Pandemic/Post-Pandemic Dentistry

[VivaColombia]

https://ca.yahoo.com/news/p-e-dentists-adapting-covid-100000592.html

Have been hearing a lot of talk about how dentistry will be impacted going forward. Aerosol procedures are high risk and respirators are low in supply, high in demand in hospital settings. Once things ease up and slowly reopen dental clinics, their has been talk of stopping open-bay clinics for the time being, PPE change every single time you leave a room, less appointment slots to maximize social distancing and some talk about removing salary reimbursement if dentists become sick due to COVID-19 and have to isolate for 14-days. What do practicing dentists think will happen going forward? If PPE change and no open bay clinics become a new guideline, wouldn't that decrease efficiency significantly, devaluing practices? I feel for the new grads, who have debts to pay and want to move on with life but are just stuck. What do people think will happen with the dental industry moving forward?

[Ostracized]

I'm a dentist.  8 years out.  I've been off work since March 13.

It is my belief that I won't be working as a dentist again in the year 2020.

Dental offices are just about the worst place for the transmission of Covid.  Even after the shut down is eased up, it will be a long time before we can practice in semi-normality.  You can't compare us to other businesses like nail salons or furniture stores or even restaurants.  We spread salivary aerosols as part of the job.

People will need dental care.  That's a fact.  How will we balance the need for dental care, the need for the safety of staff and patients, and the need to make a living and pay the bills?  I certainly don't know the answer to that.  But if we cannot meet those three needs in an equilibrium, then there will be no dental care and no dental profession at all.

Fortunately for me, I have always been a saver by nature.  I will be 'ok' for a year or even maybe 2 years with no income or greatly reduced income.  But it will certainly push my theoretical retirement back by a long long time.

[VivaColombia]

2 hours ago, Ostracized said:

I'm a dentist.  8 years out.  I've been off work since March 13.

It is my belief that I won't be working as a dentist again in the year 2020.

Dental offices are just about the worst place for the transmission of Covid.  Even after the shut down is eased up, it will be a long time before we can practice in semi-normality.  You can't compare us to other businesses like nail salons or furniture stores or even restaurants.  We spread salivary aerosols as part of the job.

People will need dental care.  That's a fact.  How will we balance the need for dental care, the need for the safety of staff and patients, and the need to make a living and pay the bills?  I certainly don't know the answer to that.  But if we cannot meet those three needs in an equilibrium, then there will be no dental care and no dental profession at all.

Fortunately for me, I have always been a saver by nature.  I will be 'ok' for a year or even maybe 2 years with no income or greatly reduced income.  But it will certainly push my theoretical retirement back by a long long time.

Do you qualify for government assistance (wage subsidy, EI)? Or are you currently being paid through an insurance policy for a certain amount of time? I'm sorry to hear about this, all dentists are probably facing similar circumstances. And it sucks since people still have mortgages to pay and other expenses too

[Ostracized]

I am getting the CERB for a few months. 

[confused_student]

On 4/14/2020 at 7:59 AM, Ostracized said:

I am getting the CERB for a few months. 

What will you do instead?

[Ostracized]

1 hour ago, confused_student said:

What will you do instead?

Well, since then I have actually moved across the country and started a new job!

[dentistrydmd]

On 4/14/2020 at 7:35 AM, Ostracized said:

I'm a dentist.  8 years out.  I've been off work since March 13.

It is my belief that I won't be working as a dentist again in the year 2020.

Dental offices are just about the worst place for the transmission of Covid.  Even after the shut down is eased up, it will be a long time before we can practice in semi-normality.  You can't compare us to other businesses like nail salons or furniture stores or even restaurants.  We spread salivary aerosols as part of the job.

People will need dental care.  That's a fact.  How will we balance the need for dental care, the need for the safety of staff and patients, and the need to make a living and pay the bills?  I certainly don't know the answer to that.  But if we cannot meet those three needs in an equilibrium, then there will be no dental care and no dental profession at all.

Fortunately for me, I have always been a saver by nature.  I will be 'ok' for a year or even maybe 2 years with no income or greatly reduced income.  But it will certainly push my theoretical retirement back by a long long time.

"Dental offices are just about the worst place for the transmission of Covid." there is zero evidence for this statement. Bars, sporting events, gyms, and hospitals may be the worst places for transmission of covid, but given infection control procedures in dental clinics and clinics operating since the pandemic in many countries, there has not been one documented cluster from a dental office. 

[VivaColombia]

50 minutes ago, dentistrydmd said:

"Dental offices are just about the worst place for the transmission of Covid." there is zero evidence for this statement. Bars, sporting events, gyms, and hospitals may be the worst places for transmission of covid, but given infection control procedures in dental clinics and clinics operating since the pandemic in many countries, there has not been one documented cluster from a dental office. 

Tell that to the public...there is a lot of fear and misperception about dental clinics especially with the media  

[Ostracized]

9 hours ago, dentistrydmd said:

"Dental offices are just about the worst place for the transmission of Covid." there is zero evidence for this statement. Bars, sporting events, gyms, and hospitals may be the worst places for transmission of covid, but given infection control procedures in dental clinics and clinics operating since the pandemic in many countries, there has not been one documented cluster from a dental office. 

You’re right.  But there’s zero good evidence for a lot of statements going around about covid.  And I wrote that 3 months ago.  
 

I’m frankly very amazed though that dentistry is mostly going on ‘almost’ as normal right now across the country.  

[dentistrydmd]

On 7/13/2020 at 9:16 AM, Ostracized said:

You’re right.  But there’s zero good evidence for a lot of statements going around about covid.  And I wrote that 3 months ago.  
 

I’m frankly very amazed though that dentistry is mostly going on ‘almost’ as normal right now across the country.  

This is the result of watching the sensationalist news too much, especially in the USA. My concern is dentists shooting themselves in the foot to the harm of their patients by scaring them from going to dental clinics when in reality it is one of the safest places you can go to during this pandemic (given ppe and screening measures etc.). You have to look at the data and make your conclusions from the evidence alone. 

[juglas9]

On 7/13/2020 at 6:16 AM, Ostracized said:

You’re right.  But there’s zero good evidence for a lot of statements going around about covid.  And I wrote that 3 months ago.  
 

I’m frankly very amazed though that dentistry is mostly going on ‘almost’ as normal right now across the country.  

So what's the update with your status? Have you been working as a dentist again? What job were you working in the meantime? 

[Ostracized]

On 7/21/2020 at 5:45 PM, juglas9 said:

So what's the update with your status? Have you been working as a dentist again? What job were you working in the meantime? 

Yes. New job, new province.  I didn’t work for 3 months.  
 

I will say that you definitely need to be very flexible on location if you want to be doing well as a dentist. Altima corp in Toronto has dropped their compensation to 30%.  Only a few years ago, 40% was the norm in Toronto.  

[uwo2008PG]

On 7/16/2020 at 12:00 AM, dentistrydmd said:

This is the result of watching the sensationalist news too much, especially in the USA. My concern is dentists shooting themselves in the foot to the harm of their patients by scaring them from going to dental clinics when in reality it is one of the safest places you can go to during this pandemic (given ppe and screening measures etc.). You have to look at the data and make your conclusions from the evidence alone. 

Absolutely correct. I don't mean for this to be a dig at Ostracized, because in early April, we didn't have all the the retrospective data we have now, and also things seemed quite dim with new cases surpassing 500+ daily. We just didn't know. I just would caution how we react in times of uncertainty. Several media outlets really tried to sensationalize this with regards to dentists. Hygienists have been the most willing to jump on board to paint this profession as a "ticking time bomb", "death trap", and "the most dangerous job". These are direct statements they made in articles. Also, these articles were printed in June when we were allowed to resume work! I can understand pessimism back in April, heck, I had some concerns myself. However, by June, we should know better. Ultimately, the only case I know of a dentist with COVID in Canada was contracted at a major dental conference where.... they did not wear any PPE at the conference. We have nearly 2 months of procedures province wide in Ontario with our universal standard precautions with several manageable COVID specific measures, and there has not been, to my knowledge, a case traced back to any dental office. I have faith in the work my staff puts in daily to keep our patients, staff, and community safe. So regards to someone saying earlier about telling it to the public. I do! I also recommend you do too. Or at the very least we should not do harm by spreading misinformation. 

Fear-mongering and sensationalism ultimately prevents people from getting needed treatment, postponing restos then becoming endos, and also preventing us from using the skills we have trained nearly a decade for. I also have to say we *are* in health care. There are occupational hazards inherent in what we do. We don't need dentist appreciation days or posts, nor will we get them. But don your PPE and help your community. That includes not scaring them from getting required care without scientific basis. I do sympathize with a precautionary approach, but even prior to COVID, it was often stipulated that precautions need to be reasonable. The highest degree of precaution with be a negative COVID test verified and administered by the state to allow you to leave the house for that one day (ideally one trip to a single location on the most direct route - almost like with your RPAL). That is a great precaution, and no one can criticize you for not being safe, however, it is not reasonable nor practical.

Regarding our practice, we fortunately had a good stock of all PPE, including some N95s. I had one staff member come in daily to take phone calls and check messages, and I was on call with an assistant to come into the office to help to the best of my ability. We still tried our best to limit aerosol generating procedures. We saw 2-3 patients about 3-4 days a week for the months of March, April, and May. In June, with the revised guidelines, we opened up all the dental, and we brought back our hygienists relatively recently. Production is down with no polishes from hygienists (they suggested this due to discrepancies between the regulatory bodies), and my appointments tacking on another 10-15 minutes each. Tends to affect quick small fillings more than long endos. Overall though, we are doing well, and I haven't crunched the numbers since May, but I estimate to be back to 90% of pre COVID levels in the next few months. I do not know when COVID will leave us, but eventually once we start to add prophies again, and either get more acclimated to the new guidelines, or go back to the old guidelines, I have confidence the practice will meet and then surpass our prior financial metrics.

I will also say that production alone isn't a good measure of the financial health. The increased PPE costs have increased overhead. However, that is a whole other discussion, but there are ways to mitigate that. The CEWS is very helpful, and helps make up the difference in increased PPE and decreased production. We certainly qualified with a 30% loss of production without any hygiene, and the government has changed the program that even with a 10% loss in production you qualify. The CEWS has also been extended into the Winter. Payroll will likely be your biggest expense so the CEWS really helps close the gap.