The Dental Registration Exams N – why not be innovative?

The Dental Registration Examination for dentists desiring a local license to work is around the corner again, end of March/beginning of April. As has been the custom since this exam has been established in 2013, you can expect once again to hear about a failure rate of almost 100%, the uproar of the ones who sat for the exam and the indifference of the Dental Council of Mauritius. However, let’s not talk about this for now; I want to sing a different tune. Let’s assume my fellow friends and colleagues do pass this upcoming exam, what’s next?
Here is a country that sets an uptight and totally unregulated exam to the local context but is there something worthwhile that the Government offers to those licensed graduates? Sadly, no, there isn’t.
 According to current statistics (on the Government Portal), there are 351 dentists in total in Mauritius. Of these 351 dentists, only 58 are employed as dentists at Public Hospitals and Area Health Centers on Government payroll! The intake in the public sector is not as consistent and regular as it is for medical practitioners, rather; it is sporadic. For instance, in total, in 2011 – there were 66 dentists, in 2012 – 59 dentists and in 2013 – 58 dentists in the public sector. Why haven’t these 7 vacancies been filled promptly since 2011? Note that this was before the registration exam was introduced in October 2013. Two reasons are possible. Either the Government does not hire regularly or vacancies are advertised but conditions are too unattractive for new dentists.
 Here is a fact at the New Dr. Jeetoo Hospital, in that newly built and impressive building, in the Nation’s Capital; there are only 5 dental chairs in the dental department! Of these 5, only 2 are in use for the practice of General Dentistry. The 3 others are for specialties such as Orthodontics, Endodontics and Oral Surgery. On a busy morning, two General Dentists have about 30 patients each to look at. Morning session is from 9am-12pm. That gives you roughly 5 minutes per patients! For some treatments requiring longer working time, patients are given an afternoon appointment probably 2-3 months later while for other extensive treatment procedures like complete dentures, metal or porcelain crowns patients are bluntly advised to seek help in private.
Now, for the overwhelming load that these General Dentists are handling on a daily basis, basic salary starts at Rs 32,000. A good dentist working in his/her own private clinic can make that amount in a week by treating 10 patients a day. The only way for a young dentist to aspire getting more money in the public sector is to request to be posted in Agalega for a year!
So, on one side you have a system that is trying to be innovative by setting up a licensing exam but on the other side, it doesn’t hold its end of the bargain to make it worthwhile for these dentists afterwards.
According to 2013 statistics, Mauritius has 2.1 dentists per 10,000 population. Based on this statistic alone, the Government should have increased the number of dentists in Mauritius instead of setting up a system that hinders it.
If you want to make Mauritius a leading country in health care in the region and a medical hub, a registration exam isn’t the only way to go. Infrastructures need to be built, working force needs to be increased and above all, health practitioners in public health care should be well remunerated.
When a dentist in the United States takes the National Board Dental Exam (NBDE), it demands many months of hard work just to prepare for it. But once cleared, that young dentist earns a salary listed in the top 10 most well paid jobs in the U.S.

Flaws

Let me finally talk about the infamous Dental Registration Exam for Mauritius. There are so many flaws in its application.  Why was the decision taken to outsource the preparation and correction of this exam paper to the National Board of Examinations of India (NBEI)? Is it that hard for a panel of our own senior dentists to prepare a proper questionnaire that is appropriate for the local context?

 Le Mauricien recently published three questions from that exam paper (http://www.lemauricien.com/article/dental-registration-examinations-des-...) and truth be told, these are questions irrelevant to dentistry in practice. The current system decides that if my colleagues and I are unable to answer such questions, we are incompetent dentists and not fit for work in this country. Don’t get me wrong, I believe these are legitimate questions but they are more appropriate for the system in India where the local universities have prepared their students for such material throughout their 5 years of study. We, however, get the syllabus for this exam one month before (or less)! I guarantee you, the dentists working in Mauritius and those who are on the Dental Council will be as clueless as the rest of us if faced with such questions. It does not mean that they are incompetent and bad dentists though. Believe me when I say that there is a huge difference between your clinical skills as a practitioner and your ability to remember minute scientific details that have nothing to do with your field.
The current contract with the National Board of Examinations of India runs until 2016. We have now had exams in October 2013, March 2014, October 2014, and soon March 2015. If the next exam does not get revoked and that contract cancelled (and the unlicensed dentists fail again), are we saying that professionals will be unemployed until 2016? Imagine graduating in 2014 and not licensed until 2016, or more. If Betamax contract was canceled, who is to say that the contract our Government has with that Indian entity cannot be revoked? 
In that same article featured on Le Mauricien, I read that the South African Dental Council’s help might be sought next.  When will we get rid of this outsourcing mentality? Does the current system imply that our dentists and doctors are qualified to treat patients but unqualified to evaluate their fellow peers?

The well-being  of the population

For the Dental Council of Mauritius, raising the bar up was only about setting up the Dental Registration Examination, nothing about providing proper support to the applicants and catering for the ramifications of such an exam. For example, it is only on the 24th January 2015 that the Dental Council has announced the construction of its website. Note that, the Medical Council has had its website created on 26th September 2008. As of date, the Dental Council’s website does not provide a syllabus and past papers for the Dental Registration Exam which had its first edition in October 2013!
How much of taxpayers’ money does that contract with the NBEI cost? Taxpayers need to know why they are paying for an exam that produces no new dentist over two years, while they still need to wait for months for amalgam restorations.
I approve and welcome the idea of the Dental Council to hold a registration exam. Any country that has a respectable healthcare needs to do so, to ensure that medical and dental practitioners are all to the appropriate level for the well-being of the population at large. However, it is the duty of the Dental Council to ensure that such an exam reflects the local context, the working conditions and the quality of health care and vice versa.

It is also the duty of the Government to ensure that conditions of work and wages for medical health practitioners and dentists reflect the obstacles such professionals have to overcome before obtaining their licenses. Why such a disparity between Private and Public sector? Yes, public healthcare is free but I am absolutely sure the gap could be considerably reduced. The country would benefit from such measures. The Governments that come and go always adopt a “reactionary progressive measure” style of governing; why not go for a “progress for progress’s sake” approach for once?
Do not be surprised, if young graduates prefer to leave Mauritius and seek jobs abroad where true meritocracy and desire for progress exists.
I read recently about a fellow Mauritian dentist who works in France and is being very innovative as his practice caters for mentally challenged patients that dentists often have difficulties to treat. Why wasn’t he being innovative in Mauritius?