Going into private dental practice

There are many young practitioners who seem to think that working in private dentistry must be the equivalent of living in Utopia.

I have worked in both NHS and private dentistry and in my view it is and it isn't. Some of the differences between NHS and private dentistry are more imagined than real and this short article is an attempt to share some of my thoughts on this matter with you.

Private patients

Many people perceive private patients as a 'demanding lot' with a disproportionate representation of retired judges and lady dowagers. They belong to a sub-set of the population with high and often unrealistic expectations with a keen eye for perfection and an even keener eye on the waiting room clock.

NHS patients

In contrast, NHS patients are sometimes thought to have an enduring affinity for opaque porcelain and visible crown margins and simply adore the prospect of having their premolars restored with large unsightly amalgam restorations. The majority have an abundance of spare time and have nothing else to do in their lives other than to go the dentist. They will thank you for keeping them waiting for an hour after their appointed time and some will even apologise for having the audacity to clutter up your appointment book in the first place.

Wrong

The reality is very different. Private dentistry does not have the monopoly when it comes to demanding patients. Furthermore NHS patients are no shrinking violets when it comes to complaining. In these times of consumer empowerment and a rights-conscious society, many have perfected the art of complaint and many are on first-name terms with their legal representatives.

Another endearing misconception is that all private patients are moneybags and that even in the current precarious economic climate have limitless financial resources. All treatment plans are therefore formulated on the sound understanding that money is no object. Again the reality is far removed from this. It is not unusual to have to devise a chequebook-friendly treatment plan rather than one based on clinical ideals. These constraints and compromises can be quite a challenge when one is only recently qualified and trained to provide the best possible treatment. In some respects it was easier when I worked in the NHS because many of my patients were exempt from charges so financial considerations were largely irrelevant.

Standards

Of course, as you will no doubt appreciate; all private dentistry is performed to a staggeringly high standard compared to the middle of the road standard prevalent in NHS dentistry. Please don't be seduced by such unfounded statements. Private dentistry is not a stamp of excellence. Many NHS dentists are more than capable of producing dentistry of astoundingly high quality, and there are many private patients who would not appear to have benefited from the same.

Contracts

At the risk of being slightly political I think it is still fair to say that many dental practitioners are still finding the 2006 contract changes problematical. Many are struggling to cope with the mind-set necessary to move from a patient-centred to group-centred treatment philosophy and this is undoubtedly having an effect on treatment trends. It is suggested by some that since the introduction of the new contract there has been a dramatic reduction in root canal therapy along with crown and bridgework - treatment that was previously the staple diet of many NHS practitioners. There is a possible shift towards shorter and simpler courses of treatment leaving the clinical palette a little less colourful.

Pension

It may seem premature to be discussing retirement with a readership that has only just started on a career but prudent financial planning is justification alone for giving the subject some consideration. An undoubted jewel in the NHS crown is the Superannuation (Pension) Scheme. Practitioners working in the NHS usually default into the scheme without thinking too much about it - and that is no bad thing. So what is it that makes it so desirable? Your contribution is based on an agreed level of clinical activity, but what makes a real difference is that your contribution is enhanced by an additional contribution from the NHS even though (in practice) the NHS doesn't actually employ you. No private superannuation scheme can come close to competing with such generosity. The snag is that (obviously) you can only be in the NHS scheme if you work in the NHS. Private practitioners have to make their own arrangements!

Private income

What about earnings? Well I have to say my bank manager did not exactly send out for a bottle of champagne when I told him of my plans to move into private dentistry. In all honesty I would have to say that my earnings probably haven't changed that much and the savings account still gets the same clobbering every 31st January and 31st July when the Taxman comes knocking for his share of the proceeds.

In summary, many of the differences between NHS and private dentistry are exaggerated by urban myth. However, there are some important differences that continue to support my own personal preference for working privately. I definitely feel less time-pressured and regulated. I feel professionally fulfilled by the diversity of treatment I am able to provide and what I don't do is go home exhausted to while away an unproductive evening in front of the television before climbing into bed. I still have something left at the end of the day to pursue hobbies and embark on new professional challenges. I even have time to write articles!

Phil Shaw