Internationally trained dentists (ITD) must overcome significant barriers to becoming qualified and licensed dentists working in Canada. That includes massive piles of verifiable documents, thousands of dollars, and numerous highly challenging exams.
This entire equivalency process is also hard to understand, especially for those immigrants that are still learning the language or are unused to information gathering in a new country.
That is why organizations designed to help ITDs along their journey are necessary to improve our country's dental and oral health.
There is a bigger goal that often gets overlooked, and that is unifying the many international students, immigrants, and working professionals focused on improving not only the lives of their families with a lucrative career but the social needs of Canadians by providing an essential service.
To that end, we had the unique opportunity to meet with Dr. Luca Salvador, founder of the Internationally Trained Dentists Association of Canada (ITDAOC).
Since March of 2021, this organization has focused on providing fair and equal representation for ITDs, offering helpful guidance, and remaining an outstanding advocate for improving the equivalency process.
Dr. Salvador received his HBSc from the University of Toronto in 2013 and was awarded his Doctor of Dental Surgery from Poznan University of Medical Sciences in 2018. This places him in a unique gray area of Canadian dental regulation as his primary degree is from a Canadian school while his doctorate is from Poland.
We discussed the future of ITDs and general oral health in Canada and how the equivalency process should be transformed to ensure a brighter future for the country.
A Long & Expensive Process
It helps to understand a bit about ITD equivalency programs. At its core, the National Dental Examining Board (NDEB) created the equivalency process for those international dentists with education, experience, or training. The idea was to get all dentists working in Canada to the same baseline of practice standards.
This is a valid concern as no one wants to interact with a dentist who is not qualified to perform operations, cleanings, or other procedures. The problem is this process is highly cost-preventative and often extremely confusing to the average ITD.
Add on top of that the immigration process, and you have a recipe that prevents more highly qualified dentists than it helps.
“If it costs $100,000 CAD or more to undertake the equivalency process and you know you are looking at a historical passing return of roughly 40%,” says Dr. Salvador, “then that is significantly below what it should be. Our goal is to encourage regulators to validate our equivalency exams using Canadian graduates.”
This is a strong argument about the NDEB equivalency process because the current belief is that 100% of Canadian dental school graduates could pass the same exams given to ITDs. Dr. Salvador and his organization have a simple ask to these regulators - prove it.
If the belief is that Canadian dental school graduates can pass these same exams without preparation, then all the ITDAOC is asking for is validation.
That is currently the vision of the short-term goals of this organization, to transform the equivalency process so it is more welcoming, cost-effective, and realistic for the backgrounds of those ITDs that apply and painstakingly pass through to the other side.
A Question of Immigration
While the short-term goals may be to update the NDEB equivalency process, the longer-term issues surround the regulation of immigration concerning dentists. There is a shortage of skilled labor for dentists in Canada.
There are roughly 12,000 job openings expected in dentistry from now until 2028, and only about 7,000 available students and trained individuals to fill them. That leaves a massive service gap, especially for rural or hard-to-reach communities.
In the meantime, you have a long line of trained individuals highly motivated to make the jump to Canadian citizenship. Canada has one of the better international reputations for immigration, but that does not mean it cannot be improved, especially in an area concerning a high-in-demand technical skill requiring specific knowledge.
“There are thousands of internationally trained dentists in Canada right now,” continues Dr. Salvador. “We’re ready to work, but can’t. So the issue is how to address the regulatory barriers preventing our forward progression as well as the self-regulation question.”
This is, again, a valid point. Most of the mechanisms in place to hold organizations like the NDEB accountable are critical and require experts in dentistry to set the rules, not those without any experience. There needs to be a check and balance on the regulators in charge of the equivalency process.
“We give them credit for recent positive developments,” says Dr. Salvador, “but more needs to be done so ITDs are given a fair opportunity to improve Canadian society.”
One of these improvements is a proposal that the new NDECC exam, a highly reliant skills component and bespoke situational judgment component, be separated into two entities. This way, if you pass one and fail the other, you are only forced to retake the other.
The Question of Cost & Awareness
ITDs are asking for fair treatment because the perception is that they are treated as something less. A good example of this was the recent global pandemic during which many equivalency exams were canceled. On the whole, the NDEB did a good job of ensuring the flow of qualified dentists through the process, except for ITDs.
Dental schools would not allow ITDs to use their facilities for the ACS exams. This could be outside of the NDEB’s control, but that resulted in a significant drop in qualified ITDs that could then progress through the process and start serving Canadian communities.
Every time there is a delay to the equivalency process, it costs those ITDs hundreds to thousands of dollars. These are individuals living in a country where they most likely do not have local support, a high-paying job, or the resources to recover from such setbacks.
If the goal of the Canadian government is to bring more services to citizens in all provinces, it only makes sense to make the process of ITDs smoother. Any failed exam due to improper design or elements beyond an ITDs control wastes thousands of dollars and months of their lives.
“Many competent dentists fail when they shouldn’t have,” continues Dr. Salvador. “That extends their process by months, if not years, and costs them thousands of dollars.
This is a big issue that has not been addressed in a satisfactory way yet. There are gaps in supplying us with information to validate what they are telling us. There should be fairness in the equivalency process because it is a challenging journey for all to undergo this series of exams.”
The problem here is representation. At many planning meetings and annual reviews, the only people allowed in the room are from the NDEB or supporting organizations like the Federation of the Canadian Dental Students Association (FCDSA). Other groups, like Dr. Salvador's, are often excluded from the meeting rooms.
This breakdown in transparency fosters apprehension and mistrust that there is an authentic effort to great a fair and just equivalency process.
“We have submitted fundamental questions over the last 6 months for which we have not received answers,” says Dr. Salvador. “That’s a big issue because if they’re not willing to discuss or address these issues openly with us, then we have to go through other means to get these issues addressed.”
The Birth of the ITDAOC
Dr. Salvador had the opportunity to meet with the executive director of the NDEB, Dr. Marie Dagenais. This was a good meeting where concerns were heard, but questions still remain unaddressed.
“I don’t think she is a bad person at all,” says Dr. Salvador. “I think she has good intent and a very challenging job. The problem is communication and transparency. When questions go unanswered, how are we to know we are receiving a fair chance to succeed?
Many ITDs come from countries where speaking out against authority has severe consequences. We’re trying to encourage people not to be afraid in Canada.
People move here because they don’t want to deal with stuff like that anymore. It is about improving the process, so the next generation of ITDs doesn’t go through the same issues ours has.”
When you visit the ITDAOC website, the very first words you see are “Together, we are strong.” This is the best representation of Dr. Salvador's organization.
Go to their board of directors. You’ll find all ITDs with truly impressive backgrounds and recent accolades working in Canada to help improve the dental profession. This is not a group of outsiders.
These are people living, working, contributing, and thriving in Canadian society seeking to make things a little better for those that follow in their footsteps. Can you think of any more authentic Canadian pursuit?
Fair Representation Breeds Trust and Opportunity
We could not be prouder to have had the opportunity to sit and discuss the future of ITDs and oral health in Canada with Dr. Luca Salvador. It is good to know there is an organization dedicated to helping ITDs find a brighter future here in Canada.
At the end of the day, it is all about having a voice at the table of decision-makers. Creating a representative body of ITDs, so they receive a fair chance at building a life in Canada that contributes to the betterment of their people.
If you would like to learn more about Dr. Salvador and the ITDAOC, please visit their website. They frequently post to their blog, host online and in-person talks, and advocate to numerous regulatory bodies within the Canadian government for fair and practical initiatives.
New members are welcome to join at any time. When you become a member of ITDAOC, you will be kept up to date with all the latest initiatives, news, and outreach programs being leveraged to improve the future of ITDs seeking a bright future in Canada.
Canada has long held a reputation around the globe as a warm and inviting country full of people who value respect and fair treatment.
Seeing an organization like the ITDAOC grow is not only a bellwether that there is an issue but a strength that Canada is a free space where voices can and must be heard to enact positive change.
We fully support Dr. Salvador and the rest of the ITDAOC Board and membership in their endeavors and will be closely watching the future developments of this well-meaning and necessary pursuit.
Karen Nunez was born in Valenzuela, Philippines. She received her Doctor of Dental Medicine degree from Centro Escolar University in Manila.
Karen currently is a practicing oral health care professional based in Alberta, Canada; and runs a Blog where she writes a slew of articles to empower internationally trained dentists to integrate into Canadian dentistry.
Read more of her blogs here.