Key considerations for new dental hygienists

Are you starting out as an independent dental hygienist? You have to comply with several rules. For example, you need an AGB code for reimbursement by health insurers. And there are different ways of doing business as a dental hygienist. Read 9 things you need to pay attention to when starting out on your own 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 the above, self-employed dental hygienists also have to consider the following:

1. Start-up opportunities

Once you have a secondary professional education (HBO) degree in Oral Hygiene, you can start your own business. There are different routes you can take, each of which has its own pros and cons.

Self-employed dental hygienist

Dental practices often hire self-employed dental hygienists to work in their practice. Their patients can then come to you for additional or preventive treatment. Alternatively, they might hire you to cope with peaks in demand, when someone falls ill, or goes on holiday. Even self-employed professionals (zzp’ers) can find themselves working in the same practice for an extended period of time. These jobs can eventually lead to a more permanent form of collaboration. You might even join an existing professional partnership (maatschap).

The advantage of being self-employed is that you can gain experience without having to invest in your own practice and can work for multiple practices. The drawback is that you work at your own risk and expense. It should be noted that ‘self-employed’ is not an official legal structure. Most self-employed professionals choose to start a sole proprietorship.

DBA Act

If you only work for one client and they determine how you work, the tax administration considers you a salaried employee. This is governed by the Employment Relationships Deregulation Act (Wet deregulering beoordeling arbeidsrelaties, wet DBA), DBA Act for short. The dividing line between self-employment and salaried employment is not always clear. By working with one of the standard contracts (in Dutch) provided by the tax administration, VvAA (in Dutch) and Dutch Association of Dental Hygienists (NVM) (in Dutch), you can demonstrate that you are an self-employed entrepreneur.

Joining a practice

Another option is to buy into an existing dental hygienist or dental practice, making you a co-owner (partner) in a professional partnership (maatschap) or shareholder in a private limited company (bv). The practice belongs to all partners or shareholders, but you treat your patients under your own name.

Established practices will have already built up a reputation and is generating turnover. When buying into an established practice you will need to pay for things like goodwill. Goodwill is what you pay for the company’s reputation and future profits. Calculate if you can recoup the buy-in within a reasonable period of time.

Taking over a practice

Dental hygienists with their own practice who are planning for retirement may be willing to sell their practice to ensure its continuity. When they are ready to retire, you might be able to buy the practice in a tax-efficient manner.

When you acquire an established practice, you do not have to worry about the basics. You know how much revenue it is generating and you already have a building and patients. In addition to the property and inventory, you will also have to pay 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

If you want to set up your own practice, ask yourself if a new practice is viable. Think about how to get patients, what would be a suitable location, and whether it would make sense from a financial point of view. Writing a business plan will help you figure this out.

2. BIG-register for dental hygienists

The BIG register describes which activities a healthcare practitioner can and may perform. After enrolling, you become a ‘registered dental hygienist’. Then you may perform more complex treatments, such as administering anaesthesia, taking X-rays, and filling incipient cavities.

Registration in the BIG register for dental hygienists is currently in a pilot phase, since July 2020. This pilot lasts for 5 years and is voluntary, so you can decide whether or not to enroll in the register.

Annemiek van der Bilt works at Almere-based JA Mondhygiëne and opted against 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."

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

3. Market research

More and more Dutch people are going to a dental hygienist (in Dutch). In 2018, 36% of Dutch people were treated by a dental hygienist. That is an 8% increase compared to 2014. The number of dental hygienists in the country is also up: according to a report (in Dutch) from the Netherlands Institute for Healthcare Research (Nivel), the number of dental hygienists grew by 11% to 3569 from 2012 to 2019. About 95% of dental hygienists are women.

You can use this industry information in your marketing plan. This will help you identify your competition and your target audience and determine how to reach them. Via the independent Quality Register of Oral Hygienists (KRM, in Dutch), Vektis (in Dutch), or by doing the KVK Company Counter, you can find out more about your competition.

4. Health insurers and the AGB code

For children and adolescents up to the age of 18, dental hygiene treatments are covered under the basic health insurance. Patients aged 18 and over have to take out supplementary insurance if they want coverage for dental treatments.

Industry associations will tell you how much insurers pay for insured treatments. Factoring company Infomedics (in Dutch) indicates that patients have insurance for about 77% of their overall treatment costs, with the average patient running up a treatment bill of €86.

To submit a claim to a health insurance company, you will need a so-called AGB code (Algemeen Gegevens Beheer code). You can request this code from Vektis (in Dutch). To request an AGB code, you have to be listed in the KVK Business Register. KVK will give you a KVK number and branch number. You will need the latter to request an AGB code.

5. Recording patient data

If you treat patients, you will have to record certain information. Their name, address, and information about the treatment and the consequences of your advice. This will allow you to identify patients and track their progress. There are rules for collecting and processing patient data (in Dutch), which you have to follow in order to guarantee your patients’ privacy.

6. Taxes

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.

If you have an sole proprietorship or professional partnership, your profit is subject to income tax. You have to file income tax returnsever year. You can file a provisional tax assessment (in Dutch) during the year, to avoid having to pay a large amount of tax in one go.

Are your profits your main source of income or do you spend more than 1225 hours a year on your business? You may possibly lower your profit with certain forms of tax relief, such as tax relief for new companies (startersaftrek), or private business ownership allowance (zelfstandigenaftrek, in Dutch).  These can reduce your overall tax burden.

7. Limiting risks

Entrepreneurs are responsible for controlling or covering the risks they run (such as injuries inflicted on a patient while you are at work or loss of income if you fall ill. With insurance, you can cover risks that you cannot afford to pay yourself.

KVK Insurance Check

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

In general terms and conditions, you lay down your rights and duties and those of your patient. You can draw up your general terms and conditions yourself. Or you can seek advice from or use templates provided by trade association NVM (in Dutch) or the VvAA (in Dutch) association of healthcare providers.

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. Trade associations

A trade association represents the interests of its members. They share knowledge, and provide information on matters like hiring staff, product and methodology development, and general terms and conditions. They also offer their members legal advice, rate advice, tax tips, group insurance, and a quality register. Dental hygienists in the Netherlands can join the following trade associations:

• NVM - dental hygienists (in Dutch)
• Quality Register of Dental Hygienists (in Dutch)

General information for new entrepreneurs

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

• draw up a financial plan
• choose a company name
• register with the Chamber of Commerce

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