Self-employed Hygienists
Question:
We currently have 3 self employed hygienists, and are currently looking at changing the way the self employed ones are paid, as currently our practice bears the full costs and burden of any empty appointment slots.
I would like to know if you pay your hygienists when they have gaps – be they unfilled slots, FTAs or cancellations, and if you do, is it at their full hourly rate. Do you know of anyone who does not pay for these empty slots but pays a higher hourly rate to incentivise them and if so, does this work or does it do the opposite? Or is anyone doing anything different?
Answer:
We pay our self-employed hygienist for a full day’s work irrespective of how many appointment slots have been filled. This is because I would regard it as the fault of the practice, and our booking system, not the hygienist if we have been unable to fill her slots.
We use Software of Excellence and have a waiting list for patients wanting appointments, so if one cancels, in theory another will be slotted in.
Answer:
We pay our self-employed hygienists on an hourly rate regardless of gaps, although I would consider changing this policy if anyone can provide a fair alternative. One of our hygienists works elsewhere and only gets paid for the patients he treats.
Answer:
We employ 4 hygienists and they are paid 50 % of the work they do. If patients fail then the hygienist still gets paid for the FTA. They don’t get paid for cancellations or if the appointments are not booked. It is very rare that the appointments are not filled and also cancellations are at a minimum.
If they are fully booked it works out at £38.32 per hour, obviously the odd cancellations and unfilled appointments affects this but our hygienists seem perfectly happy with this arrangement.. If I have to bring in locum hygienists I normally pay them a straight £32.00 an hour.
Answer:
If your hygienists are truly self employed, then they should not be paid if they are not treating patients. We used to pay ours, but this will mess up their self employed status and the HMRC will not be impressed
If a pt FTA's with the hygienist, we charge the pt, then pay the hygienist the money, but she does not get paid otherwise; dentists who are self employed don't get any money if they have spaces, FTA's, etc.
Our hygienist is not very happy with this system, but we do our best to keep her booked.
Your other alternative is to make them employees, which is the preferred status of BDHTA and HMRC. The hourly rate is less, but the hygienists do not have to worry about their tax or NI. You would also need to supply them with uniforms and equipment, but that would remain the property of the practice for you to use if/when they leave.
Whichever route you choose there will be problems.
Answer:
Bum's on chairs and half an FTA cost.. only.
Answer:
We pay our hygienists 50% of the payment but only when a patient attends the appointment, nothing if the patient FTAs or there is a gap in the books. If the patient FTA the patient will be charged £15 and the hygienist will again get £50% of this fee. The hygienists are self employed and this is quite common in dentistry.
Answer:
We pay flat hourly rate regardless of patient attendance.
Answer:
We have been looking at this situation, at the moment we pay the hygienists for the hours they work eg 7, even if they have gaps, but we are thinking of paying them a percentage of the days taking, therefor the practice would technically be paying for any unused appointments.
Answer:
We do our best to rearrange appts to flow through the day but if there is a gap, as we are are large practice with lots of odd jobs to do, like photcopying, stuffing envelopes etc I get them to help out.
If its a bad day to come in the diary we will push the appointments up together and advice hyg that she is finishing early, normally 1 week ahead or more. I'm lucky that our 3 ladies are ok with this arrangement but I know what you mean; I had 1 in the past that would swan off shopping etc in between pts and never even did the tea round!
On the day of gaps we tell all surgeries so they may have a patient in who could see hyg as well.
Answer:
The whole self employment issue is truly a nightmare!! I have looked into it – in my opinion, unless they are paid a percentage, bear the loss of FTAs etc, buy their own equipment and pay for their own locums they shouldn't be self employed!!
Having said that,ours are self employed. I did a comprehensive audit of their unfilled appointments, and put their rate up to allow for this.
I then increased that by £5 per hour and charge them £5 per hour rent of surgery, fixed equipment and admin services.
To further sweeten the deal, I pay them half rates for FTA etc, (although this is not in the best interests of the practice vis a vis the self employment situation) and only charge them £2.50 rent.
They had originally been treated the same way as all staff – eg paid to come to staff meetings, training meetings etc. paid for all gaps in appointment books etc, so tried to consolidate the whole situation without being too harsh on them when I took away the nice bits that made them look as though they were employees in all but name – if that makes any sense!!
Answer:
We also have 3 self employed hygienists. We pay them £10.50 per patient (20 min slot). The rest of the fee is divided between the referring dentist, practice etc. If there are empty slots the hygienists don't get paid. If they have an FTA the patient is charged and the hygienist receives their £10.50 bit. We also have a list of patients who are happy to come in at short notice if we have any gaps and they maybe want to bring their appt forward. All hygiene appts receive a text/e-mail/phone reminder the day before and this has really minimised the amount of FTAs.
Answer:
We solved this problem by working out how much the hygienists were paid if every appointment was booked. Then we divided the cost of the hygienists wages pro rata between the dentists. That means our 3 day a week paid 3/5ths our full timers paid 5/5ths our 1 day dentists paid 1/5th and so on. Then they could all use the hygienists as much as they wanted. Prior to this system we had a dentist who never referred to the hygienist because they didn't want to pay for the service, now that dentist constanly uses them. Definately worked for us. If they get DNA,s now it doesn't cost the practice anything. And as for the hygienists holiday if you work out what the hygienists cost over 12 months last year that included time when they took holidays.
