A Profit Center, Not a Loss Leader

Dr. Robert C. Margeas

Prophylaxis appointments are an essential component of oral healthcare, but oftentimes, they aren't viewed as an essential component of a dental practice's profitability. In this month's cover story, Inside Dentistry explores ways to remedy this situation and presents the recommendations of several experts, including Sally McKenzie, who have been successful in designing profitable hygiene programs. I implemented McKenzie Management's recommendations back in 2001, and initially, I experienced push-back from my hygienists. When I bought the practice, they were seeing about 8 patients a day, and I wanted them to be seeing 10 to 12. However, they were being paid a straight salary, and I intended to move to a model in which they would receive base pay plus a commission in order to incentivize their productivity. You don't want to become a hygiene mill, but if you're operating a primarily insurance-based practice, you need to see more patients to realize profitability.

What you pay your hygienists has to be fair to both them and your practice. For new hygienists, I start the bonus at 10% of everything above their production goal, then move them up to 33% by increasing the percentage each year. This provides an immediate incentive to meet or exceed production goals as well as an ongoing incentive to stay with the practice.

Higher production in the hygiene department translates to higher profitability, but how do you increase production beyond adding patients? One thing that I find that many clinicians are guilty of at one point or another, myself included, is periodontal neglect in the practice. Oftentimes, existing patients with developing periodontal issues are simply given a cleaning when they should be receiving scaling and root planing, which comes at a higher cost. Instead of springing this on long-term patients, which can cause some to blame the dentist, I educate them about the oral-systemic link and tell them that if they can't improve their at-home care to a degree that eliminates the bleeding in 6 months, they'll have to undergo scaling and root planing treatment. This puts the onus on the patients to improve their oral health, and if they don't, performing the higher production scaling and root planing will benefit both them and your practice's bottom line.

You'll hear some in the industry pushing the notion that hygiene is a "loss leader" as opposed to a profit center, but the reality is that if you aren't making money, then you aren't running your business properly. Once you determine your model of compensation and get the numbers right, your hygienists will work to keep their productivity high and the program will become self-sustaining. If a hygienist isn't hitting the number to justify his or her base salary, obviously, you'll have to talk and do some course correction, but in the 20 years since I've overhauled my hygiene department into a profit center, my hygienists have gotten a bonus 100% of the time.

About the Author

Robert C. Margeas, DDS
Editor-in-Chief, Inside Dentistry
Private Practice, Des Moines, Iowa

Adjunct Professor

Department of Operative Dentistry
University of Iowa, Iowa City, Iowa
rmargeas_eic@aegiscomm.com