Dentist shortage
Federal cutbacks and changes put Northern dental care in jeopardy

Dawn Ostrem
Northern News Services

Yellowknife (May 01/00) - Since the calender flipped from 1999 to 2000, at least one Northern community is feeling the New Year's hangover, in the form of decreased dental services.

The headache has trickled down in the form of health-care cutbacks in Ottawa to the hamlet of Fort Resolution. The community has been without a travelling dentist since December, and recruitment has been hampered because of funding.

The NWT Dental Association is searching for a solution.

Dr. Peter Cooney, acting director general for the Non-Insured Health Benefits program, a division of Health Canada, said he's aware of a letter the association sent to the feds asking for an immediate meeting to discuss the situation.

"We've asked them to outline the problems," he said. "And we will be going into further negotiations."

A key problem is that as of Dec. 31, 1999, the National Dentists Examining Board ceased to exist.

Don Portz, the executive director of the NWT Dental Association, said the root of it is likely fiscal restraints and that has left this area dry. The GNWT had recruited foreign dentists through a recommendation passed by the government a number of years ago, allowing foreign dentists to practise here for three-year terms.

"The legislation said that if they were from a recognized school and other various criteria, they could come up here and practise under supervision," Portz said. "They were allowed to do that but had to pass three (federal) exams.

"They can't do exams now, so we're left with trying to attract Canadian dentists --and we're not."

Another issue includes fees paid to dentists in the NWT. If fees are increased, the problem of attracting Canadian dentists may be alleviated somewhat.

The problem arises for those receiving benefits. The amount the federal government pays dentists to work in aboriginal communities is far less than what they would regularly charge in the south, Portz said.

Too much red tape

Dr. Jim Tennant operates a dental practice out of Hay River that used to provide Fort Resolution's travelling dentist. He said even though fees haven't changed, the other changes have created a paper trail and too much red tape to make continuing the service feasible.

"There's now three times as much work to claim 80 per cent of our fee and that makes (going to communities) less attractive," Tennant said in an earlier interview.

Although changes to the non-insured health benefits program may have been part of the reason Fort Resolution lost its travelling dentist, supporters say the benefits outweigh the disadvantages.

Authorization required

The program, which was changed in 1997, now requires pre-authorization for dental work costing more than $600 in aboriginal communities, but also allows different types of work to be done. This may seem beneficial to Health Canada -- which has been having difficulty coming up with funding to distribute where needed -- but all parties agree the North is suffering from a lack of dentists.

"Both dentists and patients suggested a frequency-based approach," Cooney said.

For example, under to the former system a patient could only receive a crown every three years. Now the system caters to "someone who needs, say, two crowns instead of just one," he added.

Some workers in the dental health field feel the new benefits package is also a good way to cut down on dentists abusing the system -- doing more work than is necessary to receive more money.

"If a dentist submits a (pre-authorized) treatment plan you are able to see the work needed on the x-ray," Cooney explained. "Most dentists do honour this plan and ensure the work needed is the work necessary.

"If we were to find problems, we would go to dental associations or regulatory bodies, and in some instances, the RCMP."

But Portz said that shouldn't be an issue.

"In some instances that might be a problem but not everyone is honest in every industry anywhere," he said. "To say we're going to treat everyone that way -- is that right?

"The federal government has to run around and find a way to try and keep spending low and I understand that," he said.

"But the population and utilization has increased. More and more aboriginal people are starting to concern themselves with dental health and that increases the amount of money they're having to spend. What happens when they say, 'We are not going to give those people a crown when we can just pull out the tooth?,'" Portz said. "It happens a lot that dentists want to do something that is needed and can't."

In situations similar to Fort Resolution's loss, Cooney suggested bringing in dental therapists hired by regional health boards.

These therapists are trained to do basic dental work and educate in remote communities in the place of a dentist. They are paid a salary versus charging fees for their work.

"We are also training dental therapists and where communities have problems attracting dentists there are certainly alternatives," said Cooney.

But Portz said finding dental therapists is just as difficult as luring dentists North.

"They're effective, but there's a large demand for dental therapists down south, too," he said.

Therefore, he says the dental association is looking at the fee guides of the Non-Insured Health Benefits.

"Certainly over the last three or four years, with Health Canada, these negotiations have been solely a one-way street," he said. "Down south some dentists are saying to aboriginal people, 'You pay our (regular) fees and collect what you can get out of (the benefits package).'"

Although Cooney said fees have increased four per cent over the past two years, that's not enough according to the NWT Dental Association.

"All of the cutbacks have certainly created a very difficult problem," Portz said.