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Borntobewild

The slow decay of dentistry

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38 minutes ago, malkynn said:

Except that a lot of states don’t have laws protecting dental practices in terms of ownership and a lot of practices in the states are owned by insurance companies. 

I wouldn’t say it’s all rosy in the states for dentists. 

I was at a course in Miami with dentists from all over the US and most of them were highly envious of our system up here compared to how their insurance system runs. Granted it varied by state.

The stories I heard weren’t pretty. So I wouldn’t assume that “just move to the states” would solve everyone’s problems. 

 

 

Yes some states do allow non-dentist to own a practice, there is ever increasing stress from insurance companies to reduce reimbursement rates but it’s kinda like a pick your poison when it comes to US vs Canada.

I think the situation in Canada will become so bad in the next 10years that the problems US dentists have with insurance will seem like a cake walk compared to the extreme over saturation we will have in Canada through the equivalency process.

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13 minutes ago, malkynn said:

I’m not an expert, but from what I understood, in several states there was no need to be a dentist to own a clinic. I could be wrong though. 

ETA:

https://benevis.com/content/can-a-non-dentist-own-a-dental-practice/

I did not know that, I still thought you needed to be a dentist to own a practise. My bad. Guess laws change all the times 

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12 minutes ago, member_225 said:

I did not know that, I still thought you needed to be a dentist to own a practise. My bad. Guess laws change all the times 

Yep. 

So many clinics are owned by actual insurance companies, which set their own fee guides and then pay their dentists fee guide minus 20% or 30%.

They also can dictate that once the patient’s maximum is met, that if the dentist is a subscriber to that insurance plan, that they cannot bill the patient beyond what their insurance covers. So even if the patient is willing to pay out of pocket, the dentist cannot do the work. It’s fucking criminal. 

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14 minutes ago, malkynn said:

Yep. 

So many clinics are owned by actual insurance companies, which set their own fee guides and then pay their dentists fee guide minus 20% or 30%.

They also can dictate that once the patient’s maximum is met, that if the dentist is a subscriber to that insurance plan, that they cannot bill the patient beyond what their insurance covers. So even if the patient is willing to pay out of pocket, the dentist cannot do the work. It’s fucking criminal. 

Insurance companies own practices? Are you sure? I’ve never heard this. Could you name a corporation owned by insurance? As far as I know, delta dental doesn’t own any practices. 

Not questioning your knowledge, I am just dumbfounded that I haven’t heard of it. 

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4 minutes ago, Borntobewild said:

Insurance companies own practices? Are you sure? I’ve never heard this. Could you name a corporation owned by insurance? As far as I know, delta dental doesn’t own any practices. 

Not questioning your knowledge, I am just dumbfounded that I haven’t heard of it. 

Question away. 

Again, I’m not an expert on this. I may have misinterpreted what I was hearing, I was so shocked by everything I was told. 

 

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2 hours ago, Borntobewild said:

Insurance companies own practices? Are you sure? I’ve never heard this. Could you name a corporation owned by insurance? As far as I know, delta dental doesn’t own any practices. 

Not questioning your knowledge, I am just dumbfounded that I haven’t heard of it. 

There are a lot of grey areas in dentistry in the US. I've also heard what malkynn is mentioning where insurance companies own dental practices and its becoming an issue in certain states. I have a few family members practicing dentistry in the US who graduated from Canadian dental schools and they aren't concerned at all though considering the income/property/sales taxes are lower and the dollar is strong. But, I agree the equivalency process in Canada is a concern with so many people coming and writing the equivalency exams (plus the ITD programs). There are a lot of threads on this issue but I'm not sure if we can do anything about it. Maybe its not in the interest of the government to close the equivalency process or something....

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Unfortunately the sad truth is that dentistry is going down in Canada. Just take a look at the numbers and you can see that the supply is way higher than demand.every year more and more foreign dentists get licensed, more and more grads come from Australia, Ireland, New Zealand (these universities take anyone with a heartbeat, no interview, no dat, no nothing!). Thats the sad truth and this is very difficult for dental students and dentists to digest. They can't face the fact that all these hard work and investment in their education is not gonna pay off in future and they will be struggling to make ends meet. Supply will continue to go up, demand will continue to decrease, your income will continue to go down, you will work longer hours with less pay, insurance companies will own you, corporations will take over and shit all over dentists. They will slowly choke you and throw you away. This is just the reality of our situations and its very sad. Unless we take action and fight against the system nothing will change and we will get screwed.  Dont wait till it all goes down! voice your opinion and fight till your last breath. You sacrificed a lot for this profession and you can't just let this happen to you. 

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42 minutes ago, Spack23 said:

Unfortunately the sad truth is that dentistry is going down in Canada. Just take a look at the numbers and you can see that the supply is way higher than demand.every year more and more foreign dentists get licensed, more and more grads come from Australia, Ireland, New Zealand (these universities take anyone with a heartbeat, no interview, no dat, no nothing!). Thats the sad truth and this is very difficult for dental students and dentists to digest. They can't face the fact that all these hard work and investment in their education is not gonna pay off in future and they will be struggling to make ends meet. Supply will continue to go up, demand will continue to decrease, your income will continue to go down, you will work longer hours with less pay, insurance companies will own you, corporations will take over and shit all over dentists. They will slowly choke you and throw you away. This is just the reality of our situations and its very sad. Unless we take action and fight against the system nothing will change and we will get screwed.  Dont wait till it all goes down! voice your opinion and fight till your last breath. You sacrificed a lot for this profession and you can't just let this happen to you. 

why cant the canadian government stop recognizing these foreign degrees? Canadian DDS rather than being cheaper doesnt seem to offer any other massive advantages. Even cost pales now because undergrad is needed and some foreign schools dont even ask for undergrad. Still tho, Canadian DDS will give u opportunity to practice in USA to make $$ without having to sacrifice 1 million$ in tuition.

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It’s unlikely that this will change due to government intervention.  The politics are not with dentists.  The public views dentists as greedy, cheating fat-cats, and that won’t change.  We will not get sympathy under any circumstances.  The only argument we have to make is one of quality patient care (competition leads to unscrupulous behavior).  

On the other hand, from the government’s point of view they are both letting immigrants practice their chosen profession and increasing access to care.  It’s politically expedient for any government to continue this process.  

There’s no real discussion among the dental associations about stopping it because their lobbyists know better.  

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5 minutes ago, Ostracized said:

It’s unlikely that this will change due to government intervention.  The politics are not with dentists.  The public views dentists as greedy, cheating fat-cats, and that won’t change.  We will not get sympathy under any circumstances.  The only argument we have to make is one of quality patient care (competition leads to unscrupulous behavior).  

On the other hand, from the government’s point of view they are both letting immigrants practice their chosen profession and increasing access to care.  It’s politically expedient for any government to continue this process.  

There’s no real discussion among the dental associations about stopping it because their lobbyists know better.  

this is freaking stupid. Doug ford might change things maybe. i agree dental care is expensive but thats not the dentist's fault. the government needs to prioritize Canadian DDS students. The only country that should have equivalence is USA. Instead of granting equivalence to NZ, Ireland, UK and Aus. The government can just open some more Canadian DDS schools charging higher tuition requiring lower GPA/DAT scores.

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If the ODA gets to meet with Ford or the health minister, they are going to discuss an actual realistic goal - getting social assistance dentistry reimbursement rates that don't end up actually costing the dentist money to see the patient.  I know this because I am part of the ODA political action committee.  Besides, the Ontario government has no mandate over federal licensing issues.

I believe strongly that in the next decade the major shift that will occur will be an end to the bottomless pit of money supplied to dental students by the banks.  When I got my loan 10 years ago the maximum amount you could get was $150K.  And that was when the number of new dentists each year was 40% lower than it is now.  Now the loans are, what, $275K?  At that rate is it unreasonable to assume you'll need $400K or even $500K to study dentistry in Canada 10 years from now?

No bank is going to give a collateral-free loan for $500K to a 21 year-old with no credit history when there's a good chance that they won't even break 6-figure income in their first few years of work.   

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2 minutes ago, strawberryjams said:

this is freaking stupid. Doug ford might change things maybe. i agree dental care is expensive but thats not the dentist's fault. the government needs to prioritize Canadian DDS students. The only country that should have equivalence is USA.

Governments aren’t in the business of making things fair, they’re in the business of getting and staying elected. 

We don’t represent a very big voter base and the voting public has very little regard for us. 

Protecting “rich greedy dentists” isn’t exactly a winning campaign strategy. 

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34 minutes ago, Ostracized said:

The only argument we have to make is one of quality patient care (competition leads to unscrupulous behavior).  

Which is a tough and dangerous sell because it only justifies the public perception that we are not trustworthy in the first place, which just confirms their already unfavourable view of us. 

It’s hard to defend the value of our industry while simultaneously throwing it under the bus. 

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35 minutes ago, Ostracized said:

If the ODA gets to meet with Ford or the health minister, they are going to discuss an actual realistic goal - getting social assistance dentistry reimbursement rates that don't end up actually costing the dentist money to see the patient.  I know this because I am part of the ODA political action committee.  Besides, the Ontario government has no mandate over federal licensing issues.

I believe strongly that in the next decade the major shift that will occur will be an end to the bottomless pit of money supplied to dental students by the banks.  When I got my loan 10 years ago the maximum amount you could get was $150K.  And that was when the number of new dentists each year was 40% lower than it is now.  Now the loans are, what, $275K?  At that rate is it unreasonable to assume you'll need $400K or even $500K to study dentistry in Canada 10 years from now?

No bank is going to give a collateral-free loan for $500K to a 21 year-old with no credit history when there's a good chance that they won't even break 6-figure income in their first few years of work.   

 And now, banks have started approving 350K starting this month. That should be alarming in itself. Tuition is rising rapidly I can only imagine what it will be when I graduate.

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1 hour ago, Ostracized said:

If the ODA gets to meet with Ford or the health minister, they are going to discuss an actual realistic goal - getting social assistance dentistry reimbursement rates that don't end up actually costing the dentist money to see the patient.  I know this because I am part of the ODA political action committee.  Besides, the Ontario government has no mandate over federal licensing issues.

I believe strongly that in the next decade the major shift that will occur will be an end to the bottomless pit of money supplied to dental students by the banks.  When I got my loan 10 years ago the maximum amount you could get was $150K.  And that was when the number of new dentists each year was 40% lower than it is now.  Now the loans are, what, $275K?  At that rate is it unreasonable to assume you'll need $400K or even $500K to study dentistry in Canada 10 years from now?

No bank is going to give a collateral-free loan for $500K to a 21 year-old with no credit history when there's a good chance that they won't even break 6-figure income in their first few years of work.   

There will certainly be a big shift in the next 10 years. Internationally trained dentist (trained outside of US, Aus, NZ) numbers only recently reached appreciable numbers (200+ yearly) in 2014 so we have yet to see the effects yet.

The US will likely see a flood of Canadian new grads in the next decade since they may have problems with saturation but theirs is mainly driven by new schools opening. But still the number of new schools in the US opening maybe increased the new grad numbers by 10-20% at most. The changes here in Canada has increased the new grads by almost 100% since 2011. 600 (2011) vs 1100 (2018). 

I agree that the US is the only country we should have an equivalency agreement with because:

1. Since the very beginning we have been exchanging professionals. A ton of Canadian dentists practicing I n the US for many many decades.

2. Their schools are comparable to Canadian schools in terms of standard.

3. Its the only agreement that is mutually beneficial. As mentioned earlier, a lot of Canadian grads in the US and a lot of US dentists in Canada. So the flow is both ways.

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6 hours ago, Ostracized said:

It’s unlikely that this will change due to government intervention.  The politics are not with dentists.  The public views dentists as greedy, cheating fat-cats, and that won’t change.  We will not get sympathy under any circumstances.  The only argument we have to make is one of quality patient care (competition leads to unscrupulous behavior).  

On the other hand, from the government’s point of view they are both letting immigrants practice their chosen profession and increasing access to care.  It’s politically expedient for any government to continue this process.  

There’s no real discussion among the dental associations about stopping it because their lobbyists know better.  

Thousands of immigrant doctors want to come and practise their chosen profession, why doesn’t Canada let them in? More doctors = more access to care. It’s because the numbers of doctors is regulated and continuously changed according to population needs. They should do the same with dentists. After all they’re all healthcare professions. At the end of the day, we don’t want dentists over treating their patients like doctors would do if they were over saturated. Correct me if I’m wrong 

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25 minutes ago, member_225 said:

Thousands of immigrant doctors want to come and practise their chosen profession, why doesn’t Canada let them in? More doctors = more access to care. It’s because the numbers of doctors is regulated and continuously changed according to population needs. They should do the same with dentists. After all they’re all healthcare professions. At the end of the day, we don’t want dentists over treating their patients like doctors would do if they were over saturated. Correct me if I’m wrong 

I think it has to do with public perception and how dentists are viewed. As a profession, dentists are viewed as greedy (like ostracized mentioned), money-oriented professionals. We're not viewed in the same light as physicians and haven't got much political influence on equivalency and control of foreign grads. But I do agree with what you're saying, its a tough situation.

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29 minutes ago, member_225 said:

Thousands of immigrant doctors want to come and practise their chosen profession, why doesn’t Canada let them in? More doctors = more access to care. It’s because the numbers of doctors is regulated and continuously changed according to population needs. They should do the same with dentists. After all they’re all healthcare professions. At the end of the day, we don’t want dentists over treating their patients like doctors would do if they were over saturated. Correct me if I’m wrong 

The government has to pay to train doctors in residency, and that's incredibly expensive.  There are barely enough residency spots for our own grads.  Then they have to pay them once they are out.  

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1 hour ago, Ostracized said:

The government has to pay to train doctors in residency, and that's incredibly expensive.  There are barely enough residency spots for our own grads.  Then they have to pay them once they are out.  

Wouldn't it be cheaper for the government to train foreign doctors in residency and then lower the renumeration as a whole? There's a reason why doctors are highly paid, and that's because they need to do their job right without thinking of over saturation or increased competition. I don't see why it's different for dentistry. 

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14 hours ago, strawberryjams said:

this is freaking stupid. Doug ford might change things maybe. i agree dental care is expensive but thats not the dentist's fault. the government needs to prioritize Canadian DDS students. The only country that should have equivalence is USA. Instead of granting equivalence to NZ, Ireland, UK and Aus. The government can just open some more Canadian DDS schools charging higher tuition requiring lower GPA/DAT scores.

Will he though? From what i remember of the elections, he promised to provide faster tracks for immigrants to get into their chosen professions. 

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I believe attempts at closing the door of the equivalency process and/or denying graduates of US/Ireland/New Zealand/Australia is a daunting task, one that is too politically involved for us to deal with.

I believe it is important for people to see that while saturation has hit the profession of dentistry and pharmacy significantly, it may not have hit the MD's to the same degree. I am not talking about specific specializations/sub-specializations; I speak of the big picture. The numbers are in the opening post for dentistry; pharmacy grads are mid-30/hour rates while tuition is expected to increase by almost 100% as the schools transition to PharmD; the combination of doubling tuition and decreasing wage is not a pretty sight. 

Mandatory residencies of varying duration (2 to 5+ years) are what allows MD's to prevent, or at least mitigate, the impact of saturation. Yes, it is artificial, yes it lengthens the process of becoming a practitioner, yes it reduces how long they can practice. However, I believe this is a sacrifice they make in order to protect the profession long term.

I, for one, would propose a mandatory 1 year residency requirement (akin to what they have in New York State, where everyone must complete a GPR or an AEGD) and here is a rough outline. It does not have the kinks sorted out but it is a thought in process. 

i) Accept X number of DDS's/DMD's that are eligible (Canadian grad/completed the equivalency process/international grad)

ii) Prioritize Canadian graduates (similar to how CaRMs picks CMGS first (and arguably USMDs but that's a topic for another day)) 

iii) Fill the remaining seats with international grads

iv) Upon completing the residency, they are ready to practice

It's difficult for legislature to go against the open door policy Canada has; it helps with immigration, it helps with lowering the costs for the patients, etc. 

What it may not help with is the quality of the dentist and the quality of care the dentist provides. 

While the priority should be the patients, it is hard for me to argue against the following notion: practicing dentistry to earn a living is a zero-sum game. 

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If the government is sleeping and not taking any measures to prevent Canadian students from going jobless - already in pharmacy and dentistry...who knows maybe MD is next. This stupidity needs to stop. Its common sense that domestic graduates need to be protected from foreign students (DDS and other students) so the jobs stay. If the government continues to ignore this issue, they wont stay elected for too long. The residency issue in med is joke, when CMGs are going unmatched, we continue to take iMGs. I seriously urge POLICY MAKERS of caanada go visit Australia so they know how PROTECTIONISM really works...in Australia there are alogorithms that prevent any IMG from getting match until all Australian domestic grads are matched. First, I think no politician really knows whats goin on and 2) they dont care/dont consider it a bigger issue. This next election - the political leaders have to focus on these issues on their campaign.

I think some common sense measures include;

1)stop granting DDS equivalence to countries outside of USA.

2) Ensure 100% match rate for CMGs and then give left over spots to IMGs. No dedicated IMG spots and a complete ban on having seats where both img and cmg can compete.

3)New policies to prevent pharmacy students from going jobless (no idea how).

 

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24 minutes ago, strawberryjams said:

2) Ensure 100% match rate for CMGs and then give left over spots to IMGs. No dedicated IMG spots and a complete ban on having seats where both img and cmg can compete.

There is an argument to be had where it should be merit-based. Quebec is the only province that does not do the whole dedicated IMG and CMG streams in the first iteration. As long as the IMG applying to Quebec residency spots has been vetted by the Bureau de cooperation interuniversitaire (BCI), then they can vie for the same spots as CMGs. To be vetted means (for IMG applying to Quebec), pass the MCCEE, either NAC or MCCQEII, and MCCQE1. The idea that CMGs should all match with the residual given to IMGs is one school of thought. The other is completely abandon streaming. If CMGs are truly meritorious in comparison to IMGs, CMGs might take back some of the previously IMG-designated spots. 

Edit: But there are obvious drawbacks to destreaming as well - without a truly meritocratic system, you run the risk of letting nepotism percolate more pervasively than streaming. So this destreaming change must be complemented by moving some standardized exam before the match. Quebec may also have gotten away with this bc 3/4 of the schools are francophone, so naturally there will be less IMGs being able to vie for those spots at those schools. 

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Australia was smart when it came to this dental school equivalency.  They opened up dozens of spots in each school (perhaps 100-200 spots per year across the country) for Canadian students.   Most of whom will return to Canada after.  

How many Australian students are studying dentistry in Canada?  I’d be really surprised if there were even 5 students each year.  We got played.  

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