What can smaller practices do right now to effectively mitigate the double whammy of staffing shortages and rising wages? Start thinking differently about how you’re scheduling patients—and who’s doing prophy.

By Tu-Anh Vu, DMD

Three years ago, my Brooklyn, New York, practice was accepting every insurance under the sun, including some state plans and PPOs. Today, we’re out of network. That means I’ve dealt with staffing shortages—particularly hygienists—under two sets of circumstances. And I’ve come to the same conclusion: in my situation, it made sense to hire more dental assistants and eliminate the need for a hygienist.

The current average hourly pay for a hygienist is around $35 to $70, depending on experience and location. In areas where demand outstrips supply and the cost of living is high, hygienists can easily ask for $70. Well, lucky me: I’m in New York City, where hiring is tough and the cost of living couldn’t get much higher, even in the outer boroughs.

On one hand, it might not make sense for in-network offices to pay for a hygienist, since prophy fees will be similar to their hourly pay if they’re doing one prophy an hour. On the other, the grass isn’t necessarily greener for out-of-network providers. Yes, it’s true that we can (sort of) afford the upper pay range for hygienists since prophy fees will be higher, even factoring in UCR reimbursements. But if there’s a cancellation that can’t be filled (and there always is), having a hygienist on staff will only increase overhead without bringing in more production to offset it.

So are we all damned if we do and damned if we don’t? Only if we’re unwilling to consider a different solution, at least until hygiene schools can start producing more graduates. What I’ve done is hire more dental assistants, eliminating the need for a hygienist. After working for four years after graduation at two multispecialty offices, neither of which had hygienists, I became accustomed to doing my own prophies. These days, I’ve fallen in love with it because prophies are such a meditative process. It doesn’t require thought to scale someone’s teeth; I’ve done thousands of them. Honestly? It’s like a Marie Kondo before-and-after. It has become one of my favorite procedures to do, and patients universally appreciate the fact that a doctor is cleaning their teeth.

So, are we all damned if we do and damned if we don’t? Only if we’re unwilling to consider a different solution, at least until hygiene schools can start producing more graduates.

I now employ three dental assistants, all of whom are responsible for their own room. On Saturdays, which are exclusively for recall patients, I run three columns of hygiene. Each assistant takes X-rays, polishes and educates patients on how to brush and floss. I come in to scale and do the exam. Not only do I get to build rapport at every appointment, I can spend more time with the exam and evaluate the patient’s gum health to see if any areas are bleeding.

Being out of network with all insurances, three columns of prophy an hour can become lucrative since overhead is low without paying for a hygienist. Saturdays are now the most requested appointment days in my practice; all the young professionals who can’t take time off from work compete for Saturday appointment blocks. Meanwhile, on weekdays, I book new patients and longer restorative procedures while seeing hygiene patients in between (though I run only one column for restorative and, if time permits, another column for hygiene that I do myself).

Can I practice this way forever? Not if I expand, but I’ll cross that bridge when I get there. After years of associateship that were unpleasant because I was barely paying my loans, being a practice owner feels pretty good. If I do some prophies to make it work for now, that’s fine. I like it, and maybe you will too.

TU-ANH VU, DMD owns a successful practice in the Bath Beach neighborhood of Brooklyn. She is a 2022 Incisal Edge 40 Under 40 honoree, a manga cum laude graduate of Bryn Mawr College in chemistry and a Kois Center graduate who earned her DMD from the University of Pennsylvania School of Dental Medicine.