When you think about it deeply, dentistry is sitting in a vacuum.
From the outset, when the NHS was set up in 1948, dentistry was still in its early crude stages. There were very few treatment options available for the mainstream – mainly extractions and dentures. The modern technology, treatments and materials that we are now used to, were not there. In this, dentistry could be funded by the government. In many ways, without a cap or limit.
In the 1970s and 1980s dental research proliferated and with that many new discoveries were made. Research like the effectiveness of simple non-surgical periodontal treatment, the longevity of full arch bridges etc. It was perhaps a golden era for dentistry.
The result of these research discoveries? More treatment modalities and options became available. More treatments could be offered to the public. Quietly though, the cost of treatment also went up. The UK government still had sufficient pots of money to pay for these modalities at first, and then even as the fund decreased, to continue to subsidise it heavily.
They didn’t just fund or subsidise treatments in primary care, they even fully funded and then subsidised dental undergraduate (and postgraduate training). University dental degrees and qualifications were possible.
A steady funding model created steady structures, steady career pathways, stable business models and stable organisations. Everything worked within a well defined structure. Everyone knew which way to go and what direction to follow.
Then came developments like dental implants, grafting techniques and in the latest wave, digital technologies.
In all this, we reach the present. The present where, sadly, government money has run out. This has been seen in decreased real-time funding towards dentistry and education over the last two decades.
Sadly, dental research and innovation is now also following the same trend of reduced funding. There is a trend of innovation for the sake of innovation. A dental implant that integrates like the last one but has a slightly better shape or a dental scanner that scans the same as before but is faster.
Dentistry as a profession had passed its peak overall. No matter what new technology or advancement comes out, the basics do not change hugely.
However, with decreased university and education funding, suddenly there is a gap in skill attainment. Steady career pathways are being destabilised.
With decreased government spending in NHS, there is a gap in service funding and high street practices need a new source of income to keep their businesses viable. Not all patients are able to pay dental fees. Stable business models are now being destabilised.
The rise of the information gateway and the internet, means that information sharing was easier. Of particular focus in this is social media which allowed information, events, and ideas to spread quickly. Using this new communities can establish themselves with ease. New organisations can easily be formed, each representing their own unique domain. Steady organisations that stood around previously steady, stable structures and monopolised the space, are being challenged. The rise of multiple organisations dilutes the space. These organisations are forming under various guises. Academies, courses, associations – you name it.
This has shaken the very stable well-defined structures that around which dentistry existed. It has created chaos. Chaos is where a vacuum forms. No-one knows which way to go or what direction to follow. There is no north star.
Dentistry is in such a vacuum and everyone is pulling in different directions.
There are those who still believe in the viability of the previous stable structures and continue to fight for them with solutions.
- For example, the BDA fighting for further funding in NHS contracts.
- For example, the businesses whose entire business models are built on and rely on NHS contracts. They are willing to accept compromises in clinical standards to keep the system, upon which their lifeline remains, alive. So they will fight for a larger workforce (and an increase in ORE place), accept low pay for UDAs and compromise certain systems.
- For example, government bodies who know that NHS dentistry cannot be funded to the level it needs to be, but they cannot admit it because their voting power relies on that. So they paper over the cracks with initiatives that rearrange the deckchairs on the ship. Such initiatives include overly complex regulation, high levels of bureaucracy and paperwork, and onerous tasks that appear to be doing something.
- For example, government funded deaneries who try to create educational initiatives with reduced funding.
Amidst all these, the professionals who cannot accept compromised standards, reduced pay and broken promises – feel disheartened and disengage.
Then there are those who feel that the old stable structures are no longer sustainable and are looking for other avenues.
- For example, the young dentists - coming out of university education and into early years of their career - do not feel adequately prepared. They see the limits of dental foundation training and prefer going straight into private practice. Others are looking for mentors. Others are focused on how to find courses to develop their skills. Others are looking for practices that are not aligned to the old stable structures.
- For example, practice owners who had comfortably relied on providing dental services with NHS funding, now have to think about how to keep a healthy, sustainable business through other means. They are looking for new business structures. They are looking at who can fund the treatments and which treatments will be paid for. They end up focusing on the 'high ticket items' that can generate the quick short-term high income.
Amidst all these, the professionals who want to do the right thing, whilst being rewarded and not face the pressure of income - feel disheartened and disengaged.
Then there are those who recognise that old educational structures are crumbling. Using the leverage of modern technology and the information highways, they set up their own courses, academies, and organisations in the hope of gaining a profit from education. (It also means they can step away from the clinical dentistry that they are disengaging from).
In all this chaos, where no one knows which way to go - and everyone is making up their own way. A vacuum is created.In this vacuum, uncertainty is created. Uncertainty creates fear. Fear of the unknown. The "what if" catastrophisation.
So, we look for certainty. As humans, we want certainty in outcomes. We want predictability. We want to quell that fear of the unknown. We want to be assured that something is working. We are creatures who want to find cause and effect.
We look for those who have filled that vacuum successfully to find a model that can be followed. That gives certainty.
That certainty comes first from short term winners. Those who can prove short term results. Those who can quell that fear immediately. These short term winners will always show up first. They quell that fear fast. They fill that space fast.
Poorly quality-assured, shitty courses that can build those high ticket items fill the education space fast.
Business practices that can encompass short term wins/profits fill the service gap fast. This may explain the boom in 'short term orthodontics', 'quick conversion', 'increase your income' and other types of courses.
Leaders who appear to have built multi million dollar empires in a short space of time start emerging.
Then, predictably, the effect of short-term stupidity shows up. The market matures to understand proper learning and how to build a proper cause-related business that advances the cause whilst balancing profit and trust..
In truth, what is the best thing to do in all these changing conditions?
1. Do not chase short-term wins, invest in a long-term plan: the bright lights, the award winners etc. show a flash in the pan, they don’t show a consistent trend. Long-term wins happen with a consistent trend.
2. Tolerate the short-term pain, to get long-term gain. In doing the right thing, the short-term pain and discomfort will need resilience and tolerance.
3. Build trust, not hype. Trust takes time to build. Hype can be fabricated fairly quickly. Don’t believe the hype.Trust is more solid, hype is fragile.
4. Forget everyone else’s game, focus on your game. Double down on your learning to master your craft. Become so good that no storm can sway you. Sharpen your game. This does not mean becoming good at dentistry alone. It means becoming good at the game of patient care.
And to be able to execute these four steps, you need a stronger foundation. So lesson 5 is a bit deeper.
There are some who are driven to dentistry. It aligns with their values, their strengths and their purpose.
There are some who are driven by what dentistry could give them. It is a vehicle towards some other end.
So lesson 5 is
5. Create a foundation built on a purpose or a cause. Be flexible in your approach but consistent in what you stand for.
That purpose has to be something greater than you, your own needs and your own time span. This can only happen if you are driven to dentistry.
If dentistry is simply a vehicle to drive you somewhere else, if you had never aligned to the cause or didn't come into dentistry for the cause of healthcare, the waves will hit you sooner or later.
If you stand for nothing, you will fall for anything. In a vacuum, that fall will be hard!