As a practicing dentist for 23 years now, I have seen my fair share of success during what has been a promising time for dentistry in the last decade. The overall market size of the Indian dental industry was estimated to be approximately USD 2 billion in 2019. Investors have been pumping money into dental chains and specialist dental centers over the last few years. Every fifth ad on TV is for an oral healthcare product. Dental tourism accounted for about 10% of the total medical tourism and was projected to grow at 30% per annum. The India dental service market was expected to grow at a CAGR of 7.34% through 2025.
| What keeps me awake at night is not just the uncertainty looming over my own practice, but equally, the dark gloom that has descended on the future of the profession. |
However, this scenario has changed dramatically today with the coronavirus pandemic. According to the New York Times, dental surgeons are at the highest risk of contracting and transmitting the Coronavirus, alongside paramedics, nurses, and other healthcare workers. Agreeably, dental clinics across the country have been shut for over a month and a half since lockdown measures were announced, and for longer in Karnataka. Most of us who understand the ramifications of this pandemic are preparing to hold off reopening our clinics for at least a few more months – which translates into zero earnings, and consequently a very uncertain future for us and the staff at our clinics.
Here is a quick peek into the stark future of dental practice post CoVID-19. According to the DCI’s advisory released on 16th April 2020, dentists must now strictly follow all protocols to decontaminate, disinfect and sterilize at the clinics as prescribed, enabling us to treat a maximum of only 3 or 4 patients a day. Dentists and our assistants will now need to mandatorily use PPE suits, goggles, face shields, N95 FFP3 masks, surgical gloves and shoe covers, single use chair covers etc., and more for all procedures. With this, already exorbitant treatment costs will at least double, if not more. Informal checks suggest that nearly 80% of dental clinics at present don’t follow the most basic sterilization protocols. If some of these practitioners choose to compromise on the quality of PPE used or sanitation maintained in their clinics, the resulting impact to societal health will be catastrophic. Apart from the huge monetary investments required to continue safe dental practice, there is also the equally important issue of proper training and process management in following these protocols to ensure minimal risk to patients and dentists alike. The advisory also recommends only emergency dental services in the near future, further impacting the financial plight of dentists. When the lockdown measures do ease up finally, given the overall uncertainty in the economy, people will tend to put off any elective dental procedures as they are not covered under health insurance schemes, despite repeated appeals by dentists in the last decade.
Now for some math. India has over 2.7 lakh dentists registered with the Dental Council of India (DCI) according to the NHP 2018, and we have an average of 27,000 new dentists graduating every year. Unemployment of dentists in urban areas is a huge issue already with projections revealing a surplus of about one lakh dentists in the country today. Now, multiply this with the unemployment aftermath of CoVID-19. While there are no official statistics released in India on the impact of CoVID-19 on dentistry yet, a poll conducted by the American Dental Association says 46 percent of dentists indicated they would likely need to sell their practice or file for bankruptcy if the current situation continued beyond August 2020. I suspect the scenario would be the same in our country, if not worse.
| We need a balanced combination of an immediate fiscal impetus to jumpstart the industry again, and more long-term measures that will set it on its growth trajectory over the next two decades. |
CoVID-19 is threatening to reverse the growth trajectory and ring in the death knell on dentistry as a profession in India. There is a serious and immediate need for government intervention to help support and stabilize the dental industry. Call it an urgent requirement of CPR for dentistry if you will.
Here are 5 ways the government can address the malady affecting the dental industry today.
- Inject fiscal support for the fledging industry over the next two years: This could be on subsidized provision of quality PPE, sanitization equipment and material, and reduction on import duty levied on expensive dental equipment to ensure dentists maintain adequate hygiene standards and aseptic protocols necessary for safe practicing. What would also help is perhaps an easing of taxes for the industry for the next two years, interest-free loans and top-ups. Equally importantly, there is a need for a government led business insurance plan for dentists and their practicing staff protecting them for losses and health concerns arising as a result of exposure to the viral strain or other pandemics. In parallel, we must bring dental treatment under insurance coverage for the general public. Combined with this, the government must also actively look into setting up ancillary industries that can cater to the requirements of the healthcare industry, boosting employment locally and reducing our dependence on medical imports.
- Move away from a compartmentalized approach to oral health: Dentistry has long been the forgotten, poor cousin amongst healthcare practitioners and consequently, in public perception as well. However oral health is the window to general health – with more than 120 medical conditions that can be diagnosed through an examination of the oral cavity. Regular preventive oral checkups can reduce both the risk of diseases and the cost of oral treatment which can otherwise be very expensive. The government should ensure every government hospital and primary healthcare center across the country has a dedicated oral healthcare department – this will also provide employment to the thousands of dental graduates in the country who can train to pick up expertise and practical knowledge on the field that is currently lacking.
- Restructure dental education and bring it under general medicine: I will say this one like it is. Dentistry has mostly been an afterthought profession for aspirants of general medicine who did not quite make the cut with their entrance scores. As a result, there is general apathy towards dentists both within the medical community and in the larger healthcare segment. Combined with this, the standards of dental education are abysmally low in the country. Concepts taught in dental schools haven’t changed in the last 3 or 4 decades while what is practiced on the field is vastly different, aided by technological and scientific advancements. Dental graduates are unable to diagnose basic general health conditions or read ECG / CT scan reports. Pharmacology likewise has become very advanced while dental grads fresh off the campus struggle with basic prescription details. The science of dentistry is fast disappearing and what colleges are churning out are mere technicians practicing age old procedures that are no longer relevant.
The standards of dental education must improve for long term gains. Dentistry should be brought under general medicine where students earn a primary MBBS degree and then specialize in dental sciences at the post-graduate level. The government should also relook at existing teaching licenses for colleges in the country and weed out those who do not meet the requisite standards in theory and practical exposure. This will help address 3 issues plaguing the industry currently – Dentistry will no longer be a poor substitute option for MBBS reject candidates, and quality of service will no longer be impacted. Dental graduates will be better equipped to study the field as a holistic science, understand the co-dependence of dental health and overall health, and will be better prepared in dealing with any medical emergencies in their practice, resulting in better patient care. Third, in the event of national health emergencies such as the CoVID-19 pandemic, the country will have a larger, better equipped pool of medical professionals who can provide basic health care services at scale.
- Encourage public – private partnerships: Dentistry and the medical field in general are lacking innovation and a healthy competitive spirit at the graduate level. There is a pressing need for privatization and globalization of dentistry and medicine, which will bring in a healthy dose of aggressiveness, agility and exposure to cutting-edge technology and the latest research – opening up opportunities and access to knowledge – all ultimately benefiting the practitioners, the industry and patient care. The government must encourage private partnerships within the country and with reputed universities abroad. They can well counter any perceived reduction in quality of education by formulating appropriate guidelines to be strictly enforced by regulatory bodies that govern these alliances.
- Periodic assessment and mandatory skills upgradation: The dental industry must have an active regulatory authority that periodically assesses all dental clinics across various parameters including expertise and exposure to the latest in dental practices and hygienic practicing conditions. This could be implemented through a mandatory skills upgradation program that is linked to license renewal for dentists every two years, after a thorough assessment.
The road to recovery will be painful and prolonged. But this health emergency won’t be the last one. And we must be better prepared for what is likely to come next and equip the dental fraternity and industry to overcome the next hurdle. The above measures will not only help us produce dentists and medical professionals who are competent and confident in tackling health issues in the new decade, they will also bring in much needed investment and revenue injection into healthcare. This in turn will increase employment in allied fields including dental technicians, assistants, lab specialists, etc. It will also provide an impetus to ancillary manufacturing industries that will further generate employment and revenue in the country, nudging us back onto the growth trajectory of being a leading dental and healthcare destination globally.
Author: Dr. Srivats Bharadwaj, MDS, Chairman & CEO, Vatsalya Dental
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