Stopping Staff Separation

Media item: article

Date published: 12 August 2015

Subject: staff retention

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

Why retention is a patient issue, not just an employer's problem

Continuity of address is not continuity of practitioner. The practice stays; the person may not. Is it important to have a family dentist? makes the same argument from the patient's side.

That matters clinically, and more than most people realise:

The practitioner who placed a restoration knows why, what they found underneath, how close it came to the pulp, and what they were watching — see Why do I need a filling? and How long do dental fillings last?
They know your risk profile from having seen it change — which lesion has been static for eight years and which one is moving (the stages of dental decay)
They know you are anxious (Dental Anxiety), that you gag, that you are on anticoagulants, that lying flat is uncomfortable — and that knowledge is only partly in the notes
They know what you told them you wanted, which is not always what a treatment plan records — Understanding Your Treatment

Dentistry is a longitudinal discipline. A single examination tells you what is there; a series tells you what is happening, and "what is happening" is the whole clinical question. How often should I go to the dentist? explains why the interval is set the way it is.

What actually happens when a practitioner leaves

And what you should do about it. This is the useful part of this page.

1. You are entitled to know

A practice should tell continuing patients that their practitioner has left, and who is taking over their care. Not being told is a reasonable thing to complain about. The current list here is Our Team and Dentists & Registered Specialists.

2. Your records stay with the practice

The clinical record belongs to the practice, not the departing practitioner — and this is where most confusion arises. If you follow the practitioner elsewhere, the new practice does not automatically receive your file.

What to do: request your records in writing from the original practice. You have a right of access to your own health information under Australian privacy law and, in Victoria, the Health Records Act — see the Privacy Policy. A reasonable fee may apply for copies.

Ask specifically for the radiographs. They are the single most valuable item, because they are the only objective record of change over time — How safe are dental x-rays. Without them, the next practitioner is comparing today against nothing, and uncertainty tends to resolve in favour of treating.

Keep your own copies. Practices close, merge, sell and lose data. Digital copies of your own radiographs cost nothing to store.

3. Whether to follow them is your decision

Restraint clauses in a practitioner's contract restrict the practitioner, not you. They may limit where and how soon a departing practitioner can practise or advertise nearby. They do not oblige a patient to stay anywhere.

You may choose your practitioner freely. If you want to know where they have gone and the practice will not say, the AHPRA public register at ahpra.gov.au lists registered practitioners and is free to search. Finding a dentist online in Australia and What makes a truly great dentist? are worth reading before you choose.

4. Mid-treatment is the situation that needs attention

This is where real problems occur.

If you are part-way through orthodontics, an implant sequence, a course of root canal treatment, or crown and bridge work when the practitioner leaves, ask immediately and in writing:

Who is completing this, and what is their experience with this specific treatment? — see Why would I need to see a dental specialist?
Is there any additional cost? Money already paid for work not yet done is a legitimate question, and a practice should be able to state clearly what has been paid for and what remains. The price guide shows how fees are set out here.
If I move to another practice to finish it, what will that cost, and what records will I need? — which is generally more expensive, because a practitioner taking over someone else's incomplete work reasonably charges for the risk and the time. See Second Opinions & Corrective Dentistry.
For orthodontics specifically: what is the retention plan and who provides it? Retention is lifelong, and it is the stage most often dropped when a practitioner changes — Will my teeth need retainers after I've had braces? and Why do teeth shift?

Get the answers in writing. This is the single most common source of dispute when practitioners move.

5. If treatment is genuinely unfinished and unresolved

Raise it with the practice first, in writing — Contact Us.
The Health Complaints Commissioner (Victoria) handles complaints about health services, including cost and continuity.
AHPRA and the Dental Board of Australia handle concerns about a practitioner's conduct or performance.
Every registered practitioner must hold professional indemnity insurance as a condition of registration.

Why practitioners leave

Briefly, because it explains the frequency.

Most dentists in Australian group practices work as independent contractors paid a percentage of the fees they generate — which means no sick leave, no annual leave, and income tied directly to being in the chair. Add the physical toll (musculoskeletal problems are a well-recognised occupational hazard in dentistry), the isolation of clinical decision-making, and the ordinary reasons anyone changes jobs. The Great Resignation in the Private Health Sector covers the period when this accelerated; current roles are at Join our Team.

Movement is normal in this profession, and a practitioner leaving is not evidence of anything wrong.

Turnover is still the enemy of consistency — in sterilisation, in record-keeping, and in knowing which patient needs what. Which is why staff retention is one of the very few externally visible signals that correlates with a well-run practice, while still telling you nothing directly about your own treatment. See How do I manage to keep 60 demanding clinicians happy — all under the one roof?

The practical summary

Ask who will be treating you before a complex course of treatment, and what happens if they leave.
Get treatment plans, quotes and payment records in writing, always, with ASDS item numbers.
Request and keep your own records and radiographs whenever you change practices.
You are free to follow a practitioner, and free not to.

Common questions

What is the practitioner who takes over my care actually required to have in place?

Current registration, and the Dental Board of Australia sets what that requires through its registration standards — which the Board describes as defining “the requirements that applicants, registrants or students need to meet to be registered”. The current set includes a Professional indemnity insurance arrangements standard (in effect since 1 July 2016), a Continuing professional development standard, a Recency of practice standard — the relevant one for somebody returning after time away from clinical work — a Scope of practice standard (1 July 2020), and criminal history and English language skills standards. None of that tells you whether a particular practitioner suits your particular treatment. It is the floor, and it is verifiable free on the AHPRA register.

Which conditions genuinely need the same clinician watching them over years?

Gum disease is the clearest case. The measurements are the record, not the appearance: as one review of periodontitis and diabetes puts it, “‘pocketing’ is not evident on simple visual inspection, and assessment using a periodontal probe is essential”. Periodontitis is “a slowly progressing disease” whose tissue destruction is “largely irreversible”, and in the early stages it is typically asymptomatic and not usually painful, so many people are unaware until teeth become mobile. It is common — severe periodontitis affects 10–15% of adults and moderate periodontitis 40–60%. Someone holding three previous probing charts can tell whether a 5 mm pocket is stable or deepening. Without them, they cannot.

Why is a quote from another practice so different from the one I already have?

Because Australia has no single national scale of dental fees and each practice sets its own. The Australian Dental Association's Dental Fees Survey 2022, which drew on 3,535 general practitioners in private practice, found “considerable variation in the fees charged within and between states” — within, as well as between. Across the 122 items surveyed, fees charged by general practitioners rose on average 3.7% over the two years to 1 July 2022, with the smallest rise in Preventive Services and Periodontics (1.6%) and the largest in Orthodontics (6.9%). Comparing quotes is worth doing, but compare them item number by item number rather than total against total.

What should a routine examination include, whoever is doing it?

The part worth checking is the soft-tissue examination, because it is what a rushed appointment drops. A Royal Australian College of General Practitioners paper on oral cancer screening describes it as a comprehensive examination of the mouth needing only gloves, a mouth mirror, a tongue depressor and a torch, covering the face, jaw, chin and neck as well as the lips, cheeks, gums, tongue, floor of the mouth and palate. The highest-risk sites are the lateral margins of the tongue and the floor of the mouth. It matters because oral cancer's five-year survival is around 50%, “mostly due to diagnostic delays”, and initial lesions are generally painless.

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. Directions are on Location.

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. It is not legal advice, and privacy and health records law is administered by the relevant regulator and changes; confirm current requirements with them. It is not a diagnosis or a treatment plan. Third-party published content is not reproduced.

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