Growing with Less Hygienists: New Models for the Age of Hygiene Scarcity

Dental practice owners across the country are facing a critical challenge: how to continue growing when hygienists seem impossible to find. This shortage creates a frustrating bottleneck - you've got the new patients flowing in, your clinical skills are sharp, your systems are solid, but without adequate hygiene capacity, your practice hits a growth ceiling that feels impenetrable.

The mathematics behind this problem are straightforward but concerning. A full-time hygienist seeing seven patients daily for four days weekly can accommodate 672 patients on a six-month recall schedule. For practices bringing in 80-100 new patients monthly with strong reappointment rates, a single hygienist reaches capacity within just eight months. This reality forces practice owners to make difficult decisions about resource allocation.

Beyond simply raising compensation to attract scarce hygiene talent (though that may be necessary), savvy practice owners are deploying creative solutions: becoming more selective about recalls and building robust ASAP lists; extending recall intervals beyond the traditional six months for appropriate patients; restructuring patient flow to route new patients directly through doctor exams with same-day dentistry opportunities; and implementing assisted hygiene models to increase capacity. Each approach has merits and challenges, but combining these strategies can help practices continue growing despite staffing limitations.

Remember that transparency with patients about industry-wide staffing challenges helps manage expectations, and consider that new patients often represent a population with greater immediate treatment needs than established patients who already receive regular care. By implementing these five practical solutions, you can continue growing your practice, serving your community effectively, and maintaining the profitability that supports your ideal lifestyle.

Ready to implement systems that create freedom and profitability in your practice? Visit dentalpracticheroes.com to learn more about our training programs designed specifically for practice owners who want more time off while maintaining exceptional income.

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Episode Transcript

Speaker 1 (00:02):
unfortunately, practicing without adequate
amounts of hygienists isbecoming the reality for more
and more practice owners.
So what are we to do if wecan't find hygienists?
I can tell you that, personally, I have a number of coaching
clients right now that areseeing an incredible amount of
new patients.
They had the right number ofassistants, they got the right
amount of the front end, andevery single thing in their

(00:24):
practice is primed to make theirpractice explode, but they
don't have the hygienist tocontinue growing their patient
numbers and they reallystruggled to get to the next
level because of it.
So, other than the simplesolution of find more hygienists
, what can you do?
In this episode, I'm going toshare five different solutions
for operating with less thanideal hygienist numbers so that

(00:46):
you can continue to grow andcreate a practice that gives you
the freedom to take loads oftime off, all while making an
incredible income.
You are listening to the DentalPractice Heroes podcast, where
we teach practice owners how tomake more money and work less
days, all while taking greatcare of their patients.
I am Dr Paul Edgison, author oftwo books on dental practice

(01:06):
management, a dental coach andowner of a large group practice
in the South suburbs of Chicago,I want to show you how easy it
can be to create a systemsdriven practice that is run by
your team.
So today we are talking abouthygiene.
Where did all the hygienists go?
And you've heard me joke aboutit before.
They're all on Hygiene Island.
They're all sipping on mojitosand posting things that annoy

(01:29):
dentists on dental Facebookgroups.
That's what they're doing.
They're just up there postingsarcastic comments about how
much they hate dentists and justdriving us crazy.
Obviously, I'm just kidding,but it does seem like there's a
lot of anger if you go onFacebook, and I think it's not a
good representation of the realhygienists in America.
I have a great hygiene team.

(01:51):
I have 11 hygienists.
I love them all.
They are fantastic and I thinkanytime you go on Facebook you
get the most vocal of the vocaland it can make the whole group
look bad.
But where are all thehygienists?
And what are we supposed to doif we can't find any?
And how do we continue to growour practices?
So let's think about this.
It's really just math.

(02:12):
Okay, everything we're doingwith hygiene and new patient
numbers, it's all math.
So if we've got a full-timehygienist, they're gonna see
seven patients a day.
They're gonna work four days aweek, going to see seven
patients a day.
They're going to work four daysa week and they're going to
work 48 weeks per year.
They can see 672 patients twotimes a year.
So that is the max capacity ofa single hygienist.

(02:33):
This is often why you'll seethat a full-time dentist can
service about 1300 activepatients, because that's the
math with having two full-timehygienists each seeing 672
patients each twice a year.
And if you're running a highgrowth practice, like I hope you
are, that you might be seeinglike 80 to 100 new patients a
month.
And let's say that you areseeing, let's say you're seeing

(02:55):
100 new patients a month.
If you're seeing 100 newpatients a month and you can
reappoint 85% of those people soyou're going to reappoint 85
patients a month You'll get afull-time hygienist at full
capacity within eight months.
You can see how not having ahygienist can really hold you
back, and I'm seeing this somuch with so many different
offices.
So I sat down and I started tothink about man, what are some

(03:18):
different solutions that we cando as we move into this next era
where there is a hygienistshortage?
So I've got five things for you.
Let's go through them.
Number one the easiest solutionis going to be hire more
hygienists.
That's what everybody tells you.
So you've got to decide.
You know there is a high demandfor hygienists.
Do you want to pay more toacquire another hygienist?

(03:41):
And I see this so often is thatpeople say I'm willing to pay
more for that hygienist, but Idon't want to give my whole
entire hygiene team a raisebecause that's going to cost me
so much money.
Now you've got to decide whatis right for you, what is the
right amount for you that you'rewilling to pay your hygiene
team, and how valuable is thisservice to you?
Things to think about is thatif your doctors are doing

(04:03):
hygiene and they have enoughdemand to be doing other work
that's more productive thanhygiene, it's costing you money
to not have a hygienist.
So at a certain point, if doinghygiene as a doctor is
preventing you from doing morevaluable work, it's going to be
worth a lot to you to pay for ahigh demand hygienist.
That might cost you a lot morethan you're used to paying

(04:24):
hygienists.
And this is the first solutionof five, and this is obviously
the one that everyone's told.
But everyone's like dude, Iwant to.
I just can't find them.
So what else are we to do?
Let's go through the next four.
The second one is see lesspeople for recalls.
I want you to think about this.
When I opened up my practice, mystartup I was just like.
My attitude was like I'm notgoing to care about your teeth

(04:46):
any more than you're going tocare about them.
So if my patients didn't wantto get their teeth cleaned every
six months, I was cool withthat.
So what we used to do is, afterthe cleaning, we would say did
you want to make an appointmentfor your six month recall or are
you the type of person thatjust wants to call us when
you're ready to come back?
And I would say it was about 50, 50.
We would get 50% of the peoplethat would want to make their

(05:07):
appointment and the other 50percent were like yeah, I'll
just reach out to you.
And I was cool with either.
Now, what happened downstreamfor this is that we ended up
growing a lot slower than wecould have because we were just
attritioning so many patientsbecause we weren't keeping
people in our system.
But now that we're in thissituation where we don't have
enough hygiene to see ourexisting patients.
This is actually becomingsomething that a lot of offices

(05:29):
might need to move back into.
We need to see new patients atour practice.
That's a big part of my blockscheduling program that I teach
in my training.
That sets your practice up tocreate capacity so that you can
continue to grow.
You've got to block time fornew patients, but the fact of
the matter is is if we don'thave enough hygiene capacity, we
don't have anywhere to put ourrecalls.

(05:51):
So a lot of people are sayingwell, we've got to take care of
our existing patients.
What am I supposed to do?
But you've got to see a certainamount of new patients,
otherwise you're just not goingto have the production numbers
that you need.
We never want to let our recallpatients take over our entire
schedule where we can't see newpatients.
So the possible solution is tosee less people for recalls.

(06:11):
Give them the option of say,hey, did you want to make your
appointment now?
And if they say no, and thenthey can call in six months and
they might be a little upsetbecause they can't get in, what
do you mean?
You can't get me in for fourmonths.
This is how you slowly build anASAP list that goes along with
this.
You find out who your patientsare that want to be seen.
You put them on an ASAP listand anytime you've got an

(06:33):
opening in hygiene you've gotthis list you can boom, call
somebody and get somebody tofill in right there.
When you don't have a lot ofhygiene capacity, you've got to
be super efficient on makingsure that every hour of those
hygienist days are full, and youdo that by building an ASAP
list and not scheduling thepeople that aren't going to
value your time.
So that's one way of doing it.

(06:53):
See less people for recalls.
Don't reappoint everybody, allright.
Number three see people lessoften for recalls.
So what I mean by this is whosaid we've got to see everybody
every six months?
I mean, is that just soundsgood twice a year?
Right, but why?
Is there any researchjustifying that?
And if there is, I'm sorry, butyou can see people on

(07:16):
eight-month recalls.
You can see people once a year.
It's all in the way that yourhygiene team and you as the
doctor are presenting this.
You can let people know hey,you've got really good oral
health.
Every time I see you,everything looks great.
If you're comfortable with it,I think we only need to see you
back once a year from now on.
We're happy to clean your teethevery six months if that's what
you like, but I think it wouldbe okay to see you once a year.

(07:38):
I think there's a lot ofpatients in our practice that
want to do what's right fortheir oral health.
When we tell them six months,six months, they're going to be
here every six months.
And if we say, hey, you knowwhat, I think we can see you
every year, they're going to belike, thank God, I don't like
coming here every six months.
The doctor said they can see meevery year and that's what I'm
doing from now on.
So you've got this option withso many of your patients that

(08:01):
you can schedule them out forlonger recalls.
Now remember I said a full-timehygienist can see 672 patients
a year, twice a year.
Well, how many patients canthey see a year if they're only
seeing everybody once a year?
Well, it's 672 times two.
Two times as many 1,344patients.
So you can open up your hygienecapacity immensely by just

(08:27):
seeing people less often.
So that's number three.
All right, let's go to numberfour.
This is kind of cool way ofdoing.
It is that you're saving all ofyour hygienist time for just
SRPs and recalls.
Okay, that's all they're doing.
They're not seeing new patients.
You see all your new patientson the doctor's side, and here's
what you do as the doctor.
Your assistants will take thex-rays, you'll go in there,

(08:49):
you'll do the exam, you'll dosome like probing depths and
check the perio and stuff likethat, and if they have any work
that needs to be done that day,you get that done and then you
schedule them with hygiene.
If they have no work that needsto be done, you should probably
clean their teeth, and ifthere's no one available, you
should do it as the doctor.
But a certain amount of yourpatients are going to need

(09:10):
dental work done and this justbecomes a nice same day
dentistry opportunity.
Now, no matter what you do, atsome point you're going to run
out of room in hygiene, soyou're going to have to do some
kind of combination of theprevious examples I gave you.
That's an option that I see alot of offices doing nowadays
too, because the fact of thematter is is they don't have

(09:31):
enough hygienists.
They might have two doctors andonly two or three hygienists
and they're like well, what dowe do?
We can't choke off the newpatient flow and we can't just
neglect our existing patients.
So they're finding that this isa nice little medium solution
in between.
All right, number five see morepatients per day per hygienist,
and that can be an assistedhygiene.

(09:52):
That can be by shorteninghygiene times.
Good luck shortening hygienetimes and not having people be
all PO'd at you.
They're going to be upset.
But you can do assisted hygieneand I know a number of
hygienists that do assistedhygiene and they love it.
Everybody wants to put upresistance to it, but once they
try it and they don't have toturn their own rooms a lot of
times, they like doing it.
Talk your team into giving it ashot and seeing if it works.

(10:15):
But just remember it's okay totell our patients that there's a
dental hygienist shortage.
We don't have enough people toclean our teeth and we are so
sorry.
This is the best we can do.
The best we can do is a ninemonth recall.
The best we can do is cleaningyour teeth once a year.
That's the reality.
And they are welcome to changeoffices and go somewhere else.

(10:35):
That's okay.
But what I don't want you to dois I don't want you to choke off
new patient flow and your teamwill often put up resistance to
this.
They'll say we shouldn't begiving priority to new patients
instead of our existing patients.
But let me ask you this whenyou look at your existing
patients versus your newpatients, who needs you more?
Who's a sicker population?
Most of our existing patientsthey've already gotten treatment

(10:58):
.
They have good dental health.
A lot of our new patients thatneed us, they're the sicker
people.
They need us more.
If you're getting resistancefrom your team, share that with
them.
Is that you know what?
If we want to service the mostsick people and the people that
need us the most, we need toprioritize new patients over
recall.

(11:18):
Your recall patients will bejust fine and we just don't have
a whole lot of options withwhat we can do.
So summing up here the fivethings you can do when you're
experiencing a hygiene shortageor inadequate hygiene capacity
at your office is the easy oneHire more hygienists, pay more
money for them, get out thereand try to find them.
Number two see less people forrecalls, so you're not

(11:42):
reappointing everybody and aspeople call to get in, you start
building an ASAP list that youcan work really fast for the
people that really want to beseen.
Number three see people lessoften for recalls, so we're
going to start reappointingpeople for a longer recall time
than six months.
We might be putting them on aone year recall, putting them on
an eight month recall.

(12:03):
Anything that we can push themback from six months will open
up hygiene capacity for us sothat we don't need more
hygienists.
Number four is only using yourhygiene columns for SRPs and
recalls and you're bringing allof your new patients through on
the doctor side and trying tohope that you can do some same
day dentistry instead of doingthe prophy.

(12:23):
Occasionally.
You just got to do the prophyand that's the way it is.
You're only seeing new patientson the doctor side and not
taking up big hour and a halfvisits in your hygiene column.
This allows your hygienist tosee more patients because it's
shorter appointments.
It allows you to continue togrow your practice with new
patients.
And the last option is to seemore patients per hygienist via

(12:44):
assisted hygiene or shorteningthe treatment times for your
prophy.
So any combination of the aboveis going to help.
You've got to get your teaminvolved.
You've got to have thisdiscussion with them.
We've got a problem in thedental industry right now and we
don't have perfect solutions.
There is no perfect solutionthat everybody wins with.
There are going to be pros andcons with all of them, and we

(13:05):
have to decide what is the bestway for us to take care of the
most people and also make surethat our practices stay open and
that we're profitable and thatwe can continue to grow and
provide services to ourcommunity.
So if you're looking for morepractice management tips or
looking for systems and how torun your practice like an
efficient operation that allowyou to take a lot of time off

(13:25):
and still make a lot of money,go to dentalpracticeheroescom
and learn the training, learnthe systems, learn how to
implement these into yourpractice so that you can start
living a life that everyoneenvies, as your practice gives
you the freedom to spend timedoing what you love doing,
whether that be hobbies,traveling or just spending time
with your family.
Go to dentalpracticeheroescomfor more information on that,

(13:47):
and I so appreciate you spendingsome time with me today.
Coming up on Monday, we've gota CPA.
Mike Bark is coming on and he'sgoing to tell us all about
taxes and what opportunities wehave as dentists to be utilizing
our taxes, to pay less tax andmake more money.
So thank you so much forlistening and we'll talk to you
next time.