March 2010
Walking the ethical tight rope
Recent news reports have highlighted the shortcomings of the Enhanced Primary Care (EPC) scheme and inappropriate referrals made under its guidelines. The scheme is available for people with chronic conditions and complex care needs, on referral from a medical practitioner. Eligible patients receive up to $4250 in Medicare benefits for dental services over two consecutive years.
The ADA has long welcomed additional funding for patients with chronic medical complaints. Many of these patients would benefit from dental care provided by the public purse to improve both their general health and quality of life.
Understandably, health professionals become exasperated and disillusioned when there are allegations of misuse of public funds. These reports are both disheartening and damaging as they fail to acknowledge the positive work that is done, whilst focusing abuse of fundsby a small group.
Attention has focused heavily on the misappropriation of government
funding in the home insulation scheme. As a result, their industry has suffered damage including to their public image. This serves a timely reminder that we must ensure our profession is not similarly exposed to costly damage.
In practice we are faced with the dilemma: you’re damned if you do, and you’re damned if you don’t. If you decline treatment, patients are often upset and see you as obstructing them from receiving benefits of care provided for by the public purse. Conversely, if you do treat them, you may be perceived as too willing to make use of public funds, even though the care provided fits within the guidelines of the EPC scheme.
All schemes are exposed to potential misuse. Even though there are only a few who will abuse them, the cost of misuse can be high and can result in funding blow outs. Prior to the implementation of this scheme we expressed grave concerns regarding potential funding blow outs. The scheme was implemented without further consultation or tightening of its guidelines.
The vast majority of practitioners appreciate the benefits of directed funding and demonstrate philanthropic and community-minded practice behaviour.,
The handful of practitioners who allegedly abused the scheme may be
accountable to professional service review panels for breach of the guidelines and – if proven - their conduct will be subject to further investigation.
I urge members to impress upon patients and the referring GPs the responsibility we have in providing publicly funded care. As a professional body, we have and will continue to lobby for tighter guidelines to prevent misuse of funds by all facets of the referral chain ensuring sufficient funds are available to treat ALL patients in need.
Baton change
Australia’s population, as in so many developed countries, is ageing. Over
the next several decades, population ageing is expected to have significant
implications for Australia including health, labour force participation, housing and demand for skilled labour. (Productivity Commission 2005, Economic Implications of an Ageing Australia, Research Report, Canberra). As a corollary to our ageing population, many members approach the twilight of their careers and face increasing difficulties in navigating the exchange of their often long tended practice and patient base to new practice owners. This can be an incredibly stressful process that can take years, if not decades, to cultivate in one of the longest baton changes in a professional domain.
Some of the difficulties include differences in expectations between the two parties and this may encompass the subtleties between generations. The temptation for the ‘grey army’ to make the change due to increasing burdens of practice compliance and administration may result in hasty exit from practice and increases the possibility we will see more practices managed by corporate organisations employing our members to care for the patients with whom they wish to do business. As a professional group we need to mindful of the implications of this and carefully plot our course with yet another
third party.
With the likelihood of practitioners winding up private practices whilst they are at the prime of their knowledge and experience I would encourage you to make full use of your talents and stay connected with the profession in some way.
Opportunities in the public oral health sector
You will recently have received a letter co-signed by DHSV, ADAVB and the Melbourne and LaTrobe dental schools. The open invitation extends practice opportunities to practitioners that may be winding down from full-time private practice or are otherwise under utilised but are wanting to work more hours. It may be an attractive arrangement for those who do not wish to incur further administrative impost or commitment.
With the increase in the number of dental students and dental schools training our future colleagues, there are overwhelming pressures on our academics and upon general practitioners to oversee the clinical development of our dental students. This is especially so in regional areas where training facilities operate. Visits I have made to our regional groups have highlighted for me the pressure country practitioners face. With greater
involvement from willing volunteers, the educational support of our future peers might be better tended and the burden lightened on our rural colleagues.
Breaking down some of the walls between public and private practice offers people an opening for professional enrichment and personal satisfaction. Hopefully it will contribute to making our educational model more sustainable and provide our future dentists with access to experienced and passionate mentors in the same way we benefited through our undergraduate courses.
It is an invitation, and, whilst I encourage people to consider how these opportunities may be of personal and professional benefit,
I am also mindful that many of you are already engaging in professional activities of this ilk and you should not feel these activities go unnoticed.
Dentistry10
Work on our bi-annual convention is progressing and members this month will each receive a copy of the Dentistry10 registration brochure through the post. If you do not receive a copy, contact the Branch or go online to see the PDF version. The online registration form is available website
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