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It's said that the only certainties in life are death and taxes. To this I'd add a third certainty; inexorable change, and this is particularly apparent to anyone in the dental profession at the moment. For many dentists the rate and nature of recent change is the source of unprecedented stress and anxiety, with increased costs to practice owners and reduced employment for associates. Yet newly qualified members may have to see the current rate of change as an intrinsic part of working. Dentists who qualified earlier are likely to have been told that they too were joining the profession at a very difficult time; the introduction of NHS charges to patients and the switch to the current UDA system could both have been predicted to be catastrophic changes. Dentists have repeatedly shown themselves to be highly adaptable to change and this is one quality that the recently qualified cohort certainly possesses.

While undoubtedly testing times are ahead for dentists it's worth making a few comparisons with other professions in the current climate:

According to The complete university guide,1 graduates of dentistry still have a higher mean starting salary than any other discipline (and remain the only graduates with a mean starting salary of more than £30,000). It's unlikely that our earning capacity will increase in line with previous cohorts, but it's reassuring to know we're starting out at the top. The Complete University Guide figures released in April 2013 showed that dentistry also offers the highest employment rate of any degree course in the UK.2 This is based on 99% of 2011 graduates being employed in a graduate job (and the other 1% studying). Although national recruitment to DF1 has led to a number of issues for UK graduates finding posts, the position in dentistry remains better than in any other profession; 9% of vets, for example, were either unemployed or employed in a non-graduate job. Concentra cited 'medicine and dentistry' as the most competitive degree subject in the UK in 2013,3 and the most recent data available which splits the two cited more applicants per place for dentistry than for medicine.4 It would appear that people choosing a career, and presumably examining other options, are still feeling that dentistry is the best career choice out of those available.

There is naturally no space for complacency. Aside from the uncertainty due to starting our careers during a worldwide economic downturn, there are issues facing dentistry specifically that will require solidarity from the whole profession. The recent changes by the General Dental Council (GDC) regarding direct access to dental care professionals have received a mixed response from all groups within the profession. This has the potential to dramatically change the way dentists work in the future. The GDC opened up an online consultation and all dentists and dental care professionals (DCPs) were able to share their views. The consultation failed to gain a lot of coverage among dentists and less than 1.5% of dentists responded, which could be attributable to lack of awareness rather than apathy.5 The GDC has also recently changed its guidance in the Scope of Practice document to allow hygienists and therapists to 'diagnose and treatment plan to within their competence';6 yet few in the profession seem to be aware of this important change. Public opinion of dentistry is not improving and the increases in litigation and cases brought before the GDC is now a staple topic for speakers at dental postgraduate study days whatever their speciality. In seeking to protect the public the recent GDC Standards guidance has returned to a more prescriptive style but has kept the key instruction to 'put patients' interests before your own or those of any colleague, business or organisation'.7 The equivalent statement issued by the General Medical Council (GMC) to 'Make the care of your patient your first concern'8 is softened by being specific to the patients' care rather than a hyperbolic imperative to put patients' interests before your own no matter what the circumstances. Further concerns are raised by recent additions to the already lengthy list of regulations applied to the profession, and with increased regulation comes increased scope for investigation, litigation and punitive action. It's also difficult to develop any genuine professional ethics when every decision has to be balanced by a bewildering amount of legislation and guidance. There are hopes that the new contract may enable dentists to practice more of the kind of dentistry they have been taught at dental school than the current UDA system but there is a real danger that the proposed capitation system will become yet another of the target driven systems that appear to be ubiquitous in today's workplace.

Our conditions, terms and clinical and professional judgements seem to be increasingly out of our control. As newly qualified dentists it's easy to feel that our pay and prospects are diminishing as steadily as our autonomy. Now, arguably more than ever before, newly qualified dentists need to unite and ensure our involvement at every level available. Local dental committees and local BDA branches often struggle to recruit more recently qualified members yet we are the group who future decisions will affect the most.

In 1997 I began working as cabin crew for British Airways. When I started that career I was told I was entering it at the worst possible time. When I left to start my BDS 11 years later my starting time was being remembered as 'the good old days'. If this really is the worst time to become a dentist then there are two options for new dentists: wait for an improvement and never take our security for granted; or work closely together to keep the profession firmly in 'the good old days'.