The ‘Super GDP’
With many young dentist’s keen to stay in hospital positions and follow specialist pathways, David Bretton offers an alternative pathway and vision for the future.
‘Jack of all trades, master of none’. A figure of speech used in reference to someone who has some skill in many areas, rather than gaining mastery in one.
When it comes to dentistry it is a term I often hear in a negative context, used to describe those who chose to ‘just’ be a general dental practitioner (GDP).
This is a view that has been ingrained in us from our undergraduate training. Many of the significant people and course leads during our undergraduate training were specialists and professors. This seemed like the only way to become truly ‘successful’ in dentistry. I was told horror stories about life as a GDP.
Were these horror stories to be my future, or was there another way?
The philosophy of Kaizen
Humans are goal-oriented creatures and there is plenty of research that happiness and fulfilment come when we continually grow and learn. The commitment to lifelong learning is the philosophy known as ‘Kaizen’, the Japanese word for ‘improvement’.
As dental students, it often appears that the only opportunity for postgraduate development is through a hospital pathway. There are now many private and part-time university courses that can allow even the busy GDP to continue learning.
I do believe it’s essential to adopt a philosophy of Kaizen to feel happy and fulfilled, and you don’t need to stay in hospital to do this.
We need some specialists
There is a need for dental specialists. The advantage of specialising is that you will reach a much higher level in one single area. This expert level can be vitally important in managing certain complex cases.
Specialists are often based in a secondary services NHS hospital setting or private practice. The need and demand for specialists depends on NHS funding or through willingness to pay privately for this care. NHS services are reducing, and the availability of some treatments are becoming limited.
With increasing numbers of young dentists choosing to specialise and reduced NHS services, there is a risk that in the future the supply of specialists could outweigh the demand for their services…particularly so in competitive locations like London. I see many young dentists, who have chosen to specialise, who now split their time with half-day sessions between multiple practices, while sometimes still having to work as a GDP in order to supplement their income!
Love what you do
In order to have a successful career it is important to love what you do. It may be that specialising is appealing because you enjoyed a specific area of dentistry as a student. To specialise you must love this area…but I think you must also dislike other areas of dentistry, as it is likely after specialising you will neglect these other areas.
The specialist therefore becomes an expert in their chosen field while deskilling in other clinical areas.
Vulnerable to change
The large investment required to specialise and the gradual deskilling in other areas can potentially leave clinicians vulnerable to change.
We saw this recently with the tendering process of orthodontic services. Many hard-working and committed orthodontists lost their NHS orthodontic contracts with huge implications professionally and personally for those involved.
When the general dentist encounters political changes, they are often more flexible. Furthermore, technological advancements can also alter the requirement for specialists. While there will always be some need for these abilities, due to technology, there is becoming a reduced number of situations where some skills are required. Many orthodontic cases can be treated by the GDP using systems such as Invisalign. This allows the GDP the opportunity to tackle more challenging cases themselves instead of referring cases.
Experience is vital
It is only with experience that we can identify areas that we like and dislike. Young dentists are often expected early in their careers to embark on a specialist pathway, without the opportunity for a good grounding in general dentistry. Undergraduate experience is often limited: the average student will graduate with no hands-on experience in orthodontics, having only completed a few endodontic cases and perhaps never completing a minor oral surgery procedure. How can we make the choice to specialise with this lack of experience?
By practising as a GDP for several years the clinician can gain a better awareness of what aspects of dentistry they enjoy the most and be better informed to make decisions on their future. A good grounding in general dentistry would allow much more comprehensive treatment planning and understanding when managing certain cases.
There needs to be more emphasis on experience and better pathways available for those who wish to specialise later.
Hospital posts can be a fantastic opportunity where you will likely achieve great experiences. But hospital positions are not the only way. Life as a GDP is not full of horror stories, it can be extremely exciting and rewarding, delivering high quality dentistry in a range of disciplines. Perhaps more young dentists should aspire to be ‘just’ a GDP.