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