Starting as a dental hygienist

All new entrepreneurs have to come up with a name, start keeping business records, take out insurance, and register their business with KVK. On top of all this, starting dental hygienists also have to consider the following:

1. How do you want to start?

There are different ways you can get started as an independent dental hygienist.

Self-employed dental hygienist

You can work as a self employed professional (zzp’er) in an existing dental hygienist or dental practice. You treat the patients at the practice where you work. The advantage of being self-employed is that you do not have to invest in your own practice premises or expensive equipment. You can work for multiple practices and gain experience. Working for different practices gives you greater security. And it reduces the risk of the Netherlands Tax Administration seeing your work relation as false self-employment. Use one of the standard contracts (in Dutch) provided by the Tax Administration, VvAA (in Dutch), and the Dutch Association of Dental Hygienists (NVM, in Dutch). This way you can show that you meet the conditions for self-employment

Joining a practice

You can buy into an existing dental hygienist or dental practice. You will then become a co-owner. Most practices are organised as a maatschap (professional partnership) or BV (private limited company). The practice belongs to all partners or shareholders, but you treat your patients under your own name.

An existing practice already has patients, and you can see from the figures whether the practice is doing well. If you buy into a practice, you will also have to deal with goodwill. Goodwill is what you pay for the reputation the owners of the practice have built up and for future profits. 

Taking over a practice

You can also take over an existing practice. In that case, you will know the practice’s turnover, that it has premises and that it has patients. When you take over the practice, you pay for the premises, the equipment and the goodwill. Acquiring a practice can be an interesting option if the business generates enough revenue to let you recoup the costs within a few years.

Starting your own practice

Are you thinking of setting up your own practice? If so, you should assess whether a new practice will be profitable. Writing a business plan will help you with this. Consider how you will attract patients, what your target area looks like, and how you will manage the financial side of things.

With the KVK Market Scan, you can find out how many competitors you have in the area and the demographic make-up of the local population.

2. BIG-register for dental hygienists

The BIG register describes which activities a healthcare practitioner can and may perform. You only need to be BIG registered if you want to perform more complex treatments, such as administering anaesthesia, taking X-rays, and filling incipient cavities.

Marzieh Farhadi Akinabad, who works at Mondhygiënist praktijk Groningen, is BIG-registered. "In my experience, patients appreciate that I can fill minor cavities right away, especially in children who still have their baby teeth."

Annemiek van der Bilt works at Almere-based JA Mondhygiëne does not have a BIG registration. "It seems like a good idea, but it is inconvenient in practice. If you hit a nerve while filling a cavity, for instance, the patient will still have to urgently see a dentist, which is hardly customer-friendly."

Quality Register

As well as the BIG Register, there is also the independent Het Kwaliteitsregister Mondhygiënisten, KRM (Quality Register of Oral Hygienists, in Dutch). By registering, you demonstrate that you work professionally and that you are committed to continuous professional development in your field.

3. Health insurers and the AGB code

Patients may sometimes be eligible for reimbursement for treatments. As a dental hygienist, you will need a General Data Management code (AGB code) for this. You can apply for this from Vektis (in Dutch). To apply for the AGB code, you must be registered with the KVK Business Register.

You can contact industry organisations to find out what the reimbursement rates are for treatments covered by health insurance.

4. Laws applying to dental hygienists

The Care Providers Entry Act (Wet toetreding zorgaanbieders Wtza, in Dutch) states that you must register as a care provider 3 months before you start working as a dental hygienist. You do this by filling in a questionnaire (in Dutch) from the Dutch Health Care Inspectorate (Inspectie Gezondheidszorg en Jeugd, IGJ). This will also tell you quality requirements you have to meet.

As a dental hygienist, you must also comply with the following Acts:

• Care Sector Quality, Complaints, and Disputes Act (Wet kwaliteit, klachten en geschillen zorg, Wkkgz).
• Medical Treatment Contracts Act (Wet op de geneeskundige behandelingsovereenkomst, WGBO) 
• Nuclear Energy Act (Kernenergie Wet KEW) if you work with X-rays. 

5. Recording patient data

To protect your patients' privacy, there are rules for collecting and processing patient data. For example, you may keep data only with a patient's consent.

6. No VAT

Dental hygienists are exempt from VAT. This means you do not have to charge VAT, cannot reclaim VAT on costs or purchases, and do not have to file VAT returns.

7. Limiting risks

As a self-employed professional, you face different risks to those faced by an employee. For example, you are liable if something goes wrong during a treatment. You should also bear in mind the risk of having no income if you fall ill and are unable to work. With insurance, you can protect yourself against risks that you cannot afford to cover yourself.

Terms and conditions also help to limit your risks. These set out your rights and obligations, and those of your patient. You can draw up these terms and conditions yourself. You can also seek advice or examples from the trade association NVM (in Dutch) or the association for healthcare providers VvAA (in Dutch).

KVK Insurance Check

Some insurances are mandatory, others are useful. Which do you need? The KVK Insurance Check helps you choose your insurance policies.

8. Administrative records

Entrepreneurs are required to keep accurate business administration. You can either do this yourself or outsource it. Many entrepreneurs in oral care outsource credit management to a factoring company. They take care of billing and collection on your behalf.

9. Music in your practice

Do you play music in your practice? If so, you will need a licence for music rights. You can find the costs and terms and conditions on mijnlicentie.nl, run by BumaStemra and Sena (category: Healthcare & Welfare / Salon).

General information for new entrepreneurs

In addition to the above, new entrepreneurs also have to:

• draw up a financial plan
• choose a company name
• register with KVK
• find out which tax deductions they can use

Also, read the checklist for starting a new business. You will find all the steps you have to take when starting your own business.