Home' News Bulletin : ADA News Bulletin February 2015 Contents 26 FEBRUARY 2015
Professor Mark Bartold has on a number of occasions expressed
his extreme concern at the current crisis in dental education in
his ADJ editorials. He points out that the doubling of numbers
of dental schools and the great increase in student intake in the
established schools will result in an extreme oversupply of dentists.
While some politicians may welcome this, seeing it as a way of
reducing costs and increasing access, those of us who have been
around for a long time know its main effect will be to cause
dentists to seek to cover their overheads by more enthusiastically
servicing those patients who attend for treatment and thus
potentially increase costs.
Added to this problem of excessive student numbers is the
difficulty in obtaining quality staff for all these schools, and as
Mark points out there are six dental schools in Australia presently
advertising for a Dean. Some of the older schools are down to
only a few permanent clinical academic staff remaining, and
many current staff are near retirement age. Most senior dental
academics will be aware how difficult it is to try to persuade good
young graduates to consider academic positions.
What are the core causes of this crisis? Of course there are a
number of contributing factors, though I believe one of the most
significant initiating causes occurred in 1991-2, when the federal
funding of BDS training programs was severely reduced.
I happened to be Dean of the Adelaide Dental School at that
time and have watched the decline into the current chaotic
state progressively develop since then. Until that time the federal
funding for the various disciplinary courses was based on their
assessed cost. In fact a parliamentary sub-committee in the 1970s
determined the cost of training a medical student averaged
around $12,000 a year, that for a dental student was $32,000 a
year and for a veterinary science student $34,000 a year.
Why the differential? The low cost per medical student was they
had little 'hands on' small group tutoring and where it did occur,
the teaching hospital staff mostly provided it. Their main 'hands
on' training occurred post graduation during their intern years.
The medical teaching hospitals were, and I presume still are
subsidised by the federal government to cover these extra costs.
As we know, dental students must be fully competent to treat
most dental problems on graduation, and thus require high
staff/student ratios in clinical training, and dental hospitals
receive no training subsidy.
In 1991-2, this funding formula was radically changed. The
Dawkins scheme, introduced by the then Labor Government,
decided to simplify the funding formula, by grouping all 'like'
faculties together and funding them as a block, but all according
to the least costly.
Thus dental and veterinary science students were from then on
funded at the same rate as medical students, i.e., a huge reduction
of around 60-70% of what was previously provided. It was a great
way to surreptitiously reduce university funding.
Suddenly in 1992 we at the Adelaide School found the money
provided to the University did not even pay for our permanent
staff costs, let alone the large numbers of casual and tutoring
staff. The University administration advised us to take in a number
of overseas fee paying students, which we did. Fortunately,
recognising our plight, they initially allowed us to count all these
fees in our budget, thus enabling us to not go into deficit.
However, I became aware some years later that the University
administration decided they could tap into this supply and began
to initially charge an administration fee of 50% of both federally
funded and overseas student fees. This administrative charge
had increased to 70% by 2005, thus greatly reducing any dental
school's ability to cover the cost of teaching these overseas
students as well as our Australian students. This imposed ever
increasing cost burdens on the dental hospital budget as the
University, instead of seeing dental teaching as a burden, it now
used the overseas fee paying student scheme as a 'cash cow'
to prop up ever expanding administrations and compensate for
constant reductions in federal funding.
Other universities also began to use their overseas student fees
in a similar way. This would be the main reason why universities,
once reluctant to host dental schools, suddenly became keen
to commence them. However, this will most likely prove to be
a disastrous decision for them and for dental education in the
years ahead as overproduction will be certain to reduce local
student applicant numbers. More and more schools will experience
extreme financial and staffing difficulties.
The cost of setting up a dental school is extremely high, with
recent examples costing between $160-200 million, let alone
the continued high maintenance costs. Currently, at Adelaide
the average yearly funding per dental student is $32,000, with
the University taking 50% as an administration fee, leaving the
dental school with $16,000 per student per year. It is difficult to
obtain even a ball park figure on the total cost /year of training
a dental student, i.e., that cost to the dental hospital (DOH) and
to the University combined. Of course it will vary greatly between
schools according to the numbers of students per year, the course
structure and will increase greatly in clinical years. In discussion
A PERSONAL PERSPECTIVE
on the crisis in
funding and support
of dental education
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