Do you know how much your practice depends on your work?
Imagine working in a dental practice and not knowing the practice fees. Rewind to 1991, when I worked in a busy, well-established, small-town practice. The fees were not shared with me. The dentist would write the fees on the ledger card as he left my op. I was 21 years old and fresh out of hygiene school.
Fast forward to 1994, when I found myself in Chapel Hill, North Carolina. I was finishing my bachelor's degree and working part-time at a progressive practice. There were computers in every op, each equipped with cutting-edge digital x-rays. We were presenting full-mouth cases on a daily basis. Unlike the first practice, the financials were, for the most part, an open book. I learned my role in making a practice successful. It was fun, fascinating, and a little scary. There were hygiene production goals and total practice goals. I was held accountable—and rewarded—for my performance.
The icons of practice management consulting—Linda Miles, Cathy Jamison, Debra Engelhardt-Nash, and so many more—have taught an entire industry for decades the value of sharing measurable metrics to dental teams. Now it’s the norm for team members to be aware of the financial side of the practice and how they make an impact.
Dental experts, such as practice management consultants, dental CPAs, and financial planners, have set benchmarks for hygiene performance. Their benchmarks are based on decades of studying the characteristics of practices that are financially successful over the long haul. One of those benchmarks is hygiene production as a percentage of total production. The benchmark for this number is typically 30% to 33%. This means the hygiene department should produce at least 30% of total practice production.
What if our number is much lower than 30%?
As hygiene productivity experts at Inspired Hygiene, we are looking at hygiene production every day in practices all over the US and Canada. Here are a few things we look at when we see hygiene production at less than 30% of total production:
Hygiene-service mix—It’s hard for hygiene to hit the 30% mark if there is little variety in the services performed. Prophy after prophy will keep a hygiene department busy but not necessarily profitable. Being perio-aware and performing higher-level services—including periodontal therapy and adjuncts such as laser therapy, fluoride, and appropriate radiographs—are all necessary components for healthy hygiene production.
Doctor-service mix—Alternatively, if the dentists in your practice are performing a high volume of specialty procedures, such as ortho and implant placement, it can be tough for hygiene to get to 30%. Consider this when setting benchmarks and goals for your practice.
Production per visit—Looking at production per visit as well as overall production can give you a clue for where to focus if you want to increase hygiene production. If your hygienists have a high PPV number, yet overall production is less than 30%, it could be a scheduling and appointment verification problem resulting in excessive open time. Hygienists can be very productive when they have a patient in the chair. Every hour of open time dilutes that production.
What if our number is higher than 30%?
On the flip side, we get concerned when we see hygiene production creeping toward 40%. Here are a few of the areas we examine.
Doctor-service mix—Just as hygiene should have a varied service mix, the same is true for dentists. If dentists are performing a high volume of large fillings with very few comprehensive treatment plans, hygiene may start carrying production. This can have a significant negative effect on the profitability of a practice.
Restorative codiagnosis—If the doctor is carrying the entire load for treatment diagnosis and acceptance on her shoulders, that weight gets very heavy over time. Oftentimes, dentists lose motivation to start the treatment conversation with patients who have been with the hygienists for 20 to 50 minutes before they come in for the exam. It is critical for dentists to have frequent calibration meetings with their team. The purpose should be to educate and empower team members to start restorative treatment conversations with patients well before the doc enters the op.
Doc-hygiene exams—Interestingly, doctor production can be held back by an excessive number of hygiene exams. More exams may mean more treatment presented, but if doc is overwhelmed by hygiene exams, he or she may not be having quality conversations with patients in an effort to complete hygiene checks as fast as possible. In addition, the admin team may not maximize the doctor schedule for fear of the doctor not being able to check hygiene.
Final thoughts
As hygienists, we are providers and contributors to practice production. We are also oftentimes highly skilled, well-compensated team members. This brings both privileges and responsibilities. The hygiene team can make the greatest impact on both the health of patients and the practice when it is empowered and team members are seen by the dentist as clinical colleagues. Healthy hygiene production is an important piece of overall practice health. Time and effort spent on improvements always results in a strong return on that investment.
Rachel Wall, BS, RDH, is the owner of Inspired Hygiene. Rachel coaches dental teams to build highly productive hygiene departments by implementing systems for high-quality periodontal care, enrolling restorative care through hygiene, and letting go of negative mindsets and old beliefs while managing the logistics of a high-performance hygiene department. Drawing from her 20-plus years of experience as a hygienist and practice administrator, Rachel delivers to-the-point clinical speaking presentations around the country. Her interactive teaching style coupled with a workshop environment creates a learning space where dentists and team members are compelled to get to the heart of what’s held them back and are inspired to reach for more for themselves and their practices.
