10 Mar 2020  •  Blog, Dental Landscape  •  6min read By  • Nigel Jones

The decline of the full-time dentist

Nigel Jones and Eddie Crouch discuss the difficulties in retaining young dentists and the rise of the ‘portfolio career’…

More and more young and newly qualified dentists are less and less interested in working full time within a practice for their entire professional life.

This could be part of the rising trend of ‘slashies’ that is happening across the country. A slashie is someone who has multiple jobs, i.e. dentist/DJ/coach.

A study by the Association of Independent Professionals and the Self-Employed (IPSE) showed that more than 320,500 self-employed people in Britain are working two or more jobs.

Dentistry may well not be immune to this. It seems that a lot of younger dentists are pursuing portfolio careers that span across different roles within the profession, and also outside of dentistry.

Moving away from clinical roles

When speaking to Eddie Crouch, Vice-Chair of the BDA’s Principal Executive Committee (PEC), on this topic he said that this is indeed something that is happening among his colleagues.

He said, “Many dentists are looking to do different things and are moving away from clinical aspects of dentistry. You only have to look at the popularity of managerial courses to see that this is the case.

“A colleague of mine began working for one of the indemnifiers part-time and has found it so much more rewarding than clinical dentistry that he’s decided he doesn’t want to do clinical dentistry any more.

“After five years of training to be a dentist and then working for two or three years, he has made the decision to leave. That tells me that the situation is completely different to when I first began working as a dentist.”

Indeed, the career pathways of dentists today are much more different to 30 years ago when I first began working in dentistry and 36 years ago when Eddie started practising.

Practice ownership is no longer the goal it once was – only 11% of associates taking part in the Dentistry Confidence Monitor survey in 2019 said they wanted to own a practice. The traditional career pathway has fragmented and it is no longer the aim to work in one practice as an associate and then eventually take it over.

Changing times

Eddie shared his ideas on why this might be including changes in patients, for example an increase in demand but also in their expectations and attitudes, as well as differences in the pressures now faced by dentists.

He added, “A survey by the GDC found that there is a huge fear among young dentists about falling foul of regulators and falling foul of a system that really isn’t there to support them.

“I work in a practice with many young dentists and see the time they spend treating the patient, talking to them and writing up clinical notes. I compare that to when I started in 1984 and I can understand why working in a practice 9 – 5, Monday to Friday is no longer the norm for them, because if you did that, you’d probably burn out really quickly.

“When I qualified, I saw my working life as treating patients but clearly a lot of dentists no longer see that as their future. And I don’t think it’s just a generational issue, patients have changed considerably over that time.

“Years ago, a patient would say, ‘Please don’t refer me to hospital, just have a go at doing this and if it doesn’t go right then I’ll see someone else’.

“That isn’t an option for dentists today because if you do ‘have a go’ and try to help the patient, there is a risk of being sued because you stepped outside of your competency. And therein lies the problem – how will you ever gain that competency to deliver some of these services if you can never try?

“Education is meant to be a process of learning from failures, but the fear of failure is such that dentists can’t deliver. We’re training people to become so defensive that the skill pattern of the profession going forwards must be dreadfully affected.”

Unconfident graduates

From speaking with dentists of all ages, it seems many agree with the sense that upon leaving dental school, graduates don’t feel confident to perform many aspects of clinical dentistry.

Recent graduates have also said that during their university years a lot of emphasis is placed on the risk of complaints and litigation.

Eddie said, “Graduates leaving dental school should be ready to treat patients, but they’re having to use their foundation year to refine their skills.

“The GDC say they are aware of the fear factor and they are going into dental schools now to try and alleviate this fear and make the GDC appear a nice, cuddly organisation.

“The problem is that people know of colleagues hauled over the coals for all sorts of minor misdemeanours. If we’re to go forward, we can’t have a situation where people who are making genuine mistakes – because we’re dentists, not superhumans – are going to be reprimanded and perhaps have their career jeopardised.

“That fear will make you stop doing things and that’s not good for patients or the profession.”

This combination of a trend towards multiple jobs, changes in patient expectations and demands, the move towards defensive dentistry, a fearful culture and rising litigation, are just some of the reasons that the profession may be struggling to retain its workforce full time.

The BDA has been warning for some time of a crisis in both recruitment and retention. One of the key questions this leaves then, is how can the leaders of the profession plug the gaps that are occurring and inspire the next generation of dentists to stick with it?

Listen here to a podcast between Nigel and Eddie on this issue.

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