Dental Practice Heroes
Where dentists learn how to cut clinical days while increasing profits - without sacrificing patient care, cutting corners, or cranking volume. We teach you how to grow a scalable practice through communication, leadership, and effective management.
Hosted by Dr. Paul Etchison, author of two books on dental practice management, dental coach, and owner of a $6M collections group practice in the south suburbs of Chicago, we provide actionable advice for practice owners who want to intentionally create more time to enjoy their families, wealth, and deep personal fulfillment.
If you want to build a scalable practice framework that no longer stresses, drains, or relies on you for every little thing, we will teach you how and share stories of other dentists who have done it!
Dental Practice Heroes
Navigating the Hygienist Shortage: Hiring, Retention, and Pay
The problem: an ongoing hygienist shortage leaving practices overwhelmed and patients waiting. The solution: Find out in today's episode as we dive into this crisis and proactive solutions to address these challenges in your practice. From hiring and retention strategies to navigating rising wage demands, learn how to keep your team productive and revenue steady during the hygienist shortage. Tune in now!
Topics discussed in this episode:
- The impact of the hygienist shortage
- How to address the shortage in your practice
- Balancing wage demands and practice growth
- The pros and cons of temp hygienists
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Practice owners everywhere are feeling the strain of the hygienist shortage. The days of posting a job and watching resumes roll in are over Now. Weeks can go by without a single applicant, leaving patients waiting for months without appointments and practices struggling to keep up. That means a lot of lost revenue and missed opportunities to grow your practice. Today, we're tackling the hygiene staffing crisis head on. We're going to discuss why it's happening, how to hire the right candidates and what you can do to retain the team you already have.
Speaker 1:You are listening to Dental Practice Heroes, where we help you create and scale your dental practice so that you are no longer tied to the chair. I'm Dr Paul Etcheson, author of two books on dental practice management, dental coach and owner of a $6 million group practice in the suburbs of Chicago. I want to teach you how to grow and systematize your dental practice so you can spend less time practicing and more time enjoying a life that you love. Let's get started. Hey, what's up everybody? Welcome back to Dental Practice Heroes.
Speaker 1:I'm your host, dr Paul Edgison, and I am joined with my DPH coaches, dr Henry Ernst and Dr Stephen Markowitz, and we are picking apart the topics that are important to you in dentistry, and here today we are talking about CFAFA. If you've even heard what CFAFA is, it's because we just invented it. If you've even heard what CFAFA is, it's because we just invented it and it stands for can't find a fucking hygienist anywhere. Are you in that boat as a dental practice owner? Because, shit, I don't know anyone that isn't. So CFAFA, you know, I'll go straight to you, henry. Man. Like what is this and why is this a problem?
Speaker 2:Well, we got to start with the why. You know the why is hygienists allow more consistency in the practices. They allow us to scale and grow. They're usually the main source of new patients. So without them, we're getting choked as a practice. If we're limited in that, and I want to call it a crisis. It's a crisis because not only do we have can't find the hygienist, but they're asking for insane demands, both financially and all the stipulations that they want nowadays.
Speaker 2:You know, and I think it's coming from maybe their organizations or something like that I don't know if you guys that are listening out there have heard this. I mean, we've had hygienists that have been asking for 15 minute breaks. You know, here and there They've been asking for no assistant hygiene, like all these things that all these newer people are wanting to come out with. It's just how do you make this work as a dental business? It almost used to be a lot easier, but now it's a big issue and a problem and we just have to come up with solutions and our particular practice. For a perfect example if you gave me three hygienists tomorrow full time, I'll be able to take all three of them and I'll get them all working tomorrow Right, because we just we have a big need and you know it's a struggle.
Speaker 1:Yeah, I can't remember the last time that we haven't had an add up for a hygienist, like we have been nonstop hiring for three years straight. And what I see in a lot of my clients' practices and I'm seeing this in my own practice is that right now a new patient in my practice we're recording this about mid-December can't get in until like February and that stinks and it has to do with we had two. Just unexpected things happen with hygienists, with health, and we lost two really fast and now we're sacrificing new patient blocks to the existing recall blocks and now we're seeing less new patients. So my associates are seeing less new patients, so they're having less work to do and we're coming off two of our worst months we've had in five years.
Speaker 2:And this is with you being a person who's like such a pro-blocking type person. Yeah, imagine if you weren't that.
Speaker 1:Well, I mean, but I think the problem that it is is that we're having to use new patient blocks to take care of this recall. We're trying to move things around but when it comes down to it, I think we've lost so many new patient blocks, and I'm in the same position as you, Henry, is that we could take three hygienists full time right now and get them busy right away. Steve, what do you see it in your place, man, in all your practices?
Speaker 3:Same exact things. Your practices, same exact things. I would love hygienists, the more the merrier. Not that I want to objectify the hygiene community, but I told the person in my company who's in charge of hygienists. I said we need to collect hygienists. That is the goal. Pre-covid, you would put an ad out and you would get at least five to 10 people applying for that ad, and now it may be days, if not weeks, where there are crickets. So I think that the problem is real. But as dentists, especially as dental practice owners that want to grow, we can't be doing the same thing and expect a different result because the environment is different. So we, as dental practice owners I'd love for us to dive into this next is like what can we do differently Because we want the result to be different?
Speaker 1:Yeah, I love that man. I've been working with a podcast coach and when he talks about just hypothetically about associates, he just started saying you've got a stable full of associates and I was like, did you say stable? He's like, yeah, I'm like we need a stable of hygienists, we need stability and we need to fill our stable and maybe we need better feed in our stable. I don't know where we're going to go with this, but, steve, what are you thinking? How do we get out of this? Do we get out of this? Or what are our options for pivot?
Speaker 3:Yeah, we definitely can get out of it and we need to understand what the hygienists in our own group, our own practice what is it that they want? To feel connected, because that connection is going to keep them happy at work, love what they're doing, excited to continue to show up to work. That is a non-negotiable. We need to spend a lot more time focusing on how do we ensure that our team is connected to our purpose, to our practice and to our patients, and we also, at the same time, need to know if they're not, so that we don't have to react to someone putting in their notice and then have two weeks to fill it and then not have an opening until February or March. We need to understand where the team is and that we talk about in our one-on-ones is are you happy? Is there something we can do to make sure that you're fulfilled at work? What does growing look like to you?
Speaker 3:And if we're starting to get a sense in that conversation that and there's enough trust there and we can be honest that they maybe are looking elsewhere, we need to be proactive. We know in our group it's going to take 30 to 45 days to fill a seat, so it can't be that we're going to wait two weeks. We have to be more proactive. So we talk about do we have a hot list for each department? Hygiene assistants, front desk doctors where people know us. People already know who we are. They trust us enough to pick up the phone. So if there is something that opens up, we know at least where to start and have a conversation and not have to be just so reactive, which is very different and for the average practice owner may take a lot of time to start that process before you see any results from it.
Speaker 1:I think the first takeaway that's worth pointing out is that we have a hygienist shortage and it's important for us to. I know we're focusing on finding more hygienists, but it's important to not lose focus on retaining what you have and making that problem even worse, because you might be so focused on, like, finding people but at the same time, if we lose more people, we've got an even, we got a bigger problem, and I don't think there's good solutions to this. This is definitely something we've never seen before. It's interesting.
Speaker 3:Paul, have you ever put out an ad for a new patient special and then you have 10 of your existing patients that you've seen forever come in and be like what about me? And you sit there and be like, yeah, oh yeah, we don't do new patient specials anymore because of that, but they're equally, if not more, important. That's your recurring revenue. They need to be continually cared for it and let them know how important they are to the success of the practice.
Speaker 1:Totally, henry. What have you been doing? As far as I mean, we know the wages and you mentioned the demands. How do you balance staying reasonable but still running a business? That is Because I mean anyone could look at your practice from the outside and say maybe you should be finding hygienists at all costs, no matter what the cost. But then there is a certain point where it's like, well, we're running a business too. How do you manage that?
Speaker 2:It's like anything else. It's you got to hire correctly. You can't just get nervous oh my God, we need hygienists and just bring anybody in because that's the worst thing you can do, right? So we stay steadfast in our culture and as soon as people have these unrealistic things, we're just not going to bring them in, because I've done that here and there and I've made mistakes and you learn a lot more from your mistakes than your successes and we just don't do that. You know, and I love the point that you were talking about.
Speaker 2:Steve is looking at the existing staff and I kind of maybe more baseball, like a terminology, a bullpen, right. I want that bullpen to be strong. I want versatile people right-handers, left-handers. I want a sinker ball person. I want, you know, I want variety, right, but I want servant leadership. Like we had a conversation beforehand and my lead hygienist I'm just I'm looking at her numbers here and it's not about her numbers, but she's a servant leader. She will take on other things, she'll help others. She helps our calibration meetings, which are very important in hygiene. I mean, last year she produced 510,000 and she's on track for 648. 648 as of right now, with like three weeks left, oh, wow.
Speaker 2:But it's not about that. It's about she's a leader and I won't accept somebody who's not a leader. And it's just they're going to come in with all these demands. Just put your red flags up and, as tempting as it is, just don't do it. Go for the right person.
Speaker 2:And I would love to talk about this is we can talk about all these things that we can do, but this crisis is persisting, so we can't just sit back and just hope that tomorrow is going to just fix itself. You have to be proactive and I would love to say a couple of things that we have done over these last 10 months. Because we're just like you, paul. If you call our office, you cannot get in for a hygiene appointment for any time soon, maybe like March April, maybe even May. Anytime soon, maybe like March April, maybe even May.
Speaker 2:So what we've done is we've tweaked our marketing. We don't do as much stuff at all for new patients because of hygiene. So we've really focused on new patient emergencies, so we've put those in through doctors side. We also have had conversations with our associate doctors and say hey, is everybody okay with seeing one patient in the morning, one in the afternoon block somewhere in there. That's a new patient, that's hygiene and we'll kind of do it where, like a lot of these non-hygienist systems are without, the assistant does a lot of stuff they're allowed to do and you know it's artificially keeping our new patients like stable, and I think those kinds of things are very important for the practices that are very dependent on hygienists that are maybe not don't have the ones that they really, really need.
Speaker 1:Well, what do you think about like a practice like yours or mine? Many chairs, we all have many hygienists, I think, Steve. What did you say? Steve, you got 45 hygienists. That's what I've been told. 45 hygienists, I've got 12. Henry, I got any idea how many you got. We're about 10. 10. Yeah, so it's like. What about the practice that has maybe one hygienist and the doctor is doing six, seven pro fees a day? Are they at the point of hiring no hygienist and really needs a second one? Should they continue to mull it out as a hygieneless model or do they just bite the bullet and pay some ridiculous demands?
Speaker 3:Yeah, I think there are two approaches that you need to think about as a practice owner. The first one is way more important than the second one. The first one is what do I want to do every day? And if you really enjoy profis and you want to do them six or seven a day, who the hell am I to tell you to do differently? So do it.
Speaker 3:But if you don't and you want to build a business and you want to focus on treatment or different types of procedures, then you need to be able to get yourself out of there. So if there's an opportunity cost of how do I get myself out of here from doing hygiene, and then there's the actual cost of hiring a hygienist at maybe slightly above market and then bringing now I can do treatment because I've just freed up so much time to do that. So you have to understand your numbers. It's hard to give this blanket recommendation. You have to understand your numbers, your number of patients, your number of patients that are active in your hygiene department, and then get to your P&L, your operational KPIs and your financial KPIs to really say does it make sense for me at all costs and I put that in quotes to hire another hygienist. The answer, ultimately, is yes, if you don't want to be doing what you're doing every day.
Speaker 1:Well, I think it comes down to cost Opportunity. Cost is what are you preventing yourself from doing by seeing hygiene, because my thoughts are that typically we're going to see the 30% hygiene production and 60% doctor production. I know that people are doing math and you're like you left out 10%. I sure did you know what I mean. But we're going to, if we bring a hygienist in, even if they're going to not or just barely break even, we're going to see that down the line as being able to filter more patients through our practice. And I know there's a completely different way we could go about this, and this is what we're actually going to talk about in the next episode is, you know, looking at case acceptance and our diagnosis and stuff and getting more from what we already have. But right now we're talking about hygiene. So, saying all that, henry, what would your answer be to the person? That's just, I want to grow, I want to scale, I don't have a hygienist or I only have one and these. I don't want to offend anybody.
Speaker 2:As a business person, I always am nervous about what's this going to look like. Moving forward, right, Does this mean every single person that comes after this person is going to be asking for this person that comes after this person is going to be asking for this? I think that if I was in a growing practice and I really wanted to scale, I would probably bite that bullet and look at it like you said, Steve, as an opportunity cost, for time especially, but I would probably have these. We had this conversation. If you listen to some of the old podcasts, we're talking about wage increases. When people ask for a wage increase, they shouldn't just be automatically thinking another year has gone by and I automatically get a wage increase. That's not how it should work. What value are you bringing to this practice? What are you bringing to the table?
Speaker 2:So the advice I could give to those doctors out there is if you're going to just say I'm going to bite the bullet and I'm going to pay this top level, make sure you've got somebody who's willing to do additional services. Right, you can have this conversation. Just in their interview you can tell if that's that type of person that I've always done it this way. This is the way we've always done it, and they're not open to like learning new things like desensitizer, you know, additions or fluoride to adults or stuff like perioprotector lasers. If they're totally anti that, okay, I'm happy to pay the wages, but not for you. Go on to the next one. So if you're going to bite the bullet, my best advice would be that make sure it's somebody who's open to doing other things, because you're going to pay top dollar but you should expect value from that top dollar.
Speaker 1:And that's the truth is like I have no problem paying top dollar if there's some adjuncts to support that, and I think that's a reasonable demand, that even if you jumped on a hygienist forum on Facebook that maybe some people would, you might get some agreement on that. I mean, we've migrated to my office and I'll share with the listeners how this is gonna play out. We have a very good laser bonus. It has worked very well for four or five months now and we have just opened it up to adult fluoride and sealants. Now we don't do a sealants on adults. I'm talking about sealants on kids and you're like well, I mean, aren't we going to do those anyway?
Speaker 1:Yeah, we pretty much are doing those anyway, but I want the hygienist to be checking on the coverage and I want them to be looking at replacement frequencies and seeing if there's opportunity, if it is needed, if there's needed to patch up a sealant, let's patch it up and let's make it right and let's bill for it. So we're just trying not to do all that. But my guess is this is going to bonus our hygienists maybe anywhere from $6 to $15 per hour, depending on what they do and what their performance level is. My fear is that this might come off to the patients that they feel like we're selling, and so it'll just take time to see how this plays out. But if that's how my hygienists are going to get the wages that they want or that they think they deserve, I think it's win-win for both parties, and that's what I'm exploring, and time will tell. We'll see. Yeah, sure, steve. What do you think about all that?
Speaker 3:I love that. I love to create an environment where the team member wins, the patient wins and the practice wins, and what better way to do that than provide services that the patients need? Where I was going to go with it is if you have a great team and you take good care of them and that is known in the hygiene community or whatever Facebook group or whatever it is that's out there. If it's known that your practice takes care of the team in a special way, that is your brand and utilize your team to be your biggest voice. So for us, that means we are going to give a referral bonus to anyone who they recommend that stays with us or that signs on with us.
Speaker 3:I'd much rather pay my team than pay a recruiter. I just did my taxes today for the end of the year. I'd much rather give the money to my team than to the IRS. It's the same thing Like someone's going to get it, but who am I giving it to? So I think there are ways that we can utilize and expand our voice to reach out to these hygienists. There's so many open positions. They are being filled. Why not us? That's what I tell my team. Why not us? And let's incentivize them to even not just do procedures, but let's incentivize them to grow our team and replicate what they're doing, because it helps them, it takes relief off of them in their day-to-day and it helps the practice and everybody wins.
Speaker 1:Yeah, I think it's. You know, recently we have we're trying to hire for hygienists right now and what was really cool because we have a great reputation is we had somebody go. Oh my gosh, I'm so excited. I've lived in New Lenox. You know the town that my practice. I've lived here for the past five years and I've been waiting to work at this office. I am so pumped. And then she came in for an interview. We loved her, she was so great and she was like I'm so excited, I can't believe this is happening, like I've really always wanted to work here. And then she took another job for $5 more.
Speaker 3:A story that just came up. We had a part-time doctor position open and I interviewed this woman and I thought she was amazing. She wanted five days a week. I didn't have five days a week to offer her. We went through our whole process. She was impressed every step of the way. She didn't accept the job because she needed more as far as days. Fast forward two months. She referred a friend. Oh, so I think what that told me is, if we stick to what we know is right and take care of people, the best way our brand will promote itself.
Speaker 2:Why do I feel, like on this particular podcast, that you are being the optimist, steve, which is great. You're talking about the thing and I'm just the one that's like. You know what I'm in the freaking trenches here, yeah, right, and I'm just the one that's like you know what I'm in the freaking trenches here and I'm coming up with, like the reality of how you got to weather this situation. I'll share. Another story is back in the day you were exactly right You'd put out a hygiene post there for a job and maybe there were two other dentists in your local area looking for hygienists, nobody else. And you get like I would get like 30 applications, 30, no joke. And we're extended hours, office open every Saturday. I was lying in the sand. I never want any temps in this office, ever, ever, ever, ever. And then these last few years we've just had to like, deal with it, right, and we do have some people who are temps, and some of them are consistent For any of you out there who are in the trenches in reality, be careful with temps. And I'll share a story that is a true story.
Speaker 2:We had a temp come in one time and one of the assistants said doctor, you need to come here. You never like that. Whenever you get that, come here or I need to talk to you. Those are the worst words, right? So she tells me. I think you need to listen to what this hygienist is saying to some of these patients. And I kind of just walked by and I saw her, red-handed, with a business card in her hand, handing it to a patient. That was her air quotes regular office. Whoa. So right then, and there the steam came out of my ears. I turned into the Hulk, I took about five breaths and I said, okay, let's do this nicely, I made sure there was enough.
Speaker 1:This is why your team's scared of you. This is it. We're going to hear it.
Speaker 2:I made sure that same assist. I said come here, come with me. And I just mentioned to the hygienist I can't like come here. And then we walked it into a hall, into a separate private area and said you, you know what you did, just leave, leave. And then she was escorted out and the next day I got so much grief from like people calling me from the temp agency and this, and I said listen, this is like totally inappropriate, so just FYI out there, keep an eye on these temp hygienists. I have a term that there's a reason why some of them are temps right, they don't want responsibility, they just want to come in and come out and it's great to sit on a soapbox and say no, no, I've never had temps, but sometimes it's a reality for some of us larger practice people. Now.
Speaker 1:Yeah. So I mean, ultimately we're going to weather this out. We're going to see how it goes. We got to take care of our team that we already have and we might have to get creative on what we're doing as far as in our practices. And I think if you're at a earlier growth phase, you might have to just bite that bullet and get that hygienist, because it's really the bottleneck in your growth. So we're going to leave it at that. In the next episode we're going to be talking about maybe looking in the area of case acceptance, maybe doing more with less new patients. Maybe we're too focused on new patients and we need to work with what we got. But thank you so much for listening. If you're interested in working with any of us as your coach, please check out our website dphpodcom or dentalpracticeheroescom. Thank you everybody.
