Your Hygienist Wants a Raise. Can Your Practice Afford It?

“I need to make $65 an hour.”

Your hygienist is great and you don't want to lose her. And frankly, you don't blame her for asking. She knows she can make $65 an hour somewhere else.

There's just one problem: You can't afford it.

Insurance reimbursements aren't going up. Your overhead continues to increase. You have an entire team to pay. And your hygienist is currently producing around $130 an hour.

At $65 an hour, her compensation alone would represent 50% of what she's producing. A commonly used industry benchmark puts hygienist compensation around 33% of production.

So who's being unreasonable here?

What if no one is?

Maybe the problem isn't what your hygienist wants to earn—or what you're willing to pay her.

Maybe the problem is the economics of the way we've always run hygiene.

Is Hygiene a Loss Leader in Your Practice?

I recently heard a dentist challenge the term “loss leader” by pointing out that a dental assistant doesn't directly produce their hourly wage either.

It's an important distinction. A dental assistant enables the dentist to produce at a level they couldn't achieve working alone. Hygiene also creates value beyond the production on the hygiene schedule itself—it feeds restorative treatment into the doctor's schedule.

But that also doesn't mean the economics of hygiene don't matter.

For practices heavily contracted with insurance companies, reimbursement isn't necessarily keeping pace with rising hygiene wages. At some point, simply absorbing the difference isn't a sustainable strategy.

Your hygienist isn't wrong for asking.

If another practice down the street will pay $65 per hour, asking their current employer to match the market isn't greedy or unreasonable. And at a time where the cost of living goes continues to rise, they need to do what’s best for themselves and their families, no matter how much they might love working for you.

But the practice owner isn't wrong either…

$130 of production per hour with a hygienist earning $65 per hour means 50% of production is going to hygienist compensation. For many practices, it’s simply not financially sustainable.

So how does $130 an hour become $197 an hour?

If we use 33% as the benchmark, a hygienist earning $65 an hour would need to produce approximately $197 per hour.

So what are the options?

Raise fees? This isn't much of a solution when insurance controls much of your reimbursement.

Recommend more treatment? Absolutely not.

Tell the hygienist she can't have the raise? Now you risk losing an excellent employee.

Absorb it into overhead indefinitely? That's not sustainable either.

Which leaves another possibility:

What if we changed the way the hygiene hour works?

More production doesn't have to mean more treatment. This is where conversations about production understandably make some hygienists uncomfortable. Producing more can sound like recommending more treatment, selling dentistry, or squeezing more into an already busy day.

That isn't what I'm suggesting.

I don't believe in recommending treatment a patient doesn't need simply because it increases production. I also don't believe the answer is asking an already busy hygienist to work harder or faster.

The opportunity is in looking at how we're using the hygienist's time.

How much of every appointment is actually spent doing something that requires the education, clinical judgment and skillset of a registered dental hygienist?

And how much is spent seating patients, taking radiographs, polishing and flossing, waiting for the doctor, being present during the doctor's exam, turning over rooms or completing other tasks that could potentially be delegated?

If we can give some of that time back to the hygienist, we create an opportunity for them to spend more of their day doing the work that only they can do.

What if higher production created higher earning potential?

I think it’s important for hygienists to understand the business side of their department.

Not because I expect them to carry the financial responsibility of the practice, they shouldn't. But because understanding the relationship between what you produce and what the practice can sustainably pay you creates an entirely different compensation conversation.

If you're producing $130 an hour and asking to be paid $65, there is very little room left for the rest of the costs associated with delivering that care.

But what if you could produce closer to $200 an hour without working harder, recommending unnecessary treatment, or compromising the quality of care you provide? Now $65 an hour looks very different.

And if you're a hygienist who wants greater earning potential, that's a very real opportunity.

You're helping create more value—and there should be an opportunity for you to participate in the value you've helped create.

This should be a win for both sides. I don't think the answer to rising hygiene wages is telling hygienists they're asking for too much. I also don't think it's asking practice owners to ignore the economics of their hygiene department.

Both things can be true:

Great hygienists should have the opportunity to earn great compensation. Practices need a model that makes that compensation financially sustainable.

That's why I keep coming back to the structure.

If the traditional hygiene model makes those two goals increasingly difficult to reconcile, maybe we need to stop arguing over which side is right and start questioning the model itself.

“Just because we’ve always done something one way doesn’t mean there isn’t a better way to do it.”

For me, that better way has always been assisted hygiene. A properly structured two-column model allows a hygienist to increase hourly production by changing how their time is utilized—not by working faster, recommending unnecessary treatment, or compromising patient care.

I've spent 20 years as a dental hygienist working this way myself, and it's why I believe greater earning potential for hygienists and healthier economics for practices don't have to be competing goals.

See how a properly designed assisted hygiene model can create greater earning potential for the hygienist while improving the economics of the hygiene department.