Nothing has changed, months later I still can't get dental treatment and the situation still frustrates me.
The reason I bring it up again is that today, all these months later that post received a comment from a dentist. I am hoping that he or she does not object to my publishing that comment as a post given that the original was already in the public domain when the comment was made.
My intention is not to turn this into a slanging match, rather to re-open a discussion I feel strongly about now I have the opinion of an individual from within the dental profession.
What do you think?
This is the text of that comment:
Anonymous said...
I will attempt to set some things straight because I believe the government has misled the public with lies about "greedy dentists" for decades now. The only reason dentists are abandoning the NHS is that the fees they are paid are downright ridiculous for the highly skilled job they are supposed to do.
Let me give you an example of exactly how much the government values your health:
A filling on a child is less than a donner kebab.
An extraction is less than a music CD.
A root canal treatment on a front tooth, on which outcome the future of your tooth depends, is less than a playstation game.
So dentists were forced to see a huge number of patients each day (sometimes 30-40, that's the largest in the western world) and use only the cheaper materials. Ask any dentist in the US or the better parts of Europe and they will tell you about the appallingly low quality of NHS dentistry.
Many of us decided that they're not going to play the government's game anymore and stopped compromising our patient's health just because the government is used to buying dentistry on the cheap. Who can blame those who took that step?
As a last point, I'm a dentist and proud to be member of the profession with the highest suicide rate (so life isn't exactly rosy for us, as people tend to think), and I currently work in the NHS, but I will leave on the first chance I get. A few weeks ago the government announced that the new computer network for the NHS will cost 20-30 billion pounds. That's enough to pay for 30 years of dentistry at the current level, or 10 years of dentistry at a high quality level. But they're going to spend it on computers. Politicians have got their priorities seriously wrong.
And this is my reply:
Anonymous: Firstly thank you for taking the time to comment, it's good to get the opinion of the 'other side'.
Ok, now onto the points you raised.
I can accept without too much difficulty that the government has attempted to mislead us, the general public' with regard to the dental profession's greed, it would not be the first time and I am sure it will not be the last but were many of you not trained as I stated in my original post, at a time when most of the current situation was already in place and was the training not at the expense of this country? I know there are many dentists in the UK from overseas but presumably though not trained here there was something in our system that attracted them to practice here?
I doubt there are many employees of our NHS system who are happy with their lot, I myself worked within the system for a short time and found the entire experience very negative but the one big difference between dentists and the other employees from where I am sitting, is that the others carry on their duty of care regardless. Yes many doctors practice privately along with carrying out NHS work and yes I can jump a queue for surgery with cash but ultimately if I cannot afford that surgery, I will get it in time via the NHS. That is very much not so where my teeth are concerned!!
I appreciate that your profession is highly skilled and should be appropriately remunerated but it is a fact of life that most of us are not in reality salaried as we feel our work deserves. Dentists are not alone in that. We mere mortals just don't have the power to hold the government, or those we serve in our occupation to ransom!
Believe me I would like to have more respect for the dental profession but the bottom line for me is that I had a set of teeth that had been well looked after all my life and are now not as they should be. I am completely unable to get a dentist via the NHS and in fact where I live have been unable thus far to get one even privately......though how I would pay him or her if I could remains a mystery.
I do not apologise for my belief that dentists were in my mind akin to doctors, nurses, medical professionals of other specialities, the police, paramedics and the fire brigade. These are ALL highly skilled individuals who choose to go into a profession of caring. They differ from dentists in so much as despite their sometimes appalling conditions of service and salary they continue to care for those that require their skill. Their frustrations with the system within which they are employed do not affect the service user to anything like the magnitude that the dental professions behaviour has!
I cannot dispute the suicide rate, I have no evidential statistics to support or deny your claim but I do know various professions claim to hold the 'highest rate' accolade. I'm not sure what causes the pressure in dentistry, I am assuming workload. Sorry, but have any of you tried struggling with the day to day stressors and a heavy workload with your teeth causing you pain for years??
Bottom line: I can't see a dentist because dentistry is unavailable to me, both actually and financially and I don't understand how a caring profession can justify hurting the very people they claim to care for in pursuit of economic gain. One thing is for sure, those in government who your battle is with are not suffering, it is us, your patients that are doing that.
I am not going to argue the point that you as a profession are not 'well off' for that is relative. I only know that I don't see too many dentists living in the poor part of town or with holes in their shoes.
The situation continues to anger me. Strangely I am scared of dental treatment and it took me many years to become comfortable (ish) with it, now on top of rotting teeth I have to overcome that fear again should I be fortunate enough to ever receive the attentions of a dentist.
Addendum: Anonymous, I wonder.......before you leave the NHS, you wouldn't by chance have room on your books for one more would you?
11 Comments:
Gemmak,
I thank you for a prompt reply and you raise some very good points. I do not intend to turn this into an ongoing debate, so I will just add some quick remarks.
Yes, many of us (although not me) were trained in state-funded universities, as were many other professions. Why aren't lawyers forced to to work only for the government? Why aren't electricians who were trained in state-funded colleges forced to provide free repairs? Unfortunately, we live in a free market world. Moreover, you may be aware that a new dentist now graduates with an average debt of 30K which he will have to repay somehow. Meanwhile, the "old generation" have repayed their debts to society more than enough by working in a system that awarded them so inadequately.
Yes, dentists seem similar to doctors, nurses and policemen. There is one great difference however: they are self-employed, independent contractors to the NHS. The NHS expects them to pay for their staff, their materials, equipment, premises and treat the NHS' patients at these ridiculous rates. It's not like we're getting a poor salary: we assume the risk of a small business and face bankruptcy if this doesn't work out. If you take a look at what kind of capital is needed today to establish a practice (something around 140K), you will understand why so few dentists are prepared to do it.
You may not have seen many poor dentists, but I know of people who went bankrupt or had to sell their homes to pay the debts of their practice. To put it bluntly: "To make a small fortune in NHS dentistry, you have to begin with a big fortune". Then of course, there are the crooked dentists who manipulate the system in order to milk money out of it. These are not that few and are to be blamed as much as the government.
I wouldn't object to being salaried... in fact, it would be my dream. I would like the NHS to come and buy my practice, assume all financial risks and keep me as a salaried dentist... I would be a happy bunny! Why isn't that ever going to happen? Because they know the true cost of running a practice. See, the NHS have already tried to set up their own practices, buying premises and hiring dentists. They called them dental access centres. Soon, they found out that it costs 5 times more to treat a patient than the cost to be treated by an independent contractor like me. Why? Because the foolish contractor has to survive on the poor NHS fee scale.
Why haven't we all gone bankrupt? Private treatment. Most NHS dentists do a mix of NHS and private treatment (bleaching, white fillings, the more expensive cosmetic options). In fact, that's what has kept the practices financially viable all these years. In effect, when someone pays for a private white filling, he subsidises the filling of a NHS patient (which may be done at zero profit or even at a cost to the dentist). And that's why practices won't take on new NHS patients, because it is absolutely vital that they keep the NHS-to-private ratio at a stable level. If a practice goes bankrupt, that doesn't help the patients, does it?
Sure I have rooms in my book for one more; it's because of my cavalier attitude that I'm 30 years old and still live in a rented 1bed flat without a car (so maybe you could say I live in the poor part of the town, although I don't have holes in my shoes). Problem is that you have to prepare yourself for a trip near London...
Which brings me to another point. If NHS fees are fixed over all the country, how do you expect dentists in London and the southeast to pay the bills? Another poorly thought decision by the government.
Gemmak, I understand your frustration and in the end you have to think about yourself, as we all have to. You were promised a service that we are unable to deliver anymore. Both you and I pay NI contributions, which have evolved into a 8% supertax, and for what? For having to wait 6 months to see a consultant and a few years to get an operation done? The whole health system is in a crisis and dentistry was never exactly a priority. It still isn't, despite what the government says. They promised everybody would be able to see an NHS dentist by October 2001... and four years later access is even worse than it used to be. Now they plan to solve this by importing poorly trained dentists from Eastern Europe. Believe me, worse times will come!
Anonymous:
Ongoing debate or not your reply points out to me something of which I was not aware, the fact that you are independent contractors with all the inherrent problems and set up costs that involves. I have to admit (loath as I am) that information alone puts a slightly different slant on my feeling of the situation, tho' presumably those that go into dentistry are aware of that at the outset?
As for why are lawyers and electricians not forced to work within the same restraints as dentists, I would say again that it was my belief that dentists, like doctors etc. are in a caring profession, lawyers and electricians are not. Perhaps I am naieve or out of touch but for me that is the difference. It is by no means to say I agree that anyone who is highly skilled should be under valued or under paid but that the moral duty of care seems to no longer exist. This sad state of affairs is not only restricted to dentists I admit..... but sad it is none the less.
I can see the frustration of the dental profession, it does seem, even to me, overty unfair but it still does not address the question of moral care either by government or yourselves, one just blames the other and we in the middle still remain in a state of rotten teeth.
I understand that you have to supplement NHS income with the cosmetic private work for those that can afford it but why then can I not even find myself a private dentist?
The question of fixed tariffs throughout the country is the same for many, I too have lived the life of the South East, struggling with a massive mortgage or high rent, on a salary barely higher than in other less expensive parts of the UK....how did I cope? I did three jobs for much of the time, have experience of bankruptcy and ultimately ended up in rented accomodation at 40 something. It's not right but it affects many professions.....most just don't have the ability to hold us all to ransom.
My apologies if this reply is a little disjointed, I really need to be in my bed.....a long underpaid day at work and all that.....
I thank you for your interesting points and giving me food for thought. I hope you take my points in the manner they are intended, not as an accross the board 'slating' of your chosen profession, rather my frustration at being caught between a rock and a hard place.
One last thing.......I am born and bred 'near to London', I visit there regularly, so a trip 'near London' presents me with no problem! I leave the ball in your court :o)
Anon, i have news for you..Lawyers ARE forced to work for the government.
Michelle, lawyers are not forced to work for the government. Those who want to participate in the Legalaid system do it, the rest don't. As a matter of fact, fees for Legalaid are so low that there is a huge level of fraud within the current system.
Gemmak, there is certainly a duty of care. Under the NHS, dentists would be both unprofitable and their patients would suffer from a low standard of care. So they go private to maintain a reasonable income and offer their patients decent treatment. You are right in that we start from the outset knowing what the score is, but the fact is that the situation has been eroding greatly for the last 15 years, each year with more fee cuts (while on the other hand unreasonable legislation ups the costs). As I said, if a dental practice goes bankrupt or ends up heing unprofitable, patients don't gain anything. It is my belief that the government knows it cannot (or will not) fund dentistry properly but they dont want to admit it. They're trying to force dentists to leave the NHS by leaving them with no choice, so that they can blame the "greedy dentists".
As for being like other professions, well you can't really blame someone for setting up HIS OWN business and not trying to make the best of it. Dentists go tthrough 5 years of intensive training, are expected to take new courses every year (and somehow find the money to pay them) and take huge loans to establish their practices. Why would anyone go through all that if it meant the government can hold him at ransom and that he's going to haver to take an oath of poverty or overwork and burnout?
As you're scottish, I believe you will find this article interesting http://news.scotsman.com/topics.cfm?tid=1254&id=145222005
it kind of explains the current situation, there a lot of articles in the web if you do a little search.
Now, for your personal problem. If you can't find a private dentist you're unlucky to live in an area with very few dentists (courtesy of the government when they closed down dental schools in the 90s). If you are prepared to go on a trip, you shouldn't have to go to London. If you go to www.nhs.uk and click on find a dentist, the website could inform you on who is accepting new patients, so you can find a dentist closer to you. Be prepared to make that trip several times, as the first appointment is usually only for an assessment/evaluation and treatment can take some visits. I won't give you my details, but if you want to come all the way down to Luton we have some practices here taking on new patients.
Michelle: I have to admit to not being aware of that.....can you expand for me please, I am interested :o)
Anonymous: The duty of care seems only to go as far as the consumers ability to pay. I agree that assuming dental practice is unprofitable under the NHS then the standars of treatment would suffer and hence the migration to the provate sector but that solves only the problem for dentists and those with the ability to pay at private rates. It does nothing but further alienate the majority of the population who, while dentists and the more comfortable among us thrive, relatively speaking, we Jane/John Doe's still have no options open to us.
I would be interested as to what you feel is the solution in the immediacy for the likes of us!
I do not of course blame anyone in any walk of life for trying to set up a business and make a success of it but the fact remains that whilst many dentists have lost thier business under the current system, most have not.
Whilst you have raised some interesting points and enlightened me some on the plight of dentists, I still do not see where from the dentists point of view there is genuine concern or care for those of us who cannot afford private treatment. I am still left with a feeling that ultimately the profession will blame government (and they you) and in the meantime the rest of us can go to hell, the one thing dentists will not do is treat patients privately or under the NHS at an affordable cost. Where is the care in that?
I appreciate that dentistry, like all forms of medicine is an expensive business, it is never going to be cheap but there surely must be some middle ground?
Where surgery is concerned etc. I may have to wait an interminable length of time but ultimately I can be treated, in dentistry I can't.
How does the BDA in one breath advocate the care of ones mouth and teeth and then in the next promote it's members in not assisting us to do that.
From a personal point of view I would be interested in your feelings regarding those, that for whatever reason as you see it, are unable to enjoy dental care. Do you morally write it off as the fault of someone else or do you have sleepless nights and genuinely worry?
One aspect of this strikes me hard. The current situation will ultimately be in the interests of the dental professional. 10-15 years from now, if not sooner, many of us through pain will be forced into treatment one way or another. This will either line the pockets of the dentists or cost the NHS a great deal in emergency treatments being carried out in A&E departments. From the point of view of the governments this is extremely short sighted is it not?
I think we are going to have to agree to differ. Whilst you have given me some insight and therefor sympathy with a dentists situation, it still seems to be more of the same that we hear in the media, dentists blaming the government and government blaming dentists. Irefer you to this article:
http://news.scotsman.com/topics.cfm?tid=1254&id=119262005
I am sure an income of £52,000 is not accross the board but I for one would be happy to be have half that income and live in London! I managed it on less.
Finally.....ain't it a small world? As you do not want to give me your details, and I fully understand that I cannot give you mine. I am for obvious reasons not prepared to identify myself to closely in this forum but suffice to say whilst I live in Scotland, I am not Scottish and you would be horrified at just HOW close to Luton I hail from and visit regularly. Lets just say that on occasion I stay in Luton and when I don't I am but a 15 minute drive away! I do appreciate that in reality tho', a dentist so far from my current home would not be practicle by the nature of the required multiple visits. You need not fear, I am unlikely to arrive on your doorstep for treatment...... tho' if you ever fancy this discussion face to face you know how to contact me! :o)
Firstly, let me say i have no idea on how competitive it is in the legal profession in the UK and that i can only comment on the way the system works here in Oz.
Anon, legal aid solicitors are no more "bent" than those in private practice here in Australia. Yes i agree legal aid funding is being cut back at an outrages rate however the affect is being felt with the shortage of legal aid solicitors, not the amount of fraud.
Perhaps the UK has a definite problem, as i said i am flying blind in dealing with UK issues.
Because of the competitiveness of the industry many are not able to practice in private law firms unless they "know" the senior partner to get a foot in the door so some are "forced" into taking up positions with the State government and work for the DPP. If they choose not to then they stay unemployed.
Ok, its not like being forced into working only for the government but if they make the decision not to take a position up with the DPP's office, legal aid funding is virtually non existant in many places and difficulty in gaining a position in private practice then what do they do? So yes, they are pushed into accepting a governemnt position.
An income of 52K is certainly very respectable (unfortunately I'm not anywhere near it), although most of it actually comes through the private options offered to patients . It's not too excessive, as the average income of a doctor is 70K and we are a surgical profession after all. The thing most people don't understand is that going fully private isn't going to do much about a dentist's income.
To make this more simple:
NHS: Low profit, but 40 patients/day + cheap materials = 52K.
Private: Higher profit, but 10-15 patients/day + modern materials/equipment = more or less the same.
Actually the situation in dentistry can be summed up like this:
Imagine you are a business owner and you have a small minimarket. One day, the government decides that it's everyone's right to get free food (or at least food at a greatly reduced cost). They set up an organisation called the National Food Service. People from the NFS visit you and say "We're sorry, but you can't charge whatever you want, these are the prices you should have". When you try to object they mention about everybody having to make sacrifices for thr good of society etc etc. So you shut up and operate in the new shceme of things. As years pass, the government sees that the NFS is just too expensive to maintain. There is a lot of demand (who doens't want free food), the budget is way too high, we have other needs, we need money to send our army to some third-world country. So, they cut the budget by lowering the prices and force you to take an income loss.
Soon, you are only able to afford the cheapest of food to sell to your NFS customers. You can only pay your staff the minimum wage possible. You are considering to take a pay cut yourself. Remember that the NFS hasn't bought you out; you are still responsible for paying your bills, premises and staff, but you are forced to work at their low profit margin.
But one day you decide you had enough. Your service to the people has been devalued for years, but you're not going to take it anymore. You abandon NFS food provision and the government of course retaliates by claiming you did for your own selfish reasons.
Your duty of care (to your clients, your staff and yourself) has dictated you that you had to abandon the awful, cheap NFS.
It is the government's responsibility to ensure that everyone has access to NHS dentistry, not the individual dentists'. Tony Blair made a promise in 1999 that everyone could have a NHS dentist by 2001. He made that promise, not us.
If you ask me what should be done, there is not a simple answer. The government should be made to understand that NHS underfunding has reached a critical level. Adding some extra bonus there, shifting funds around and changing the names of things isn't going to solve any problem. They could at least be honest about not being able to afford modern dentistry, which is as you've guessed a very expensive business.
NHS dentistry could remain as a viable "core" service: pain relief, extractions, simple fillings, dentures for pensioners etc. All the complex, cosmetic options should go. Managers and other parasites, which drain most of the budget, should also go so that more money can reach the front line where it is needed. NI contributions should be lowered accordingly to the loss of the service and people should be able to claim private healthcare expenses off their tax. I think thats the way forward.
I was going to comment here but I quickly realised that my comment would end up as an essay and since it's a personal experience and more lighthearted view I decided to blog it instead :)
Anonymous:
I like the analogy with the NFS and I can see where you are coming from, I still consider the situation appalling but I perhaps have more usnderstanding and a little more sympathy with the plight of dentists. That said....52k is a respectable income by most people's standards tho' I accept many earn less.
I agree wholeheartedly with your vision for the way forward, that the NHS should become a core service leaving the more expensive cosmetic etc. treatments to be financed privately. The option of lowered N.I contibutions to enable the purchase of insurance of some kind would be welcomed I'n sure. The worry is that many will still not take out that insurance.... but that being the case I suppose they then only have themselves to blame.
I am only too happy to pay for my treatment, providing the cost is reasonable. I need root canal work, that is prohibitively expensive but as I am unable to even get a 'check up' let alone an appointment it is unlikely that for the forseeable future I will nedd to raise that money.
This situation is complex, probably more so that I understood and I thank you for the time you have taken to comment but as an individual I remain dentist-less and it would appear that who ever the responsibility lies with ( I suspect compromise on both sides is required) I remain stuck in the middle of someone else's wrangle and ultimately it is we the consumer who is suffering, the government nor the dentist appears to be. The government make promises but won't provide a realistic budget and the dentists dig their heels in and take on no more clients other than a few privately paying ones.
The more people are forced to pay privately the less the government and dentists suffer and the less likely any one is to do anything about the situation. Everyone wins it seems barring the service user.
Catch 22!
.....and till I have root canal work not done.
I do root canal on a molar in a single visit, one hour start to finish. If you don't think Luton is too far away, maybe I can help you, with the understanding that nobody can offer you a guarantee for success with root canals. If you're interested, leave your mail in the forum. By the way, my name is George (getting tired of being called anonymous).
George: Hi, nice to have a name to go with the comments.
You can email me on:
say-it@gemmak.co.uk
....or from the link button in the sidebar. Cheers. :o)
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