Stop paying associates hygiene referral fees


I went to see my hygienist last week. 45 minutes of blissful tooth cleaning, gentle care, informative and supportive help and finished off with an Air Polish. £75 very well spent.

I know the practice well and I know that around 33 per cent of the fee will be used to pay the hygienist, 62 per cent of it will pay the surgery overheads and five per cent of it will be profit.

Here’s the maths:

  1. 5 hours a day at £100/hour less 1 hour of no-shows is a revenue for the hygienist surgery of £650/day
  2. Hygienist gets paid 33% of gross = £217
  3. Leaving the principal £433
  4. Surgery overheads/day £400
  5. Profit/day £33

This means that the hygienist service is a profit centre in this practice, the hygienist is paid fairly and the overheads are fully covered, leaving a modest profit which, when repeated four days a week 46 weeks a year, adds up to a very modest profit of £6,000 a year. In my world that’s just about washing its face and is really no more than an important service for the practice’s patients.

So, I was really surprised when Zac Fine, Breathe’s very own copywriter, sent me the content of a Facebook discussion he had come across, where principals, associates and hygienists debated the best way to “deal with” associate referrals to the practice hygienist(s).

The most popular suggestion was that the associate should be paid all of the hygienist fee and then be charged the hygienist’s hourly rate (rather like a lab bill), and then be paid 45 per cent of the balance as per their pay plan.

So the maths would look like this:

  • Hygienist fee counted as associate earnings, so associate grosses £75
  • 45 minutes of hygienist time at £33/hour = £25
  • £75-£25 = £50 gross fee earned by associate
  • Associate is on a 45% contract and therefore receives £22.50
  • Principal receives £27.50

If (as in my example) the hygienist surgery overheads are £400 a day, for a 6.5-hour day (when actually seeing patients), then 45 minutes of overhead costs are £46. Meaning that the principal makes a loss on these 45 minutes of £19 (or £165 a day…). So, in this situation, the principal is paying for the associate’s patients to see the hygienist.

The next most popular model was that the hygienist gross is received by the practice (not by the associate) and that the associate is paid a “referral fee” or a “prescription fee” of something between £5 and £15 per patient! If this were to happen in my first example (you will remember that the modest profit comes to £33) then a £5 referral fee for 10 patients will wipe out the profit and some more.

Money down the drain

Money down the drain

So, I’m sure some of you will tell me the answer to this (especially when Zac publishes this article on social media), but my question is:

Why oh why do associates believe they should be paid ANYTHING for referring a patient to the practice hygienist?

Why do they believe they have ANY claim on this fee?

I’m assuming they don’t receive a financial kickback for referring their patients to the local orthodontist, endodontist, periodontist or oral surgeon? And I believe that if they do receive a kickback for referring patients to the practice hygienist(s), it flies in the face of the GDC rules on paying for professional referrals.

I know what you’re thinking; if I don’t reward my associates in some way for referring to the practice hygienists, then they will simply do the hygiene treatments themselves and my hygienist(s) won’t have enough to do.

There is a simple way to stop this and that is this: if the associates insist on doing their own hygiene treatments, set the fee for this at the practice hourly rate for dental treatment (circa £200/hour) rather than the hygienists’ hourly rate (circa £100/hour). Also, insist that the associate books their patient for a half hour hygiene appointment with themselves (rather than a quick ultrasonic scale while the local is working) so that the associate has to charge the patient £100 for a proper half hour hygienist appointment rather than sending the patient to the hygienist for £50. Then let the patient decide which is the best value!

If you would like some help with implementing these tactics in your practice, why not contact me for a chat:

m: 07770 430576


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2 Responses to Stop paying associates hygiene referral fees

  1. Michael Walsh says:

    I think this is absolute rubbish. There is no way on earth that most Practices in the real world could do this. Rarefied atmosphere of private practice in a city, maybe.

    • Simon says:

      Hi Michael. Thanks for your comment. I’d like to understand why you disagree with my article so strongly. Within the Breathe cohort of around 40 practices, most are able to follow this advice without the associates rioting! In fact, Oasis brought this system into their practices about three years ago. In our experience, once the associates stop being hygienists, they find that they can earn a much better hourly rate being restorative dentists. If you would like some help in migrating your associates onto this regime, we would be happy to help. Best wishes, Simon.

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