Workforce challenges in post-Covid Europe

The CED held its first in-person General Meeting in Porto in May.

The recent Council of European Dentists (CED) General Meeting in Porto was the first in two years, and was a welcome return to in-person discussions between the dental associations of Europe.
As part of CED internal affairs, delegates adopted the CED Final Accounts for 2021 and the CED Budget for 2023. The Statutes were amended to limit the time served as Treasurer to three years for two consecutive terms, and the maximum term on the Board was set at four mandates of three years.
In his opening address, CED President Dr Freddie Sloth Lisbjerg mentioned a wide range of topics common to all countries, including: n

  • issues of substitution and delegation within dental teams;
  • the changing roles of partnerships, groups and corporate models;
  • young staff, workforce challenges; and,
  • ever-evolving equipment as dentistry continues to develop in the digital age.

There was a statement of solidarity regarding dentists from Ukraine, noting the shortage of medicines there and the challenges raised by considering allowing access to registration across the EU, while continuing to maintain the requirements of dental education and qualifications. All countries are suffering the impact of the crisis in Ukraine, with increased inflation, destabilisation and rising energy costs. There is no doubt that these things will impact on dental practices, many of which have only just regained momentum after the Covid-19 crisis.
Support for CED members in recent months has included: surveys among member states on VAT issues (Irish Dental Association); dental specialties (Germany); interviews for media (Spain and UK); and, correspondence with the Lithuanian authorities.

New policy statements
In addition to updates on the work of CED Working Groups and Task Forces, the General Meeting adopted two policy statements: ‘e-skills for dentists’ and ‘Dentistry and patient safety during the ongoing Covid-19 era’.
The CED statement ‘e-skills for dentists’ focuses on the digital transition in dentistry, and the importance for dentists of broadening their understanding of how dental applications, telemedicine, digital workflow models, digital health information and artificial intelligence (AI) equipment are evolving and affecting traditional dental practice. The role of e-skills in the patient-dentist relationship in matters of communication, consent and data protection is becoming increasingly important and ever more complex. There is a recognition that dentists will need to continually upskill in this area right through their practising lifetime, just as with their clinical skills.
The updated CED statement ‘Dentistry and patient safety during the ongoing Covid-19 era’ reflects the importance of vaccination and aims to capture the current pandemic status quo and its impact on dentistry. There is a recognition of a change in focus at EU level from emergency measures during the two years of Covid-19 to stabilisation now, with a focus on vaccinations. The European Centre for Disease Prevention and Control (ECDC) has a new mandate focusing on non-communicable diseases. The CED is collaborating with the European Medicines Agency as part of the healthcare professionals organisational policy officers group. The Working Group on Oral Health informed us about the IMMUNION project, which aims to increase the uptake of vaccination in the EU via communication, training, media coverage and PR. There will be a webinar on June 28, which members can access – please contact the IDA if you are interested. The One Health Initiative between doctors, vets and dentists is seeking to form a consortium that will set up a project to train the healthcare workforce in the One Health approach; this will include multi-professional education on antimicrobial resistance – ever an ongoing healthcare challenge.

AI and aligners
AI and aligner orthodontic systems are hot topics in almost every jurisdiction and there was considerable debate around the regulation of these enterprises. Aligners being printed and manufactured with no dental input – and treatment plans being drawn up by unqualified personnel – are significant issues. These companies have very significant resources and are likely to strongly resist attempts to limit their market and marketing. Discussion took place around how to influence legislation that might make access more difficult, and to try and ensure that patients are made aware of the risks of engaging with non-dentally trained providers, often remotely.

Workforce issues
Of particular interest were workforce issues, as some countries reported national or local shortages of dentists, while others saw numbers increase; this was reflected in the initial discussion on a CED policy paper on workforce challenges that will be prepared for adoption during the November 2022 General Meeting. The issue of public and private dental schools is still very alive on mainland Europe and we were made aware of ‘educational tourism’, where there is a brain drain from poorer to richer countries.
There was discussion around the challenges for young dentists of trying to gain experience in new models of practice, which are often very different to the traditional mentoring/apprentice-type associate model of traditional practice. Concerns were expressed at the level of support and mentoring available to young dentists as they develop their skills, and the challenges they face in some scenarios (although not all) with aggressive commercial focus. There was a range of views expressed concerning the various corporate models that exist in different jurisdictions and a recognition that this model is part of the future of dentistry and we need to work with it rather than against it. As ever, there are differing views across the various associations on how the dental team should be structured and what tasks can be delegated.

Sustainability and global health
The CED will be supporting a project on ‘Sustainability in Dentistry’ based in the Dublin Dental Hospital. We look forward to hearing more details of this in the coming months.
The delegates also heard from Prof. Dr Pål Barkvoll, President of the Association for Dental Education in Europe (ADEE), who focused on the possible collaboration on the WHO global oral health strategy and the study ‘Mapping and assessment of developments for one of the sectoral professions under Directive 2005/36/EC – dental practitioner’, carried out by Spark Legal Network. We are awaiting an update on the results of the study, which examined dental school curricula across the various countries and will hopefully provide recommendations on minimum standards that should apply, in line with the Professional Qualifications Directive. In addition, Ivana Ligusová, President of the European Dental Students Association (EDSA), presented on the EDSA’s activities, impressing the delegates with her enthusiastic and detailed presentation outlining the broad range of issues that the EDSA is involved in.

IDA presentation
Fintan Hourihan, IDA CEO, gave a presentation at the meeting on ‘Communicating with MEPs – a national perspective’. Fintan’s presentation showed how the CED and national dental associations can work together, and the different roles at different stages of the advocacy process. It also showed how advocacy takes place in different locations, i.e., Brussels, Strasbourg and within national parliaments, and with governments and regulatory authorities. He concluded that the CED provides us with great advocacy tools and showed how working together we are definitely stronger!

It was, as ever, a stimulating and fruitful two days of conversations and sharing of experiences and challenges regarding the provision of dental services to our patients from many different perspectives. We would like to convey our appreciation to the Portuguese Dental Association for their generous hospitality.

Dr Nuala Carney
Dr Kieran O’Connor
IDA CED Representatives