The Canada Dental Care Plan – Will The Profession Survive?

If you’re a dentist in Canada, unless you have been living under a rock, you know about the new Canada Dental Care Plan (CDCP). What you may not know is what to make of it yet.

Let me preface this by stating that this is obviously a continuously evolving conversation, so what I write today may be factually incorrect or irrelevant a month or even a week from now. I will share my opinion based on what I know as of today.

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The Pros:

Giving Canadians access to care is something we all want. It is something the profession has asked for, and we are happy to discuss the issue.

Our provincial governing bodies have been presenting a united front and have tirelessly been negotiating and attempting to further negotiate the details of the plan, including the right to balance-bill. This is a huge win because if you do some simple math – with the increased overhead from the pandemic, most offices are pushing up to 70% overhead. The fees from the CDCP right now are about 70% of the Ontario fee guide. Giving up 30% off the top is not just a 30% drop in profit, it is a 100% drop in profit – therefore dentists would be asked to treat patients for free. The right to balance-bill is critical and MUST be protected, or the profession will suffer greatly. This isn’t about dentists being greedy, this is about dentists staying open for business.

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The Cons:

Again, the provincial associations have done a great job in my opinion of pointing out some major red flags in the CDCP in its current format. These are many, but the most glaring is the need to “register”. The document that dentists are being asked to sign is being red-flagged by the associations. Basically, a dentist is being asked to sign that they will accept the plan, but the plan can change at any time, and if the plan administrator would like to, at their discretion, they can withdraw money from the dentist’s bank account against any claims made to the plan.

A question that every dentist who hears about this asks is simply: "Why would a dentist need to register and sign this document, when the presently do not need to do this for ANY other plans in existence, including other federal plans like the Non-Insured Health Benefits (NIHB) plan?"

It is interesting to note that when a dentist accepts ANY insurance, they are agreeing to similar terms. Though I can understand why this is more concerning - the sheer volume of people affected means that making a decision to agree to something that turns out to be a bad deal will have greater consequences than what could happen if it affected only one private insurance carrier.

I know that the Ontario Dental Association and other provincial associations are united in negotiating around this provision and asking that it be removed or changed, as well as reminding Health Canada that there is one minor detail missing in the equation. They need US. This program cannot happen without dentists and existing dental practices.

BUT...

Having said that, I think every dentist in the country would love to see this plan go through. It just needs a little more work. To say that dentists are against the plan is wrong - nearly every dentist I speak to wants to and already does help people who need help. Dentists are well aware of their "social contract" and all to some degree or another already deliver care at fees below the cost of providing the care to some marginalized groups, usually through one of the existing government plans.

Dentists are just asking for clarity and for assurance that the rug doesn't get pulled out from under the profession. Dentists want, and rightly so, assurance of the economic viability of the model going forward.

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What would make the CDCP a huge success?

1.????? As stated, allow balance billing and encourage it, as is the case for every other dental plan.

2.????? Allow provincially funded plans to be second payer to CDCP. This would make it 100% coverage for the end user (win), and if CDCP can supersede these other plans, for which the reimbursement is very low and as a result, uptake is also low - then they can just cover the difference on the CDCP treatment which would be another big win for the end user.

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What would I do right now as a dentist in Canada?

READ what your provincial dental association is putting out. They are being clear with the profession about these issues. They just can’t tell you whether you should sign up or not. So let me tell you what I would do. I would NOT sign up today, because we just don't know enough to make a decision. I would stand behind the ODA and other provincial associations – and stand together as a profession. This plan could have been a great success – and it still can be. As it stands today, it is just not at the point where it needs to be for dentists across the country to participate. I want to help people. If you are a dentist reading this, so do you. I know you do. If you don't then quit. The bottom line here is that we need clarity as a profession, and we also need solutions. That will hopefully come in the near future through our provincial associations doing what they do in continuing to work with the federal health minister to move this forward to the benefit of all Canadians.

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What to tell your patients?

Yes, I know. I hear from our members across the country every day that patients are asking and calling and stating that they are covered 100%. Obviously, this is not the whole truth, but the public knows that the plan is in place and will be available soon as the government has made some announcements that have been then translated to varying degrees by the public. I hear about patients delaying their next visit because they want it to be covered by the plan. I know that is causing anxiety.

What you want to do in this case is to avoid putting yourself in the line of fire. Just communicate the truth to your patients that:

1.????? The government is rapidly trying to put this program together, but we don’t have enough information yet to be able to administer it (true).

2.????? You also are waiting for your provincial association to give you further advice on what to do next (true).

3.????? When this plan does come online, it should work like any other plan, where the plan pays most of the fee and the patient pays the difference (also true, if balance billing is maintained).

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In summary, I want to shout out our provincial associations. They have not missed anything in the way they have represented the profession thus far. They are putting pressure on government, and they are clearly communicating to the profession. I know it’s easy to pick at the associations for not doing more. If you don’t think the profession is being well represented right now, you are not seeing the full picture. This could be the biggest benefit to Canadians in a long time, or it could turn into the start of the decline of the profession, and we will end up like the medical system in this country. In my community of Sault Ste. Marie, 10,000 people just lost access to a primary care physician due to shortages in the profession – see the CBC article here: https://www.cbc.ca/news/canada/sudbury/doctor-shortage-sault-family-physicians-1.7096429

This is in a town of 75,000.

In a very much related CBC article, Ontario physicians (and it’s not just Ontario) are considering alternatives to family medicine due to the under-funding of the profession and excessive administrative burden. See here: https://www.cbc.ca/news/canada/toronto/family-doctors-meeting-alternative-care-paths-underfunding-1.7105807

I know this personally, as many of you reading this probably do if you speak to your family physician friends. The average paperwork load is 19 hours per week – on top of seeing patients. The net result of this is the decimation of the profession – even further than what has happened over the past 3 decades in this country.

This is what we must guard against.

I want this program to succeed because it will help so many people, but I don't want to see it happen on the backs of dentists who would be subsidizing care if it must be delivered at a lower fee and balance billing is not permitted.

Our associations have pointed this out without saying it. I know more information is imminently forthcoming from the ODA. Please keep yourself informed and keep the discussion going with your peers. It is easy for us as small business owners to get isolated and operate in silos. This is a time to stick together and keep communication at a high level.

It is also a time to focus on solutions. Let's collectively avoid an us-vs-them mindset and let's instead encourage stakeholders to talk openly and to find a solution that works for all. We want to avoid being seen as unreasonable as well. I do believe the provincial associations are doing a good job of maintaining the balance in this regard.

Let's hope in the very near future we see some progress and in a short time from now we can deliver care to millions of Canadians who have had to go without because of cost.

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