Back in April this column suggested that the NHS has let down young dentists by making it difficult, if not impossible to pursue their careers in general practice to a point where they can set up or purchase a practice. Do the pilots in process for a new NHS contract offer any hope for career progression for these dentists in the future or are our younger colleagues doomed to a life of reduced earnings and less professional autonomy and satisfaction than their older colleagues?
At first sight, the outlook from the pilots looks less than encouraging. Associates are being replaced with therapists when vacancies occur or are being asked to work longer hours for less pay. But it's not just in the pilots that there are problems for younger colleagues. Some UK graduates have found it difficult to find places on Foundation Training Schemes and will struggle to find employment in their chosen profession despite years of study and increasing burdens of debt.
For those able to find posts as associates the earning potential within the NHS is extremely variable with UDA rates falling fast as practice owners attempt to compensate for the increasing expenses involved in running a modern practice with the escalating costs of compliance with CQC and HTM01-05.
The BDA is aware of the difficulties faced by younger colleagues. Speaking at the LDC Conference in Sheffield this year GDPC chair John Milne said: "Bullying and exploitation are not terms we associate with professionals, but I understand that for some associates, working conditions are not ideal and pay is poor. Local Dental Committees represent associates too and they deserve a fair deal. Perhaps we need to look carefully at proper career structures for our younger colleagues, and collectively fight to enable them to enjoy a fulfilled professional life whichever type of practice they work in and wherever they trained."
The idea of proper career structures for dentists is not new, and it's strange that the accountancy and legal professions provide a pathway from simple employment through non-equity partnerships through to a real share in practice ownership but the same route is not there in dentistry.
So why is dentistry so different? Associates cling on to the comfort blanket of their self-employed status and perhaps miss out by not considering other options. Is the profession open minded enough to consider the future of younger colleagues? Or will it journey in a direction where the majority of practices are owned by companies with only shareholder profit to consider and little chance of progression for the practitioners who provide the patient care?
This isn't a job just for LDCs, it's a job for the profession as a whole and for the BDA to lead. It's time for a serious look at career pathways for dentists in practice and for some old fashioned trade union influence to protect the interests of associates. The Department of Health will be beginning to work out the details of how the pilots will move towards a definitive contract for the future. Perhaps now is the time to ensure that process works for the whole of the profession and not just the few.