Dental Dilemma: Navigating the High Cost of Hygienists

Announcer:
Hello, everyone. Welcome to The Millionaire Dentist Podcast, brought to you by Four Quadrants Advisory. On this podcast, we break down the world of dentistry finances and business practices to help you become the millionaire dentist you deserve to be. Please be advised, we do speak with an honest tongue, and may not be safe for work.

Casey Hiers:
Hello and welcome. This is Casey Hiers back at the Millionaire Dentist Podcast in studio with co-host Jarrod Bridgeman.

Jarrod Bridgeman:
Casey, how are you?

Casey Hiers:
Doing great.

Jarrod Bridgeman:
You and I had a fun little work trip over the week. We got to go to our Grand Rapids event, our 4Q CE event with bourbon tasting, and steaks, and all that. What did you think? How'd you think of the event?

Casey Hiers:
Well, it's about the subject matter. It's not about the steaks and bourbons, Jarrod.

Jarrod Bridgeman:
Right. Oh, my bad.

Casey Hiers:
Yeah.

Jarrod Bridgeman:
That's the part I enjoyed the most.

Casey Hiers:
You loved it.

Jarrod Bridgeman:
I did.

Casey Hiers:
Yeah. No, it was nice. We had a great, great venue. I mean, you talk about bone, bone marrow, and Tomahawk rib-eyes and Eagle Rare, and Blanton's and all this. I mean, it was a very well-done event.

Jarrod Bridgeman:
It was an excellent event. I really enjoyed getting to see you speak again and getting to take some photos. That was the main reason people I went. I went to actually work, 10 minutes of the two-hour presentation I was working on.

Casey Hiers:
Yes.

Jarrod Bridgeman:
But no, it was great to see so many different practice owners, and dentists, and spouses in that room, all talking, all having a good time, but also listening hard to what you had to say.

Casey Hiers:
Well, ideally, they're there for a very serious reason. Because money is- financial business side decision. I mean, there are so many things that go into being a practice owner that we talk about week in and week out. But yeah, you want to have a good time, and you want to enjoy the evening. And we do a pretty good job of making sure people do that.

Jarrod Bridgeman:
I mean, when you hear some of these things that you talk about, sometimes you might need a little bourbon to go with it.

Casey Hiers:
I think only one person teared up and cried. And we actually had a client there, which was really nice. Because, while they did know some people there, at the very end, they asked if they could say a few words and said, "Listen, this stuff that they're talking about, we all experience it." But on the clients that are on my end of it, having this team help us master this, we blow these numbers out of the water. And I can retire in my early 50s, should I choose, which some of the older people I think we needed another drink. But again, you can hear a course, you can hear subject matter. But when you see and hear a peer say, "Yep, this is my life. This is exactly what happens. My income goes up 25 to 50%. I save hundreds and hundreds of percentage points more than I ever was before." It hits a little different.

Jarrod Bridgeman:
It does. You know, folks, we're going to get into our actual subject matter of this podcast here in just a second. But, go to fourquadrantsadvisory.com/events. We're going to be in Austin, we're going to be in Dallas, and we're going to be in the Philadelphia area. But we'll come back to where we're going to be after our big topic here. But, Casey, you came in here, bright-eyed and bushy-tailed, and you had something you really wanted to speak on today.

Casey Hiers:
I did?

Jarrod Bridgeman:
You did.

Casey Hiers:
What a compliment.

Jarrod Bridgeman:
You even have notes, it's crazy.

Casey Hiers:
Yeah. Interestingly enough, during our course, a lot of times there'll be some questions, and stump the chomp, and even some debate, and we like that. We enjoy those conversations. But a lot of times, employee wages versus the percentage of production that can be one that can get lively for a couple of reasons. One, it varies on geography. There's a lot of nuance to it. But so many, especially in this, the current landscape, current timing in the last four or five years, paying employees has gone off the charts. It's a lightning rod topic, and we're a data-driven firm. We're constantly gathering data, reviewing our own, and analyzing others. And we have a whole bunch of data to share about really one of the... It's kind of a surface-level issue with practice owners from our perspective when it comes to employee wages. Because there's so many other areas that need to get mastered. But this one's a real big one, so we want to talk about it.

Jarrod Bridgeman:
In your opinion, why is this such a focal point for practice owners, over top of these other underlying issues?

Casey Hiers:
Well, they're trying to produce great dentistry. They're trying to have a good personal work-life balance, and that's stress and money, and do all these things. And then you feel like you're humming, you're cruising along, and then boom, two hygienists decide to leave, or a front office person decides to leave, or decides to move. And it just throws a wrench into a practice owner's life, and it's real, and it's hard, it's stressful. And so, that comes up periodically. It's been coming up more often over the last handful of years. So it's an emotional topic that really, really can negatively affect practice owners, the practice, and your mindset.

Jarrod Bridgeman:
Well, you know, you and I have sat and done interviews looking for new people to come and join our firm. And not many people love to do them, really. And so, adding that onto your list as a practice owner with the 8000 other things you have to do that day, is probably not the best.

Casey Hiers:
Well, it's funny you say that. We help our clients with staffing and all those things. But then, as a firm ourselves, we're constantly living this out. Like, to our listeners, we are with you. We understand hiring is time-consuming, and it's hard, and finding and retaining. And then if they leave, and if they don't, it is a tough bag to carry. But yeah, we're just going to kind of jump into it. I mean, I think that the dental hygienist space has been really challenging, keeping the hygiene departments where you want them. But I do have a couple disclaimers here. There's a lot of averages here. I mean, these are surveys, and thousands of registered dental hygienists, and it's national, and it gets into different states.
But averages are great. Every practice is different. And it goes back to you and your practice needs a custom solution for what you're dealing with, not with your friend, competitor, or peer down the road. And that comparison thing comes in sometimes. But again, every practice is different. Now, here at Four Quadrants, yes, we have our own metrics that we help plug, and make sure each client specifically gets the best advice on employee wages and how to structure those. You know, you want to be competitive, but not at the cost of wrecking your overhead and your cash flow. I'll just off the jump, give a sports analogy.

So in college athletics, NIL, name, image, and likeness, basically, since 2021, you can pay your collegiate athletes. So here's my example. I'm a Purdue Boilermaker, right? So Alabama football, they're going to pay an offensive lineman, I don't know, 3 or $400,000 a year to be a lineman. Well, if the Purdue Boilermaker football organization goes, "Well, you know what? We need to start paying our offensive lineman $300,000." We would just wreck our program, because that doesn't fit for who we are. Right?

Jarrod Bridgeman:
Correct, yeah, yeah.

Casey Hiers:
In the dental world, so many of you look at the guy down the street, or the person you think is successful in your study club, and you try to mimic something they do. And unless you are getting into the weeds of analysis, it can wreck your practice. And so again, some of these are averages and good things to learn about, but it need to be customized. And in this current environment, pay is inflated. I mean, bottom line it is, and especially in the assistance, and front office, and hygienist world.

Jarrod Bridgeman:
Casey, with this data that you've been looking at, what has really stood out for you?

Casey Hiers:
I highlighted a few things, and this is... I mean, data gets old. It's probably 18 months old at this point. But-

Jarrod Bridgeman:
But geriatric.

Casey Hiers:
... some of this is our data, and some of this is just industry things that we found. But with dental hygienists, average income is increased by 4.5% in private practice, and about 7.5% in corporate practices. But despite increased incomes, more than 31% of dental hygienists are considering a job change.

Jarrod Bridgeman:
Oh, wow.

Casey Hiers:
Yeah.

Jarrod Bridgeman:
Okay. Do we have any psychological background to what may be causing that?

Casey Hiers:
Well, it kind of piggybacks. It was interesting talking about one in three who changed jobs. It was primarily for higher-income individuals. One in four was for the desire for a more positive work environment. So money's important. The answer to most questions is money. But what kind of practice do you have? What kind of culture? What kind of environment? Is it a place people want to be? That's really, really important. That's not a newsflash.

Jarrod Bridgeman:
No. If you're running the practice from hell, you may pay people a lot, but it may not make them last a long time.

Casey Hiers:
Yeah. You can keep overpaying people, but that might not actually be the root issue or problem. Now, when you look at national averages, again, if you talk about income for registered dental hygienists, I mean, in Alabama, maybe it's 46,000 bucks. Well, in California, it's 91,000, damn near double. Texas: 75,000, Florida: 70,000. A lot of times, we see maybe that 65 to 72,000, but again, then you're talking, well, are they working 32 hours? Are they working 28? There's a lot of nuance there.

Jarrod Bridgeman:
So Casey, in my experience, most of the time you get a pay raise, you're happy. It seems like that may not always be the case with hygienists in that role. What's up with that?

Casey Hiers:
Well, the human mind in psychology, there's probably a lot of podcasts on that, right? But 40% asking for a raise in the last year, that probably doesn't surprise many listeners, because once one does, then they all do. But it kind of goes back to your staff asking for more money, they're getting more money, but yet a lot of them are still looking. And so I think, just as a culture, we're always looking for that next thing. And ultimately, once you start making more money, you go, "Huh, well, I thought I'd be happier. This doesn't make me happy."

Jarrod Bridgeman:
That sounds familiar about something we tend to talk a lot about.

Casey Hiers:
What's that?

Jarrod Bridgeman:
Just being kind of plateaued in your income, you know?

Casey Hiers:
Yeah. Well, unfortunately, if a practice owner's trying to pay a staff every wish and whim that they have, patients get great care, staff's well taken care of. Practice owner and spouse are typically the ones that are left looking up, going, "Huh, I make decent money, but..." But yeah, this all ties back into when we do our course and how frustrated people get, or they don't want to pay their people less. You can't look at it through one lens. I think the importance is, again, for our clients, they have a full custom team that's looking at our metrics, national metrics, and making sure proper decisions are made without wrecking overhead, but yet keeping retention. There has to be a balance of keeping good people, but not wrecking your overhead in the practice, your income, your cash flow. You can't do that, right?

Jarrod Bridgeman:
Right, right.

Casey Hiers:
It's the Purdue Alabama analogy. Just because they're doing it, it doesn't mean it's the right thing for you. But human nature, people are still going to be looking for the next best thing sometimes. And so, as a practice owner, accept it's the environment we're in. But you have to be creative, and it doesn't just mean take your team to Cabo every February, that sounds great. But most people that do that, they're like, "Oh, that was a pain in the ass." And somebody got thrown in Mexican jail, and, you know?

Jarrod Bridgeman:
Well, how many of those people that you took on that trip would rather just have that money?

Casey Hiers:
Well, that's a whole other conversation there. Even the bonus structures, and "Oh, I want a bonus structure for my team." Well, that's cute to lay out at a Monday meeting. But if you don't structure that correctly, you're still going to be frustrated. And again, 30, 40%-ers probably are still going to be looking. Because loyalty, while one of the most important qualities in my opinion in life, there's not a lot of loyalty out there right now in the dental world with-

Jarrod Bridgeman:
The almighty dollar.

Casey Hiers:
Yeah, with employers. But, you know, death and taxes, right?

Jarrod Bridgeman:
That's right.

Casey Hiers:
What you're going to know is, your staff or team, they can be finicky, money's important. But they also want a place that they can enjoy. But if you really get into some of the stuff we looked at and broke down, you can't be a one-trick pony with just throwing money at the problem. Do you have the right people? Is it structured correctly? Are they motivated? But it's motivation and discipline. If you look at motivation, okay, if somebody's motivated, you're going to get a good pop from for a little bit, and then it gets less, and less and less. Somebody who's disciplined, they're going to be more consistent. And so that comes down to hiring as well. Are you hiring the right people or the wrong people?

Jarrod Bridgeman:
That's also throwing in, do you have the right training processes in place for how to work within your practice?

Casey Hiers:
Yeah. Setting those expectations and things of that nature. But yeah, I mean, it's funny to say, but if a staff member or a hygienist is going to leave for another dollar an hour, it's not like you're going to say, "Well, if I find somebody better than you, I'm going to... Turnabout's fair play, then if I find somebody that can cycle through another patient a day, then you're out, and they're in." So it's kind of at a disadvantage, unfortunately, as a practice owner, but you have to have a plan. You can't wait for mutiny. You can't wait for people to come in and demand all this stuff. Know that it's coming, and what's the plan around it?

Jarrod Bridgeman:
What's another statistic that really stood out to you?

Casey Hiers:
Yeah. Another one, 54% received their last pay raise within the last 12 months, but 69% have been with their current employer for two years or less. And so that kind of gets back into a lot of practice owners are paying more, but when's it enough?

Jarrod Bridgeman:
So it sounds like a lot of people, a lot of hygienists out there are doing lateral moves for little increases in pay. They're kind of hopping around from practice to practice.

Casey Hiers:
They're just, more money, more money. I mean, if they can just keep doing that. But again, hygiene shortage it's a real challenge. Obviously, going the temp route is not ideal either. You're going to pay a premium for that. At least there you know what you're getting. It's an agreed-upon like, "Well, I'm going to pay you too much, and you're going to work for me for a little bit, but I'm not married to you." But yeah, I think the key is that understanding your practice, your overhead, your cash flow, the geography, the cost of living, things of that nature. Knowing what you can do, what you should do, and where that zone is. Where, if you do decide to pay, "Well, they're just really good, and I can't lose them. I'm going to really open the checkbook for them."

Understanding all the implications behind that. What is the domino effect of it? So many practice owners tell me they don't really have a plan. Again, that ready, fire, aim, and I think it's important to have a strategy. And typically, you need that with some people, with a consultant. Unfortunately, so many people just ask one person. But if you can have a firm or a team that's comprehensive, that understands your personal and your practice and all those things-

Jarrod Bridgeman:
What if you just ask your hygienists?

Casey Hiers:
Well, yeah.

Jarrod Bridgeman:
Yeah. Can't answer that.

Casey Hiers:
You will be paying to do dentistry, because they will be earning more than you. Well, it's like the example of how many associates, if you distill it down, associates can make more than owner sometimes, because they have offered a terrible income structure with very little analysis. But your staff's going to want more money. But are they accountable? Are they responsible? What are their metrics? And some of them are some soft team goals. I think strong leadership is really important. And as a practice owner, if you're not a strong leader, you'd better have a good team who can lead you, so that you at least know, "Here's what I can do, and here's what makes sense, and here's why."
Again, if a lower-level college football team goes and pays a bunch of money for a couple of linemen, that's great. How about your running backs, and your wide receivers, and your special teams, and your quarterback, and your coach? So not everybody's Alabama football. Not every practice is printing money. Most aren't. And so, the lack of strategy is what really gets people in trouble. But it's so easy to just bitch about staff and say, "It's just not possible. It's just not possible to pay your staff 20 to 25% percent of production. That's outrageous." Well, it's done all the time.

Jarrod Bridgeman:
Yep, you just got to put your mind to it, or at least find someone to put their mind to it for you.

Casey Hiers:
You have a team that could put their time and money, and effort towards it. Then there's the fun topic of insurance. If you're a big insurance shop, and you're paying all this money to your staff and team, and you're producing all this, but then you're getting a big haircut. Then, well, what's your insurance strategy? What are your insurance adjustments? If you're not getting a comprehensive view and analysis from somebody, hopefully a team, it's going to put you in that position. Instead of being able to what retire on your terms in your 50s with millions of dollars. Being cynical, we see that almost everywhere we go. There's a cynical, jaded, older dentists or specialists who've done okay, but they have simply accepted all of this, and the tail's been wagging the dog.

Jarrod Bridgeman:
So you need to know your numbers. Are you putting down what do you expect to collect? Things like that. You need to know the full breadth of things. And even if you don't know these numbers right away, there are people who can help you track that down.

Casey Hiers:
Yeah, yeah. No, I think that's really important. But even some of the time we spend looking at these things, you and I, for a podcast. A lot of times, we actually have learned more in a little bit of research and practice owners that we talk to; we have a whole team here that does that stuff in a masterful manner, but again-

Jarrod Bridgeman:
We're damn good at it.

Casey Hiers:
... averages are great, but every practice is different, and you have to be mindful of that. And you cannot let, "Well, I've got to be competitive in my area and my staff and all that stuff," wreck your financial situation.

Jarrod Bridgeman:
Right. Casey, thank you so much for bringing this topic to the table today. I'm sure everybody out there is finding it pretty fascinating. I mean, it's something that nearly everybody I've ever chatted with in the field has brought up at some point or another. If you want to learn more about Four Quadrants, about mastering the business side of dentistry, about the things that we can do to help, not everybody out there, but that we can help owners out there do, go to fourquadrantsadvisory.com/events, see where we're going to be. Again, Philadelphia, Austin, Dallas, we're coming to your areas in 2025, we're loading up. We're going to be in even more places and even more towns, and just really helping people.

Casey Hiers:
Well, worst case, you have some great food, and maybe a nice tasting of some wine or bourbon. The best case you learn something. And even a better case than that is you figure out, "Wow, somebody can help me have millions more," and that's what it's about.

Jarrod Bridgeman:
Thank you so much, Casey. Folks, please review us and rate us on iTunes, Spotify, wherever you hear us. Thank you so much.

Announcer:
Hello everyone. Welcome to The Millionaire Dentist Podcast, brought to you by Four Quadrants Advisory. On this podcast, we break down the world of dentistry finances and business practices to help you become the millionaire dentist you deserve to be. Please be advised, we do speak with an honest tongue and may not be safe for work.