The Great Resignation in the Health Sector

Media item: article

Date published: 23 May 2023

Subject: health workforce

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

Note: the workforce shortage itself is covered at Staff motivation and confidence, and what to do when your practitioner leaves at Stopping Staff Separation. The article of the same name is The Great Resignation in the Private Health Sector.

This page covers the thing underneath both, and the question patients actually ask: where does the money go?

Why dentistry costs what it does

The honest answer has two halves, and only one of them is about the practice.

Half one: you see the whole price

Dental care sits largely outside Medicare. There is no general Medicare rebate for adult dental treatment. Is dental really different to pharmacy? takes the same argument somewhere else.

So you see the full cost of dentistry in a way you never see the full cost of medicine. A GP consultation, a specialist appointment, a pathology test and a hospital admission all cost real money to deliver; most of it is paid before you get to the counter. In dentistry, none of it is.

That single structural fact explains most of the sticker shock, and it explains why cost is the leading reason Australians delay or avoid dental care — see Explosive uplift in Australians tapping into their super for dental treatment.

Half two: a dental surgery is a small surgical facility

Where a fee actually goes, roughly in order of size. Surgery Portfolio walks through the room itself, and Our Technology lists the equipment.

Staff. By a wide margin the largest cost. Dental assistants, sterilisation staff, reception, practice management, and hygienists and therapists. Most dentists in group practices are contractors paid a percentage of what they generate, so a share of the fee is the practitioner's own income — out of which they fund their own leave, superannuation and time off. The people are listed on Our Team.

Laboratory fees. For anything indirect — a crown, a denture, an appliance, a mouthguard. This is a real third-party cost inside your quote, and it is a large part of why the same crown differs in price between practices: the material, the time, and whether the ceramics are layered by hand or milled monolithic. See our in-house laboratory and How much does a dental crown cost in Melbourne?

Premises. Rent or mortgage, in commercial space, with the fit-out amortised over it. A dental fit-out is not an office fit-out — see below.

Equipment and its maintenance. A dental chair and delivery unit is a major capital item, and there are several. Add imaging equipment (how safe are dental x-rays), autoclaves, a compressor and suction plant, digital scanners, milling units, and the service contracts on all of it.

Consumables. Overwhelmingly single-use: gloves, masks, gowns, bibs, suction tips, burs, needles, anaesthetic cartridges, impression material, composite, bonding agents, cements, matrices. Single-use means single-use, and a single restoration consumes a surprising quantity of it.

Sterilisation. Instruments are cleaned, inspected, packaged, autoclaved and stored, with validated cycles and records kept of every one so that a failed cycle can be traced to the instruments and the patients involved. The staff time in that room is substantial and entirely invisible.

Compliance. Radiation licensing and shielding, waste contracts including amalgam separation, waterline management, infection control auditing, and record retention over decades — see the Privacy Policy.

Insurance and registration. Professional indemnity insurance is mandatory for registration. Add public liability, business insurance, and annual registration fees for every practitioner in the building — Dentists & Registered Specialists.

Continuing professional development, which is a registration requirement and is paid for by the practitioner or the practice.

Software, data security and backups — increasingly significant, because health is consistently among the most-breached sectors in Australian data breach reporting.

And time. A long appointment with one patient in one chair with one assistant cannot be run in parallel. The unit of production in dentistry is an hour of one person's attention, and that is why it does not get cheaper the way manufactured goods do.

What this does not justify

Being honest cuts both ways.

Dental fees are unregulated in Australia, and the same treatment varies substantially in price between practices in the same suburb. Some of that variation is laboratory quality, appointment length and practitioner experience. Some of it is simply what the practice has decided to charge.

So the cost explanation above is not an argument against comparing prices. It is an argument for comparing them properly:

And if the cost is genuinely out of reach

Delayed dental treatment gets more expensive, not less — The stages of dental decay is the clinical version of that sentence — which is the argument for finding a way to do the urgent part now, and staging the rest.

Related pages: Price Guide, Payment Plans, Staff motivation and confidence, General Dentistry, and the rest of the media record.

Common questions

Why does the same treatment cost different amounts at two practices in the same suburb?

Because nothing sets the price, and the profession's own survey says so. The Australian Dental Association's Dental Fees Survey 2022 — 3,819 valid responses from 11,035 dentists invited, covering fees as at 1 July 2022 — reports "considerable variation in the fees charged within and between states". On average across the 122 items surveyed, general practitioners' fees "appear to have increased by 3.7% during the two-year period since 1 July 2020". By state, the ADA found general practitioners in South Australia and Western Australia charging the lowest fees on average and those in the ACT and Northern Territory the highest — while cautioning that, because of small samples in those two jurisdictions, "their results should be viewed with caution".

Which kinds of dental work have gone up fastest?

In the same ADA survey, fees rose across every service category, but unevenly: "the smallest increases seen in Preventive Services and Periodontics (1.6%), and the largest increase in Orthodontics (6.9%)". Read the direction of that carefully — the cheapest thing to buy is the thing that stops you needing the expensive thing, and it is also the category that has risen least. On specialist fees the ADA is blunt about its own data: only 284 self-identified specialists responded, and "survey results for specialists should be interpreted with considerable caution".

How much is the Child Dental Benefits Schedule actually worth?

Services Australia covers "up to $1,158 for each eligible child over 2 calendar years for basic dental services under CDBS", and "the cap amount is indexed yearly on 1 January". Two things catch families out. First, it is a pool, not an annual allowance: "You can use the full amount up to $1,158 for each eligible child in the first calendar year. This will leave no funds for the second year." Second, the second year depends on continuing eligibility — an unused balance carries over only if the child is still eligible. Check the balance through myGov before booking anything large.

Will the CDBS or Medicare pay for treatment under a general anaesthetic?

No, and the profession has said for years that it should. The ADA's position statement records that "dental procedures under general anaesthetic are not universally covered by Medicare", so "for most families, this means that dental treatment under general anaesthetic is either out-of-pocket or covered through private health insurance, leading to financial inequities". On the children's scheme it is more pointed: "the inability for patients and families to access funding from the Child Dental Benefit Schedule for treatment under general anaesthesia remains a significant and unreasonable barrier for access", and the ADA's own recommendation is that general anaesthesia be added to the schedule — which is to say it is not on it.

Is it true that about a third of Australians put off going because of cost?

That figure is widely repeated and worth attributing properly. A submission to the Senate inquiry into the value and affordability of private health insurance and out-of-pocket medical costs cited an Australian Institute of Health and Welfare 2013 survey in which "nearly a third of people aged 5 or older (32%) avoided or delayed visiting a dentist due to cost", and argued that "the absence of a national dental fee schedule may have contributed to the comparatively high cost of dental care in Australia". That is one submitter's argument to a committee, not a finding of it. What is not contested is the scale: the ADA puts the cost of dental caries to the Australian economy at "up to $1 billion per year".

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; enquiries go through Contact Us.

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

This is an archive record of a published article and its date, with general information — not current clinical advice. No Smile Solutions fees are quoted here, and costs vary by case and by practice; the survey figures above are third-party data as at the dates stated. This is not a diagnosis, a treatment plan or financial advice. Eligibility for government programs and benefit caps are determined by the relevant body and change; confirm with them. Payment plan terms are set by the credit provider and change; confirm current terms directly before you commit. Third-party published content is not reproduced.

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