Unit 4: Administrative Operations
Administrative Operations

Section 2. Human Resources

Salaried Employees, Contractors, and Volunteers

The most common manner of employing clinic personnel is through salaried positions. Terms of employment usually include a salary and benefits package, vacation and sick leave, and specific work hours. Salary may be based on an hourly wage, a monthly or annual salary, remuneration in a base salary plus a percentage of billings or collections, or any number of other formulas. If you intend to pay dentists and hygienists with a base salary plus bonuses based on productivity, make sure the productivity levels that trigger the bonuses are attainable and reasonable. Unattainable goals will hinder staff retention if the base salary is not competitive for your region. When personnel are employees, the clinic will be responsible for all state, federal, and local tax withholding, workers' compensation insurance, and any other such expenses required by law or regulation.

Contracting with professionals is another method for employing personnel. Contracting commonly is done with dentists and dental hygienists but less often with dental assistants, receptionists, or office managers. This type of hiring involves drawing up a legally binding contract between an independent oral health professional and the clinic. The contract will specify hours the professional will work, the rate of pay (usually per hour or per day), and other details. An independent contractor is self-employed, does not receive a benefits package (e.g., health insurance, malpractice insurance), and is responsible for paying all state, federal, local, and payroll taxes. For this reason, the clinic must expect to pay a higher hourly or daily rate for a contractor than for an employee. Internal Revenue Service criteria distinguish between a contractor and an employee.

Contracting with private sector dentists can be an important approach for increasing access to oral health care services for underserved populations. The Children’s Dental Health Project’s document, Increasing Access to Dental Care Through Public/Private Partnerships: Contracting Between Private Dentists and Federally Qualified Health Centers, has information about why and how a federally qualified health centers (FQHC) might consider entering such contracts. This publication is specifically for FQHCs.

Many charitable and safety net clinics provide a portion of services through the work of volunteers. Staffing through volunteers can be an economical way to provide services. The use of volunteers was introduced in Unit 1 and revisited in Unit 3 in relation to reducing personnel costs.

  • How will you choose to use volunteers? Will volunteers provide the majority of services, or will they supplement a full-time staff?
  • Dentists may volunteer frequently or only a few times a year. The number of volunteers you need will depend on your clinic’s days and hours of operation, scope of services, number of operatories, patient load, and number of paid dental staff, among other things.
  • Each volunteer will need to be oriented to the policies and procedures of your clinic.
  • If volunteer dentists will utilize their own dental assistants, an orientation to what instruments and supplies the clinic has available and where they are stored will be needed.
  • The clinic will need to have a staff member capable of organizing and coordinating the schedules of all volunteers and finding coverage for the clinic for those times when a scheduled volunteer is unable to work.
  • Recruiting volunteers will likely require frequent meetings with local dental societies, visits to local or regional dental meetings, and other outreach activities.
  • Retired dentists or dental hygienists may be a volunteer resource for clinical care if they maintain an active license.
  • Volunteers usually find it helpful to have paid staff available to provide continuity with policies and procedures.
  • Scheduling of patients with volunteer oral health professionals may depend on the level of services volunteers are asked to provide. Complicated procedures that require multiple visits might best be reserved for paid staff to maintain continuity of care.
  • In some states, volunteers may be covered for malpractice by the state’s good Samaritan or volunteer protection laws; in others, volunteers will need to provide proof of their own malpractice insurance. Check with your clinic’s professional liability carrier about any other implications the use of volunteers will have on your clinic’s coverage.
  • The credentialing and privileging of a large number of volunteers can be very time consuming.


Considerations that Affect Volunteering

Why Do Oral Health Professionals Volunteer?

What Makes Oral Health Professionals Wary of Volunteering?

  • To do the right thing; to make a difference
  • Personal or spiritual calling
  • Sense of social responsibility
  • Concern about access to care
  • To be able to care for patients without the hassles of managed care and paperwork
  • Value of prevention
  • In response to a colleague’s invitation
  • To use clinical skills they might not be in a position to use otherwise (e.g., retirees)
  • Already doing their part
  • Misconceptions about the uninsured
  • Concerns about patient compliance
  • Legal (malpractice) concerns
  • Worry about time and scheduling
  • Personal safety concerns
  • Wary of the working conditions
  • Sense professional tensions


Reprinted, with permission, from Hanson SA, Goldin M, Goldin GL, 2002. Using Volunteer Dental Professionals to Provide Services to the Underserved: Types and Characteristics of Model Programs. [Presentation by Volunteers in Health Care at the American Public Health Association Annual Meeting Philadelphia, PA.]