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. 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. They might hire you to cope with peaks in demand, for example, or when someone falls ill, or goes on holiday.

The advantage of being self-employed is that you do not have to invest in your own practice. You can work for multiple practices and gain experience. Make sure you always have several clients per year. This gives you more security. It also  ensures that the tax authorities do not see you as an employee under the Wet deregulering beoordeling arbeidsrelaties, Employment Relationships Deregulation Act (DBA Act.)

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 theDutch 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 maatschap (professional partnership) or shareholder in a bv (private limited company). 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

You can also look for a practice to take over. 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. There are registered and non-registered dental hygienists. Registered dental hygienists are listed in the BIG register. They may perform more complex treatments, such as administering anaesthesia, taking X-rays, and filling incipient cavities. You can also choose to register in the independentHet Kwaliteitsregister Mondhygiënisten, KRM (Quality Register of Oral Hygienists, in Dutch).

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. Health insurers and the AGB code

To submit a claim to a health insurance company, you will need an 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.

Sector organisations 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.

4. Laws: Wtza and Wkkgz

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 Care Sector Quality, Complaints, and Disputes Act (Wet kwaliteit, klachten en geschillen zorg, Wkkgz).

5. Recording patient data

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

6. 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

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.

General terms and conditions also help you limit risks. You set out 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 sector organisation NVM (in Dutch) or the association of 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. Sector organisations

A sector organisation 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 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.