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I had some extraordinary conversations last week in what was an exceptional week of ‘work’.

Last week I had one of those weeks at work where none of it felt like work at all and I was privileged to be able to have conversations, conference calls and face-to-face meetings with some extraordinary people about some extraordinary subjects.

In the mist of this I was able to read stuff because I had a little bit of time to then open my mind up to other ideas and concepts I have. I took a step back after conversations with some high level people in dentistry about the state that our profession is in and think what might happen next.

A couple of heads up in relation to the information that has come my way that has influenced my thoughts…

I wrote in a previous blog about the consultation regarding healthcare regulation that was released to me by the GDC in an email and the move towards a super regulator for healthcare.

I also found out this week that Liverpool Dental School appear to have announced that they plan to merge the first three years of dental education with dental students, hygienists and therapists. I’ve not had this confirmed yet, but if that is the case it apposes all sorts of very serious and sinister questions regarding the future of dental education and it’s availability to the general public.

All of this is framed by the fact that it’s quite clear that dentistry is in a shocking state of affairs in terms of it’s provision for patients in the NHS, in particular for the lower end of social classes.

I have independently found out as I have mentioned in these pages that one of the major corporates in dentistry sold three practices for £1 earlier this year and the same corporate it seems has given back a contract in a rural society that has not been picked up by any other dentist or corporate. Leaving 15,000 patients who were guaranteed NHS dental care with no access at all.

This is likely to be the tip of the ice burg and the start of things to come.

Match that up against the fact that it’s reported that we have the highest amount of new graduates in dentistry (and medicine incidentally) leaving the profession during their first year of their career, as well as the highest amount of people being expelled from dental and medical school for fitness to practice issues.

Where does this leave the profession going forwards? With people exiting dental school that are reported to be ill equipped clinically for the challenges that lie ahead.

The corporate bubble has indeed began to burst and if you haven’t sold your practice and carpet bagged the money yet then you better do it quite quickly because it’s likely that the value of practices is going to plummet over the next 12 months (certainly those in NHS dentistry).

Commissioning groups in London have been heard to say they intend to slash the orthodontic budget in the capital by 50% and I have on reliable sources that this will be at least 33% in the East Midlands. So what next and where do you go from here?

It depends upon your age and your stage.

If you were a young dentist just about to qualify you’d need to take a long hard look at yourself and have a really clear view of where your career pathway will travel. You were that same young dentist with a high five or low six figure debt; that would be a problem indeed.

If you were a 35 year old associate looking to buy your practice for the first time how would that work? It might work well if you had money in the bank but if you were leveraged heavily on debt trying to live the old fashioned life style of a dentist you might have difficulty there too.

If you were 45 and above you might be thinking that you couldn’t take it any more and it was time to get out.

For all of these people the only option is to rise to the top.

Obtaining critical knowledge both in clinical skills, the management of your business (if you have one) and the management of yourself.

It’s my belief that within the next 5-10 years dentistry will be engulfed as a sub speciality of medicine and from what I see in dentistry I’m sad to say I think that might be the best option for it.

When I compare many of my dental colleagues to my medical colleagues who I know in terms of how they work, their ethics, their empathy and not to mention their salary I think if I were a patient I would be encouraging the move for dentistry into medicine.

As it is though in medicine it will be in dentistry, the top 10% will be rewarded, whatever reward means, and mediocrity will be rewarded with mediocre.

Blog post number: 1462