Whither Dentistry ? WINTER   Template                      George Paul
What is Quo Vadis?Several people have asked me the meaning ofQuo Vadis(1). Many in the older generation mayremember a Bata...
Dr R Ahmed 1890- 1965Dr R Ahmed qualified as aDentist from the University ofIowa in 1910. On returning toIndia he establis...
Journey of anyoung teacher                Let me begin with                a small story. In                1952 a young  ...
In 1952 ….Unsuccessful, he was returning home viaBombay (now Mumbai), when heaccidentally bumped into an old classmatefrom...
Dr G Paulose            1929-2008Four years later, the young schoolteacher became a qualified dentist. Theonly problem was...
From a foot peddle drill to Laserdentistry- 60 years of progressThe story of my father Dr GPaulose, who passed away in2008...
From barbaric tooth puller to              WINTER sophisticated medical specialistHe grew with hisprofession and saw it   ...
The Dark Side                  of practiceBy the time of his death in2008 he also witnessed thefirst signs of decadence an...
Unethical advertising and marketing – The result ofunhealthy competition caused by glut
„It was the best of Times. It was the worst oftimes‟ Charles Dickens in The Tale of Two Cities
From 1910- 1985                    WINTER                      TemplateThe number of dental collegesstagnated in the first...
Did this make a significant                      WINTER positive impact on health care?Perhaps Yes!Template threshold     ...
Stats on increase from Independence through 1986 andthen to 2008  . Over the next 20 years the increase became more dramat...
Did India’s Oral Health Care          improve?                    WINTER                      Template                    ...
“There are three kinds of lies: lies, damned lies, and                      statistics”.‟A Government of Indiaand WHO coll...
How we can sometimes get things wrong! Projectionsmade in 2002 in an Indian Journal Dental Education The amazing aspect of...
Wrong Expectations !!                      WINTER“Thus, the end of the twentieth century and the                          ...
Growth in number of graduates from Indian dental schools*In reality there were 200,000 dentists in 2012 as against the pro...
Was the Planning commission relying on false statistics when it said “2 lakh                         Dentists needed”!!?  ...
The dangerous course of       Dentistry in Kerala• A Case Study
Dental Colleges in Kerala *•   1980- 1•   1985- 1•   1990-2•   1995-2•   2000-2•   2005-8•   2010-24
Demographics of Kerala 2011*      Population of Kerala – 33.38 million      Number of Dentists Registered in      Kerala- ...
Number of admissions    WINTER         1980-30     Template         1985-60        1990- 100        1995-100        2000-1...
Number of admissions per year in            Kerala
Recommended Dentist Population Ratio 1:7500• Karnataka 1:2130• Kerala     1: 3388 *• Tamilnadu 1:4500 (approx)* Most Denti...
Projected number of Dentists in             201516,000 (approx) for a population of 37 million  (approx)• Kerala populatio...
Points to be taken in projecting population growth in                    WINTER                         2015   All 24 Coll...
Today several of these colleges have applied forincrease in seats. Even if we did not count theseincreased seats, by 2020 ...
Projection for             Kerala in 2030• Conservative estimate 1 dentist for 1500  population if there are no more colle...
The result of       population glutThousands of dentists work for Accenture andother multinationals around the country.100...
Dental Schools and Population globally      •   USA 260 million-       61 dental schools      •   Australia 30 million   9...
Is India’s Oral Health Care                   WINTER   better than that of China?                     Template            ...
21% dentists in rural area with a population share of 73%79% dentists in urban area with a population share of 27%
Why don’t dentists go to rural areas?• Rural India has a different health priority-  malnourishment and starvation in addi...
Can Dental tourism justify increase in dentists?I have no issue with dental tourism.If dentistry needs to be a part ofthe ...
Health in Tribal India- RealityThere are two important factors whydentistry cannot be meaningful in the ruralregions. One ...
Why do we have so many   dental colleges??
Why did Dentistry alone face this      unplanned growth?           WINTERMoney! Money! Money!            TemplateUnplann...
The Role of Money in Dental         Education• Money required for starting Dental  College- Rs 5 Crores, 5 acres land and ...
Dr. Ahmed‟s philosophy was: „„Education is theresponsibility of the State; but if no one is willing to     carry the cross...
A Twist in the Tale- How R Ahmed was              funded???? • R Ahmed Dental   College                       • Soda Fount...
A National Shame!Collusion ofmanagements withregulators and othergovernmentagencies havecausedembarrassment andshame to me...
Pop Stars of Dental regulation!                     WINTER                       TemplateCouncil heads came tobe treated l...
Paper Clippings on Dentists on Strike- 2008. No                    action    Public resentment    and opinions were    ign...
Media Reports were ignored to        Lack of good jobs-Teething troubleShrabonti Bagchi| December 24, 2011.Times of India ...
Dentists turn into BPOs- waste of           Training??• Thousands of  young  Professionals  have become  BPOs in  major ci...
So where are the new graduates         financially?
It is easy to be a Dentist- Click on the screen to see a popular               advertisement demeaning dentistry
Are we missing the message again? A recent newspaper     cutting- more dental colleges for a staturated state!!• “ Those w...
Solutions!!??    “It is easier to fight forprinciples than abide by them”        Adlai Stevenson
Will the new NCHRH make a difference?A major restructuring of theregulatory bodies. The NCHRHis already on the anvil. It m...
Are the regulatory bodies   cancerous??? A need for NCHRH!                            WINTERThe classic case of the bar be...
Two Elephants- Different Tasks (Tusks!)
Do we need a Flexner Report??In 1900 a gentleman called AbrahamFlexner was faced with a similar situationin the USA. There...
Hercules                  • One of the labours of Hercules                    was the cleaning of the horse               ...
We may need another „Tahrir Square‟
Or another „Occupy Wall Street‟         WINTER          Template
Or another Anna Hazare movement
“All that is necessary for thetriumph of evil is that good men do               nothing. “                       Edmund Bu...
The thin edge of the wedge! Tamilnadu and                      Kerala• Tamilnadu is the only state where the IDA has  chal...
What about the rest???   They can complain by singing the popular song   „Why this kolaveri di?‟
Why this Kolaveri…Kolaveri… Kolaveri ….DiClick the screen to hear the song! (Kolaveri means „mental torture‟              ...
I have Hope!
सत्यमेव जयते (Truth Alone will         Triumph)     • Mundaka Upanishad, Mantra 3.1.6
Thank You• The text of this Oration will be available  on the website of the HMA Trust at• www.dentethics.com or• on my pe...
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Excerpts of r ahmed oration george paul

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Quo vadis is an Oration delivered by Dr George Paul at the National conference of the Indian Dental Association in Mumbai on february 11th 2012. It outlines the future of dentistry in India. the excerpts of the oral presentation are added to the slides as a brief note.

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  1. 1. Whither Dentistry ? WINTER Template George Paul
  2. 2. What is Quo Vadis?Several people have asked me the meaning ofQuo Vadis(1). Many in the older generation mayremember a Bata footwear by the same name. Formany people of my generation it was a popularfootwear from the famous house of Bata. QuoVadis simply means “Where are you going?”- inLatin. Simple as it may sound, it has a profoundprovenance. It has been used by hundreds ofwriters and speakers to ask a question that is bothmeaningful and rhetorical. There is an apocryphalstory that this was a question put to Jesus Christby St Peter. “To be crucified again” Jesus issupposed to have replied. This seems to be thepredicament of dentistry in India.
  3. 3. Dr R Ahmed 1890- 1965Dr R Ahmed qualified as aDentist from the University ofIowa in 1910. On returning toIndia he established the firstdental college in the country,calling it the Bengal DentalSchool. He funded the collegehimself. Dr Ahmed then donatedthe Dental College to theGovernment of India in 1949. Hewas a minister in the BC RoyGovernment. He was also thePresident of the Dental Counciland later President of the IDA.He was later inducted into thePierre Fauchard Hall of Fame.This Oration is dedicated to hismemory for the outstandingcontribution to Dentistry.
  4. 4. Journey of anyoung teacher Let me begin with a small story. In 1952 a young school teacher from a small village in the South of India travelled to several cities across the country in search of an opportunity to do a post graduation in botany.
  5. 5. In 1952 ….Unsuccessful, he was returning home viaBombay (now Mumbai), when heaccidentally bumped into an old classmatefrom his village in the YMCA. The teacherwas amazed to learn that his friend wasdoing a four year course in „dentistry‟ inBombay. It was at a time when Dentist orDentistry was unheard of in the smalltowns and villages of India. The onlydentist that the teacher knew of was adubious gentleman who wore a black robeand pulled teeth at the weekly market.The teacher accompanied his friend on avisit to the Nair Hospital Dental College.After being surprised that dentistry wastaught in a college for 4 years, he wasfurther taken aback by the 5 storeybuildings and the well dressed peoplegoing about in bow ties and white coats.On a whim, he joined the college.
  6. 6. Dr G Paulose 1929-2008Four years later, the young schoolteacher became a qualified dentist. Theonly problem was that back in hisvillage, no decent family would givetheir daughter in marriage to someonewho pulled teeth for a living. Finally hemarried a shy girl from a nearby villageconvincing them that he was some kindof doctor. The salvaging fact was that inany case he was also a former schoolteacher.This newly minted dentist wasmy father!
  7. 7. From a foot peddle drill to Laserdentistry- 60 years of progressThe story of my father Dr GPaulose, who passed away in2008 after practicing dentistryfor more than 50 years is moreor less the story of dentistry inthat period.. In his fifty years ofpractice he saw theestablishment of dentistry as aspecialty of medical sciencefrom being a mere semi skilledvocation.
  8. 8. From barbaric tooth puller to WINTER sophisticated medical specialistHe grew with hisprofession and saw it Templateflourish. As a Dentist hewas recognized insociety as an importanthealth professional. Heeven saw theestablishment of adental college in hissmall city. Courtesy Dr Rohera‟s clinic
  9. 9. The Dark Side of practiceBy the time of his death in2008 he also witnessed thefirst signs of decadence andthe dark side of theprofession. Proliferation ofcolleges, cheapadvertisements,unemployment, ethicalmisconduct and several illshad begun to creep into theonce respected professionwhich he accidentallystepped into 50 years before.Dentistry had come a fullcircle.
  10. 10. Unethical advertising and marketing – The result ofunhealthy competition caused by glut
  11. 11. „It was the best of Times. It was the worst oftimes‟ Charles Dickens in The Tale of Two Cities
  12. 12. From 1910- 1985 WINTER TemplateThe number of dental collegesstagnated in the first 50 years ofthe twentieth century. Therewere just two colleges for apopulation of 350 millionpopulation in 1947 when Indiabecame independent. Less thanforty years later in 1985 therewere 21 dental colleges. Thiswas a 10 fold increase in 40years.
  13. 13. Did this make a significant WINTER positive impact on health care?Perhaps Yes!Template threshold It was theof the golden period of dentistry.Dentistry went on to become a much sought after vocationrecognized by the medical fraternity and society. It reached itspinnacle about 25 years ago. At the height of its gloryDentistry became a competitive profession with entry only forthe brightest
  14. 14. Stats on increase from Independence through 1986 andthen to 2008 . Over the next 20 years the increase became more dramatic. The number of college rose sharply to approximately 240 dental colleges. This was an increase by 1200% in 20 years.
  15. 15. Did India’s Oral Health Care improve? WINTER Template No!*Today, dentistry is crowded by mediocrity. As a professionit is losing its glamour. Hundreds of seats in GovernmentUniversities are going vacant. Dental education has movedback into the hands of the private sector where admissionsare open to candidates with moderate scholastic ability.Thousands are jobless. * GOI and WHO Conference of Manpower resources, New Delhi
  16. 16. “There are three kinds of lies: lies, damned lies, and statistics”.‟A Government of Indiaand WHO collaborativeworkshop on manpowerresources in Delhi in2006 concluded that the • George Bernard Shawincrease in the numberof dentists had no impacton the dental health carein the country • Benjamin Disraeli
  17. 17. How we can sometimes get things wrong! Projectionsmade in 2002 in an Indian Journal Dental Education The amazing aspect of the increase in dental institutions were based on absolutely faulty data and projections. A n article on growth of dentistry actually predicted that there would only be 31,000 dentists in the country by 2010 based on the fact that there were only 20,000 registered dentists in 1990.
  18. 18. Wrong Expectations !! WINTER“Thus, the end of the twentieth century and the Templatebeginning of the twenty-first century saw an increasein the number of enrollments. But in the near futurethere may be a reduced number of people enteringthese colleges as the rapid growth in the number ofdentists might tend to discourage some prospectivecandidates who may feel that the increasedcompetition would limit their future earnings.”** Challenges to the Oral Health Workforce in India**********, B.D.S., M.D.S. Manipal College of Dental Sciences, Manipal Academy of HigherEducation (A Deemed University), Manipal, India
  19. 19. Growth in number of graduates from Indian dental schools*In reality there were 200,000 dentists in 2012 as against the projected 30,000. • 1960 1,370 • 1970 8,000 • 1980 13,930 • 1990 20,000 • 2002 26,000 • 2012 200,000
  20. 20. Was the Planning commission relying on false statistics when it said “2 lakh Dentists needed”!!? “As per a Planning Commission study, the country is short of six lakh doctors, 10 lakh nurses and 2 lakh dental surgeons…….” *Kounteya Sinha, TNN Dec 13, 2011, 04.02AM IST
  21. 21. The dangerous course of Dentistry in Kerala• A Case Study
  22. 22. Dental Colleges in Kerala *• 1980- 1• 1985- 1• 1990-2• 1995-2• 2000-2• 2005-8• 2010-24
  23. 23. Demographics of Kerala 2011* Population of Kerala – 33.38 million Number of Dentists Registered in Kerala- 10,000 (approx) * Census figures 2011 and State Dental Council registrations
  24. 24. Number of admissions WINTER 1980-30 Template 1985-60 1990- 100 1995-100 2000-100 2005-300 2010-1400 - Projected 2015- ??? - Projected
  25. 25. Number of admissions per year in Kerala
  26. 26. Recommended Dentist Population Ratio 1:7500• Karnataka 1:2130• Kerala 1: 3388 *• Tamilnadu 1:4500 (approx)* Most Dentists graduated from out of state. The new colleges had not started graduating studentsSource: Manpower resource utilization- GO and WHO 2006
  27. 27. Projected number of Dentists in 201516,000 (approx) for a population of 37 million (approx)• Kerala population is projected to grow at less than 4.8% decadal grow. (population growth from 2001-2011 is from 33.3 million to 36.4 million) ***http://en.wikipedia.org/wiki/Demographics_of_Kerala#CITEREF GOK2005b **: Census of India 2011
  28. 28. Points to be taken in projecting population growth in WINTER 2015 All 24 CollegesTemplate start graduating dentists Assuming no more colleges are sanctioned and seats are increased Assuming same population growth rate (likely to decrease)
  29. 29. Today several of these colleges have applied forincrease in seats. Even if we did not count theseincreased seats, by 2020 the dentist populationratio will be 1:1500 (approx). By 2030 the ratio willbecome 1:733. With increase in seats or increasein colleges it may end up as one dentist for everystreet or even worse. Can a Dentist actuallysurvive as a professional???
  30. 30. Projection for Kerala in 2030• Conservative estimate 1 dentist for 1500 population if there are no more colleges and no more increase in seats• Possible ratio if seats are increased . 1 dentist for 733 population• Dentist Population Ratio in the USA 1:1700 (approx)• Significant number of dentists even if the colleges are shut down to produce only 200 per year.
  31. 31. The result of population glutThousands of dentists work for Accenture andother multinationals around the country.1000s of others work in pharmacovigilance,BPO and other allied fieldsAverage salaries of fresh graduates seekingemployment in Private clinics (Rs 5000).Average salaries of drivers with schooleducation (Rs4000-5000)
  32. 32. Dental Schools and Population globally • USA 260 million- 61 dental schools • Australia 30 million 9 dental schools • China 1.3 billion- 102 dental schools • India 1.21 billion - 291 dental schools
  33. 33. Is India’s Oral Health Care WINTER better than that of China? Template No!** GOI and WHO Conference of Manpower resources, New Delhi
  34. 34. 21% dentists in rural area with a population share of 73%79% dentists in urban area with a population share of 27%
  35. 35. Why don’t dentists go to rural areas?• Rural India has a different health priority- malnourishment and starvation in addition to death from tuberculosis, malaria, AIDS and preventable diarrheal diseases.• 250 of the 291 dental colleges are private institutions churning out students who have paid large donations and tuition fees. Does not make economic sense to practice in rural India
  36. 36. Can Dental tourism justify increase in dentists?I have no issue with dental tourism.If dentistry needs to be a part ofthe health programme in India, itneeds to have responsibility for theterrible inequities in accessinghealth in our country. A significantpart of income from health tourismshould mitigate the suffering of themillions who do not have access tobasic health. The excess Dentistsmay find meaningful incomes fromservicing foreigners but we alsohave a responsibility to our own!
  37. 37. Health in Tribal India- RealityThere are two important factors whydentistry cannot be meaningful in the ruralregions. One is the cost of private dentaleducation and the other is the inability of thepoor to pay for advanced dental treatment.We will first need to understand andassimilate the fact that dentistry isexpensive business and they can find ameaningful market for their skills only in thepockets affluence in our country. MostDentists today are the products of dentalinstitutions that cost an arm and a leg tostudy in.The poor just cannot afford dentistry unlessit is subsidized by the government. The ruralpoor need protection from preventablediseases including TB, Malaria and ofcourse hunger and malnourishment.
  38. 38. Why do we have so many dental colleges??
  39. 39. Why did Dentistry alone face this unplanned growth? WINTERMoney! Money! Money! TemplateUnplanned Growth- reliance on faultystatisticsLack of response by the Governmentdespite protestsCorrupt Regulators
  40. 40. The Role of Money in Dental Education• Money required for starting Dental College- Rs 5 Crores, 5 acres land and the name of tem MDS persons (only names required!)• Returns on investment better than Medicine or nursing- avaricious private players• Every license is up for sale
  41. 41. Dr. Ahmed‟s philosophy was: „„Education is theresponsibility of the State; but if no one is willing to carry the cross, I will, for as long as I can‟
  42. 42. A Twist in the Tale- How R Ahmed was funded???? • R Ahmed Dental College • Soda Fountain
  43. 43. A National Shame!Collusion ofmanagements withregulators and othergovernmentagencies havecausedembarrassment andshame to medicaland dentaleducation in thecountry
  44. 44. Pop Stars of Dental regulation! WINTER TemplateCouncil heads came tobe treated like deities atpublic places
  45. 45. Paper Clippings on Dentists on Strike- 2008. No action Public resentment and opinions were ignored by the government and regulators
  46. 46. Media Reports were ignored to Lack of good jobs-Teething troubleShrabonti Bagchi| December 24, 2011.Times of India • At 6 pm every evening, Abhishek Chaitanya steps out of his house in Thippasandra, Bangalore, and into a glassfronted building that houses the offices of a technology MNC and its BPO unit. Chaitanya, 27, walks in, goes to his desk and dons the traditional gear of his tribe: a high-end headpiece that gives him crystal-clear quality during calls. Theres nothing out of the ordinary here except that Chaitanya is a dentist by qualification. Lack of good jobs and his inability to start private practice pushed him to become a call centre executive.
  47. 47. Dentists turn into BPOs- waste of Training??• Thousands of young Professionals have become BPOs in major cities. • A Waste of Training??
  48. 48. So where are the new graduates financially?
  49. 49. It is easy to be a Dentist- Click on the screen to see a popular advertisement demeaning dentistry
  50. 50. Are we missing the message again? A recent newspaper cutting- more dental colleges for a staturated state!!• “ Those who cannot remember the past are bound to repeat it” George Santyana
  51. 51. Solutions!!?? “It is easier to fight forprinciples than abide by them” Adlai Stevenson
  52. 52. Will the new NCHRH make a difference?A major restructuring of theregulatory bodies. The NCHRHis already on the anvil. It maytake a while to go through theprocess of legislation, but it willcertainly bring a freshprofessional approach to thestatutory bodies. The checksand balances seem adequate.I do not believe that abureaucracy will be necessarilyabove board. At least they areless likely to be biased andcertainly can be moreaccountable to the public andthe government. Graduatingdentists have every right tomake a decent living.
  53. 53. Are the regulatory bodies cancerous??? A need for NCHRH! WINTERThe classic case of the bar beinglowered to allow mediocrity can be found Templatein the 2007 regulation of the DCI. Mostpeople are unaware that the minimummarks required to gain entry intodentistry has been lowered to 40% forbackward communities. It was previouslyonly for Scheduled Castes. This wasdone insidiously to allow the children ofthe rich and powerful with low marks.Today Dentistry is the only professionalcourse where Backward communitiescan gain entry with 40%. Nursing,Pharmacy, Homeopathy and every otherprofessional admission requires 50% inthe qualifying examination for evenbackward communities.
  54. 54. Two Elephants- Different Tasks (Tusks!)
  55. 55. Do we need a Flexner Report??In 1900 a gentleman called AbrahamFlexner was faced with a similar situationin the USA. There were too many MedicalSchools and the standards wereappalling. There was no uniformity or alevel playing field. Abraham Flexner wasappointed by the Federal Governmentwith a grant from the CarnegieFoundation to study the matter in detail. In1910 he recommended that 50% of thecolleges/ schools did not deserve to exist. Abraham FlexnerThe Government acted on thisrecommendation and on seats andseveral measures including closed downor merged colleges. It also imposed Even if 50% dental colleges are shutrestrictions exit examinations to down, there will still be a glut by 2030rationalize medical education. !!
  56. 56. Hercules • One of the labours of Hercules was the cleaning of the horse stables that accumulated enormous amount of dung- the Augean Stables. Hercules isDiverting a river supposed to have done so by diverting a river. That is the challenge we have. There is so much dung to be cleaned out and we badly need a Hercules and plenty of water to wash away the filth.
  57. 57. We may need another „Tahrir Square‟
  58. 58. Or another „Occupy Wall Street‟ WINTER Template
  59. 59. Or another Anna Hazare movement
  60. 60. “All that is necessary for thetriumph of evil is that good men do nothing. “ Edmund Burke
  61. 61. The thin edge of the wedge! Tamilnadu and Kerala• Tamilnadu is the only state where the IDA has challenged the PG seat selection, corporate advertisements, petitioned the Government for moratorium on Dental Colleges• Kerala filed a petition for writ when Internship was abolished. Is currently fighting corporate advertisements
  62. 62. What about the rest??? They can complain by singing the popular song „Why this kolaveri di?‟
  63. 63. Why this Kolaveri…Kolaveri… Kolaveri ….DiClick the screen to hear the song! (Kolaveri means „mental torture‟ WINTER Template
  64. 64. I have Hope!
  65. 65. सत्यमेव जयते (Truth Alone will Triumph) • Mundaka Upanishad, Mantra 3.1.6
  66. 66. Thank You• The text of this Oration will be available on the website of the HMA Trust at• www.dentethics.com or• on my personal blog site www.maxfaxgp.blogspot.com

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