Judith Husband, a leading dentist and member of Council at Medical Protection Society – of which Dental Protection is part – reflects on dentistry as a career as we mark International Women’s Day on Saturday 8th March
Thanks to the historical efforts of women, and men, in the UK, we have built a broad range of legal protections for women in work and society in general. The dental profession in the UK has long been in the vanguard of being considered as supportive and inclusive. I have had the great pleasure to meet some of the women at the forefront of the fight for fairness, most notably including maternity payments in the NHS.
Many dentists are self-employed, both in the NHS and private sectors. This affords benefits and was personally part of the attraction of general practice and dentistry for me – but it can also place additional pressures on women dentists. Women associates can find themselves responsible for sourcing locums to enable them to have maternity leave, and those in the private sector are not afforded the maternity packages other sectors provide. We must always be mindful that many women in the dental profession are not dentists and there are a wide range of opportunities in nursing and hygiene/therapy, with new roles developing with the expanding role of DCPs.
Dentistry is not one single career but a profession that has huge variety of workplace, employment status and specialities – this is its greatest selling point but also requires careful research and consideration.
In countries around the world as more girls and women are educated, gain personal autonomy and are given the opportunity to pursue careers, we see steadily increasing numbers joining the professions, including dentistry.
Dentistry, although incredibly technical, at its heart is about caring for people, building trust and relationships. Emotional intelligence and good communication skills are very important in the caring professions and traditionally women are perceived to excel in these key areas.
Dentistry is inherently a flexible career with the opportunity to work part time, or out of regular office hours. Some other professions are more prescriptive, especially in early years training, and so dentistry can be a much more attractive option than, for example, medicine to some.
NHS dentistry is a very broad term encompassing a huge variety of workplaces and contracting models. It is possible to have a varied and flexible career within the NHS, working across a multitude of sectors and employment options. In primary care and, more specifically, general dental practice, NHS practice can have advantages with respect to maternity and superannuation options. Contracting models differ across the devolved nations, and it is important to understand the requirements to make an informed career choice.
Private practice carries advantages of greater control over treatment and patient choice but also added responsibilities, like out-of-hours care which can adversely impact personal and family life.
Career flexibility may be enhanced by practice ownership for some. For others, including myself, being an associate enabled significant diversification of my professional portfolio.
We return to the importance of understanding the options, researching and identifying each individual’s priorities.
Systemic barriers
There remains the systemic barrier in the workplace for dentists of the gender pay gap. This is reported in independent NHS figures and needs to be taken more seriously. In any reformed NHS contract, due consideration for all parties must be a golden thread running through modelling, negotiations, implementation and reviews.
Potential pay gaps in the private sector are more difficult to measure but, as a profession, we should be finding methods to investigate and not assume that everything’s just fine because there are high numbers of women dentists.
Within the sphere of political representation of dentists, there remains a significant leaning towards men. This is in part women not standing, but also an outcome of the electoral process. For example, the General Dental Practice Committee of the BDA remains disproportionately male, and it still has never had a woman chair.
Women face bias, conscious or unconscious, both within the profession and from patients, with many women dentists facing multiple discrimination due to race and religion.
Registration reports show special care dentistry and paediatric dentistry have a higher female employment rate compared to specialities such as endodontics, oral surgery, prosthodontics and restorative dentistry. These are stark and clear differences that the profession really should be interested in, researching and addressing. These trends are not shifting despite the continued increasingly high proportion of women registered as dentists in the UK. The causes will be multifactorial and may well differ across individual specialities. If there are barriers to women entering our specialities, it is a stark warning for the future, both for patients and training future dentists.
Dental Protection data shows practice principal members are predominantly older males. Practice ownership has been a topic of debate during my entire career. With the increased number of women dentists, there has also been a seismic shift in the commercial landscape of dentistry in the UK. Effective deregulation of the market, enabling large corporate entities to form, has impacted adversely some individuals’ ability to purchase. NHS contracting in England and Wales dramatically affected the historical freedom and opportunities to open new practices, leaving younger dentists with rising practice values and few alternative options.
Financial institutions are actively targeting women dentists, so there are increasing opportunities for professional advice and support. Peer support is available with some excellent women dentist networks for those considering practice ownership.
Practice ownership is also not the career choice of an increasing number of dentists. In the 90s, I was an outlier. Now, more dentists, male and female, are choosing the opportunity to have flexibility and variety.
From my student days, joining the BDA Students Committee, right up to being Deputy Chair of the BDA, there have been incredible women role models, many of whom I had the pleasure of knowing personally and working with. With Dental Protection, we have supportive and inspiring women, together with men who are true allies. We have spoken a lot about women, but greater inclusion and a fair profession relies on the support of our male colleagues.
Role models and their support has been key to getting (and staying) involved with dental leadership and representation. The importance of seeing people you can identify directly with is really important, and having trusted colleagues or mentors invaluable.
In recent years, there has been little improvement in the balance of those representing us, and this has been a constant disappointment. Increasingly, there are courses and events with all-male line ups. There are incredible women dentists and wider team members able and willing to represent us, to teach us, to negotiate on our behalf and ,yet, time alone is not shifting the dial towards are more balanced representation.
Mind the gap
On average, in the UK, men generally earn more than women. Research suggests they also have more confidence when it comes to applying for jobs and climbing the corporate ladder. It is recognised that women are less likely to take credit for achievements or share successes. Therefore, it is vital to build personal confidence to use the platforms and opportunities as they arise to showcase yourself. Dentistry can be very isolating and having a network of supportive professionals, virtually or face to face, is vital.
Understand what success looks like. Explore opportunities and options with an open mind and try to remain agile. Build a plan and be prepared to make some sacrifices. Progressing within a career and, most importantly, enjoying it is very personal; be driven by your goals.
On a boring practical note have a degree of financial stability, or a rainy day fund – it will always give a degree of freedom both personally and professionally. Some opportunities will not be financially rewarding immediately but will prove pivotal in years to come.
My friends are a broad mix of professions and ages, but they have always been the cornerstone of my support network. Sharing concerns and problems, not necessarily for solutions but to mentally address and acknowledge them, is my personal approach to stressful events. A form of talking therapy.
Building clear deadlines for work projects and being honest with what is achievable have helped me juggle many different, competing pressures at times.
Better wellbeing support
My experience working with different organisations and businesses has highlighted to me just how different most general practices are when compared to large organisations in the terms of the help, support and reasonable adjustments that can be put in place for individuals.
The nature of clinical dentistry is also limiting in its physicality, time pressures and detailed complex work.
Different practices will be able to offer varying levels of practical support but there should be a culture of openness and dialogue within teams to address locally any individual challenges.
Future NHS contracting must take into consideration the workforce needs and not just an abstract concept of value for money. If working conditions remain poor then dentists will continue to retire early or increase private care, and valuable team members will be lost.
Groups and networks for women in
There is Women Dentists Network, which can be found at https://www.womendentistsnetwork.com/. They have a a private group all women dentists and students can join that currently has more than 600 members.
Dental Protection provides a range of educational resources through its Online Learning Hub, which comes at no extra costs and counts towards CPD. Online, on-demand CPD courses have been a game changer personally – helping to avoid long evening drives to lectures or days away from work. However, I always attend some face-to-face lectures and events each year.
Dental Protection have a super selection of on demand courses covering all areas of dentistry, some short others larger modular based courses. The live webinars are a great way to access learning with the opportunity to ask questions and be part of a real community.
The College of General Dentistry also have events, both virtual and face to face.
It is important for me to also remain up to date with corporate governance and world events, and so international news publications and the Institute of Directors are part of my regular reading.
Mentorship
My mentors have been informal but none the less invaluable.
With the advent of online meetings and learning there is less opportunity to build relationships within the profession and, as such, informal mentorship. More formal structures could be useful and have proven of great value in other sectors.
It is worth considering the wider team when looking for clinical mentorship. Often colleagues within the practice can prove a great source of support and even take on a mentor role.
Top tips for the future
Be informed and stay informed. Understanding your rights, the contract you work under and the drivers within your sector are essential. Clinical dentistry is only one part of a career in dentistry.
Choose your professional support network with care. Indemnity is a GDC requirement, but the right provider will be able to help and support you in the good times, as well as when complaints or other medicolegal matters arise. I am aware of the exceptional support that Dental Protection provides to members, and know it can make a real difference. Complaints and litigation will happen, don’t be scared, but do be prepared and know how and where to seek help.
Ensure you have trusted friends and colleagues. Online forums have value but cannot replace a real person.
Start planning your finances, paying debts, building financial security.
Most importantly, think about what makes you happy. What is your definition of success?
We should all be proud of our profession and ensure the great steps forward already achieved with inclusivity and fairness are embedded and used as a foundation to develop on for the future.
Personally, I believe NHS dentistry is important, but the dreadful downward spiral witnessed during my career will need to be halted. Dentistry could be the model of a well-functioning mixed economy, and the private sector can and should work supportively with the NHS for patients and the profession.
Finally, the regulatory burden we work under in the UK needs to be fit for purpose, protecting patients but also enabling clinicians to do their best, without fear or defensive practice.
These future hopes would of course not only benefit women. We often see diversity and inclusion efforts benefit the entire workforce and community – dentistry is no different.
