Dr. Norman Miller


Dentists for the Queen

BRONWYN CHESTER | When the Queen Elizabeth Hospital was closed in 1996, it looked as if that would be the end of McGill's long association with the century-old institution.

But, just as the hospital wrote itself a ticket to survival, changing its vocation to that of a multi-service health complex, part private, part public, so did dentistry professors Norman Miller and Antonio Mirarchi find a way to combine the public and private spheres of dentistry to make it possible to teach dentistry in a "community setting."

Community setting, in this case, means a place that is neither a private office, nor a hospital, which is where all McGill dentistry students received their training before. It also infers dentistry that is affordable.

While this clinic is staffed by dentistry residents -- recent graduates who are licensed to practice -- and supervised by McGill-associated practising dentists, patients pay only 70% of the regular fee.

Finally, "community," in this area of Notre-Dame-de-Grace means a high concentration of elderly people -- the highest in Canada -- so this practice of dentistry will be particularly attuned to the needs of that population, including having a portable set-up for tending to people in old-age homes.

Mai Trang Nguyen, one of the three residents in the newly opened Queen Elizabeth Oral Health Centre, was attracted to this residency program in part because of the experience it would give her with elderly people.

"They're the future," she says, in reference to our aging population.

Working on an elderly patient, she explains, requires paying particular attention to the types of medication they take, some of which, like aspirin, may be used for medical reasons to thin the blood but may cause excessive bleeding in the case of a dental extraction.

"So," says Nguyen, "you might ask the patient to stop taking aspirin three days before.'

Nguyen says she opted to do the year-long Multidisciplinary Residency Program in Dentistry, officially launched last week, because it would give her more experience than if she had gone directly into private practice.

What makes the program multidisciplinary is that McGill-affiliated practitioners, or "demonstrators," will spend time at the clinic, making themselves available to the residents for consultation in such specializations as periodentics (gums), endodentics (root canals) or oral surgery.

"Wednesdays might be root canal day, for instance," says resident Joseph Vaccaro who chose this residency over one in a hospital, because of "the ideal learning environment."

And who paid for this $500,000, state-of-the-art set-up, spread over 6,000 square feet? Well, McGill contributed $40,000 toward the start-up costs. The rest was put up by the clinic's founders and co-directors Miller and Mirarchi, both of whom are quick to recognize all the support the project received from dental supply companies in providing good terms for the lease of equipment.

"Every single company I dealt with gave us amazing rates," says Mirarchi, who directs the business side of the clinic and who came up with the concept for the clinic.

They also thank the Centre-West Community Health Corporation, the non-profit owners of the health complex, for waiving rent and taking responsibility for the equipment leases until the clinic is up and running. The not-for-profit organization also permitted Miller and Mirarchi to recycle any of the old hospital's fixtures. "The two of us and the contractors did the picking," says Miller, pointing at the glass-doored cabinets in his office. "That helped with the construction costs."

Miller is proud to point out that revenues from patient fees will, eventually, cover all expenses including the residents' salaries of $12,000 each. "This clinic is completely self-sufficient."

One way of remunerating the demonstrators, says Miller, who directs the residency program, may be to offer them the use of one of the four dental suites, built especially for private practice, in exchange for their teaching time with residents.

Normally, demonstrators aren't paid much for their time, if at all, making it very difficult to attract dentists away from their practices in order to teach, adds Miller, a long-time demonstrator himself.

"We needed innovative ideas in order to facilitate teaching and making a living. The residency program must run as a non-profit entity within a private facility.

"For me, this is made in heaven, integrating practice with teaching and being part of McGill," he says, noting that medical people already have this arrangement.

This isn't Miller's first foray into changing dentistry education.

Seven years ago when the University threatened to close down his faculty, Miller, then a part-time demonstrator, was a central figure in the effort to save dentistry and reshape it for future needs.

This new residency program, the only one of its kind in Canada, is part of Miller's continuing quest to maintain McGill's dentistry program as robust and adaptable.

One of Miller's challenges in this private/public hybrid of a clinic is assuring that his own patients, all of whom moved with him from his former Westmount practice, feel comfortable. "I have my McGill demeanour and my private demeanour," chuckles the 25-year veteran of general practice. "I may have to watch my jokes."