Irish Times article - Why I'm closing my practice

Mad Benny · 21-09-2010 02:25PM #1

The article can be found here http://www.irishtimes.com/newspaper/health/2010/0921/1224279345754.html.

NEWS FOCUS: Draconian cutbacks in state-sponsored dental schemes have led to a severe drop in the number of patients. Dentist Paul O'Dwyer tells his story

NEXT MONTH, after a decade serving the community in rural Co Tipperary, my dental practice will close.

When I graduated from UCC in 1997 I could not have foreseen this sad day. I hardly expected that over the coming years the State would sequentially cut the levels of financial support for patients in need of procedures, and thereby put them out of reach.

So how has it come to this?

Dentistry in Ireland is at a crossroads. This time last year, two State-sponsored dental schemes operated in this State and covered dental bills, at least in part, for 80 per cent of the adult population here.

That is not a typo. Eight out of every 10 Irish adults who attended their dentist could seek benefit under one or both of these two schemes.

The Dental Treatment Benefit Scheme (DTBS) allowed employed PRSI-entitled patients and their dependent spouses to attend their dentist for an annual free check-up and scale and polish per year. They could also be subsidised for routine procedures such as fillings, extractions and dentures, where the service was provided by their local dentist who was paid on a fee-per-item basis.

Meanwhile, the Dental Treatment Services Scheme (DTSS) allowed medical card holders to attend their dentist free of charge for routine examination, scale and polish and general dental procedures without the burden of expense to them. Again the service was provided by the patient’s local dentist and he/she was remunerated on a fee-per-item basis.

The obvious advantage to the patient was not alone costs – it also encouraged patients to attend their dentist, leading to improved dental health for the population as a whole.

Then came the clouds. Last year, An Bord Snip Nua recommended that the PRSI scheme be downgraded. Efforts by the dental profession and considered opinion from health experts were ignored. An independent

I have enormous sympathy for any business that is forced to close in this curreny economic depression however having recently been to the dentist and paid €600 for three hours work I find this story difficult to swallow.

My recent visit was with a Dublin dentist for root canal treatment. The entire procedure from start to finish took three hours on one sitting. I priced this with other dentists and found it to be similar.

If the dentists of Ireland charged a reasonable amount then maybe the government wouldn't have decided to target them in cost cutting measures. Why can dentists in the north charge a fraction of the cost and make a living?

Cookie_Monster · 21-09-2010 02:42PM

because:

rent
rates
staff
electricity
gas
water
insurance
professional fees
red tape expenses
accountant fees
supplies
equipment

are all more expensive down here than up north.
All these costs need to be reduced (across every business) for the consumer to see the benefit, but most are directly or indirectly controlled by the government who have shown no interest in trying to aid cost reduction.

Permabear · 21-09-2010 03:01PM

This post has been deleted.

Madd Finn · 21-09-2010 03:01PM

Cookie_Monster wrote: »

because:

rent
rates
staff
electricity
gas
water
insurance
professional fees
red tape expenses
accountant fees
supplies
equipment

are all more expensive down here than up north.

Cobblers!

If his electricity is more expensive than elsewhere, so is mine.
If his gas is more expensive than elsewhere, so is mine.
If his water is more expensive than elsewhere, so is mine, or at least it will be when they get around to metering it where I live.

How come food costs mostly more or less what it does up north?
How come computers cost more or less what they do up north?
How come many people's services cost less here than they do elsewhere?

One interesting question the interviewer didn't ask: where's this guy going to go and what is he going to be doing? If he goes to the UK he'll be the same whining gob****e complaining about lack of state support for his services than he was here.

It's about time those who buy medical/dental/pharmaceutical services on behalf of the tax payer started putting the boot into those professions who have been riding us all for years.

We did it to the taxi drivers more than ten years ago. (and we were dead right to). It's well overdue time to do the same to such professions as the medical ones listed above.

And solicitors.
And accountants.

We'll get around to all of them eventually.

keithclancy · 21-09-2010 03:01PM

I went to one dentist who wanted me to pay 40 quid on top of the PRSI contributions and went to a different one who didnt charge anything extra.

I dont think thats the reason, I think the Dentists have just become accustomed to a certain lifestyle and can't go back

i.e. Mercedes, 400k house, second house down by the sea, another one rented out to students etc etc.

SkepticOne · 21-09-2010 03:02PM

Cookie_Monster wrote: »

because:

rent
rates
staff
electricity
gas
water
insurance
professional fees
red tape expenses
accountant fees
supplies
equipment

are all more expensive down here than up north.
All these costs need to be reduced (across every business) for the consumer to see the benefit, but most are directly or indirectly controlled by the government who have shown no interest in trying to aid cost reduction.

Keeping prices high (and I think he would have mentioned it if he had lowered them) didn't help the dentist in the article meet his costs. There seems to be a lot of denial out there among certain types of businesses ("the professions") and a belief that keeping prices high is a way to maintain income.

hinault · 21-09-2010 03:10PM

The letter writer says he lives in rural Tipperary.

I live in Thurles Town and there are five separate dentistry practices in this town alone.

Perhaps there is an oversupply of dentists throughout Tipperary, coupled with the cutbacks in this scheme?

SkepticOne · 21-09-2010 03:23PM

Madd Finn wrote: »

We did it to the taxi drivers more than ten years ago. (and we were dead right to). It's well overdue time to do the same to such professions as the medical ones listed above.

The taxi drivers only lost their closed shop because the government which was trying to protect them lost their case in court.

dunsandin · 21-09-2010 06:12PM

Surely the title of the thread is the fundamental issue -why I am closing my practice-??? If this guy was ripping the p1s5 with his clients, surely the thread would be called "why I am having to reduce my prices"???
I know €600 for 3 hours sounds like a rip-off, but I can kinda sympathise. To rent even a room in a shared dental practice is a SERIOUSLY expensive business. The dental nurse is not on the minimum wage, and like aero-spares, if you tack the word "Dental-" onto a product or tool, it starts to get very pricey.
For an example(and no, im not a dentist) I did a job today, I needed some fairly specialist supplies to do it, so I went along to the one outlet that sells them - that'l be €290.00 please. I put diesel in the van_€40.00 please, I needed some basic consumables to do the job, -€30.00, and I needed to have a house and feed people who refer to me as dad and husband, pay some bills, and generally exist. So, no doubt the client was thinking that the hour I spent doing the job for them was a complete rip-off. But with fixed costs(and I forgot to add lenno's cut) at €360.00, and my overheads running at €56.00 an hour, before my own bit, and an hours drive there and another back, a bill for €600 for three hours is about where its at. And I aint no dentist, and was not making any killing whatsoever. And sadly, I didnt have a pretty nurse in a low cut outfit to hand me things either. Pity though....maybe the lad who's closing up could spare me his?

danbohan · 21-09-2010 06:18PM

Cookie_Monster wrote: »

because:

rent
rates
staff
electricity
gas
water
insurance
professional fees
red tape expenses
accountant fees
supplies
equipment
DENTISTS
are all more expensive down here than up north.
All these costs need to be reduced (across every business) for the consumer to see the benefit, but most are directly or indirectly controlled by the government who have shown no interest in trying to aid cost reduction.

just brought a bit of realism to that for you

murphaph · 21-09-2010 06:25PM

Lol at the poor dentists.

I also had the misfortune of needing root canal (5 roots) and a crown...total cost in Ireland €1,200. (I claimed about 500 back from the taxman)

BUT! I found out at the time that a heck of a lot of dentists were not part of that treatment benefit scheme, ie, they didn't want to be paid a set fee by the state for certain procedures.

Now they are wishing they had that income...like a lot of landlords turned their noses up at rent supplement folks, but are now desperate for them. I have NO SYMPATHY for the vastly overpaid "professions" in Ireland.

Solicitors in Germany have set fees BY LAW! They all charge the same and if they are found out overcharging they will be "struck off".

dunsandin · 21-09-2010 07:46PM

WHY DONT YA FECK OFF TO GERMANY THEN IF ITS SO GREAT>LOL:D

I-Shot-Jr · 21-09-2010 07:51PM

dunsandin wrote: »

WHY DONT YA FECK OFF TO GERMANY THEN IF ITS SO GREAT>LOL:D

I know I would if I spoke German!

amen · 21-09-2010 08:03PM

if he is really closing due to the cutbacks then he should publish his accounts for the last few years and lets see what
1: he was paying him self as a dentist including pension provision
2: any monies he was drawing as the director/partner etc

dunsandin · 21-09-2010 08:06PM

I-Shot-Jr wrote: »

I know I would if I spoke German!

you could bunk up at murphs in Berlin - its a savage city.

Callan57 · 21-09-2010 08:16PM

The professions have been ripping off this country for years ... I have no sympathy for them.
A dentist recently quoted me 2,000 for some work & when I asked him if he was joking his response was 'Do I look like I'm joking' so I asked him if I looked like a fool? Needless to say I walked & will be checking out Budapest & Belfast.

KindOfIrish · 21-09-2010 08:19PM

dunsandin wrote: »

WHY DONT YA FECK OFF TO GERMANY THEN IF ITS SO GREAT>LOL:D

All clever Irish people have fecked off already!

KindOfIrish · 21-09-2010 08:22PM

Callan57 wrote: »

The professions have been ripping off this country for years ... I have no sympathy for them.
A dentist recently quoted me 2,000 for some work & when I asked him if he was joking his response was 'Do I look like I'm joking' so I asked him if I looked like a fool? Needless to say I walked & will be checking out Budapest & Belfast.

Budapest is the place! Check in a 5* Hotel, enjoy good food and drink, weather, Danube, do your dental work and it will be less than 2000 anyway!

nadir · 21-09-2010 08:57PM

As a person employed in the private sector, I've been paying a fortune for dental treatment (several thousand euro) over the past 6 years, for me and my dependent. It's not covered by VHI and neither of us qualify for any state help. Dentists & Doctors fees have been a major drag financially, especially considering the poor quality I've generally received!
I think it would be highly beneficial for me(and probably others of my ilk) if many more dentists/doctors practices went out of business as it would surely instill some decent competition which would normalize prices and increase quality of service.

dunsandin · 21-09-2010 09:10PM

Yeah, missus just informed me of somthing I'd forgotten - one of my kids needed a lot of work done a few years ago and the bill was €6500, so maybe there is a point to all this.:o She reckoned I was talking b0ll0x, so I will defer to her higher wisdom. Wouldn't be the first time.:o I was just going with the first figure of €600 that I saw and thinking back on todays job I did. And the Germany bit was a joke, I worked there for a year and loved it, would go in the morning if I thought I could make a living. So, anyway, down with dentists, feckin rip off merchants................. solicitors are not much better. Not a huge fan of them, either. Right, thats enough backpedalling for one evening.

BehindTheScenes · 21-09-2010 09:39PM

He needs to model his business practice on these guys.

http://www.independent.ie/national-news/dentist-paid-euro577000-by-state-2269846.html

Anyone earning €200,000 in a year is doing grand.

Chris_5339762 · 21-09-2010 09:49PM

When most of the population gets some government grant for something the prices rocket because well, you would put the price up if you were running that business and people could get grants for it.

SkepticOne · 21-09-2010 10:07PM

dunsandin wrote: »

Surely the title of the thread is the fundamental issue -why I am closing my practice-??? If this guy was ripping the p1s5 with his clients, surely the thread would be called "why I am having to reduce my prices"???
I know €600 for 3 hours sounds like a rip-off, but I can kinda sympathise. To rent even a room in a shared dental practice is a SERIOUSLY expensive business. The dental nurse is not on the minimum wage, and like aero-spares, if you tack the word "Dental-" onto a product or tool, it starts to get very pricey.

I know this has been retracted somewhat but the costs you mention here are those generated by dental and related professions. A dental nurse, for example, in the boom time might be able to charge an arm and a leg but is that still appropriate in an economic crisis? Also the room in a dental practice may be expensive but that is because another dentist has decided to make it that way. Unfortunately all these costs need to be adjusted to reflect the new reality otherwise people are going to continue going up North and further afield for dental treatment.

wowa · 21-09-2010 10:25PM

GPs will likely go the same road in time. The system is shot and has become unworkable for many GPs. If they don't have a list they rely on private folk. If they do have a list it's reimbursement is a joke! Many conditions are needing many visits per year and patients aren't prepared to pay to address the 'silent killers'- blood pressure, cholesterol and diabetes. The litigation- second now only to US, has also ensured GPs are now just a referral service to the over paid specialists- highest in the world for several specialties. After all, its what the patient expects and if they don't get it, expect a lawyers letter fired your way, blame or no blame. The public hospitals are fit to explode (in Cork anyway) but who does this arrangement serve- thats right, the specialists who cream off the increasing number of patients who say feck it with this, I'll pay whatever it takes to avoid sitting in a corridor for 16 hours! The country is a feckin' joke!!

As for the whingers who begrudge the earnings of GPs/dentists, you probably weren't complaining when you were earning the equivalent for laying some flooring, fixing a leak or plastering walls!

johnnyskeleton · 21-09-2010 10:44PM

On dentistry, if you pay certain stamps you get a little bit of dentistry for free (but again not S class, even though the self employed pay nearly as much as the employed (more if you are earning less than minimum wage and self employed) and there's talk of the self emloyed paying the same as workers).

However, if you are on a medical card:

Medical card holders are legally entitled to more extensive dental, ophthalmic and aural services from the Health Service Executive (HSE) but, in practice, the availability of these services varies from area to area

http://www.welfare.ie/EN/Schemes/DentalOpticalAndHearingBenefits/Pages/Dental.aspx

So in Ireland if you are self employed you can go swing. If you are employed you get a little bit of benefit, but if you are unemployed and/or a medical card holder you get gold star service. I think its something like 4 check ups per year plus any required work, which is more than even the richest employed/self employed can realistically afford.

SkepticOne · 21-09-2010 10:47PM

wowa wrote: »

As for the whingers who begrudge the earnings of GPs/dentists, you probably weren't complaining when you were earning the equivalent for laying some flooring, fixing a leak or plastering walls!

I'm not sure you are gaining much sympathy for your plight with the above paragraph.

21-09-2010 11:02PM

As a student I paid 600 euro for 3 fillings a year ago. I got one done one day which was 150+50 consultancy. So I got two done the next time thinking I'd save 50 and they just charged me double consultancy..

I got sent a letter recently that I'm due a checkup. My teeth would want to be falling out by the time I can afford to go back.

jimmycrackcorm · 21-09-2010 11:17PM

Although I have a well-paid job, my teeth are in a poor state because dental care is prohibitively expensive. When you consider how many dentist we have compared to eye / ear / elbow specialists, then you have to wonder why it isn't more of a commodity service.

The truth in reality is that dentistry has been pushed forward to be a premium service and the costs have risen to match the perception. The same happened with pharmacists as I recall a colleagues daughter straight out of college being offerd a job in a Galway pharmacy with a salary of €55k.

Granted that people in these professions have studied a lot but their expectations are of a very lucrative career and not as a service. I'd love to see a detailed analysis of the costs compared to somewhere such as Bulgaria.

Why does a dental nurse cost more than a retail shop assistant ?
Why are materials more expensive than importing them from another EU country e.g.g Bulgaria - surely an xray machine there costs much the same as here (no business vat and all that).

jimmycrackcorm · 21-09-2010 11:20PM

wowa wrote: »

As for the whingers who begrudge the earnings of GPs/dentists, you probably weren't complaining when you were earning the equivalent for laying some flooring, fixing a leak or plastering walls!

Most of these people have taken enormous paycuts since then - has that happened to many GP's / Dentists?

andydrew · 21-09-2010 11:22PM

I think a major symptom of why Dentists overcharge is the same as for many professions within our Island... School leavers who are high achievers academically choose these professions based on the basis that they can and they then qualify feeling as the intellectual elite they merit the top salaries...So many of the routine tasks undertaken on a daily basis could be undertaken by assistants but due to our legal system combined with a "SUE NATION" mentality of the population this can never be achieved. Rectifying this is I believe the answer none the less.

TheInquisitor · 21-09-2010 11:33PM

amen wrote: »

if he is really closing due to the cutbacks then he should publish his accounts for the last few years and lets see what
1: he was paying him self as a dentist including pension provision
2: any monies he was drawing as the director/partner etc

Just requested a set of his accounts. Shall be interesting to see how he did for the last period

Irish Times article - Why I'm closing my practice

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