How Separating Hygiene and Doctor Production Can Make (or break) a Practice

Recently we had an office ask what it would take to separate their doctor and hygiene teams. This was not something we had done for an office before, so we set out to do some research. For years, dental practices have operated under an unspoken rule: one team, one set of numbers, one shared set of benchmarks. What we are seeing in the industry now, though, is that as practices grow, expand their services, and juggle increasingly difficult schedules. Owners are discovering that there can be separate business departments within their practice.

If this process is handled correctly, separating them into two clearly defined teams can streamline the scheduling process, improve accountability, and strengthen productivity.When handled poorly, it can create tension, confusion, and an “us vs. them” culture that drags the whole practice down. So how do you make this model work?

What is the benefit of separating the teams at all? The hygiene department drives the preventive side of the practice. The doctor team is the diagnostic and restorative side. Both are essential to the practice. 

But they require different:

• Workflows

• KPIs

• Scheduling strategies

• Resources

• Expenses

• Compensation models

When everything is lumped together, these differences can get blurred and then the accountability disappears. When you know what is expected and how to get the job done, everyone will succeed.

What exactly does it mean to track the revenue separately? If you can see hygiene and doctor revenues as two unique profit centers the shift can be made. 

It will help answer questions like:

• Is hygiene producing at industry standards?

• Are perio numbers healthy?

• Is the doctor side carrying too much overhead?

• Are we staffing appropriately?

• Are we diagnosing enough treatment to sustain both teams?

We found that when you separate the income streams, you can immediately see what’s working, and what’s not. You can see where bottlenecks form, which systems break down, where training is needed and which team needs more/less support. This clarity creates better decisions, and therefore better results.

How can you track expenses for each team (the right way)?

This is where some practices get stuck. This is where we got stuck at first as well. Here is what we came up with…you don’t need to create two separate businesses. Instead, you will just categorize expenses by whether they support doctor production, hygiene production, or shared operations.

Here are some examples:

• Doctor team expenses: 

  • burs

  • composites 

  • crowns 

  • implants

  • high-ticket equipment

• Hygiene team expenses

  • trays 

  • scalers

  • prophy paste 

  • fluoride

• Shared expenses: 

  • rent

  • utilities

  • front-office salaries

  • marketing

    
    

The biggest challenge a practice will face is maintaining harmony when the numbers are separated. When you separate responsibilities within the team, you must be careful not to separate the people. Remember, you are only wanting to separate the numbers. You want to encourage teamwork within the team members.

Here are some ideas to keep that culture of teamwork alive:

• Monthly meetings should still be held together to review both sets of numbers

• Celebrate wins for both teams

• Make it clear that success is as a practice and not separated by each team

• Train teams on how their success affects each other

• Have shared goals alongside individual team goals

The last question is how to pay the hygiene team without creating chaos. The compensation, for us, was the trickiest part. Some practices pay hygienists hourly and others pay on commission or hourly + commission models. With this model, it seems to be easiest to pay on commission but you could also add in some type of bonus for any same-day dentistry coming out of their operatory. This creates a sense of ownership without pitting the departments against one another.

Can this model work? It does in many other practices. The feedback we received was for it to work properly you must have strong systems, definitive training on how this is going to work in the practice and clearly defined expectations. We find most problems occur when there is confusion about how the system, any system, is going to work. Be sure that you are clearly communicating with your team. 

Separating hygiene and doctor production isn’t about dividing your practice. It’s about magnifying the strengths, weaknesses, and opportunities you already have. When your team understands the numbers, the goals, and how their work impacts the whole practice, everything changes.

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Janice Janssen, RDH, CFE, Consultant

At age 14, Janice Janssen got an after-school job working for her dentist. Twenty-something years later, she is the co-founder of Global Team Solutions and an expert in practice consulting. Besides hands-on experience, Janice has gained professional recognition for her hard work and commitment to excellence. She is co-author of OMG! Office Management Guide, the “bible” used in GTS training workshops. She is a member of the Academy of Dental Management Consultants (ADMC), and is a Certified Fraud Examiner (CFE), which positions her as an expert in educating dentists to deter fraud and embezzlement in their practice.

Janice can be reached at: janice@gtsgurus.com