘I'm more important than the rest of the team.’ So, there’ll be a piece of gauze on the floor, and the hygienist will be like, ‘Well, I'm not picking it up because I'm the hygienist.’ Or the phone will be ringing, and all of your administrative staff are on the phone, and they won't answer the phone, even though they're just sitting there. So, I tell them, ‘Listen, here’s the scoop. We’re all in the same plane. That's including me. Because you can't do your job without me, and I can't do my job without you. And the hygienists are no more important than the administrative staff. The administrative staff are no more important than the dental assistant. I'm no more important than any of the rest of them. Everybody is on the same plane.’” (22:53—23:33)
• “You're like, ‘Augh, I need a hygienist. I need a dental assistant.’ That's the other thing too, ‘You can't find quality dental assistants right now.’ But I've got to tell you, it comes down to what the vibe is and your culture in your office. You're not going to attract good candidates if you have a bad vibe in the office. So, is it taking longer to find people? Yeah, it is. But they're out there.” (29:06—29:26)
• “I think it’s about the journey. It’s not about the destination. If you are not enjoying your journey, then you need to reevaluate what you're doing and make changes to make yourself happier, because this is a difficult profession.” (56:30—56:42)

Snippets:

• 0:00 Introduction.
• 1:15 Dr. Groth’s background.
• 3:11 Dr. Ritter’s background.
• 4:58 Dr. Lillis’s background.
• 7:15 Roasting Dr. Bob Margeas.
• 9:27 Two ways for hygienists to make bonuses.
• 14:13 The employment landscape.
• 15:16 How to track and calculate hygienist production.
• 16:15 The employment landscape, continued.
• 17:48 Give your hygienists the same salary.
• 19:24 The conundrum with new hires.
• 22:47 Everybody is on the same plane.
• 24:55 “I can't find a quality hygienist.” 
• 27:24 Good hygienists are out there.
• 30:33 Letting the team hire and fire employees.
• 33:02 Calculating and implementing monetary changes.
• 34:24 Is it the employer’s job to force CE?
• 36:56 Check-ins and team meetings.
• 39:48 Empower your team to be the best.
• 43:00 Don't burn out your hygienists.
• 44:24 Be productive with less workdays.
• 49:52 Lessons learned from Die With Zero.
• 51:51 Stats on health.
• 53:35 Last thoughts.
• 1:00:10 The Protocol course information.
• 1:01:47 Conclusion.

Reach Out to Dr. Groth, Dr. Ritter, and Dr. Lillis:

Dr. Groth’s email: [email protected] 

Dr. Groth’s Facebook: https://www.facebook.com/grothdental

Dr. Groth’s social media: @drkevingroth

Dr. Ritter’s Facebook: https://www.facebook.com/robert.g.ritter.3

Dr. Ritter’s social media: @drrobritter

Dr. Lillis’s email: [email protected] 

Dr. Lillis’s website: https://opdentaldesign.com/

Dr. Lillis’s Facebook: https://www.facebook.com/patrick.lillis.33

Dr. Lillis’s social media: @drlillis

Resources:

Die With Zero by Bill Perkins: https://www.diewithzerobook.com/welcome

Sign up for The Protocol: https://www.ritterandramsey.com/the-protocol/

Dr. Kevin Groth Bio: 

Dr. Kevin Groth’s primary goal is for every person to walk out of his office knowing that they received the highest-quality, most personalized care possible. Dentistry is more than just a profession for Dr. Groth. He sees every patient as an extension of his own family, and when you are in his chair, you’ll always be treated well.   

Dr. Groth’s favorite part of being a dentist is that every day and every patient is different. He loves the variety of people he gets to meet and procedures he performs to help patients maintain their smiles.   

Since graduating from the University of Michigan School of Dentistry, Dr. Groth has been recognized locally by Hour Detroit Magazine as a Top Dentist, and nationally as a Top Doc. As a passionate dentist who wants to provide the best care for his patients, Dr. Groth pursues continuing education through The Dawson Academy, serves on the executive board of the Periodontal Bunting Society, and is the Assistant Clinical Director of the Society of Comprehensive Dentists. He has also served as an adjunct clinical faculty member at the University of Michigan School of Dentistry. 

Dr. Rob Ritter Bio:

Dr. Robert Ritter grew up in Palm Beach prior to attending Medical University of South Carolina College of Dental Medicine. Practicing since 1994 and logging more than 200 hours of continuing education per year, Dr. Ritter is an extremely proficient doctor of restorative dentistry. He has had the opportunity to research, write, and publish several articles on adhesive and cosmetic dentistry in several professional publications, including Practical Periodontics and Aesthetic Dentistry (PPAD), Signature, Spectrum, Dentistry Today, DPR, and Contemporary Esthetics. He is on the editorial board of PPAD, as well as Spectrum, The Journal of the Academy of Cosmetic Dentistry, and The Journal of Esthetic and Restorative Dentistry.

Dr. Ritter is an editorial board member of REALITY, a publication to keep dentists up to date with advances in the products, techniques, and research of esthetic dentistry. He is a product consultant to numerous dental manufacturers, and has lectured nationally as well as internationally on cosmetic dentistry, adhesive dentistry, porcelain veneers, and restorative implant dentistry.

Dr. Pat Lillis Bio:

Dr. Patrick Lillis graduated from Marquette University in Milwaukee, Wisconsin, with a Bachelor of Science degree majoring in Biomedical Science. After graduation, Dr. Lillis attended Creighton University School of Dentistry in Omaha, Nebraska, where he received his Doctor of Dental Surgery degree. Upon completion of dental school, Dr. Lillis did a two-year Advanced Education in General Dentistry residency program at the University of Missouri-Kansas City School of Dentistry in Kansas City, Missouri. This university-based residency program provided a heavy emphasis on implants and cosmetic and complex restorative dental modalities. Dr. Lillis’ training provided him a unique opportunity to focus and treat extremely difficult dental complexities. He had the opportunity to work under some of the foremost leaders in implant, prosthodontic, and cosmetic dentistry in the Midwest.

Dr. Lillis is among an elite network of dentists from around the country who routinely work together to discuss the latest dental technology. In addition to running a practice, Dr. Lillis holds the distinction of being a keynote speaker for several dental manufacturers. This allows him to lecture on such topics as dental implants and full-mouth rehabilitation utilizing esthetic and adhesive dentistry. Further, Dr. Lillis has had the opportunity to speak at numerous study clubs and larger peer-reviewed meetings nationwide. He routinely carries out these complex dental procedures in his practice, both on patient and doctor referrals.

When he isn’t running a full-time private practice, lecturing, and teaching, he loves spending time with his wife and two children. His hobbies include running, skiing, and golf.