Number of dentists registered in the UK in 2007: 146 in 2008: 187 in 2009: 202 in 2010: 249 in 2011: 264
The Dental Division of the Hungarian Medical Chamber reports that the workforce is decreasing in number as fewer Hungarian dentists are being trained than those retiring, or otherwise leaving full-time work as a dentist. Figures show that there are a large number of dentists (both male and female) over the age of 50 who will be retiring in the years up to 2013, more than the number of Hungarian nationals who will graduate from the four Hungarian dental schools (5). In 2011, male dentists accounted for 43 per cent of the total and females 57 per cent (5).
It has been concluded that there was relatively little movement of dentists into and out of Hungary during the period between 1970 and 2005 (13). Migration of dentists into Hungary appears to have occurred for political, economic and cultural/linguistic reasons (12). However, before 2005, relatively few dentists had been motivated to leave Hungary. It appears that in spite of major political changes, no more than 85 dentists emigrated from Hungary between 1989 and 2005 (12). More recently, a number of Hungarian dentists have come to the UK (28).
The number of dentists registered in 2010 was 5,673, and the number in active practice was 4,963.
There are specific regulations defining radiation protection. Radiographic equipment must be registered by the Department of Public Health Service, and is checked regularly (5).
No vocational, nor foundation training programmes currently exists. Prior to 2010, the government provided financial support for a limited number of dentists who were undergoing specialist training. This has now ceased and specialist trainees have to pay their own tuition fees during their specialist training which lasts for three years for all specialties other than oral and maxillo-facial surgery. Although maxilla-facial trainees start with a medical degree, they are required to attend special dental theoretical, pre-clinical and clinical courses, which form a significant part of their postgraduate training.
Hungarian dentists are required to register with the Ministry of Health in order to practice dentistry. The annual registration fee is 5000Ft (19 Euros).
The ethical code in Hungary is enforced by both local and national ethical committees. This is a joint system with the medical profession, but the ethical committee always includes two dental members.
Dentists, and those who work for them, must be vaccinated against hepatitis B. The employer usually pays for vaccination of the dental staff.
Indemnity insurance is compulsory for all dentists in Hungary and there are many insurance companies which offer this service.
Dentists are allowed to form corporate bodies (companies). A non-clinician can own or invest in a dental surgery. The person undertaking the dentistry must be a dentist, but there is no requirement for the investors to be a dentist.
There are specific regulations defining radiation protection. Radiation equipment must be registered by the Department of Public Health Service, and is checked regularly by them.
Amalgam separators are not mandatory in older dental units, but are a legal requirement in all new units. By 2008, approximately 50 per cent of practices were appropriately equipped with amalgam separators.
2. Education and Training
There are four dental schools, all state funded. The largest of the four dental schools is at the Semmelweis University in Budapest. The other three schools are at Szegred, Debrecen and Pecs. The Ministry of Health determines the number of publicly funded places annually. There are a number of dental students from other countries. There are over 650 dental students at the Budapest school with about a third from EU and non-EU countries – Greece, Cyprus, Israel, USA, Sweden, Canada, Ireland, China and countries in the Middle East. Most are taught predominantly in English, but there is one course taught in German.
Since 2004, the Hungarian Doctor of Dental Medicine (DDM) degree has provided full competence and the right to practice dentistry independently on qualification. Previously, after qualification, there was a two year mandatory vocational training programme as well as a licensing examination. However, Vocational or Foundation Training programmes do not currently exist.
The recognised dental specialties which involve three years of training are: orthodontics; periodontology; paediatric dentistry; endodontics and conservative dentistry; prosthetic dentistry; oral and maxillofacial surgery (available for medical doctors only) and dento-alveolar surgery which is a new speciality, for dentists only (5).
Since 2004, a new specialty "conservative dentistry and prosthodontics" has replaced the previous "general dentistry and oral diseases" vocational training examination.
3. Support Systems
The Hungarian Medical Chamber is the national professional association with a dedicated dental division. However, membership to this body has not been mandatory since January 2007. In 2008, about 90 per cent of all Hungarian dentists were voluntarily registered.
The Hungarian Dental Association is a scientific organisation and incorporates several professional societies. – the Hungarian Society of Periodontology, the Orthodontic and Paedodontic Society, the Society of Implantology, the Prosthodontic Society, the Association for Preventive Dentistry, the Society of Oral and Maxillofacial Surgeons, the Society of Dento-maxillofacial Radiology and the Endodontic Society. Membership of the Hungarian Dental Association is not mandatory.
There are three kinds of dental care professionals: dental hygienists, technicians and nurses
In 2010, there were 2,077 dental hygienists. Most dental assistants have a dental hygienist qualification, however only 600 are actively practicing as a hygienist. To become a qualified dental hygienist, it is necessary to undertake training in a school specifically delivering a dental hygienist training programme for one year, following two years of training as a dental assistant. They are required to work under the supervision of a dentist and their duties include scaling and polishing, the placement of preventive sealants and delivering oral health education. Currently, registration is not a requirement, but this is planned for the future
The training for dental technicians is three years in duration; theoretical training is undertaken at school, and practical training at appointed laboratories. They are responsible for constructing prostheses according to a dentist’s treatment plan
In 2010, there were 4,307 dental nurses (28). Dental nurses assist the dentist at the chairside. Until 2008 they were trained for two years, in one of 22 specialised secondary schools, after leaving secondary school with the general certificate of education. However, since 2008, training has been centralised to fewer centres
It is compulsory for a dentist to work with a dental nurse (chairside assistant)
It is presumed that there are illegal denturists in Hungary because of the complaints received from patients (5).
5. Dental care delivery
In 1993 a National Health Insurance Fund (NHIF) was introduced which is based on compulsory payroll contributions from employers (75 per cent), and employees (25 per cent). Almost all Hungarians are members of a public healthcare scheme. Dental services are provided through the NHI, or by private dentists (5).
Almost all Hungarians have insurance and are members of a public healthcare scheme (9). The National Health Insurance Company provides oral health care for most of the population. All employees and employers are obliged to pay into this insurance company. The NHIF is financed by compulsory contributors. Employers contribute 75 per cent, while the employee contributes the remaining 25 per cent. Complementary schemes and voluntary funds also exist and 70 per cent of their total expenditure is spent on dental treatment.
Dental treatment is free for children and young adults between 0-18 years, and those over 60, but these patients must pay full laboratory costs (5). Expectant mothers, nursing mothers (168 days following the birth of a child), military personnel, pensioners and people with work related illnesses also receive free care (9).
For dentists with a contract with the NHIF, the prices are regulated; the Insurance Fund establishes the minimum cost of each treatment intervention. For procedures not financed by the Fund, e.g.: crown and bridge work, the dentists’ fees are matter of a negotiation between patient and dentist. There is no centralised control on dental and laboratory fees.
A dentist would typically have up to 2,100 regular patients on his/her “list”.
In a few towns there are dental clinics which owned by the local government. Dentists may work in these clinics and participate in the NHI system on the same terms as private dentists, although they are salaried employees of the clinic. Patients may receive fillings, surgery and endodontics within the NHI, but will have to make co-payments for prosthetic appliances.
Prevention programmes are generally poorly developed (5).
There are only 160,000 people who have private health insurance in Hungary (2008), with one of the 42 private insurance companies (just 9 private insurance companies have more than 5,000 members) – so they have little significance in the dental health care system.
About 40 per cent of dentists work wholly privately, outside the state system (2008). Patients pay their dentist directly, under an item of treatment system. There is no regulation of private fees. Of the 70 per cent who work in the state system, some will also work privately, part-time. For dentists who are contracted to work with the NHI the only private items that can be provided are those which are not covered by the insurance scheme. For those dentists who are in private practice, their patients pay for all of their care.
Domiciliary care is not formally provided in Hungary, although some private dentists may provide it (5).
6. Quality assurance mechanisms
Continuing professional education is mandatory in Hungary. The system is managed principally by the Dental Division of the Hungarian Medical Chamber. There is a scoring system, with accredited continuing education courses. A dentist must achieve 250 points in five years. This represents 250 hours, and a limited amount of reading can be included. The ultimate sanction for non compliance is suspension from practice. Radiation protection training is mandatory for both undergraduate dentists and for practicing dentists possessing X-Ray equipment. The licensing course must be retaken in each five year period.
There is a compulsory internal quality insurance system for those dental care providers who are contracted with the National Health Insurance Company.
Quality Assurance in public clinics is undertaken by the heads of the respective clinics, (5).
Patients’ complaints about state or private care can be sent to the dental care providers, to the National Public Health & Medical Officers Service, or to civil courts. Ethical complaints are judged by the Ethics Committee of the Medical Chamber.
Only the Hungarian Ethical Court may withdraw the license to practice for a practitioner.
There are authorised regional legal representatives for patients, who help with obtaining remedial actions on their behalf. The most serious penalty is that a dentist may lose their license to practice, but this is very rare. A member may also be admonished. It is possible to appeal to an upper level and finally to the courts.
Key Points to Consider When Inducting or Supporting a Dentist Qualified in Hungary
Dentists qualified in Hungary:
Have limited experience of a publicly funded health service, unless they qualified before 1990;
Have limited experience of UK monitoring procedures (e.g. NHS dental services) or UK requirements for clinical governance (e.g. clinical audit);
Will not have undertaken vocational or foundation training in Hungary, unless they qualified before 2003;
May have little experience of working within the wider team of dental care professionals;