Ed Rabinowitz

	The more direct involvement employees have in reporting and tracking their own time, the better.

How important is it for dental practices to have exceptional recordkeeping in place? Adam Chotiner, an attorney with Florida-based 

, believes there’s nothing more important.

“Everything flows from one or both of these main principles, documentation and consistency,” Chotiner says.

And when he says “everything,” he means it. From employment applications to tax, immigration and I-9 forms, to the signing of agreements or restrictive covenants, to having accurate time and payroll records — there’s no room for assumptions or, as Chotiner puts it, “Winging it.”

According to Chotiner, time and payroll records may be the most significant elements where proper documentation is concerned because it’s the area where a practice is most likely to have legal problems if not handled correctly. That includes whether workers are correctly classified as exempt or non-exempt.

“One of the common myths I encounter is employers believing that if they pay someone a salary, they don’t have to pay them overtime,” Chotiner says. “That’s a false statement. It’s only part of the equation, and usually not the biggest part.”

Especially in small practices, he adds, where dentists will place all assistants and clerical staff on salary and figure that's good enough.

Where tracking is concerned, he offers some sound advice.

“The more direct involvement employees have in reporting and tracking their own time, the better,” Chotiner explains. “You don’t want a situation where some manager is just keeping tabs on when everyone comes and goes. That’s just way too easy to challenge.”

Case in point, Chotiner says that for years south Florida has seen “an absolute glut” of wage and hour cases across all industries. That can include situations where employers are paying a worker straight time for overtime, rather than time-and-a-half.

“In most cases, they didn’t even know they were doing the wrong thing,” he says. “But you can’t claim ignorance there.”

Hand in hand with documentation is consistency. For example, if your practice has an employee handbook that sets forth practice policies such as for workers to not show up late, or where disciplinary issues come into play, it’s important to treat each situation consistently.

To illustrate, Chotiner says that if a practice has a policy in place indicating that an absence of 3 times a month is grounds for termination, then that policy must be enforced consistently. You can’t fire 1 employee who may be African-American or a member of any minority or protected group for an infraction but not fire 3 other employees.

“That highlights the main component in my view of consistency,” Chotiner says. “You want to maintain consistency in all of your human relation aspects, not just timekeeping.”

That can be as simple as sending an email to yourself that an employee was late that day. You spoke with him or her and told them not to be late again, then add the email to the personnel file. It may not be a formal document, but it’s better than doing nothing.

“The key is to at least document the incident, and enforce policies in a consistent way,” Chotiner says. “And that goes back to the idea of a handbook, because it sets forth what the policies are.”

Even for something as rudimentary as vacation time. How much paid time off do employees receive? Explain to employees how they accrue vacation time, and when they are entitled to use it. Then, enforce that policy in a consistent manner.

“If you give people a reason to think they’re being treated differently, whether it’s true or not, they’re probably going to think it,” Chotiner says. “And that’s where you get into trouble.”

Chotiner says the best place to start down the road to proper and consistent documentation is by speaking with a human resource professional, and also a labor employment lawyer. Because “what you don’t know can hurt you.”

After all, many practices are not large enough to justify a full-time or even part-time human resource person. There may be a practice administrator or office manager who fills that role, but are they properly trained in human recourse issues?

And it can all start by preparing, or revising, or updating a handbook — putting policies in place, and making sure everyone understands how to consistently maintain records and enforce those policies.

“There are outsource HR companies and people you can bring in to help,” Chotiner says. “But as a labor employment lawyer, my advice is, have a conversation with someone who can start you down the right path.”

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Excellent recordkeeping and policy handbooks are the heart of any dental practice. Too often, thorny situations arise without proper documentation, but potential lawsuits can be avoided with the aforementioned elements in place maybe it's time to have a conversation with a human resource professional or labor employment attorney.


Build On Solid Foundations with Documentation and Consistency

According to Dave Monahan, patients want an experience when they engage with their dentist.

Dave Monahan has spoken with several hundred dentists over the past year. Two topics that come up most in conversation are attracting new patients into their practice, and dealing with insurers and complex insurance issues.

, a free cloud-based dental membership plan designed to help dentists attract and retain fee-for-service patients while providing access to affordable dental care, says the two topics are connected.

“Most dentists get their new patients from insurers, but they’re not happy with the terms of the insurance the patients are coming into their practice with,” Monahan says. “So, there’s this sort of issue that they’re dealing with.”

And in terms of bringing new patients into their practices, many dentists are not doing a very good job.

Monahan explains historically in the dental marketplace, dentists turn to local advertising modes such as direct mail, inserts in publications or even church bulletins to attract new patients. Those channels of communication, he says, are fading fast.

“The old, traditional ways of advertising locally just don’t work any more,” he says.

 work is a referral program — incentivizing existing patients, their friends and family to refer new patients to the practice. There are many variations on this theme, but most offer credit or discounts on services to existing as well as new patients.

“When it’s done right, it’s very successful,” Monahan says.

The other avenue is digital advertising. Facebook, Monahan points out, is a great platform for narrowing in on the types of patients and consumers dentists want to reach. A good website is also key —one that focuses not just on the clinical side of dentistry.

“Patients want an experience when they engage with their dentist,” he says. “They want to know that you care about patients, and that they can trust you.”

And yet, many dentists remain intimidated by the internet and social media platform —but that’s no reason to shy away.

“There are consultants out there, plenty of people who can help dentists through that, and very simple and inexpensive tools they can put in place,” Monahan says. “It’s a matter of taking the step to reach out and ask for help. Because the dentists I’ve seen that have done [digital marketing] swear by it.”

Monahan’s research into consumers’ oral health habits uncovered some interesting information — well beyond the basics of why more than 50 percent don’t go to the dentist on an annual basis. Digging deeper, he found nearly 80 percent of consumers he spoke with want more dental care. They believe they can’t afford it, or don’t have dental insurance.

“So on one side we have dentists who would like to offer their services more directly, and on the other side are consumers who want more care but don’t think they can afford it,” Monahan says. “That’s where Kleer came from. We connect the two.”

Consumers, Monahan says, want a dental plan that’s affordable, transparent and easy to understand. Kleer enables dentists to set up their dental care plan in as little as 15 minutes. They can pick and choose options, offer set pricing and show comparisons to market rates. Patients can download a mobile app or open the website and select a dental plan in two minutes.

“It’s very consumer oriented,” he says. “It’s what consumers expect of apps and services they purchase today. Simple to purchase and to use.”

Monahan says about 10 percent of dentists offer their own dental plans to patients, but they’re typically paper-based. As such, renewing patients each year can be time consuming and expensive. In contrast, the Kleer app has an auto renew feature.

“And the dentist doesn’t have to do anything,” he adds.

Monahan says that under most insurance plans, patients are paying premiums and have to deal with deductibles and co-pays. When everything is netted out, approximately 50 percent of all payments made by patients end up with the dentist. The remaining 50 percent go to the insurer.

“Under a membership plan, dentists clear 90 percent of all patient payments,” he says. “We take about 10 percent. So it automatically boosts their top and bottom line.”

Dentists, Monahan says, don't pay anything to get started. No patient fee, and no annual fee.

“We don’t get paid unless the dentist gets paid,” Monahan says. “We haven’t spent a lot of time going out to talk to dentists yet. But once you spend a few moments with them, they get it.”

Discover more Dentist’s Money Digest® news here

Consumers are frustrated over the perceived cost of dental care, or the lack of coverage, while dentists lament the hassle of dealing with complex insurance issues and reduced reimbursement. Easing patient concerns, reducing hassles and bringing in new patients could be use a couple of clicks away.


There's a Kleer Path to Finding New Patients

Expanding your skills and setting yourself apart are 

The dream of graduating from dental school and opening an independent practice is over. Or is it?

 of Dental School Seniors in 2016, 50.5 percent of seniors indicated their immediate plans following graduation were to work as a private practice dentist. That’s up slightly from 49.4 percent in 2015.

Those figures mesh with the results of the ADA’s 2014 Survey of Dental Practices, which indicates that 70 percent of all practices are sole proprietorships.

And while those millennial dental school graduates may be carrying a sizeable education debt on their shoulders, the good news is the process of owning your own practice hasn’t changed.

“You still have to consider the same things whether you’re buying a practice or starting your own practice,” says 

., a West Hills, California-based integrative and cosmetic dentist. “You have to look at the area. Is it growing? Is it stable? What type of practice do you want to have? Lots of those considerations are still the same.”

Rathee believes it’s particularly important for young dentists to set themselves apart. For example, Rathee says she uses some unique strategies that allow restorations to last longer. She recommends additional training beyond what was learned in dental school.

“Expand your skills and become more adept at doing advanced procedures,” she says. “But it doesn’t happen overnight. I’ve taken lots of continuing education. It makes me realize that you really don’t know what you don’t know.”

She says that being able to offer patients advanced procedures, and perform these procedures in your own office, are important benefits. Patients like to know they can get everything they need done in one place.

Additional practice management training, she says, is also beneficial. She also believes it’s helpful to have a mentor — someone who can guide you through the process of learning how to run a dental practice.

“The practice of dentistry is also the practice of running a small business,” Rathee says. “I formed a relationship with a mentor by being involved in the 

. When you’re involved in organized dentistry, you get an opportunity to learn from dentists who are in similar practices.”

And as you learn, clinical expertise and practice management experience will provide significant long-term dividends.

While Rathee acknowledges she doesn’t heavily engage in social media where her practice is concerned, she recognizes it’s an important element as part of overall marketing.

“Social media is not necessarily going to make or break a practice,” she says. “But it’s definitely an important part of helping people understand what your practice is like.”

What Rathee does engage heavily in, and highly recommends especially for young dentists, is establishing communication with patients. She says that patients don’t understand the services and treatment dentists are providing and the related benefits if time isn’t allotted for explanation.

“When you take the time to talk to patients about things, they get the feeling that you actually care about what’s happening to them,” Rathee says.

That’s crucial, she adds, because patients have choices. But it’s also important to remember that you’re not going to attract everyone to your practice — and you probably don’t want to. Your goal should be to attract the patients who want the level of service you provide—who want the best treatment plan rather than the best cost option.

“You draw the type of people you want to the type of practice you have by communicating well with them,” she says.

Like any small, independent business, addressing the issue of overhead is always challenging. Rathee says one strategy that can help independent dentists is building collective efforts with other independent practices.

“We’re seeing that trend, and I think we’re going to see more of it in the future,” she says. “Small, independent practices are going to have to find innovative ways to manage their overhead.”

But, she adds, the dream of owning an independent dental practice is, and always will be, very much alive.

“They may be fewer in number than they were historically, but we’re always going to have them,” Rathee points out. “In any market, there’s always a demand for different types of services. I think we’ll always have the opportunity to do what we want.”

Not everyone shops at Neiman Marcus or Nordstrom's. Some prefer Walmart or Target, or a small, independent boutique. The same holds for dental practices. Anita Rathee, D.D.S., M.P.H., an integrative and cosmetic dentist, says there will always be a market for every type of practice. The key is knowing how to make it work.


Restrictive covenants can leave you with limited options if an employment arrangement doesn't work out.

If you’re a young practitioner coming out of dental school, chances are you’re saddled with some pretty exorbitant education loans that make it impractical to start up a practice from scratch.

If you join an existing practice as an associate, you will likely negotiate and sign a dental associate contract. But it’s not as simple as putting pen to paper with your signature — there’s a great deal to consider. Do you want to work in a private or corporate practice? Is future ownership a consideration?

William Prescott, Esq., E.M.B.A., is a practice transition and tax attorney with Avon, Ohio-based 

. He says it’s critically important to understand what you’re signing and to recognize going in that all contracts are negotiable. In other words, it’s a two-way street.

It’s likely you spent time in dental school wondering what your dream or ideal practice would look like. Prescott points out that just because you’re signing on as a dental associate doesn’t mean you need to give up your dream. The structure of your contract can go a long way toward helping you eventually achieve that dream.

“Your dream may need to be put off, but you will eventually get it because that’s your vision,” Prescott says. “The problem is, people don’t have vision.”

Prescott believes there are many young dentists working for corporate practices because they don’t think private practices can pay them enough. As such, they compromise, and sometimes they compromise too much.

“The contract is not so much about living your dream as it is, ‘What opportunities do you have at this particular practice?’” he explains. “’Is this the place I want to be, or are you going to move on at some point?’”

There are common contract provisions that you need to be aware of, Prescott says. Some of them can be down right uncomfortable. For example, there could be a stipulation that if you leave, you cannot practice within a specific distance from any location the current practice may have or will have in the future. Or, if you’re a specialist, such as an orthodontist or periodontist, you will continue to refer patients back to the general practice.

“You need to have an advisor with experience in dentistry,” Prescott says. “And don’t sign what you can’t live with.”

If you’re considering signing on with an independent or multi-doctor practice, your dental associate contract could contain a restrictive covenant. This is a clause in the contract that prohibits you from competing with your employer for a certain period of time, or across a specific geographic area, should you leave their employment. It could also restrict you from soliciting or dealing with patients from that practice.

Prescott sees the dilemma of a restrictive covenant from both sides of the equation.

“For the dental practice owner, I would never give an associate the door to my patients without a restrictive covenant,” he says. “If [the employment arrangement] doesn’t work out, the associate will go down the street and take the patients.”

But there are also considerations if you’re a prospective associate.

“I don’t want associates signing restrictive covenants,” Prescott says. “We had a client in Columbus, Ohio, and she joined a practice that had three locations. She had to work really hard to figure out where she could go if it didn’t work out. Guess what? It didn’t work out. Restrictive covenants need to make sense for everybody.”

The thought of receiving a regular paycheck may seem terrific, but the reality may be less than desirable depending on how you are being compensated. Prescott advises against accepting a draw that must be repaid against future compensation. In other words, do you really want to find out three or four months later that you need to repay thousands of dollars?

It’s also best not to be paid based on collections.

“If I was the associate, I’m not going to make anything for 120 days,” Prescott says. “I want to be paid.”

He recommends a compensation package based on the greater of a dollar amount per month or a percentage of adjusted production. By calculating the differential on a quarterly basis, the associate avoids the peaks and valleys of pay versus production.

In addition, an expenditure of time provision reflects whether you will be employed full- or part-time, how many days a week you work, how many hours in a day, and vacation and personal time off. Don’t assume that full-time means eight hours a day, five days a week. Schedules vary from practice to practice, and full-time could mean 7 a.m. until 6 p.m., three days a week.

“It’s about being specific,” Prescott says about a dental associate contract. “Know what you are agreeing to, and don’t leave anything open.”

Just because finances prohibit you from opening your own practice fresh out of dental school, that doesn't mean you have to give up on your dream. This second of a two-part series examines the dental associate contract from the perspective of the incoming associate. What's in the contract, and just as importantly what's not, can make the difference in achieving your dream.


Dental Contracts Can Make or Break an Associate's Dream

Incorrect or late filing can lead to heavy penalties for your dental practice. 

“It’s never too early to begin planning” is an adage that holds true where business tax filing is concerned. And tax season, often thought of as November through the following March for small businesses, is right around the corner.

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Penalties for filing late or incorrect information can be costly. According to Rick Roddis, president of ComplyRight’s 

, the amount of the penalty is based on when the correct form is filed. For example, if you correctly file no later than 30 days after the deadline, you will be fined $50 per form with a maximum penalty of $186,000 per year for small businesses.

As a dental practice, that hurts. But starting to prepare early can prevent those costly and painful penalties.

Roddis explains that the due dates for distributing 1099 and W-2 forms to employees and contractors is January 31, but that doesn’t mean there aren’t some best practices dentists can and should do now.

“Number one, make sure you have your employees properly classified,” Roddis says. “I would imagine that most dental offices classify their employees as W-2s, but that can be an area of confusion.”

It’s a good idea to use this early time to look through vendor records and identify people who you have paid, or are on pace to pay, more than $600 to during 2017. These are generally people who have provided a service to your practice, not necessarily physical product providers, who would receive 1099s.

As noted earlier, the penalties for filing late or filing incorrectly can be steep. If you file correctly more than 30 days after the due date but by August 1, the fine is increased to $100 per form, with a maximum penalty of $532,000 per year for small businesses. And if you file correctly after August 1, incorrectly, or don’t file at all, the fine is $260 per form, with a maximum penalty of $1.06 million per year.

And the IRS, Roddis says, has increased its enforcement of these penalties.

“They’re just sending out automated letters to businesses with the fines,” he says. “They’re not really allowing for an appeal process. They’re just issuing the fine and holding people accountable.”

Another reason for starting early, Roddis says, is determining the method by which you plan to distribute your 1099 and W-2 forms. That should be done in September, or October at the latest, and there are a variety of methods to select from.

“Dentists can choose to do what we call a traditional method, which is you buy some 1099 and W-2s at the office supply store, and you fill them out,” Roddis explains. “You can also buy package software — different 1099 or W-2 software that will help you populate the forms and print them.”

A new trend is making use of a cloud provider, such as efile4biz.com. Dental practices enter the data in January, and the provider prints, mails and electronically files it with the government. Cloud providers like efile4biz are able to connect with many software providers, like QuickBooks, making it easy to move the data into the cloud system.

Working with a cloud provider offers additional benefits. For example, using the traditional method of disseminating W-2 and 1099 forms, each year a dental practice will need to purchase these forms and they have to figure out how to populate them. That can be a tedious process. Working with a cloud provider results in the elimination of paper and streamlining the process.

“With our cloud processing, the data is saved from year to year,” Roddis says. “So, you don’t have to re-enter all the data every year. Most likely, your contractors are the same year in and year out, so the data’s all saved in there at the highest levels of security.”

And if someone needs an additional or replacement copy of their W-2 or 1099, it’s easy enough to log into the provider’s website and reprint or email the form.

“It’s really about convenience and access to your data,” Roddis says.

With all that’s potentially at stake, Roddis strong recommends consulting with your dental practice accountant.

“With the IRS increasing its fines and its approach, you really need to have some professional help,” he says.

And if you choose to prepare and distribute W-2 and 1099 forms on your own, a cloud provider like efile4biz’s website has a content section designed to help educate users about the process, or understand the difference between a contractor and an employee.

“You can’t take this process lightly,” he adds.

If you think it's too early to start planning your 2017 business tax filing, think again. From determining how employees are classified to which method of form distribution is right for your practice and avoiding costly penalties there's a lot to be considered well before next January. Continue below for advice on getting the process started. 


Get a Leg Up on Business Tax Filing

In her journey to become a prosthodontist, Susan Brackett drowned out the voices of naysayers by seeking guidance from supportive faculty and mentors.

Susan Brackett, D.D.S., M.S., F.A.C.P., worked as an assistant for a general dental practice while in high school. The experience piqued her interest in dentistry, and she planned to work toward a career in dental hygiene upon entering college.

Because, Brackett says, that’s just the way it was in Bartlesville, Oklahoma in 1971.

“At that time period, women went into hygiene, the guys went into dentistry,” she recalls.

That changed when she began interviewing for hygiene programs and was encouraged to pursue dentistry due to her exceptional grades and test scores.

Brackett’s wheels started turning and carried her on to dental school. Today, in addition to having a successful private 

The decision to pursue a career in dentistry, and specifically prosthodontics, may have been an easy one for Brackett once she put things in motion, but her parents were not initially thrilled with her decision. Raised during the Great Depression, they believed that a college education was very important, but did not view dentistry as an appropriate career for a woman.

“As I matured, I realized they weren’t being mean,” Brackett recalls. “It was just their frame of reference, and they just wanted the best for me.”

Undeterred, Brackett attended the newly opened dental school at the University of Oklahoma, and with the assistance of loans and scholarships, supported herself through the endeavor. But as the only women in her class, she often found herself the subject of ridicule.

She also developed a relationship with the department chair, Herbert T. Shillingburg, Jr., D.D.S., whose textbook, 

, was a mainstay in a large number of dental schools.

“He was quite intimidating,” Brackett says. “But somehow through the course of my dental school career, we developed a relationship where he became more of a mentor. Ultimately, after I graduated, I ended up working for him, and he was the one who encouraged me to go back and get my graduate training in prosthodontics.”

Brackett has focused much of her career on education and encouraging young dentists to pursue advanced training to become dental specialists. She attributes some of this focus to the difficult relationship she had in dental school with her fellow classmates. Those challenges prompted her to find solace and inspiration from faculty who provided encouragement.

“I think — not only from that influence of faculty, but also that I was having a difficult time — I was hoping that by teaching I could help influence young people’s lives,” she says.

Along the way, Brackett co-authored an award-winning textbook, 

, with her mentor Dr. Shillingburg, and she’s seen a significant change where women and careers in dentistry are concerned.

“Now, when a young woman says she wants to be a dentist or a prosthodontist, people don’t say, ‘Why?’” Brackett explains. “They say, ‘Why not?’ These young women are bright, attractive and no one’s holding them back.”

Brackett says she and a prosthodontist colleague and friend of 30 years often gauge the gender-related changes in the industry when they attend conferences by seeing how long the lines for the women’s restrooms are during breaks.

“You used to be able to walk right in,” she laughs.

Brackett has been a dedicated leader to the ACP throughout her career. She was director of the Public Relations and Communications Division on the ACP Board for six years, and served as ACP secretary and as a member of the ACP Education Foundation Board for nearly 10 years. She was installed as vice president of the organization in 2014 and rose to her current position as president in 2016.

She credits much of that give-back mindset to another prosthodontist, Thomas McGarry, D.D.S., with whom she still practices at 

Oklahoma City-based Implant & Prosthodontic Associates

“He’s the one who instilled in me that it’s important to give back, particularly to a profession that has treated you well,” Brackett says. “When I joined him in practice, he was leading up that chain to be president of the ACP. It worked out well that I was able to help cover his office and his patients while he was traveling and spending so much time working for the college,” Brackett added.

Brackett also does charity work outside the field of dentistry. She and her husband are both active in giving time to organizations that reflect their passions. For Brackett, one of those passions is ballet and dance. It started when a friend in college encouraged her to take a ballet class.

“It was a nice break from dentistry,” she says. “I was never any good at ballet, but it gave me an appreciation for the art form that I never would have had if I hadn’t tried it myself.”

Today, Brackett is not only involved with the University of Oklahoma School of Dance, but also a member of the board for the Oklahoma City Ballet.

For practitioners looking to become more active in their professional organizations, Brackett recommends starting with the state or local chapter in order to learn what’s happening at the national level.

“For the American College of Prosthodontists, we have a great public relations opportunity every year in April,” Brackett says. “It’s a whole week that's called National Prosthodontics Awareness Week, and our staff has put together a great packet on things that you might be able to do to increase your community’s exposure to the specialty of prosthodontics.”

As for personal and professional fulfillment, Brackett maintains her support for continuing education.

“One of the hardest things for me to achieve was also one of my greatest accomplishments,” she says. “Becoming board-certified.”

In 2016, Susan E. Brackett, D.D.S., M.S., F.A.C.P. became the third woman ever to earn the title of president of the American College of Prosthodontists. As a practicing prosthodontist who has been active in the ACP for several decades, Brackett has been recognized as a philanthropist raised to give back, a philosophy she espouses to aspiring young dentists.


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More than 40 percent of the U.S. workforce will 

 of independent contractors in the next several years.

There’s a new trend afoot toward a gig economy — or in other words, an environment in which temporary positions are common and organizations contract with independent workers for short-term 

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 A recent study by Intuit indicates that 34 percent of the American workforce is part of this trend, which is expected to expand to 43 percent within the next three years.

That means more workers being independent contractors rather than full-time employees. And that, says Shanna Wall, Esq., labor law attorney for 

, can create quite a bit of confusion for dental practices, especially where wage issues are concerned.

Wall says it’s normal to think in a growing gig economy that if you take someone on as an independent contractor, they’re hired to perform one certain function. This is where things can become complicated.

“When you’re trying to determine if somebody is an independent contractor versus an actual employee, there are numerous tests or questions to be answered to determine which category the individual falls into,” Wall explains.

For example, how will taxes be paid? The IRS has a specific test, and individual states might as well. There are also different tests where worker’s compensation insurance and benefits are concerned. A dentist might also operate a mobile clinic. If so, how much control does the dentist have over the person operating the clinic, so as hours worked or equipment used is concerned?

“If you’re talking about a transcriptionist, you give them a bunch of files and say, ‘Transcribe these,’” she said. “They’re using their own equipment, and there are no set hours. Then, they’re more than likely to be an independent contractor.”

In other words, Wall says, if you can’t describe a person’s title in definite terms, they’re an independent contractor.

In addition to the full-time employee versus independent contractor conundrum, there are other wage-related issues dentists need to be aware of. They include what full-time employees are being paid versus part-time employees, the gender wage gap, and geographic influences.

“If I have a male dental hygienist and a female dental hygienist, are they paid around the same amount of money?” Wall asks, rhetorically. “If they’re not, why not? Does one have more education? Have they been with the practice longer? Or are they pretty much identical in terms of their level of expertise?”

One method enabling dentists to work around the confusion is to ask what an individual was paid at their last job. However, many states are now making employers remove that job/salary history question from applications. Instead of trying to negotiate what you’re going to pay that person based on what they’re used to being paid, you’re paying them what the position calls for. It doesn’t matter what they were paid previously.

“The philosophy behind that is since women are typically paid less than men, they’re always going to start at a disadvantage if you’re negotiating based on what they were paid before,” Wall says.

In addition to defining status between an independent contractor and full-time employee, along with the assorted wage-related questions that accompany those determinations, dental practices should be aware of the impact that inflation has on employee and contractor salaries.

 Index indicates that while wages have risen 9.5 percent since 2006, when inflation is factored in, real wages have actually declined 7.4 percent. It means that the income for dental practice employees has less purchasing power today than it did 10 years ago. Loyalty goes out the door if a practice on the other side of town is willing and able to pay more.

“When you’re trying to consider what you should be paying your employees, you also have to take into consideration turnover and other factors,” Wall says. “If you have competitive wages and competitive benefits, things like that that you’re offering, the chances of you keeping your employees dramatically improve.”

The only thing the law requires is that employees are paid minimum wage and overtime. But beyond the law, there is clearly a wide range of other considerations. What’s the going rate for the position? For the geographic locality?

Staying competitive is critical, but so is employee retention, Wall says. Consider how much time and money is spent training staff on equipment and processes.

“That’s why a lot of different industries are looking more at this gig economy,” she says. “If you can classify someone as an independent contractor, you can just pay them their wages and be rid of a lot of other considerations. There are a lot of benefits to that.”

Small businesses are facing increasingly complex wage issues driven by a trend toward a gig economy, as well as care delivery that happens outside a practice's walls. Is a worker classified as a full-time employee or an independent contractor? The answer to that and other important wage-related questions can impact a practice's finances.


Growing Gig Economy Presents Complex Wage Issues

A high turnover rate for hygienists is detrimental to practice continuity.

While most hygienists still receive an hourly wage, there is considerable talk about hygienists being paid on straight commission. Dianne Watterson, a Lexington, North Carolina-based 

, says that while statistics indicate that only 7 to 8 percent of hygienists are paid straight commission, it has become a popular topic.

“There are pros and cons to both methods,” she says. “But it seems that more doctors are moving to straight commission pay.”

Regardless of trends, Watterson believes there are more negatives than positive when it comes to straight commission for hygienists.

Watterson says that hygienists often make more money than any other staff member — and they should—due to their level of education and because they are producers. They generate revenue for the practice.

Where dentists become unhappy, however, is when they’re paying hygienists anywhere from $30 to $60 an hour, but there is no patient in the chair. That can prompt a dentist to consider a straight commission arrangement, which Watterson says is a great opportunity for hygienists to make exceptional wages.

“Hygienists have bills to pay too,” she points out.

A straight commission arrangement also gives hygienists the flexibility to leave during slower periods, and they receive a rise with every fee increase.

But, Watterson says, that arrangement becomes problematic when hygienists recognize that they don’t earn money if there is no patient in the chair. And that can have a negative ripple effect throughout the practice.

“I’ve been in offices where the hygienist, because she likes making that big take-home check, will sacrifice quality for quantity,” Watterson says. “Once they get used to that big take-home paycheck, it’s hard to back off and have a bad day or a bad week.”

If you're paying your hygienists straight commission, are you also checking their periodontal charting? That's one of the first omissions when quantity takes precedence over quality in a straight commission arrangement. But it's not the only downside to this payment arrangement that has been gaining traction.
