Inuvik clinic feels pinch of federal policy changes
Inuvik (Jun 23/00) - The North is facing what industry professionals are calling a crisis in dental care.
This concern follows the breakdown of recent talks to negotiate a funding solution between the NWT/Nunavut Dental Association and the federal government's Medical Services Board.
With a serious shortage of dentists and a juggernaut of paperwork and bureaucratic delays from Ottawa, dentists say patients are suffering because of recent changes in federal policy.
The problem is two-fold, said Terry and Jean Clark, who own the Western Arctic Dental Group in Inuvik. Firstly, the federal government now handles all dental claims made through the Non-Insured Health Benefits (NIHB) for registered Indians and eligible Inuit and Innu.
The Clark's Inuvik clinic services Aklavik, Fort McPherson, Tsiigehtchic, Paulatuk, Tuktoyaktuk and Sachs Harbour, and they have a clinic in Norman Wells to service the Sahtu. The Clarks say 80 per cent of their patients are covered through NIHB and the bureaucracy is costing them money and causing patients undue suffering.
"The paperwork hoops that we're jumping through now, with the changes to the non-insured services are restricting the type of service that we can deliver," Terry said. "We're fairly-well dictated to as to what we can and can not provide."
Although the patients may indeed be eligible for the work, he said it often never gets done or gets progressively worse before a dentist can do what's needed. Terry said approval can take anywhere from three to six weeks and the travelling dentist may not be scheduled to return for another six months.
"It may be a year until we see that patient again," he added. "So what might have been a small filling is now an extraction. Ethically it's not right; I didn't go to school for somebody in Ottawa to try and tell me how to deliver the service."
Jean said, that ethically, the work should be done, but legally their hands are tied.
"We can't go ahead and do that work until we get approval," Jean said.
"It's frustrating professionally," Terry said. "Because our ethic has always been the patient comes first, the money will follow."
The Clarks say they are still in business because they own the building they work out of, but overhead has been so high, they've dipped into their savings to keep afloat.
"We're actually billing for less than Edmonton, for a service that's costing us more than Yellowknife to provide," Terry said. "Now it's getting to the point where we're starting to look at the bottom line, just so we can keep the doors open."
The second situation adding to their problems, is an acute shortage of dentists, due largely to changes in the National Examination Board tests, which approve foreign dentists to operate in Canada.
Terry said foreign dentists are now restricted from practising until they pass national examinations. Previously, foreign dentists could take up to three years to write the exams.
"Our hiring pool is just demolished," he said. "I have never heard a reason; I've never seen a statement why. We heard it was coming. We tried to get information and couldn't."
The new regulation may be fine for Toronto, they said, but it's hurting dental care in the North.
They spend the better part of the year travelling south to attempt to recruit new dentists. They usually have five dentists on staff, and are now trying to recruit two more to fill vacancies.
"We speak every year at the (University of Alberta) and send out flyers to the various Canadian universities, to expose our situation with employment," he said. "We're out more than we're in, looking for people; which isn't right. We should be up here doing our thing in Inuvik. Not out scouring around looking for personnel."
"We're private; we're not government, so we're out there doing this on our own," Terry added.
Their payment through the NIHB program is almost 10 per cent less than 1995 fee guide, they spend thousands on travel and recruitment and they are now dipping into their savings to keep the practice open. Why do they stay?
"That's a real good question," Terry said. "The older we get the more we start asking ourselves that same question."
"For us to just up and leave it ... it's kind of like, it's our baby," Jean said. "If we do, where is dental health going to be? There's not going to be any."
Now in their 50's, the couple are starting to think about retirement. They had taken on a partner, who they thought was going to carry on the business, but the young dentist backed out, seeing "no profit margin." The pair worry about what will happen when they leave.
"I can't see us doing dentistry up here, when I'm 80-years-old, and we are concerned about the future of dentistry up here," he said.