A career conundrum

15 August, 2019 / insider

Without a clearly defined pathway, there is little support to encourage progression up the dentistry ladder to the very top of our profession. A framework to help our future leaders develop their talent is vital

Arthur Dent is a practising NHS dentist in ScotlandGot a comment or question for Arthur? Email arthurdent@sdmag.co.uk

Currently in Scotland we have an Oral Health Plan without any significant detail, timescale, or leadership. We have heard the dogma about ‘evolution not revolution’, which sounds like an excuse for a distinct lack of progress or new ideas. Repeatedly, we have heard the cry of ‘no economic destabilisation’. All leading to stasis, indefinite timetabling of changes and no significant detail on what the changes may be. This in itself creates economic destabilisation by making the future so unpredictable that businesses cannot reasonably plan or invest. The former CDO was clear she wanted economic predictability so that investment could be continued to secure the future of NHS dentistry in Scotland. However, this hollow rhetoric was based on a complete lack of any understanding of the mechanisms involved in the business of general practice. 

This is indicative of the way our profession runs. The Government has decided we no longer need to be under the direct control of the Cabinet Secretary for Health. Dentistry is no longer of political import. Patients can find dentists and the hierarchy that controls us can operate unchecked without a leader. Before that we had a leader who had no concept of how 90 per cent of us operated. No one in government or at the top of our profession has any clue (or at least recognises) how cheap it is to run dentistry using the model we have in Scotland.

If they did, they’d realise how important it is to keep it going. To keep it stable with continued but reasonable investment. One of the problems is our lack of a CDO. We have no leader. The next problem is who will do it? Who has a range of experience in all facets of dentistry? Who can command respect from GDPs, salaried dentists, and academics? Who actually understands, or at least is willing to understand the economics of practice? Who can fill the job spec?

This mini-rant brings me towards my fundamental point. I take myself back to my youth. Before you say it, quite a while ago. I was young, enthusiastic, maybe even idealistic. I had my future to look forward to and, after VT, I realised that I liked general practice. So that was to be my life. I realised quite quickly that there was little career progression in general practice once I had become an associate. 

Further CPD, yes. Development of my skills, absolutely. Refining my practice, my life’s work. Add in the challenges of buying and running a business. Advancing the property and facilities to meet and exceed guidance. Taking on a VT. These are things I am proud and happy to have done. However, when I speak to friends, dental and non, I don’t recognise a clear career progression. Other professions talk of exams, promotions, drive from line managers and corporate schemes to develop their talents.

Public Dental Service dentists may experience some of this in their learning programmes. An MSc or doctorate could be a way forward. However, often this is dictated by interest and availability rather than necessity or service requirements. 

Most importantly of all, this requires drive by the individual. Not determined by a career pathway. At 23 years old I thought I had reached the sum total of what my dental life would be like. This is what I expected. My own personal endeavours and challenges aside, that is what I got. Now, I like what I do and the patients give me the ‘biz’ and the variety I like. However, I do understand why people get bored and want to ‘get out’ of clinical work. 

On behalf of the younger dentists, I’d love to see a more-defined career pathway. More patients, more money, more techniques just lead to a bigger hamster’s wheel. Education is great but who decides whether it is good or appropriate, let alone useful? Without definition of process, people often get it wrong or they just don’t bother. To be solely self-motivated throughout a decades- long career isn’t practical. To continually challenge and reinvent yourself isn’t easy. It requires a long-term view and constant personal drive and ambition to find your own way. That simply isn’t for everyone. 

Even more so, and to get back on point, you’d have to invent your pathway and that of any other dentist. Where is the predetermined, tried and tested path to reach the top of our profession? At no point in my career could I have said, you know what, I started as a GDP and I’ll follow the process and maybe one day I’ll be CDO. I’ll be able to command the respect of my peers, garner the diverse knowledge of the various facets of my profession, and reach the dizzy heights of governmental healthcare. 

I know there can be only one CDO. However, shouldn’t there be a way to put yourself in the frame? Especially as a GDP who understands how the vast majority of dental care is provided.

The disconnect from reality is a major problem. The reality of being able to stop developing your professional skills at 23 is frightening. A framework to help future leaders and followers develop into the best they can be is necessary. For professionals and patients alike. Let’s keep ourselves interested and involved. It makes us much more interesting and satisfied people  and ultimately better dentists. 

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