Dentistry: a sinking ship or a one risen afloat
A few days ago, I talked with a good friend of mine. He seemed worried. On asking whether everything was ok, he told me his clinic has not been running too well for some time now. The situation was bad enough that he had to bear the expenses from his own pocket. I did what I could- listened to him, tried to cheer him up, tried to encourage him a bit. That’s all I could do. Honestly, the conversation made me worried too. For someone like him who is great at his job- precise and aesthetic handy work, awesome social skills, calm and relaxed demeanor, good diagnosis- it was a difficult time.
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Let’s start this story from the beginning- I went to college to
pursue dentistry. There I realized that the hefty tuition fees were not enough;
my parents had to spend a lot more so that I can have good books of foreign
authors, high-end instruments of foreign brands, materials, and many more things
to make sure I learn properly. I attended conferences and CDEs/CMEs (continuing
dental/medical education programs), which I was told was an important thing
to do, with expensive fees for a middle-class guy to bear. With everybody
assuming that the students are well off, I remember being spurred once for my
apron seemed of cheap and low quality and apparently I should have a few custom-made aprons with cloth from suiting and shirting brands. So to sum up, a lot
was invested in me for five long grueling years so that I could become a
dentist, a doctor, along with about 300 more, from West Bengal, that year.
When I had completed college and was looking for
jobs in clinics and hospitals, I had the greatest reality check of my life- how
difficult it is to secure a job with a decent salary, how difficult it is to
sustain in such salaries, and how fewer opportunities there are in dentistry. It
was as next to impossible to afford a dental clinical setup for me- everybody
knows that a good dental chair alone comes at Rs. 1 lac and above- as it was to
pursue post-grad MDS. While government jobs were a sight for sore eyes with
an average salary over 40000/- a month, the seats used to be as limited to a
few left for the general category, the real backward in today’s world. I also
remember one of my friends shared that he learned from one of our own professors
how the seats for government jobs are literally sold for around 25lac rupees. The
first job offer that I received from a dental polyclinic was of just 8k per
month. And when I started a private practice, with a hectic routine of 6:30 am to
10:30 am in about 5 clinics daily, around the metro city of Kolkata, I could
barely manage 10000/- a month. No doubt I not only learned my work, owned my
skills, and learn how life and the world run, but I got frustrated and
saturated at the undergrowth I had achieved.
I went to pursue post-graduation and chose a subject
of not only my interest but more importantly which could open opportunities
other than a clinician. It has been around 6 years now that I have passed out. After
years of struggle, even with a post-graduation, I am working in a non-clinical
and unconventional field and planning to pursue Ph.D., but am earning a
decent living. My lack of patience and faith can be considered as the reason I
opted out of the traditional dental profession. But let me point out a lot many
more.
With the advent of privatization, education in
medical fields has increased manifolds. With a common aspiration of the
respectable profession of a doctor, the comparatively economical and easy
branches, from the management’s perspective and the student and his/her
family’s view, dental colleges are literally manufacturing thousands of
graduates each year. However the lack of awareness in the general population
regarding oral health and the increasing demand for general health in the
country, the government has little to invest in opportunities and vacancies for
the dentists fresh out of colleges. The private jobs pay too little to dentists
to sustain, as a result of the corporate hierarchy system. Moreover, the
bribery, quota system, and the political sources and influences further diminish
the government opportunities. Even well-established dentists from old times not
only do less for the profession but also disrespect it by hiring their young
colleagues in real underpaid wages.
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With the horde of the ever-increasing young dental surgeons indulging themselves in a rat race of the next vicious cycle of post-graduation MDS and mostly unpaid house-surgeon ship in government hospitals, which ultimately acts as nothing but an escape from the harsh reality for a few years, the remaining population of these young dentists end up in the struggles of highly competitive clinical practice, taking years to reach minimum sustainability.
Other options of the country’s brain drain by
applying for examinations like NBDE for foreign practice are restricted to a
certain financially secure class of people. As per NEET-MDS, it is a tough exam
to clear. The very meritorious ones are the lucky ones to complete their PG
from government colleges and end up at a touch better level. But the others
either fall in the loop of reappearing again and again or drain enough
currency to bargain for a better subject in private colleges. I even heard of a
scheme of pursuing MDS part-time, where one only needs to appear in colleges
for examinations or even only to collect the final certificate if one is
willing to invest enough to just buy the degree. This poor quality of education
further deteriorates the condition of the already stained dental fraternity.
Clinical practice has the security of self-employment. But earning is always in a question mark when there is competition
in your neighborhood or even next door. With a lot of financial constraints as
one has to invest in property, electricity, water, instruments, materials,
auxiliaries, and other establishment costs, a dental practitioner has to
struggle to meet ends, often running negative in balance. With the pandemic
worsening the condition even further, it is sad to see well-qualified doctors
relying on seasons of wedding like beauticians, stylists, photographers,
caterers, and decorators. I mean no offense to any of those professions and
respect them all, but that is the sorry situation of dentists which makes one
feel the failure of the years of studying, learning, sacrifices and
compromises.
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Even well-settled and successful dentists are not
happy because of the excessive workload and lack of appreciation. This happens
due to low awareness about oral health among common people, who end up treating
dentists as any other shopkeepers and vendors, bargaining, ordering, and
misbehaving with them at the drop of a hat. There are also instances where
patients trick dentists and get treatments done for free. Thus while Google®
often hails dentistry as one of the highest-earning professions, in some pages
it also presents dentistry as one of the most unhappy ones.
The other alternative career prospects that are emerging
like forensic odontology, public health, etc. are getting choked in no time due
to the desperation the young dentists are in. This leads to zero trickles down
to younger contemporaries in terms of opportunities. Also, by personal
experience, I would express that these parallel branches fall victim to
prejudice, office politics, and widespread rigid conventionalism, often not
getting the deserved credibility and as a result very limited opportunities and
growth.
Sometimes though, the problem lies right at the
beginning. Most students pursue dentistry as a result of not qualifying for
MBBS, then comes a section of students from doctor families pursuing BDS out of
family pressure, leading to very few actual sincere aspirants. By the time
these students complete their studies the subject is reduced to just a means of
business and money maker. While clinical practice, in my opinion, is still quite
a matter of luck, it can be better if students are also professionally taught
practice management, ethics, and about other related career prospects and
parallel sources of income.
One more thing that I would like to point out is- in
a country where basic education is still not reachable to many; there is no
justification for pursuing higher education just for the sake of it. Again, no
offense to anybody, many of the girls who are often good in studies and may
become good doctors, end up as just so-called trophy wives to wealthy husbands,
dumping the years behind them. I also know many people, who after completing
dentistry, that too sometimes with post-graduation, ended up as great bakers,
models, singers, writers, etc. Some of them are even celebrities. I am not
judging them. Maybe they got their calling quite late. Maybe they did it out
of will or family pressure. If that is out of the hobby, or a parallel source of
income, then it’s great. But in case you abandoned the subject, you have wasted
for five-seven years, time, efforts, and resources, not to mention robbing a
worthy, enthusiastic and willing candidate of his/her opportunity. Moreover,
something that applies to such people, as well as the practicing dental surgeons, is that you can only expect that the subject gives something to you if you
contribute something to the subject.
The great entrepreneur, Jordan Belfort, the “Wolf of Wall Street”, once said in an
interview that he dropped out of dental school on learning from the professor
that “the golden age of dentistry is
over”. It’s a shame that I learned this after passing out from college. Jokes apart,
there are thousands of students that are still pursuing dentistry in the hope
of doing well. It comes to our responsibility to still try to work together to
save the profession and make it better for the new joiners of the fraternity. Dentistry should not necessarily remain a subject that has to be at the mercy of money to be available to study and practice but rather flourishing with much essential awareness and respect.
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