She’s been employed by corporates and private practices but Dr Angie Nilsson, president of the ADA Tasmania, feels she can do the most good working in the
public health system. By Frank Leggett
When Dr Angie Nilsson graduated from Leeds University in 2003, she never imagined herself ending up on the other side of the world as president of the ADA in Tasmania. Her professional journey is a little unusual. After spending extensive time working in public and private dental practices, she has chosen to tether her career to the public system. In addition to her work with the ADA, she’s also employed by Oral Health Services Tasmania—and she couldn’t be happier.
“After I graduated, I worked in the NHS for seven years,” says Dr Nilsson. “So I started with public-minded, community-based family dentistry. In the UK, the NHS covers all dentistry including orthodontics. It’s actually a pretty good system that gives people a variety of options.”
Working in the NHS was certainly a high-pressure job. Dr Nilsson was seeing 40 to 50 patients a day and eventually the stress started to affect her. Simply trying to maintain the pace was exhausting.
“I loved my job but I just couldn’t keep working like that,” she says. “My husband and I had visited Australia in the past and we managed to organise a sponsored visa. We moved to Townsville in Queensland where I was employed by a corporate dental group. I only lasted nine months.
“I really didn’t feel comfortable. The nature of private practice puts a lot of pressure on the owner and it’s essential that they keep an eye on the profit and costs of the business. As a dentist, you’re not just serving your patient, you’re also serving the owner of the practice. That wasn’t for me. I was becoming less of a useful associate.
“I tended to bulk-bill more and discount more, to the point that I was then going back to what I was doing in the UK—overworking to try and make my salary balance.”
What made matters worse was that Dr Nilsson was employed in a small community. The more she got to know people and build friendships, the more favours she did for them. It was a constant battle between heart and head and wallet.
“I needed to take money out of the equation,” she recalls. “Then I could get on with my work and not think about it. If I can just do the dentistry I was trained to do, then I’m much happier.”
Dr Nilsson spent the next four years working in an independent family practice in Townsville. After a holiday in Tasmania, she and her husband decided to move there. Tasmania offered a complete change of scenery and her Swedish-born husband loved the climate. For the next two years, Dr Nilsson worked in a private practice in Hobart. While she enjoyed the work, she still felt torn.
“Even though private practice allows you to be a health professional and serve people, the money issue is always in the background,” says Dr Nilsson. “I’m not good at selling things. My passion was minimal intervention dentistry, which directed me towards public service again.”
Having started a Master of Health Professional Education while in Townsville, Dr Nilsson needed to be in contact with students and the public system in Tasmania. Everything was pushing her towards employment in the public system so Dr Nilsson began working at Oral Health Services Tasmania.
Here, she splits her time between supervising dental students from James Cook University who are on clinical placement and seeing patients who need general dentistry. As one of the more experienced dentists, she also mentors new graduates and oral health therapists.
“I believe I’m the first public dentist Tasmania has had as a president of the ADA. I work with a really great council and I’d like to hope I’m offering a lot to the ADA.”
Dr Angie Nilsson, president, ADA Tasmania
“I don’t think private ever really suited me and I’ve never had an ambition to buy a practice,” says Dr Nilsson. “While many of the students I’m supervising do plan to own their own practice, others have a range of plans for their future. Some want to work for NGOs or within health promotion and it’s really refreshing that they’re not all coming out saying, ‘I want to buy a practice and then I want to buy a Porsche.’”
While the senior dentists at Oral Health Services Tasmania tend to spread themselves over the clinic, Dr Nilsson also performs general anaesthetic dentistry and prison dentistry. Risdon Prison Complex has its own health clinic and surgery where Dr Nilsson visits once a month, alternating with another dentist.
“I love working in the prison,” she says. “It’s just so nice to have a change and get away from the normal clinic. A lot of patients in the prison have experienced things that put them in high-risk groups. Inevitably, I see a lot more decay and problems arising from drug use.”
This year, Dr Nilsson also started a PhD centred around aged care and dental curriculums. She believes one of the biggest problems in aged care facilities is with clients who have advanced dementia. They can’t communicate their problems or their pain, and the people who are caring for them don’t necessarily know what’s happening. It means that patients can’t advocate for themselves.
“It’s a very difficult situation for the patient, the carers and the family,” says Dr Nilsson. “The residents that are capable and communicative will probably utilise a dental clinic. However, the residents that have difficulty moving and communicating can be easily overlooked. The other major problem is that we are not getting dentists into aged-care facilities. It’s one thing talking about an older person’s dental scheme, but is that going to get dentists into the facilities? It’s an oral health time bomb.”
Dr Nilsson has been president of the ADA Tasmania since 2018. She sees her role as an opportunity to advocate for positive change and to represent public and private dentists. What she found a little surprising is how time-consuming the position is.
“I don’t think people realise how much goes on behind the scenes,” says Dr Nilsson. “I spend at least two hours every day emailing, writing newsletters, writing to politicians and going to meetings. I believe I’m the first public dentist Tasmania has had as a president of the ADA. I work with a really great council and I’d like to hope I’m offering a lot to the ADA. I know that I’m learning an awful lot and I really enjoy it.”
Another big part of her presidency is working with the mentoring program. Being a senior dentist and supervisor, Dr Nilsson mentors graduates and junior dentists as part of her day-to-day work. She’s also involved with private practice mentorship.
“I still mentor the associates at the private practice where I worked in Hobart,” said Dr Nilsson. “I have a really good relationship with the owner. I think the public system allows mentorship to go beyond the mere clinical aspects of dentistry. I’ve worked with some young female dentists who want to know how to communicate with patients who query their experience and professionalism. While a lot of mentorship relates to the clinical, often new grads want to know how to communicate or to work through interpersonal problems they are having. The public system allows me to take the time to really address the problems new grads are experiencing.”
While Dr Nilsson sees a place for both private and public systems in Australia, she believes that the public system is ideally placed to get to the root of a lot of dental problems in the community.
“Dental caries is a disease that is largely preventable,” says Dr Nilsson, “but private dentists are relatively poorly paid to give oral hygiene instruction and diet advice. Prevention is key to solving any oral health or general health problems. For example, fluoride is working really well in Tasmania. The majority of towns with a population above 1000 have fluoridated water now. We’re starting to see decay rates for children drop. It’s one way a public health system can prevent a problem at the root of the cause.”
Dr Nilsson plans to finish her PhD in three and a half years. She has worked hard on her advocacy within the community and would like to be involved with students through a dental school—mentoring and helping wherever possible. The only spanner in the works is that there is no dental school in Tasmania.
“We get quite a number of students over from the mainland because James Cook University focuses on placing dentists into remote communities,” says Dr Nilsson. “Bringing groups of students over to Tasmania encourages them to think about the possibility of placement and how vitally important is that work.”
As president of ADA Tasmania, Dr Nilsson’s main focus is on advocating for the introduction of an older person’s dental scheme. “There is a looming problem with the dental health of older people in our near future. At present, it’s getting worse and is not being tackled. Funding is part of the problem but we also need a mind shift among dental professionals in addressing the issue. I’d like to be part of the change that sees things getting better for the frail, the care-dependent and older people in aged-care facilities.”