Every hygienist is talking about it. Signing a commission contract is a deal you want to evaluate closely. You might be saying to yourself, “I want 30% of my billings and I am worth every dollar!”
The truth is your skillset value surpasses that of scaling, polishing, and applying floride. You don’t want to reduce yourself to only being paid on those procedures.
Let’s look at all your options before you set your sights on a contract that may not consider all the factors.
Scaling and polishing are time-based services. What that means is you can never get faster at a minute because a minute is just that: 60 seconds. You can’t improve and do a minute in 45 seconds. That’s not a thing. Neither is polishing, that is also a time-based service you can’t get better at a minute.
Probing is a service that falls under patient exams; therefore, you are probing for free. Probing is a significant part of patient care and cannot be overlooked even with no billing structure in place for you.
Recalls also take a significant amount of time but are unavoidable. Since recalls do not contribute to your production, they can feel like a time-suck when booked during your time with patients. Do you then shorten your appointments and have the patient come back to see the doctor in their chair? The questions on how you structure your new commission-based schedule are endless.
Adding radiographs to your commission structure can help you but does not guarantee success. Patients decline their scheduled x-rays; it can feel like wasted chair time. You lose money and wonder how you can make up for the loss.
Most practices will not commission x-rays, and if they do they will reduce the percentage to mitigate their loss of revenue. They pay their associate or primary their 40%, and when they add a cut for the dental hygienist, there just isn’t much room left to pay the balance of the office overhead.
Let’s look at both options in a day, a commission verses hourly, and see how they compare:
Let’s say for example, as a dental hygienist, you make $50 per hour; your working hours are 8am-5pm with a 1-hour break. You begin your day 20 minutes before patients begin, so you can prepare your op and review your patients’ charts. Invariably by lunch you run 15-20 minutes behind from op turn-over, running sterilization cycles, and completing chart notes-sometimes writing an entire morning of patient notes!
Then you repeat the same routine at 5pm, and your day completes at 5:20pm. So, your 8-hour patient care day is extended to 9 hours with all the preparation, sterilization, writing, and breakdown. So, at $50 per hour, your gross is $450. That is the number we need to beat with our commission-based pay. You may think it will be simple. “I’m going to make a killing.” Well, let’s see what that killing probably looks like (Ontario fees) per day.
Your Cut with X-rays | Your Cut no X-rays | ||
Recall | 44 | ||
Bw's | 60 | ||
Scale 3U | 200 | ||
Polish | 38 | ||
Fluoride | 38 | $100.80 | $82.8 |
70 min appt | 380 | ||
Scale only |
| ||
3U | 200 | ||
pt refused pol | |||
pt refused fl |
| ||
60 min | 200 | $60 | $60 |
NPE | 178 | ||
BW's | 60 | ||
4 PA's | 60 | ||
Pan | 80 | ||
Scale 3U | 200 | ||
Polish | 38 | ||
Fluoride | 38 | $142.8 | $82.80 |
120 min | 654 | ||
|
| ||
NO SHOW |
| ||
LUNCH |
| ||
|
| ||
Scale only | 200 | ||
60 minutes | 200 | $60 | $60 |
|
| ||
Scale | 200 | ||
Polish | 38 | ||
60 minutes | 238 | $71.40 | $71.40 |
Recall |
| ||
Scale | 77 | ||
Polish |
| ||
Fluoride |
| ||
mother refuses recall, pol, fl | |||
advises not covered | $23.10 | $23.10 | |
Total for the day | $458.10 | $380.10 | |
So, remember the number to beat is $450.00. The above 2 examples of with and without x-rays reflect your real world. Patients really do cancel. Days really do fall apart and it’s you who is left holding the bag in your new commissioned life.
In the first example with x-rays, you earned $8.10 more than you would have as an hourly employee. The difference is, as an hourly employee you didn’t lose your mind when a patient declines a service, you didn’t blow your top when a patient canceled, and you didn’t start looking at your schedule like the people that booked it are stupid.
All those thoughts will cross your mind. Now, look at the next column. I don’t even have to explain to show to you why that’s not an option.
Before you walk up to the front desk to complain because you feel your schedule is poorly booked, I’m going to let you in on a little secret: the minute you start that routine with the people that were potentially your work friends before your new commissioned based life, will become the people that just got to see a side of you they didn’t know existed.
You see, now that you’re on commission, it’s you who is assuming the no-show and treatment refusal risks of the hygiene practice.
The potential of conflict has increased between you and the members of your team that are not involved in the same compensation package. In your mind you think they are jealous of your new deal -- spoiler alert! They just think you are greedy.
Does this concept resonate with how some of you feel about dentists? The reality is, when you have skin in the game you see scheduling issues with a new eye. You didn’t become greedy with a change in compensation - you became creative and therefore efficient. Creative and efficient does not equal greed, but they can be viewed as greedy when everyone is not involved in the same compensation plan. If everyone in your office was risk involved, their view would be the same.
The next logical question should be: How do I make bank, look after my patients well, and still sleep at night? That my friends, is what I have spent the last 8 years perfecting.
RNA 180 | ||
Recall | 44 | $7.92 |
Bw's | 60 | $10.80 |
Scale 3U | 200 | $36.00 |
Polish | 38 | $6.84 |
Fluoride | 38 | $6.84 |
70 min appt | 380 | $68.40 |
Scale only |
| |
3U | 200 | |
pt refused pol | ||
pt refuse fl |
| $36.00 |
NPE | 178 | |
Bw's | 60 | |
4 Pa's | 60 | |
Pan | 80 | |
Scale 3U | 200 | |
Polish | 38 | |
Fluoride | 38 | |
100 min | 654 | $117.72 |
Recall | 44 | |
4 year old | 77 | $21.78 |
|
| |
NO SHOW |
| |
|
| |
LUNCH |
| |
|
| |
Scale only | 200 | |
Fluoride | 38 | |
Polish | 38 |
|
|
| $49.68 |
Scale | 200 | |
Polish | 38 | |
|
| $42.84 |
Recall | 44 | |
Scale | 77 | |
Polish | 38 | $28.62 |
Recall | 44 | |
Bw's | 60 | |
Scale | 200 | |
Polish | 38 | |
Fluoride | 38 | |
|
| $68.40 |
Total for the day | $433.44 | |
+ | $33.20 (set up & break down) = $466.64 |
Same schedule, but with added efficiencies, creating a better scheduled day by flagging everything the patient needs. If you look over the nuances of each option, there is little difference except how we optimized the schedule for better efficiency. I was able to strategically open space and allow the reception team to fill all the spaces with procedures I could complete in that time frame.
The best part of it all? I made bank! I made an additional $16.64. When you breakdown my day to 9 hours (not 8 hours patient care hours), I made an additional $1.90 per hour. That’s close to $4,000 annually without even trying. All it took was a critical eye and some math.
Good news?
With RNA 180, the work is done for you.
Take the math component out of the equation and let RNA 180 do the heavy lifting.
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