Is dental really different to pharmacy?

Media item: article

Date published: 15 December 2015

Subject: the regulation and ownership of health businesses in Australia

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

The short answer: yes, and the difference is ownership

Dentistry and community pharmacy look alike from the street. Both are private businesses providing regulated health services, both sit largely outside bulk-billed general practice, both are run by registered practitioners, both take walk-ins from a shopfront.

Under Australian law they are regulated on fundamentally different models, and the difference is one of the most consequential and least understood facts about how health care is delivered in this country.

Pharmacy: ownership is restricted

Community pharmacy in Australia is subject to two overlapping layers of restriction that dentistry has neither of.

1. Pharmacy ownership rules

Under state and territory pharmacy legislation, community pharmacies must generally be owned by registered pharmacists, and the number a single pharmacist may own is capped. Corporations and supermarket chains cannot simply buy pharmacies.

This is administered by state pharmacy authorities and has been repeatedly reviewed, defended and contested. The stated rationale is that professional judgement about medicines should not be subordinated to a commercial owner.

2. Pharmacy location rules

Separately, approval to dispense PBS-subsidised medicines is subject to location rules administered federally. A new pharmacy cannot simply open wherever it likes and expect PBS approval; there are distance and location criteria relative to existing approved pharmacies.

The combined effect is that the number and location of community pharmacies is actively managed.

And pharmacists are registered

Pharmacists are registered by the Pharmacy Board of Australia, through the same AHPRA scheme that registers dental practitioners. They appear on the same public register, subject to the same National Law, the same advertising provisions, the same mandatory notification obligations and the same complaints pathways. The dental side of that register is explained at Dentists & Registered Specialists.

Dentistry: ownership is not restricted at all

Australian law places no equivalent restriction on who may own a dental practice.

An individual, a company, a private equity fund or a health insurer may own one. There is no cap on numbers, no location rule, and no requirement that the owner hold any health registration whatsoever.

What is regulated is the practitioner. Every person providing dental care must be registered with the Dental Board of Australia, must work within their scope, and is personally accountable to AHPRA — regardless of who owns the business. When do you need to see a dental specialist? covers what scope means in practice.

So the two professions are regulated identically at the practitioner level and completely differently at the business level.

Why that difference matters to a patient

It shapes the incentives around the advice you receive.

In pharmacy, the person who owns the business is a registered pharmacist, personally accountable to a board for their professional conduct. Commercial pressure certainly exists — the retail floor of a modern pharmacy is full of products with weak evidence — but the owner's registration is on the line.

In dentistry, the owner may have no registration at risk at all. The practitioner does, and that is the substantive protection. But the person setting revenue targets, designing remuneration, and deciding what the practice promotes may be entirely outside the health regulatory system.

This is not an argument that dental corporates provide poor care. Many provide very good care, and consolidation has brought real benefits in equipment, infection control and availability. It is an argument for understanding the structure, because the recognised risk in the literature and in regulator commentary is the same in both professions: when income is tied to the volume or value of what is supplied, the pressure runs toward more of it.

The archive carries the profession's own arguments about this: the Australian Dental Association panel discussion on professionalism versus commercialism and the panel item featuring Dr Kia Pajouhesh, together with Buy now pay later: abuse of process in the sales-centric approach to health care and Patient payment plans: the next big disruption on the dental horizon. On the scale question specifically, see Is a bigger dental practice better? Part 1 and Part 2.

The other real differences

Funding. Pharmacy sits inside a major federal subsidy scheme — the PBS — which caps what patients pay for listed medicines. Dentistry has no equivalent. There is no general Medicare rebate for adult dental treatment, and this single fact explains most of what is difficult about dental access in Australia. The narrow exceptions are the Child Dental Benefits Schedule for eligible children — see the CDBS page and how the Child Dental Benefits Schedule operates — and state-funded public dental services for eligible adults. The pressure this creates shows up elsewhere in the archive, in the rise in Australians tapping into their super for dental treatment.

Price transparency. A PBS medicine has a known co-payment. A dental treatment plan has whatever the practice charges — fees are not regulated, and the same treatment can differ substantially in price between practices in the same suburb. The Australian Schedule of Dental Services and Glossary item numbers are the tool that makes comparison possible, and asking for them on a quote is entirely normal. See the Price Guide and Understanding Your Treatment.

Reversibility. A dispensing error is serious and can be catastrophic, but a course of medicine ends. Dental treatment is frequently irreversible — removed enamel does not return, an extracted tooth is gone, a prepared tooth is prepared forever. See Enamel is the hardest substance in the body — so why do teeth break? and Replacement options for missing teeth. That asymmetry is the reason the recurring advice across this collection is a second opinion before extensive or irreversible work — Second Opinions and Corrective Dentistry.

Frequency of contact. Australians visit pharmacies far more often than dentists. A pharmacist may see a patient monthly; a dentist may not see them for a decade, and cost and fear are the two documented reasons. On the second of those, see Dental Anxiety and Can I ease anxiety about visiting the dentist?; on how often attendance is actually warranted, How often should I go to the dentist?.

What is identical

Worth stating, because it is the part that protects you in both settings:

Both professions are registered under the same National Law, and both registers are public, free and searchable at ahpra.gov.au. Finding a dentist online in Australia explains how to use it.
The same advertising provisions apply: no testimonials about clinical care, nothing misleading, no unreasonable expectation of benefit, no inducement without terms, no encouraging unnecessary services.
The same complaints pathways apply — in Victoria, the Health Complaints Commissioner for services and AHPRA for practitioner conduct. The consequences of a failure to refer are illustrated in Record payout to patient for failure of GP's duty of care to refer to a specialist.
Both carry mandatory professional indemnity insurance as a condition of registration.
Both are bound by the same privacy and health records obligations, and you have the same right of access to your own records — see the Privacy Policy.

Common questions

If the owner of a dental practice needs no registration, does the advertising law reach them at all?

Yes — and this is the part of the picture the ownership argument above leaves out. AHPRA's advertising guidelines are explicit that "anyone (person, business or corporate entity) who advertises a regulated health service, is considered an advertiser and must comply with the advertising requirements of the National Law", and that advertisers include "individuals who are not registered health practitioners" and "businesses, partnerships and corporate entities." The advertiser is whoever controls the content.

What differs is the enforcement toolkit, and the difference is substantial. For a registered practitioner the guidelines list powers to investigate their conduct, "impose conditions on the practitioners' registration, such as restricting their ability to advertise their services", take disciplinary action in a panel or tribunal, and prosecute. For everyone else: "for corporate entities, business and individuals who are not registered health practitioners, the tools available under the National Law include the power to prosecute which may lead to a financial penalty." Section 133 sets that penalty at a maximum of $5,000 for an individual and $10,000 for a body corporate. So an unregistered owner is bound by the same rules, but the sanction available against them is a fine, not their livelihood.

A practice offered me a discount if I booked this week. Is that allowed?

A discount is not in itself prohibited — advertising it without its terms is. Section 133(1)(b) of the National Law makes it an offence to advertise in a way that "offers a gift, discount or other inducement to attract a person to use the service or the business, unless the advertisement also states the terms and conditions of the offer." If you cannot find what the offer excludes, what it expires against, or what the undiscounted fee was, the advertisement is incomplete.

The deadline is the part worth noticing. AHPRA's guidelines give worked examples of language that may be unlawful where it is not clinically justified, naming phrases that "create a sense of urgency" — "'don't delay', 'act now before it's too late', 'don't miss out', 'time is running out', or 'for a limited time only'" — because s.133(1)(e) also prohibits advertising that "directly or indirectly encourages the indiscriminate or unnecessary use of regulated health services." A clinical reason to act this week is a clinical reason. A marketing deadline attached to irreversible treatment is a different thing, and the honest response to one is to ask what happens if you decide in a month.

There is no set fee, so how do I actually compare two quotes?

By item number, not by total. Every procedure has a number in the Australian Schedule of Dental Services and Glossary, and two quotes are only comparable once you can see that one includes a step the other does not. Ask for the plan itemised, and ask which items are estimates rather than fixed.

For a sense of the spread, the ADA runs a Dental Fees Survey — the 2022 edition drew on 3,535 general practitioners across 122 items — and its finding on variation is blunt: "there was considerable variation in the fees charged within and between states." It also reports the movement, with fees charged by general practitioners rising on average 3.7% over the two years to 1 July 2022, the smallest increases in preventive services and periodontics (1.6%) and the largest in orthodontics (6.9%). Those are ADA member averages as at that date, not a schedule anyone is bound by, and they date quickly — but they establish that a difference between two quotes is normal and is not by itself evidence that either is wrong.

Is there genuinely no Medicare for dental, or are there gaps I am missing?

For adults, outside the public system, effectively none. The main Commonwealth scheme is the Child Dental Benefits Schedule, and Services Australia's own description of it is narrow: it covers "up to $1,158 for each eligible child over 2 calendar years for basic dental services", with the cap "indexed yearly on 1 January". Basic means "check-ups, X-rays, cleaning, fissure sealing, fillings, root canals, extractions" — and it explicitly does not cover "orthodontic dental work, cosmetic dental work" or "any dental services in a hospital."

Two details people are caught by. Unused balance does not roll forward indefinitely: "if you don't use the full amount within the 2 calendar years, you can't use the remaining funds." And CDBS services "don't count towards the threshold of both the Medicare Safety Net and Extended Medicare Safety Net" — so dental spending does not help you reach a safety-net threshold the way other out-of-pocket medical costs do. Eligibility and the cap are set by Services Australia and change; confirm yours through them or myGov rather than through any practice.

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. See also Our Location and Contact Us.

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

This page records a published article and its date, with general information about how these professions are regulated in Australia. Ownership, location and subsidy rules are set by legislation and change; confirm current requirements with the relevant regulator. This is not legal advice, a diagnosis or a treatment plan. Third-party published content is not reproduced.

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