The beginnings of Sophie, a young dentist
Sophie Sarrazin does not have the look of a grubber. Yet…
This young woman of 26 years is a dentist ( dentiste de garde dimanche ) in Gradignan. After a baccalaureate
obtained in 2000, Sophie joined Bordeaux 2 in PCEM1 (first year of the first
cycle of medical studies) to study masso-kinesitherapy. “I was told that
the medical program was reserved for the best students. Finally, the training
of physio requires so much work … When I arrived at the university, I felt
lost.I came from a private high school where I was very framed, I failed.” For
her second PCEM1, the student sees wider and also enrolls in medicine and
odontology contests (the study and treatment of teeth). “This time, I was
admitted to physiotherapy and dental, I chose dental because I preferred to
study for a long time”.
At the end of the fifth year, Sophie obtains her CSCT (certificate of clinical and therapeutic synthesis), which allows her to practice. During her sixth and final year of studies, the young woman began to replace dental surgeons on vacation. Replacements of a day, a week, a fortnight … “It’s very common to start, you can find these positions thanks to the word of mouth, the Council of the Order (which establishes a list of advertisements), the specialized press or Internet. In this case, I consulted dentist-remplacant.com, a site created by the doctor Laurent Dussarps, then assistant university-hospitalist with the school of Bordeaux “. An important meeting in the career of the dentist. “I replaced him at his office on August 15, 2006. Then, once my thesis was defended in September 2007, he offered me a collaboration”. The young woman did not experience a period of inactivity. “In general, when you want to find a replacement or a collaboration, you can find some, sometimes you just have to change the corner”.
Therefore, when Dr. Dussarps is away, Sophie takes over. “I work part-time, I do not have a share in the firm as one can have as a partner, I donate 40% of the profits I receive for renting equipment and using the chair. The way of working makes it possible to discover the terrain smoothly some graduates associate themselves on leaving college, but it is not easy. In the beginning, we do not know how a practice works. One reason or another – I want to leave, it is enough that I give a notice of three months. On the other side of the medal: I am on an ejection seat “. Compared with occasional replacements, the collaboration also makes it possible to follow patients in the long term (thus to retain them) and to perform more interesting acts.
Sophie is a “generalist” dentist: she practices all the dental care, including the most difficult like the extractions of teeth. “Today, I’m more comfortable than when I started even though I still have a lot of things to learn! The college is doing well, but in the field we have to work without a net. Our decisions are validated. by no teacher, you have to trust yourself and show the patient that you know what you are doing “. Other difficulties that the young woman had to face: fill the paperwork (“we really realize it only in the heat of the action”) and create his patient. “There are two types of collaboration: those that are already created and those where everything is to be done. It was my case. In the beginning, I happened to care only two patients in a morning …”
Today, Sophie’s earnings vary according to the month. “In January 2009, for example, I made 6.000 € in turnover. If we deduct the 40% allocated to Dr. Dussarps and expenses (pension, business tax, URSSAF …), I won 1,700 €. As a replacement, I was getting more because I did not have any expenses to pay, for example, when I went to work a month in Reunion in January 2008, I pocketed € 4,000 “.
Dentists can stay together for a long time. “But it sure is better to own a property,” says Sophie. “For the moment, I’m still learning, and then we’ll see, I’ll be able to set up a practice, pick one up or join in. That is what most dentists do. Today, at the national level, there are more retirements than young people coming into the market so there is no need to worry …”
The next one is a testimony from an “honest dentist” who goes with the username Tommy KnockerzZ on the webpage: http://forum.doctissimo.fr (October 9, 2010)
It is regrettable to note today a quality of care to be desired, or the realization of inadequate prostheses, having as a direct consequence the non-improvement of the patient’s troubles, but sometimes even a deterioration of the situation.
However, the incompetence of some is matched only by the ignorance (normal) of patients but also (insurmountable) leaders, problems inherent to our profession. The sub-treated prostheses are an example, the realization of unnecessary care or poorly done is another. I think the embarrassing situation of dentists today brings more than one to take the step of sloppy care…
If you wish, I will continue this digression on the causes of the problem, which everyone seems to ignore. They are obviously at the level where the rub: the money. Moreover, as everyone knows, under the pressure of money, many dishonesty emerge.
Modern dental practices are much more expensive for their owners than thirty years ago, the cost of living, and the expenses, increased for all professions. However, the care in our agreement with the health insurance (having a tariff and a refund), have themselves almost no change in tariff since 1981. The problem also affects the stomatologists, cannot live any more extractions, the latter not even paying for the equipment used to produce them. Caregiving dentists are therefore harmed and are forced to increase fees for free-of-charge deeds, to compensate for their loss on fee-based fees. These are for example prostheses, and all modern care. We understand then that French dentists practice a high fee on these acts. on the other hand, conventional care costs are low (for example, devitalizing a molar costs 81 euros to the health insurance, the dentist wins. In Spain, this rate is multiplied by 4 with about 320 euros on average, and it n there is no refund.)
Also, some practitioners try to make prostheses or care “out-nomenclature” when these care are unjustified! This throws stigma on the whole profession, because you, patients, can not differentiate an unscrupulous dentist from an honest practitioner because can not judge his diagnosis.
I do not blame the less honest dentists, no one is perfect. However, I think that easy solutions affect everyone, including you.
The truth is that our system is outdated and does not want to admit it; dental surgery has leapt forward in recent years, and today can achieve what was impossible thirty years ago. The known treatments (filling, descaling …) have also evolved and became acts of high precision.
Mercury amalgams are now calibrated and packaged in the form of “compules” for single use, to handle very precisely with expensive equipment, in order to take advantage of the material’s advantages while minimizing the risk for the patient and the practitioner ( we are the first to die of mercury, and it is we who have asked to modify this protocol). This security and this performance have a cost, which is not the cost of the “lead” dangerous of thirty years ago, but the health insurance does not care, our remuneration remains the same.
A second example. Thirty years ago, we could place “screws” in the roots of some teeth, and these screws are still inscribed in the nomenclature, while they cause fractures! Today, “tenons” fiberglass or carbon are used, safe for the teeth and much more efficient for the patient, but cost much more than “screws”, and that the tariff proposed by the Health Insurance. Thus, some continue to install screws, because ask “fibrated tenons” costs them more than it yields them.
A final example, descaling is no longer done with curettes “hooks” which damaged the teeth and hurt the patient. Ultrasonic curettes have replaced them, which can descale without damaging, and do not even need anesthesia, the pain is completely absent. However, this material is once again very expensive, the remuneration of the act becomes ridiculous in comparison.
The examples are endless, I can summarize by the fact that today, our (mine in any case) acts are modern high-tech fruits, treated and remunerated as crafts of another age, which are not only less effective, but sometimes dangerous!
No actual care for science is repaid today. That is to say that the surgeries of the gum or the bone, being able to reconstruct a smile, or the implants, allowing to find “real” teeth for the life thanks to artificial roots, as well as dozens of other acts, are unknown to our convention. Yet other specialties do not have this problem. cardiac stents, hip prostheses, are reimbursed, and are extremely expensive. Dental unions just do not do their job, and the patient suffers.
To put it simply: If I
want to make a good living with the current convention, I have to work as I did
thirty years ago, and that does not suit me because I want the best for my
So we will achieve a two-speed dental surgery. The “contracted” will treat patients for cheap, with techniques and materials “outdated”. The others will de-convention and will exercise our true profession. This is wanted by our leaders, because our branch is not “desired” in repayments. Dental care is not necessary for survival, nor are painkillers. Yet you know as well as I that some pains are unbearable, and that the fact of not being able to eat properly is unacceptable.
To conclude, I will tell you that I do not know any dentist who has a bad life, thanks to some well-off patients who can afford the new acts. Arbitrarily, I consider it normal for a high graduate, to earn a good living in a liberal profession. Coming from a medium smicard, I do not complain about my fate. What worries me is the future of my patients, because I do not wish to take heart to care only for the rich. Still, I do not want to offer “discount” care and will be forced to leave the convention if I can not make a living in this lost system. I can now do all the care, even the underpaid, with the best technique available. But it’s only thanks to funding through my prostheses and expensive care. I find this unacceptable because all work deserves pay, and even the smallest descaling is essential for the good performance of future treatment.
The solution would be to balance all the tariffs in a new convention. The prostheses and new acts would be cheaper, but all other acts would be valued, so that all dentists are encouraged to care for their patient as a whole and can make a living whatever actions they perform. I am utopian, it would cost money to health insurance, so it is simpler and demagogic to simply treat dentists thieves.
I thank you for reading
me, and hope without believing that the two speeds will stay together.
The dentist n ° 11
Alain Derouineau, dental surgeon: “We must run after profitability”
Alain Derouineau, a dental surgeon in Beaugency, Loir-et-Cher, reacts to the non-replacement of one of his colleagues who retired to the region.
This is the site of the New Republic that gave the floor to Alain Derouineau. This practitioner wanted to express himself on the causes explaining the demographic situation of the dentists in certain regions of Province.
“The administrative burden, the increase of the expenses (the contributions were multiplied by 10 in fifteen years), the heaviness of the technical platform, the cost of the material, the new standards, the traceability, the elimination of the waste, the standards of hygiene, work overload, stress, increasing responsibility, staff management, lack of security, multiple attacks that we suffer through the media and public authorities.
For Alain Derouineau, the dental surgeon is today a true entrepreneur. “We forget to say what all this implies morally. Consequence: since there has been no revaluation on the care for years and that for fifteen years, there is a strong increase of expenses, the head of company must run after the profitability whereas the employee, which take less risk, feel more protected. The remuneration is no longer rewarding compared to other European countries. The practitioner looks closely at the development of “increased competition” of dental centers and health networks, with a stated objective, that of “the reduction of dental fees, which may seem desirable, but attention to quality” .
“In view of all this, young people do not always have the ability to return to the dental office, especially if they have only one position. And so they choose at the exit of the college a salaried exercise. That’s why most independent dental practices do not find buyers. “
According to Beaugency’s dentist, a young person who is coming out of college today needs counseling, support and security. “We should study senior-junior collaboration contracts that are very easy to set up, active internships in 6th year under tutoring, reduce the time between the exit of the university and the defense of the thesis, set up dental services in the territories without faculty to bring the young people and to raise the numerus clausus. Our elders, who created the Association dentaire française and obtained the doctorate in dental surgery, our professional ability recognized around the world, would be very disappointed to see what is happening today. Some of our representatives think more of their own interests than of the general interest. The liberal exercise in France is totally complementary to the public exercise. Let me explain what is the dogma that justifies the destruction of our liberal professions? To care for a tooth, to perform complex prosthetic work is not trivial. The technique at home implies excellence.”