Background
Methods
Research design
Sampling strategy
Data collection
Data analysis
Description of the sample
Categories | N |
---|---|
Age (years) | |
21-30 | 6 |
31-40 | 8 |
41-50 | 9 |
51-60 | 5 |
61 or more | 5 |
Gender | |
Female | 12 |
Male | 21 |
Background | |
Western background (Canadian) | 18 |
Non-western background (Non-Canadian) | 15 |
Years of experience as a dentist | |
0-5 | 2 |
6-15 | 14 |
16-30 | 9 |
31 or more | 8 |
Type of clinical setting | |
Multi practice | 21 |
Solo practice | 12 |
Professional status | |
Owner (or co-owner) | 25 |
Employed (paid by percentage) | 8 |
Results
Types of issue | Problems reported by dentists | Explanations provided by dentists | Main sources of the issues according to dentists |
---|---|---|---|
Organizational
| Dentists find the organization of appointments and scheduling difficult for people on social assistance | ● People on social assistance tend to consult in an emergency | ● People on social assistance |
● They often miss appointments and have no valid reasons for that | ● People on social assistance | ||
● They have little availability during off-peak hours | ● People on social assistance | ||
Biomedical
| Dentists feel unable to provide them with adequate treatments and improve their oral health | ● Public dental insurance does not cover several treatments | ● Public health care system |
● People on social assistance lack motivation to care for their health | ● People on social assistance | ||
Financial
| Dentists perceive patients on social assistance as non lucrative and a threat to the financial sustainability of their clinic | ● The reimbursement rates of the government are too low | ● Public health care system |
● The treatments performed are often basic | ● People on social assistance | ||
● Missed appointments cause lost wages | ● People on social assistance |
Themes | Quotes |
---|---|
Organizational Issues – Dentists find the organization of appointments difficult for people on social assistance
| |
People on social assistance tend to consult in an emergency and often miss appointments |
That, I’ll be honest, is one of the things that bugs me the most even now. They don’t show up. They don’t show up, they don’t call, they don’t let us know, and that’s just how it is. [CL3] |
People on social assistance do not have valid reasons for missing appointments |
“I went to bed at 4 in the morning. I didn’t feel like coming.” They’ll tell you. They went to a bar, they went out to a strip show. They were watching t.v. They went out on the town with their buddies. And then, well, of course, when you go to bed at 4 and you have an appointment at 10 in the morning, well, sometimes… [CL12] |
People on social assistance are not flexible and have little availability during off-peak hours
|
It’s simple; you don’t give a morning appointment to someone on social assistance because that’s when he sleeps! […] They tell us: “not in the morning, not too early in the morning. Not 9 a.m. Not 10 a.m. We get up late.” Fine. “So we’ll give you one in the afternoon.” “Well, no; I work.” […] So these patients want to come in the evening when I don’t work, so they’ll come on a Saturday and take the spots of my good patients’, who make an honest and steady living. [CL13] |
Biomedical issues - Dentists feel unable to provide people on social assistance with adequate treatments
| |
Public dental insurance does not cover several treatments; people on social assistance cannot afford to pay for treatments not covered |
It is unsatisfying to be very limited in the treatments I can offer people on assistance. The treatments we can offer people on assistance are treatments that date back to the thirties, to the fifties. […] So for someone who likes technology a lot, who likes to perform a lot of state-of-the-art treatments, it’s disappointing. I have to say that, usually, I get no pleasure from treating people on social assistance; it’s not because they’re on social assistance, it’s because of the limits placed on me in terms of treatment options. [AL10]
|
People on social assistance lack motivation to care for their health and neglect themselves |
I have experienced the same thing my colleagues have; we all have. Patients on welfare are not always reliable. [CB2] |
Dentists feels powerless and discouraged |
We try telling them, « floss and brush your teeth ». There is often a generalized level of neglect. The [dental] hygienist, for example, often gets really discouraged. [AL5] |
Financial issues – Dentists perceive patients on social assistance as non lucrative and a threat to financial sustainability
| |
The government fee schedule is too low |
Even though we’re paid, when it comes down to it, it’s almost pro bono work. Because to, say, remove a tooth, I think it’s something like 13 dollars. It costs me more in electricity, material, my assistant, my secretary, and all that, than what I make. [AL3] |
The low reimbursement rates are unfair and frustrating |
It annoys me to be paid less by [public] health insurance. It really annoys me because I don’t take less good care of that particular patient. I can’t sterilize the instruments less. I can’t use poorer quality materials. I only have one kind of amalgam, so I use it for everyone. Of course, maybe, for another [person not on public assistance], I might give them a crown, but you can’t work less well just because someone is on social assistance. So I don’t know why we shouldn’t be paid the same price. But instead of giving to the United Way [charity], I give to the public insurance scheme. [CL8] |
People on social assistance's missed appointments create a “wage gap” |
Given that, first of all, just seeing them pays less than the same procedure I would give to you or someone who has [private] insurance, I don’t get the same fees. And if I’ve scheduled an hour for restorations and he doesn’t show up, plus, you know, in addition to losing the fees I would have had with a normal patient, I lose the hour as well. [CL2] |
People on social assistance are a threat to financial sustainability |
Currently, I have very few. I don’t mind at all. It’s not like I have a big clientele of only them… [CB2] |
Dentist: I like my work. Except for the fact that my colleagues make more money than I do, and they’re always rubbing my face in it, and I have to live with it. […] The only thing… society judges success according to how much money we make, so psychologically it has an effect [on me], to see that I am below average, I guess, compared to other dentists. [AL4] |
Organizational issues – Dentists find the organization of appointments and scheduling difficult for people on social assistance
The child supposedly is in pain because he has a big cavity. We’ll say: “Ok, fine, we’ll schedule him as soon as possible”. And then, [it’s] a missed appointment. You know, it’s frustrating because the kid was in pain, it’s free, he has an appointment, we want to treat him, we make room and then, missed appointment. So in the long run, you develop a kind of [attitude]: “Oh, no; not a welfare patient!” [CL2].
It’s because they don’t wake up in time, it’s not nice out, it’s too nice out, they have the flu. Excuses. Except that at a certain point, when you schedule five appointments and he misses four of them, with different excuses… my tolerance decreases after the third one. [AL5].
Even though they didn’t work, they weren’t available as we would have wanted, like in the morning. They could demand an evening appointment. The secretary was a bit bothered by that. […] She of course complained: “So, they don’t work; why don’t they come in the morning?” Because morning appointments are always much harder to book. [CB1].
Biomedical issues – Dentists often feel unable to provide people on social assistance with adequate treatment or to improve their oral health
Even if I offer to let them pay bit by bit, it doesn’t work at all. [The patients say] “No, I don’t have any money”. The government reimburses extractions, [so] it doesn’t cost them anything. [CB1].Each time a patient needs a root canal and it’s not paid for by social assistance, well, obviously, they never have it done. So then, we have to extract teeth, often even those of children, of adolescents. To remove permanent teeth. That, I would have to say, has been my worst experience. [CL11].
Most of the time, I find they’re not motivated enough. Their [oral] hygiene is very poor. Even though dental services are free, not everyone takes advantage of them. [CL4].
When someone comes to you and says,“This tooth hurts, it’s swollen”, you look at the rest of the mouth and, yikes, you wonder where to start; that’s not pleasant. That’s what we see with people on social assistance. [CL21].It’s as if I’m wasting my time talking to a wall. [CL7].
So we can’t apply everything we’ve just learnt in school, and therefore we’re forced to practice two kinds of dentistry: dentistry for our regular clientele and dentistry for our welfare clientele. It’s frustrating for the dentist. [CL9].
Financial issues - Dentists perceive patients on social assistance as non lucrative and a threat to the financial sustainability of their clinic
I like doing good quality work but, unfortunately, with the fees that social assistance gives us, I mean, we’re talking 12 dollars for an extraction and 5 dollars for the second one, that barely pays for the anesthesia and your muscle power. And that is if it’s an easy extraction. So even for restorations, exams, cleanings, everything is really a lot less. So, if we want to do a good cleaning, then what the government pays is not much. [CL7].
That’s what’s frustrating for a dentist. I’ll perform an extraction that, to my mind, is worth the price I would charge you, say, but when I perform the same extraction for a person on social assistance I’ll get paid maybe a fourth of what it’s worth. So it’s frustrating. Of course it’s the person on assistance who suffers the consequences in the sense that we’re maybe frustrated… [CL2].
You know that [insurance for those on social assistance] pays about a third of the standard rate of the Dental Association. […] I don’t mind. But when they miss their appointments, then I pay for it three times over. I am already only getting a third as it is and then… I lose a regular patient that could have had that spot, stuff like that. [AL6].
But I can’t of course complain because I don’t have many of them. So if I have one once in a while I don’t mind treating them, but if I had ten a day I’d be stressed out. It would annoy me. [CL2].