The experience of migrant dentists

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migrant dentists
photography: Dinis Tolipov-123RF

Overseas-trained dentists have a few hurdles they need to clear first if they are to practise successfully in Australia. By Kathy Graham

Nepalese-born Dr Astha Shrestha was very relieved when she passed the Australian Dental Council exam, the primary pathway to general registration for dentists with overseas qualifications. Many candidates aren’t successful, so she was “scared. I knew others who’d tried three, four times. So I always had in my mind, ‘Oh, it’s my first attempt, I might not be able to clear it’.” It’s a legitimate fear. Not only do candidates have different qualifications and experience—so fresh graduates are competing with seasoned specialists—the exam itself is notoriously difficult. 

“In 2019, out of over 1200 written exams, the pass rate was just 35 per cent,” says Dr Stephen Liew, a Victorian dentist on the ADA Federal Executive, who adds that “only 13 per cent then go on to pass the practical exam”. As he says, “The ADC’s responsibility is to make sure that anyone who graduates is of a standard that Australia would deem acceptable.”

Helping candidates achieve that standard is why Dr Shrestha, with her husband Anil, started Pioneer Academy, their ADC Training and Coaching Centre. “There’s not many coaching centres for overseas dentists,” Dr Shrestha says. “And what there are, are very expensive which on top of the cost of the exam itself (more than $5000) is another added stress.” The couple specialise in providing one-on-one coaching in specific exam tasks, mainly targeting communication skills, an area in which many candidates underperform, especially in the exam’s clinical component, and not just because English is a second language. “The way we communicate with the patient is completely different here,” Dr Shrestha says. “For example, here we explain everything. And really, it’s up to the patient to decide what they want to do. Whereas back home we tend to decide for the patient.”

It’s estimated approximately 300 overseas-trained dentists qualify for general registration every year. But as many are dismayed to discover, passing the ADC exam is no guarantee of a job, as Dr Liew explains. “Australia prides itself on producing high-quality dental clinicians, and even among Australian graduates, that produces a highly competitive environment in which to get a job, let alone establish a new practice. And the number of dentists graduating actually exceed Australia’s workforce requirements. So we’ve achieved self-sufficiency.”

Moreover, an overseas-trained candidate competing for a position with a local is somewhat at a disadvantage, says Dr Amit Gurbuxani, who came to Australia from India in 2009. “The local candidate, because he studied at a local dental school has a network of tutors—colleagues who are working in practices and know each other. This is opposed to someone who comes from abroad and passes the exam. Who’s their referee to say, ‘Yep, he’s good enough?’”

This country does reward and respect high-quality clinicians. But to gain that trust requires jumping all the hurdles and a long-term commitment to building a solid reputation within the profession.

Dr Stephen Liew, ADA Federal Executive

Now a partner at Mi Dental in Perth and a senior clinical lecturer at the University of Western Australia, Dr Gurbuxani says that even after getting over the hump of finding work in Australia, migrant dentists who often “have to work twice as hard as the locals to earn the goodwill of patients and staff” may still be tripped up by people’s prejudices—“I’ve heard some of my patients ask, ‘when did he get off the boat?’,” Dr Gurbuxani recalls jokingly. Also, by a language and culture that isn’t their own. “Communicating with the patient who needs to understand where you’re coming from can be challenging at times,” says Dr Gurbuxani. “Even communicating with your dental nurse. For instance, here you say ‘smidge’ for ‘little bit’. Those words over time become part of your repertoire. But at first …”

More crucially, many migrant dentists are not “trained and hardwired to Australian standards and expectations”, says Dr Liew. Culturally, Australian dentists are trained to and must operate with a patient-centred—and not a top down—approach. In addition, healthcare here is very tightly regulated and the standards required to maintain your practices are very high. “So there’s a few fundamentals that an overseas-trained dentist must comply with and the first, most important one to my mind, would be the ability to communicate complex health care concepts in English because without that ability, you cannot obtain the patient’s informed consent,” he says. “And in Australia, performing a procedural treatment on a patient without their permission may constitute assault.”

The Shresthas cite lack of assertive communication skills as another potential problem for migrant dentists, especially those who’ve come from countries where unquestioned deference to elders and superiors is expected. Here those dentists can very quickly find themselves being taken advantage of, even bullied. “We had this really hard transition when Astha started work,” says Anil. “The challenge was because we come culturally from the idea that we have to follow the peace process and be quiet rather than confrontational.”

Dr Liew has no doubt that migrant workers especially, are vulnerable to workplace bullying. “Many employees, regardless of origin, often feel afraid to speak up against their employer or even worse, when they do it’s just brushed aside and ignored. So I could imagine if there’s a language barrier, and your life in Australia depends on the job you’ve been lucky enough to get, you’d be even more at risk.”

While conceding “all the difficulties” of acclimatising, Dr Liew says that migrant dentists can take heart that “this country does reward and respect high-quality clinicians. But to gain that trust requires jumping all the hurdles and a long-term commitment to building a solid reputation within the profession. It can be done—and indeed some of our most highly respected colleagues originally graduated outside of Australia.”  

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