Simon Palmer, March 2005 - In Australia, there are less than half the number of dentists per capita in country areas compared to the metropolitan areas. Massive pressure has been placed on these practitioners as a result of this shortage. In many locations, the shortage is reaching critical point and these dentists are becoming overwhelmed with the demand for their services. Being swamped with patients can be a curse or a blessing - it depends on how well your practice is managed.
Communal obligation
Pressure on rural dentists is exacerbated by the feeling of community in these areas - the rural dentist often feels a huge obligation to the community and does not want to let down anybody down. Many dentists feel a deep responsibility to see all the patients that they possibly can. But sometimes this is not enough; I have heard of staff being frightened to go to the local shops for fear of being accosted by erstwhile patients complaining about not being able to get an appointment.
While it is impossible for the rural dentist to change the undersupply situation, implementing effective practice management protocols can assist in managing the resulting pressure. Improving areas such as appointment book control, staff leadership and verbal skills can result in creating a low or lower stress practice without compromising the standard of care given to the community.
Type of teatment
While all the evidence points to there being no difference in the standard of work performed by rural practitioners, the ‘service mix’ can be considerably different. Metropolitan dentists are also more able to refer on the procedures that they do not want to do, whereas their rural counterpart has this option far less often. Due to the relative lack of specialists available outside major cities, there usually just isn’t the option to refer off the slightly more difficult surgical extractions or endodontic procedures to a nearby colleague or specialist. As a result, most rural dentists become skilled in a wider range of dentistry, and become adept at a broader variety of procedures.
The distances involved for many patients getting to a rural dentist and the difficulty in getting an appointment can often result in the rural practice seeing more emergencies, which in turn may inhibit the dentist’s time to spend on other procedures such as comprehensive discretionary cosmetic solutions. But by implementing simple procedures such as pre-blocking emergences, more quality time will available for the dentist to spend on other patients and procedures.
Employment
Dentists in city locations around Australia and NZ constantly complain that there is a paucity of applicants for jobs such as DAs or front office management. Sometimes they are lucky to get any applicants at all. This is one area that non-metropolitan dentists have a considerable advantage. The relative shortage of employment opportunities in these areas makes work in the local dental surgery highly sought after. I was in a practice in outback Queensland a few weeks ago, where the dentist commented that any advertised job is likely to be swamped with applications.
However, it is a rather different situation when it comes to employment of clinicians. Finding a dentist to employ is difficult, no matter where you’re situated. The situation is exaggerated the more remote from a CBD that one gets. Again this is an issue based on supply and demand. The changing demographics of the undergraduate population means that less new dentists are available to work in the practices in rural areas of Australia. Sometimes, looking overseas is the only option. Australia’s leader in the recruitment of dentists from overseas is DJS. (www.djs.com.au). They provide an excellent service in bringing dentists from overseas and placing them in rural areas.
As most practitioners would be aware, there is also a considerable shortage of qualified Hygienists. This trend is magnified in country Australia where it is relatively uncommon to even hear of a hygienist, let alone get a range of applicants to choose from. As a result, the rural dentist is more likely to have to assume all hygiene procedures than their city counterparts adding to the difference in service mix (mentioned earlier) between city and country dentists.
Practice sales
Adding to the difficulty in finding a dentist is the difficulty of finding a dentist to sell part or all of your rural dental practice to when the need arises. The main reason a GP would buy into a practice rather than start up their own from scratch is for the patients and goodwill that comes along with an already-established practice purchase. However, the undersupply of rural dentists in Australia means that there is often an abundance of work for them making it relatively easy to set up shop on their own and become very busy, very quickly without having to buy an established practice.
But setting up a practice from scratch in a new town is still an expensive gamble for any dentist. For a rookie/graduate with no experience clinically, managerially, professionally and financially, it is even more so. With that in mind, if you create a ‘well oiled’, low stress practice with protocols and systems in place it will look very attractive to a potential purchaser wanting to minimise their risk.
Costs
On the plus side for the non-metropolitan dentist, there is usually a lesser amount and percentage of gross takings that gets allocated to facility and staffing expenses in rural practices. Due to the general abundance of staff, lower wages are commonly on offer compared to a metropolitan situation. The same goes for supply and demand for office space.
Conclusion
Ultimately, as with all dental practices, the philosophy of the principal dentist will shine through. Create the practice that you want, and treat the patients who choose you for their dental needs because of your approach and personality. If you want to be all things to all people, you will ultimately be sacrificing either their care or your peace of mind.
So all is not lost for the rural dentist - create an ideal working environment, and good staff will come. Good dentists and hygienists will seek you out if you have the sort of practice they want to work in. Create an atmosphere of excellence - clinically, managerially, professionally and financially and clinicians will beat a path to your door. In the meantime, the benefits of a well run and managed practice will lead to decreased stress, better equipment, happier and more productive staff, and more money. Not bad as a side effect, while you are aiming for something else!
From what I have seen, dentistry in rural Australia and NZ can potentially be both fulfilling and lucrative. Although the issues experienced by dentists practicing in the country are often different to those practicing in the city, applying effective practice management principles can resolve many of those issues and make it a happier environment for dentist, staff, and patients alike.
[Published in Australasian Dentist, Autumn 2005]