Ask most dental practice owners what their least favorite management conversation is, and raises come up almost immediately. Not because they do not want their team to earn more. Most dentists genuinely do. The problem is that raise conversations, handled without a system, become one of the most destabilizing forces in a growing practice.

Say yes without a framework, and your payroll climbs past 30% before you realize what happened. Say no without a framework, and your best team members start looking for a practice that will value them. Neither outcome is what you were going for.

In Episode 48 of My Dental Playbook, Gary Bird and Dr. Blake sit down with Christian, a practice owner from Virginia Beach who has grown from $1.1 million to $2.6 million in collections and scaled his team from nine to seventeen people. The conversation covers exactly how to handle raise requests in a way that is honest, fair, and sustainable, and how to build a compensation culture where the best team members thrive and the ones who are not pulling their weight eventually self-select out.

Why Dentists Handle Raises the Wrong Way

Christian is candid about his starting point: he hates conflict, wants everyone to feel valued, and has a natural tendency to say yes before he has done the math. That combination is extremely common among practice owners, and it creates a specific and predictable problem.

When someone asks for a raise, the instinct is to agree, move on, and deal with the financial implications later. The result is a payroll percentage that creeps toward 30% or above, team members who received raises that were not tied to any change in performance or responsibility, and a compensation structure that is based entirely on whoever asked most recently rather than on the actual value being delivered.

The deeper issue is that unstructured raise decisions communicate something unintentionally: that compensation in your practice is negotiated, not earned. Once that belief takes hold, the team members who are most comfortable asking for things will always outpace the ones who quietly do excellent work and wait to be recognized. That is not the culture most practice owners are trying to build.

The Three-Part Framework for Handling Raise Requests

Part One: Figure Out the Business Side First

Before any individual conversation about compensation, you need to know what your practice can actually afford. That means understanding your current payroll as a percentage of collections, identifying where you have flexibility, and establishing what the realistic ceiling is for each role given your current production.

This is not about being stingy. It is about operating with integrity. If you agree to a raise without knowing whether the business can absorb it, you are making a promise you may not be able to keep, and the downstream consequences hit the entire team, not just the person who asked.

Christian’s practice is currently around 29% to 30% payroll before any new increases, and the Virginia Beach market has moved significantly on hygienist wages. What was $40 to $42 per hour in 2022 is now closer to $50 to $55, and that shift is happening across the country as the profession loses an estimated 2,500 hygienists per year nationally. Knowing those market numbers and your internal numbers at the same time is what allows you to have an honest conversation rather than a reactive one.

Part Two: Build Vertical Pay Bands Tied to Responsibility

The most sustainable compensation structure is one where pay levels are visible, predetermined, and tied directly to skills and responsibilities rather than to individual negotiation.

Dr. Blake describes this as creating multiple tiers within every position. For hygiene, that might look like a junior hygienist who is building core competencies, a mid-level hygienist who can perform anesthesia and manages more complex patient relationships, a senior hygienist with advanced clinical skills and leadership presence, and a department lead who carries both clinical and management responsibilities. Each tier has a defined pay range and a defined set of skills or contributions required to reach it.

This structure changes the entire nature of the raise conversation. Instead of a team member coming to you and asking for more money with no defined path forward, the system already answers the question before it is asked: here is what the next level looks like, here is what it pays, and here is what you need to be able to do to get there.

It also creates lateral mobility. A hygienist who is interested in leadership can move toward a department lead role. A clinical assistant with strong communication skills can develop toward a front-of-house role. When people can see multiple paths forward in a single practice, they stop evaluating whether the grass is greener somewhere else.

One additional piece that most practices skip entirely: pay bands need to be able to move in both directions. If a team member who earned a raise stops performing at the level that justified it, the conversation about moving them back down is legitimate and necessary. That is a harder conversation, but Dr. Blake makes the point directly: it takes a different level of leadership, and it is critical. Practices that can only move pay upward end up carrying compensation levels that no longer reflect the value being delivered.

Part Three: Replace Surprise Raise Requests with Regular One-on-Ones

When team members have clear scorecards, defined advancement criteria, and consistent one-on-one conversations with their leader, they stop making surprise raise requests. Not because they stop wanting more, but because they already know exactly where they stand and what they need to do to move forward.

Most practices skip one-on-ones because of time or because the conversation feels uncomfortable. The irony is that skipping them creates far more uncomfortable conversations later, in the form of the exact raise requests and team friction the practice owner was hoping to avoid.

A well-run one-on-one is not a performance review. It is a regular check-in where the team member and their leader look at the numbers together, identify what is working, surface what is not, and discuss what development or support would help the team member advance. When those conversations happen consistently, there are no surprises on either side.

The Raise Conversation Done Right

When a team member comes to you asking for a raise, Dr. Blake’s approach reframes the entire interaction. Rather than agreeing immediately or deflecting, the response is genuine agreement paired with a real question: “I want you to make more too. What are three things you think you can bring to this organization that we don’t currently have, that would allow us to pay you at that level?”

That question does several things at once. It honors the team member’s desire to earn more. It makes clear that compensation is connected to value creation, not to seniority or to who asked. And it opens a productive conversation about where the team member actually wants to grow, which is information that benefits the practice as much as it benefits the individual.

The other piece of that conversation is transparency about how money flows through the practice. Most team members hear the top-line production number and assume there is an unlimited budget available for raises. They do not see overhead, marketing costs, lab fees, equipment, or debt service. Walking a team member through the reality that every dollar is accounted for, and that a raise in one area requires a decision in another, is not discouraging. It is treating people like the capable adults they are, and it almost always earns more respect than a vague yes or no.

Hygiene Metrics That Actually Move the Needle

One of the most practical segments of the episode is the discussion around which hygiene metrics are worth tracking and how to set targets that motivate rather than deflate.

Christian’s practice currently tracks three metrics per hygienist on a weekly basis: number of laser procedures performed, number of perio charts missed, and number of x-rays missed. The latter two are calculated automatically through Overjet, which uses AI to pull the data without requiring manual reporting.

The perio chart target is fewer than one missed appointment per hygienist per week. The laser and x-ray targets are set using each hygienist’s own historical average, with a 5% to 10% improvement goal layered on top. That approach matters because targets set against an arbitrary external standard often leave team members feeling like they can never win. Targets built from a baseline the individual already achieved are ones they can actually reach and feel good about reaching.

Dr. Blake adds a layer to this that is worth understanding: he tracks microscope usage not as the primary metric, but as a leading indicator for laser procedures. The logic is that hygienists who are doing thorough diagnostic work with the microscope will naturally identify more cases that benefit from laser treatment. If laser numbers drop, the first question is whether the microscopes are being used. The measure is connected to the behavior, not just the output.

This distinction between leading and lagging indicators runs through the entire conversation. A lagging measure tells you what already happened. A leading measure tells you what is about to happen if the right behaviors are or are not occurring. The practices that build scorecards around leading indicators give their teams something they can actually act on in real time, rather than reviewing a number after the opportunity to change it has already passed.

Christian references Goodhart’s Law to frame the risk on the other side: when a measure becomes the goal, it stops being a useful measure. Teams that are incentivized purely on a number without understanding what that number represents will find ways to hit the number that undermine the actual purpose behind it. The fix is connecting metrics to outcomes the team member genuinely understands and cares about.

Build the Culture Around Your High-Accountability People

One of the most important points in the episode comes from Christian’s leadership coach, and it runs counter to how most practice owners naturally operate.

Most practices unconsciously structure their culture around the lowest-accountability team members. Why? Because those are the people most likely to complain, to create conflict, or to leave if the standard goes up. The path of least resistance is to accommodate them. But doing so sends a clear signal to the team members who do show up, perform, and hold themselves accountable: this is not a place where excellence is recognized or rewarded.

The practices with strong cultures do the opposite. They set a standard that high-accountability people can be proud of and build systems that make it easier for those people to thrive. The low-accountability team members either rise to meet that standard or eventually leave, and both outcomes are acceptable.

People want to be led. That phrase appears more than once in the episode, and it is worth sitting with. Team members who seem disengaged or unresponsive to direction are often that way because no one has given them a clear picture of where the practice is going and what role they play in getting there. When leaders provide that clarity, most people respond to it. The ones who do not are giving you useful information.

Why AI Is the Next Conversation for Practice Owners

Christian teaches AI integration at DSI, and the episode ends with a preview of a topic they plan to develop in a future episode. The short version is this: most practice owners are using AI the way they used to use a search engine, as a tool to find quick answers to individual questions. That is a fraction of what it can do.

The real leverage is in using AI to reduce administrative burden, analyze practice data without needing a dedicated analyst, automate communication workflows, and make informed decisions faster. Christian’s framing is that AI does not just save time. It gives practice owners the ability to execute on ideas they previously could not move forward because the support infrastructure was not there. Gary’s counterpoint is also honest: that same capability tends to generate more work because suddenly things that were previously impractical become doable, and the ambition of the practice owner expands to meet it.

Both observations are true, and both are worth understanding before assuming AI will simply make your practice easier to run.

Frequently Asked Questions

How should a dental practice handle team members asking for raises? The most effective approach combines three elements: knowing what the business can actually afford before any individual conversation happens, having a visible pay structure that defines what each level of compensation requires, and using regular one-on-ones with scorecards to create clarity before the conversation becomes a request. When team members know exactly what they need to do to advance, surprise raise conversations become rare.

What is a fair payroll percentage for a dental practice? Payroll as a percentage of collections varies by practice size, market, and model, but most well-run practices aim to keep total team compensation between 25% and 32% of collections. Going above 30% without a clear plan for production growth to offset it creates margin pressure that compounds over time, particularly when market wages for hygienists are rising.

How do you create a pay structure for dental hygienists? A tiered pay structure defines two to four levels for each role, each with a specific pay range and a specific set of skills or responsibilities required to reach it. For hygiene, this might include a base-level hygienist building core competency, a mid-level hygienist with additional clinical skills such as anesthesia, a senior hygienist, and a department lead. Each level should be visible to the entire hygiene team so advancement is a transparent goal, not a back-room negotiation.

What metrics should a dental hygiene department track? The most useful hygiene metrics are leading indicators connected to behaviors that drive production, not lagging indicators that only report what already happened. Common effective metrics include number of perio charts missed, number of laser procedures performed, hygiene reappointment rate, perio percentage, and x-ray completion rate. Setting targets based on each hygienist’s individual historical average, with a modest improvement goal, tends to drive motivation more effectively than arbitrary external benchmarks.

What is the difference between leading and lagging indicators in a dental practice? A lagging indicator measures an outcome after it has occurred, such as monthly SRP production. A leading indicator measures a behavior that predicts that outcome before it happens, such as the number of perio charts completed on schedule. Scorecards built around leading indicators give teams something they can act on in real time. Lagging indicators alone only tell you what you missed.

Why do dental practices lose good hygienists even when paying competitive wages? Compensation is one factor, but clarity and career path matter as much or more. Hygienists who do not see a path forward in a practice, who feel their contributions are not measured or recognized, or who work in a culture that rewards low accountability equally with high accountability tend to leave regardless of hourly rate. Building a visible advancement structure and a culture that consistently recognizes top performers is often as important as the wage itself.

How should a dental practice use AI tools to reduce administrative burden? The highest-value AI applications in dental practice management include analyzing financial data to identify production gaps and overhead inefficiencies, automating patient communication sequences, generating reports and summaries that previously required dedicated administrative time, and assisting with systems documentation and training materials. The key shift is moving from using AI for one-off questions to building it into repeatable workflows that reduce how much time the practice owner and team spend on tasks that do not require their direct judgment.

What This Episode Is Really About

The practices that scale past $2 million without burning out their owner are almost never the ones where the owner is the smartest person in the room. They are the ones where the owner has learned to create clarity, build systems, and lead people toward a shared outcome rather than managing individual requests as they come in.

Christian’s practice went from $1.1 million to $2.6 million not because he hired more people. He did hire more people, from nine to seventeen. But the growth came from building the infrastructure around those people: the metrics, the pay structure, the one-on-ones, and the leadership culture that made high-accountability team members want to stay and grow.

That infrastructure is what you are building when you stop saying yes to every raise request and start building a system that makes the answer clear before the question is asked.

Join the Mastermind

Gary Bird and Dr. Blake host a monthly dental practice mastermind at $299 a month with no long-term contract. It is where conversations like this one happen live, with practice owners who are actively solving the same team management, compensation, and growth challenges you are facing.

If you want to build the systems that let your practice grow without creating constant chaos in the process, join us.

Listen to Episode 48 of My Dental Playbook here or wherever you get your podcasts.