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Cissy Mangrum

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The DA Hours Question Is Really a Revenue Question (And Most Practices Are Solving the Wrong One)

Writer: Cissy Mangrum MBA, CMPE, CPC, CDC, CDBS, GSD
Cissy Mangrum MBA, CMPE, CPC, CDC, CDBS, GSD
May 13
8 min read

Updated: Jul 27

I keep seeing the same types of post, just with different names attached from Dentist and OMs. 


A doctor sits down at the end of the month and finally writes what they've been carrying for weeks. Production is down. Treatment plans aren't closing. The schedule has holes a mile wide. The team feels off. And then, somewhere in the middle of the post, the question that always lands hardest:


“How do you guys handle DA hours? Do you guarantee them 80 hours every two weeks, or do you tie it to the schedule? Because right now I'm paying for hours I'm not producing on, and I don't know what to do.”

The comments split into two camps within an hour. Half say guarantee the hours, your team is everything, you'll lose them. The other half say tie it to the schedule, you're not running a charity, payroll is the biggest variable cost you have.


Both camps are right. Both camps are also missing the actual problem.


Because the DA hours question isn't really about DA hours. It's a symptom of a practice that doesn't have control of its schedule, its case acceptance, or its operating model — and trying to fix payroll first is like trying to fix a leaky roof by buying smaller buckets.


Let me walk through how I think about this with the practices I work with.



First, the legal piece! Because you can't strategize past the law!


*Disclaimer this is not legal advice, absolutely reach out to your legal team for additional questions!*


Before we even get to philosophy, dental assistants are almost always classified as nonexempt employees under the Fair Labor Standards Act. That means they're paid for hours actually worked, they have to clock in and out, and they're entitled to overtime when they cross the threshold. Under federal law, employers are not required to guarantee a set number of hours unless there's a written or verbal agreement that says otherwise, but several states have stricter rules, and some cities now have predictive scheduling ordinances that require advance notice of schedules and "predictability pay" when shifts change last-minute.


A few things that trip practices up:

The "80 hours every two weeks" framing some doctors use is a payroll period concept, not an overtime concept. Under federal law, overtime is calculated weekly, anything over 40 hours in a single workweek is overtime, regardless of how the second week looks. California, Alaska, and Nevada layer daily overtime rules on top of that. So an assistant who works 50 hours one week and 30 the next has 10 hours of overtime owed, not zero, even though the two-week total is 80.


Sending an assistant home early when the schedule falls apart is generally legal under federal law, but you can’t ask them to stay off the clock to "help out for a few minutes" that's a wage-and-hour violation that adds up fast. And in states with strict meal and rest break rules, missed breaks can mean an hour of penalty pay per missed break, going back years if it ever gets audited.


Predictive scheduling laws are still mostly limited to large retail, hospitality, and food service employers in specific cities, but a few jurisdictions are now extending them to healthcare. If you're operating in those areas, last-minute schedule changes can trigger required premium pay.


None of this is a reason to panic. It’s a reason to write things down, your scheduling policy, your call-off policy, your time-tracking practice, and to make sure your payroll system is actually calculating overtime correctly. The most expensive payroll mistakes I see are not the result of bad intent. They're the result of “we've always done it this way.”


Now the real question: guaranteed hours vs. tied to the schedule


Here's the case for guaranteeing hours.


When you tell a great DA I will pay you 36 to 40 hours every week, period, you are buying loyalty, predictability, and recruiting power in a market where good clinical assistants are genuinely hard to replace. They can plan their lives. They can pay their rent without anxiety. They aren't watching the schedule with one eye and Indeed with the other. When a competitor calls trying to poach them, the conversation ends quickly because what you're offering is rare.


You also remove a daily friction point from your office manager's job. Nobody is calling someone at 7:30 a.m. to say don't come in, we had three cancellations. That’s a small thing operationally and a huge thing culturally.

Here's the case for tying hours to the schedule.


Payroll is typically 25 to 30 percent of collections in a healthy general practice, and clinical labor is the biggest piece of it. When production drops 15 percent and payroll stays flat, your overhead doesn't go up by 15 percent, it goes up by a lot more, because the fixed costs are now spread over less revenue. Practices that guarantee hours through a downturn without addressing the cause of the downturn run out of cash faster than they expect to.

Tying hours to schedule also creates a healthy pressure on the front desk and the treatment coordinator. If the assistant team knows their hours depend on the schedule being full, they become natural allies in confirming patients, reactivating the lapsed list, and supporting case acceptance. They stop being passive participants in the practice's revenue and start being active ones.


Both of those answers are incomplete on their own


The mistake is treating this as a binary choice. The practices that get this right do something more nuanced, and it's something I'd push back on. Build a base and a variable layer.


Most of my clients land somewhere around a 32-hour weekly base for their core clinical or dental assistants, enough that the assistant can plan, qualify for benefits, and feel secure, with the remaining hours tied to the schedule. When production is strong, hours flex up. When production is soft, hours flex down to the base, and the assistant uses that time productively: deep cleaning, sterilization audits, supply organization, treatment plan follow-up calls, training on a new system, helping the front desk with reactivation. None of that work is glamorous, but all of it touches future revenue.


This solves three problems at once. The assistant has a floor they can count on. The practice has a ceiling on labor cost during slow weeks. And the "non-production hours" are not actually non-production, they're invested into the systems that fix the schedule.


But here’s what nobody is saying


If you’re seriously asking whether you can afford 80 hours of DA time every two weeks, the DA hours are not your real problem!!!!!


Your real problem is one or more of these:


Your schedule isn’t full because your hygiene reactivation system is broken, your new patient flow has slowed, or you’re losing patients out the back door faster than you’re bringing them in the front. Treatment plans aren’t closing because your treatment coordinator isn't trained to handle financial objections, or because the doctor is presenting clinically and walking out without a warm handoff. Production is soft because your procedure mix has drifted toward low-margin work, or because your case presentation is reactive instead of comprehensive.


Cutting DA hours when those are the real problems is like turning the thermostat down in a house with the windows open. You'll save a little money and your team will feel the cold, but the heat is still leaving.


The doctors I see come out of these slumps the fastest are the ones who run the math honestly. They look at their daily production goal, their average production per scheduled hour, their case acceptance rate, and their hygiene reappointment percentage. They figure out exactly where the leak is. Then they make staffing decisions, and almost always, the staffing decision turns out to be a smaller piece of the puzzle than they thought.


What I'd tell the doctor!


If I were sitting across from him or her with a coffee, here's what I’d say. Don't change your DA's hours this week. You'll spook a team that's already feeling the tension, and you'll signal that the answer to a revenue problem is to take it out of payroll, which is rarely true and almost never sustainable.


Instead, spend the next two weeks getting honest data on three production numbers. Your case acceptance rate by treatment plan size. Your hygiene reappointment percentage. Your hourly production rate by provider. Those three numbers will tell you where the actual hole is.


Then sit down with your team, including your DAs, and tell the truth. Production is down. Here’s what we’re going to do about it. Here’s how each role contributes. Here's what hours look like in the meantime, and here’s what the path back looks like. People will rise to a real conversation. They won't rise to a surprise schedule change with no explanation.


The DA hours question is a real question. But it’s the second question, not the first. The first one is: what is actually broken in how this practice is producing revenue, and what's my plan to fix it?


Answer that, and the hours question usually answers itself.


If this resonated, I'd love to hear how you're handling it in your practice — especially the doctors and office managers who are in the thick of this right now. The comments are open.


Cissy Mangrum, MBA, CMPE, CPC, CDC, CDBS is Principal Consultant at MaximizeRCM Consulting and Co-Founder and Chief Revenue Officer at RevTech Partners, LLC based in Franklin, Tennessee. She has over 30 years of revenue cycle leadership experience across dental, medical, hospital, DSO, and MSO settings. RevTech Partners develops AI-powered RCM software solutions for the dental and healthcare market.


Connect with Cissy on LinkedIn or reach her at Cissy.mangrum@revtechpartners.com



References & Further Reading

On FLSA classification of dental staff (nonexempt status, hourly tracking, overtime):



On guaranteed hours, off-the-clock work, and overtime calculation:



On daily overtime rules in California, Alaska, and Nevada:



On meal and rest break penalties (one-hour penalty pay):



On employment law complexity for dental hygienists and assistants:



On predictive scheduling / Fair Workweek laws:



On scheduling, productivity, and revenue systems:



Primary federal source:



*Disclaimer: This article is for educational purposes and reflects general practice management principles. It is not legal advice. Wage and hour laws vary significantly by state and locality, and several states (notably California) have stricter rules than federal law. Practices should consult a qualified employment attorney or HR professional licensed in their state before making changes to staffing, scheduling, or compensation policies.



 
 
 

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