Dental News Staffer
In Pakistan patient awareness about dentistry is not enough to encourage patients to seek out dental treatment actively. Secondly, the collaboration between a dentist and medical practitioner is nonexistent; patients are still being prescribed painkillers and antibiotics for tooth related problems by taking their issues to their general physicians. When these factors jointly come in to play, they create patient drain for dentists, which results in loss of revenue ultimately creating a price hike, which causes further patient drain. Interestingly, it also highlights the lack of awareness medical doctors have about dentists, as well.
It is rare to find people that are clear about dentistry as a future career path. Most are led to believe that ‘doctor’ is a prestigious title to have, and it is better to have it with an MBBS rather than a BDS degree; the practical differences matter little to them. The society has glorified the label of “doctor” to the point of reverence, but failed in the department of awareness. It was never openly talked about how there were not many jobs available, that patients did not know enough to actually visit a doctor or a dentist like they should, or that post-graduation seats were hard to achieve, and in some cases subject to whom you knew and how well you knew them.
Pakistan Medical and Dental Council est. 1962 was the regulatory body that was keeping all medical and dental colleges, hospitals and professionals in check, or at least that is what it was supposed to be doing. An institute that may have started out with the right ideas started to crumble as the years went by. The increase in colleges vying for PMDC approval made it easier to engage in shady businesses. Efforts to better the healthcare system became secondary and monopolizing these opportunities on the business end became a priority to people in the institute. So when on October 20th, 2019, Dr Arif Alvi, the president of Pakistan, ordered abolishment of the PMDC in hopes of revamping the medical system and renaming it PMC, people should have rejoiced. That was, however, not the case. The ordinance that was the basis of this dissolution, the document and its contents touted as “a short term pain for a long term gain” by Pakistan’s minister of health sent the medical and dental community in a frenzy.
First of all, the blatant erasure of Dental from the Pakistan Medical Commission’s (PMC) title left dentists feeling underrepresented. In a country where dentistry is already seen as second best, this is a huge concern for the future of dentists. This shake in faith was further solidified by the appointment of only a single dentist as member of the new Medical and Dental Council (MDC), Dr Anees Rahman, against five medical practitioners that were appointed by the Prime Minister of Pakistan. In a parallel situation, even if a separate commission is promised to dentists, it will further aggravate the divide between medical and dental doctors and it will allow employers who do not have adequate knowledge of dentistry to purposefully be biased against dentists, which could affect employment opportunities and salary structures in the long run. The concern was raised by a professor of Orthodontics who was appalled by the ordinance. He said, “Dentists haven’t displayed the vision it takes to bring about change if they are separated from their medical brethren, and since mindsets can’t be changed, a separate dental commission will only imbibe more discrimination against dentists”
Secondly, giving private medical colleges the autonomy regarding student selection criteria, fee structures, their choice of university to affiliate themselves with, and having no minimum faculty limit is a slippery slope in itself. The medical and dental colleges that are being run by businessmen as opposed to doctors or dentists are likely to reap extraordinary benefits from this ordinance’s rules and regulations. There will be no accountability as to where the extra fee is being applied without a governing body to regulate its proper application in programs that will benefit the student body and faculty. Hence, this autonomy, especially when it is unchecked, is being deemed an even worse idea by health professionals than PMDC’s many issues. Dr Shahmain Shahzad was of the point of view that “The new ordinance takes away job security, and the lack of proper and vigilant regulations will deter the system further, because there will be no accountability”. Given the state of job opportunities in Pakistan, this is alarming for young dentists working in colleges because demonstrators and registrars will be deemed dispensable, and administrations might take steps to terminate them knowing that they can get maximum work done by the fewest number of employees.
Having no regulatory body checking up on these colleges, there may very well be a possibility that the only admission criterion that remains is the ability of students’ families to pay the unregulated fee that the colleges will set for themselves, which will produce poor doctors and that would deteriorate the health system even further. It will also take away the chance from the students who deserve to be admitted to a medical college just because they might not be able to pay the high fees. That will be further aggravated by the introduction of an exit exam and National Licensing exam (NLE), which these students might not be able to pass, creating unemployment and frustration amongst the graduated individuals. Licensing exams are being taken in a lot of other countries, but the preparatory phase and selection criteria for their enrolled student body are strenuous enough that by the time these students graduate they are fully equipped to take their licensing exams. Moreover, the exit exam required to qualify for a house job negates the efforts of the students made during their professional exams and in turn negates the very system PMC claims it will create in medical and dental colleges.
While this ordinance and its members promise for a future where health education in Pakistan will be able to stand at par with its foreign counterparts, the collateral damage to the already existing doctors and dentists seem too great to be ignored. This will encourage further brain drain from Pakistan, and the fluctuating policies will turn away the few professionals willing to give back to their country. Many professionals are of the point of view that the existing body should have been corrected as opposed to being eradicated. It was very rightly said by Dr Usman Muneer: “PMC is an unknown and unclear entity, it would be much better to improve the already existing system rather than building it from scratch”. Although the ordinance has been rejected in the senate, it is still very much in play and if it has to go forward, severe amendments must be made in order to secure the futures of dentists and doctors before it can be considered beneficial for anyone.