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re: Is it legal for dental hygienists to open a teeth cleaning practice?
Posted on 4/16/15 at 12:19 pm to ruzil
Posted on 4/16/15 at 12:19 pm to ruzil
At $80/cleaning (which is low), a dozen patients produces around $1,000/day. With a small (2-chair) office and one additional employee (doing receptionist and assistant duties), overhead could be kept in the 40% - 50% range. Easily. I'd call that decent money.
My practice's overhead was around $1,200-1,300/work day, and that was a 5-chair office with 2 dentists and 5 other employees. A small hygiene office would easily run on $400-500 day.
Also, why wouldn't the hygienist be able to take x-rays and give them to the patients to bring to their dentist? I'm guessing this is to prevent the hygienists from diagnosing patients. The hygienists that I employed were very good at diagnosis, and allowing them to diagnose increases the chance that the patient follows up with their dentist if there are problems requiring treatment. Otherwise most people would just show up for the cleanings and only visit the dentist when they have a problem - they won't visit the hygienist for a cleaning then schedule a dentist appointment solely for diagnosis. Then a dozen patients grosses closer to $1,500, assuming there are a few panos taken daily. Initial overhead increases if we throw in x-ray equipment, but the overhead percentage doesn't change drastically on a daily basis.
And if you have an assistant who sets up the patient and takes x-rays in one chair while the hygienist sticks to cleanings, there is no reason a competent hygienist can't see 15-16 patients a day. At that rate plus x-rays, you're easily over the $2,000/day figures I suggested. Again, I'm not talking about a single 30 minute cleaning on a perio patient. But a routine 6-month or yearly cleaning on a patient who visits regularly should not take more than 30 minutes (if the assistant is doing set-up and x-rays).
My practice's overhead was around $1,200-1,300/work day, and that was a 5-chair office with 2 dentists and 5 other employees. A small hygiene office would easily run on $400-500 day.
Also, why wouldn't the hygienist be able to take x-rays and give them to the patients to bring to their dentist? I'm guessing this is to prevent the hygienists from diagnosing patients. The hygienists that I employed were very good at diagnosis, and allowing them to diagnose increases the chance that the patient follows up with their dentist if there are problems requiring treatment. Otherwise most people would just show up for the cleanings and only visit the dentist when they have a problem - they won't visit the hygienist for a cleaning then schedule a dentist appointment solely for diagnosis. Then a dozen patients grosses closer to $1,500, assuming there are a few panos taken daily. Initial overhead increases if we throw in x-ray equipment, but the overhead percentage doesn't change drastically on a daily basis.
And if you have an assistant who sets up the patient and takes x-rays in one chair while the hygienist sticks to cleanings, there is no reason a competent hygienist can't see 15-16 patients a day. At that rate plus x-rays, you're easily over the $2,000/day figures I suggested. Again, I'm not talking about a single 30 minute cleaning on a perio patient. But a routine 6-month or yearly cleaning on a patient who visits regularly should not take more than 30 minutes (if the assistant is doing set-up and x-rays).
This post was edited on 4/16/15 at 1:08 pm
1
Posted on 4/16/15 at 12:27 pm to lsunurse
quote:
Why would anyone want to go to a separate place for cleanings that doesn't have a dentist there?
It would probably be cheaper for one. I would list the 10,000 other reasons but I have to go take a small loan out to pay my dentist.
Posted on 4/16/15 at 2:57 pm to 911Moto
quote:
At $80/cleaning (which is low),
In my zip $80 puts prophy fee in the 80th percentile. So that fee is realistic.
quote:
why wouldn't the hygienist be able to take x-rays and give them to the patients to bring to their dentist?
So, the hygienists takes xrays only to pad fees then. Not a good idea in my book and asking patients to bring their xrays to their dentist to have them read is laughable. What is the fee for this procedure?
quote:
The hygienists that I employed were very good at diagnosis, and allowing them to diagnose increases the chance that the patient follows up with their dentist if there are problems requiring treatment.
Why don't we just anoint the hygienist with DDS degrees that they didn't earn attending dental school. Heck, for that matter, let's just let them start biopsying suspicious lesions and doing the histology. That makes sense as well.
Who sees perio patients?
Posted on 4/16/15 at 3:25 pm to ruzil
You're fooling yourself if you think a hygienist can't look at a set of bitewings and do an exam and tell a patient they need to see the dentist. It's not a matter of whether they are trained and fully capable of doing it - it's more a matter of dentists not wanting money taken out of their pockets. You and I both know full well that's the case.
Who treats perio? We both know that hygienists are capable of measuring pocket depths and telling the patient that they need to see the dentist for a perio treatment plan (not because most hygienists can't do it - but just to make the dentist feel good). And the dentist will send the patient back to the hygienist for root planing, because what dentist in their right mind really WANTS to do root planing? Unless, of course, the dentist now has to in order to recoup the money he has now lost to the hygienist.
Physician' assistants are taking over MANY basic duties at the doctor's office - eventually we may see hygienists doing the same. If dentists are able to fight it, it's strictly about money - not training or capability.
Who treats perio? We both know that hygienists are capable of measuring pocket depths and telling the patient that they need to see the dentist for a perio treatment plan (not because most hygienists can't do it - but just to make the dentist feel good). And the dentist will send the patient back to the hygienist for root planing, because what dentist in their right mind really WANTS to do root planing? Unless, of course, the dentist now has to in order to recoup the money he has now lost to the hygienist.
Physician' assistants are taking over MANY basic duties at the doctor's office - eventually we may see hygienists doing the same. If dentists are able to fight it, it's strictly about money - not training or capability.
This post was edited on 4/16/15 at 3:26 pm
Posted on 4/16/15 at 3:30 pm to ruzil
...and if we stick with the $80 fee, 12-15 patients, no x-rays, no exam, etc - are you still saying a small hygiene office couldn't net $600/day for the hygienist?
This post was edited on 4/16/15 at 3:32 pm
Posted on 4/16/15 at 9:36 pm to 911Moto
quote:
...and if we stick with the $80 fee, 12-15 patients, no x-rays, no exam, etc - are you still saying a small hygiene office couldn't net $600/day for the hygienist?
It most certainly could do that, that's not my concern. I don't think having a hygienist charge for radiographs that they are not licensed to interpret does not make sense and not good dentistry.
Posted on 4/16/15 at 10:00 pm to 911Moto
quote:
You're fooling yourself if you think a hygienist can't look at a set of bitewings and do an exam and tell a patient they need to see the dentist.
I once had a hygienist tell a patient she had an abcess on a lower premolar that was obviously the mental foramen. I think if they want to practice dentistry, they should go to dental school and pass their respective dental boards.
quote:
Who treats perio? We both know that hygienists are capable of measuring pocket depths and telling the patient that they need to see the dentist for a perio treatment plan (not because most hygienists can't do it - but just to make the dentist feel good). And the dentist will send the patient back to the hygienist for root planing, because what dentist in their right mind really WANTS to do root planing? Unless, of course, the dentist now has to in order to recoup the money he has now lost to the hygienist.
Who doesn't have the capability to measure pocket depths? I will do root planing occasionally if I need to as I find it enjoyable to see how well the oral cavity will heal if pathology is removed and the patient initiates good oral hygiene. This treatment is arguably the best money that a patient can spend in dentisty especially as the body of evidence increases regarding the link between perio and cardiovascular diseases.
quote:
Physician' assistants are taking over MANY basic duties at the doctor's office - eventually we may see hygienists doing the same. If dentists are able to fight it, it's strictly about money - not training or capability.
PA's are as important to a MDs office as hygienists are to dental offices, I agree. I think your statement that it would be foolish for a dentist to perform a root planing and that dentists fighting against independent hygiene practice is telling. I think it is you that is focused on money and not the proper care of the patients.
So, when you were in private practice, did your wife work with you either in the capacity of hygienists or office manager? Just curious.
Posted on 4/16/15 at 11:43 pm to ruzil
quote:
PA's are as important to a MDs office as hygienists are to dental offices, I agree. I think your statement that it would be foolish for a dentist to perform a root planing and that dentists fighting against independent hygiene practice is telling. I think it is you that is focused on money and not the proper care of the patients.
Jesus, dude, are you really this off base? In the discussion of a hypothetical independent hygiene practice, you asked me who sees the perio patients...I'm replying that the hygienist does. I'm not saying it is wrong to treat periodontal disease. I'm saying very few dentists do the root planing themselves - they have their hygienist do it.
How could you possibly misinterpret that??? Read my response again. I said that in the hygiene practice scenario, the hygienist is capable of measuring pockets and recognizing a problem - which will in turn be sent to the dentist for a treatment plan. Who treats the perio? The hygienist. After the dentist makes the treatment plan, he sends the patient back to the hygienist for root planing because most dentists do not enjoy doing root planing (most feel it is beneath them). I did not say perio treatment is foolish. I said that the actual root planing is usually done by the hygienist - and this is true EVEN in most periodontists' offices!
I ran the most non-money-hungry dental practice you'll ever find. I saw one patient at a time and worked one chair at a time, despite having 2-4 at my disposal on any given day. My fees at one time were in the bottom 25%. My partner and I bought a 1.2 million dollar practice and turned it into a $600,000 practice BY CHOICE because quality dentistry was more important than money. Before my partner and I took control of the office, it was a money mill with a history of bad dentistry. Also, over 20 years I did more discounted or free dentistry than anyone I know.
This simply started as a debate on whether or not a hygiene-only practice can be profitable (note that I joined this thread in response to someone saying that hygiene is a money-loser), and I gave ample evidence that it can be very profitable. You say that you saw a hygienist diagnose a foramen as a lesion - I've seen dentists do a LOT worse than that, and they most certainly went to dental school.
For the record, I'm against independent hygiene practice. The discussion here was whether or not it could be profitable. And of course, I 'm against it because it would take money out of dentists' pockets. As far as capability, the hygienists in my practice were fully capable of running their own practice, and I would 100% trust their ability to diagnose patients to the extent that they would know whether or not a patient would need to be seen by a dentist for further treatment. And a couple of them could write a full treatment plan better than many dentists I know.
ETA: My wife did not work while I practiced dentistry. In my opinion, my income was enough to support my family on, and it was more important to us that she stay home and raise our children. And for much of my career I worked 4 days/week, because the extra family time was more important than more money.
This post was edited on 4/17/15 at 12:31 am
Posted on 4/17/15 at 12:22 am to ruzil
Gotta say I'm a little disappointed in you. I've been posting in dental threads here for quite some time, as have you. And it should be readily apparent from my previous responses what kind of practice I ran for 20 years.
I have to say that I still don't know where the hell you are coming from with this. My office had 2 dentists, 1 full time hygienist, and 4 other employees (no wives or girlfriends, btw). We took most insurances (and yes, on assignment), cash payments were almost non-existent, had modest hygiene fees, and it was a major source of profit for us. Take away the hygienist and you would take $40K net out of my pocket - and the same amount out my partner's. Sorry you hired crappy hygienists who don't produce and can't read radiographs.
quote:
Maybe in a FFS practice not accepting assignment and the dentist wife/hyg/receptionist lapping all that tasty cash at the front desk.
I have to say that I still don't know where the hell you are coming from with this. My office had 2 dentists, 1 full time hygienist, and 4 other employees (no wives or girlfriends, btw). We took most insurances (and yes, on assignment), cash payments were almost non-existent, had modest hygiene fees, and it was a major source of profit for us. Take away the hygienist and you would take $40K net out of my pocket - and the same amount out my partner's. Sorry you hired crappy hygienists who don't produce and can't read radiographs.
This post was edited on 4/17/15 at 12:46 am
Posted on 4/17/15 at 6:02 pm to 911Moto
Bump...just to give Ruzil a chance to apologize for his poor reading comprehension.
Posted on 4/17/15 at 6:38 pm to 911Moto
OK, so I've been following this thread for a few days and I'm curious - in a normal dental office, say two dentists and a fairly busy practice, what would a hygienist make ?
Posted on 4/17/15 at 7:09 pm to ElderTiger
One of my daughters is a dental hygienist. She does ok.
Posted on 4/17/15 at 8:28 pm to roadGator
quote:
You were the "latter". Damn, just damn
Wtf happened here? I trust ruzil over 911 on these things because 911 is full of shite and wants to buy his kid a Mustang GT instead of a v6 for some arse backwards logic whereas ruzil raised his kids right and is a real baller.
Posted on 4/18/15 at 8:08 am to mikelbr
bullshite. I was buying him the 4-cylinder ecoboost, though he will now have to drive a Volvo XC90 for a year first since the insurance on the 4-cylinder Mustang is nearly $6,000/year and he has to pay part of it. The GT discussion was simply one of the many occasions that I toyed with the OT since you guys are so gullible and easily manipulated by those of superior intelligence such as myself.
Posted on 4/18/15 at 9:06 am to 911Moto
No apologies needed.
What you describe makes no logistical sense:
Patient gets appt with independent hygienist. "I need my teeth cleaned"
Pt has heavy calculus b/u 4-6mm pockets bleeding on probing a and attachment loss.
I'm sorry mr trench mouth we can't clean your teeth today because you have perio and you'll have to go to your dentist instead, is that ok?
Pt goes to dentists office. Yes mr trench mouth you indeed have perio and need root planing let me refer you back to the hygienist for that.
Doesn't this sound efficient?!
It's difficult enough to get pts in regularly for their re care appts because of time issues. Imagine how fun this little scenario would be.
Can independent hygiene be legal,sure. Does it make sense in the real world, not in my opinion.
Your mileage, of course may vary.
What you describe makes no logistical sense:
Patient gets appt with independent hygienist. "I need my teeth cleaned"
Pt has heavy calculus b/u 4-6mm pockets bleeding on probing a and attachment loss.
I'm sorry mr trench mouth we can't clean your teeth today because you have perio and you'll have to go to your dentist instead, is that ok?
Pt goes to dentists office. Yes mr trench mouth you indeed have perio and need root planing let me refer you back to the hygienist for that.
Doesn't this sound efficient?!
It's difficult enough to get pts in regularly for their re care appts because of time issues. Imagine how fun this little scenario would be.
Can independent hygiene be legal,sure. Does it make sense in the real world, not in my opinion.
Your mileage, of course may vary.
Posted on 4/18/15 at 9:20 am to ruzil
quote:
Is it legal for dental hygienists to open a teeth cleaning practice?
Ask my third wife. She tried it and is now doing a 10 year stretch at St. Gabriel.
Posted on 4/18/15 at 9:53 am to ruzil
Dude, you're not following. You read my "Who treats perio?" comment as saying that I am a dentist who does not believe in treating perio - as if perio treatment is not legitimate or something - like I don't think it works.
And in the scenario you describe, the hygienist would still do a gross debridement and remove the bulk of the calculus likely present - which would make it easier for the dentist to truly diagnose the pocket depths and perio condition.
And in the scenario you describe, the hygienist would still do a gross debridement and remove the bulk of the calculus likely present - which would make it easier for the dentist to truly diagnose the pocket depths and perio condition.
Posted on 4/18/15 at 9:58 am to 911Moto
...and again, I've stated that I do not advocate independent hygiene practices. But if it were a reality, it would be extremely profitable. And it would likely go down exactly as I described. This whole argument revolved around whether or not hygiene practices would be financially successful - with you saying they are not even profitable in a dental practice (which is a joke in any well run practice). Then you tried to make it look like I don't believe in TREATING perio disease at all - which is simply poor reading comprehension on your part.
Posted on 4/18/15 at 10:07 am to 911Moto
I never said you don't believe in treating perio. I simply questioned who would treat perio to illustrate the poor logistics of the ind hyg model.
I wouldn't have hygienists in my practice if I lost money by their presence. If hyg didn't do any perio sealants bleaching procedures, that dept would exist as a convenience to my pts and to feed the restorative side of the practice.
It would make a little money but nothing I couldn't live without.
I wouldn't have hygienists in my practice if I lost money by their presence. If hyg didn't do any perio sealants bleaching procedures, that dept would exist as a convenience to my pts and to feed the restorative side of the practice.
It would make a little money but nothing I couldn't live without.
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