Article
In my time in the medicolegal business I received requests for help in resolving disputes between dentists who worked together, or between a dentist selling a practice and the person purchasing it. They were generally asking for advice from the wrong source, but it left me thinking that dentists often did not treat their fellow professionals with much respect: ok, when running a practice, money has to be involved because the practice has to generate income for its owner and the staff employed in it, but surely it is professional behaviour rather than solely money which should govern what we do and how professionals behave? I also heard recently of an associate who simply left a practice without working any notice, leaving many patients in the lurch, another example of unprofessional behaviour. Surely, unfair or unkind behaviour of one dental professional to another is just about as serious as mistreating a patient?
I reflected on this after reading the GDC Publication giving details of the Registrant Survey which they undertook on dentists who took and passed the ORE (Overseas Registration Examination),1 with this also being described in a paper by Jenkins and colleagues.2 ORE qualified dentists between 2009 and 2014 were selected to participate in the survey, there being 1106 in total: there were 465 responses (42%). I should preface the findings by stating that those taking the examination most likely did so because of a desire to live and work in the UK, but the other side of the coin is that we need this cohort of workers to help maintain NHS dentistry, especially if, after Brexit (if that happens), the number of dentists joining the UK dental profession becomes limited. The results make uncomfortable reading. Some dentists spent considerable time, energy and money in passing the exam, given that, for Part 2 of the ORE, 35% had attempted it once, 42% twice and 17% three times. At the time of the study, 71% were working as dentists, but 14% were not in paid employment and 8% were employed, but not as a dentist. The time taken to find employment makes salutary reading – it took 31% more than 6 months to find a job, while for 22% it was one to two years.
Readers may or may not be aware that those who pass the ORE face a second hurdle, namely finding a position in which they can take Vocational Training by Equivalence (VTE), also known as Performers List Validation by Experience ((PLVE), which are required if they are to work as dentists in the NHS. This was not so much a hurdle but a Becher's Brook for many. A common theme related to unfair treatment of ORE dentists after passing the exams, with poor working conditions, some accepting positions without pay or having to pay principal dentists or practices to secure a placement. The report states that ‘Others mentioned exploitative contracts regarding lower payment compared to their peers (for example less pay per UDA), longer hours and being locked into contracts at low pay for a few years’. It appears that the ORE dentists did not know where to go for help in such situations.
The report adds that ‘a significant proportion of participants commented on the negative impact that the ORE exam, employment opportunities and unfair employment contracts had on their life, including feeling disheartened, disappointment and stress which was impacting on their personal and family life.’ It also adds: ‘Various mentioned the fact that the lack of awareness of the ORE exams (in terms of the difficulty and achievement in obtaining them and therefore being recognised as a UK equivalent qualification) meant that ORE dentists were being treated as inadequate compared to their UK and EU peers.’ The impact on ORE graduates was expressed in some responses:
The situation is summed up by other respondents, as follows:
All of the above strike me as fundamentally unfair. While some ORE registrants considered that they had been treated satisfactorily, I ask: ‘What is the point of having the ORE if successful candidates are stigmatized and not treated similarly to UK and European graduates? OK, some may need help and support clinically, as many FD1s (previously known as VTs) do, that is the raison d'etre of the scheme, but there appears, to me, to be something wrong, even immoral, about this situation.
What is the point of funding an examination (which the ORE candidates do) if the successful candidates are not able to find positions in which to practice? Perhaps the GDC can help with this? In that regard, some respondents suggested, according to the report that ‘The GDC should restrict numbers of those sitting the ORE to match the number of VTE placements available, rather than set false hopes by allowing a large number to go through the exam process’. However, surely the dental profession at large can help too, rather than treating some of the ORE registrants so poorly? If we choose not to, it is surely a collective shame on the dental profession (and I include the GDC in that) in the UK?