Ed Rabinowitz

Do you know that you’ve got a built-in moneymaker at your dental practice? It’s called hygiene production, and enhancing this aspect of your practice can provide substantial benefits.

The problem, however, is that hygiene production—and in some respects hygienists in general&mdash;are often overlooked.

Deborah Lyle, RDH, MS, director of professional and clinical affairs for 

, says that based on her 18 years in dental practice, as well as what she hears anecdotally, hygienists are not necessarily utilized as effectively as possible.

Cosmetic Dentist Focuses on Changing Lives

“Sometimes offices do 30-minute (hygiene) appointments,” Lyle explains. “And that is just not enough time for the hygienist to really establish a rapport and understand a patient’s interests.”

Increased face time, Lyle says, enables hygienists to better educate patients to make informed decisions from which the practice will benefit.

Lyle explains that if hygienists are empowered to schedule appointments and time as needed, rather than being held to a fixed block of time, they’re better equipped to develop a relationship. That enhanced time may enable them to identify work needing to be done, and that can help grow the practice as well as hygiene production.

“I would never work in a practice that gave me less than an hour for my patients,” Lyle says.

In a typical first visit, new patients are often scheduled for a basic cleaning. But Lyle says that’s not good use of a hygienist’s time. Instead, time needs to be devoted to oral cancer screening, oral home care, and full periodontal charting. That gives the hygienist the ability to use all of her skills to establish a relationship.

“You can develop a care plan for that patient, which would include other visits with the hygienist,” Lyle says. “It’s good internal marketing as well as external marketing. Your practice can grow from that.”

Video: Common Social Media Blunders for Dentists

And the benefits, Lyle adds, extend well beyond the 4 walls of the practice.

“There is a huge benefit, especially the more we’re finding out about the link with oral healthcare and other systemic diseases to the patient.”

A 28-year-old patient may not realize their blood pressure has gone up, or because there’s no history of diabetes in their family may not even have that on their mind. But hygienists are educated to recognize that.

“You’re empowering the hygienist to really utilize her skills and critical thinking,” Lyle says. “And also that collaborative effort when you bring the dentist in, and then between the 2 of them, they can work up a nice treatment plan and present it to the patient.”

Lyle explains that from the standpoint of patient care, it’s important that a high level of communication and mutual respect exist between dentists and hygienists. Dentists, she says, are experts in restorative and diagnostics, but hygienists possess an expertise in prevention.

Video: Using Social Media to Retain Dental Patients

“As a combination, it’s a great team as long as everyone respects what the other person brings to the table,” she says.

With any business, someone needs to be in charge and make most of the decisions. But Lyle explains that the way those decisions are made is important to that aspect of mutual respect. For example, a dentist may listen to an idea the hygienist has, think about it, and then come back and say, “Yes, I would like to do that,” or, “Based on where we’re located, or our patient pool, I’m not going to do that now, but I appreciate you bringing it to me.”

“They don’t always have to agree,” Lyle says. “But that professionalism is very important. That’s why I think being able to utilize multiple skills in your role as hygienist in the practice and really be part of the team, a well-educated licensed part of the team, is very fulfilling.”

Lyle says that growing hygiene production in a practice can have a positive bottom-line impact overall. When patients feel good about the relationships they’re building with their oral health practitioners, the aspect of referral kicks in, and they tell others, “You’ve got to go to my dentist.”

It’s what sets one dental practice apart from others, says Lyle, who used to do oral cancer screenings and a head and neck exam with every patient. And when she explained what she was doing, patients often said, “Wow, no one has ever done that before.”

“That’s one thing I didn’t like to hear,” Lyle says. “I know hygienists who have actually found lesions and referred patients. So, you can definitely increase the bottom line.”

Articles

How to address aspects of hygiene production that are often overlooked within dental practices.

Enhance Your Bottom Line by Maximizing Hygiene Production

When Tim Stirneman was a young boy, he heard the usual negative stories about friends’ dental experiences. Going to the dentist is bad. Nobody likes going to the dentist. It hurts.

Those negative feelings, however, were foreign to Stirneman.

“When I was in high school, I always had good experiences,” Stirneman recalls. “And I thought, why can’t everybody have those kinds of experiences?”

One Dentist’s Journey from Practitioner to Practice Owner

And while Stirneman admits that “it might sound corny,” that’s where his career aspirations began.

“I thought, if I go to dental school, maybe I can make a difference in my own small, little way,” he says.

Today, as the owner of Albonguin, Illinois-based 

, formerly All Smiles Dental, he has accomplished all that and more.

Stirneman, DDS, believes the reason behind peoples’ negative dental experiences is in the way the dentist and his or her team approach their work. Or 

 to approach their work, because times are changing.

“The world is expecting more out of everybody,” he says. “People are no longer accepting that this is the way it’s got to be. And I think dentists realize that if we want patients to keep coming back, then we need to make the experience as pleasant as possible.”

Stirneman compares some aspects of dental work to performing outpatient surgery while people are awake—never a pleasant thought.

“We’ve had to learn, as quickly as possible, how to make the patient experience pleasant,” he explains. “And I think because of that more people are starting to seek out dental care whereas they didn’t before.”

It was several years ago when Stirneman learned about 

, a worldwide nonprofit organization based in Port Richey, FLA. founded by Vincent Monticciolo, DDS, MBA, 14 years ago. The organization is dedicated to providing free dental care to those in need.

“When I first found out about it I thought, that is really cool,” Stirneman recalls.

So he joined the movement, so to speak, and for the last 4 years has been opening his practice one day each year to offer free cleaning, fillings and extractions for those in need.

“There’s no screening process or financing,” Stirneman explains. “If you’re willing to come and wait in line, well, you must really need it. Because some of these people wait 3 or 4 hours. And typically people who either have more time or more money are not going to wait that long.”

Stirneman estimates that the first year the practice opened its doors as part of the Dentistry From the Heart effort he and his team saw more than 130 people and “gave away” close to $40,000 worth of dentistry in one day.

And his team agrees. Stirneman says one of the core values of his dental practice is that his team performs extensive volunteer work. Getting their buy-in to donate their time and services for a day was not a problem.

We’ve hired people who have already shown that they have a propensity toward helping others,” he explains. “Everybody is there because they’ve chosen to be there. And at the end of the day, while it’s unanimous that it’s one of the hardest days of the year, it’s also the most rewarding.”

, a New Jersey-based public relations firm, to help a deserving veteran in need of dental care. The veteran, who was heavily involved in a veterans’ group local to Stirneman’s practice, was in need of a complete set of dentures.

“This veteran would speak before different groups, and he was so embarrassed by his teeth,” Stirneman recalls. “Here was a guy who was so willing to give up his time for others, and yet it was hard for him to smile. But that didn’t stop him from doing what he needed to do.”

Stirneman secured a complete denture set, pro bono, for the veteran. And when the vet’s wife saw him, she literally began to cry.

“She said it was the first time in 30 years she had seen him smile,” he says. “It was just so cool to see that.”

Stirneman has also made adjustments in his practice so that patients can receive affordable care. He explains that dentistry has changed over the years, and no one wants to pay any more than they have to. That means being more efficient, and in some respects that means cutting costs without cutting corners.

It also means taking steps to help those patients who do not have dental insurance.

“We have this in-house savings plan,” Stirneman says. “If you’re not covered by any kind of insurance plan, you can elect to join this affordable savings plan. That helps out a lot of people.”

Family is important to Stirneman. He recently drove to Nashville to help babysit his girlfriend’s 18-month-old granddaughter. After that, he was traveling to Las Vegas to watch his son, who plays football for the University of Wyoming, compete against UNLV.

“I told my son when he was in high school that if he worked hard enough and got a football scholarship, I would go to every one of those games,” Stirneman says. “In 4 years, I think I’ve missed only 4 or 5 of the 48 games.”

He also spends much time with his 2 younger children, and took them to a World Series game this past October when the Chicago Cubs erased the curse.

“We lost 2 of the (home) games, but it was such a great experience,” Stirneman says. “And when I’m long gone, they can at least say that dad took them to a World Series game.”

Changing lives—it’s what Stirneman is all about. Whether it’s family, or patients.

“When a patient leaves the office grinning from ear to ear, and their excitement is contagious, that’s when I am most satisfied,” he says. “That’s what makes me the happiest and brings me the most joy.”

Through charity and improvement of the patient experience, Tim Stirneman, DDS, works to elevate dentistry.

It doesn’t happen often. But when communication breaks down between dentist and patient, or when payment or other confrontational issues arise, it may be time to end the relationship.

“There are cases where some patients become verbally abusive to the front office staff,” explains 

, DDS, who has been working with patients since 1977. “That’s when you send a termination letter.”

But there’s a lot to consider in the process.

Graskemper says that often times the breakdown in the dentist-patient relationship is based on finances, where patients don’t pay for treatment provided. Electing to terminate a patient for non-payment can, however, be a double-edged sword.

“You can terminate a patient, but you have to realize that you’re going to end up writing off that amount,” Graskemper explains. “They’re not going to pay after you terminate them. So, it becomes a practice-management issue then in that situation.”

Which may be just fine if the patient wasn’t going to pay anyway, and repeated attempts to rectify the situation are not worth the related headaches. And while some patients don’t like being terminated, feelings may be mutual in others.

“Sometimes a patient will say, ‘Yeah, I’m done with you too,’” Graskemper says. “And from the dentist’s perspective, you think, whatever their balance is, just forget about it. You just want to get them out the door.”

Ending the dentist-patient relationship, however, is not as simple as it may seem. Graskemper says that all state statutes are similar, and they clearly indicate that dentists cannot abandon a patient. If a patient goes a year without making a payment, they’re still your patient. If they haven’t been to your office for two years, they’re still your patient.

“If either party dies, or the patient moves away or goes to another dentist, that breaks the doctor-patient relationship,” Graskemper says. “Or you send a termination letter. But you don’t want to get rid of patients just because they haven’t been in to see you for several years.”

There are specific reasons for sending a patient termination letter, as well as elements that must be included in the letter, says Graskemper, who wrote a textbook—“

Professional Responsibility in Dentistry: A Practical Guide to Law and Ethics

”—on the subject . For example, if a patient is not following through on their home care, or doesn’t show up for 5 or 6 consecutive appointments, those are reasons for discontinuing treatment.

“They’re wasting your time,” says Graskemper, noting that such behavior is a breach of the doctor-patient contract.

For starters, a letter terminating the doctor-patient relationship needs to indicate the specific date when services are ending and the reason for ending services.

“You can state a valid reason like, ‘You no longer have trust in me as your dentist,’ or ‘For non-payment,’” Graskemper says. “Just provide the facts for why you’re letting them go.”

Dentists must also inform the patient of their oral health condition and what treatments still need to be done, and they must allow for emergencies. For example, in the latter situation, wording needs to be included to the effect that, “For the next 2 months, I will take care of any emergencies you have.”

Dentists also must indicate willingness to make copies of the patient’s chart, and transfer any records required to a new dentist.

“Most states allow you to charge nominal amounts for the copy,” Graskemper says. “Seventy-five cents a page, or something like that.”

The problem, Graskemper adds, is that you’re trying to get rid of this patient. Now you’re making it harder for them to leave—especially if you’re ending the relationship because of lack of payment.

“You also have to give them information on how to seek a new dentist,” he says.

Dentists also need to include a form called A Release of All Claims for patients to sign. And in the release is an anti-defamation clause stating that the patient cannot defame or slander the dentist in any way.

Reading from his book, Graskemper suggests the clause indicate, “It is further agreed that the terms of this release are confidential during the time and thereafter. The patient agrees to take no action, written or oral, which is intended or would be expected to harm the dentist or dental office.”

“It basically prevents the patient from going onto Facebook and saying how nasty you are,” Graskemper says. “Without that, even though you have a release of all claims, it doesn’t prevent them from badmouthing you.”

When and how to go about getting rid of a troublesome patient.

The Delicate Process of Terminating a Patient

When Josephine Chang Pallotto, DDS, was in dental school she never thought she’d be a business owner.

“I didn’t think I could handle it,” she recalls. “It’s a daunting task.”

That was until four-and-one-half years ago when she purchased 

Cosmetic Dentist Maximizes Cross-Cultural Experiences

After 35 years in practice, Pallotto’s father-in-law, Nicholas J. Pallotto, DDS, was approaching retirement. All was in place for his son Anthony, Pallotto’s husband, to purchase the family practice. Everything changed when Anthony was offered an opportunity to work in a different office that pertained more to his specialty—prosthodontics.

“It was a natural transition,” Pallotto says. “The next person in line to take over would be me.”

But unlike being the heir to the throne and having the crown handed to you, Pallotto knew there would be significant challenges—not the least of which was securing and repaying the loan.

“That’s always a scary thought because you’re taking on even more 

 after dental school,” Pallotto admits. “So far it has been great. But I know there is still a lot to learn.”

Pallotto always knew that she wanted to work in healthcare, and started pursuing a career in medicine in college. But after 5 years volunteering in a hospital, she decided it wasn’t the right fit. She explored other avenues in healthcare, including nursing and pharmacy, but everything clicked when she took a weekend dental course for undergrads at UCLA.

“That’s how I discovered this was the field for me,” she says.

Her time spent volunteering in the hospital, as well during a general practice residency at a hospital following dental school, has served her well.

“I love talking with patients,” she says. “And I feel very comfortable in that environment talking with nurses, physicians and pharmacists about medically complex patients, such as what they can have done in their mouth while undergoing medical treatment.”

And the transition from being a member of the team to owning the team, while challenging, is going well. That, Pallotto says, is because she enjoys being the leader of the team.

“I like challenges,” she says. “And I actually enjoy learning something new every day. Even when I make mistakes I admit it wholeheartedly to my team, and I make it known that we’re all learning and nobody is perfect. We’re all just trying to do the best we can for our patients.”

Pallotto has always loved the academic atmosphere. In dental school she was a teaching assistant, as well as a mentor for the first-year class. More recently, she was part-time faculty at the 

University of Illinois at Chicago School of Dentistry

, but had to stop after the spring 2016 semester due to a scheduling conflict.

Military Dentist Spreads the Value of Fitness

“I know I’m going to go back when my schedule permits,” Pallotto says. “You have the most up-to-date information in the field at your fingertips. And you have a great group of colleagues to bounce ideas off, and to learn from when you’re teaching. And I love the fact that students keep you on your toes. They teach you too while you’re teaching them.”

Despite not teaching at the university, Pallotto still has an education orientation. She’s in the process of organizing an 

 walk that she says will be a great way for the community to come together for a good cause.

, unfortunately, is described as one of the not-so-popular cancers,” Pallotto says. “I think in our field it’s very important to get the word out.”

The 5K walk will be held in May 2017, and is focused on education rather than competition.

Pallotto has competed in 2 marathons, but the toll they took on her knees prohibits her from any further participation. So, she’s become a yoga enthusiast. Staying healthy, she says, is important.

“You have to have a balance,” Pallotto explains. “You can’t work all the time. And I’ve found that being active really helps bring that balance to my life. You can’t think about work (while doing yoga) because you really have to focus or you could hurt yourself.”

Pallotto brings her dedication and awareness of health to her patients and her practice team. In fact, it’s in the family. The practice manager, who is also Pallotto’s mother-in-law, is a yoga instructor on the side.

“When I took over, one of my main goals was to bring health consciousness into the practice, and to encourage our team members to stay healthy and active as well,” Pallotto says. “We all try to implement that into our daily routine.”

Being tired at work and not being able to function, not being able to be on her A-game for her team or patients, is unacceptable to Pallotto.

“That in itself is a reason for me to stay healthy.”

When it comes to patient care, Pallotto says it may sound corny, but she truly loves putting smiles on her patients’ faces. She knows that many of them are nervous about visiting the dentist, and not necessarily happy about having work done.

“But when I’m able to make someone feel better and improve their oral health, and make them okay with it, that to me is my favorite part of the healthcare aspect,” she says.

As for being a business owner, she loves having taken on that role. Now she’s thinking of continuing her education and getting an MBA.

“That aspect of dentistry wasn’t brought to our attention in dental school,” she says. “And that personally is rewarding because I’m learning something new and different.”

But it’s the dental field in general that Pallotto says is the most fulfilling.

“There are so many things you can do with your career,” she explains. “I love being able to teach, being able to lead, and being able to treat and care for people. And I feel lucky to be in the field, doing what I’m doing.”

I like challenges, said Josephine Chang Pallotto, DDS. And I actually enjoy learning something new every day. Even when I make mistakes I admit it wholeheartedly to my team, and I make it known that we're all learning and nobody is perfect."

One Dentist's Journey from Practitioner to Practice Owner

HIPAA is an acronym that dominates language within the medical community. But the same is not always true in dentistry—although the challenges and risks to oral practitioners are almost identical.

Choate Hall & Stewart Health Care partner

, routinely works with dental industry clients as well as the healthcare industry across the board providing advice related to privacy and security issues. She says the privacy- and security-related risks and challenges dentists and physicians face are almost identical.

What You Need to Know About New Federal Overtime Rules

“Dentists have an equal obligation to maintain privacy and security of their patients’ dental records,” Hesse explains. “Each dentist is subject to HIPAA, and they’re also subject to state laws regarding confidentiality of personally identifiable information.”

But Hesse cautions that there is “wide variability among dental practices” regarding how they perceive themselves with regard to being HIPAA compliant.

Hesse says that many of the dentists she works with rely on their medical records software provider to ensure that they’re HIPAA compliant. But compliance with data privacy and security, she points out, goes beyond that one facet.

“They need to be notifying their patients about their HIPAA obligations,” Hesse says. “They need to be securing their claims records and other databases as well. I think generally speaking, dentists are becoming increasingly sensitized to their obligations under the data privacy and security laws, but I perceive them to be a little behind their medical counterparts here.”

For example, when it comes to sharing information, Hesse says there’s the question of practical risk versus legal risk. From the purely legal point of view, sharing patient records among providers features no innate legal risk. But practical risk is a different story.

The Value of Creating Lasting Patient Impressions

“There’s a lot of variability within the dental community about how sophisticated a particular practice may be with regard to their patient records and security practices,” Hesse says. “If you, as the dentist, are less sure about whether your colleagues are securing their records, there’s practical vulnerability there.”

Consider the global interventions a patient may require during his or her course of care. That most certainly could require input from more than one provider—from the dentist to the orthodontist to the periodontist. That means trading often identifiable records among providers&mdash;especially where the goal is to use data and analytics to measure quality of care for reimbursement purposes.

“Any time you’re aggregating information from multiple sources and sending information outside the four walls of your firewall, there is potential risk there,” Hesse says. “Dentists should be focused on ensuring that the ways they connect with other entities are secure.”

Hesse says that while there’s an uptick on hacker activity to obtain patient records specifically intended to engage in medical fraud, hacker attacks within the dental community are focused more on personal financial information. For example, there may be an attempt to go through the dental records of the office portal in order to get at the financial or credit information dentists may have in order to provide credit to their patients.

“We’re seeing a trend where people fraudulently attempt to obtain access to the dentist’s medical and claims records in order to make fraudulent claims for credit,” Hesse says.

And the potential for fines, penalties and settlements is significant.

“Look at HIPAA’s recent settlements,” Hesse says. “It used to be that a million dollars was a large settlement. Now they’re trending much higher than a million dollars. And the Federal Department of Health and Human Services is making a point to impose fines and penalties on smaller providers, essentially as a wake-up call that they, too, are subject to these laws.”

Hesse works with clients to develop mitigation strategies for when a HIPAA violation has occurred. But she says that before development mitigation strategies, the more proactive approach is for dentists to conduct annual risk assessments with their IT or medical records provider.

Case Acceptance: A Fast Way to Increase Profitability

“You can’t prevent everything, but there are some very low-intensity strategies dentists can take,” she says.

That can start with encrypting records, and requiring unique usernames and passwords on their systems. And if an annual risk assessment sounds too frequent, Hesse points out that in today’s age of rapidly changing technology, a lot can happen in one year.

Then, the first step in a mitigation strategy is to identify the person you’ll need to contact if you have an IT incident.

“Most small practices don’t have an IT guru in house, but dentists should be working with their EMR provider, or even the folks from whom they’re licensing their computers and getting their Internet service to help identify the problem,” Hesse says. “Because time is really of the essence in figuring out what the root cause of an incident is, so that way you can stop it.”

Dentists have an equal obligation to maintain privacy and security of their patients dental records, says Julia Hesse, a partner at Choate Hall & Stewart Health Care.

HIPAA Violations: Taking a Proactive Approach to Guard Against Them

When we think of dentistry and impressions, the first thing that comes to mind is the imprint of hard and soft tissues in the mouth from which a reproduction can be formed. But another type of impression, a 

 impression, may be just as, if not more important.

That’s because, as the expression goes, you don’t get a second chance to make a first impression. And the value of dentists making lasting impressions on their patients cannot be understated.

“Most patients come in very anxious,” says Timothy Stirneman, DDS, with 

 in Algonquin, Illinois. “We often hear, ‘No offense doc, but I really don’t like dentists.’ If I had a dime for every time I heard that, I’d be a millionaire.”

And quelling those fears can go a long way toward creating that lasting impression.

Stirneman says knowing that patients are anxious, that they really don’t want to have their mouths poked and probed, dentists and staff simply need to be extra nice to patients in order to turn their perspective quickly. That starts, he says, by not making patients wait long when they arrive for their appointments.

“We try not to make them wait, because they’re so used to waiting everywhere and having people treat them like they’re just a number,” Stirneman says.

One of Stirneman’s favorite questions to patients is, “How do you feel about your teeth?” He usually gets responses like, “Wow, nobody has ever asked me that.” And by asking these questions, patients will often provide some amazing answers. For example, he says that a lot of people really feel bad about their teeth, for one reason or another. They go through life, and they don’t smile in pictures.

“Any dentist can be a tooth carpenter,” Stirneman says. “We’re all trained to fix teeth. But when you actually take the time to get to know your patients, it helps you treat them as a whole. They’re more than just a tooth.”

Stirneman believes that creating that lasting impression with patients starts with the culture in your practice. It starts from the first time the patient phones in, or has contact with the office either face-to-face or through your website. And it needs to continue throughout the entire patient experience.

Toward that goal, Stirneman says that All Smiles Dental isn’t a typical dental office. For example, every treatment room has a theme. There’s a Paris room, a Las Vegas room, a jungle room, even a “Wizard of Oz” room.

“We’ve got an Egypt room where we have a big mural of the pyramids,” he explains. “For the Las Vegas room we have a large wallpaper rendering of the Strip. Patients don’t feel like they’re in a clinic, and it immediately takes the edge off.”

When patients arrive, staff is supposed to stand up, walk around the front desk, and greet them.

“The person who answers the phone, or the person who greets patients can make or break your practice,” Stirneman says. “A patient may have 20 different contacts with different team members when they come to the office, so you want to make sure everybody is onboard with the fact that this patient is really important. If you just want to punch a clock and come to work 9 to 5, this isn’t the place for you.”

He and his staff also “do a really good job of hiding all the scary looking instruments.” And, he keeps a watchful eye on what other industries are doing with regard to customer service.

For example, Stirneman says that if you get your hair cut or you go to a spa to get a massage, the way that they talk to you, the way that they treat you, is all about creating a very good customer experience.

“I’m like always looking at how people are doing things, and I try to bring those to our office,” he says.

Stirneman says that consumers tend to think all dental practices are alike. And they don’t want to pay any more than they feel they have to.

“It’s gotten to the point where you have to get really good at what you do,” he explains. “You have to be very competitive with your fees. And the best way to really affect your bottom line is to just make sure people keep coming back.”

That means paying attention to patients’ needs, and when they want to schedule appointments. As such, Stirneman’s practice is open 7 a.m. to 7 p.m. Monday through Friday, and 7 a.m. to 2 p.m. every Saturday. He’s also in the process of re-branding the practice as Compassionate Dental Care.

“I wanted to set us up to really have our name match what I feel is our philosophy in the office every day,” he says. “And also to kind of put my team on notice that this is what we expect.”

When you actually take the time to get to know your patients, it helps you treat them as a whole. They're more than just a tooth, says Timothy Stirneman, DDS.

In less than one month—December 1, 2016, to be specific&mdash;the Department of Labor’s 

final rule updating overtime regulations takes effect

. Specifically, the rule sets a new minimum required salary of $913 per week for employees to be considered exempt from overtime pay—more than double the previous minimum of $455 per week.

The rule is creating considerable confusion among many small businesses, including dental practices, that don’t have legal or human resource departments. Shanna Wall, a compliance attorney with 

, says the Department of Labor estimates the new law will affect more than 4 million workers.

“It’s going to affect how people get paid,” Wall says. “It could affect other requirements such as recordkeeping. And a lot of people either don’t know about it, or don’t know what they need to do about it.”

And in this case, ignorance is not bliss.

If the new rule sounds like a lot of people are going to receive sizeable raises, that’s certainly one of the possibilities. But first, Wall suggests dentists take a step back and look at their staff, consider what they’re paid, but more importantly, consider what they do.

“In dental offices, you’re going to have to take into consideration education,” Wall says.

For example, Wall explains that dental employees are either going to be exempt or non-exempt, and there are two “tests” to being considered an exempt employee. The first is meeting the salary threshold of $913, but there’s more. An employee also has to meet a “duties” test, which considers what the person actually does.

“In order (for a dental hygienist) to qualify for a (learned professional) exemption, they have to successfully complete four academic years of pre-professional and professional studies in an accredited college or university that’s approved by the Commission on Accreditation of Dental and Dental Auxiliary Educational Programs and the American Dental Association,” Wall says. “So, there are very specific requirements just for a dental hygienist.”

In other words, a staff member’s title doesn’t matter. They could already be earning well over the range stipulated by the new law, but if they don’t meet the duties test, they’re still considered non-exempt.

“That’s something a lot of smaller dental offices might not understand,” Wall says. “And if an employee who was classified as exempt now needs to be re-classified as non-exempt, that makes them eligible for overtime.”

Wall explains that while Federal law states an employee must be paid overtime if they work more than 40 hours per week, state and local laws need to be considered as well. For example, in some states overtime is calculated on a daily basis. If a staff member works more than eight hours in a day, they would be eligible for overtime regardless of how many hours they worked that week.

“You really need to look at this to consider what your best financial options are,” she says. “If you have an employee who’s going to work 5 to 10 hours of overtime a week, it may actually cost you less just to go ahead and give them a raise, as opposed to paying them and then paying them overtime.”

The implications are far reaching, and could create a recordkeeping nightmare for whomever handles payroll at the practice. Consider that employees who were always misclassified as exempt have never had to keep track of their time. But if they’re now non-exempt, a time-keeping policy may need to be put in place.

“Are you going to do that manually on paper?” Wall asks, rhetorically. “Are you going to have a punch clock, or some kind of electronic system to keep time? These are things that dental practices may not have taken into consideration before.”

The penalties, Wall explains, for not adhering to the new law can be huge. For example, depending on how many employees the dental practice has, civil lawsuits could be filed against the dentist. It could even result in class action lawsuits if there are multiple employees in the same category who were not receiving overtime pay.

“The Department of Labor can get involved, and open your books to check that everyone in the office is getting paid accurately,” Wall says.

A can of worms could also be opened if the practice has an employee misclassified as exempt, and therefore no time records are being kept. If that employee later sues the practice for overtime, and there are no records of how many hours that person actually worked, it can become a costly he-said, she-said situation.

“These are things that dental practices may not have taken into consideration before,” Wall says. “But that’s going to change.”

New federal overtime regulations take effect on Dec. 1. Do you fully understand how they will affect payroll in your practice?

By his own admission, Trey Wilson, DDS, was a precocious child--a first born who figured he needed to know what he wanted to do with his life by age 14.

So it came as no surprise when Dr. Wilson--following his first art show and some encouragement from his teacher to pursue more training in sculpture--announced he wanted to be a sculptor.

“I really did enjoy it,” says Dr. Wilson, today a highly successful 

But his father explained that it would be very challenging to live a full and successful life as a sculptor, and offered an alternative plan.

Trey Wilson, DDS, has taken his holistic approach to dentistry around the world to help those living in underserved areas.