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Public health vs private practice wages

I have been a RDH for 18 years. After about 15 years in private/corp group practices, I decided to go into a public health setting. I work for a FQHC (Federally Qualified Health Center) and see patients of all ages. I do the same procedures as I had always done in private practice (child prophy, adult, sealants, SRP, perio maint). I realize that public health settings do not pay the same as private practices. I knew that coming to this type of setting would mean a pay cut which I took. When I started with this particular office, I was making less than I made 15 years ago. I have since received a raise after 14 months, which is still less than I made 15 years ago. Since then, we have implemented an assisted hygiene schedule which I’ve been doing for roughly 7 months now. In the first quarter of last year, I saw a total of 317 patients. At the end of the first quarter this year, I have seen 521 which is an increase of 204 patients over the 3 month period. I love the office I am in and I love serving these patients. My heart is here in public health serving the underserved. We have a great team and we all work very well together. My dilemma is finding the balance between understanding that public health is not about making private practice pay but yet being paid a fair amount for the treatment I provide. I know that the local hygiene school is telling their graduating students to ask for about $1 less/hour than I what I am currently making as an experienced RDH doing assisted hygiene…. What’s up with that? How should I handle this?



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In my opinion, just because you work in a public health clinic does not mean you should be making wages of that from 15 years ago. You are performing the same duties and services as a hygienist in private practice and you are just as valuable.
 
I was wondering if my thinking was off, so I reached out to another hygienist, Andrew Johnston, who is extremely knowledgeable in all things hygiene. He is also part of the dental podcast, A Tale of Two Hygienists, speaks on occasion, among other great things. When I explained your situation and asked if my thinking was on the right track, Andrew said, “So many thoughts about this, its hard to narrow down. First of all, you are right that the services are the same, so the pay should for those services rendered should be similar for this hygienist. Secondly, there is a market value that needs to be considered. The wages of a public health hygienist in one area might be significantly lower than say midtown Manhattan, so it’s hard to judge overall, but I would tend to agree with you in that a hygienist working in private practice and a hygienist working in public health in the same general location should be paid similarly. A public hygienist may have to give some perks by working in public health, but that is a sacrifice many are willing to make.”
 
What I would suggest is taking a look at your state’s employment website for occupation wage breakdowns. Wages vary not only state to state, but county to county, so this is more accurate than say salary.com or other salary surveys I’ve seen floating around online. Normally, these breakdowns give a range from the lowest 10% up to the 90th percentile of wages, averages, median, etc. Print this out and have a discussion with the appropriate person. This is an assumption, but I bet the doctors aren’t making wages from 15 years ago, so neither should you. Again, you are providing the same services as any other hygienist in the area and should be paid as such.
 
The fact that you are now doing assisted hygiene at such a low wage is not okay in my book either. Many would argue that you should be making the upper end of hygiene wages for assisted hygiene, as you are seeing double (or so) the amount of patients, hence double (or so) the amount of production. Simply put, your wage should be about 35% of your production.
 
This is certainly a dilemma, especially because you love public health and even further, the office and people you work with. However, you shouldn’t be taken advantage of. By letting yourself be taken advantage of is not only bad for you, but bad for the hygiene profession as a whole. If hygienists keep accepting this kind of treatment, our profession will never move forward. You’ve got to fight this! I really wish you the best of luck, this is not an easy situation!

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