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Borntobewild

The slow decay of dentistry

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6 hours ago, inquirer007 said:

Why does this page from the government contradict everything said here, stating that there will be shortages in the future? 

https://www.jobbank.gc.ca/marketreport/outlook-occupation/4092/ca

Here's a quote : "Although this occupational group has had balanced market in recent years, projected job openings are expected to be substantially higher to job seekers, creating a shortage of workers over the 2015-2024 period"

Based on this report you would think the golden age of dentistry is coming back! I'm too cynical to trust the feds, but surely they can't be this out of touch (assuming the Doom and gloom talks bear some truth)?

 

 

There are tons of dental jobs and the incomes are much higher than the national average. This doesn’t account for the debt, of course. If you looked at what the average new grad can actually afford to spend, you would see than many are at or well below the national average.

Job bank isn’t wrong, it just isn’t seeing the whole picture.

A lot of clinics actually have a hard time staffing positions, and it’s suuuuuuper easy to find a job. It took me a day to have 7 jobs lined up when I was last looking.

That reality is not incompatible with what we are saying. 

Why is it so hard to staff those jobs? Because they are typically part time, evenings and weekends, with not enough patients to fill the schedule, so the dentist will make $0 for several hours that they are at work during the week, and the pressure put on them may be enormous and unethical. 

Or maybe the principal dentist is poaching all of the best work and using their associates as a dumping ground for everything they don’t want to do.

There are tons of reasons why a lot of associate positions are hard to keep filled.

Oversaturation doesn’t make it harder to find work, it actually makes it easier. It’s a lot harder to find *good* work and it’s A LOT harder to try and own, which leaves so many of us dependent on finding those harder to find quality associate positions.

See the problem?

 

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2 hours ago, malkynn said:

There are tons of dental jobs and the incomes are much higher than the national average. This doesn’t account for the debt, of course. If you looked at what the average new grad can actually afford to spend, you would see than many are at or well below the national average.

Job bank isn’t wrong, it just isn’t seeing the whole picture.

A lot of clinics actually have a hard time staffing positions, and it’s suuuuuuper easy to find a job. It took me a day to have 7 jobs lined up when I was last looking.

That reality is not incompatible with what we are saying. 

Why is it so hard to staff those jobs? Because they are typically part time, evenings and weekends, with not enough patients to fill the schedule, so the dentist will make $0 for several hours that they are at work during the week, and the pressure put on them may be enormous and unethical. 

Or maybe the principal dentist is poaching all of the best work and using their associates as a dumping ground for everything they don’t want to do.

There are tons of reasons why a lot of associate positions are hard to keep filled.

Oversaturation doesn’t make it harder to find work, it actually makes it easier. It’s a lot harder to find *good* work and it’s A LOT harder to try and own, which leaves so many of us dependent on finding those harder to find quality associate positions.

See the problem?

 

Yeah super easy to find a job because jobs with maybe 10hrs of chair time are advertised as “Looking for a full time associate in a busy office”. Yeah it’s busy but just for the owner. You’ll be in your office watching YouTube vids most of the time in these jobs. 

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Like Fairtrade coffee or Rainforest Alliance, should Canadian-trained dentists start certifying/branding themselves? I personally would choose a Canadian- or US-trained dentist over someone who has done the equivalency process. I think most patients would but they’re not aware of the issue. 

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35 minutes ago, No one said:

Like Fairtrade coffee or Rainforest Alliance, should Canadian-trained dentists start certifying/branding themselves? I personally would choose a Canadian- or US-trained dentist over someone who has done the equivalency process. I think most patients would but they’re not aware of the issue. 

Most patients don’t care. 

In 5 years I’ve had maybe a dozen people ask where I went to dental school. 

It’s also not permissible for licensed dentists to market themselves as more qualified than other dentists with the same license. 

Our advertising standards are incredibly stringent. Granted, most dentists with a website flagrantly violate these rules, but the rules are there nonetheless. 

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2 hours ago, No one said:

Like Fairtrade coffee or Rainforest Alliance, should Canadian-trained dentists start certifying/branding themselves? I personally would choose a Canadian- or US-trained dentist over someone who has done the equivalency process. I think most patients would but they’re not aware of the issue. 

Well nothing wrong with listing where you graduated from of putting a DMD or DDS behind your name instead or a BDS.

The concern with internationally (outside US,Aus,NZ,Ireland) trained dentists  is not an issue with fairness. When you’re working it doesn’t matter where you got your degree from or what grades you got in undergrad. It has to do with the fact that they graduated from non-accredited programs. Graduating from a dental school in India, a third world country or even Eastern Europe means that the standard of care you provide will be just that level: third or second world country 

If you’re uncomfortable getting your dentistry done by dentists in less developed countries then we should stop accepting graduates of those countries directly via the equalivency process.

My concern is not with Canadians that go to school in US, Aus etc. Because

1. Turth be told their education is at a higher level than in most Canadian schools. They are well trained.

2. It’s very much mutually beneficial that Canadian dentists can move to the US

3. The numbers going to those schools have remained stable and are not really increasing. Also consider that a good portion of them decide to stay in the country where they got their education

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2 hours ago, No one said:

Like Fairtrade coffee or Rainforest Alliance, should Canadian-trained dentists start certifying/branding themselves? I personally would choose a Canadian- or US-trained dentist over someone who has done the equivalency process. I think most patients would but they’re not aware of the issue. 

I'm not sure that's the best criteria in picking a dentist...unless you meant "with all things being equal, I'd pick the Canadian graduate".

It's no secret to my patients that I was trained in Australia, as it is in my bio on the office's website, and reception have introduced me to patients as dr. ____ from Australia.

So far no one has declined to see me because of where I was trained.  In fact, it's a great topic of discussion, and it allows me to build rapport with my patients, which is what most patients value when looking for a dentist.

 

 

 

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5 minutes ago, McMarauder said:

I'm not sure that's the best criteria in picking a dentist...unless you meant "with all things being equal, I'd pick the Canadian graduate".

It's no secret to my patients that I was trained in Australia, as it is in my bio on the office's website, and reception have introduced me to patients as dr. ____ from Australia.

So far no one has declined to see me because of where I was trained.  In fact, it's a great topic of discussion, and it allows me to build rapport with my patients, which is what most patients value when looking for a dentist.

 

 

 

The schools there are accredited. Standard of education and care in Australia is high. No patient would mind. The concern is that:

3 exams can not replace a 4 year education from an accredited school

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19 minutes ago, Borntobewild said:

The schools there are accredited. Standard of education and care in Australia is high. No patient would mind. The concern is that:

3 exams can not replace a 4 year education from an accredited school

To clarify, this is what I meant. Something to represent graduates of accredited schools (including US, Aus, etc). I don't think patients care because they assume all licensed dentists are equally qualified. If they learned how many new dentists are coming from non-accredited programs, I think they would do more research when picking their dentist.

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1 hour ago, Borntobewild said:

 

 

24 minutes ago, No one said:

 

The equivalency process is not meant to replace a 4 year education from an accredited school, that's not the point of NDEB. The NDEB serves to maintain a, "national standard of competence for dentists in Canada" (https://ndeb-bned.ca/en/about)

The point of board exams in many professions is to ensure the certified individuals meet the bare minimum to practice. In dentistry's case, it is to ensure they are able to provide care at a level that does not cause harm, but more importantly, they are capable of learning how to treat.

If they passed the NDEB, Canada as a nation is telling the public, this person is adequate to practice dentistry in the country. 

 

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10 minutes ago, No one said:

To clarify, this is what I meant. Something to represent graduates of accredited schools (including US, Aus, etc). I don't think patients care because they assume all licensed dentists are equally qualified. If they learned how many new dentists are coming from non-accredited programs, I think they would do more research when picking their dentist.

You realize that you are talking about the same patient base that generally thinks it's reasonable and low risk to get their implants in Mexico, right???

I think people here are drastically over estimating the concern that patients have with respect to where and how their dentists were trained. I don't think many of them give it too much thought, nor do I think that knowing about accredited vs non accredited programs would change people's decision making process when it comes to choosing a dentist, which is primarily determined by location and availability of parking.

The ones who do care will primarily look for online reviews and recommendations from friends and family, and probably won't be dissuaded from someone who comes with glowing reviews just because they were trained in a foreign country at a non-accredited school.

Do you genuinely believe that all dentists from non-accredited schools should be branded as inferior in some way? Would this matter to anyone if it wasn't creating a over-saturation problem? I get that people want to be protectionist, and I don't disagree with it at all even though it won't happen. However, let's not conflate wanting to protect Canadian dentists with character assassinating foreign dentists. 

One of my dearest friends was trained in India, was an excellent clinician, and now retired from practice, teaches at a top school in the US. I would sooner trust her with my teeth over any of you here, no offense. 

 

 

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1 hour ago, Stethescope said:

 

The equivalency process is not meant to replace a 4 year education from an accredited school, that's not the point of NDEB.

 

Yes obviously that isn’t the point of the NDEB. Anyone who took their exams would realize that. But the problem remains that Canada is giving licenses to graduates of schools which we have no idea the quality of. And 3-4 exams do not determine if they will be able to provide a standard of care comparable to graduates of accredited schools.

Exams+graduation from an accredited school would be more reflective of competency.

However the NDEB has replaced the requirement of graduating from an accredited program with more exams. In their eyes those 3 new exams are equivalent to passing 4 years of dental school from an accredited program in terms of assessing the competency of a potential practioner 

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2 hours ago, malkynn said:

You realize that you are talking about the same patient base that generally thinks it's reasonable and low risk to get their implants in Mexico, right???

 

2 hours ago, malkynn said:

However, let's not conflate wanting to protect Canadian dentists with character assassinating foreign dentists. 

Just found it funny how you character assinated Mexican dentists and then advocated against character assinating foreign dentists. No hate, I respect you in these forums. Just that it made me laugh out loud.

And I agree, once you get your license you should be judged on the history of work you do, not where you graduated from.

However, I have spoken to many practice owners who have told me that they do not hire Internationally Trained Dentists (ITDs) because they’ve had bad experiences having them as associates, in regards to their treatment of patients and ethics.  This has also been said to me by ITDs who own practises; that they won’t hire other ITDs as associates.

Obviously it’s completely wrong and inaccurate to blanket all ITDs as unethical. But it seems to me that this problem is common enough for owners (including other ITDs) to prefer Canadian, US and Aus grads over them. It kinda says something about the equivalency process.

With that being said, their exams are much harder, with very low pass rates. Rumours are that there is a negative bell curve applied so instead of requiring 75 to pass, you require 85. This whole situation is not fair to them or their families either.

I have great respect for those that went through the equalvaency process because of how hard and draining emotionally it is.

But still, it is a broken system not only to them but also to dentists in Canada and the public. And the statistics of the low past rates are there for them to see before they start the process hence they should be prepared for the roller coaster.

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42 minutes ago, Borntobewild said:

 

And really, I agree with your points for the most part.

A lot of this has to do with politics in my opinion (immigration, accepting professionals from all countries, not just USA/Ireland/etc). To play politics, you need to involve money.

The equivalency process generates millions of dollars in revenue, where they have the test 3 times a year:

https://ndeb-bned.ca/en/non-accredited/fees for non-accredited school graduates

https://ndeb-bned.ca/en/accredited/fees for accredited school graduates

There is zero incentive for NDEB to think about limiting the seats.

Perhaps adding more hurdles i.e generating more revenue through processing fees might be plausible but how would one lobby for that?

It would be more feasible in terms of logistics to start a change at the provincial level, i.e. CDSBC, RCDSO, ADAC. 

It is one of the reasons why I refer to states like New York and Delaware where they have a mandatory 1 year residency requirement. Have the revenue generated by the resident divided for the clinic sponsoring the residency, the provincial governing body, and a stipend for the resident. The governing body gains money, the owner of the clinic gains money, the resident loses a year of income in the hopes of protecting their job outlook. 

 

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1 hour ago, Borntobewild said:

 

1 hour ago, Borntobewild said:

 

Just found it funny how you character assinated Mexican dentists and then advocated against character assinating foreign dentists. No hate, I respect you in these forums. Just that it made me laugh out loud.

And I agree, once you get your license you should be judged on the history of work you do, not where you graduated from.

However, I have spoken to many practice owners who have told me that they do not hire Internationally Trained Dentists (ITDs) because they’ve had bad experiences having them as associates, in regards to their treatment of patients and ethics.  This has also been said to me by ITDs who own practises; that they won’t hire other ITDs as associates.

Obviously it’s completely wrong and inaccurate to blanket all ITDs as unethical. But it seems to me that this problem is common enough for owners (including other ITDs) to prefer Canadian, US and Aus grads over them. It kinda says something about the equivalency process.

With that being said, their exams are much harder, with very low pass rates. Rumours are that there is a negative bell curve applied so instead of requiring 75 to pass, you require 85. This whole situation is not fair to them or their families either.

I have great respect for those that went through the equalvaency process because of how hard and draining emotionally it is.

But still, it is a broken system not only to them but also to dentists in Canada and the public. And the statistics of the low past rates are there for them to see before they start the process hence they should be prepared for the roller coaster.

Sorry if I don’t find it so funny. 

There’s a huge difference between getting work done by an international grad who is licensed to work in a country where the standards are incredibly high vs getting work done in a country with extremely lax standards and virtually no legal recourse for mistreatment of patients.  

Comparing my two statements as equivalent is wholely inaccurate and not particularly appreciated.

If there are problems with ITDs on average, then that absolutely is an issue that needs to be addressed, and it sucks if patient care suffers in the meantime. 

However, I’ve seen plenty of sketchy shit from Canadian dentists, so I’m not about to support measures that brand Canadian grads as fundamentally superior because I don’t think it helps the problem. 

That doesn’t mean that I don’t think that better measures to evaluate or train foreign dentists is a good idea, that doesn’t mean I think the equivalency process is sufficient, I’m just unwilling to paint them all as inferior. 

Now excuse me while I go prepare to handle the nightmare case of dentistry from Mexico that landed in my chair, referred to me by a respected denturologist who is at a loss at to how to handle the cluster fuck that the guy came back with. 

So yeah, sorry if I don’t find it funny. 

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1 hour ago, malkynn said:

Sorry if I don’t find it so funny. 

There’s a huge difference between getting work done by an international grad who is licensed to work in a country where the standards are incredibly high vs getting work done in a country with extremely lax standards and virtually no legal recourse for mistreatment of patients.  

Comparing my two statements as equivalent is wholely inaccurate and not particularly appreciated.

If there are problems with ITDs on average, then that absolutely is an issue that needs to be addressed, and it sucks if patient care suffers in the meantime. 

However, I’ve seen plenty of sketchy shit from Canadian dentists, so I’m not about to support measures that brand Canadian grads as fundamentally superior because I don’t think it helps the problem. 

That doesn’t mean that I don’t think that better measures to evaluate or train foreign dentists is a good idea, that doesn’t mean I think the equivalency process is sufficient, I’m just unwilling to paint them all as inferior. 

Now excuse me while I go prepare to handle the nightmare case of dentistry from Mexico that landed in my chair, referred to me by a respected denturologist who is at a loss at to how to handle the cluster fuck that the guy came back with. 

So yeah, sorry if I don’t find it funny. 

You are still slating Mexican dentists whether you admit it or not because the quality of work done by healthcare practitioners around the world should not depend on the fear of legal recourse. If it does then they are unethical. Hence you are essentially calling them unethical.

You can’t slate a group of foreign dentists while simultaneously saying you don’t see them as inferior.

Its a funny point of view, to put it in the kindest way.

Good luck with your work

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30 minutes ago, Borntobewild said:

You are still slating Mexican dentists whether you admit it or not because the quality of work done by healthcare practitioners around the world should not depend on the fear of legal recourse. If it does then they are unethical. Hence you are essentially calling them unethical.

You can’t slate a group of foreign dentists while simultaneously saying you don’t see them as inferior.

Its a funny point of view, to put it in the kindest way.

Good luck with your work

I’m going to politely stop participating in the debate because it’s starting to aggravate me.

 

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8 hours ago, malkynn said:

Most patients don’t care. 

In 5 years I’ve had maybe a dozen people ask where I went to dental school. 

It’s also not permissible for licensed dentists to market themselves as more qualified than other dentists with the same license. 

Our advertising standards are incredibly stringent. Granted, most dentists with a website flagrantly violate these rules, but the rules are there nonetheless. 

I've heard the same and I gotta agree. If they pass the exams, they are accredited. But I do think that Canadian Boards should be more practical based cause right now they don't involve any clinical work unlike the US board exams where you have to work on patients for your boards. I think this would probably filter out more foreign applicants. 

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On 7/12/2018 at 12:59 AM, No one said:

Like Fairtrade coffee or Rainforest Alliance, should Canadian-trained dentists start certifying/branding themselves? I personally would choose a Canadian- or US-trained dentist over someone who has done the equivalency process. I think most patients would but they’re not aware of the issue. 

That is a horrible way to pick your healthcare practitioners...........
If you think that the Canadian or US system is superior, then I fear you are quite ignorant of the fact that there are many countries that produce very qualified doctors/dentists. 

Some of these people who are passing the equivalency process are actually specialist from their own respective countries.
Now i'm not gonna say you're completely wrong as to there are some countries that produce lower-tier graduates or their graduates are just not trained as well as graduates from Canada/US/Aus/Uk/Ireland/Europe. 
Even within these countries there is a HUGEEEEEEEEEE variation between the amount of clinical work that their graduates do prior to being "let free" on the public. 

I've heard Canadian dental grads only doing 1 extraction and maybe 1 root canal before they graduated from dental school IN CANADA. Would you trust yourself with a dentist like that? 
Or would you prefer someone who graduated from a "non-accrediated program" who's completed the equivalancy process and has done thousands of these procedures? 

just my 2 cents 

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1 hour ago, cookiemonster99 said:



I've heard Canadian dental grads only doing 1 extraction and maybe 1 root canal before they graduated from dental school IN CANADA.  

just my 2 cents 

Well that’s a slight exaggeration but it’s true that many Canadian school are severely lacking in clinical experience.  And that’s a separate but related issue.  

After you graduate you NEED a year or two (or more!) of clinical learning before you are really a capable dentist.  That means you need a) a good mentor to help you when you get stuck and b) lots of patients to practice on.  I’m 6 years out of school and I’m still learning all the time and still finding knowledge gaps more than I’d want to admit.  

So another concern for new grads in our increasingly cut-throat system is lack of clinical growth, on top of financial concerns.

 

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10 hours ago, Ostracized said:

Well that’s a slight exaggeration but it’s true that many Canadian school are severely lacking in clinical experience.  And that’s a separate but related issue.  

After you graduate you NEED a year or two (or more!) of clinical learning before you are really a capable dentist.  That means you need a) a good mentor to help you when you get stuck and b) lots of patients to practice on.  I’m 6 years out of school and I’m still learning all the time and still finding knowledge gaps more than I’d want to admit.  

So another concern for new grads in our increasingly cut-throat system is lack of clinical growth, on top of financial concerns.

 

 

I agree that Canadian Dental students graduate with insufficient clinical experience. In fact, US and Aus schools are generally far superior to Canadian schools in terms on clinical experience. There’s a reason that these schools are accredited.

Dentistry is changing. General dentists are doing more “traditionally specialist” procedures e.g implants, wisdom teeth ext, biopsies, clear aligners etc. So the concept of a 1-2 year residency is much more relevant today.

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11 hours ago, Ostracized said:

Well that’s a slight exaggeration but it’s true that many Canadian school are severely lacking in clinical experience.  And that’s a separate but related issue.  

After you graduate you NEED a year or two (or more!) of clinical learning before you are really a capable dentist.  That means you need a) a good mentor to help you when you get stuck and b) lots of patients to practice on.  I’m 6 years out of school and I’m still learning all the time and still finding knowledge gaps more than I’d want to admit.  

So another concern for new grads in our increasingly cut-throat system is lack of clinical growth, on top of financial concerns.

 

Well....I'm not sure about all of the dental schools in Canada but yes there are grads in Canada that graduated with very minimal clinical experience compared to some US or Aus schools. 
I do agree everything else you've said. 
The amount of practices in major cities that are looking for people who can just step in and complete "complex" work is increasing and mentorship in major cities may also be lacking due to competition. Not to say there aren't any opportunities available but it's becoming rarer and rarer. 

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On 7/13/2018 at 9:20 PM, cookiemonster99 said:

Well....I'm not sure about all of the dental schools in Canada but yes there are grads in Canada that graduated with very minimal clinical experience compared to some US or Aus schools. 
I do agree everything else you've said. 
The amount of practices in major cities that are looking for people who can just step in and complete "complex" work is increasing and mentorship in major cities may also be lacking due to competition. Not to say there aren't any opportunities available but it's becoming rarer and rarer. 

Absolutely, associate opportunities are very low in Canada right now. Even northern jobs have multiple interviewees. Times are changing due to the equivalency process...I predict that in the next 5 years, new grads will not even be able to find multiple part time jobs equal to full time employment 

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On 7/16/2018 at 5:44 PM, Borntobewild said:

Absolutely, associate opportunities are very low in Canada right now. Even northern jobs have multiple interviewees. Times are changing due to the equivalency process...I predict that in the next 5 years, new grads will not even be able to find multiple part time jobs equal to full time employment 

Every new graduate from my school I know has lined up a job before or right after graduation. Some full time. Golden Horseshoe region.

YMMV

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3 hours ago, Steins;Gate said:

Every new graduate from my school I know has lined up a job before or right after graduation. Some full time. Golden Horseshoe region.

YMMV

The issue is NOT finding work.  The issue is finding quality associateships where you are sufficiently busy, and are learning on the job.  Full/part time doesn't really mean a thing in dentistry.  You can have multiple part time jobs, and make a killing if each clinic is busy.  On the flip side, you can be full time at a clinic that is dead making barely anything.   Dentists are paid on commission (~40%) - if you see a lot of patients and do a lot of treatment, you will make more money.  If you're working at dead clinic that is in a plaza with 5 other dental clinics around, you'll make very little.  40% of 0 is 0.

That's just one thing oversaturation is doing - there's not enough work for everyone.  One of the sad outcomes of this is that dentists start "looking" for things to do when the finally get their hands on a patient, whether it is necessary or not...

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