Why I've changed my mind

Nigel Jones speaks to Jasmine Lobo about her experience of beginning a career in NHS dentistry and why she feels the need for a back-up plan for her career…

The retention of dentists in the NHS may be seen as one of the biggest challenges facing the profession. Repeated surveys* show that the majority of dentists don’t see themselves working in the NHS within five years’ time.

One particularly troubling aspect of this issue is that it is not just restricted to those who have been at the coal-face for a long time and, some might say, have earned their right to feel jaded and weary. It feels like there are more and more stories of younger dentists who are reaching this point within the first few years of embarking on their career.

Towards the end of 2017 I met a dentist at this stage in her career – Jasmine Lobo, who had qualified from the University of Leeds earlier that year and was working as a dental foundation trainee in a mixed NHS-private practice in Swansea. I recently caught up with Jasmine again, now she has finished her foundation training year and is working at Leeds General Infirmary in Oral and Maxillofacial Surgery, to hear more about her experience and how it has impacted her feelings about a long-term career in not just the NHS, but dentistry in general.

Nigel Jones (NJ): What was your experience of your foundation year in practice?

Jasmine Lobo (JL): I was doing mostly NHS work during that year, and I loved my practice and I was incredibly supported by the team there, but I did not enjoy working within the system. I only worked in it for a year but that was all it took for me to finally understand the problems the older generation in the profession talk about when it comes to practising within the NHS.

For example, one of the main issues I had was trying to do the best I could within the amount of time I had to spend with patients, which doesn’t necessarily mean doing the best dentistry I am capable of. Working under the time pressures of the NHS and the UDA-based system, I just ended up feeling like I was on a treadmill.

NJ: That’s quite sad to hear from someone at such an early stage in their career, how did this reality match with the expectations you had before leaving dental school?

JL: I don’t think I was prepared for the harshness of the system. As part of foundation training, we have to treat and present high-needs cases to our peers. This involves doing a financial analysis of the case so we would gain insight into what it would be like as an associate. We found that in order to meet the needs of some patients as NHS associates, we would either make very little profit or a total loss to the point where we would have to pay for the patient’s treatment from our own pocket.

Forget all the clinical skills – that was the biggest lesson I learned about NHS dentistry, and it made me see it in an entirely different light, which was quite deflating. I started considering whether I could really work as an associate in a high needs area, where that could be the case with every patient and the answer, really, is no.

“We found that in order to meet the needs of some patients as NHS associates, we would either make very little profit or a total loss to the point where we would have to pay for the patient’s treatment from our own pocket.”

I went into my degree with the intention of working for the NHS but it’s not viable. I loved working in the practice and the actual career, but the system is unfair and I didn’t break my back studying for six years to be earning one or two pounds an hour for the work I do. My friends who are a similar age are earning more than me and they have savings, spare time and a good work/life balance, and yet I did a long, demanding degree and seem stuck in the same place.

NJ: It feels as if there’s a perception out there among some people that a lot of younger dentists are simply shying away from the hard work of the NHS, do you feel that’s fair?

JL: Absolutely not. I would want to work in the NHS where it is supposed to be affordable for all, but I feel like, if I did do that, I would actually be de-skilling, and I wouldn’t be offering the best service for my patients.

So many experienced dentists are advising people like me to only work four days a week or we’ll burn out, which is a phrase I seem to hear all the time. It’s like they’re saying, based on their experience, if you do four days a week you will last 40 years, but if you do five you will only survive for 30 years…I can only conclude that in order to have the stamina to stay in the system, you simply can’t work full-time hours.

NJ: How do you and your peers feel about a career in the NHS?

JL: I definitely think that most younger dentists view the NHS as an okay place to start out, but really, it’s just a means to an end, with the end being moving to private practice. It is a bit disappointing that we feel that, before we reach the age of 30, we need to be in private practice in order to be living a comfortable balanced life.

I feel that this is the message that is being pushed out to students who think they have to go on all these different courses and do all they can just to get their foot in the door of private dentistry and make the move as soon as possible.

For me, I think it’s going to be more difficult to get a job because I’m so hesitant to go into an NHS contract but I feel like I have to in order to have that experience and prove myself first. It shouldn’t be seen as a stepping stone, but, in reality, it is.

NJ: The analogy with a stepping stone is a sentiment I’ve heard expressed by a lot of other dentists, so I don’t think you’re alone with your views. If you don’t see your future in NHS primary care where do you see it?

JL: During my foundation year I felt a bit lost and couldn’t see a progression pathway, which I could when doing my hospital core training, so I see my future in secondary care. I am going to see how I fare this year and then may pursue a further year of core training or I might even go back to medical school to become a surgeon.

“I think one of the reasons a lot of people are leaving the profession and looking at different careers, including myself, is the emphasis on the risk of complaints and litigation, and the pressure that brings.”

I think one of the reasons a lot of people are leaving the profession and looking at different careers, including myself, is the emphasis on the risk of complaints and litigation, and the pressure that brings – which is referenced during every lecture at dental school. People often wonder why I delve into different things outside of dentistry, such as my microbiology degree and teaching languages. The truth is, I do these things because I enjoy them but also so that I have a back-up plan.

NJ: It seems such a shame that you feel you need a ‘back-up plan’, however I suspect you won’t be the only one in that position, which is a real tragedy for the profession. I’m afraid we’ll have to leave it there for now, but hopefully we’ll meet again soon to see how you’re faring.

* http://www.nhsdentistryinsights.co.uk/

* https://bda.org/news-centre/press-releases/half-of-nhs-young-dentists-heading-for-the-exit

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