Thank you very much, Mr. Chair and members of the committee.
Good afternoon. I'm Dr. Wayne Halstrom. I'm the president of the Canadian Dental Association, and I welcome the opportunity to speak to you today about employability and human resources in dentistry.
I am joined at the table, as you have heard, by Mr. Irwin Fefergrad, the registrar of the Royal College of Dental Surgeons of Ontario, who will share some of his thoughts on these issues following my remarks.
I would like to begin by addressing the issue of how foreign credentials are recognized in Canada. I imagine that for government there are two main pressure points. One is the apparent shortage of medical personnel in some fields, and the second is the population of foreign-trained professionals themselves.
On the first point, in dentistry we are fortunate that we are not currently experiencing major manpower shortages. Except in a few remote areas, most patients are able to readily see a dentist if they need to. Looking down the road a decade or two, we may have some challenges with the aging population of the profession, but fortunately we have enough lead time to deal with these concerns preventively.
On the second point, we recognize that it is important for foreign-trained professionals to have a good sense of the certification process before they decide to come to Canada. The Canadian Dental Association has made this information available through its website for several years, and we are happy to provide specific information to foreign-trained dentists who inquire.
In considering possible changes to the recognition of foreign credentials, one thing is paramount: we cannot compromise patient safety or Canadian standards of care. In fact, the concern is far more far-reaching than standards of care; it also includes appropriateness of care, which includes important cultural and language issues. This by no means suggests that we are unwilling to look for ways to make the process more understandable and smoother, and if appropriate, less time-consuming. However, this must be achieved in a way that maintains the appropriate care that our patients deserve and expect.
How do we know that practising professionals are meeting the high standard that Canadians expect? In dentistry, we have ensured this through a solid, four-part process of education, accreditation, certification, and licensure. This process ensures that licensed Canadian dentists have the training and skills that are needed to deliver safe and effective dental care. Education is delivered at 10 dental schools across Canada. The schools offer either DDS or DMD programs that are equivalent general practice degrees. Many also offer specialty programs in one or more of the nine recognized Canadian dental specialties. As well, a number of universities offer qualifying programs or degree completion programs. These programs were created specifically to meet the needs of the foreign-trained dentists in order to assist them in integrating into Canadian dentistry.
The limited available positions are allotted to candidates on a competition basis, drawing in large part on their scores on an eligibility exam. There is a similar procedure for Canadian students who complete dental aptitude tests as part of their admission requirements to dental schools. They must compete against other students for the finite seats in dentistry.
When we speak of accreditation in dentistry, we're talking about it at the institutional level, not at the level of individual dentists. The Commission on Dental Accreditation of Canada, or CDAC, is responsible for accrediting all dental and dental hygiene programs, as well as some of the dental assisting programs.
Accreditation is a lengthy, involved, and expensive process that requires regular site visits and considerable expense. CDAC has a reciprocal agreement with the American Dental Association. As a result, schools accredited by one are also recognized by the other. Graduation from an accredited program, be it a program leading to a DS or a DMD in Canada or the U.S., or one of the qualifying programs, is required prior to certification.
Certification of general dentists is done through the National Dental Examining Board of Canada, and as the name suggests, it's national in scope. The NDEB has undergone extensive changes in its processes over the last few years in order to achieve a system of examination that is fair and effective and that is recognized as one of the best worldwide. It is accepted as a basis for licensure by all provincial regulatory authorities for dentistry in Canada, which allows NDEB-certified dentists to apply for licensure in any province without having to undergo further testing of their qualifications.
Dental specialists, such as orthodontists or periodontists, are certified by the Royal College of Dentists of Canada. An NDEB certificate is required prior to certification as a specialist, which brings me to licensure.
As I mentioned, each province has a dental regulatory authority that licenses and regulates all general dentists and specialists in that province. In addition to licensure, these bodies are also responsible for the maintenance of quality assurance programs and for investigating complaints about dentists and taking appropriate action. Continuing education is an ongoing component of dental licensure, in order to keep dentists current as the profession develops.
This four-part system effectively ensures the ongoing monitoring of the way Canadian dentists practise, from their entry into the dental program all the way through to their retirement.
In terms of entry to the profession, I want to bring your attention to our concerns about the costs of dental education. Because of a number of factors, the tuition fees in dentistry are the highest of all professional programs in this country.