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Extortionate dental care is our national disgrace

Having that hard, white stuff in your mouth fixed up at a reasonable cost should not be such a pipe dream — the Brits do it at low cost. It’s unacceptable that dentistry is so unaffordable in Australia.

Dentist chair

Hello hello, this is your dentist calling.” It was 7.45 on a grey London morning, and there he was on the phone. “It is time for your check-up.” Was this real? Was I awake, or dreaming it? Was he outside the front door? Only the fact that my dentist is a British Asian with an Indian lilt stopped it from being the opening scene of some sort of slasher movie.

But that’s what a genuine public health system looks like. Dental care, like all other health care in the UK, is free, and the dentists hound you whenever your six-month appointment comes due. It’s a neat little system, based on the inherent paternalism of the NHS — in order to get free care, you have to be registered with a local dentist, and in order to stay registered, you have to go for a regular check-up (thus letting the dentist click over her/his fees from the government).

Should you skip it, you’ll be thrown off the dentist’s list, and when you have a real dental emergency you’ll be stuffed. Even then, there is always one free clinic in each major city that will see you, free, no questions asked, with a two to three-hour wait and a fast track for those in great pain.

The London one is in the Whitechapel Hospital, a towered Gothic extravaganza, close to Jack the Ripper’s old haunts. Using it is like being drafted into a Victorian painting: hours passed in a tiled waiting room, steam on the windows, children screaming, South African dentists coming out for their next case, with blood on their apron and pliers in their hands. But they have lovely lovely gas, and no one gets turned away.

That’s an essential part of any health service. That it’s never been a part of the Australian Medicare system is a standing disgrace — both to the Hawke/Keating who failed to fully integrate it into the Medicare system from the start, the Howard governments who stripped $100 million out of such services as there were, and the Rudd/Gillard government, who cancelled the chronic care dental scheme and had to be dragged towards a Denticare scheme kicking and screaming by the Greens.

There was one push by a major party to have guaranteed dental care for Australians, by opposition leader Kim Beazley. Unfortunately, Bomber, with unerring political savvy, announced the policy on the day the US invaded Iraq and it rather got lost in the melee. Nothing is easier to ignore, since anyone who can afford it will pay whatever they need for dental care when a crisis hits. Those who can’t — the old, the poor, indigenous people disproportionately — suffer in silence. Free and low-cost clinics are locally managed, ad hoc and often more or less invisible to the people who need them most.

But now there’s been movement on this issue, the Dental Association has come to the party — by suggesting we should be training fewer dentists, so that those who make it through can continue to charge through the nose for working in your mouth. This is despite the fact Australia has only a fair to middling ratio of dentists to population — about 1:2000, compared to something closer to 1:1200 in Northern Europe and Japan. The US ratio is halfway between, but is skewed because about 20% of the population get no dental treatment whatsoever.

The public-spirited thing for the Dental Association to do would have been to call for more funding, so that all these new dentists — coming through new dental schools at places such as James Cook and La Trobe, all of which the Dental Association objected to — would have work to do. Given the ADA is complaining about underemployment of some dentists, and that the waiting times for free dental clinics is averaging three years, that would seem the obvious solution.

The greatest disparity is between rural and urban services, with, for example, beachside Sydney having five times the number of dentists of rural NSW.”

But of course the other thing the ADA wants to protect is pricing, and high labour costs, to preserve the stupendous income potential of the members within the charmed circle. Just as the AMA used to be known as “the Painters and Doctors Union” for its rigorous exclusion, the dentists are a sort of Molarside Workers Federation, protecting their own.

The aim is not merely to keep fees high — it is to make them look inevitably high, as if the sheer and often urgent necessity of the service is somehow a “natural” reason for its huge costs. That is nonsense of course. Whatever material costs are involved in things like caps and crowns, the major cost is the hourly rate for the dentist’s time. In the Whitechapel chamber of horrors in the ’90s, I had a three-session root canal and the eventual cost was … 14 pounds. You can be sure that the UK government wasn’t refunding that dentist the 986 pounds or so that I would have been charged as a private patient.

The magical nature of dentistry — that having some white hard stuff in your mouth fixed should be something you have to save up for, tremble in fear over at night — needs to be demystified, just as the old idea that a doctor’s appointment was a luxury not a right has been knocked down.

Essential to that is lowering the expectation that medical training is the pathway to a ludicrous income, rather than merely a decent one. There has been some movement towards this, with the creation of a dental internship scheme. But at the same time the Chronic Disease Dental Scheme was closed because treatments billed to it had ballooned to $3 billion, from a projected $600 million or so. Had the Greens not pushed for Denticare and the Dental Health Reform Package as a replacement, Labor would have been happy to allow public dental treatment to lapse into its previous slipshod state.

The greatest disparity is between rural and urban services, with, for example, beachside Sydney having five times the number of dentists of rural NSW. The numbers there — one dentist for every 5000 people — is a third-world level of medical care.

The answer to that is obvious, and it would also serve the task of demystifying medical services and medical costs: a scholarship scheme, for dentists and doctors, bonding them to three to five years’ rural work depending on the level of support, with a punitive buy-out clause. Should the Painters and Doctors, and the Dentists object, they should be threatened with an influx of foreign doctors. After all, if we shipped in 300 Cuban-trained doctors for remote services, the problem of indigenous health would be greatly mitigated overnight.

Twould be better to extend medical training to our own people, but needs must. In our current state, it is cheaper for many Australians to fly to the UK, take advantage of the NHS-Medicare reciprocal scheme and get their teeth done here.

What greater condemnation could there be than that we are worse than British dentistry?

44
  • 1
    Julie Briggs
    Posted Friday, 18 January 2013 at 1:11 pm | Permalink

    Thank you for this article.

    Nice when someone tells it like it is.

  • 2
    Cyndi
    Posted Friday, 18 January 2013 at 1:20 pm | Permalink

    Well done, Guy. This failure of successive governments to focus on the very real correlation between dental and overall health is a national scandal. Clearly they’re too busy trying to work out how to tax soft drinks.

  • 3
    Saugoof
    Posted Friday, 18 January 2013 at 1:29 pm | Permalink

    Some 20 years ago I put my name down at a free dental clinic. I was told there would be a two year waiting list for non-emergency treatment, which seemed ludicrous at the time. In two years time anything I needed to get fixed would have gotten much worse and fixing it would be far more costly and labour intensive. Still, I had no money so I had no other choice. A year later I went back to check on the status and was told that they were very busy and the waiting period was still two years from then, I hadn’t progressed any in a year!

    I went back to uni shortly afterwards and thankfully that was in the pre-Howard/Costello VSU days and the student union at Monash offered dental services where I managed to get everything fixed for $15 per visit.

  • 4
    ozziejack
    Posted Friday, 18 January 2013 at 1:34 pm | Permalink

    Spot on, Guy. Good dental care is way beyond the reach of many Australians. I know why many Australians go to Thailand for big dental work - have all your dental work done and have a holiday for less than half of what they would pay in Australia.

    The idea of dental ‘traineeships’ where a person is trained as a dentist at govt. expense and then is bonded to the government for a certain number of years is excellent (with a heavy pay-out if they don’t complete it). My university degree and teacher training in Victoria were part of a studentship. I was bonded for 3 years and was sent to the rural areas where teachers were short. There were lots of us. Some left early and were hit with a payout but most of us stayed on and teaching became our career. It’s a great idea and means that we don’t have to deplete trained people from overseas countries where the shortages are worse than Australia.

  • 5
    Posted Friday, 18 January 2013 at 2:10 pm | Permalink

    I couldn’t agree more Guy. I was blown away last month when the bill for a filling was $85, and I got $15 back from my private health insurance, and was told that there was nothing back on medicare!

    And that didn’t include the rest of the cost of the visit, for which I got nothing back at all.

    I don’t know how people can have major dental work done unless they go to Thailand. It’s just not affordable otherwise.

  • 6
    robinw
    Posted Friday, 18 January 2013 at 2:11 pm | Permalink

    Right on Guy. My wife just had a root canal procedure, cost $1500. 10 years ago I had two implants put in where I had been missing front teeth for over 40 years. Cost $10,000 in the year 2000. A friend had the same procedure done just recently in Manilla by a top flight dentist, the cost for 2 teeth $1000. We are getting so ripped off by a bunch of closed shop unionists that I expect that they have even the AMA standing by watching in admiration at their chutzpah.

  • 7
    drmick
    Posted Friday, 18 January 2013 at 2:39 pm | Permalink

    Just had a “Dentist” tell me that I needed $40,000 worth of work done on my teeth. I say “dentist”, but he could have been a mafia extortionist or a lobbyist; hard to tell the difference these days.
    All I know was, he was wearing a mask.
    They rate with Pharmacists, (who dont wear masks but should), and “Specialists” as the greatest parasites on a system they are prepared to take from, and supply very little. They even have the power to regulate the number of parasites to ensure that they control who kills the hosts………literally.

  • 8
    John Bennetts
    Posted Friday, 18 January 2013 at 2:44 pm | Permalink

    It is clear beyond doubt that cartels run the medical professions - especially speciallist medicos and private dental practices.

    The obvious answer, of course, is to outlaw the b_stards. Unfortunately, like big businesses everywhere, the rulers of these cartels are able to give instructions to governments. Australian governments of both persuasions are too weak and spineless to do what is needed to bring banks into line, to control multinational corporations and their tax-avoiding, rentseeking ways. They are also far too spineless to take on the robber barons of the dental, medical, aged care and optometric industries. These are the extortionists who trade in human pain and suffering behind a facade of imagined caring.

    Whenever attention is drawn to the multimillion dollar boys of these professions, it seems to be diverted to the mining employees earning $100k per year or airline pilots or others who have little choice about where they live and when they next see their family, the hours that they work or when they will get take their holidays.

    The cry goes up: “Look… over there… a filthy unproductive unionist. Get him!”

    All the while, the cream tier of professionals is pocketting multiples of this, without even thinking about moving away from the luxuries of prime beachfront living.

    And I haven’t even started on the legal profession!

  • 9
    klewso
    Posted Friday, 18 January 2013 at 2:53 pm | Permalink

    What do the poor need good health for? They’d only live longer and more happily!
    And look who’d have to pay! …. now pass the foie gras, and where’s the claret, Nelson.

  • 10
    zut alors
    Posted Friday, 18 January 2013 at 2:54 pm | Permalink

    One would assume that a resources-rich country like Oz, with an enviable economy, would be able to cover the cost of total dental care.

    A bad tooth or gums can cause a myriad of expensive health complications: it’s false economy by the government to stint on funding maintenance and treatment.

  • 11
    iggy648
    Posted Friday, 18 January 2013 at 3:01 pm | Permalink

    Jetstar to Manila, under $1000 return. Crown in Manila, under $200. Crown in Oz? Around $1500? Have a nice holiday at the same time. Just avoid the typhoon season.

  • 12
    Hugh (Charlie) McColl
    Posted Friday, 18 January 2013 at 3:04 pm | Permalink

    A “false economy”. WTF?

  • 13
    tonyfunnywalker
    Posted Friday, 18 January 2013 at 3:05 pm | Permalink

    For the poor in the UK before the NHS dental system - it was one out all out. I still have my free fillings and almost a full head of teeth. I cannot understand the problem in Australia especially for the elderly. Equally the level of fraud in the now defunct the Howard scheme. Dentists are by definition well educated, but failing to complete proper documentation is poppy cock and the level of fraud is scandalous.

    Another Pink Bats and Tin Shed scale investigation by the OZ is called for.

  • 14
    Posted Friday, 18 January 2013 at 3:05 pm | Permalink

    Surely an important step, in dentistry as in general medicine, is to replace the current fee for service charging and government partial reimbursement with salaried dentists and physicians.

    This is of course opposed vehemently - naturally by the ADA and AMA - but also by health organisations which ostensibly serve the public but are controlled by dentists and medicos to advance their interests. It is one reason for the implementation of medicare clinics that it is proceeding so glacially that all the glaciers will be melted before the ‘super clinics’ are finished.

    Nonetheless, I think it’d be worth the blue. If governments can break the pilots and warfies and keep trying to break the builders’ labourers, the dentists and medicos are obvious and gettable targets.

  • 15
    Mike Flanagan
    Posted Friday, 18 January 2013 at 3:27 pm | Permalink

    Thanks Guy, yet another wonderful, informative and cogent piece from you, that many of us have grown to accept as your norm and forte.
    I recently was afflicted by a barking molar that wouldn’t respond to either copious amounts of rum or any other of my granny’s remedies.
    So after considering the bureaucratic and economic implications to my age pension I found a pair of long nosed pliers and a mirror and got rid of the bastard.
    The rum quickly removed the taste of axle grease.

  • 16
    shitesherlock
    Posted Friday, 18 January 2013 at 3:29 pm | Permalink

    So glad this issue is being discussed here!I thought I’m the only one feeling ripped off getting billed $400 (with health insurance already taken off) for a ‘check-up and clean’ job. People I’ve spoken to on this are now doing the Aussie-Dentist-skip, overseas trip service on their mouths. Which is fine if you can afford it. But surely, dental services in this country can’t be that bad that it is now the equivalent of saving for a holiday?

  • 17
    John Mendoza
    Posted Friday, 18 January 2013 at 3:33 pm | Permalink

    Well said Guy. The evidence is increasingly clear that the more a health system is privatised the higher the GDP spent on health and the greater the inequities in access to basic care.

    We need a wider community debate in Australia about the future of the so-called universal care system called Medicare. Its has long ceased being universal. How can a private practitioner set up where they choose and be paid (largely) by the public healthcare system? Who else has such a protected and privileged position?

  • 18
    Malcolm Street
    Posted Friday, 18 January 2013 at 3:34 pm | Permalink

    The call by the Dental Association to reduce trainee dentist numbers struck me as chutzpah on a grand scale. When there is an oversupply, prices go down. Prices are going up. Therefore there isn’t an oversupply. Similarly if there is an oversupply I should have no problem getting straight in to a dentist. However, here in Canberra I have to book on average three weeks ahead.

    The only oversupply seems to be in the more genteel areas of the capital cities where most dentists came from, where they’d most like to live and where dental health is relatively good and hence there is less need for dental services.

    Meanwhile the areas with the most need for dental services don’t have dentists, and even if they did a lot of people who need them can’t afford them.

    Re. costs: had a root canal done about a year ago for $2k. Then had to have a crown on it for $1.6k. The root canal has gone bad so I’ll now have to go to an endodontist to have it redone - I reckon I’m looking at another $2k. (The dentist has at least agreed to redo the crown for free). I can afford it (just) but how many people with young families and a mortgage could, especially single mums?

  • 19
    Daly
    Posted Friday, 18 January 2013 at 3:35 pm | Permalink

    Not only do I pay a ridiculous fee for the dentist to spend 5 minutes looking in my mouth and noting with disappointment that ‘everything seems stable’ but I pay dentists’ rates to have my teeth scraped. Agreed it isn’t a nice job but hardly worth $75 + an hour! A cartel!

  • 20
    klewso
    Posted Friday, 18 January 2013 at 5:01 pm | Permalink

    Remember Dr Wooldridge limiting doctor numbers (in tandum with Dr Nelson playing with our teriary education too, making degrees dearer, less affordable for the less well resourced of us, to study for)? That would have a positive impact on their wages too?
    A decade wasted, when we could have been producing more doctors, that we’re paying for now.

  • 21
    mikeb
    Posted Friday, 18 January 2013 at 5:02 pm | Permalink

    How could dental care be covered under medicare now given the extortionist prices dentists charge? One front tooth crown - $7,000. A checkup with clean and xrays - $260. The medicare levy would be astronomical.

  • 22
    Michael Lines
    Posted Friday, 18 January 2013 at 5:22 pm | Permalink

    This is a very vexed issue. I’m a dentist, not in private practice, and I find it disgraceful that a first world country like ours, people seem to be unable to access quality dental care.

    But there are many facets to this story.

    The failure to incorporate dental care into Medicare was the fault both of the Government at the time and the dental profession itself in the early 1980s. Those same parties have failed to address the issue spectacularly since then - both sides of politics are at fault. As to the costs to patients, simply saying that prices are too high is kind of missing the point. Dentistry is an expensive business to run. If you want to work as a dentist there is a minimum level of infrastructure you must provide by law - the dental chair, the instruments, the consumables and the office furniture are simply the things that the patient will notice. Behind the scenes there is a whole raft of back office equipment and materials - including sterilisation, record keeping and storage, IT etc. And this is just to comply with the law. If you are going to practice safe and ethical dentistry you need to employ at least two people (a chairside dental assistant and a receptionist) in addition to yourself. All of that has to be paid for and maintained - so the practice running costs are high to begin with. These things are not necessarily under the control of dentists and most of the equipment and material we use is imported from overseas. If you are getting prosthodontic work done (dentures, crown and bridge work, implants etc) you will require the services of a dental laboratory, who will levy fees on the dentist to make the prosthesis you are getting. Add to that, issues such as registration fees, mandatory professional development courses and professional indemnity insurance, all of which are actually there to protect members of the public, not the dentist, and you start to get an idea of where those dentists fees are actually going.

    The statement by Guy Rundle that the cost of the dentists time is the greatest factor in the cost of dental care is simply not true. Sorry Guy, do better research, I’d be very keen to see where you got that information from.

    Then there is the question of quality. The fact is that in medicine as in anything else, you get what you pay for. Dentistry in Thailand may be cheap, and there’s a reason for that. Just ask yourself, do you really understand what legal, ethical and professional framework they are adhering to? Are you confident in their infection control protocols? Many of my colleagues, especially prosthodontic specialists tell me horror stories about dental work done on the cheap in foreign countries that they have to fix up when a patient gets referred to them with a major problem, particularly implants. Buyer beware! As to British dentistry - I have direct experience of this and I can tell straight away when someone has been treated under the British NHS. I have had numerous expat Brits (invariably with multiple large amalgam fillings) tell me that they are sure that they didnt really need many of those fillings and that they thought the Dentist was either doing it for practice, or because the NHS was paying, not the patient. I cant confirm whether that is true, but I have heard it repeatedly from numerous people. One does have to wonder about the incentive structure there.

    But finally, the greatest frustration all dentists face: patient compliance. People simply dont take good enough care of their teeth. The dental profession has been trying to put itself out of business for 100 years through such efforts as oral health promotion, education in oral hygiene and fluoridation of drinking water (the WHO describes this as one of the single most effective public health interventions in human history). The vast majority of dental problems can be prevented through simple measures such as cleaning your teeth properly and reducing the refined sugars and sources of acid in your diet. Its amazing how many people dont do simple things such as this, then go on to develop major dental decay problems as a result and then complain when they have to pay to have them fixed. I just ask, what do you believe your health is worth?

    It is a little irritating to us that we keep being told we are overpaid, that we overcharge and that we have a privileged and protected position in society. Well, thats not my experience, nor any of my colleagues. Sure some are making a very good living, but they’re also working very long hours to do that. Dentistry is a cottage industry in Australia and they are running a small business, ultimately just like any other and they face the same pressures, demands and rewards as any other small business, with the added complication that they are bound by very strict legal and ethical requirements.

    In my perfect world, everyone would have ready access to all aspects of health care at minimal or no cost, but I’m a social democrat idealist. The world at the moment is not quite built that way, but we are working toward this. Should dentistry be funded under a universal health care model - of course it should. How we achieve that without sending the country broke is the issue. Simply blaming the dental profession and accusing them of profiteering achieves nothing and avoids the real issues - greater attention toward preventative health care so that problems dont happen in the first place and making all health care, including dentistry more affordable to conduct.

  • 23
    drmick
    Posted Friday, 18 January 2013 at 6:19 pm | Permalink

    My Bullshite detector just went off the scale.

    1.3 billion dollars for residents in aged care was swallowed up by consortiums in return for “examinations”; no care or work, that costs extra; just examinations. There are 30 million people in Australia, I am not sure how many of them qualified for dental assistance, but even if every man woman and child in Australia was “examined” by these masked men it would cost, $13,500 dollars each. Except they didn’t do the Whole population, they “examined” a lot less than that. So we can feel justified accusing them of profiteering and avoiding the real issues. Thankfully you don’t have to visit a proctologist to recognise this type of dirt when you see it.

  • 24
    Mike Flanagan
    Posted Friday, 18 January 2013 at 6:45 pm | Permalink

    Thanks to drmick for some clarity.
    My moderated expose at 15 of my recent past personal experience is an lauphable example of the impact of our contemporary dental practices and policies in this country.
    And I am honestly confident that my actions and remedy are not an isolated experience in the bush.

  • 25
    GF50
    Posted Friday, 18 January 2013 at 6:46 pm | Permalink

    Good on you Micheal, You must be the only dentist in practice that has any altruism. This really doesent exist! Where are you practising and what is your Phone no:?
    I have had some experience with dentists/oral surgeons as I worked in RPAH dental clinic. I worked with some great dentists way back. Now I find that most dentists consider /and advertise that they are “cosmetic dentists”. Basic good actual dentistry is not practised with any regard to bite /alignment, best result for a functional mouth. They suggest orthodontic realignment of 60yr+ teeth,( only 7K +, ) that had no problem before latest replace 50yr old ammalgam (cusp snapped off) and removal of all old fillings and crown all teeth. Hello 30K!! nothing wrong with my teeth or the alignment. Have always had comment as to great teeth and super smile:)
    tfw, agree with your comment esp the rip off that occurred and the Govt chasing repayment from some dentists to the tune of $50+ million. Don’t even get me started on the medico’s , most of whom were on the free Uni system that own the private hospitals that mean they are far too busy being millionaires on the public teat, to operate in the centres of excellence Public Teaching Hospitals, that taught them all they know EXCEPT ETHICS. Dr shop folks. you are all entitled to excellence of care! Go to a Public Hospital and give them your private Health Cover card. You have to pay your surgeons fees (no anaethetists fees) and your bed is paid for by your fund. win! win! You have not sucked on the public teat and have added much needed funds to the Public system! without supporting the two tier system, and believe me the Public Hospital is by far and away, Worlds best practise.! Sorry all this is not available to those living in rural areas as excellence comes at a price and requires specialist staffing and extremeley expensive equipment. You have to travel, pros and cons to living/making a living.

  • 26
    Guy Rundle
    Posted Friday, 18 January 2013 at 7:08 pm | Permalink

    hi michael l.

    thanks for the info. to clarify - i didn’t mean the dentist’s time as profit above and beyond costs - i meant the dentists’ time, ie rate per hour, including costs, as opposed to the actual stuff put in the mouth, crowns, fillings etc.
    I don’t doubt that costs take up a large chunk of the fee. But every cost is an asset. You’re building a practice, which can be sold on, attract partners etc, and which contains the goodwill that guarantees you a client base.
    So even if your fee of $X/hour is composed of $Y costs + $Z profit (used as take-home pay and re-investment, as you choose), the $Y costs create an asset for you. Teachers, garbos and shop assistants do not have that happy opportunity.

    If, as a way of thinking about it, we had twenty large dental clinics based in hospitals across Australia, with 25-30 dentists working for scale payments, then the bulk cost of equipment, compliance and staff would be much lower. But the dentists wouldn’t be building an asset.

    In the meantime, perhaps as a way of furthering the debate, you could tell us what your gross take-home pay is, and the annual turnover of your practice?

  • 27
    Rambling Rose
    Posted Friday, 18 January 2013 at 8:05 pm | Permalink

    Just had my son’s 3 wisdom teeth removed - total cost was $2550 shared between the dental surgeon, anaesthetist and day hospital. After rebates from Medicare and private fund the out of pocket expenses total $2009.75. What a joke.

  • 28
    Michael Lines
    Posted Friday, 18 January 2013 at 8:13 pm | Permalink

    Guy,

    Sorry, but thats exactly what you implied, intentional or not and I’m pretty sure this is exactly how it was taken by what is clearly an agitated and engaged audience. In fact it was this single comment which finally prompted me to launch a response. Something I would not normally do. But thats Ok, you have now clarified your position. My take on this is that the Government (and the non-dental parts of the health care sphere are quite happy for the attention to focus on what dentists charge, and give the impression that that is the problem, and in this way they can duck responsibility for doing anything realistic about instituting genuine preventative measures and treating the unmet need.

    As I showed above, there are a of of cost pressures in all health care industries, and dentistry is probably more subject to that than most. The actual physical plant and equipment are fixed assets thats true, but like all fixed assets, they wear out and require regular maintenance and repair - they are not set and forget. Speak to anyone who operates earth moving machinery - they know all about this kind of thing. Dentists need this stuff to do their work, and unless you work for the Government as I do, nobody is going to give you several hundred thousand bucks worth of machinery for free. You will have an overdraft the size of an average mortgage. Plus the staff - they dont come cheap, especially good ones. Everything has to be paid for. My point is there is a lot of bulldust circulating around this and everyone wants to blame the dentists solely. Well, its not that simple. Everyone seems to have a story about some rip off merchant dentist - well I’m curious about that too, Id like to see some evidence. There may be some charlatans and overchargers out there, but I cant help thinking theres more to each of these stories than we’re told. I’m really curious about the “1.3 Bn” to pay for dental exams too- theres something pretty fishy about that claim.

    As to solutions, I agree there are probably many ways to fix this, and I would like to see them implemented. Many of my colleagues are sceptical though, (most people are when confronted with changes affecting their workplace - just ask Journos about the Blogosphere), but that reflects their doubt that this or any other government is going to invest the kind of money that it will take to create a real difference. The way your article is framed you make it sound like the dentists conspired to make this situation. Well, thats not the case. The ones running private practices are running a small business in competition with eachother and are free to charge whatever it takes to cover their costs and ultimately what the market will stand - and thats what they are doing. The unmet need exists because there is a large group of the population who are unable or (in a great many cases) simply unwilling to pay this. The trouble is that they have no other alternative than the extended waiting list in publicly funded clinics because successive State Governments have not allocated sufficient funding to this.

    The bottom line is that the dentists in private practice are not the enemy here - lack of funding of public dental care is the real issue.

    Most dental graduates dont want to work in state clinics because the pay is lousy, the workload immense and the treatment you are able to provide is very limited. I blame state governments for this because health care is their responsibility (but they’re ducking for cover behind the Feds). But in addition, I wonder about peoples’ priorities sometimes. I am aways amazed by how much people will spend on a car, or even having one fixed, but baulk at paying to have something inside their own head fixed so that it doesn’t cause pain or infection. I have seen some truly shocking things in patients mouths and have wondered how they can live with them. Its testimony to the resilience of people I suppose.

    As to my own situation, questions of what I get paid and practice turnover are pretty meaningless - I work in a large Government organisation which wears green a lot. My salary is about 113K a year. I work whatever hours are required (at least 7am - 5pm) and there is no such thing as paid overtime. The benefit is that I can give patients whatever treatment they need to maintain their oral health without worrying about their capacity to pay.

  • 29
    Janet Watterson
    Posted Friday, 18 January 2013 at 8:16 pm | Permalink

    Immoral to steal overseas dentists, We must train more. Fluoride in every water supply would help too. A universal denticare should be affordable to our wealthy nation.

  • 30
    Michael Lines
    Posted Friday, 18 January 2013 at 8:20 pm | Permalink

    Rambling Rose, pardon me for being intrusive, but would you mind pointing out who got how much out of that $2550? I doubt most of that went to the oral surgeon (who is usually an oral maxillofacial surgeon with about 14 years of formal training). The one who usually charges the most is the anaesthetist (again about 8-10 years training) - they are the one who is taking the most risk in these cases so their fees are higher.

  • 31
    Mike Flanagan
    Posted Friday, 18 January 2013 at 9:17 pm | Permalink

    Rambling Rose;
    $2550 is nearly two months aggregate of the old age pension.

    Michael Lines;
    My local bush hospital has a nulla nulla nailed above the anaethetist’s office door.
    The old surgery offices has a two man cross cut saw nailed above their door.
    I am unsure whether they wished to deter attendance of the punters or they were their tools of trade but someone had an irish sense of humour to leave them affixed.
    I am not joking, I can send you a pic.

  • 32
    Rob Sivertsen
    Posted Saturday, 19 January 2013 at 10:44 am | Permalink

    I worked with visiting Cuban dentists in Zimbabwe. Their standards were far worse than that of the British NHS, which is probably best described as extremely disappointing in itself.

    Australian standards are substantially higher.

    Unfortunately the cost of rectifying cheap overseas dentistry can be substantially greater than the cost of having the work done properly in the first place. Many tourists to Thailand could testfy to this, but are generally reluctant to do so publicly; just as we tend to hear of gambling wins far more frequently than we hear of losses.

    The gambling industry would not exist if that was reality.

    As low as NHS standards may be, I do not believe for one minute that there were “dentists coming out for their next case, with blood on their apron and pliers in their hands”.

    Fortunately balanced readers will recognise this as being flippant and fictional, and take that into consideration when appraising the content of the remainder of the article.

  • 33
    drmick
    Posted Saturday, 19 January 2013 at 3:05 pm | Permalink

    There is nothing “anecdotal” about the bills we have to pay and it is reassuring to everyone who reads this blog that they are not alone in believing that the visit to the Dentists / Orthodontist and using the “system” is an exercise in a fraudulent disgrace; They have no control, no assistive advice, and a “closed shop” as far as getting quotes and forcing market pressure is concerned.
    The explanation/justification, that it is because state and federal governments ” blame each other” is ridiculous and perfect example of another “medical service”, that has abused the political process to this obvious conclusion.
    There will only be dentistry for the very rich and the very poor. Everyone else can choose to ride a bike or ride in a rolls; free market says you get what you can afford.
    The difference here is that the bike and the rolls are the same price, and that we pay for both even though we cant use the Rolls.
    What pi$ses everyone off is even the very poor subsidise the rich by way of Private Insurance Levy & medicare. Yet more than 40% of the population cannot afford the subsidised health care that they are helping the rich to pay for. WTF?
    As far as the 1.3billion? That is on the public record.

  • 34
    Mike Flanagan
    Posted Saturday, 19 January 2013 at 4:54 pm | Permalink

    Thanks again Drmick;
    If I had treated my cattle and stock in the same vain that dentistry has treated, public policy, the publlic purse and the public at large, I would be, rightfully, behind bars at the RSPCA’s insistance.

  • 35
    drmick
    Posted Saturday, 19 January 2013 at 5:31 pm | Permalink

    Mike I am a nurse
    I was training as a Registered Nurse when Gough introduced Medicare.
    In a large District Hospital, the effect of the AMA response to Medicare was devastating.
    In 1946 the argument over Prescription medication cost the Labor government the election. The BMA (as it was then), alleged that prescriptions, or “government subsidised medication”, was “communism”. The government wanted to make sure that the public had access to the 5 most commonly prescribed medications at the time, (mostly antibiotics) and they would ensure that the patient paid no more that 5 shillings; the government would cover the rest.
    The greedy fascist, self regenerating parasites of the BMA, wanted the same deal for all medications on the British Pharmacopoeia; not just the 5 most important ones. This created the opportunity for abuse, and every generation of BMA/AMA larvae since has lunched on the Governments aversion to upsetting the status quo.
    In a small public Hospital, and in the local community, the response from the “family” doctor was a disgrace. They already knew who could pay and charged for visits commensurate for their ability to pay.
    Why do you think that the Doctors have the “choice ” to bulk bill, or to charge like angry plumbers?
    These fleas have gouged the national health bill from 7% GDP in 1980, to 15% GDP last year. Its Time

  • 36
    Rambling Rose
    Posted Saturday, 19 January 2013 at 5:40 pm | Permalink

    Mickael, the oral and maxillofacial surgeon charged $1326 to remove three wisdom teeth from a 21yr old in a day hospital. No complications. Bupa returned $300 which was the limit under our policy. The anaesthetist charged $675 for one hour’s work (as per the invoice) and Medicare returned $180.75. Both these specialists seem to have a licence to charge what they like. The average worker is on about $40/hr. How can these specialists justify their exhorbitant charges.

  • 37
    Mike Flanagan
    Posted Saturday, 19 January 2013 at 5:46 pm | Permalink

    For reason of accuracy the above should read…’cattle, sheep, horses and dogs’. I stll miss many of the old blighters.

  • 38
    ozziejack
    Posted Sunday, 20 January 2013 at 10:18 am | Permalink

    Yes, drmick, it is very hard these days to find a doctor or dentist who isn’t in the game for the money. Like many things in life, greed has taken over. The few doctors and dentists that do the right thing are usually horribly overworked because they are the only lifeline that the less well-off can afford. Pity really.

  • 39
    Mike Flanagan
    Posted Sunday, 20 January 2013 at 11:00 am | Permalink

    drmick;
    Thanks for your explanation. A nurse with clarity and objective perceptions together with a social conscience!!! Well buggar me!
    I can only offer some levity with an overlay of subtlety to your clarity of expression, even with my constricted and contorted ‘veins’.

  • 40
    Malcolm Street
    Posted Sunday, 20 January 2013 at 4:55 pm | Permalink

    Michael Lines - thank you for your perspective as a (salaried) dentist.

    It’s obvious to me that there’s an awful lot of overheads in a dental practice, but that in itself doesn’t explain the local prices.

    One would assume that patients going to the Philippines or Thailand are going to by the standards of those nations very up-market private practices catering to the local elites with similar equipment standards to ours, and the dentists are going to be paying themselves enough to part of that elite. Is the equipment going to be *that* much cheaper? Or are we just being gouged?

  • 41
    Ken Gover
    Posted Monday, 21 January 2013 at 12:01 pm | Permalink

    Why choose Dentistry? I can get a nice meal in Katmandu for one dollar. the local Macdonald’s charges ten times that for a not very good meal.( And I hear Macdonalds operates on a low profit margin ,high turnover basis.) Different overheads maybe? Different rules and regulations to comply with maybe? Just a thought, I am no economist. Could also be why a massage and full body wax is so cheap in Katmandu. Over here that often costs more than having a tooth filled.

  • 42
    michael r james
    Posted Monday, 21 January 2013 at 4:25 pm | Permalink

    GR, I have been reluctant to dive into this argument because of my anti-Brit bias and limited experience of British dentistry (and the likelihood I was approaching it in non-optimal manner even after 10 years). But with two letters in today’s Crikey (Rebecca Barnett & Daman Langguth) jibing with my impressions, I want to repeat my usual formula when it comes to modeling anything on the British experience: don’t.

  • 43
    gapot
    Posted Tuesday, 5 February 2013 at 11:37 am | Permalink

    So if there is under employment of dentists, why is it my dentist can never see me at the time he demanded I turn up

  • 44
    Jason lewis
    Posted Tuesday, 5 February 2013 at 9:33 pm | Permalink

    Government cut our pockets by the name of health tax but on their side they are reaping their own business.
    Government must improve their dental education policies.

    It was informative and near to truth, please keep updating.
    thank you.

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