Payroll is the biggest line item in almost every endodontic practice. It is also the line most owners look at in dollars instead of as a ratio, which is the reason a staffing problem can grow for two years without anyone noticing.
Dollars always go up. A raise, a new assistant, a busier quarter, and the number climbs. Climbing dollars tell you nothing on their own. The question that matters is whether your team costs more of what you collect this year than it did last year.
Take everything you spend on people: wages, payroll taxes, benefits, bonuses, and any temporary help. Divide that by collections for the same period. Two rules make the number honest. Leave the owner out of it, because your own pay is a distribution decision rather than a staffing decision, and mixing the two hides both. Use collections, not production, because production is work you did and collections is money that arrived.
A well run endodontic practice usually sees staff labor between 26 and 32 percent of collections. That range sits inside a total overhead target below 58 percent.
A ratio above 32 percent tells you that people cost more of your collections than the benchmark. It does not tell you why. Those are two separate findings, and treating the first as if it were the second is how owners end up cutting the wrong thing.
There are four common reasons, and they call for opposite responses. Too many people for the schedule, meaning staffing set for a busier season than the one you are in. Not enough cases, meaning the team is right sized and the schedule is thin, so payroll looks high because collections are low. Pay that grew faster than volume, meaning raises given year after year with no matching rise in cases per day. And turnover, where recruiting, overtime cover, and training a replacement all sit in payroll. The second reason is the one owners misread most often, because cutting a clinical assistant when the schedule is the real problem shrinks your ability to fill the schedule later.
Practices ten miles apart can sit on opposite sides of a state line and face a different bottom of the pay ladder. Virginia's legal wage floor rose to $12.77 an hour effective January 1, 2026. Maryland sits at $15.00 an hour statewide, and some counties set a higher rate of their own. The District of Columbia rose to $18.40 an hour on July 1, 2026, for all workers regardless of employer size.
Most endodontic staff earn well above these floors, so no floor sets your assistant's salary. The floor sets the bottom of the local market, and every rung above it sits on top of that bottom. A front desk hire in DC and the same hire in a Virginia suburb are two different offers, even when the job description is identical. That matters in two ways. If you compare your ratio against a benchmark built on national averages, a DC practice will look expensive when it is paying the market it is in. And if you are opening a second location across a line, the payroll model from your first location will not travel with you.
Before you touch anyone's job, get four facts on the table. Cases per day, this year against last year, which separates a staffing problem from a schedule problem. Payroll split into clinical and administrative, because the fix for one is rarely the fix for the other. Overtime as its own line, since regular overtime usually means the schedule and the staffing plan disagree with each other. And what turnover cost you in the last twelve months, where owners often find a full salary nobody planned to spend. Two of those four facts pull the ratio down without a single change to your team.
If a DSO ever calls, this ratio is one of the first things underwriting looks at, because a buyer is deciding what the practice earns without you in it. A practice that runs 5 points above benchmark on $1.2 million in collections is spending roughly $60,000 a year more on people than a benchmark practice does. That figure comes off earnings, and the offer is a multiple of earnings, so it comes off the price more than once. Knowing the number early means you fix it on your own schedule instead of explaining it on theirs.
If you cannot state your staffing ratio for last quarter right now, that is the gap, and it is a quick one to close. We benchmark endodontic practices in Virginia, Maryland, and DC against endodontic numbers, never general dentistry ones. The review takes 30 minutes, needs no documents, and you leave knowing where your practice stands.
Sources: Virginia Department of Labor and Industry, minimum wage rate increasing effective January 1, 2026 (doli.virginia.gov). Maryland Department of Labor, wage and hour facts (labor.maryland.gov). DC Department of Employment Services, Office of Wage Hour Compliance (does.dc.gov).