The slow decay of dentistry

[Borntobewild 6]

Look at the number of dentist certified via the equlivalency process in 2017 vs the number of those who graduated in Canada.

https://ndeb-bned.ca/en/dental-programs/historical-pass-rates

307 vs 438

These dentists are from non-accredited programs.

Programs we have no idea about the quality or standard of care because no Canadian/Canadian recognized accreditation agency has even step foot in that school. 

To get a license here via the equivalency process only 3 exams have to be taken. But...

3 exams do not replace 4 years of education from an accredited program

That number is increasing every year. So what we have happening is the equivalent to almost doubling the Dental schools in Canada since 2012. If a country of 35million doubles its approved licenses for a particular profession... What do you think would happen to that profession?

Here are the myths, which used to be facts

1.Rural areas are not saturated

Dentistry is saturated already, this myth that the northern/rural areas are not saturated are a myth, just ask any rural dentist if there is enough dentist in his town.

2. Employment rates are high 

They are only high because there is plenty of associate jobs with only a part time patient load advertising for full time associate positions. In jobs like this you will have plenty of downtime not getting paid. You’ll see 2-3 patients a day etc

3.Buying a practice is the way to go

Not anymore because the dentist population ratio is so high now that it has increased the price of practices to ridiculous levels. After paying your practice loan, you will be left with an associates wage or less for dealing with the added stress of being an owner.

Its absolutely amazing how this profession decidedly committed sucide.

[PhD2MD 292]

Sad that it's a decaying profession

How will the system carie all of those all of those extra dentists?

 

[PhD2MD 292]

Young grads better brace themselves.

[strawberryjams 6]

1 hour ago, Borntobewild said:

Look at the number of dentist certified via the equlivalency process in 2017 vs the number of those who graduated in Canada.

https://ndeb-bned.ca/en/dental-programs/historical-pass-rates

307 vs 438

That number is increasing every year. So what we have happening is the equivalent to almost doubling the Dental schools in Canada since 2012. If a country of 35million doubles its approved licenses for a particular profession... What do you think would happen to that profession?

Here are the myths, which used to be facts

1.Rural areas are not saturated

Dentistry is saturated already, this myth that the northern/rural areas are not saturated are a myth, just ask any rural dentist if there is enough dentist in his town.

2. Employment rates are high 

They are only high because there is plenty of associate jobs with only a part time patient load advertising for full time associate positions. In jobs like this you will have plenty of downtime not getting paid. You’ll see 2-3 patients a day etc

3.Buying a practice is the way to go

Not anymore because the dentist population ratio is so high now that it has increased the price of practices to ridiculous levels. After paying your practice loan, you will be left with an associates wage or less for dealing with the added stress of being an owner.

Its absolutely amazing how this profession decidedly committed sucide.

Its possible to move to USA and make more money/find jobs. Also I doubt if DDS from other countries can specialize in something like OMS or orthodontics in Canada. Great points tho

[Coronaxtra 53]

I think it’s more about flexibility than anything. If your willing to work a little outside he GTA for example, you will find a good paying job and have the ability to build a practice. Or, you could move to the states as strawberryjams has mentioned but that would bring another set of issues. 

[drown besk 6]

1 hour ago, Coronaxtra said:

I think it’s more about flexibility than anything. If your willing to work a little outside he GTA for example, you will find a good paying job and have the ability to build a practice. Or, you could move to the states as strawberryjams has mentioned but that would bring another set of issues. 

What's wrong with the states

[Borntobewild 6]

1 hour ago, Coronaxtra said:

I think it’s more about flexibility than anything. If your willing to work a little outside he GTA for example, you will find a good paying job and have the ability to build a practice. Or, you could move to the states as strawberryjams has mentioned but that would bring another set of issues. 

Let me guess, you live or work in the GTA? The grass always seems greener on the other side. I work well North of the GTA. Its not at all the goldmine people in the GTA make it out to be.

Why?

Because these small towns are not increasing in population, if anything most of them are reducing in population. So say you have a town of 2000 people and 1 dentist. Hence 1:2000 ratio. 2 dentist move in within the next 10-20 years, more than likely considering the influx in the past 6 years. What happens? 1:630 ratio now. Boom more saturated than downtown Toronto (1:900 ratio). Dentistry will be dead unless smarter decisions are made by organized dentistry.

[member_225 69]

What are you going to do about it? Haha

[4mbition 4]

the problems caused by oversaturation resulting from people going to school abroad and coming back for certification affect a lot of professions. lawyers have it way worse.

i think only the medical profession has stayed relatively insulated from this problem because of the static number of residency positions which acts as a gatekeeping function.

[PhD2MD 292]

17 minutes ago, 4mbition said:

the problems caused by oversaturation resulting from people going to school abroad and coming back for certification affect a lot of professions. lawyers have it way worse.

 i think only the medical profession has stayed relatively insulated from this problem because of the static number of residency positions which acts as a gatekeeping function.

Good point. I would add pharmacy to that list of saturated professions. Tons coming back from England in particular.

[Xbox Skully 9]

Do you think the dental specialties are immune to the saturation?

[Xbox Skully 9]

Because of how few seats those programs have. 

[drown besk 6]

3 hours ago, malkynn said:

Why on earth would they be?

So they are equally saturated?

[Ostracized 82]

10 hours ago, Xbox Skully said:

Because of how few seats those programs have. 

There is a separate method for foreign trained specialists to become licensed in Canada.  The DSKCE which you can see on that NDEB link.  

[Borntobewild 6]

2 hours ago, malkynn said:

Except that the more saturated general dentistry becomes, the more generals take on specialty procedures, so the specialists aren’t just competing with each other, they’re competing with the generals upon whom they depend for referrals. 

When I was looking for work, almost all clinics were looking for a general who could help them refer out fewer specialty cases. 

Because specialists don’t have a monopoly on their procedures, they aren’t shielded from oversaturation in any way, and are in some ways even more vulnerable. 

Yes absolutely. GPs are already doing wisdom teeth, implants, IV sedation. OMFS will likely be hardest hit, maybe endo and ortho (with the yearly increasing indications for clear aligners) after.  Perio would be hit by less implants referred out. Even pediatrics may be hit with more sedation on kids...but it takes some balls to sedate kids imho.

But I always wonder why dentistry in Canada decided to open its borders to the WORLD. And when the equlivency process will end. Because it was available many years ago but shut down for a good while and then came back up. Correct me if I’m wrong

[DDSER 37]

I’m sure enough people feel the same way as you, why doesn’t anyone try to form some organization and do something about it. Complaining on forums doesn’t actually accomplish anything

[member_225 69]

Ultimately the patient suffers, dentists will try to over treat in order to maintain their incomes in face of the saturation. This is why it's a problem and needs to be addressed. 

[Friendlyapplicant 48]

13 minutes ago, member_225 said:

Ultimately the patient suffers, dentists will try to over treat in order to maintain their incomes in face of the saturation. This is why it's a problem and needs to be addressed. 

This is very true- my own family members were victims in being pressured to undergo unnecessary procedures

[member_225 69]

With less saturation, dentists will also be more inclined to refer out the necessary procedures to specialists without trying to keep them in house since they have more patients to take care of. The patients will be in better hands that way. Sadly, whoever decided on the equivalency process is digging dentistry in a big hole that will take a long time to fix 

[Borntobewild 6]

1 hour ago, DDSER said:

I’m sure enough people feel the same way as you, why doesn’t anyone try to form some organization and do something about it. Complaining on forums doesn’t actually accomplish anything

I am not entirely sure if this is true but the equlivalency process is associated with the Canadian Dental Accrediation Agency since they are responsible for accreditation.

Commission on Dental Accreditation of Canada 
1815 Alta Vista Drive 
Ottawa, Ontario K1G 3Y6 
Tel.: (613) 523-7114 
Toll free: (866) 521-2322 
Email: cdac@cda-adc.ca

Going to the US might become a very attractive option for Canadian trained dentists in the future since they ONLY approve licenses to dentists graduating from accredited programs hence Intertnationally trained dentists are unable follow suit. In fact many Canadians trained in the US are deciding to just stay in the US. Some states accept the NDEB written exam and OSCE for licensure such as Colorado and Washington state. Given of course that you have graduated from an accredited school as determined by the American licensing bodies such as the ADA.

[member_225 69]

5 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. 

 

Yea, even though you need to be a dentist to own a dental practise, they found a way around it and a lot of the practises are now not owner-operated.

[Borntobewild 6]

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.

[member_225 69]

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 

[Borntobewild 6]

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. 

[Incisor94 85]

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....