Salary vs Commission: What Increases Your Bottom Line?


“I earn more working three days on commission than five days an hour.” What a dream, isn’t it? This is true for many dental hygienists, but it doesn’t happen without understanding the many variables involved. While an hourly rate can provide a sense of income security, working on commission has the potential to increase your flexibility and maximize your earnings.

What variables should you ask about when considering dental hygiene commission or salary? There are plenty of pros and cons to each choice. Here are six questions to ask employers to negotiate fairly and competitively.

1. What is your commission percentage and what is the comparable hourly rate?

This is the most obvious question, and this percentage affects the following questions so that you can determine whether it is worth spending time on commission or accepting a commission rate in general. To find general statistics on dental hygiene compensation, visit job seeker sites such as to review your offer against national averages. As a general rule, you should aim for 30-40% of your daily production in a simple commission structure.

For example, if you work eight hours a day four days a week with constant clientele, and you close $1,200 in business every day at 35% commission, you earn about $420 a day, $1,680 $ per week. A commission percentage requires an understanding of the office, patients, and callback protocols. You might consider an hourly rate if you are new to a practice.

2. Are the appointment books consistent?

A commission means no patients = no revenue. Are appointment books consistent enough to compensate for cancellations and lulls when the practice isn’t as productive? When I say consistent, aim for at least 80% of your day to be taken up with 60-minute dates, and make sure there are no more than two gaps per day max. Tracking downtime is also essential and it’s a good idea to ask what protocols are in place for cancellations and what is being done to keep downtime to a minimum.

Don’t be afraid to ask what the books look like now. If you see mostly an overflow of patients, there may not be enough patients to fill your diary. Who manages the schedule? Remember dentistry is a business so in this scenario the owner may offer a commission package as your books may not be consistent. I would get a guaranteed base salary amount to secure you a minimum wage or agree an hourly rate and renegotiate it during your performance review. Federal law requires that non-exempt employees, which include most dental hygienists, be paid at least minimum wage for the hours worked. Hours worked include all time an employee is on duty, including clinic maintenance and front desk assistance with scheduling.

Related reading

Dental hygiene tasks paid on commission: the job description is often too vague
Common Questions When Developing a Commission-Based Compensation Plan for Dental Hygienists

3. Is this a new appointment calendar or does it replace an existing calendar?

Another variable may be clinicians who have been in the practice for years and have seen most patients. This can have an impact on the growth of your appointment book and the time it takes to fill days when you are under contract. If you’re taking over an existing consistent appointment book, that may work better for you than a commission structure. In addition, for direct commission to be effective, the dentist must place importance on preventative work and a periodontal program must be in place. If none are in place and your goal is to build it, an hourly rate may be more appropriate.

4. What payment methods are available?

A hygienist’s salary can be paid as a single commission, a combination of salary and commission, a fixed annual salary, or a daily/hourly rate. Each has its advantages and disadvantages. Salaried hygienists often receive paid sick leave and vacation time, while direct commission arrangements may not have any benefits. However, if the expected commission salary exceeds the hourly rate offered, you may think it is worth it. You need to carefully evaluate a combination of commission and salary: can you live on just the base salary? Does your dentist value preventative treatment? Commission salaries require a constant flow of patients, so if the dentist doesn’t like it, the patients often don’t like it either. If you have an assistant, it can free up your time to see more patients, which means more production and commissions.

5. What are the benefits?

Benefits should be negotiated as an hourly rate or percentage commission. In addition to benefits mandated by law, these may include continuing education, production bonuses, free dental care, parking, vacation pay, sick leave, health insurance, or retirement benefits. For example, if an employer negotiates a lower commission salary, I recommend negotiating benefits to compensate until you can ask for a raise in your performance review. Of course, every situation will affect how someone perceives a benefit package, so negotiate for the benefits you value the most.

6. Is there flexibility?

Working on commission allows you to work your career around your lifestyle. Prove to your boss that you are productive and taking initiative in your earning potential. Whether you need to start late to drop your child off at school or prefer to work part-time, commission work allows for that flexibility more than an hourly rate based on your productivity.

Flourishment in dental hygiene requires a plan that provides job security, as well as flexibility to adapt to life changes, personal goals and interests. Many leave the profession because of burnout and stress, family responsibilities or to pursue new interests. Challenging yourself by finding ways to advance your professional development and compensation programs can lead to great job satisfaction.


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