Who Gets the Exam Fees?
I recently received the following in an email from a dentist client. The subject line read Hygiene Drama.
We have a conversation going on as to whether the fee for exams should be credited to the hygienist’s production or the doctor, and does it make a difference whether it is the initial comprehensive exam or periodic?
Here is my answer:
Wish I had a nickel for every time I’ve seen the words hygiene and drama used in the same phrase or sentence:)
I prefer that everything that happens in the hygiene room gets credited to the hygienists production (less any lab costs for appliances or any substantial product costs, like for a Sonicare toothbrush). “Who gets credit for the exam?” often becomes a problem when an associate doctor becomes a part of the practice. The key point of the whole thing is whether or not the hygienists will (and whether the doctors will allow them to) have everything explained to the patient before the doctor walks in the room. I’ve heard it described as the hygienist having everything teed up so that all the doctor has to do is knock it down the fairway. The goal is for the doctor to only spend a couple of minutes in the hygiene exam, then be back doing things that are much more productive. I’ve said this to many doctors: You don’t make a nice income and retire comfortably based on exam fees. Another thing to consider is that patients are generally much more inclined to believe and accept what they are told by a hygienist (or assistant) than what they are told by the doctor. The patients just feel more like a “peer” with the hygienist or assistant than they will with the doctor. So it comes back to the hygienist doing more and the doctor doing (especially saying) less. If you want the hygienist to basically be conducting the exam (finding out if the patient is having any problems, looking at everything in the mouth, explaining what they’re seeing, and stating what the doctor might say) then it only makes sense that they get the credit for the exam.
Here’s an example of what I mean: While working with the patient, the hygienist notices a crack on the lingual of tooth #3. She simply says, “I notice a crack here on one of your teeth on the upper right, on the side closest to the tongue. Is that bothering you at all?” Regardless of the answer, she then says, “We see these cracks all the time and what the doctor typically recommends is a crown. I can see that you don’t have any crowns, so let me explain.” Then she explains what a crown is and why it’s needed and what could happen if left untreated while she continues to work. When the doctor comes in, the hygienist verbalizes the condition of that tooth and that she has already explained it all, etc. The doctor then takes a look and says “Yep – definitely a crack there. Best solution is a crown. I know that Sally has told you all about crowns. Do you have any questions for me?”
That’s pretty simple. But I heard that very dialogue many times in Mike’s practice. And it really doesn’t make any difference to me whether it’s the comp exam or the periodic. Maybe the comp exam takes one more minute of doctor time (3 instead of 2).
And look at the math when the production credit stays with the hygienist: Since she is paid on commission she is really only getting about 30% of the fee added to her production numbers while 70% goes back to the office. It may be an incentive for the hygienist to move over or accept the commission and it certainly simplifies tracking the numbers. If done the way Mike did it in his office she definitely earned it. In addition, he spent almost no time checking patients while looking competent and caring plus knowing a larger number of patients would follow through on getting the dentistry done. A definite win-win scenario if ever there was one. (MG)