Dr Kia Pajouhesh – 'Victorian Business of the Year' Speech

Media item: recorded speech

Occasion: Victorian Business of the Year award

Date: 8 July 2014

Speaker: Dr Kia Pajouhesh, founder and principal dentist, Smile Solutions

This page records the media item. The recording is the property of its publisher and is not reproduced here.

What a business award records, and what it does not

A state business award assesses business performance — growth, employment, governance, customer measures, sustainability. It is judged by business people against business criteria.

It says nothing about clinical outcomes. No business award panel reviews radiographs, audits restoration survival, examines endodontic success rates or asks about complication rates. A business award is evidence about a business, not about dentistry, and this page does not present it as anything else. What a business award is actually judged on is set out at length elsewhere in this archive.

Under Australian advertising rules for regulated health services, a practice may state that it received an award, but must not use it to imply superior clinical care. That distinction is the whole point of this page.

The thing a business award actually points at: how dental practices are owned

There is something genuinely useful behind an item like this, and it is almost never explained to patients: who owns an Australian dental practice, and why that changes what happens in the chair.

Australia has no ownership restriction on dental practices

Unlike some jurisdictions overseas, Australian law does not require a dental practice to be owned by a dentist. Anyone — an individual, a company, a private equity fund, a health insurer — can own a dental practice.

What the law regulates is the practitioner, not the owner. Every person who provides dental care must be registered with the Dental Board of Australia, must work within their scope of practice, and is personally accountable to AHPRA for their clinical decisions regardless of who signs their pay.

So ownership does not change who is legally responsible for your treatment. It does change the incentives around it.

The four models you will actually encounter

Practitioner-owned solo or small partnership. A dentist owns the practice and works in it. Continuity is high — you tend to see the same person for years. The limitation is breadth: one or two general dentists cannot cover every discipline, so complex work is referred out.

Practitioner-owned group practice. A dentist or dentists own a larger practice employing multiple practitioners, often including registered specialists on site. Continuity is lower than solo practice but the range of care available in one place is greater, and internal referral is easier than external. Smile Solutions is this model.

Corporate dental groups. A company owns many practices, often dozens or hundreds, and employs or contracts practitioners in each. Corporates brought real benefits — capital for equipment, standardised infection control, easier locum cover, better after-hours availability. The recognised risk is the relationship between clinical decisions and commercial targets: where remuneration or performance review is driven by production, revenue per patient or the uptake of particular treatments, the pressure runs in the direction of more treatment rather than the right amount. This has been the subject of published concern in Australia and internationally, including regulator interest.

Insurer-owned or insurer-affiliated practices. Health funds own dental practices in Australia. The benefit to members is lower out-of-pocket costs at those clinics. The structural tension is that the same organisation both pays for the treatment and provides it, and separately publishes the preferred-provider arrangements that steer patients toward specific clinics.

None of these models is inherently good or bad. Every one of them contains excellent practitioners and poor ones. But the incentives differ, and a patient who understands them can ask better questions.

What to ask, whatever the ownership model

These questions work in any practice, and none of them are confrontational. More of them here.

"What happens if I do nothing?" Every legitimate treatment plan has a no-treatment option with a describable consequence. A practitioner who cannot state it is not giving you a choice.
"Is this urgent, or is it something to monitor?" Early enamel decay can remineralise. Not everything found needs drilling today.
"What is the least invasive option that would work?"
"Can I have the treatment plan and the itemised quote in writing, with item numbers?" The Australian Schedule of Dental Services and Glossary item numbers are the standard code set. With them, you can price the same treatment elsewhere and check your health fund rebate before committing.
"How long has the practitioner who will do this been doing it, and who does it if there is a complication?" Our team is listed with each clinician's registration.
"Are you a preferred provider for my fund, and what does that change about my out-of-pocket cost?"

A second opinion is normal and reasonable, particularly before extensive or irreversible work. Any practitioner confident in their plan will not be troubled by one, and you are entitled to a copy of your records and radiographs to take with you.

The employment structure inside a practice

One more piece that patients almost never see: most dentists in group practices in Australia are not employees. They commonly work as independent contractors paid a percentage of the fees they generate.

That arrangement has consequences worth knowing about:

It ties income directly to treatment volume and value, which is why the governance around treatment planning matters — peer review, second opinions within the practice, and specialist input on complex cases are real safeguards, not decoration.
It means the practice and the practitioner may have different obligations to you if something goes wrong, though the practitioner's registration and their professional indemnity insurance — which is mandatory for registration — remain the substantive protection.
Practitioners move between practices, so continuity of care is not guaranteed by continuity of address. Records stay with the practice; the person may not.

Making a complaint

If treatment goes wrong, or you believe you were pushed into unnecessary work, the pathways in Victoria are:

Raise it with the practice first, in writing. Most matters resolve here.
The Health Complaints Commissioner (Victoria) handles complaints about health services, including cost and conduct.
AHPRA and the Dental Board of Australia handle concerns about a registered practitioner's conduct, performance or health. Notifications can be made by any person.
Consumer Affairs Victoria and the ACCC deal with misleading claims and unfair contract terms, including in payment arrangements.

Common questions

Why can a practice mention an award but not say the dentistry is better?

Because the second is a comparative claim about clinical quality, and AHPRA's advertising guidelines treat those as needing evidence a business award does not supply. The guidelines list, among the things that make advertising false, misleading or deceptive, advertising that “compares health outcomes, regulated health professions or practitioners or prices without complete information” and advertising that “makes claims about providing a superior regulated health service”.

They also name a subtler route to the same breach: advertising may mislead “either directly or by implication through the use of emphasis, comparison, contrast or omission”. You do not have to write ‘best dentist’ to make the claim. An award badge placed beside a clinical promise does it by arrangement.

The guidelines name “comparisons between health outcomes and quality of care offered by different regulated health services” as comparative advertising requiring evidence — and no business judging panel produces that evidence.

What does being ‘registered’ actually guarantee about a dentist?

Four specific obligations, each with its own published registration standard from the Dental Board of Australia: Scope of practice, Continuing professional development, Professional indemnity insurance arrangements, and Recency of practice.

The first is the one that matters most in the chair. The Board states that its “Scope of practice registration standard applies to all practitioners registered with the Board” and “requires dental practitioners to practise within the scope of their education, training, and competence at all times.” That obligation attaches to the individual, which is why an owner — dentist or not — cannot direct a practitioner past it.

What registration does not do is rank anyone. There is no grading on the register, no quality score, and nothing that distinguishes a careful practitioner from a hurried one. It tells you someone is qualified, insured, current and working inside their competence. Dentists and Registered Specialists explains what the register shows.

How do I check that a specialist title is genuine?

On the register, and it is free. Specialist registration is a separate entry built on top of general registration — the Board's own wording is that “all dentists who wish to apply for specialist registration must have general registration and be on the Register of practitioners under the division of dentists.” So a genuine specialist appears twice: as a dentist, and with a specialist entry naming the field.

The consequences of getting this wrong are not trivial. Misuse of a protected title “is an offence under the National Law”, and AHPRA notes that “in the case of an individual, there may be a financial penalty, imprisonment or both.”

A related thing to watch for that is not a title at all: the guidelines caution that “abbreviations or post-nominal letters to indicate membership of a body or association” must not be “misleading by implying the practitioner has more qualifications, skill or experience than is the case.” Letters after a name can mean a rigorous qualification or a paid membership, and they look identical.

Which wordings in practice marketing should make me read more carefully?

The regulator's own list of what may be misleading is a usable reading guide. Advertising may breach the National Law where it:

“provides partial information and/or omits important details”
“makes unqualified claims about the effectiveness of treatment by listing health conditions that a treatment or service can ‘assist with’ or ‘treat’”
“minimises, underplays or under-represents the risk or potential risk associated with a treatment or procedure”
“uses scientific information that is inaccurate, unbalanced, not easily understood by the public, or does not clearly identify researchers, sponsors and the academic publication in which the results appeared”

That last one is the most practical test available to a reader. A page that quotes a survival figure or a success rate without naming who published it is doing the thing the guidelines describe — and it is a fair question to put to any practice, including this one.

Practical details

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000. Phone 13 13 96, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment.

Every practitioner's registration can be verified free on the AHPRA public register at ahpra.gov.au.

This page records an award and a speech, with general information about how dental practices are owned and structured in Australia. It is not a diagnosis, a treatment plan or a promise of any particular clinical outcome, and an award is not evidence of clinical quality. Third-party content is not reproduced.

Smile Solutions trades under ABN 28 193 514 103.