49
Volume3 Issue2
|
CDA
at
W
ork
I read thearticlesbyDrs. BruceWallaceand
DavidBairdabout theCoolAidDental Clinic in
CDAEssentials
(Volume2, Issue7, pp. 18-20, 23,
29). Oddlyenough, I came to the totally
oppositeconclusion.
I doagree that “the feespaidby the
government towardministrydental plans
are sodeficient that theygenerallydonot
cover theoverheadofmostdental offices.”
I disagree that communitydental clinics
are the solution.
Communitydental clinics stigmatize the
patient. Everyoneknows that everyone
attending theseclinics ison somekindof
government assistance. Communitydental
clinicsdonot allow thepatient tochoose the
providerorofficeof their choice. Community
dental clinicsnormallydonotoffer extended
hours. Communitydental clinics forcepatients
to travel greatdistancespassingdozensof
privateclinicson theway.
The solution is reimbursingdentistsproperly
for treatment rendered.
TheCoolAidDentalClinic, anot-for-profit clinic,
isprobably runasefficientlyasanydental clinic
can. Yet itcannot surviveon thedental feespaid
by thegovernment plans. Out of anoperating
budget of $930,000,whichdoes “not include
equipment capital costsor amortizationcosts
for theclinic’s clinical assets,” only$700,000 is
recovered from treatment fees. $225,000 (24%)
comes fromanoperatinggrant.
If oneveryconservativelyaddsanother 5% for
equipment and leaseholdcapital costs, the
government subsidizes theCoolAidDental
clinic29%aboveandbeyond the treatment
feespaid todentists inprivateclinics. If the
government simply raiseddentist feesby29%,
wewouldnothaveanaccess tocare issue.
Patientswouldbe treatedwithdignity in the
dental officeof their choice.
Dr. RaffyChouljian
Toronto,ON
TheAuthorsRespond
I thankDr. Chouljian foroffering
hisobservations. I agree that
communitydental clinicsarenot
theonly solution, butbelieve
alternative service settings (such
ascommunitydental clinics)
areacritical partof the solution
in reducingbarriers tocare for
vulnerablegroups.
However suchclinics, even if
dramaticallyexpanded,would
notbeable to treat vulnerable
Canadiansona scale that is
responsive to the level of unmet
oral healthcareneeds (suchas
identifiedby theCanadianHealth
MeasuresSurveyandelsewhere).
Acomprehensive solution to
this issuewouldalso require
increasedaccess toprivatedental
practicesandenhancedpublicdental benefits.
I also shareDr. Chouljian’sconcernsabout
howvulnerablegroups riskbeing stigmatized
inaccessingdental careandhowwemust
ensurepatientsare treatedwithdignity.
Dentistsworking inbothcommunitydental
clinicsandprivatepracticehaveaprofessional
responsibility toensure that vulnerablegroups
(due to socioeconomic factorsorotherwise)
areneither excludednor stigmatizedandare
providedwithanequitable standardof care.
Dr. BruceWallace
Victoria, BC
Theobjectiveofmyarticlewas
tobringattention toaccess tocare issues in
BritishColumbiaandour attempt to somewhat
address thoseneeds.
Wecanall agreewithDr. Chouljian’scomment
thatgovernment feespaid topractising
dentists fallswell shortof covering thedelivery
costsofdental services. Theunfortunate
reality is that thegovernment isunwilling to
increase its feespaid fordental servicesand
havenotdone so for 8years, despite intense
lobbyingeffortsby theBritishColumbiaDental
Association.
Thesenot-for-profit (NFP) clinicsarebyno
meansa solution for access tocareproblems,
but theydo representoneway thatBCdentists
are trying tohelpa segmentof thepopulation
whowouldnototherwisebeable toaccess
dental care.
Foodbanks, subsidizedhousingandNFP
dental clinicsareall factsof lifeandprovide
averyessential service formanyvulnerable
groups. That is thepurposeof these services—
theyarenotmeant tocompetewith theprivate
sector.
Mypersonal experiencewithNFPclinics
involves theCoolAidClinic inVictoria. Every
patient seen in theclinic is treatedwithcare,
respect anddignitybyallwhowork there. And
although somepatientsdohave to travel to
come to thisclinic,wehavemanypeople that
choose
to travel to theclinicanddonot feel
stigmatizedbeing treatedhere.
Dr.DavidBaird
Sidney, BC
ReaderResponse
CommunityDentalClinics:
Partofthesolutionorpartoftheproblem?
