What if you have spent years studying for a rigorous degree program and then graduates with no job opportunities in your field? Public universities are now allow to decide how many students they enrol in bachelor’s level courses. These universities receive commonwealth funding, also known as the demand-driven system.
This legislative change has been implement by many universities to increase student numbers. La Trobe University is one example. It aims to increase its student numbers by 30% between 2013 and 2017. Some professions, especially in the health sector, talk about an oversupply. How can we tell if there is an oversupply of qualified graduates? Are universities profiteering from this oversupply?
An Increasing Graduates Number
Two excellent examples of disciplines that have seen an increase in graduates under the new system are dentistry and speech pathology.
Both fields have seen an increase in their numbers due to the availability of courses and lower entry requirements. All over the country, speech pathology courses are being offer. There will be seven new courses on the east coast of Australia from 2011 to 2014. Before that, there were ten.
Three courses are now offering training for approximately 230 speech pathologists each year in Melbourne. However, there have not been many job openings in Victoria after this explosion of speech pathologists. From our most recent cohorts of Victoria graduates, we know that some people have had difficulty finding work.
With more courses available, this situation will only get worse. Australia is expect to train more than 1,000 speech pathologists each year at the current pace, with most of them hoping to get into the workforce after graduation. Some graduates have decided to go into private practice, where it may be more difficult to obtain continuing professional education.
The Australian Dental Association has been calling for a limit on the number of dental students. The ADA anticipates that around 580 students will graduate in Australia this year, while only 250 graduates go on to the workforce each year.
Do You Have A Clinical Need?
This expansion is clearly being driven by universities, which are capitalising on the desire of students to pursue more vocational courses that promise a high-paying job.
However, can we just judge an oversupply based on the workforce numbers? Many people argue that these services are still needed. Professors Peter Brookes of Australia and Mike Morgan from the University of Michigan suggested that an increase number in dental graduates could be a response to the real need for more dental services in the community.
It is possible to argue that more speech pathology services would be beneficial for the community, with an estimate of about 5% of Australians having a communication or swallowing impairment at any given time.
Over one million Australians need the services of a speech therapist. One in five Australians will require the services of a speech pathologist during their lifetime. The demand for clinical services will increase with an aging population. Australia has approximately 7,500 clinicians. However, not all are practicing clinicians. Many others work part-time.
This makes a positive ratio of one speech pathologist for every 150 people who need their services. This is a poor number if society aims to reduce the social and health costs of communication disability.
These fears are being echoled in the United Kingdom, where cuts to speech therapy have led to longer waiting times for essential services.
Losers And Winners Graduates
There are many problems that the industry and similar industries may face due to recent expansions in speech pathology programs. The other issue is the oversupply in qualified clinicians looking for employment.
The second is about the quality of new graduates. The quality of education received and the required entry scores to enroll in courses can affect the standard of graduates. The entry requirements for courses that are popular tend to be higher if there are fewer places available. If places are easy to find, the opposite is true.
These issues are magnified in the case of speech therapy because there is no legal requirement that clinicians register with any board of health professionals. The National Registration and Accreditation System (NRAS), which applies to most health professions, including medical (physicians), allied health (physiotherapists), and complementary therapies (osteopathy) is a requirement for accreditation.
The NRAS views its primary function as protecting the public from misconduct in the health profession. Individuals can practice in many places without being registered or accredited because there is no formal regulation.
Limitation Of Numbers Graduates
Higher student numbers will bring increased revenue to universities, which are the ones who train the new graduates. Universities might argue that they are not responsible for regulating graduate numbers based upon job opportunities in the health sector. In the case of medicine, the government has resisted the idea of limiting student numbers, except for those who are qualified to train in hospitals.
This could also be true for any profession that is health-related, where clinical placements are an integral part of training.
The best opportunities for employment may be available to students, so they might end up choosing the courses and universities that are most appealing. They can limit the number of graduates by choosing courses that maximize their opportunities for employment.
You might be unsure if it is really necessary if your dentists recommends a crown or wisdom teeth extraction. We don’t know the extent of this over-servicing. Our research, which include interviews with Australian dentists, has been publish today. This is not only a problem for patients but it also makes dentists feel pressured to suggest unnecessary treatment. This is encourage by the fact that dentists get paid to perform their services.
What Is Over-Servicing Dentistry?
There are many kinds of over-servicing, and each type has its own definition. Our research has shown that over-servicing in dentistry is when dental care is provided beyond what is clinically necessary or without any justification. Internationally, over-servicing in dentistry has been reported and is discussed online. It’s something we have known about in Australia for a while. A Sydney dentist was charged with performing nearly $75,000 worth of dental treatment on one patient. He knew it was ineffective and unnecessary, and was sent to court.
Another Sydney dentist found guilty in 2013 of serving elderly patients in nursing homes, some with dementia. He filed their teeth in order to fit crowns they didn’t need without anaesthesia. Over-servicing is not always as extreme as it appears in these court cases. We spoke with dentists who felt that they were often under-servicing as part of their daily practice.
What Dentists We Found
Interviews with and diary entries of 20 Australian dentists in private practice were analysis. This was the first study to examine their views on over-servicing. Many dentists that we spoke with felt under pressure to give unnecessary care. The pressure came from the owners of practices or their financial obligations. They talked about a culture of finding treatment in certain practices, as opposed to treating patients issues.
My first job too commercial so I quit. It was a matter of How many crowns do you do per week? Our clinicians should be doing at most one crown per day. There was no care factor to consider, such as what the patient really needs. It was a matter of Okay, I’m seeing a new patients, see if I can get this amount of revenue from that one.
Why Is This Dentists Happening?
Private dentists in Australia paid a salary that is link to the amount of treatment they provide. This fee-for-service system provides an incentive to them to offer more care than they provide. Over-servicing is not inevitable. Some participants claimed that their professions as dentists helped them to place patients ahead of profit.
My professionalism was always my top priority. There have been times when I recommended a crown. I was unsure if I did so because it was expensive or because I truly believe it is the best for the patient. Our dentists spoke out to say that they had spent much time thinking about how to manage patient care in a system that favours over-servicing.
What happens when the fee-for-service model change? As a trial in the United Kingdom, this might include a monthly charge for patients who register with a service or practice. Patients notice little difference in their clinical care, and the amount of treatment was reduce.
What Can We Do To Address This Problem?
The way that dentists paid could change to address the problem of over-servicing. Instead of focusing on how many dentists work, payments could tie to tangible improvements in oral hygiene. However, fee-for-service is so deeply rooted in Australian dentistry that we acknowledge this would be difficult despite increased awareness of the topic brought about by research like ours.
What If I Am unsure if I Need A Treatment Recommendation?
Ask your dentist if you aren’t sure why he or she recommends a particular treatment. Ask about other options. You can always ask for a second opinion if you aren’t satisfy with the answers. To avoid having to take them again, you should ask your dentist to provide a copy of your medical records and x rays. You will likely need to pay for another appointment if you visit another dentist. Your dentist is the best place to go if you are unhappy with your treatment. They really appreciate feedback and will try to make things right.
Websites of many Australian dentists proudly state that holistic dentistry is a philosophy that encourages health and wellness, rather than treating disease. It considers the whole person, not just the teeth. It sounds very exciting. This practice is certainly different and more exciting than the mainstream dentistry. However, it doesn’t necessarily mean better qq online.
Many holistic dental practices embrace and encourage alternative treatments. You can find Australian dentists who practice or endorse homeopathy, Bach flower essences and naturopathy. The Australian Health Practitioner Regulation Agency has all registered dentists. This means that the public assumes they are trustworthy and their treatments, even if unusual, must be effective. We must also respect the ancient wisdom that influenced many of these treatments over the centuries. Yes, and no.
Not Quite Right Holistic
Modern medical treatments have been influence by many ancient remedies. Hippocrates recognized that powdered willow bark, which contained aspirin, relieved headaches. South Americans used quinine-rich cinchona bark to treat malaria. Ephedrine, a common stimulant and decongestant in traditional Chinese medicine, was also use to treat malaria. Both of these drugs are now highly effective.
It doesn’t mean that you can do something for hundreds of years. Misguided medicos have bled patients from the early Greeks and Mesopotamians to the late 19th Century, often to their death, trying to cure a variety of ailments. Traditional health systems still hold bloodletting as a fundamental belief.
Traditional Chinese medicine uses bear bile, shark fins, tiger penises and rhino horns. None of these medicines, despite the cruel methods they are use, has shown to have any health benefits. Rhino horns weigh more than gold, but are also more expensive. Because they largely made of protein keratin, buyers could have save a lot by simply chewing their toenails.
Noel Campbell, a former Victorian dentist who was self-describe professor, was practicing (very) alternative dentistry when she was charge with administering oxygen to the rectum of a patient to alleviate her facial pain. It didn’t work, not surprising. Campbell avoid being discipline by allowing his dental registration lapse, but he continues to offer unproven alternatives therapies to cancer patients through his website. He’s not the only one.
The cases of Jessica Ainscough, Wellness Warrior, and Belle Gibson, Whole Pantry’s Belle Gibson are two examples of how safe and effective recommendations for health-care should be based on more that a beautiful smile and social media presence.
Evidence Is Important Holistic
Aren’t there other therapies that are safe and effective? How can we tell the difference between them? We have many ways to determine if treatments for health are effective. Over the last few decades, evidence-based healthcare has become almost universally accepted as the standard for professional practice in health.
Evidence-based dentistry is open to patients preferences and needs, but insists on high-quality scientific evidence. Regular systematic reviews of publish research are require. Alternative therapies are currently support by very little evidence and have poor research methods. Even if a positive effect found, it often less than the placebo treatment and much lower than mainstream healthcare.
Because they haven’t proven effective, most natural medicines have not been add to the Australian Register of Therapeutic Goods. Alternative therapies that safe and effective have been add to the mainstream health-care arsenal. Is it really important that patients get the treatment they need and feel better? It does matter.
While holistic practices can provide a wonderful environment for patients, trust and professionalism are essential to a good patient-dentist relationship. If a dentist recommends or endorses treatment options that are based on centuries-old eye of the newt and toe of the frog, without verifying if any positive effect is real, it is not in the patient’s best interest. Patients may not only have lost significant amounts of money, but they could also have been denied legitimate treatments that would have offered much greater benefits.
Hippocrates was writing this more than 2,000 years ago. In fact, there are two things: science and opinion. The former is the source of knowledge, while the latter is the source of ignorance. The public expects health professionals to practice professionally, ethically, and competently. Do you prefer a dentist that provides advice and treatment based on the latest research? Or a dentist who relies on dubious and unsupported mysticisms?
1948’s preamble to the World Health Organisation constitution defined health as a complete condition of physical, mental, and social well-being and not just the absence of illness or infirmity. This definition is still valid today and fits well with holistic dentistry. Holistic dentistry is not new. Holistic dentistry should be practiced by all dentists. They should also be practicing evidence-based dentistry.