IDA President Dr. Caroline Robins
IDA President Dr Caroline Robins speaks about finding her feet as a dentist from outside Ireland, and about some of the issues facing the profession.
When Dr Kieran O’Connor formally introduced new IDA President Dr Caroline Robins at this year’s Annual Dinner in Galway, he gave part of the introduction in Maori, a gesture acknowledging Caroline’s New Zealand heritage, and also the fact that she is the first non-Irish graduate to be President of the Association.
Originally from Ruapuna in Mid Canterbury, Caroline’s decision to become a dentist sprang from her own childhood experiences, but not, perhaps, as one might expect: “I was probably every dentist’s nightmare because I was terrified. My father’s cousin, Peter Robins, was a dentist, and once I was older and a little bit calmer, he set about fixing all the issues. He put an anatomy book in my hand while he worked, and talked about what dentistry involved. He also talked about how it’s a good career for a female from the point of view of family and things like that. He stirred an interest in me while I had a lot of work done”.
It was a good fit: “I’m a people person, and I’m artistic, I’m creative – I like nothing more than making something look like a tooth again”.
Caroline studied dentistry at Otago University, where the approach is slightly different to the Irish system, with a common entry first year where students of medicine, dentistry and pharmacy study together, and have the opportunity to take a range of subjects. She feels that the combination of her childhood experiences and this broad education gave her a great preparation for a career in dentistry: “I was lucky enough to do anthropology and psychology in my first year, which I really enjoyed. I love psychology. I often say that dentistry is one-tenth the mechanical and nine-tenths the person, and that’s what I enjoy most about my job, my interactions with patients. I’ve also had a wisdom tooth out, I’ve had fillings, I’ve had injections. I have a degree of empathy with patients when they sit in the chair and have a fear, because I had it myself”.
“I’m a people person, and I’m artistic, I’m creative – I like nothing more than making something look like a tooth again”.
After graduation in 1995, Caroline went to Australia, and spent three years working in Westmead Hospital in Sydney, where she says she got a terrific grounding in many areas of dentistry, from paediatrics and oral surgery, to caring for patients with oral cancer, and even forensics: “I used to spend a lot of time in the morgue doing identifications and I really loved that. I think if I had gone down the medical route, pathology is possibly what I would have done”.
Like many of her fellow Antipodeans, Caroline planned to travel to the UK to work for a time, but meeting her future husband Anthony on a night out in Australia changed all of that, and she found herself travelling to Ireland in 1999: “I came for a look, and as I tell them, I’m still looking!”
“I used to spend a lot of time in the morgue doing identifications and I really loved that. I think if I had gone down the medical route, pathology is possibly what I would have done”.
Despite being a well-rounded general dentist with plenty of experience, Caroline quickly found that working in Ireland was not as straightforward as she’d expected, as her degree was not recognised here: “When I look back, it was farcical. You couldn’t apply for a job without a panel number, but you couldn’t get a panel number without the offer of a job”.
Not to be deterred, Caroline arranged a meeting with the then registrar of the Dental Council, who alerted her to the fact that she could work in a hospital under the supervision of a consultant. This led her to Prof. Derry Shanley, then Dean of the Dublin Dental School, who offered her a position as a registrar. Over the next two years, she completed her fellowship exams at the RCSI, and eventually sat the statutory exam to be registered in Ireland. But this wasn’t the end of her problems, as she now needed a work permit. She was fortunate enough to find work with Dr Brenda Barrett in Carlow, where she worked for 11 years before starting her own practice, Kiwi Dental, in 2012.
All of these experiences give Caroline particular insight into the plight of foreign-trained dentists seeking to work here, as well as non-Irish dentists who train here as international students, but then cannot stay to work: “Work permits aren’t easy and you can see why principal dentists may shy away from them. It’s an employee situation that is completely different to the traditional self-employed model and there’s a lot more to take on as the employer. That said, I am extremely grateful to Brenda for taking me on and being prepared to do the mountains of paperwork required each year until I got married in 2006 and my residency status changed”.
Caroline’s personal experience is particularly pertinent at the moment, as the profession deals with a major personnel crisis. It’s something she wants to focus on in her year as IDA President, but she’s all too aware that it’s a complex problem with no easy solution: “There’s no one single factor. It’s like a perfect storm: feminisation of the profession, dentists working fewer hours generally, younger dentists not doing traditional dentistry. Then there’s the difficulty getting registered, the fact that the statutory exam is only run once a year and there’s only such a tiny number that can sit it each year, combined with current numbers graduating from dental schools”.
As a general practitioner in a rural community, Caroline sees the impact of this crisis first hand: “The Dental Council says that there’s never been so many dentists on the Register, but on the ground, no one can get dentists. It’s a real worry. If I was to lose a dentist, I’m not sure what I’d do”.
Finding other dental staff, particularly hygienists, is just as difficult, and the housing crisis and rising cost of living are adding to the problems. The knock-on effect, of course, is felt by patients, who are waiting longer for appointments, or finding that they can’t get a dentist at all. Caroline feels it’s also contributing to the number of dentists quitting the DTSS, as they consolidate their practices and adapt to working with the staff they have.
Whatever the answer, it will be multifaceted, and will involve all stakeholders working together. Caroline says she would welcome the opportunity to meet with the Dental Council, and other institutions are already joining the discussion. The IDA recently met with representatives of the RCSI’s Faculty of Dentistry, where Dean Prof. Albert Leung is keen to look at issues such as increasing the number of places in dental schools (an opinion piece on the shortage of dentists by Prof. Leung is on p.184 of this edition). Other changes that might help would include changing the rules to allow non-Irish dentists who train here to work for a time after graduation, or implementing proposed changes to the scope of practice of auxiliary staff, but these involve regulatory and legislative change, which is notoriously slow, and in the meantime the crisis continues.
“Until we can have a chance to sit around the table and talk about a better model, the DTSS is still going to haemorrhage dentists”.
Talks about talks
Increasing the number of dental graduates also takes additional funding, at a time when the profession is also lobbying for an overhaul of the medical card and PRSI schemes, and the health service in general is struggling to recover from the pandemic. The IDA is still waiting for an official start date for talks on these issues, and Caroline is understandably frustrated at this. The recent allocation of additional funding for the DTSS was helpful, but doesn’t address the fundamental issues: “It doesn’t change the fact that we just don’t have enough people offering the service and dentists are still leaving the scheme. It’s reinforcing what we’ve always said: it’s not about the money, it’s about the system, and the system is still broken. Until we can have a chance to sit around the table and talk about a better model, it’s still going to haemorrhage dentists”.
She hopes that further talks will also help to rebuild the trust that has been lost between dentists and the Department/HSE in recent years. She feels strongly that only by understanding each other’s point of view can progress be made, and says that a recent meeting with representatives from the Department felt like a positive step: “There was a good, open, frank discussion. We got a chance to have a conversation with each other and get some points across that perhaps neither side had fully appreciated”.
She acknowledges that it won’t be an easy road, but it’s a necessary one: “We need to be able to sit down and try and iron out the issues, so we can all move together for the common goal, which is the oral health of the nation. The reality is, we’re one of many, and we’ve all got our hands up trying to get attention, to get what is obviously important to us as a profession, and we feel that it should be important to the Department of Health. But we are one of many fields in health that need attention and are failing”.
“I think as a professional body, in any profession, your association is your advocacy. If you lose your advocacy, you lose your voice”.
Having been a member of the Australian Dental Association, Caroline is a firm believer in getting involved in your professional organisation, so joined the IDA as soon as she came to Ireland. She got involved with the GP Committee when she set up her own practice as a way of meeting others in the same boat: “Dentistry can be lonely. I didn’t have that [university] class back-up. You’ve got to make your own friends if you’re on your own, you’ve got to go out and introduce yourself, so that’s what I did. When I was setting up my practice, there was a lot of stuff I didn’t know. What do you pay nurses and what do you look for? What materials and equipment should I buy and what’s unnecessary? I came away from my first meeting feeling so relieved that I was normal, that my worries and concerns were everybody else’s worries and concerns. I got so much information and help”.
This progressed to involvement with the Board, and from there to her current role as President: “I really have enjoyed it so far. I’ve always been interested in politics and how things work. Everyone in IDA House has been so welcoming and they’re all fantastic people”.
Using your voice
Perhaps because of these experiences, Caroline also wants to use this year to get dentists talking face to face again. With so many issues and crises affecting the profession, from staff shortages and State contracts to VAT, it’s never been more important to get dentists’ views and input. Caroline feels that one of the many negative impacts of Covid-19 has been to limit communication in many instances to the virtual world: “I want to see people come back together as the profession and as people. I think we’ve become very isolated.
“Everyone has an opinion from the safety of a keyboard, but when you have a meeting and you ask people for ideas or what they think, nobody says anything. I want us to get back to actually having a decent, frank conversation about what is going on in our profession, which is a failing public health system where we can’t meet the needs of our medical card patients. Everybody needs and has a right to basic decent oral health: pain free, disease free and clean. Maybe we need to look at how meetings are run, to get that conversation going. You don’t have to agree with us. Whether you like us or don’t, come and talk”.
Her final comment is a cautionary one: “The New Zealand Medical Association, the NZMA, folded this year because not enough people were participating in it. I think as a professional body, in any profession, your association is your advocacy. If you lose your advocacy, you lose your voice”.