Canadian Forces dentists' productivity questioned

A CBC News investigation has revealed a number of highly-paid dentists in the Canadian Forces have been performing little or no dentistry, according to documents obtained through the Access to Information Act.

Military records show some Canadian Forces dentists — who make between $200,000 and $300,000 a year plus benefits — have treated only a handful of patients in their chairs over the last few years, while the dental unit contracted out millions of dollars worth of work to private dentists.

"My first reaction is sadness," said Murray Cuff, a former military periodontist who retired in 2010 and lives in Victoria, B.C.

"It's pretty disgraceful when you think of the performances in comparison to the salaries these guys are receiving and the number of dentists that there are."

The military has roughly 140 salaried general dentists and specialists who are enlisted members. CBC News examined their productivity records between 2007 and 2013.

In each year, approximately 75 per cent of them performed less than $200,000 worth of treatments — many performed less than $100,000.

In 2008, for example, 112 of 149 salaried dentists and specialists — 75 per cent — did less than $200,000 worth of dental work. The following year, that number went up to 77 per cent, or 112 of 149 Canadian Forces workers.

In 2010, 80 per cent of salaried dentists and specialists performed less than $200,000 worth of treatments.

This graph represents the value of the dental work done by military dentists and contracted dentists, known as Calian, between 2007 and 2013. The value of the work is based on the Ontario Dental Fee guide. (CBC)

"I would say anybody should be able to produce $200,000 worth of dentistry," said Cuff.

He said it's common for general dentists in the private sector to bill between $400,000 and $800,000 a year. Most specialists, he said, would bill upwards of more than $1 million annually.

Col. Kevin Goheen, the commanding officer of 1 Dental Unit, calls the numbers an "indicator" of productivity but not the only way the military measures success. He said the Canadian Forces concentrates on getting people dentally fit to deploy, while private dentists tend to do more expensive or cosmetic work.

"I just go back to 100 per cent of our people who are deploying, this is CF military members deploying, are dentally fit all the time," Goheen said.

The productivity numbers are based on the Ontario Dental Fee guide. Because military dentists are salaried, they do not actually bill anyone.

Deployment means less time in chair

In the data examined by CBC News, some specialists worked on no patients. In 2007, four specialists did zero dollars worth of work. It was the same for two specialists in 2008 and one specialist in 2011.

Others did less than $50,000 worth of procedures.

Col. Kevin Goheen said the Canadian Forces concentrates on getting people dentally fit to deploy, while private dentists tend to do more expensive or cosmetic work. (CBC)

Goheen said some of those dentists may have been deployed or getting ready to deploy, which means less time in the chair.

"Anybody right up to the rank of lieutenant-colonel is expected to do at least a day [a week] of dental care if they're in a staff position," said Goheen. "If they're in a position of a specialty care commander, of which we have six, those individuals will do at least two to three days a week of dental care."

Goheen said dentists also spend a lot of time on paperwork once done by less expensive administrative officers whose positions no longer exist. 

But Cuff and other recently retired dentists say too much attention is paid to careerism in the dental unit with no incentive to do more dental work.

"What's really expected of them is to assume as many administrative roles as possible and of course, if you shun that in lieu of doing dentistry, your career is toast," said Cuff.

Ratio doesn't add up, says critic

According to the Canadian Dental Association, there is one civilian dentist for every 1,664 people in Canada.

In contrast, there are 72,000 Canadian Forces members and 140 salaried dentists, making the ratio roughly one dentist for about 500 serving members. That means the military has triple the ratio of dentists to patients compared to the civilian population.

Murray Cuff, a former military periodontist who retired in 2010, said 'anybody' should be able to produce $200,000 worth of dentistry a year. (CBC)

Cuff said even if you take into consideration the percentage of civilians who don't go to the dentist, the ratio doesn't add up.

"You're still talking about twice the number of dentists available to our servicemen and women than the civilian population," he said.

Despite the smaller dentist-to-patient ratio, the military hires about 40 civilian contract dentists in its clinics. From 2008 to 2012, it also referred between $8 million and $14 million of dental work a year to civilian dentist offices through Blue Cross.

'It's pretty awkward'

Kevin Lacey of the Canadian Taxpayers Federation said the numbers suggest huge inefficiencies.

"We should see more private sector doctors doing work that is currently being done by right now by expensive military dentists," he said.

"Second is to release the dentists we do have from a lot of the administrative red tape that obviously shows and that the military admits goes on."

The Canadian government spends about $56 million on salaries alone in the dentistry unit. That includes military members, public servants and the contracted dentists. Most military dentists receive between $50,000 and $100,000 a year in pension and other benefits in addition to their salaries.

Cuff said the unit needs to undergo a full review in order to improve efficiency.

"The majority, by far, among the military dental corps officers know this. Will they say something about it? It's pretty awkward," he said.

"They're hoping for the best and punishment postings can happen. It's not the kind of thing people like to stick their neck out on."

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