As of June 7, 2024, the vast majority of Canadian dentists are not participating in the CDCP. This may be puzzling to a casual observer. Why are most dentists turning down this opportunity to help more patients?
To understand why the Canadian Dental Care Plan is struggling one must understand the origin and development of this plan in order to appreciate its potential, challenges and pitfalls.
The Origin of the CDCP begins with the 2021 Canadian Federal Election
The birth of the Canadian Dental Care Plan (CDCP) is tangled up in politics and election moves, making people wonder if it will help or hurt Canadians.
After the Canadian Federal Election on September 20, 2021, no one party had a majority of seats in the House of Commons.
In order to be in power and stay in power one needs to control at least 170 seats in the House of Commons of Canada. Minority federal governments in Canada are rare and do not stay in power for long as key tasks of the government require majority support.
The Liberal-NDP Coalition Gives Momentum to CDCP
To combat this issue Justin Trudeau (Liberal) and Jagmeet Singh(NDP) formed an alliance, giving them a combined total of 185 seats and control of the federal government.
For the liberal government, this coalition ensures that Justin Trudeau stays in power as Canada’s Prime Minister until 2025.
The Liberal-NDP coalition also ensures that Jagmeet Singh becomes a real influencer in Canadian federal politics. Jagmeet only got 25 seats out of 338 seats in the federal election which made him an insignificant figure in federal politics. Yet the Liberal-NDP coalition allowed him to direct the actions of Justin Trudeau under the threat of withdrawing from the coalition, which would lead to Justin Trudeau losing his Prime Minister position.
Justin Trudeau and the Liberals are Forced to Support Dental Care
One of the influences Jasmeet has had is the CDCP program. Dental care has been noticeably absent from the Liberal election platforms, which means that the issue of dental health is irrelevant to Justin Trudeau. In fact, the Liberals voted against dental care. The Liberals and Justin Trudeau fundamentally do not care about the dental health of Canadians.
Jagmeet Singh is the political driving force behind CDCP. Under the Liberal-NDP coalition, and the threat of Justin Trudeau losing his Prime Minister position, Jagmeet Singh has gotten Justin Trudeau to push through a dental care plan. However, this is not a move out of care for the people, rather Jagmeet is desperately trying to increase his popularity as his support is declining; he hopes that a dental care plan will help him achieve more votes and power in Canadian politics.
Political maneuvering and lust for power is the birthplace of the Canadian Dental Care Program. Power and politics are the wrong reasons for a dental care program, nonetheless, can Canadians arrive at the right place with a dental care plan?
CDCP: A Dental Program Constructed Without Dentists!?
The last time the federal government considered funding a Canada-wide dental plan was before the Canada Health Act was introduced in 1984. A national dental care program is a massive undertaking, to develop it properly it would take 5-7 years.
The federal government which has not been involved in dentistry is trying to piece together a national dental plan within 2 years as Jagmeet Singh set a tight timeline for Justin Trudeau to comply. Furthermore, a federal election is coming up in 2025, and the Liberals and NDP are desperate to gain popularity.
The rush to start the CDCP in just 2 years shows how sketchy its beginnings are. But here’s the real shocker…
The CDCP was developed entirely by the Liberal-NDP coalition, without the help or input of the Canadian Dental Association (CDA), representing the voice of all practicing dentists in Canada. The Provincial Dental Associations such as Ontario Dental Association and British Columbia Dental Association were not consulted. Instead, the government used undisclosed consultants to develop the CDCP.
The Canadian Dental Association, representing the voice of all dentists in Canada, has long been asking for more dental care money for a long time, but the government never cared much before.
Relying on “undisclosed consultants” to shape the program’s framework raises questions about transparency and accountability in the decision-making process and lack of responsibility for spending taxpayers money.
The CDCP is a dental care program developed without dentists to keep Justin Trudeau in power as Canada’s Prime Minister.
CDCP: The Government Promise: Dental Care for all Canadians!?
Even though the CDCP was started for the wrong reason, namely for Justin Trudeau to stay in power, could it still help people get dental care? Maybe Canadians can turn the wrong reason for starting the CDCP into the right outcome.
The CDCP was constructed hastily and without consultation with the dentists who are supposed to deliver the dental care under the plan and hence many problems need fixing.
CDCP Problems for Dentists
The vast majority of dentists are not participating in the CDCP. This may be puzzling to a casual observer. Why are most dentists turning down this opportunity to help more patients?
“ A program rushed out the door in a desperate attempt to buy votes…”- Anna Roberts
1. First Impression Will Strain the Patient-Dentist Relationship
The government, specifically the Liberal-NDP coalition, has been promoting the CDCP program as free dental care to win public support. However, the reality is that CDCP is not free dental care. CDCP is a dental care subsidy covering a portion of some procedures. The government has set many restrictions and limitations in the CDCP, the details of which the government has shared with the dentists, but not the public.
The government messaging to the public equating CDCP to free dental care has those who have signed up expecting not to have to pay for their dental visits. Most people who have signed up for CDCP believe it’s free dental care. The government has left it to the dentist and dental offices to explain the reality that CDCP is not free dental care, the limitations and restrictions. The messenger, the dentist, will not be well received by CDCP patients as the patient’s expectations have been misdirected by the government.
Dentists care deeply about their relationships with their patients and the first impression of being the messengers of bad news that patients need to partly pay for the care they receive is not well received and yet free dental care is not the promise they made. Dentists are stuck in the middle, getting blamed for problems with the CDCP program and yet dentists who are supposed to deliver the dental care were not involved in the development of the plan.
The government has not made efforts to educate patients about the realities of CDCP and align their expectations with reality.
2. Administrative Burden
COVID has placed unprecedented stress on the whole healthcare system including dentistry. Dental staff and dental offices Canada-wide are still recovering and suffering from COVID-19 burnout. There is still a shortage of dental assistants, hygienists and administrative staff.
The CDCP is unlike any other dental plan in Canada:
- Dentists need to sign a contract with the government
- Dentists have to obtain preauthorizations with Sunlife and check if a patient is eligible for CDCP before providing treatment
- Dentists have to keep track of patient’s family income
- In 40% of cases, post-treatment records need to be provided to Sunlife for verification
- Sunlife can conduct onsite audits
- Balance billing and co-payment collection
- De-enrollment from CDCP is a complex process
These special CDCP hurdles add unnecessary additional strain on dental staff that is recovering from COVID burnout.
The administrative burden that the government has placed on medical doctors is forcing medical doctors to quit practicing medicine. CDCP will do the same for dentists.
3. Unilateral Changes and Lack of Stability
The CDCP is unlike any other dental plan in Canada, a participating dentist must sign a 5-page agreement. Amongst other issues, there is a clause in the contract that grants the government full authority to control how a dentist practices by requiring the dentist to allow the government to change the contract unilaterally without notice!
The government has an extremely poor track record in administering dental care programs. Why would dentists sign a partnership agreement with the government which allows the government to change the terms and conditions of that agreement at any time? A lawyer acting in the best interest of their client would never allow such a clause in any agreement!
4. Unsustainable Budget Allocation
Dentists make long-term commitments to their patients. The government looks short-term: how to get elected in the next election.
The government likes to use irrelevant numbers that impress the public to get attention and win votes. The reality is that the government has allocated under $300 per CDCP patient, well under the cost of a full exam and a cleaning!
Dentists worry this plan won’t last long because the government has not allocated enough money to make the plan work long-term. Given the failed track record of government dental programs, it is the belief of the vast majority of dentists that this program will not survive more than a year. Why would dentists sign up for a plan that they know will fail? When a dentist takes on a patient they make a long-term commitment, however, the government has set up the CDCP to fail.
5. Lack of Information for Informed Decision-Making
Dentists believe in and practice informed consent every day. It’s a process whereby a dentist shares with the patient all the relevant facts about the choices that a patient has, then and only then the patient can make an informed decision. It is a fair process.
Dentists are unable to make an informed decision about accepting the CDCP because the government has not settled all the relevant issues. The government is designing and re-designing the plan on the fly because they have not consulted practicing dentists during the development stage of the dental plan.
Without access to comprehensive information, dentists struggle to make informed decisions about their involvement in the program. Patients come to dental practices expecting their dentist to know, accept and answer questions about a program that the dentist struggles to understand because the government itself has left many of the dentists’ questions unanswered.
6. De-Insurance.
Two-thirds of Canadians have dental benefits provided by an employer. Employer-sponsored dental insurance, often called “private insurance”, is the foundation on which the majority of Canadians enjoy world-class dental care. It took decades to build a system in which high-quality dental care has had the opportunity to thrive.
CDCP is inferior to employer-sponsored dental insurance. However, employers motivated by cutting costs (and increasing profits) have already started encouraging their employees to drop the superior employer-sponsored insurance for CDCP. Unknowingly, employees are trading in their great dental plans for inferior CDCP, which will lead to inferior dental coverage and inferior dental care.
The government does not have a plan to prevent de-insurance. Two-thirds of Canadians who have earned dental benefits provided by an employer are at risk of ending up with inferior dental care.
7. Privacy Concerns
A CDCP patient agrees in the application process to have their full dental records available to Sunlife and the government. This is a privacy issue for patients. Furthermore, it’s a legal issue for dentists. A dentist has a legal obligation to uncompromisingly protect patient information. The CDCP is set up to illegally obtain patient records as a CDCP patient does not agree for the dentist to release records. A dentist has to protect patient privacy under provincial law, the federal government has ignored that obligation when designing the CDCP.
8. Respecting the provincial and territorial fee guides.
Becoming a dentist has always been and will always be the most expensive educational pathway. Dentist training involves acquiring a tremendous amount of knowledge, however, it is the development of the hand skills that sets it apart from any other educational program both in extent and cost of training. Canadian-trained dentists graduate with over $300,000 in debt and US-trained dentists graduate with over $600,000 in debt.
Dental offices require specialized equipment, materials and staff. Dental offices are governed by the same standards as hospitals. Dental offices are extremely expensive to operate. Despite what people may think, the profit margin of a well-established and well-administered dental office is 15%, this is public knowledge because of the existence of a dental corporation listed on the public stock exchange. The profit margin of an independent owner-operator dentist is considerably lower; in Canada, 70% of dental offices are independently owned.
The CDCP fees are about 80% of the Provincial fee guides, which means that the majority of dentists are expected to operate a dental office at a loss when signing up for CDCP as the government discourages balance billing. The government has plans to remove balance billing and will do so at the first opportunity, just like they did for medical doctors. Removing balance billing will lead to dental offices closing, this is exactly what has forced medical doctors out of business. It is predicted that 1 in 4 Ontarians will be without a family doctor by 2026!
Dentists, like most small business owner-operators, put their heart and soul into their dental office. A dentist’s pension is the value of their dental practice at retirement, the CDCP reduces a dental office’s value to zero by making a dental office unprofitable. It will force dentists to leave dentistry, just like medical doctors are leaving medicine.
9. Co-ordination of Benefits Uncertainty
CDCP is not the only government-sponsored dental care program. The government has not released the details about how to handle patients with 2 government-sponsored programs. Dentists are unable to provide all the relevant information for the patient to make an informed decision about their care, as often a patient choice comes down to the patient asking “Will it be covered?”- the dentist has not been provided that information from the government.
Conclusion:
In conclusion, the Canadian Dental Care Plan (CDCP) in its current form is unsustainable, underfunded, and destined to fail if significant changes are not made. The rushed implementation and lack of consultation with the dental community have led to numerous issues that undermine its potential success. Dentists across Canada are striving to salvage this poorly conceived government program, yet their efforts are hampered by administrative burdens, inadequate funding, and unilateral changes imposed by the government. Without the active involvement and support of the practicing dentists who are supposed to deliver dental care, the CDCP will not succeed. It is imperative that the government addresses these concerns and works collaboratively with the dental profession to ensure the program’s viability and effectiveness for all Canadians.
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