Which Employment Laws Apply to a Small Dental Practice?

Your first hire puts you under federal law before any headcount threshold is in sight, and a few more rungs arrive before you reach double digits.

• Equal Pay Act — from one employee. The EEOC's small-business guidance starts here: with at least one employee, you are covered by the law that requires equal pay for equal work to male and female employees. A male and a female hygienist doing the same work fall under that requirement from day one.
• USERRA — no minimum at all. The military reemployment law defines an employer to include any person or entity that pays salary or wages for work performed. There is no employee minimum to clear, so it reaches a solo dentist hiring a first chairside assistant.
• FLSA — a separate coverage test. Minimum wage, overtime and recordkeeping under the Fair Labor Standards Act do not follow this ladder. Enterprise coverage reaches businesses with at least two employees and at least $500,000 in annual sales or business done; the DOL's other named enterprise categories — hospitals, businesses providing medical or nursing care for residents, schools, preschools, government agencies — are not aimed at an outpatient dental office, so whether your practice is enterprise-covered turns on the dollar test.

Even without enterprise coverage, the DOL says an employee is individually covered by the FLSA if their work regularly involves them in interstate commerce.

Treat that broadly: do not assume a small practice sits outside the FLSA — the working question is which of its tests you meet, not whether any does.

At four employees, the Immigration Reform and Control Act adds anti-discrimination rules of its own: employers with 4 to 14 employees may not discriminate based on national origin, and employers with 4 or more employees may not discriminate based on citizenship status or in the Form I-9 employment-eligibility process.

The federal thresholds at a glance

State law can cut in below these rungs — see the state thresholds below.

Fifteen employees brings several federal laws enforced by the EEOC into scope at once.

At 15 to 19 employees, the EEOC counts you among the employers covered by the laws that prohibit discrimination based on race, color, religion, sex (including pregnancy, sexual orientation or transgender status), national origin, disability and genetic information — Title VII, the Americans with Disabilities Act and the Genetic Information Nondiscrimination Act.

Title VII, the ADA and the PWFA share one coverage test.

Title VII applies to employers with fifteen or more employees for each working day in each of twenty or more calendar weeks in the current or preceding calendar year.

ADA Title I uses the same 15-employee, 20-week test, and the Pregnant Workers Fairness Act covers employers with 15 or more employees as defined in Title VII — at this rung, the PWFA applies to the practice itself, not just to larger employers.

Practically, this threshold reaches the whole hiring funnel: the wording of your job ads for hygienists and assistants, illegal interview questions, how you document why one candidate ranked ahead of another, and how you handle a termination.

It is also where it pays to keep a consistent, written rationale for pay decisions — who gets a raise, whose hours get cut.

One caveat: under 15 you are not automatically in the clear.

The EEOC notes that an employer too small for the federal anti-discrimination laws may still be covered by state or local law.

Two more federal laws attach at twenty.

Age discrimination (ADEA).

The Age Discrimination in Employment Act applies to employers with twenty or more employees for each working day in each of twenty or more calendar weeks in the current or preceding calendar year.

The EEOC's summary for owners: at 20 or more employees, you are covered by the law that prohibits age discrimination against workers 40 or older.

Any assistant or hygienist aged 40 or older is inside this protection, which makes written, consistent performance documentation worth having before any hard personnel call.

COBRA continuation coverage.

Federal COBRA generally requires group health plans sponsored by employers with 20 or more employees in the prior year to offer employees and their families a temporary extension of health coverage, and qualified individuals may be charged up to 102% of the plan's cost.

If you sponsor a health plan and expect to cross 20 employees during a year, ask your benefits broker what COBRA administration adds before it arrives.

States can add continuation-coverage rules of their own for smaller employers — your broker or state insurance department can tell you which ones apply to the plans you sponsor.

Fifty is where leave and benefits law start in earnest, and it is a rung a single-site dental practice may not cross on its own — group practices and small DSOs do.

FMLA leave.

The Family and Medical Leave Act applies to private employers that employ 50 or more employees for each working day during each of 20 or more calendar workweeks in the current or preceding calendar year.

Crossing 50 does not make every employee leave-eligible on its own: eligibility also requires at least 12 months of service, at least 1,250 hours in the 12 months before the leave, and a worksite where you employ 50 or more employees within 75 miles.

That 75-mile count is determined when the employee gives notice of the need for leave, and leave that has already started cannot be ended because the count later drops below 50.

One point that applies at every size: the DOL notes there is currently no federal law providing or guaranteeing paid family and medical leave for private-sector workers, though some states run their own paid leave programs — check your state's leave laws before finalizing your policy.

ACA employer mandate.

Under the Affordable Care Act, an "applicable large employer" is one that employed an average of at least 50 full-time employees on business days during the preceding calendar year.

A full-time employee is one whose average is at least 30 hours of service per week for a month.

Part-time hours can also matter to the full-time-equivalent calculation, so a practice with several part-time assistants does not automatically sit below the line — check current IRS guidance for the arithmetic.

At 100 employees: EEO-1 reporting and WARN

Two federal obligations wait at the top of the ladder.

Employers with 100 or more employees (or federal contractors with at least 50 employees and $50,000 in government contracts) must complete and submit an EEO-1 Report to the EEOC and the U.S. Department of Labor every year.

The federal WARN Act separately defines a covered employer to include a business that employs 100 or more employees who in the aggregate work at least 4,000 hours per week, exclusive of overtime — a size a multi-location practice group can reach.

If a practice that size ever plans a large reduction in force, talk to employment counsel before notices go out.

The EEOC says it directly: even if you don't have enough employees to be covered by the federal laws it enforces, you may still be covered by state or local law.

It matters for a small practice because several of the states below set the bar at one employee — or none.

The spread is wide.

California runs a two-level rule: FEHA's general employment provisions apply to employers regularly employing five or more persons, while its harassment provisions apply to any employer regularly employing one or more persons.

New York State's Human Rights Law includes all employers within the state, regardless of size — the same no-minimum approach as New Jersey's Law Against Discrimination, and as Colorado's law, which covers "every other person employing persons within the state."

Illinois covers any person employing one or more employees during 20 or more calendar weeks, and applies that one-employee threshold to disability, pregnancy and sexual harassment claims.

Arizona's law reaches employers with fifteen or more employees generally, but employers with one or more employees for sexual harassment claims.

In between sit Massachusetts, whose Chapter 151B excludes employers with fewer than six persons; Washington, whose Law Against Discrimination applies to employers of eight or more persons; and Ohio, whose civil rights law covers employers employing four or more persons within the state.

Texas and Florida mirror the federal test at 15 employees across 20 or more calendar weeks.

This table lists the states whose thresholds were verified for this guide — it is not a 50-state list, and it does not cover city or county ordinances.

Confirm your own state's threshold with your state labor department or fair-employment agency before relying on a federal headcount alone.

Every threshold on this page counts employees, and the counting rules have details that trip up practice owners.

• Part-timers can count; contractors don't. Per the EEOC, a worker can usually be counted as an employee if they have worked for you for at least twenty calendar weeks in this year or last — so some part-time workers count toward coverage. Independent contractors do not.
• Look at this year and last. Title VII, the ADA and the ADEA all test the current or preceding calendar year: the headcount — 15 or 20 — must hold on each working day in each of twenty or more calendar weeks. A sustained stretch at the higher headcount puts you over even if your average census for the year is lower.
• Worksites can be counted together. The EEOC says that in some cases, if the employer has more than one worksite, employees at each worksite can be counted together — so with a second office, the coverage count may include staff at every location, not just the office where a given employee sits.
• The count is taken when it matters. For the FMLA's 75-mile test, whether 50 employees are employed within 75 miles is determined when the employee gives notice of the need for leave — and leave already under way cannot be ended because the count later drops below 50.
• ACA counting is its own arithmetic. The employer mandate counts the average number of full-time employees on business days over the preceding calendar year, with full-time set at 30 hours of service per week — a different measure from the EEOC's 20-week headcount, and one where part-time hours can still matter.

If you are hiring toward a threshold, run the count before you extend the offer, not after.

The dental hiring hub collects the guides for each step that follows — pay, classification, screening and contracts.