JCDA - Canadian Dental Association

l E t t E r s
The Modern Realities of
Choosing a Practice Location
Although I too lament the
shrinking number of practitioners
in rural Canada, 1 I ruefully
admit that I am one of the many
young dentists utterly tied to an
urban setting. Dr. Williams blames
the desire to live in the city on illinformed
stereotypes of small-town
life and the misconception that rural
folk have little disposable income or
have no demand for comprehensive
care. I am certain he is correct, but
humbly put forth that he has overlooked
the changing face of dentistry
and the rise of the dual-income professional
couple.
Dental schools throughout North
America now graduate almost an
equal number of male and female
dentists. Our spouses are typically
fellow professionals with blossoming
careers who have little interest in the
operation of a dental office. True,
some spouses might also be dentists
or other health professionals in high
demand in rural communities. But
others are employed in industries
that are primarily based in cities.
My husband, for example, is management
level in the financial sector
with an American custodial bank in
downtown Toronto. Therefore, he is
only employable in his chosen field
in major international centres.
Many of us, men and women
alike, are married to people who had
careers before we graduated from
dental school. As such, our spouses
are loath to abandon their current
employers, benefits and accumulated
seniority, or the start-up businesses
they worked so hard to establish.
If some colleagues are lucky to
have more portable partners, then
the challenge becomes finding or
creating adequate work opportunities
in the new location. Rather
than looking for work for one, they
must job hunt for two.
The case can be made that the
financial gain from moving out of
the city will more than make up for
any monies lost from a second income
and that a spouse can be a
stay-at-home parent or enjoy a premature
retirement. I believe such a
life would satisfy few highly educated
and workplace-accustomed
young men or women for more than
a handful of years.
The unmarried dentist moving
to rural Canada faces a different
problem altogether — meeting
other single professionals. A good
friend who practised in small-town
Ontario after graduation remarked
that the only men she was meeting
were elderly widowers. All the men
her age were either happily married
with school-aged kids or had left
long ago to seek their fortunes in
the city.
What are the solutions to this
impending dilemma? While I think
Dr. Williams proposes some good
suggestions, I would like to respectfully
add that communities, brokers
or existing practice owners hoping to
attract new dentists might somehow
court their spouses with job or small
business opportunities. Social introductions
to other professionals in
the vicinity would also be invaluable
to those considering a rural lifestyle
and location.
Dr. Maria van Harten
Mississauga, Ontario
Reference
1. Williams J. Making the case for rural and
remote dental practices in Canada. J Can Dent
Assoc 2008; 74(6):515–6.
The Right Person to Lead
CDA Forward
Dr. Stymiest has convinced me
that she is the right person to
lead CDA forward. 1 I hope that
recognizing the public health issues
of access to care and early childhood
caries also puts them on the agenda
for CDA to address. Solutions may
not be simple, but by taking one step
at a time, we can solve the problems.
Dr. Luke Shwart
Calgary, Alberta
Reference
1. McNamara S. Dr. Deborah Stymiest leads CDA
into a new era [President’s Profile]. J Can Dent
Assoc 2008; 74(4):313–14.
Cochrane Review Abstracts
I would advise JCDA readers to use
caution when reading the Cochrane
Review Abstracts. 1 At its worst, a
meta-analysis can be extremely misleading,
especially when applied to
orthodontics.
It seems that some in our profession
are falling over themselves to
board the evidence-based dentistry
(EBD) bandwagon. I expressed misgivings
about EBD years ago, when
it was coming to the fore. It became
clear to me during my residency that
some of the research performed in
orthodontics was fraught with flaws.
One could poke holes in many of
the studies without trying very hard.
But we learned to consider what the
research had to say, take what good
it might have to offer, and move on
without considering it as law.
Now, in the era of EBD, metaanalyses
are being touted as the
great godsend, enabling us to deliver
care based on the “best available”
evidence. My concern was,
and still remains, if you build a doctrine
on flawed research, you have
a flawed doctrine. I am also concerned
that EBD will cast some of
the free thinkers and innovators in
our profession as “witches.” Worse
yet would be if conclusions based
on these tenuous meta-analyses are
scooped up by legislators at various
levels and become prescribed as
standards of care.
My concern with meta-analyses
in orthodontics has been borne out
JCDA • www.cda-adc.ca/jcda • September 2008, Vol. 74, No. 7 • 573