Nigel Jones speaks to young dentists about whether the reality of practising dentistry matched their expectations…
As someone who has worked in dentistry for almost 30 years, I’ve seen the truly life-transforming impact that clinicians can have on their patients. The satisfaction this must give, is surely hard to match in other professions. And yet, there is a very real problem with recruiting and retaining new dentists.
Of course, alongside the positive feel-good factor of making a difference to your patients’ lives, there are many challenges: managing patient expectations, delivering the quality care you want to while working within the parameters of the NHS, mounting regulation, the fear of complaints and litigation, to name but a few.
With the current struggle around recruiting and retaining dental professionals, it seems as though the balance is tipping and the negative factors are out-weighing the positives. It may well be that for those entering the profession, their expectations of delivering this transformational dentistry is not matched by the reality of being a dentist, resulting in them deciding early on that it is not the career for them.
Already on the ‘treadmill’
To discuss this issue in more depth, I recently hosted a panel of young dentists to hear more about their experiences and opinions of joining the ranks of dental professionals. One of the dismaying things was to hear the phrase ‘treadmill’ – something that comes up a lot during conversations with long-standing NHS dentists – from those who are just embarking on their career.
Jasmine Lobo, who has recently completed her foundation year in a mixed NHS practice in Wales, expressed exactly that sentiment. She said, ‘I loved my practice and I was incredibly supported by the team there. However, one of the main issues I had was trying to do the best I could within the amount of time I had to spend with patients, which doesn’t necessarily mean doing the best dentistry I am capable of. Working under the time pressures of the NHS and the UDA-based system, I just ended up feeling like I was on a treadmill.’
Bethany Rushworth, an associate in a private practice, had experience of working in a mixed NHS and private practice as a dental nurse before beginning her degree. She said, ‘The practice I worked in was NHS until 4pm, and then private after that. It was the same staff using the same materials in the same practice, but at 4pm there was a shift in mentality of the staff, almost a palpable relief, that the time they could spend with patients was different.
‘Recently, I had an interview and was asked why I wanted to work in private dentistry if it wasn’t about the money. My reply was that I’d be happy to work in the NHS if I could spread 3,500 UDAs across five days, but I know that no principal is going to do that.’
The NHS stepping stone
David Bretton graduated in 2013 and is an associate in a private practice. He suggested the treadmill could be applied to the lack of career progression within the NHS and that is why so many view it as a “stepping stone” to private practice.
He said, ‘When I qualified I had a five-year plan to move into private practice, which is what happened. I think that NHS dentistry is great as a short-term plan to help you gain the clinical experience that you don’t get while studying – people are leaving dental school having done one molar-endo and are thrown into general practice.’
Petros Mylonas graduated in 2012 and, as well as working in private practice is also a Research Fellow at King’s College where he teaches dental students at King’s Hospital. He agreed that the majority of students see the NHS as something to be endured until they go private.
“When I qualified I had a five-year plan to move into private practice, which is what happened. I think that NHS dentistry is great as a short-term plan to help you gain the clinical experience that you don’t get while studying” — David Bretton
He said, ‘I think this is something they are picking up from social media a lot. Even though they have never worked in the system, they already have an opinion of it, so I try to instil in them that they are not learning to become an NHS dentist or a private dentist, rather they are learning to become a good dentist.
‘They see a lot of amazing things on social media around what can be achieved in private dentistry, but I try to keep them grounded and ensure they’re learning the skills they will need when they graduate, which they can then build on through other specialist courses. That way it’s not so much of a culture shock once they get into practice.’
A balancing act
Bethany raised the issue that many foundation dentists’ experiences of training in NHS practices will vary so much that it can lead to confusion, which adds to the feeling of being under-prepared for working life.
She said, ‘There is a discrepancy in terms of what different practices will provide on the NHS, so as foundation dentists some will be told ‘we don’t do white crowns on the NHS’, whereas others will, etc. This means you can leave foundation training confused about where the line is in terms of whether we’re aiming to make people clinically healthy on the NHS or are we acting in their best interest? If the patient was my relative, I would prefer them to have an implant compared to a removable denture.’
“I went into my degree with the intention of working for the NHS but it’s not viable.” – Jasmine Lobo
As well as clinical confusion, the hands-on training also brought to light the need to balance providing quality care within the parameters of an NHS system, something Jasmine described as her ‘biggest lesson’. She said, ‘As part of foundation training, we have to treat and present high-needs cases to our peers. This involves doing a financial analysis of the case so we would gain insight in to what it would be like as an associate. We found that in order to meet the needs of some patients as NHS associates, we would either make very little profit or a total loss to the point where we would have to pay for the patient’s treatment from our own pocket.
‘Forget all the clinical skills – that was the biggest lesson I learned about NHS dentistry. I went into my degree with the intention of working for the NHS but it’s not viable. It’s such a shame because I loved working in the practice and the actual career, but the system is unfair and I didn’t break my back studying for six years to be earning one or two pounds an hour for the work I do.’
David added, ‘You can be professional on the NHS and provide good quality care but it will come at a loss. You always hear that working in the NHS is swings and roundabouts – your five-minute children’s check-ups are funding your molar-endos, which does work in some practices. I was lucky that I was working in a good mixed practice in a low-needs area but could I transfer that to a busy NHS practice in a high-needs area? No.’
Careers outside of dentistry
Balancing professionalism within the financial and time constraints of the current NHS system is an oft-debated subject, and inextricably linked with the fear of complaints and litigation. The heavy focus on the latter during her studies, came as a surprise to Jasmine, ‘It’s something I never anticipated or expected about studying dentistry and becoming a dentist. This is why a lot of people are leaving the profession and looking at different careers, myself included. People often wonder why I delve into different things outside of dentistry, such as my microbiology degree and teaching languages. The truth is I do these things because I enjoy them but also so that I have a back-up plan.’
Anecdotally I am hearing about more and more dentists leaving the profession, often early on in their careers, to something entirely different – retail management and plumbing, are just two examples. It is, then, understandable that young professionals hearing this about their peers are giving themselves the escape route of a back-up plan.
But whilst it may be understandable, it’s also a tragedy for the profession, and surely one of the biggest problems it’s currently facing.
About David Bretton:
Dr David Bretton graduated from Newcastle University Dental School in 2013 and is an associate dentist at The Cosmetic Dental Clinic in Newcastle-upon-Tyne and Durham. He was the winner of ‘Best Young Dentist’ at both the 2017 Dentistry and Private Dentistry Awards. David is currently completing his master’s degree in endodontology and is a regional representative and committee member for the British Academy of Cosmetic Dentistry (BACD).
About Petros Mylonas:
Petros is currently a Research Fellow in Prosthodontics at King’s College London Dental Institute, and works as a part-time GDP in private practice. Petros graduated in 2012 and has completed his Dental Core Training and Academic Dental Core Training posts in restorative dentistry, oral surgery, oral medicine, and oral and maxillofacial surgery. He recently completed his Masters in Medical Education (MMedEd) from Warwick Medical School, specialising in curriculum development and e-learning content creation. He is currently the President of the King’s College London Dental Institute Postgraduate Researchers Society. He is past divisional member of the FGDP (UK) West Midlands Division, and past secretary of the BDA Hospitals Group West Midlands.
About Jasmine Lobo:
Jasmine qualified in June 2017 from the University of Leeds. She completed her dental foundation training in a mixed NHS-private practice. She currently works at Leeds General Infirmary in Oral and Maxillofacial Surgery. At university she was the co-founder and chairwoman of Open Wide, a widening participation organisation for those from underprivileged backgrounds wanting to pursue dentistry. She was the first dental student at Leeds University to intercalate in microbiology and currently sits on the Junior Advisory Board for Wesleyan financial services.
About Bethany Rushworth
Dr Bethany Rushworth graduated from the University of Leeds with distinction and worked in general practice in Sheffield providing both NHS and private treatment. She’s been awarded the Diploma of Member of the Faculty of Dental Surgery with the Royal College of Physicians and Surgeons of Glasgow and has a passion for education and an interest in restorative and cosmetic dentistry. She regularly lectures both dental students and qualified dentists, and works in private general practice.