It’s been difficult to find good staff lately, and the hygienist position is probably the toughest to fill. This has left a lot of dentists “hygienist-less” recently. Why is this? And what can you do about it? That’s what Jeff discusses in this week’s episode.
Topics:
:49 – Why the owner doctor doing their own hygiene is a bad solution
2:46 – The stats: why it’s so difficult to find a hygienist currently
8:25 – How should you go about finding a hygienist right now?
17:39 – When could it make more sense to hire an associate doctor than a hygienist?
Links:
Bureau of Labor Statistics Survey - https://www.bls.gov/oes/current/oes291292.htm
Learn more about MGE - https://www.mgeonline.com
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Questions From This Episode
Should a dentist do their own hygiene if they can't find a hygienist?
No. Jeff says hygiene is how a practice keeps patients coming back to maintain their oral health, and it's what builds the practice. Given two practices each producing $1 million a year, he would buy the one doing $500,000 in hygiene. A dentist's chairside time is worth far more per hour than hygiene, so an owner doing hygiene long term, or cutting hygiene days that patients could fill, limits growth.
How do rising hygienist wages affect a practice in PPO plans?
They can make hygiene nearly unaffordable. In Jeff's Southern California example, a hygienist asked for $68 an hour. The MetLife in-network fee for an exam, four bitewings, and an adult prophy in that ZIP code was $131, so the hygienist's pay would be almost 52% of the revenue from that visit. At the area's average full fee of $308, it drops to about 22%.
What is the first step to finding a dental hygienist?
Place ads on job sites like Indeed or DentalPost, written from the hygienist's point of view, showing the benefits of working in your office. Respond to every applicant as close to instantly as possible, because good candidates keep looking and take other jobs. Remove filters that aren't critical to success, like years of experience, and ask your team to reach out to hygienists they know.
What if job ads don't turn up a hygienist?
Escalate. Jeff's sequence is to contact local hygiene schools and their instructors, post in local hygienist social media groups, and use the American Dental Hygienists' Association. Next, call every dentist in your town and ask if they know someone. Then reach hygienists across your state, since they're licensed statewide, with a broadcast email to a rented list. Even at $3,000 to $4,000, plus a modest relocation allowance, that usually costs less than a headhunter.
What should you do if you still can't find a hygienist?
Hire an associate dentist to cover hygiene temporarily, rather than doing it yourself or cutting days. Look for a newer graduate who wants mentorship, or a dentist who is slowing down. As hygiene volume grows, move the associate into doing dentistry. Jeff recommends a ratio of no more than 1.5 hygiene days per doctor day, so one dentist working four days a week supports up to six days of hygiene.
Episode Transcript
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Are you having trouble finding a hygienist? If you are, you're not alone. Since reopening in 2020 after the pandemic shutdowns, this has been a problem industry-wide, even for MGE clients. To that end, we here at MGE had to dig into the issue and figure out a way around it, because we couldn't have our clients hygienist-less, if that's a word. And that's what I want to talk about in this episode of Dental Business Rx: specifically, what's happening in the hygiene labor market, along with how to find and hire a hygienist in today's business environment. My name is Jeff Blumberg, and I'm your host.
Before I get into the actions to take to find a hygienist, I just want to cover a couple of points on the subject of your hygiene department in general. Because inevitably, and I saw this happen, not to clients, but to other dentists I spoke with, they lost their hygienist, because their hygienist decided not to come back to work or moved out of state after all the shutdowns and whatnot. And they made the decision to just keep going and do their hygiene on their own, or reduce their number of days of hygiene. That was not a good idea.
Hygiene, or your hygiene department, is extremely important for your practice. If you're a general dentist, it's actually critical. Number one, it's how your office actually achieves its purpose. If the purpose of your office is to improve patients' health, function, and aesthetics long term, to help them keep their teeth for the rest of their lives, well, your hygiene department gives you a mechanism to see these patients regularly, keep their gums healthy and their teeth clean, and have them keep coming back into the practice so you can maintain their oral health.
Number two, it's what builds your practice. I've used this example before. If you had two practices you were going to purchase, and they were each doing a million dollars a year, and one was doing $500,000 in hygiene production and the other was doing $100,000 with a part-time hygienist, which one do you buy? I would hope you'd buy the one doing a lot of hygiene production, because you're not going to have to go in there and do all kinds of crazy procedures to hit your production target. So it builds your practice. It makes your practice more viable.
And if the owner doctor is doing hygiene as a routine thing with no end in sight, it's a no-go. There's going to be no expansion long term. It's a bad business idea. And if you look at how much a dentist is worth chairside per hour, there's no way doing hygiene is ever going to come close to what you could potentially be doing.
So let's start off by looking at the overall market conditions for finding and hiring a hygienist right now. In 2020, the Bureau of Labor Statistics, bls.gov, and I'll have this link on the podcast page, noted that there were 194,830 hygienists in the United States. As a point of comparison, that same survey from the BLS showed there were 201,117 dentists, but that includes specialists, and it wasn't broken out. In 2019 there was a separate report, and it was about 160,000 dentists. You figure that of those 200,000 dentists in the US, about 40,000-plus are specialists, so we're talking about 160,000 general dentists in the US and 194,830 hygienists. So there are more hygienists than general dentists.
Now, truthfully, that's probably not enough, and it's very locality-based. You'll have areas where there are a lot of hygienists available, and other areas where there are very few. Back in the 1990s, when I was in Chicago, the ratio of dentists to hygienists was five to one. There were five dentists for every one hygienist in the Chicagoland area. So if you were calling for a temp hygienist, nine times out of 10 you were getting a dentist who was filling in that day. So sure, there could definitely be more. There could absolutely be more.
But this has only been exacerbated post-pandemic. It seems like, and this is more anecdotal, at least from the reports I'm getting from clients, more hygienists are either not coming back to work full-time or have decided to move or change careers, et cetera, than has occurred with dentists. So it seems like the hygiene supply has definitely dropped.
And on top of that, making this worse, you have less availability, and wages have gone up drastically. You've probably seen this. I'm not telling you something you don't see. But to give you an idea, in 2020, that same BLS report listed the median wage, the middle wage, for a hygienist in the United States at $37 an hour, and at the high end it was $50 an hour. So the average was $37, and the high end was $50. Compare that to what you're seeing now, just a year later.
And this becomes a real problem, and I talked about this back in Episode 7 with insurance plans, when you are accepting a lot of reduced-fee plans. If you're in network, with a bunch of PPOs where what you're getting is next to nothing compared to what you'd get at full fee, then when hygiene wages go way up, all of a sudden what you're paying the hygienist goes up as a percentage of what you collect.
Let me give you some basic math here. I had a client at a seminar a couple of weeks ago who's in the process of hiring a hygienist. He's in Southern California, and he told me he had two applicants. One wanted $68 an hour, and one wanted $70. $68 and $70. So just for fun, I decided to look at how this would impact a dental practice in his area.
I took his ZIP code, and there's a website called feelookup.com. It looks like it's made by MetLife. MetLife's logos are all over it. So if it's not made by MetLife, I'm sure they're going to be sued shortly. But I believe this is a MetLife site. I entered this doctor's ZIP code. This doctor does not participate in MetLife. I just wanted to see: if I were a dentist in that area and I did participate, how would this impact me?
I took a basic prophy visit: a periodic oral exam, four bitewings, and an adult prophy. You know, the 0120, the 1110, a cleaning. The MetLife in-network fee for this ZIP code was $31 for the exam, $36 for the bitewings, and $64 for the cleaning, for a total of $131. On that same site, they show the average full fee in the area, and they give you a range. So I took the average. The average full fee for those three procedures is $308. So $131 in network, and $308 out of network.
Now get this in your mind for a second. Let's say you practice in this area in Southern California, and you're in MetLife. You're charging $131 for an adult six-month recall, including bitewings and an exam, and that hygienist wants $68 an hour. That's almost 52% of the revenue you're making from that procedure. And remember, things have slowed down a bit post-COVID as far as how long it takes to turn a room over and whatnot. So 51.9% would be the hygienist's pay for that procedure if you were in network. It becomes almost unaffordable. Now compare that to the $308, and you're at 22%. That starts to work.
So you need to get out of plans. That's a whole thing I talk about in Episode 7, as far as what to do. I'm not going to get into that here, but I just wanted to throw it out there, because I know this has been a consideration when you're looking to find a hygienist, since wages have started to go up exponentially. Post-pandemic, especially in 2021, it's become a real problem.
So let's say you don't have a hygienist, or you need one, or you're going to be looking for one. How would you go about finding one in this environment? What are we telling MGE clients? I'm going to give you a sequence of actions, and obviously it's up to you whether you want to do them or not. Everybody's responsible for their own condition. That's my drug company disclaimer. You've got to decide what you're going to do and what you're not.
But I'm going to describe these as an escalating sequence. In other words, start here. If that doesn't work, then do this. If that doesn't work, then do this. You could do them all at the same time if you wanted to, but I'm going to escalate as we go, assuming we're not seeing any benefit from the initial steps.
So let's look at the first step, which is probably what you've already done: place ads on Indeed or DentalPost or something of that nature. A couple of things I'd mention about your ad. First, make sure the ad isn't all about you. This is important to know when you're placing an ad to hire somebody. Very often, and I've seen this with doctors, and I've seen it with managers too, and it even applies to new patient advertising, when you're writing your ad, you're doing it from the viewpoint that you're advertising to yourself. In other words, what would you like? The problem is, you are not your potential public. If you're advertising for a hygienist, you're not the hygienist you're trying to hire, so you have to step into that mindset. What would they be looking for in order to come to work in your office? Make sure your ad communicates to them in a way that shows them the benefits of working in your office. That's point number one.
Point number two: when you get responses to these ads, you need to respond quickly. You need to call them back, email them, contact them, and set up that interview quickly. If I had to pick one of the biggest mistakes small business owners, and dentists especially, make in the hiring process, it's this. And this goes for any position, not just hygienists. You call everybody back quickly. Especially in a job market like this, someone responds to your ad, you're really busy, so you don't have time to call them today, and you don't get around to it for three or four days.
What do you think they're doing in that three- or four-day period? They're still looking for work. How often have you waited too long and then found out they took another position? Generally, if somebody is moving and hustling, trying to get work, that's what they're going to do, especially the really productive employees. They're going to want to find a job quickly. So you want to call them back as close to instantly as possible. That's the point. Call them back quickly and get them in for an interview, unless it looks like it's absolutely not a match. Say they want one day a week, you're looking for full-time, and you cannot reconcile yourself to having somebody there one day a week. Otherwise, you want to contact them quickly.
The last point with regard to your ads is that you may want to remove some of the filters you're putting in that aren't critical, like five years of experience, or some other filter that isn't critical to whether or not they're going to make it in your practice. We have a tendency to want to filter things down so we can get the best product out at the end. For example, this happens with new patients. You'll have somebody giving a new patient who's calling in the third degree, just to make sure the patients we bring into the practice are the ideal patients. That's the wrong viewpoint. Sure, if a patient asks, "Do you take my HMO?" and you don't, I'd tell them. But I'd want to do as much as I could to get the person in. You don't want to add too many blocks or barriers to getting leads when you have potential inquiries.
So that's the subject of ads. The next thing I would do, at the same time I'm placing ads, is ask my team. Chances are some of the team in your practice, at least one or two of them, maybe more, have had experience in the dental industry for quite some time, so they have contacts. You'd want them to put the word out to people they know. Maybe they know somebody and can round up someone who could be a decent applicant for your practice.
So let's say that's not going anywhere. You've placed ads, you've asked your team, and nothing's happening. You're not finding the hygienist you need. From there, you could reach out to the local hygiene school or hygiene program, if there's one in your area, including the instructors, because they'll know hygienists. They trained a lot of the ones in your area. You might have hygiene Facebook groups or other social media groups in your area that would allow you to make a post of some kind. You could also reach out to the American Dental Hygienists' Association, the ADHA. They have a website you could advertise on, and possibly a newsletter. There are also emails, which we'll talk about in a little bit. The point is, you could reach out to local organizations in your area and possibly place ads as a way to reach potential applicants.
One other thing you could do, and this is something I've told people to do, and some people take me up on it and some don't. The first time we ever experienced this was years back, in 2003. We had a client who just could not find an associate. This wasn't a hygienist, it was an associate, but she could not find one for the life of her. Her husband was the office manager, and they were talking to Sabri. Many of you have heard Sabri on an earlier podcast. She's our Deputy Chief Operating Officer. And Sabri told him, "Look, you need to contact every dentist in your town and see if they know somebody." He said, "Really?" She said, "Yeah, really."
So this fellow got home, and he was great. He took out the Yellow Pages, which, for you young people, was that thick book that someone dropped at your door, and when you were younger you used to ask your parents, "What's this stupid book?" That's what my kids did. The Yellow Pages had business listings in it. Obviously, most of us know that. So he pulled out the Yellow Pages, went under dentists, started with A, and started calling people. He got down about, I think, 12 or 15 names, and he found an associate. The doctor he called knew a friend or colleague who was moving into town, and boom, there was his associate.
You could do the same thing for a hygienist. You call: "Hey, we're looking for a hygienist. Do you know of anybody?" It's also not a bad idea to get to know the dentists in your town, and those folks are going to know hygienists. So that's the next thing you can do.
We're escalating here now. Let's say I've done all that. I've put out all this communication. I've called all the dentists in my town, which could take quite a while depending on where you practice. I've contacted the local associations, made social media posts, and placed ads. Still nothing. Assuming I'm calling people back when they apply, and I'm not making it impossible to apply, I now need to crank it up a notch.
If you practice in the US, let's say in, I don't know, well, let's just take our area, Tampa Bay. If you're practicing in the Tampa area, the hygienists you're looking for have to be licensed in the state of Florida. So a hygienist practicing in Miami could also practice in Tampa Bay. So the next notch up, if you wanted to step this up a bit, is to reach out to the hygienists in your state.
How would you reach out to them? There are a number of different ways. You could start with email. The ADHA does email list rental, where they'll broadcast an email out for you. That might cost you a couple of bucks, but it would be worthwhile. Dentaltown could probably filter out the hygienists on their list, as an example. I'm not saying they do. I'm just throwing some ideas out here. There are different organizations that are going to have hygienists on their email lists, if you want to start with email. You could also buy advertising in some of these magazines, although I really don't know what the readership for these is like anymore. I would prefer a more direct, individual communication.
Because now I'm spending a couple of dollars. But if I'm calling an employment agency or a headhunter, I'm paying a lot more than that. With a broadcast email, and again, I know what broadcast emails cost in general, but I don't know the fees for these specific organizations, let's say you spent $3,000 or $4,000. I know that sounds like a lot. We've spent more on broadcast emails to the whole industry, though not that much more, funnily enough, and we hit every dentist they had on file. So say a broadcast email costs you $3,000 or $4,000. You'll probably get a bunch of applicants, and if you hire a hygienist from it, it will cost you a lot less than paying a headhunter. It just would.
So you hire somebody from within the state, and you can pay some nominal relocation costs. Boom, you have a hygienist. And most likely you'll have more than one or two applicants at that point. Again, depending on where you're at, it might be desirable for someone to move to your area. For instance, here in Tampa Bay, someone might be living in Miami and want to move up to Tampa Bay. It could happen. We moved to Tampa from Jacksonville. You'll have the same thing going on in your state. So that's the series of actions we've advised clients to take, where you escalate, escalate, escalate until you finally find somebody who works out in your practice.
Now let's say you've done all of that. I've yet to see this happen to somebody. Yet to see it. But let's say you've gone through all of that, down this whole line, and still no hygienist. So do you start doing your own hygiene at that point, or cut hygiene days? No. Here's what you do. You hire an associate who can fill in as a hygienist temporarily until you can find one.
I know that sounds a bit weird to some people. Why would a doctor want to do hygiene? Some doctors are just looking for work. In many areas, there's more availability for dentists than there is for hygienists, as I was mentioning earlier about when I was up in Chicago. And with where hygiene pay is going at this point, like the example I gave you earlier of $68 to $70 an hour for the client I was speaking with: if you're paying $68 or $70 an hour for a hygienist, for an extra $60 a day you can get a doctor. Something to think about.
And that might actually offer you some growth opportunity. Let's say you had four days of hygiene that you needed a provider for. You hire an associate and have them take over that hygiene. You tell them, "Look, I know it's not your ideal situation, but the idea is that eventually we're going to replace you as a hygienist and move you over to becoming our associate and doing dental work." That could work. I've seen lots of people do that, and it's worked out really well. And especially with where wages are going, it's becoming more and more realistic.
The only warning I would give you there is this. If you're building a practice, a standard, run-of-the-mill general dental practice, you don't want to ever exceed a ratio of one to 1.5 for doctor to hygiene. Let me explain. If you have one general dentist in a four-day-a-week practice, you don't want them to have more than six days of hygiene. Because what's going to happen is you have those double days, where it actually becomes counterproductive. If you're having to bop out of your chair twice an hour to do an exam, it becomes counterproductive to your ability to sell dentistry and deliver it. It can actually lower your production. So one to 1.5 is the ideal position to be in, and once you start exceeding that, it's time to bring in an associate doctor.
So let's talk about this in relation to bringing in an associate as a hygienist. Let's say you just lost your hygienist. You had four days of hygiene, and it's a four-day-a-week practice. You're practicing chairside four days a week, and you had a hygienist four days a week. So what do you do? You just lost your hygienist, so you bring in an associate, and they start covering the hygiene.
Again, consider the kind of associate we're looking for. We're not looking for somebody who's been out of school for nine years and is placing implants regularly. That's probably not your guy or gal. You're probably looking for a newer graduate who may be looking for a mentorship type of situation where they can learn, or maybe somebody who's slowed down a bit and just wants to keep their hand in the industry.
This offers a couple of advantages. Number one, in some states you can't have hygiene done if there's not a doctor on site. Well, if you have a doctor doing hygiene, you can walk out if you have to. They may even be willing to be on call for you to cover emergencies and things like that.
But then let's take this scenario. You've brought this associate in, they're covering your four days of hygiene, and you're doing four days of dentistry. So what do we want to do? Most likely, we want to work toward adding two days of hygiene somehow, and we might bring in two part-time hygienists to cover those two days. Why are we doing this? We're trying to create more volume, because then there's going to be enough volume to justify expanding that associate, who's now doing hygiene only, into doing some dentistry.
So what might that look like long term? The original configuration is you as the doctor and the associate acting as a hygienist, so it's one to one. Now you add two days of hygiene, and it's one to 1.5. Then we could balance this out. If the associate were to pick up two doctor days, and you replace the two hygiene days they're doing, then they're doing two days of dentistry and two days of hygiene, and you have hygienists doing the other four days of hygiene. And this also buys you time to find a hygienist. I know I got a little into the math there, but I wanted you to think with this as a potential expansion opportunity. You could use this for expansion going forward.
So those are the points I would go through. That's how I would escalate, if I needed to, in order to find a hygienist. Not having a hygienist at all, canceling or reducing your hygiene schedule when the patients are there to fill it, or doing it yourself long term are not good business answers. It's something you absolutely don't want to do. And if you're having trouble with this or any other area of your office and you want help, feel free to give us a call here at MGE at (800) 640-1140. You can find us online at mgeonline.com.
And also, the whole intention of this podcast originally was just to help, to provide information you could start using in your practice right away. We don't ask for anything for it, and that's the way it's structured. We just want to help. But if you have a second, and you enjoy the podcast and want to hear more stuff like this, take a minute to follow us. It definitely helps in the long term, and we'd appreciate it more than you know. Anyway, folks, I will see you at the next episode. Hope you have a great week. Take care.