Top dentists grossing $1-million a year on First Nation reserves
- Top dentists grossing $1-million a year on First Nation reserves
Tom Blackwell Feb 2, 2012 - 7:10 PM ET | Last Updated: Feb 2, 2012 9:38 PM ET
Treating impoverished First Nations patients is a surprisingly lucrative enterprise for the country's dentists, with the six highest-billing practitioners receiving more than $1-million a year from Health Canada, according to government figures the National Post obtained.
Subtracting the 60% of dental billings typically spent on staff salaries and other overhead, the top 25 billers would earn personal income from work on aboriginal patients of about $200,000 to $640,000 a year, the Health Canada statistics suggest. The average full-time dentist in Canada makes $142,000 a year.
The figures, released under the Access to Information Act, come as the cost of dental care for aboriginals - who suffer from sky-high rates of dental decay - climbs swiftly, with spending on the program jumping more than 9% per capita in 2009-10.
The department says the steep billings are explained at least partly by the fact that several of the dentists have multiple clinics on different reserves and provide specialized services, though one on the list is under investigation for possible irregularities.
Representatives from the Assembly of First Nations and aboriginal health groups were not available for comment.
A Winnipeg-based expert says the numbers may appear lofty but are not out of line, especially since a limited number of dentists serve the First Nations market, often providing urgent or emergency care.
"These practitioners may be among the few in an area who are willing to go to these [remote] communities," said Robert Schroth, a dentist and researcher with the Manitoba Institute for Child Health. "They are the only show in town, and there may be few competitors."
Dr. Schroth was co-author of a Canadian Pediatric Society report last year that highlighted the extent of poor dental health among aboriginals, suggesting that more than nine in 10 young children have cavities in their baby teeth, some with so many they require surgery under a general anesthetic.
Dr. Robert MacGregor, president of the Canadian Dental Association, said it is hard to judge the billing figures, because there are a lot of unknowns. But those dentists who serve First Nations communities tend to work hard, he said.
"We do know the disease rate is higher in the aboriginal population, so there's more work to be done," he said. "If a person is working 12-hour days, which is not uncommon, as I understand, in some of these clinics . that obviously makes an impact on your income."
Health Canada pays for a number of health services for aboriginal people under the Non-insured Health Benefits (NIHB) program, including dental care, prescription drugs and eye care.
All of those on the list of the 25 highest-revenue dentists billed at least $500,000, with the top six ranging from $1.1-million to $1.6- million. The identity and location of the practitioners were removed by the department for privacy reasons. Dentists say the rule of thumb is members of the profession take home 40% to 45% of the fees they charge, after paying hygienists and other staff and financing often-pricey equipment.
According to Statistics Canada, the average employment income for full-time dentists in Canada is about $142,000, after overhead is paid.
Seven of the dentists on the list have multiple clinics on different reserves, each with their own support or technical staff, and two of the dentists are specialists, whose fees tend to be higher, said Oliva Caron, a spokeswoman for Health Canada, in an email response to questions.
The dentists' staff can include dental "therapists," who are allowed to perform limited procedures, such as minor fillings. High billing can also result from practitioners visiting remote communities, said Ms. Caron.
At the same time, the NIHB program has a "rigorous" audit system for the 14,000 dental practitioners who do work for the department, with particular focus on those claiming large sums, she said. "Every provider on this list of top-25 providers has been audited by the program, and many have been audited multiple times," said the official.
Any inappropriate billings must be repaid, repeat offenders are de-listed and evidence of fraud is turned over to police and regulatory colleges, she said.
Health Canada spent $194-million on dental services in 2009-10, the most recent year for which it has issued an annual report, up more than 9%. Still, the report notes that many First Nations people go without dental care at all, as just 36% of those eligible had any kind of dental appointment in 2009-10.
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