What should you check before taking a higher-paid job in private health?

Seven things, and none of them is the headline salary: why the pay is above market, what the job actually excludes, when the next rise comes, how the employer feels about paying you, how overtime is treated, whether your hours are guaranteed, and where the role leads.

This is written for practice staff — dental assistants, hygienists, oral health therapists, receptionists, practice managers, nurses — weighing a move. It is a business and employment article rather than clinical content. If you are considering a role here, careers at Smile Solutions lists what is open; the graduate program and the dental internship are the two structured entry points.

If you are earlier in the decision — working out which role you want rather than which employer — what does a dental hygienist do?, dental hygienist vs dentist: what’s the difference? and what is the difference between a dental therapist and a dental hygienist? set out how the roles differ, and dentists and registered specialists how the titles are regulated.

The background

In the wake of the first wave of the COVID-19 pandemic, the labour market was dubbed the “Great Resignation”. Many health-sector employees, taking advantage of the widespread skills shortages that followed an unprecedented increase in consumer demand, negotiated better conditions and salaries with their employers. Others switched jobs altogether — many more than once.

Moving for better pay is a reasonable thing to do. The point of what follows is that the headline number is the easiest term to compare and the least likely to determine whether you are better off in eighteen months.

1. Danger money

A practice offering well above market rates may be offering danger money. Some practices struggle to retain staff and are forced to pay above the market simply to attract anyone. The reasons vary — poor HR practices, weak infection control, difficult workplace culture, a demanding owner.

How to check: look for long-serving current employees in similar roles. A practice where nobody in your role has stayed more than a year is telling you something the salary is not. Ask directly: “who held this position before me, and how long were they here?” A straight answer is a good sign in itself. A published team list with tenure, and public reviews, are both worth reading before the interview.

2. Job descriptions that do not match the job

You may sign off on a job description you are comfortable with, only to find the role comes with tasks and expectations that are not worth the additional unsupported physical and mental load the pay rise is buying.

How to check: be very clear on the proposed job description — not only in what it includes, but in what it excludes. Ask for the exclusions to be written down. Sterilisation duties, opening and closing, stock ordering, social media, chasing accounts, covering reception: any of these can be reasonable, but they should be named before you accept, not discovered afterwards.

Scope varies a great deal with the size and structure of a practice. Is a bigger dental practice better? Part 1 and part 2 set out one view of that trade-off, and everything under one roof what a large multi-disciplinary practice involves day to day — including an on-site laboratory and its own technology.

3. This may be your last pay rise for a long time

A practice paying above market simply to secure you may have nothing left for the next review. The rise that got you in the door can be the ceiling.

How to check: as well as negotiating the rate, negotiate the date of your next review and the approximate size of the rise, conditional on meeting reasonable expectations that are written down. “We review annually” is not a commitment. A date and a range is.

4. The employer who resents the number

Some owners and managers who pay danger money to secure staff begrudge it, and the relationship starts from there. The symptoms are shifting and unrealistic expectations about performance, hours and additional duties — an unspoken sense that you owe extra because of what you are being paid.

How to check: pay attention to the tone of the negotiation itself. An employer who is uncomfortable with the figure during the interview will be more uncomfortable with it in month six. How do I manage to keep 60 demanding clinicians happy — all under the one roof? and running a large dental practice are the owner’s side of the same conversation.

5. Overtime that quietly disappears

Your overtime hours may simply be disregarded. There may be an expectation that you start early, finish late, and work through part of your lunch break — almost always unpaid. Some employers also avoid paying penalty rates for weekend work and long shifts.

The arithmetic is worth doing, because the effect is larger than it feels. An expectation of an extra 15 minutes at each end of the day plus 15 minutes of your lunch break is 45 unpaid minutes a day — 3.75 unpaid hours a week. Against a 38-hour roster, that is roughly a 9 to 10 per cent reduction in your effective hourly rate. A pay rise of 10 per cent that comes with those expectations is not a pay rise at all.

How to check: ask what time staff actually arrive and leave, whether lunch breaks are taken, and how overtime and weekend work are paid. Check the rate against the applicable Award — the Fair Work Ombudsman publishes them, and a rate that looks generous is sometimes only just above the minimum once penalties are accounted for. Published opening hours are a rough guide to the shape of the roster; ours are on the contact and location pages.

6. Hours that fluctuate

Minimum weekly hours feel safe in good conditions. A downturn in revenue, or gaps in the appointment book, can lead to a reduction in your weekly hours — obligatory late starts and early finishes that eat heavily into your pay.

How to check: get your guaranteed minimum hours in writing, and understand whether you are engaged as permanent, part-time with set hours, or casual. The employment type determines what protection you actually have, and it is not always what the conversation implied.

7. The dead-end move

Some roles in the health sector are a stepping stone to more learning and career development. Others are dead ends with no pathway.

How to check: ask what training is supported and funded, whether there is a progression structure, and what the last two people in this role went on to do. Weigh a near-term financial gain against progression within the business and the industry as a whole — a role that pays 10 per cent more and teaches you nothing can cost considerably more than that over five years.

What a genuine pathway looks like: structured entry through a graduate program or internship, exposure to specialist care and complex cases rather than a narrow slice of routine work, and clinicians willing to teach — what makes a truly great dentist? and how important is communication in dentistry? are worth reading on what that looks like from the inside.

Where to get independent information

Before accepting, it is worth checking your entitlements against an independent source rather than relying on what you are told:

Common questions

I am registered. Which obligations move with me, and which belong to the employer?

Almost all of them move with you, and that is the part most easily lost in a conversation about salary. Registration attaches to the individual practitioner, not to the practice, so a change of employer changes who pays you and changes nothing about what the Dental Board of Australia requires of you.

The Board publishes a defined set of registration standards — the current list covers criminal history, scope of practice, continuing professional development, endorsement for conscious sedation, English language skills, general registration for overseas-qualified practitioners, limited registration for teaching or research, limited registration for postgraduate training or supervised practice, professional indemnity insurance arrangements, recency of practice, and specialist registration. The Board's own description of what these are is plain: “registration standards define the requirements that applicants, registrants or students need to meet to be registered.”

Four of those are worth checking specifically against a job offer, because the employment arrangement can affect whether you meet them: professional indemnity insurance arrangements, continuing professional development, recency of practice, and scope of practice. The questions that follow deal with each. Read the current version of the relevant standard on the Board's own site rather than relying on a summary — the standards are revised, and several on the current list carry dates of effect years apart.

The role includes tasks I am not trained for. Whose problem is that?

Yours, in regulatory terms, and this is the single most important reason to insist on the written job description that pitfall 2 describes.

The Board's position is unambiguous: “the Board's Scope of practice registration standard applies to all practitioners registered with the Board. This requires dental practitioners to practise within the scope of their education, training, and competence at all times.” Note all times — there is no exception for being asked to, being short-staffed, or being told that is how the practice has always done it. An employer's instruction does not extend your scope, and if something goes wrong it is your registration that is examined.

That makes the job description a registration document as well as an employment one. Before accepting, read it specifically for tasks that sit at or past the edge of your training, and ask three things: what training and supervision is provided for them, who signs off that you are competent, and what happens if you decline a task on scope grounds. An employer who treats that last question as awkward has answered it.

This cuts both ways, and the more encouraging version is worth stating. A role that deliberately extends your scope with real training and supervision behind it is precisely the pathway pitfall 7 is about — the difference is whether the extension is trained and documented, or simply assumed.

I am taking a break between jobs, or dropping to one day a week. Does that matter?

It may, and it is the consideration people discover too late because nothing warns them at the time.

The Board maintains a recency of practice registration standard, which is separate from continuing professional development and does a different job: CPD is about keeping your knowledge current, recency is about having actually practised. A gap between roles, a long period of leave, a move overseas, or a sustained drop to very few hours are all situations where it is worth reading the current standard before committing rather than after.

The practical implications for a job move are concrete. If you are negotiating reduced hours, check the hours you would actually work against the standard rather than against what feels reasonable. If there is a gap between finishing one role and starting another, know how long a gap the standard treats as significant. And if you are returning after a break, ask the prospective employer what supervision or supported return they offer — the Board also maintains a limited registration for postgraduate training or supervised practice standard, which indicates that supervised arrangements are a recognised route rather than an admission of anything.

None of this is a reason not to take a break. It is a reason to find out the requirements while you still have choices about timing.

What money questions do the seven pitfalls above miss?

Two, and both are costs that arrive after you have accepted.

Professional indemnity insurance. The Board maintains a registration standard: professional indemnity insurance arrangements, and meeting it is a condition of your registration. Employers commonly hold cover that extends to employed practitioners — but commonly is not always, and the terms matter more than the existence. The questions to ask in writing: does the practice's policy cover me for the work described in this job description, what is the limit, what is my excess if a claim is made, and what happens to cover for work I did here after I leave. If the answer is that you hold your own, that premium is a real reduction in the offer and belongs in the comparison.

Continuing professional development. The Board maintains a continuing professional development registration standard, and it applies to you whether or not your employer funds a dollar of it. So CPD is not a perk; it is a cost you carry, and an offer that funds it is materially better than one that does not, even at the same headline rate. Ask for the specifics rather than the sentiment: an annual dollar allowance, whether course time is paid time or leave you take, whether travel and registration are included, and whether the allowance survives a quiet quarter. Get the answer in the contract, because a verbal CPD commitment is the first thing to disappear when the appointment book softens.

Add those two to the arithmetic in pitfall 5 and the picture often changes. A 10 per cent rise that comes with unpaid overtime, no CPD funding and a personal indemnity premium can be a pay cut.

Related reading

Practical details

This article is general commentary on employment in the private health sector. It is not legal or employment advice, and it does not account for individual circumstances. For advice about your own situation, consult the Fair Work Ombudsman, your union, or a qualified employment adviser.

Registration standards referred to above are those published by the Dental Board of Australia. They are revised from time to time; check the current version of any standard on the Board's own site before relying on it.

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000 — getting here. Phone 13 13 96, contact us, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment.

Published 13 April 2023, by Dr Kia Pajouhesh.

Smile Solutions trades under ABN 28 193 514 103.

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