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Calls are growing for government action to help regional and rural towns attract dentists. Cameron Cooper reports
As much as Kritika Mehra and Jimmi Patel love practising dentistry in the agricultural stronghold of Riverina in New South Wales, they face a stark truth—most other dentists don’t want to join them.
They own the Local Dental practice and run four regional clinics, one each in Deniliquin, Finley, Hay and Barham. However, they are struggling to get other dentists and dental assistants to swap the city for the tranquillity of the bush.
After growing up in India before moving to Australia, Dr Mehra and Dr Patel have made a successful transition to regional life and business.
The key, Dr Mehra says, is that she and her husband arrived in Deniliquin with only positive thoughts when they first moved to the town over a decade ago to work for the existing practice owner, Dr Ian McAtamney.
“When we came here we came here to stay,” she says. “And it’s worked out well.”
The dilemma for Dr Patel and Dr Mehra is a common story across regional Australia, which is facing a shortage of dentists and other professionals such as GPs, lawyers and accountants. At the heart of the problem is a fear that country Australians will miss out on crucial oral care.
A report from the Australian Institute of Health and Welfare, called ‘Oral health and dental care in Australia’, states that people living in regional and remote areas generally have poorer oral health than those in major cities, and oral health status generally declines as remoteness increases.
Dr Mark Hutton, the Australian Dental Association (ADA) president, believes a significant issue in remote areas is a lack of focus on personal oral care. “It’s true that the more remote you live, the less access there is to a full range of healthcare professionals, but the real issue is—and this is not limited to people who live in the bush—that many Australians don’t prioritise oral health,” he says.
The ADA notes that the latest figures from the AIHW show that the number of dentists per 100,000 population has increased from 41.1 in 2013 to 45.3 per 100,000 people in inner-regional areas in 2019, and from 36 to 37 per 100,000 in outer-regional areas in 2019. The figures for remote/very remote areas show a similar growth from 20 per 100,000 in 2013 to 27.7 per 100,000 in 2019. “This would indicate that there are now more dentists available to rural populations than ever before,” Dr Hutton says.
However, he acknowledges that recruiting health professionals to rural and remote areas has always been challenging. “Working in regional Australia can be very rewarding work and is a choice many dentists make. I came to work in a rural practice more than 45 years ago and am still there today.”
With the COVID-19 pandemic highlighting the safety of rural areas and opening up the possibility of more people working from home in the regions, the hope is that more dentists will flock to the regions.
“But that absolutely has not happened yet,” says Dr Anup Shenai, the principal dentist at Rochester Dental Clinic in rural Victoria and Moama Dental Clinic in NSW.
A practice owner for the past 12 years, Dr Shenai has the capacity for eight dental chairs across his two clinics, but he simply cannot get enough dentists to utilise that number. “We can only get four chairs filled at the moment and that’s a real problem.”
The upshot, too, is that regular patients may have to wait months to get an appointment. While the two clinics sometimes attract graduate dentists, Dr Shenai says the typical scenario is that they come to rural towns, get invaluable all-round experience and mentorship and then head back to the city with a strong résumé. A similar situation has occurred whereby city students flood the La Trobe University dental courses in Bendigo, but head back to the city after getting their degrees.
Dr Mehra says the constant turnover of dental practitioners in country areas “seems like a betrayal of patients’ trust”. She believes four factors contribute to the dilemma. First, many dentists have a “closed mindset” about country jobs and see them as merely a plan B option if they cannot get a role in the city. “They don’t want to come here and stay.”
Second, if dentists do come they typically do not have accompanying family members and are forever returning to Melbourne to see family and friends. “There’s no family support; that’s really missing.”
Third, they can often suffer burnout, especially principal dentists, because of the absence of support. Fourth, because of the combination of the other three points, they may not get involved in their community and suffer from a feeling of being temporarily in the town and end up leaving.
The experiences of Drs Mehra, Patel and Shenai reflect the findings of a 2018 University of Western Australia study, which found that although the number of dentists in rural and remote areas is on the rise, it is still not keeping up with the growth in demand. Furthermore, it reported that there is a divide between access to dental treatment in cities compared to regional areas.
For much of the past decade, government initiatives such as the Dental Relocation and Infrastructure Support Scheme (DRISS) have encouraged dentists to work in regional and remote areas where there has been a shortage of practitioners. The initiative provided funding for infrastructure and fit-out costs for dentists to get established in regional locations.
However, the scheme has been wound up, raising questions as to whether regional and remote dentistry is sustainable without government support. Dr Hutton says the DRISS scheme was a recommendation from the ADA and resulted in about 100 dentists relocating. “While some have continued to practise in rural settings, there has never been a longitudinal study to determine the success of these initiatives.”
To improve access to care and promote better oral health outcomes, the ADA has developed The Australian Dental Health Plan, which provides the funding framework for those in the community who cannot afford to pay. “However, without a commitment from government to fund such programs, there will always be a challenge for a dentist to run a viable practice in some areas,” Dr Hutton says.
To woo new dentists, Dr Mehra advocates potential tax breaks for regional and remote dentists that are tied to a timeframe for which they have to stay in bush areas.
Dr Shenai also suggests a scenario whereby immigrant dentists would have to work in the regions for at least three years before they could get an unrestricted licence to practise in Australia. This would echo a similar scenario for GPs when they come to Australia.
The good news for Dr Shenai and his team is that the Rochester and Moama clinics are performing better than last financial year, with home-bound residents opting to get their teeth fixed in the absence of activities such as overseas travel because of COVID-19.
“The problem now, though, is that there’s an oversupply of patients, but not providers.”
Dr Shenai believes that if dentists have a long stint in country towns, they will grow to love the bush and stay. “Why wouldn’t you want a good lifestyle where you don’t have to sit two hours in the traffic to go six kilometres.”
For Dr Mehra and her husband Jimmi, the dearth of dentists who are willing to move to the country presents daily challenges. However, they do not regret their decision to settle in Deniliquin.
“This is home,” she says.