Dental Education In Hungary And The Current Position Of Dentists
This summary is intended to provide a snapshot of Hungarian dental education and the current position of dentists in Hungary today. In addition to a general assessment, this paper also includes an account of my personal experience gathered over the past 25 years, both as a university instructor and a practising private dentist.
In 1938, before World War II, there were 2,093 dentists in the Hungary. According to the population statistics of that time, 4,300 inhabitants were served by one dentist. 40% of the dentists worked in Budapest, the remainder were employed in the rest of the country. The number of dentists dropped by half towards the end of World War II. A dentist’s diploma was awarded at that time following a 3-year period of professional practice after a general practitioner's diploma had been earned. This constraint resulted in a stagnation of the number of dentists. The situation became even worse when, pursuant to Government Decree no. 12. 170/ 1948 issued in order to decrease the shortage in dentists, 120 dental technicians obtained qualification as “certified dental specialists.”
According to WHO data, an ideal situation involves 1200 patients being served by one dentist.
In order to mitigate this problem, an effective measure was taken in 1950, when the training of dentists in Budapest was launched for the first time (with 70 students enrolled annually).
In the period between 1960 and 1968, it appeared necessary to raise the number of students to 180 per year, with as many as 203 students enrolled in academic year 1961-1962. Shortage in dentists in the cities and villages of the country forced the Ministry of Health Care to implement — predominantly unsuccessful — administrative measures.
This led to “decentralization” of dental education. Training of dentists commenced in Szeged in 1960, in Pécs in 1973, and in Debrecen in 1977, with enrolments ranging between 15 and 30 students.
Over the past 10 years, on average 130 dentists graduate each year in Hungary.
At present, there are 2,880 dentists in Hungary, which is far below the ideal rate of supply.
No inflow of foreign employees arriving from the neighbouring countries can be anticipated owing to the fact that a part of them have a similarly ageing human resources structure, the other part (those working in the EU countries) can achieve 5 to 10 ten times higher salaries in those EU countries, compared to current income levels prevailing in Hungary. Hungary’s’ accession to the European Union, on the one hand, and a diploma in dentistry obtained in the EU and one obtained in Hungary being recognized as equal, on the other hand, will presumably further decrease the supply of dentists in Hungary (emigration to an EU country for a significantly higher salary).
Migration for the purpose of finding a job after earning a diploma is typically oriented toward the capital. A large percentage of the graduates try to find a job in Budapest or in West Hungary, where the prospects of a good income are considerably more favourable.
One should also take into consideration the highly flourishing Hungarian dental tourism, which attracts patients arriving from western countries for treatment for a fraction of the prices they have to pay abroad. This type of service is predominantly offered along the western border and in Budapest, as a result of easier access (the airport in Budapest and the proximity of Austria, Switzerland, and Italy to our western borderline). The opening of a new motorway around the end of 2005 may open up similar opportunities for Szeged as well. Dental tourism basically involves middle-aged and elderly people typically arriving for complex dental treatment, although occasionally younger patients and, not infrequently, whole families are seen visiting a dentist for treatment.
In-vogue treatments include implant placement, preparation of multiple crowns and bridges, placing of ceramic shells, and teeth whitening. Often times, patients request a complete denture or want all their amalgam fillings replaced at once. The procedure involves the following steps: requesting detailed information from the client via e-mail or over the phone in order to clarify a number of questions pertaining to treatment and care. If possible, the patient is asked to provide a panoramic image so that the problems expected to occur during treatment are known in advance. For example, a foreign patient may arrive on a Sunday evening and treatment may commence already on Monday morning. The patient spends about a week - maximum 10 days – in Hungary. In the event of implantation, another visit is necessary to accomplish the treatment, usually half a year later. Overall actual time spent on treatment is not more than 10 hours. The rest of the time is available to the patient for other, more pleasant activities.
As a matter of fact, selecting a dentist is an issue of trust: after a flight across Europe and arrival in an absolutely unknown country, requesting dental care from a total stranger is by no way an easy issue – no matter how low the price is. Establishing sympathy, through the provision of appropriate information, options to choose from, and sufficient time to allow the patient to think it all through, appears a must. Sometimes foreign patients need to be told that Hungarian doctors use the same materials and apply the same procedures as their western colleagues. The only difference is that they do it for one-third or one-fourth of the western price. In addition to patients arriving from Great Britain and Ireland, we also have clients from Spain, the Netherlands, and Scandinavia. There are even patients from Canada and the USA who decide on crossing the ocean for the sake of receiving treatment in Hungary.
Business experts believe that it is still a good idea to launch an enterprise in this flourishing business sector because the difference in prices is not expected to disappear within the next 10 years. Over the long term, however, Hungarian treatments will probably “adjust” to the level of prices of dental treatments in the countries of West Europe. Until then, however, a large number of patients from the United Kingdom, Switzerland, and the States will get seated in a Hungarian dentist’s chair.
Low state-provided salaries and profitable private practice
The most striking disproportion characterizing dentistry is attributed to the extreme difference between the income of state employees and those working in the private sector. It is clear that there is a high demand for highly qualified specialists who work in dentist training institutions and universities, speak several languages, carry out scientific activities and publish the output of their research. But what is their remuneration in Hungary??!!
Highly qualified top level dentists employed by the state perform work at an international level for a net amount of about HUF 150,000 (USD 750) per month. As a consequence, 90% of the dentists are forced to pursue, after their main daily assignment, private practice as a second job. Given the present level of Hungarian prices, the current amount of monthly income is less than sufficient for covering even the minimum expenses of living of a physician. It is also important to note that the University of Szeged can contribute to the costs of attendance of a researcher at a Hungarian conference or a conference abroad by an annual amount of HUF 50,000 (USD 250). In general, that amount is less than half of a usual registration fee at a conference, and there are also costs related to travel and accommodation. It is thus clear that even the financial needs that are related to professional requirements can be satisfied with the help of income realized during private consultation. The schedule is thus organized as follows: starting the day at 7 a. m. at the Department of Dentistry of the University, teaching activities, patient care, research, etc., during full-time work. After that, patients are received in the private consultation facility until 8 or 9 p. m. If you are lucky enough to be involved in dental tourism and also have foreign patients to treat, then you can treat your private patients also over the week-end, and everything will start anew on Monday.
As a result of the above situation, the number of dentists working exclusively for their private patients has increased considerably, while the number of state employees, especially in the eastern regions of the country, has dropped to a large extent, while there is extra supply in western Hungary and Budapest. The rate of migration of specialist to various countries of the European Union, hoping for higher salaries, has grown significantly, which places the supply of highly qualified Hungarian specialists at risk.
For those who choose, notwithstanding the above circumstances, to carry on teaching, research and patient care activities in Hungary, the only solution will be to utilize the benefits of western / American dental tourism in order to make ends meet, as a compensation for those specialists who stay home and are willing to undertake extra work.
Katalin Nagy D.D.S.; Ph.D.
Department of Dental Surgery
University of Szeged
Faculty of Dentistry