Tuesday, January 19, 2010

Northern Exposure, Dental Style

Hey all,

Remember when asked all my non American dentist readers to write me. Well ONE guy answered the call and you are going to be so glad he did. I am so glad he did. Well I will let him tell you all about himself and where he practices.

My first blog...here goes nothing. I've been an avid reader of Dr. John's blog for well over a year now, and when he asked for volunteers for an international perspective on dentistry, I figured i'd give it a go. Not exactly exotic, but different.

I am Jamie Bumbac, a 33 year-old Canadian working in the northern part of the province of Manitoba (think 600 miles straight north of Bismarck, North Dakota). I've been practicing for the past 9 years as an associate/locum dentist in more than 15 different offices in western Canada. In my short career I've seen a lot. From artistically gorgeous work to “oh my god, you've gotta be kidding me” dentistry that would make you puke. The patients who brush once a year, I've seen it. So, here's my frank and interesting (hopefully) Canadian perspective on dentistry.

To start, I gotta dispel one big myth. Contrary to popular belief, all Canadians don't have government-funded dental care. When chatting with Americans and dentistry comes up, the assumption is that all Canadian dental care is covered under the blanket of “socialized health care”. (As a side note, Health Care Reform in the States is seriously interesting to follow on CNN these days...man, you guys are passionate about it! Most Canadian politics almost put me to sleep.) I do see how easily the assumption can be made. The fact is, Canadian dentistry is simply a fee-for-service industry, as it is in the States. The only Canadians with governmental dental coverage are Treaty Status Indians (and Inuit), as well as those people who qualify for Social Assistance (or Welfare Coverage, which is VERY basic). Status Indians must have a Treaty Card to qualify for the federally-run plan known as FNIHB, and yes...they are covered 100%. All minor dental and (with pre-approval from the plan, a lot of) major dental services are covered. Sounds wonderful, but by no means perfect. Just ask a First Nations person (the “politically correct” term for our aboriginal peoples) about waiting for pre-approval for RCT on a "hot" tooth for 2 months and then having to wait another 6 months to, possibly, qualify for a crown. Better than nothing, absolutely...perfect, nope.

Unfortunately, in the past, it has also been very easy to be unethical when dealing with this system. Not many dentists will tell you this (and I feel a bit “traitor-ish” saying it myself), but I get sick of seeing it over and over. Crappy dentists making huge amounts of money doing garbage, “drill and fill” work on these poor people. That is, if they actually DO the work. Very little accountability was put in place. Thankfully, committees are being set up and governing bodies are cracking down on these “disgraces to the profession”. I guess the government simply assumed that dentists would be honest and ethical when dealing with this coverage (I mean, we did take some kind of oath at graduation, didn't we?....hmmmm) How silly to assume.

Anyhow, I don't want to give the impression that Canada is full of rotten dentists. The opposite is true. People are people. I'm unfortunately very passionate about this topic because I'm currently in an area (north of the 53rd Parallel) where I deal with this system a lot, and I see more of the bad stuff than most. A typical, urban dentist in Vancouver, Toronto, Montreal, or Calgary might see what I speak of about once a year, if that. FNHIB is like most federally-run government programs...full of flaws and hard to change. It does, though, have potential to be a good system. Aside from FNHIB, a lot of people seeking dental care in Canada would have some type of 3rd party coverage, either from their employer or a personal insurance plan. It is then up to each office to either assign the benefits (bill the insurance directly), or not. The rest of our patients would simply fall under the category of paying for services out-of-pocket. We still battle the same issues with collecting payments, overdue accounts, and office overhead, as I'm sure most of you do.

I would say that dentistry in major Canadian and American cities is quite similar. Possibly the only differences that I can think of are fees (I would guess considerably lower here), advertising allowed by our governing bodies (stricter....no billboards, or 1-800-DENTIST here), a higher population:dentist ratio here, and much less litigation (I've never even considered being sued).

I hate to even admit this to John and Ric (who have admittedly had significant fallout from the recession), but I don't know many guys in Canada that have even blinked at the recession. One of the things that I hear quite often is that dentistry here is really very “recession-proof”. Smaller economic fluctuations, higher population:dentist ratio, lack of easily accessible specialists (therefore GPs do a lot more and refer less), and a high percentage of patients with 3rd party insurance, makes dental economics here pretty stable. I think we do pretty well up here for being socialists (cough, cough...wink, wink). I won't get too political, because I'm truly clueless when it comes to politics.

hmmmm....what else....

Everyone and their dog is looking to place and restore implants up here (topic for another day). Cosmetic dentistry and esthetics are front-and-center in a lot of CE courses. An ugly number of new grads seem to only see dollar signs (I'm getting old). Always wondering how to run a more efficient practice (bill more, work less, and do it well). I'd consider most Canadian dentists to be humble and reserved. I think a lot of Canada is still very under-serviced by dentists. And, I still consider the education I got to be as good as anywhere in the world. I'm a proud U of S alum (Saskatoon, Saskatchewan)!

So, that's Canadian dentistry in a very small nutshell. I'm an regular guy, doing regular dentistry, with regular issues....I've never even seen an igloo....I do say “eh!” a heck of a lot...I think American beer tastes a bit like water....I don't know your buddy in Toronto...I cheer for the Maple Leafs and hate the Red Wings!...I got depressed when the USA beat us in World Junior Hockey last week (not supposed to happen!)...I feel right at home in a Montana bar...I cheered for Orlando in the playoffs last year.....I love to curl....I still plug a bunch of posterior amalgams.....I like a strong American dollar....Las Vegas is like my second home....and, for the majority of the winter I really wish that I was Dr. John Gammachia in sunny, warm Florida!

Hope you enjoyed it....I'm spent!

I told you you were going to like it.
I have to admit, I was one of those people that believed that Canada had socialized dentistry.
And I didn't know anyone watched curling other than in the Olympics.
Great stuff, thank you Jamie, eh.

Ps What the heck is up with Canadian football?


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