Coping With A Large Patient Base

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When a dentist has a large patient base, it can be very logical to hire an associate or a restorative hygienist to increase productivity to better care for the patients. Let’s look at these two alternatives.


In most situations, associates doing general dentistry are remunerated forty percent for the procedures they do. The concept of a recent graduate as an associate is to improve their skills and speed with a mentor. The long term objective of the associate is generally to have their own practice. When I refer to an associate this is the group I am referring to.

Ideally, the associate can buy into or purchase outright the practice in which they are working. But this generally does not work out and the associate leaves to get more experience with another practitioner or to purchase their own practice. Generally, the timetable of the associate and the principal dentist are not the same. The associate is generally wanting ownership before the principal dentist wishes to sell the practice. Also, there is a risk that the associate will take your patients with them when they leave, even with a sound associate agreement including a reasonable restrictive covenant, this can happen. It certainly helps to have a dental lawyer draft this agreement.

Remuneration to associates varies within some practices to reflect the special circumstances within the practice. If an associate is brought into the practice to have some high-end procedures kept in-house, the remuneration can be higher such as fifty percent. If the associate is a specialist the rate can jump to 60 or 75 percent. Generally at 75% the specialist brings his/her own chairside assistant. As stated above it is not their primary objective to enhance your practice, it is to gain experience.

Restorative hygienists

We have recently completed a number of valuations where a restorative hygienist was engaged. Generally, the dentists were pleased with the assistance of their restorative hygienist. It takes a lot more planning by the team to keep the restorative hygienist productive as compared to scheduling an associate dentist. Restorative hygienists are paid on an hourly basis and their salary continues even if they are not productive. Their salaries tend to range from fifty to sixty dollars per hour which would equate to an associate dentist producing $150 per hour. Both the associate and the restorative hygienist would have their own dental assistant.

A definite advantage of a restorative hygienist is that they do not leave and take patients with them. The difficulty of the restorative hygienist is to employ one in whom you have confidence to follow you and complete the restoration with the quality of dentistry which meets your standards. There will be an investment of your time at the beginning to monitor and train the restorative hygienist to meet your standards and to give you confidence to turn your patients over to them to complete the treatment.

Recently, I valued a practice where the owner of the practice had a restorative hygienist for the associate and the associate paid the wages of the hygienist by deducting the hygienist’s salary from the associate’s gross fees and the principal dentist paid forty percent on the net billings. I am not convinced this would be as satisfactory as hiring two associate dentists.

I had another situation where the principal dentist employed two restorative hygienists for himself. When all the analysis was done this was not efficient as he only achieved a 50% efficiency from the two restorative hygienists. Better to have one fully employed and save the second restorative hygienist’s salary.

I have also talked to several dentists who tried to utilize a restorative hygienist but gave up as they could not get the results that they wanted.

Summary: having a large patient base is great but it creates its own problems and requires more administration time. Associates and restorative hygienists solve some of your problems but they also bring new challenges.

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