What is the future of Dentistry in Malaysia (Artikel ini ditulis pada tahun 2014 oleh Maj-Gen (R) Dato’ Dr Mohamad Termidzi Hj Junaidi)

The year 2014 means we are 6 years closer to 2020. According to the MOH National Oral Health Plan, the dental surgeon to population ratio of 1:4000 should be attained within that time. So how are we faring with regards to that ratio today?

At the end of year 2013 the number of dental surgeons stood at 4264 and Malaysia’s population in the same year was  about 28.9 million. With an estimated 600-700 dental graduates entering the Dental Register yearly, the ideal ratio should be met by year 2020

The Public Service Picture:

A ‘ideal’ dentist to population ratio looks good on paper but  does this really mean that treatment  will be accessible to all patients? Even if the ideal ratio is reached within 2020, what about distribution? Will those who needs it most have physical and financial access to professional dental services? As Malaysia progresses towards developed nation status there should logically be more urban areas and even rural areas will have better amenities than what is available today. Will that

induce new graduates to serve in rural areas after the 2-year compulsory service under the Dental Act 1971? The contribution of the dental nurses needs to be taken into account. Will there still be a need for them? If so, will their contribution

still be restricted to school children or will there be an expansion of duties? Even though the new Dental Act will expand their sector of practice, will there be a market for them in the private sector? Is their basic training suitable for what private practitioners require?

Private Sector Concerns:

Indeed, what will the picture be like in the private sector? Will private dental practitioners continue to be allowed to set up practice wherever they want? Will they still be allowed to establish practices in urban areas where there is a better market? Or will the MOH be forced to impose distribution rules like those practiced in some developed EU nations? Can the younger private dental practitioners make ends meet in an environment of escalating costs of equipment and materials and greater competition? The rising cost of setting up a practice in an environment of continually rising expectations of the regulators and the

public, calls for a rethinking of private solo practice. Group practices seem to be the logical choice. This will ensure that more sophisticated equipment will be available in the clinics, shared by the practitioners in the group. It will ensure easily available intra-practice consultation, more efficient work distribution and coordination, better support and easier downtime for the dentist, create a one-stop station for dental care, and provide a more conducive environment for continuing professional development. Professionalism, effectiveness,

cost-effectiveness, efficiency and a better balance of work-leisure will be achieved

to the satisfaction of all stake holders.

Local Dental Industry:

Dentistry continues to be an extremely technologically-driven equipment-intensive profession. Most of the large equipment and dental materials is still imported and therefore subject to government tax, which makes it expensive. So can more of

these equipment and materials be manufactured locally? Is there technology and expertise available in Malaysia to encourage home-grown manufacture of the dental practice armamentarium? Are current incentives in this area adequate

or favourable for a sustainable local dental industry to meet the growing demands of the future?

Specialist Care:

The path to developed nation status with a high income creates a higher demand for and necessitates more specialist treatment becoming readily available. More specialists, and hence more intensive specialist training, will therefore be required. Do we really know what specialties are needed most and how do we encourage young graduates to take up the so-called less popular, less “glamorous” specialties? It is estimated that more than 3000 specialists, in various fields of dentistry, are required presently to meet the needs of dental

faculties and the service. At least 250 to 300 specialists need to be trained annually in order to fulfil the requirement by 2020. However, more detailed planning is required in this aspect of manpower requirement: it should take into account the nature and present trends of dental morbidities, pay heed

to public demand, and have sufficient to serve in our local

dental schools.

The Right Stuff and Right Mix:

Although the ideal ratio of dentist to population has been calculated commensurate with developed nation status, there must be checks and balances to ensure they are trained with the right skills and attitudes to meet the needs of the patients and dental schools alike. There appears to be a plethora of dental schools established locally (14 at the last count) totrain dental surgeons but there is a dire shortage of lecturers and clinical assistants. The concern is so great that the Ministry of Higher Education has placed a moratorium on the setting up of new schools. If conditions become more conducive, can these schools, new and long-established, ensure that our local graduates have the right mix of technical skills, moral rectitude, empathy and caring, political and social conscience plus the skills to exercise their entrepreneurial spirit in private practice?

The number of adequately trained dental auxiliaries must also be taken into account. Dentistry is practised as a team. Are there enough trained auxiliaries at present and is there adequate capacity to train more? The future status, role and function of the dental nurse may be uncertain, but there is definitely a need for trained dental surgery assistants (DSA). The training of this auxiliary group appears to be unprofitable and therefore, at present, only the public sector fomally trains these invaluable team members. If these DSAs are mainly employed in the public sector, what can be done to ensure the private sector train their own? Is the on-the-job training provided by individual practitioners adequate to meet set standards?

What of the dental technologists (DT)? Is there sufficient willingness and capacity to train these laboratory technologists in all sectors? The new Allied Health Profession Bill will impose stricter rules on the practice of these auxiliaries. There are at present more than 400 apprentice-trained dental technicians in the country. What will be the mechanism to raise their skills to be on-par with professionally trained DTs? Is there a need to do so in the first place?

Globalisation and Liberalisation:

What will the impact of these two government policies have on the practice of dentistry? On the one hand it can facilitate and encourage the import of foreign technology and expertise to aid in the training of dentists, assist in dental research and provide specialist care in Malaysia, but are the conditions imposed and incentives provided suitable and adequate to attract and retain the world’s best o work and live in our country? Globalisation and liberalisation

allow two-way traffic. Are conditions in the country conducive to retain the best of our own to serve the nation or will we continually lose them to more developed nations? Steps have been taken to entice certain specialists to come back home but is this move sustainable?

Future Governance with 1Malaysia:

After all that has been said above, what would actually be the scenario when there is a marriage of the public and private sectors in the future? How would our practices change and what would the governance of those practices be like?

What kind of balance is expected to ensure a continuance of

“private” enterprise and the need to exercise greater corporate social responsibility for the less privileged? How would we ensure equity of manpower distribution and best care in this situation?

This article seeks to pose questions that dental service providers and manpower production authorities need to ponder

on and work towards reaching a viable solution. Before we seek solutions we must ask the right questions. Whatever the challenges faced and outcomes hoped for, there must first be a change in our current perceptions of dentistry in Malaysia, by taking note of the changes in the local and international environment. Taking stock of where we are is vital in planning a future that we desire, in formulating politically- and morally-correct achievable goals, defining and assigning roles and responsibilities to all parties involved, and mapping out

the pathway to get there.

Contributed by:

Maj-Gen (R) Dato’ Dr Mohamad

Termidzi Hj Junaidi