JOHN K. HARCOURT, DDSc, FRACDS, FICD, Editor

How Much Is Too Much?

In December 1990, the late Dr Lloyd Carr wrote a guest Editorial for the Journal entitled ‘Dental Work- force: What is enough?’. In this paper he analysed the situation as he saw it at that time. Over the past four years there have been other changes, many of which have been forced on the profession and the community by the economic downturn. These have seen reductions in funding for public dentistry, and changes in the numbers of auxiliary dental personnel who are in training. Now that we are in a recovery mode, the Federal Govern- ment has made considerable funding available to each of the States through the Commonwealth Dental Health Program (CDHP) to assist in dental care for those unable to afford private dental care. The second phase of this funding will come into force in July.

The question that needs to be asked is whether this funding is necessarily being directed into the best channels in order to achieve value for money and to ensure that those genuinely in need of dental care in the community but unable through circumstances often beyond their control to afford it are being adequately catered for.

In Victoria, for instance, there is a suggestion to set up training facilities

for 60 dental hygienists. In an ideal world these additional members of the dental workforce could assist in the provision of some of the commun- ity needs for oral hygiene instruction and preventive periodontal services and oral hygiene care. However, there has been no demonstrated need for this massive increase in this particular auxiliary. Indeed there are probably already some 45 hygienists registered in the State of whom only 30 to 35 are actually employed and some of those are only employed part-time. If money is available for the training of auxiliary personnel, and it seems there is, since there is a misguided conception that somehow service provided by these auxiliaries after qualification will be cheaper, how much better would it be to provide these funds for the training of fully qualified dentists who are in a position to provide to the public the full range of dental services that are needed. Dental Schools and Dental Hospitals are being starved for money and yet are being expected to maintain their outputs. It can be argued that the community would be much better served by the use of any additional funds within the Dental Hospital/ Dental School systems to ensure adequacy of support staff for dentists working in these institutions and to fund places for new graduates in intern type positions working both in

capital cities under the auspices of dental hospitals and out in both suburban and country areas in suit- ably staffed community health centres.

The CDHP envisages that some of the funding also can be used to assist health care card holders to be treated in private dental practices where community clinics with dental facil- ities are unavailable. It makes much more sense for treatment to be avail- able in local areas, rather than for patients to have to spend time and money travelling from remote country or suburban areas to a treatment centre in a capital city.

Before embarking on expansion or even maintenance of existing training programmes for dental auxiliaries, a full examination of the need for these positions needs to be undertaken. It is probable that the present dental auxiliary workforce is more than enough for the needs of the present generation. Thus any expansion can be conceived to be a waste of resources, with people becoming qualified for positions for which there is no demonstrated need or demand. In the interests of commonsense and best use of limited resources, it is vital that those involved in workforce planning channel funds into those areas which will best serve the dental health needs of the community. With- out argument, those best able to provide for these needs are fully qualified dentists.

Australian Dental Journal 1994;39:3. 193