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The slow decay of dentistry


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3 minutes ago, malkynn said:

I would recommend researching what the CDA actually does. Their mandate is limited. They don’t have the clout to do anything about this. They could try and fight tooth and nail on this and the government would smirk and say “that’s cute”

https://www.cda-adc.ca/en/about/membership/

Advocacy - Influencing outcomes that protect, promote, and advance the dental profession 

I think we have different meanings of protection 

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4 hours ago, McMarauder said:
30 minutes ago, malkynn said:

Advocating and influencing, yes, but that influence is limited. 

I get it. This shitty situation is shitty, but no matter how much you feel like someone should be protecting your future career, it ain’t gonna happen and you need to be prepared to handle that. 

I work with the CDA, if I thought someone there could fix this, I would be scheduling a meeting with them and hammering home that point. 

Ostrasized works with the ODA and he too is saying that they can’t do anything. 

Irwin Fegergrad from the RCDSO has said repeatedly that the government has no intention of budging on this. 

I don’t know what to tell you other than brace yourself, a great career can still be made in dentistry, but you will have to be savvy and good at identifying opportunities. 

 

I think things could be done. It's just that noones willing to really go out of their way to initiate the movement of any changes. But it's saddening how much power CDA has over these policies.

There could also be movements started by dentists themselves.. ex. though questionable, preference of hiring associates that are Canadian dental school grads, an organization set for more communication, information accessibility, etc for Canadian grads, etc

 

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5 minutes ago, drown besk said:

I think things could be done. It's just that noones willing to really go out of their way to initiate the movement of any changes. But it's saddening how much power CDA has over these policies.

There could also be movements started by dentists themselves.. ex. though questionable, preference of hiring associates that are Canadian dental school grads, an organization set for more communication, information accessibility, etc for Canadian grads, etc

 

I have seen several job postings that have stated "Graduates of Canadian dental school" listed as a criteria.  

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Honestly not down to study hard and get a 3.98 gpa to go to a Canadian dental school, then endure 4 years of rigorous training and education just to struggle to get a stable job cuz of someone with 3.45 gpa who paid for their degree elsewhere 

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No limit, more and more each year.  They opened up a testing centre in Hong Kong for crying out loud.

Pretty much a career path for many dental students in India is to get your BDS in India without ever having the intention to practice in India. I.e there are a lot of students in India getting their BDS just so they can write the equivalency exams and practice here.

The intention of the equivalency exams should have been to allow Canadian citizens with international dental degrees (refugees, long time immigrants) who are already living in Canada an alternative pathway (from the 2 years of dental school) to practice dentistry in Canada. Instead the program has opened the flood gates to Canada.

According to payscale.com the average salary of a dentist in India is 5-6k Canadian YEARLY. Compare that to the Canadian average. They would be stupid to not take the equivalency exams and move here.

 

Yes, different schools in different countries have varying levels of standards in regards to admission.

Yes, immigrants from other countries can come to Canada to practice dentistry and be more lucrative with their chosen profession.

However, those that go to countries outside of Canada or the immigrants that decide to come here to earn more money are not our enemies; they are not the ones to blame; they are part of the certified dental professionals and I would wager they came to this country to take advantage of the profitable field. That's fine, but if they don't do realize the issue that is at hand, they too will be affected. It's not about your friends you have in India that also want to take advantage of the equivalency process, or your friends that are also in Australia/Ireland/etc getting their DMD/DDS, it's about you, your income, your family, and your future. 

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Advocating and influencing, yes, but that influence is limited. 

I get it. This shitty situation is shitty, but no matter how much you feel like someone should be protecting your future career, it ain’t gonna happen and you need to be prepared to handle that. 

I work with the CDA, if I thought someone there could fix this, I would be scheduling a meeting with them and hammering home that point. 

Ostrasized works with the ODA and he too is saying that they can’t do anything. 

Irwin Fegergrad from the RCDSO has said repeatedly that the government has no intention of budging on this. 

I don’t know what to tell you other than brace yourself, a great career can still be made in dentistry, but you will have to be savvy and good at identifying opportunities. 

I agree, it's not easy to do anything about this and it's easier to go with the flow. However, I believe if we try to make a change at the provincial level first (not ODA or BCDA but  RCDSO, CDSBC, etc) we can make an impact.

Are there ways of adding requirements at the provincial level, so that you need more than a dental education, NDEB completion, and a jurisprudence exam? Like the aforementioned mandatory 1 year GPR or something of that like.

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For those already in the field, what advice would you give to incoming students who will be undoubtedly affected by this over-saturation? Is the problem becoming concerning enough that you wouldn't recommend the career? 

I'm not going into dentistry under the assumption that I will get rich. I come from a very poor family and am happy to live on little if it means I can do something that interests and challenges me, but I also don't want to go 300K+ into debt and not be able to pay that off... 

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4 hours ago, theberry said:

For those already in the field, what advice would you give to incoming students who will be undoubtedly affected by this over-saturation? Is the problem becoming concerning enough that you wouldn't recommend the career? 

I'm not going into dentistry under the assumption that I will get rich. I come from a very poor family and am happy to live on little if it means I can do something that interests and challenges me, but I also don't want to go 300K+ into debt and not be able to pay that off... 

It’s hard for me to give advice on this matter with great confidence because I am only one dentist, working in a terrible geographic location.  Although I keep as well informed as I can, most of what I can convey at an individual level is anecdotal (either of myself or colleagues).  

I’m hesitant to recommend dentistry even at the prices that are being charged for tuition by all but perhaps the least expensive Canadian schools.  Why?  Because if you have the aptitude to gain admission to a Canadian dental school, you have the aptitude to consider other careers with comparable lifetime earnings (adjusted for student debt) and far lower financial risk.  

Anyway I’m a pessimist.  I’m sure there are younger dentists still making bank in this country, even in saturated areas.  I myself am doing fairly well, and I probably earn more than most or all of my friends (with the exception perhaps of some lawyers).  But I work 5+ days a week and my time off is spent working in northern Canada a couple weeks at a time.  Boy, I’d love to get ‘paid vacation’ some day!

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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)?

 

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Well most of the members commenting on this thread are discussing the harsh realities pertaining to Ontario/BC. Outside those 2 provinces, dentistry is still a stable profession. Usually, over-saturation hits the the biggest of markets first and slowly spreads out. In your link, you can see this most of ON is now considered a "fair" outlook but used to be a "good" outlook; whereas every other province is considered "good". Also, the categories for outlook that jobbank uses aren't well defined and could extremely broad terms.

As others have pointed out, there's no stopping this declining trend (in outlook) as there is no 'cap/limit' to the equivalency process + rising debt for grads. 

Also, jobbank is probably using a simplistic formula when calculating outlook (b/c they have to do outlook for every profession)

incoming immigrants ( i.e. internationals whom have completed equivalency)  + school producing graduates - retirees

jobbank may be using an average of the last 5 years for incoming immigrants to simply analysis rather than projecting rising amt of internationally trained dentists (i.e. using 1000 immgriants rather than 1000+200x immigrants by yr)

TL;DR jobbank analysis is meant to give simplistic look and without more details, you shouldn't infer too much from their data 

 

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43 minutes ago, evanli78evanli said:

 

I would agree, as I am also from BC as well. I just don't want people thinking it won't affect other provinces given the facts from NDEB. 

1 hour ago, inquirer007 said:

 

I can't speak much for other jobs but I have family members in pharmacy and at least in BC, it is quite the doom and gloom situation as tuition has increased nearly double while wages continue to go down. Yet, jobbanks says there's a "shortage". I would think rural areas might be short on supply of pharmacists, but definitely not Vancouver or the GTA

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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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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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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, 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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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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