Should you pie private dentistry?

private dentistryAre you looking to move into private dentistry? Bethany Rushworth weighs the pros and cons with moving away from the NHS.

I spend a lot of time talking to dental students and young dentists. A common goal I hear time and time again is to work in private practice.

I have worked in both admin and clinical roles on the NHS and privately. Over the past 11 years, I have experienced first-hand the differences in each environment. This includes in both a general practice and hospital setting.

There are certainly some significant perks to working as a private dentist. However if considering transitioning to only offering private treatment, there are some things you should be aware of.

The perks of private dentistry

To me, one of the biggest advantages with working privately is the lack of targets. This contributes to some peace of mind and a feeling of clinical freedom.

In private practice, I can present patients with all of the options regardless of their cost. It is down to them whether they go ahead with treatment or not. There is no need to consider what ‘band’ this will fall under, whether you will be remunerated fairly for treatment or whether you are putting in an appropriate claim for the work you have done. 

In private dentistry, the accepted practice is to charge for time. You also charge for materials and laboratory costs. Therefore more complex work including articulation of models, wax ups, extensive planning, multiple appointments and temporisations come at a cost to the patient, not to the dentist.

In my opinion this makes it a lot more likely the patient will be offered the best treatment available. Although it isn’t all about the money, it simply isn’t feasible for dentists to fund courses of treatment for the patient whilst working under the NHS system.

Patient rapport

Having more time with patients also makes it easier to build a rapport with them. You can explain treatment options clearly, allowing the dentist to go into more detail and answer questions.

With a large proportion of complaints resulting from miscommunications, the more time spent ensuring that I cover everything, the better.

Although there is nothing to say an NHS dentist cannot spend as much time with their patients, it would be very difficult for UDA targets to be met with 20-minute examinations and 60-minute restorations every time. You can set prices accordingly in private practice. Timings of appointments can be accounted for in the costs.

Personally, I have found discussing more complex treatment options more straightforward whilst working privately. This is because patients are expecting to pay for all treatment. In most cases understand why they are doing so. On the NHS there are some grey areas as to what is ‘covered’.

This can leave dentists in an uncomfortable position when there comes a situation in which some treatment will need to be paid for privately, such as orthodontic or cosmetic work.

Private problems

Despite the advantages, as with any job, there are some negatives, which are important to consider before transitioning to private practice.

To begin with, not all patients realise that theoretically, private dentists are not different to, or better than, NHS dentists. I have had multiple instances where patients have been advised something by their NHS dentist (such as a tooth being unrestorable) then come to me for a second opinion stating they thought I would be able to save the tooth because I am a private dentist.

There will definitely be some circumstances where you get what you pay for. However as a general rule there isn’t a specific qualification or experience level essential to providing private dentistry. Patients don’t necessarily realise this.

Higher expectations

Secondly, expectations can be higher. Personally, I think this is reasonable. If I am paying a premium for something, I tend to expect more (for example if you are travelling first class, staying in a five star hotel, eating in a Michelin restaurant, you expect something above and beyond for your money).

However, for a dentist it can be challenging to manage these expectations. In some cases simply spending more money won’t fix the problem. For example severe tooth mobility, oral medicine conditions or facial pain.

I have noticed a greater proportion of patients want more specific information on prognosis, success rates and how long the treatment is likely to last them. Managing patient expectations is a key skill that all dentists would benefit from mastering. 

Initially, I found it difficult to discuss costs of treatments with patients. Not because I don’t think my time or treatments are worth it, but because I wasn’t used to having these conversations and I was worried that patients would either dislike me for charging them or make assumptions about me (not many people acknowledge that dentistry is also expensive to provide).

Over time, because I know I am providing quality treatment to the best of my ability, always putting patients first and taking time with my patients, I have become more comfortable with charging fee per item as I genuinely think it is worth it for what I offer.

That being said, it can take some getting used to and isn’t for everyone.

Things to consider

The final thing that is crucial to consider (although of course this is not an exhaustive list) is that as a private dentist you do not receive maternity pay. There is also no pension contribution. These things might not affect you if you start planning early (you might earn more privately for example, therefore covering the difference for your maternity leave). However, it is definitely one disadvantage to consider when leaving the NHS.

There are plenty of private pension options and other ways to save and protect your money. Although, the NHS pension contribution is super an, hopefully, fairly secure.

Ultimately incredible, ethical dentistry can be provided by dentists working in both NHS and private practice. Though, I personally feel more able to offer the type of dentistry I enjoy providing in a private practice. I never feel pressurised to consider numbers/targets/quantities in my work, which I know would cause me a significant amount of stress.

This article first appeared in Young Dentist magazine. You can read the latest issue here.

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