Dr Phillip Palmer, July 2006 - All around the world dental regulatory bodies are starting to recognise and implement the need for dentists to engage in regular continuing education and are putting minimum mandatory requirements in place. UK has 250 hours (75 hours of this must be verifiable) over five years. NZ has 80 hours of verifiable and 80 hours of non verifiable over 4 years.

Australia in general and some states in particular have been sluggish in this recognition. Some states in Australia as yet don’t have any requirements in place.

Why is this? I don’t think many dentists would be arrogant enough to be thinking that they learnt everything that there will ever to be to know about dentistry in their undergraduate course. Or that there’s been no advances worth learning about in even the last, say, 7-8 years. Most dentists who have recently graduated know that they have a lot to learn about the practice of dentistry from more seasoned veterans who have spent time ‘in the field’. Dentists who have been around for a while know that there are advancements all the time. Different procedures, different materials, different equipment, different standards of sterilisation, different legislation.

There are also a lot of skills that a dentist needs to learn and hone outside of the clinical skills taught at dentistry school. Practice management, communication skills, infection control, succession planning, business skills, human resource management and occupational health are all subjects that the 21st century dentist needs to get a handle on. Most dental schools don’t even claim to give the new dentist sufficient clinical skills to do all facets of dentristry. (i.e. implant dentistry, or molar endo, or Cad-Cam ceramics)

I think the vast majority of dentists would agree that a dentist has a responsibility and an obligation to the dental community and to their patients to keep up to date clinically. I also think the vast majority of dentists would agree that dentists who had their last clinical dental update 20 to 40 years ago would be a risk to patients and themselves and that dentists would also benefit from doing some non-clinical continuing education (CE) courses in areas like the ones mentioned above.

Apart from these reasons, there are financial benefits to be considered in doing CE courses. The expertise that can be gained by doing CE clinical courses helps to:

• Extend the services that you able to offer the patients,
• Justify above average fees for the services.

Dentists find it difficult to charge a fee that in their hearts they don’t feel worthy of. Continued development of clinical skills is usually necessary to give you the peace of mind that what you are providing your patients is a state of the art level of skills, justifying the fee that you are charging for your service.

In the case of doing a practice management course, dentists almost universally get considerable increases in their take home pay, and usually with less face to face clinical time spent. Apart from this they learn skills to help take away the stresses of HR management, financial and business management, and add to their general enjoyment of their clinical dentistry.

If there are such obvious benefits to be gained by doing regular continuing education courses and there are such obvious downsides to not doing continuing education course and if the vast majority of dentists would agree that dentists need continuing education, then why don’t the majority of dentists engage in regular continuing education courses?

I think the reason lies in the fact that most Australian and NZ general practitioner dentists probably spend about 4 and a half days per week doing clinical work for around 48 weeks per year (some do much more, some do much less but this would be about average). Spending that many hours clinically leaves little time for going on CE courses; especially when you have a family that you want to spend time with.

It’s much easier to postpone CE and say you’ll do it next year, or the year after when things will be a little quieter. It’s easier to think about all the updates that you’re getting from, say, the dental magazines and the supply company reps that come every week and think ‘that will do me until I have time to go to a course’. Next thing you know 5 – 8 years have gone by and you’ve done nothing about enrolling in continuing education courses.

Surely this isn’t good enough. Surely we owe our patients more than this. I’m not sure how sustainable a workload like 4 and a half days per week/48 weeks per year is anyway in a profession that takes as much intense concentration and sustained stress as dentistry. If it is budgeted for at the beginning of the year into an annual financial plan, most dentists should be able to organise themselves towards the situation where they can work face-to face clinical dentistry for a maximum of 34 hours a week, and should be heading for a maximum of 45 weeks a year. That should still allow them the possibility of 10 days CE per year, and 4 to 5 weeks a year of holidays.

When you think about it, the dentist is in essence, their own ‘golden goose’. The one that keeps laying golden eggs-producing the income to pay the bills, to afford the lifestyle, and eventually pay for retirement.

Doing CE courses helps to get the dentist receive larger golden eggs, more of them and for a longer time. Why would you kill the golden goose through either over-work, or by not being able to provide the best treatment options for patients?

[Published in Australasian Dentist, July/August 2006]