“Gentlemen, Gentlemen, be of good cheer, for they are out there and we are in here.” This is the toast given every week at Hugh Heffner’s (founder of Playboy) weekly gathering of his inner circle of friends at his LA mansion. It speaks of a privilege that the participants feel to be at that place at that time. When I heard this quote it made me think that it could quite equally apply to our privileged position as members of a profession.
Times are not good for many but dentists, and those that work with us, are not doing too badly relative to the general public. We have skills that are always in demand and those that are providers or performers on an NHS contract have a more-or-less predictable income. I have often felt that my surgery is a window into the outside world; I come into contact with patients from all walks of life, some I probably wouldn’t otherwise meet.
Through this window I get exposure to the misery of the job insecurity, redundancy and unemployment that has produced as a result of these uncertain times. My general impression is that dentists like to complain about the lots we have drawn (or been given) but really, I think it is fairly clear just how privileged we are - for now.
In society there is a push towards deprofessionalisation. Whether it is medicine, dentistry, the legal profession, the traditional structures are being torn down and work once reserved for those who had completed lengthy (and expensive) courses is now being done by quasi-professionals who have completed training pathways that are considerably shorter. Has this change brought about a fall in quality? Probably not actually, this is quite a bitter pill for most professionals to swallow as it does shatter the perception that only a highly-qualified individual like themselves can do that particular job. This happens all throughout our profession, the arguments that go on between cosmetic dentists and orthodontists about the use of simple appliances in general practice, the battle between oral surgeons and maxillofacial surgeons over where each specialities’ remit ends and begins and now most recently between dentists and hygienists and therapists with direct access. It seems that if you have a skill, somewhere, someone else is offering the same thing with fewer qualifications to their name.
As long as patients’ interests are served and good quality, predictable treatment is delivered with sufficient frameworks in place to deal with unforeseen consequences, surely there is little issue with who provides care?
The simple fact is, at the present time cash is short for a lot of people and money talks. If you can offer a genuine and quality service cheaper than a competitor, regardless of that fact that competitor is more highly qualified, you have a good chance of winning customers.
I am at the start of my career as a dentist, I am 25 now, potentially I will be working until I am 65. In the next 40 years I imagine I will see a huge restructuring of the way the dental workforce is planned and the way dentistry is provided in this country, much greater than preceding 40 years.
My assumption is that there will be an inversion in the number of dentists trained compared to hygienists and therapists, with the numbers of dentists graduating from dental schools each year decreasing. As it stands, there are more dentists in the workforce than would be needed if hygienists and therapists are to take on more of the simple conservative treatment. As the ‘heavy metal generation’ either becomes edentulous (fewer and fewer will) or ceases to require the service of their teeth, those brought up in an age of fluoride and better prevention will probably only require simple maintenance which will not require dentists to treat. It would be foolish in this case if the current proportions of different dental professionals remain the same.
One thing that Hugh Heffner’s friends say about him is that he loves continuity in his routine and habits. He has spent a huge part of his life and fortune preserving this and as an 87 year old, states his only ambition is to maintain what he has, and the way he lives until his end. We dentists don’t have this luxury, we can’t sit back and deny the inevitability of change.
The advice I have had of late from those in the know regarding the new contract is to find a niche and make yourself irreplaceable. Good advice I think, but it does beg the question, surely we can’t all specialise? And what about those of us that don’t want to? Will there be room in the future for the common or garden GDP who knows all of his or her patients and has enjoyed treating them for years?
The new contract may offer a better solution to providing public funded patient care than UDAs, but if it paves the way for being able to phase out the general dentist when there are so many of us around still, is this really the way we want our profession to be moving?
I ask a lot of questions but I don’t give any answers. This is because there aren’t any, not yet anyway. The new contract is still being assembled and there is no clear framework for when this will be introduced or even if it definitely will be. So for now, I am happy to be of good cheer, but I am uncertain for how long I will remain this way as we go from those in here to those out there.