From: "Jeremy Rourke"
To: "ROOTS"
Sent: Friday, January 15, 2010 2:54 AM
Subject: [roots] The whole sorry process repeats itself - Dental Health Care Reform

I have worked in the United Kingdom in the General Dental Service (NHS) dental system
I went there in 1991 to give my family a better life

Six weeks after I arrived the health minister in the government of Prime Minister,
John Major, announced a 13.8 percent cut in dentists fees.

Socialised dentistry in Britain had almost completely destroyed the ability of the
dental profession and individual dentists to deliver even basic, honorable, professional
and ethical dentistry.

One commentator on Britain stated they were a Nation of people with beautiful accents
and dreadful teeth.

I remember a British Dental Journal study that showed 96 percent of root canal fillings
were short of the apex to the extent that they would be considered a failure in
University undergraduate clinics

The Chairman of the UK Dental Laboratories Association wrote an open letter (study) to
the profession stating that crown preparation impressions and models were of such poor
quality to make it almost impossible for dental laboratories to make a crown that fitted

The authorities in Eastbourne that ran the NHS dental service have consistently changed the
standards they use to assess dental care to cover these issues

An open crown margin is NOT considered a failure if it is less than ONE millimeter

A root filling is considered a failure if there is an unfilled canal or the
filled canals are filled LESS than 50 percent of their length

I was shocked to learn that the average replacement time of small amalgams was 8 years
and large amalgams 5 years.

The most obvious failure of NHS dentistry was that the average age of total tooth loss was
REDUCED by 5 years and women who visit the dentist more often that men lost all their teeth
at an earlier age than the men

In Scandinavian socialized dentistry this is worse with 5 years for an occlusal composite and
three years for large composites.

In Australia I had a job at the Sydney Town Hall clinic of a private health Fund -
The Government Employees Health Fund

The clinic had been open for just on one year a few weeks after I started work there on a
piece meal (sweat shop) fee for service basis.

Dentists were paid for the work they did
low production = low income
high production = high income

With a family to support I worked as hard as I could without descending to the standards of
care found in the UK

The accountants went over the financials of the dental clinic and found it was running at a loss
The equipment was under a lease contract, monthly repayments were fixed
The premises were rented and the rent was fixed
The supplies had to be bought at market rates
And the staff had to be paid the legal award rate

But the dentists were paid an agreed rate and there was no signed contract and the
fund accountant set the fee for service rate

At the end of my third week there it was "explained" to me that the dentists fees would be
reduced by 33 percent to sdave the financial viability of the clinic, if it closed it would be
an embarrassment to the Fund Directors.

The Fund had a budget and it had to be balanced - none of the clinic expenses could be shaved
except the dentist payments

I resigned.

This tale of woe is what ALWAYS happens with socialised dentistry and medicine

For the accountants at the clinic in this story transpose the National Department of Health and Treasury

The only thing they can cut back on when the dentists work too fast and hard is the fee for service.
In the UK there have been a number of Parliamentary enquiries into the NHS dental service.

No one quote from any of these is of more value to read than this one;

The reference is paragraph 2.14 of the Tattersall Report of 1964 and it was consider so pivotal to
an explanation of the problems in Dentistry that Sir Kenneth Bloomfiled decided to reprint it
in the Bloomfiled REPORT to Parliament in 1992.

"The scale of fees as at present used is little more than a device to ensure that the individual
dentist cannot earn at the approved rate unless he completes a certain quota of work, that quota
being determined by the speed at which "average" dentist works. The speed at which the average
dentist is working, or the quota of work necessary to achieve the standard rate per hour, can
only be ascertained in retrospect over a period. No individual dentist at any given time can know
how fast the profession as a whole is working; what he can know is that the faster he personally
works the greater will be his pay cheque next month. He also know that he on his own can have
very little influence the factors which affect the scale of fees. If one man in ten
thousand decides to work more slowly the practical effect on the average will be nil, but the
effect on his own finances may be serious. Therefore he works as fast as he can, and so do his
ten thousand colleagues. When the > reckoning comes we find that the rate per hour of the average
practitioner  has exceeded prescribed. Therefore it is necessary to devalue the scale of fees and,
conversely, to set a new higher quota which the dentist must meet in order to maintain his rate of
earnings and to keep pace with his financial commitments. He has no way of ascertaining at which
precise rate he must now work in order to maintain the previous balance, even assuming that his
colleagues do likewise. All he knows is that he must work harder than before. He does so, and
so do his colleagues, and the whole sorry process repeats itself.''

And so this whole sorry process is about to repeat itself in the USA with the Obama health reforms
and in Australia with the Rudd Government inspired National Health and Hospital Reform Commission
proposal of a Universal Denticare system.

http://nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/188-interim

Dr Jeremy Rourke




This is the result of a culture that thinks access is more important than quality.
Exceptionalism and Excellence takes a back seat to just "getting it done".  The AAE's focus on
access as a theme is politically correct ------- that demeans the entire purpose of elevated specialty
level care.  These cowardly submissions to mediocrity make me vomit.

Socialized medicine is not medicine it is a dismissal of human empathy and consideration, an abortion
of the very essence of care-giving - Terry

I remember a British Dental Journal study that showed 96 percent of root canal fillings were short of
the apex to the extent that they would be considered a failure in University undergraduate clinics

The Chairman of the UK Dental Laboratories Association wrote an open letter (study) to the profession
stating that crown preparation impressions and models were of such poor quality to make it almost
impossible for dental laboratories to make a crown that fitted

Personally, I don't like the UK system, but the above statements has more to do with the dentist,
rather than whether its socialized or not. Many of you will say that socialized dentistry causes this,
but that's BS. Bad or uncaring dentists cause this. If the endo is 5 mm short of the apex, then its
the dentist's fault and no one else's. Low fees would have nothing to do with getting the proper length.
If the impression is so poor that the lab can't make a proper crown, then its, wholly, the dentist's
fault. You can't blame bad work (not cheaper materials) on whether is socialized or not. Even using
generic brand materials, a conscientious dentist can do quality work -  Jack

That’s where you are wrong =- absolutely wrong
The choice is to go bankrupt financially or go bankrupt morally there is no other choice
The TANI and TAGI figures for NHS payments indicated that an average dentist working at average speed
had a total of 14 minutes and 40 seconds to start and complete a single root canal debridement and obturation

My boss asked me to do his RCTs and I stated I was losing money doing mine properly and couldn’t afford
to lose income doing his as well

Unless you have worked in the UK NHS system you can’t possibly know how appalling it is - Jeremy Rourke