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re: Is it legal for dental hygienists to open a teeth cleaning practice?
Posted on 4/18/15 at 10:29 am to ruzil
Posted on 4/18/15 at 10:29 am to ruzil
quote:
hyg fees are generally a loss leader.
If it's a loss leader, you're doing it wrong.
quote:
Maybe in a FFS practice not accepting assignment and the dentist wife/hyg/receptionist lapping all that tasty cash at the front desk. Sound familiar?
Implying that this is what it takes to generate serious profit from your hygienist indicates that you don't know what you are doing.
This post was edited on 4/18/15 at 10:33 am
1
Posted on 4/18/15 at 10:33 am to 911Moto
Ok, please detail for me exactly how it is done.
TIA
TIA
Posted on 4/18/15 at 10:50 am to ruzil
Let's use your $80 fee and not credit the hygienist for the bitewings or any part of the exam fee - though we both know that without the cleaning, most patients aren't scheduling an exam/x-ray on a routine basis unless they are having some indication of a problem. But let's assume the hygienist only gets credited with the actual $80 cleaning. We'll also assume that of the 12 patients scheduled, one fails to show in the morning and one fails in the evening. So 10 patients x $80 = $800/day gross.
The only significant overhead is the hygienist's salary - in an area where the cleaning fee is only $80, a generous salary would be $275. We're now left with $525/day.
There is virtually no other overhead. The front desk person scheduling the patients, making confirmation calls, filing insurance or collecting fees still has to be there all day whether you have a hygienist or not. Her salary does not go up because she does this for the hygiene patients. The rent for that extra space for that additional chair is insignificant. The electric bill for the extra light on in that hygiene room is insignificant. All your other overhead remains virtually unchanged.
Of course, there will be some minimal supplies needed. A bib for the patient. Some gauze, prophy paste, a toothbrush to send home with them, etc. But let's overstate this and call it $125/day in supplies and the other overhead costs that we know didn't really go up. We're still left with $400 straight profit each day the hygienist is in your office.
How is this a loss leader?
The only significant overhead is the hygienist's salary - in an area where the cleaning fee is only $80, a generous salary would be $275. We're now left with $525/day.
There is virtually no other overhead. The front desk person scheduling the patients, making confirmation calls, filing insurance or collecting fees still has to be there all day whether you have a hygienist or not. Her salary does not go up because she does this for the hygiene patients. The rent for that extra space for that additional chair is insignificant. The electric bill for the extra light on in that hygiene room is insignificant. All your other overhead remains virtually unchanged.
Of course, there will be some minimal supplies needed. A bib for the patient. Some gauze, prophy paste, a toothbrush to send home with them, etc. But let's overstate this and call it $125/day in supplies and the other overhead costs that we know didn't really go up. We're still left with $400 straight profit each day the hygienist is in your office.
How is this a loss leader?
Posted on 4/18/15 at 11:00 am to ruzil
quote:
I think it is you that is focused on money and not the proper care of the patients
...and sending root planing to the hygienist would be the opposite of putting money first. It is sending money OUT the door. But there's a reason that the overwhelming majority of dentists (and most periodontists) have their hygienist do the root planing - they are better at it. It's what they are trained to do, and they do it virtually all day every day. Any dentist that thinks the can out-root plane a good hygienist is fooling himself. Sure, most dentists do some cases here and there, but there's a good reason they have their hygienist perform it. If independent hygiene practices became a reality, the only dentists who WOULDN'T send it to the hygienist would be the dentists who can't fill their daily schedule with other work.
Posted on 4/18/15 at 11:20 am to 911Moto
All that makes sense except you left out a few things: taxes, equipping a room suitable for hygiene and any benefits the owner pays. The compensation is also a bit high.
Now, those margins get a bit tighter when the hyg as to pay rent,buildout costs, insurance, cam, rec/asst salary and any personal and propert taxes.
If ind hyg is such a viable model why don't you set up a bunch of practices in a state like Colorado that allows it and rake in the fat stacks of cash.
Now, those margins get a bit tighter when the hyg as to pay rent,buildout costs, insurance, cam, rec/asst salary and any personal and propert taxes.
If ind hyg is such a viable model why don't you set up a bunch of practices in a state like Colorado that allows it and rake in the fat stacks of cash.
Posted on 4/18/15 at 12:22 pm to ruzil
Since the hygienist is also taking bitewings, the occasional pano or full mouth series, and giftwrapping that examination fee for you (which is only possible since the patient came in to see the hygienist), all those extra expenses I didn't mention are more than taken care of.
I have no interest in moving to Colorado, but if they let this happen in Louisiana (which they never will), I'd definitely be open to backing an office or two if I were healthy enough to run things. This would only work for certain hygienists. I've had a couple that were excellent at hygiene procedures that patients just dreaded seeing. I've also had some who did a great job, were pleasant, and were very efficient (and people don't want to be in the chair any longer than possible) - and patients would want to follow them anywhere.
You're not the first dentist I've seen that proclaimed that hygiene was a loser - and I just don't know what y'all are doing differently. Certainly, if you don't have enough patients to fill a hygienist's schedule but you still keep her around, it's a losing proposition. But a busy hygienist is a goldmine for a thriving practice.
ETA: When the dentist before me had the hygienist seeing 16 patients/day, I assure you he was netting well over $1,000/day (in today's dollars) from that department. And rarely did patients cancel or fail appointments, because it would take a month or two to get another appointment. But that dentist also averaged 40 crowns/week, so hygiene was chump change to him.
I have no interest in moving to Colorado, but if they let this happen in Louisiana (which they never will), I'd definitely be open to backing an office or two if I were healthy enough to run things. This would only work for certain hygienists. I've had a couple that were excellent at hygiene procedures that patients just dreaded seeing. I've also had some who did a great job, were pleasant, and were very efficient (and people don't want to be in the chair any longer than possible) - and patients would want to follow them anywhere.
You're not the first dentist I've seen that proclaimed that hygiene was a loser - and I just don't know what y'all are doing differently. Certainly, if you don't have enough patients to fill a hygienist's schedule but you still keep her around, it's a losing proposition. But a busy hygienist is a goldmine for a thriving practice.
ETA: When the dentist before me had the hygienist seeing 16 patients/day, I assure you he was netting well over $1,000/day (in today's dollars) from that department. And rarely did patients cancel or fail appointments, because it would take a month or two to get another appointment. But that dentist also averaged 40 crowns/week, so hygiene was chump change to him.
This post was edited on 4/18/15 at 12:28 pm
Posted on 4/18/15 at 12:47 pm to 911Moto
What are you guys thoughts on the rise of the expanded duty dental assistant. Would you see this akin to hygienist able to open own practice?
Posted on 4/18/15 at 1:00 pm to 911Moto
quote:
but if they let this happen in Louisiana (which they never will),
There was an independent hygienists group in Baton Rouge in the late 80s, they had a office somewhere around the Perkins Road/ Essen Lane area. I don't remember the name , but they ran ads on one of the local FM stations with a tag line that was something like " want your teeth cleaned, but can't deal with the hassle of making a dentist appointment call us!", the ads ran only for a few months. I had considered it at the time because appointments at my dentist always had to be scheduled months in advance, and I would end up rescheduling several times.
Posted on 4/18/15 at 3:28 pm to ruzil
As a dentist myself I find this argument distasteful at time and a bit confusing. Gained respect for Ruzil. Confused, sounds like 911Moto is retired. Owned or ran a practice 20 years?
Could investing in a hygiene only practice be a motivation for Moto911?
Every dentist as well as every other person has to decide when is enough enough
I've practice 30 years and still love what I do. I thoroughly enjoy my staff & most of my patients
Could investing in a hygiene only practice be a motivation for Moto911?
Every dentist as well as every other person has to decide when is enough enough
I've practice 30 years and still love what I do. I thoroughly enjoy my staff & most of my patients
Posted on 4/18/15 at 4:20 pm to jack6294
Yes, retired due to disability. Practiced for 20 years in a low fee, high quality practice. And I actually bragged about turning a $1.2 million practice into a $600K practice because quality dentistry was more important than money.
Ruzil has taken this thing so off track. He started out by painting hygiene as a money loser - I pointed out that it is a major earner in a well-run practice.
He tried to say that I must be money-hungry and run a shady practice with my wife skimming cash if hygiene turns a profit. I pointed out how contradictory that was to the type of practice that I actually ran.
He said an independent hygiene office couldn't run on low overhead and turn a substantial profit. I pointed out with facts that it can easily do that, and demonstrated how I thought things would operate in that scenario.
I pointed out that I hired hygienists whose diagnosis and treatment planning skills were better than some dentists I know, and he pointed out that he hires hygienists that can't tell a mental foramen from an abscess yet wonders why they aren't earning him money.
He has tried to turn that into me being an advocate for independent hygiene practices. In no way, shape, or form do I think it's a good idea. I just pointed out that if it happened, it would be profitable for hygienists.
You might have gained respect for him, but I lost all respect for him. And I actually held him in the highest regard prior to this thread.
Ruzil has taken this thing so off track. He started out by painting hygiene as a money loser - I pointed out that it is a major earner in a well-run practice.
He tried to say that I must be money-hungry and run a shady practice with my wife skimming cash if hygiene turns a profit. I pointed out how contradictory that was to the type of practice that I actually ran.
He said an independent hygiene office couldn't run on low overhead and turn a substantial profit. I pointed out with facts that it can easily do that, and demonstrated how I thought things would operate in that scenario.
I pointed out that I hired hygienists whose diagnosis and treatment planning skills were better than some dentists I know, and he pointed out that he hires hygienists that can't tell a mental foramen from an abscess yet wonders why they aren't earning him money.
He has tried to turn that into me being an advocate for independent hygiene practices. In no way, shape, or form do I think it's a good idea. I just pointed out that if it happened, it would be profitable for hygienists.
You might have gained respect for him, but I lost all respect for him. And I actually held him in the highest regard prior to this thread.
This post was edited on 4/18/15 at 4:34 pm
Posted on 4/18/15 at 4:21 pm to 911Moto
only if they are good looking and smell really good - and most do
Posted on 4/18/15 at 4:29 pm to 911Moto
As I lie on an ice pack, I feel your pain.
Your position was confusing which made your motivation suspicious
Amazing how we can make one person the personification of a problem we perceive
Your position was confusing which made your motivation suspicious
Amazing how we can make one person the personification of a problem we perceive
Posted on 4/18/15 at 5:42 pm to jack6294
From a non dentist standpoint. I would go to a place that did not have a dentist present in a heartbeat. My opinion and faith of dentists , based on my personal experience in the Baton Rouge market, is very poor. I put dentists on a level with car salesman. I don't trust them and try to avoid them as much as possible. That said I have a new dentist, not in BR, that seems honest. When we switched to her she was new and needed patients. I guess only time will tell if she stays honest or starts up selling.
Posted on 4/18/15 at 7:35 pm to 911Moto
quote:
quality dentistry was more important than money.
Agree 100%
quote:
Ruzil has taken this thing so off track. He started out by painting hygiene as a money loser - I pointed out that it is a major earner in a well-run practice.
He tried to say that I must be money-hungry and run a shady practice with my wife skimming cash if hygiene turns a profit. I pointed out how contradictory that was to the type of practice that I actually ran.
Come on man, I asked you a simple question that you didn't answer. I certainly did not accuse you of running a shady practice, that's simply what you inferred from my question. Don't be so touchy.
quote:
He said an independent hygiene office couldn't run on low overhead and turn a substantial profit. I pointed out with facts that it can easily do that, and demonstrated how I thought things would operate in that scenario.
I have no problem with the concept of independent hygiene, I just don't believe the the numbers would work and I think that it would be tremendously inconvenient for the patients. I would applaud any hygienist that could make this work.
quote:
I pointed out that I hired hygienists whose diagnosis and treatment planning skills were better than some dentists I know, and he pointed out that he hires hygienists that can't tell a mental foramen from an abscess yet wonders why they aren't earning him money.
I had previously worked with, not employed or hired, hygienists that made these obvious mistakes reading radiographs, and used this fact to illustrate why I don't believe it's a good idea for them to take and read radiographs in an independent hygiene setting.
Moto, your constant bragging of how great you are in all settings is getting tired and reeks of overcompensation.
quote:
He has tried to turn that into me being an advocate for independent hygiene practices. In no way, shape, or form do I think it's a good idea. I just pointed out that if it happened, it would be profitable for hygienists.
Why are you so angry about something you don't think should exist?
quote:
You might have gained respect for him, but I lost all respect for him. And I actually held him in the highest regard prior to this thread.
Moto, your level of respect for me, affects me how?
This post was edited on 4/18/15 at 7:37 pm
Posted on 4/18/15 at 7:56 pm to Hankg
quote:
From a non dentist standpoint. I would go to a place that did not have a dentist present in a heartbeat. My opinion and faith of dentists , based on my personal experience in the Baton Rouge market, is very poor. I put dentists on a level with car salesman. I don't trust them and try to avoid them as much as possible. That said I have a new dentist, not in BR, that seems honest. When we switched to her she was new and needed patients. I guess only time will tell if she stays honest or starts up selling.
That's too bad that you feel that way. I sometimes feel the same way, but realize that it's just a few bad apples that spoil the public's perception about dentistry.
Can you detail what happened, how exactly were you upsold?
Prior to dentistry, I worked in medical sales and I am very cautious about how I talk to my patients about necessary treatments. About 5 years ago, I started a preclinical interview with all new patients where I ask them to rate the health of their oral cavity and what issues prevent them from having perfect oral health. I then ask them what they expect me to do for them and what their treatment goals are.
I have found that this interview relaxes the patient, gets them talking about their issues and allows me to offer treatments (if needed) that meets their goals without them thinking that they are being upsold (whatever that means). It also sets the table for a satisfied patient that is happy to refer their friends and family.
I wish you luck with your new dentist.
Posted on 4/19/15 at 7:38 am to ruzil
quote:
Maybe in a FFS practice not accepting assignment and the dentist wife/hyg/receptionist lapping all that tasty cash at the front desk. Sound familiar?
Sure, you didn't imply anything here - it was all in my head.
quote:
I have no problem with the concept of independent hygiene, I just don't believe the the numbers would work
You don't believe the numbers would work because you don't know how to implement a profitable hygiene department in your own practice - I did you the courtesy of showing you how the numbers work on both accounts (independent and in your practice). You're welcome.
quote:
I had previously worked with, not employed or hired, hygienists that made these obvious mistakes reading radiographs, and used this fact to illustrate why I don't believe it's a good idea for them to take and read radiographs in an independent hygiene setting.
Do you need me to point out all the crappy things I've seen from dentists over the years? How many people walked into my office with 12-restoration treatment plans from other dentists when they only had 2 cavities. Sound familiar? (See how that works?)
quote:
Moto, your constant bragging of how great you are in all settings is getting tired and reeks of overcompensation
What did I brag about? Hiring competent hygienists? If so, you should try it some time. Or was it a brag when I said I bought a $1.2 million gross practice and turned it into a $600K gross practice? I haven't bragged in this thread, I've only stated facts. If that comes off as bragging to you, maybe it's just an inferiority complex on your part.
Even if I did - bragging on the OT? Oh, the horror.
quote:
Why are you so angry about something you don't think should exist?
When did I get angry over this?
The only thing that angered me was your implication that I'm doing something shady if I'm profiting from the hygiene department of my dental practice. Sorry you don't know how to run a practice and have to throw stones at those who did it successfully.
quote:
Moto, your level of respect for me, affects me how?
Jealousy is obviously more of a motivating factor than respect in your case.
:This post was edited on 4/19/15 at 7:41 am
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