WORD OF MOUTH:'PRESIDENT SIGNS law to avert shortage of doctors." This was a headline that grabbed a lot of attention recently. It got me thinking. Could there ever be a similar headline featuring dentists? Unlikely, I hear you say.
The traditional model for graduating dentists has been to first practise as an associate dentist, working for a principal dentist/owner, and then buy an existing practice, or to “boldly go where no one has gone before” and set up from scratch and hope that patients attend.
In the past 15 years, successive governments oversaw the expansion of the two State-sponsored dental schemes.
The Dental Treatment Benefit Scheme (PRSI dental scheme) provided PRSI-qualified patients and their dependent spouses access to free dental examinations, scale and polish, and subsidised treatments.
The second scheme, the Dental Treatment Services Scheme (Medical Card scheme), allowed eligible medical cardholders to attend for routine examination, scale and polish, and basic dental treatment free.
Regrettably, as recorded in these pages, the PRSI scheme was effectively collapsed in 2010, leaving the free examination as a token political gesture. But with PRSI patients still paying full social insurance, one wonders what value they are getting from this?
The Medical Card scheme was also targeted by the last government in 2010, replacing it with free examination and a bizarre ruling on “two fillings” per annum, extractions and “emergency treatment”. The two fillings rule smacks not just of cynicism but also, on a practical level, it’s like telling your car mechanic, “I have four bald tyres, can you just replace two?” It makes no clinical sense, jeopardises patient care and provides a clinical dilemma for the family dentist.
“What has all this got to do with a shortage of dentists?” I hear you ask. When operating, the two schemes provided State assistance to 80 per cent of the adult population. Eight out of every 10 adult patients could avail of either reduced-cost (PRSI) or free (Medical Card) dental treatment. This encouraged patients to attend, promoted good oral health nationally and, as a direct consequence, ensured Irish dental graduates could find a future in Ireland.
Their removal has not only disenfranchised 80 per cent of the population from dental care, it has sounded a death knell for the high level oral health this State has attained over the past 20-30 years. It also has had ramifications for the profession of dentistry.
So what’s the picture like now? In just 18 short months since the two combined measures came into effect, patients have been adversely affected. With the loss of the schemes, increased taxes and rising unemployment, a trip to the dentist has now become a luxury for most patients.
Dental staff have been affected too. Recent studies conducted among family dentists suggest that profession wide, there have been close to 1,000 redundancies (incorporating nurses, hygienists and associate family dentists). The inevitable ripple effect into dental material companies, dental laboratories and other auxiliaries has yet to be measured.
Those most affected within the profession are younger dentists. At the height of the boom, they bought premises, installed equipment and employed staff. They now find themselves with fewer patients attending, many have reduced their working hours and yet more are closing their doors, in many cases lumbered with significant practice debt. The trusting relationships built by these family dentists with their patients have come to a dramatic end.
The public may argue that dentists have had it good for too long. “There are another 450,000 unemployed you know,” is a retort.
I am a realist. Regrettably, I know in a popularity contest, dentists hover somewhere between banker and clamper. However, this snapshot of the current situation merits closer scrutiny to predict the future, not just for dentists but, more importantly, for patients.
Indicators suggest that further closures are inevitable. Older established practices (which have paid off equipment and mortgage) will probably survive, mainly in larger towns and cities.
Smaller and newer practices (usually rural) may not. Patients have a tough enough time finding and trusting a dentist to start with, and these relationships are hard to replace, as patients tend to favour returning to the same family dentist. Finding a new family dentist further away and forging that same relationship is another hurdle for an already nervous patient.
Maybe we have too many dentists? Is this a market correction? The two dental schools in Ireland graduate 35 dentists each per annum. Almost 100 per cent of the classes of 2010 and 2011 emigrated.
With a rising Irish population of 4.5 million, Ireland ranks second last in the dentist to patient ratio, far below the European average, according to a 2008 survey of 32 countries by the Council of European Dentists.
I wonder what that figure would look like today?
What does the future hold? In the next few years as the older established practitioner approaches retirement and sells on his/her practice, who will buy? The younger dentists, burnt from the Government’s collapse of the schemes, a property debacle, lumbered with debt, scarce bank lending and an uncertain turnover, will think twice.
Surely the Government’s chief dental officer has raised a red flag? I’d like to think so, except there’s a catch. We don’t have one. The last chief dental officer (CDO) vacated the post almost a decade ago.
In the height of the boom, there was no CDO to raise awareness or advise Government. Minister for Health James Reilly has given assurance that a CDO will be appointed. But when? In the meantime, patients are suffering. Dental decay, neglect and decreased access to service, through closure and part-time opening, will yield significant problems in the long term.
These inevitable problems will require Exchequer funding in some shape or form. This, coupled with more dentists leaving the country and/or the profession, will lead to a manpower crisis.
There are very few easy fixes in the health service which will benefit patients, increase employment and safeguard health. This is an easy fix. Doing nothing is tantamount to supervised neglect. Let’s hope James Reilly will agree because there is a difference between saving money and not spending money – just ask any car mechanic.