A two-location dental practice, an $84,000 hygienist, and the month the decision stops being reversible

The moment

Two Rivers Dental has two offices in Springfield, Missouri. Four chairs at the original, three at the second, which opened fourteen months ago. Two dentists, three hygienists, four assistants, two at the front desk.

It is late September. Hygiene is booked out eleven weeks at the second office. Eleven weeks is past the point where patients stop rescheduling and start drifting, and the practice knows it, because the recall list is visibly thinning.

The obvious answer is a fourth hygienist at $84,000. Cash in the operating account is $38,000. Collections run about $268,000 a month and everything going out runs about $266,500 — the second office is carrying its own fit-out loan, so the practice is clearing about $1,500 a month.

$38,000 of cash and $1,500 a month of headroom, against a hire that costs rather more than $84,000. That is the actual question, and "can we afford it" is not a form of it that can be answered.

What they did instead

They asked their accountant, in August, in an email, and got a correct and useless answer: budget about 1.3 times salary. So $84,000 became $109,200 and the practice decided it could not be done this year.

The 1.3 multiplier is a management convention. It is fine for a board slide. It is useless for the question actually being asked, which is not "what does this person cost" but "does payroll clear in month seven".

So the decision was deferred. Deferring is a decision with a price, and here it is roughly this: hygiene production at the second office is capped at what three hygienists can see. The eleven-week book does not get shorter on its own. Every month of delay is a month of recall patients quietly moving to the practice with an appointment next week, and those do not come back when the schedule opens up.

There is a second cost, which is that the practice never found out that the answer was yes.

The questions a CFO asks first

1. What happens if you do not fill this? Turning away work is a different answer from being uncomfortable.
2. What is in the bank today?
3. What comes in and what goes out in an ordinary month?
4. What is the base pay?
5. When would they start, and how long until they are producing?
6. What does the role add each month once they are producing? Zero is a real answer.
7. How much notice or severance would you actually give if this did not work?

Question 7 is the one nobody asks themselves, and it is the one that sets the date the decision stops being reversible.

The arithmetic, shown

The practice's figures. $38,000 in the bank. $268,000 collected a month, $266,500 out. Base pay $84,000. Health contribution $9,600 a year. $3,500 of one-off cost for credentialing and a second instrument set. Start in two months, producing two months after that. Expected added collections once producing: $14,000 a month. One month of notice if it does not work, and ten days of PTO accruing a year.

First, what the person actually costs.

Employer taxes are computed month by month against the published rates, not multiplied:

On $7,000 a month, that is $535.50 of Social Security and Medicare every month, plus $42 of FUTA until the $7,000 base is used up.

The FUTA base is paid twice in two months, because it resets on 1 January and the hire starts in December. A rolling-twelve-month approximation misses that entirely.

Across the first twelve months of employment: $6,510 of employer tax on $84,000 of wages. That is 7.75%, not 30%. Add the $9,600 health contribution and the true monthly cost settles at $8,335.50, with $8,377.50 in the two months that carry FUTA and $11,877.50 in the first month because of the $3,500 of one-off cost.

$8,335.50 a month, not $9,100.

Scenario one — it works as expected.

The practice never runs out of money. Cash dips to $23,745 in January 2027 — the fourth month, when the hygienist is being paid and is not yet producing — and climbs from there. Once producing, the month runs $1,500 − $8,335.50 + $14,000 = +$7,165.

The answer is yes. The accountant's $109,200 said no.

Scenario two — the chair does not fill.

Same hire, and the added collections turn out to be zero, because the recall list has thinned more than anyone thought.

March is the number. In March the practice still has $10,074 in the bank, which does not feel like an emergency — but it is now less than the $11,013 it would cost to end the arrangement. From March the practice is committed whether the hire works or not, and nobody in the building would notice that happening.

The money runs out in May. The decision stops being reversible in March. Two months, and almost nothing on the market computes the earlier one.

Scenario three — the two ways of buying time.

Part-time and delay buy roughly the same amount of runway by different means. Part-time buys it by costing less. Delay buys it by starting later, and it also delays finding out whether the chair fills — which is the thing the practice actually needs to know.

On the six-month convention — common practice is not to hire into fewer than six months of runway — this hire clears, on these numbers.

What changed

The practice hired, at 0.6 FTE, three days a week.

Not because part-time was cheaper. Because the honest answer to "what does the role add each month" was that nobody knew, and 0.6 FTE moves the point of no return from March to August. That is five extra months of finding out, for $3,031 a month less.

The offer letter also said three days with a review at six months rather than a vague expectation of going full-time, which cost nothing and put the review before the August date rather than after it.

What the tool will not do

It does not include state unemployment tax. Your SUTA rate and state wage base are on your state's annual rate notice, and the tool says on its face that they are missing rather than filling them with a national average. Federal employer taxes are complete. SUTA typically adds a few tenths of a percent to a few percent of wages.

It does not estimate benefits. If you do not supply a figure it excludes them and says so.

It does not know the Social Security wage base for years that have not been published. A projection running into 2028 uses the latest published base and flags that it has done so. It only matters for pay above that figure.

It will not compare against a contractor unless you supply a contractor rate. It does not invent one — and for a licensed clinical role the comparison is frequently not available at all, which is a legal question rather than a financial one.

It does not tell you whether the role is worth doing. It answers whether the business can carry it, and those are different questions with different answers. A role that is obviously worth doing can still be unaffordable this year.

It does not know your state's employment law, your notice obligations, or what a termination actually costs where you are.

It is arithmetic on figures you supplied. The added collections figure is the one doing the most work in the answer, and it is the one nobody can know in advance — which is why the second scenario above is worth running every time.