Dentists under attack?

Are recent media stories an attack on the integrity of the dental profession, or do they highlight problems that we need to address?

Recent media stories highlighting the dramatic spike in the use of superannuation for dental treatment has provoked a sadly predictable response from a small section of the dental profession. They argue that the media has a vendetta and relentlessly pursues negative stories in order to paint the dental profession in the worst possible light. It seems to happen every time there is a dental story in the press.

Our profession is the subject of constant attack by the media.

There is a strange dichotomy at play here. On the one hand, a handful of dentists are complaining about the negative media treatment as if it is somehow an unwarranted and unfair attack on the integrity and professionalism of dentists. But at the same time there is opposition from many of these same critics to bringing dentistry into Medicare because they argue that dentists will inevitably rort the scheme. We can’t have it both ways. If we believe that some dental practitioners will misuse publicly funded schemes, then we can’t complain when this is eventually reported on, because it is genuinely a public interest story when there are allegations that public funds are misused in this way. And it’s worth reflecting on our professional responsibility to call this out. We should in fact be happy that these stories come to light, because sunlight is the best disinfectant. Claiming there is not a problem, or trying to cover it up will be seen as self-serving and will be more damaging to professional trust.

Is there a problem with dental practitioners misusing the compassionate release of superannuation scheme? Have a look at the data – the amount taken out for dental treatment has grown from $171 million in 2021/22 to $313 million in 2022/23 to$526 million in 2023/24. Over the same time period, the ‘other medical’ category has gone from $92 million to $156 million. It’s hard to believe that there has suddenly been a three-fold demand for dental treatment plans that average $24,000 per patient to treat life-threatening illnesses, alleviate acute or chronic pain or alleviate acute or chronic mental illness. Affordability has long been a problem and there is no doubt there is pent up demand for care – we saw a similar thing with the introduction of the Chronic Disease Dental Scheme in 2007. Overlay that with some of the aggressive marketing that promotes using superannuation for dental treatment and it is easy to understand the recent surge. These are some of the many things that other dental practitioners have said to me over the past week:

I have had patients come to me for a second opinion after being told that they needed extensive dental treatment (implants, crowns) and that they should access their superannuation.

There are some predatory dental practices that need to be reported.

Sadly, over-servicing is a known issue in dentistry.

Many dental practices seem to be almost entirely reliant on treatment using superannuation.

Someone described this situation aptly as a tragedy of the commons – the idea that a small group will exploit a resource to the detriment to the larger group. We saw it with the Chronic Disease Dental Scheme. Now it is undoubtedly true that there are cases where superannuation has been used appropriately and within the stated guidelines to provide a benefit to the patient. But we don’t really know what proportion, because the ATO doesn’t seem to collect or report on this data. We also know that some patients submit an application, receive the money and never return for dental treatment. But again, we don’t know how many. That is why it is important to highlight this issue – so that we get better reporting, auditing and compliance of the scheme.

It’s also worth reflecting again on the purpose of superannuation, and the false economy that we are creating when we encourage patients to use their superannuation for other than its intended purpose. Because these patients with extensive treatment will likely need further ongoing maintenance and repair, and will therefore raid their superannuation again in the future. And the financial impact will hit in retirement when they are forced to access a government pension – public monies – in order to survive. So we can think about publicly subsidising some dental treatment now, or pensions in the future. I know which one makes more sense.

Back to the issue of media vendettas. I probably have as much experience dealing with the media as anyone in the dental profession, stretching back since before my time as the President of the Australian Dental Association Victorian Branch in 2011, and not surprisingly I have a completely different view. Over more than a decade, I have participated in, contributed to and instigated a range of stories on dentistry and oral health with most major media organisations in print, radio, television and online. I have defended the dental profession against allegations of rorting the Chronic Disease Dental Scheme, advocated to increase funding after exposing long public waiting lists using freedom of information requests, successfully campaigned for a record pay rise for public sector dentists and promoted oral health targeting sugary foods and drinks. The media was an important tool in arguing to remove restrictions on dental practices during the pandemic and highlight the importance of access to dental care. In nearly every instance, journalists are interested in telling public interest stories, and helping to promote the importance of good oral health. The journalists that I have worked with have shown honesty and integrity in their reporting, and they are just as interested in telling positive stories about our profession.

There are many dentists who are calling for action here – not against the media, but wanting the ATO to tighten the rules around early access to superannuation. Don’t shoot the messenger.