The Tiered Hourly Pay Model Based on Production
“The other thing that we've seen that's worked really well is a tiered hourly pay based on production,” says Wall. In one instance, there was a hygienist that had been with the practice for a long time and had become a leader more than a producer. The dentist in the practice wanted to give her incentives on production as well as leadership. A plan was created so that when she achieved a certain production level for a period of time, her compensation was elevated to the next tier of production.
“When she got to the next level of production, she would elevate to the next tier, so she might increase a couple times a year,” says Wall. It gave her something to look forward and increased the profitability of the practice. The compensation model was designed to guarantee there would be profit for the practice at each elevated level of production and compensation.
Base Plus Commission Model
“Another thing that we've seen a lot is base plus commission,” says Wall. The hygienist has a base. If a patient doesn’t show, the hygienist helps the rest of the team. On the other hand, with solely commission-based programs, there is a tendency for hygienists to “clock out” and not help the team because staying clocked in may count against their commission rate.
“The highest producing hygienists typically have some type of commission in place,” says Wall. The base plus commission model sets the expectation for hygienists to not clock out and this improves the productivity and morale of the entire team.
If you are going to move into this model, Wall recommends you have a clearly-written agreement between the hygienist and practice owner to set expectations. For example, “As the business owner, we can provide a productive schedule for you, and our expectations are that you are a part of this team, even if you don't have a patient. We all want to support you, and we expect you to support the team and the doctor's production as well.”
Additional Pitfalls of the Pure Commission Model
“I recall a hygienist on commission, who was great but was packing her schedule with patients. She didn’t have time to complete her treatment notes,” says Wall. “Hygiene production can't come at the expense of the doctor production.” The compensation agreement can say, “We expect you to complete all of your treatment notes each day.”
One of the common issues with a pure commission model is schedule packing. Then, “when it comes to diagnostics, they’re missing the boat,” says Wall. It also leads to no open time to provide higher level Perio and to readily fit in new patients.
Commission Percentage Guidance
“One of the things that we've done recently more than in the past is we've helped dentists overcome some unhealthy inherited Hygiene compensation plans,” says Wall. A dentist will purchase a practice where the hygienists were making 50 percent commission. “When we look at that three to one that we've talked about, the hygienists should be producing three times the PR. A third of that production, can go to Hygiene compensation. A third goes to overhead… instruments, electricity for the operatory, all of those things that it takes to run that hygiene department and then there should be at least a third that's left over for profit.”