“No, I can’t accept a 1099”: New dental hygienists advocate for their careers and futures

As much as students try to assimilate everything while in school, it’s natural to mostly focus on passing the national board exam and regional licensure boards. For years workplace or tax laws have received little attention even though this information directly impacts licensure and subsequently earnings. From an academic standpoint, students need to pass the exams, and if possible, educators add this content some time before graduation, but the importance can be lost in the rush to graduate.

But dental hygienists need to understand the downsides of being paid as a 1099 independent contractor. And new graduates are not the only ones who need accurate information—many dental hygienists are currently seeking new dental homes. Others are working in temporary positions to either test out the workplace landscape or earn additional income.

For decades dental hygienists have been misclassified as 1099 workers. To bridge the information gap, the Texas Dental Hygienists Association invited me to create a course covering this topic and hosted the live session on December 1, 2021. The course, open to clinicians all over the U.S., attracted hygienists from Maine to Alaska. The content covered worker classifications for both the IRS and the federal Department of Labor and included how to access specific state information.

There were dozens of questions at the end. Within days, three new graduates reached out with their courageous and insightful stories.

No, I can’t accept a 1099 from your office

Tasha was scheduled for a working interview in a week. The day after the course, she contacted the office and explained she would be unable to be paid as an independent contractor. The office manager got angry and insisted that was the way Tasha would be paid. Even though she was gripped with fear, Tasha remained calm and firm in her refusal to be paid as a 1099.

As Tasha got off the phone, her heart was pounding, and her hands were shaking. She felt drained. Despite taking a very scary stand, Tasha knew this was the right decision. Even though she was a brand-new graduate with a toddler to raise, Tasha simply decided not to start her career off in a compromising matter. Tasha’s action took courage, and she is now focused on only accepting positions where she is paid W2 employee wages.

Here is her advice to fellow hygienists: “I encourage not only new graduates but all RDHs to take the time to invest in information that will help you grow as a professional. Ignorance will not pass as an excuse when it deals with the law.”

A cloudy mess

When Maria Ana was in high school, she was an exchange student from a Central American country. After practicing dentistry for 10 years in a country with increasing political turmoil, she chose to emigrate to the U.S. Rather than repeat dental school, she enrolled in a dental hygiene program, graduating in 2019. In 2021, Maria Ana, her husband, and four-year-old son relocated to Texas, where she now practices four days a week.

Always curious, she decided to test the local waters working as a hygienist du jour. A dental assistant recommended a cloud-based app. It sounded like an easy way to earn extra money and check out the landscape. Growing up in an unstable country, she learned to be wary. But something did not seem right: the app had an entire section devoted to “the 1099 myth.”

When Maria Ana attended the TDHA course, she learned that the IRS considers supervised workers employees. Her state dental hygiene license required she work under the supervision of a dentist, so the cloud-based offers were not in compliance. Her suspicions were confirmed. Violating her license was serious and could put her financial health in jeopardy. In the meantime, representatives from the cloud-based app contacted her repeatedly offering pay rates higher than her local area if she signed up immediately. She declined.

Here’s Maria Ana’s takeaway from the course: “If my license requires that I work under the supervision of a dentist, how is it possible to be paid as a 1099? I learned to stay away from 1099 offers." Looking back, she realized there was never a conversation about taxes and worker classification in her academic program.

Avoiding a hypertensive crisis

Rachel’s program had a short presentation from a local agency, but the 1099 issue was never brought up. As a new graduate she was lucky. She was paid as a W2 employee by nearly every office, but her luck did not come from knowing the laws. Fortunately, most of her assignments are booked through a staffing service that requires all workers be W2 employees for the agency. This arrangement ensures that workers and dental offices are in compliance with both federal and state licensing and tax laws.

Rachel began following local social media posts last fall and paid close attention to employment matters. She signed up for the TDHA course to make sure that she had the latest information, which has come in handy on several occasions. Periodically she would reach out for advice on how to handle a specific situation. Several weeks ago, she sent a frantic text message. Her patient’s blood pressure reading was 176/98. The office expected her to proceed as if everything was fine.

Rachel was clearly shaken. She needed clarity and took two active steps. First, she confirmed the blood pressure parameters on two websites: the American Heart Association the Mayo Clinic. The blood pressure readings were just below the hypertensive crisis threshold, but at the very high end of stage two hypertension (data needed to support a professional conversation with the doctor). Ultimately, Rachel declined to see the patient. The doctor had treated this patient for years and said the blood pressure reading was not uncommon, so subsequently chose to perform the scaling services. A similar situation had happened one week earlier at the same practice. Another temporary dental hygienist declined to treat a patient whose BP reading was 178/110.

Rachel took a second important step. She immediately contacted the staffing agency to alert them of her decision not to treat the patient. As an employee of the staffing service, she was wise to alert the agency about this situation. Rachel’s quick and decisive action gave the agency an opportunity to ensure their field employees were not being put in an awkward position trying to treat a potentially compromised patient.

After it was all over, Rachel reflected on her experience: “As I faced this dilemma it was good to know that I could call the staffing agency about something I thought was unethical. I was glad I refused and would encourage other hygienists to also stand up for what they know is right even though they may be told otherwise.”

Kudos to these brave new graduates

When the Texas DHA proposed the course, my answer was an immediate yes. And it was heartwarming to see registrants sign up from all over the country, but I never anticipated the content would have such an immediate and profound impact. It is humbling and exciting to see new graduates willing to question what is going on, gather information to make sound decisions, and take a stand. They are brave, and their futures are bright.

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