Table 3 Illustrating quotes

Organizational Issues – Dentists find the organization of appointments difficult for people on social assistance

People on social assistance tend to consult in an emergency and often miss appointments

That, I’ll be honest, is one of the things that bugs me the most even now. They don’t show up. They don’t show up, they don’t call, they don’t let us know, and that’s just how it is. [CL3]

People on social assistance do not have valid reasons for missing appointments

“I went to bed at 4 in the morning. I didn’t feel like coming.” They’ll tell you. They went to a bar, they went out to a strip show. They were watching t.v. They went out on the town with their buddies. And then, well, of course, when you go to bed at 4 and you have an appointment at 10 in the morning, well, sometimes… [CL12]

People on social assistance are not flexible and have little availability during off-peak hours

It’s simple; you don’t give a morning appointment to someone on social assistance because that’s when he sleeps! […] They tell us: “not in the morning, not too early in the morning. Not 9 a.m. Not 10 a.m. We get up late.” Fine. “So we’ll give you one in the afternoon.” “Well, no; I work.” […] So these patients want to come in the evening when I don’t work, so they’ll come on a Saturday and take the spots of my good patients’, who make an honest and steady living. [CL13]

Biomedical issues - Dentists feel unable to provide people on social assistance with adequate treatments

Public dental insurance does not cover several treatments; people on social assistance cannot afford to pay for treatments not covered

It is unsatisfying to be very limited in the treatments I can offer people on assistance. The treatments we can offer people on assistance are treatments that date back to the thirties, to the fifties. […] So for someone who likes technology a lot, who likes to perform a lot of state-of-the-art treatments, it’s disappointing. I have to say that, usually, I get no pleasure from treating people on social assistance; it’s not because they’re on social assistance, it’s because of the limits placed on me in terms of treatment options. [AL10]

People on social assistance lack motivation to care for their health and neglect themselves

I have experienced the same thing my colleagues have; we all have. Patients on welfare are not always reliable. [CB2]

Dentists feels powerless and discouraged

We try telling them, « floss and brush your teeth ». There is often a generalized level of neglect. The [dental] hygienist, for example, often gets really discouraged. [AL5]

Financial issues – Dentists perceive patients on social assistance as non lucrative and a threat to financial sustainability

The government fee schedule is too low

Even though we’re paid, when it comes down to it, it’s almost pro bono work. Because to, say, remove a tooth, I think it’s something like 13 dollars. It costs me more in electricity, material, my assistant, my secretary, and all that, than what I make. [AL3]

The low reimbursement rates are unfair and frustrating

It annoys me to be paid less by [public] health insurance. It really annoys me because I don’t take less good care of that particular patient. I can’t sterilize the instruments less. I can’t use poorer quality materials. I only have one kind of amalgam, so I use it for everyone. Of course, maybe, for another [person not on public assistance], I might give them a crown, but you can’t work less well just because someone is on social assistance. So I don’t know why we shouldn’t be paid the same price. But instead of giving to the United Way [charity], I give to the public insurance scheme. [CL8]

People on social assistance's missed appointments create a “wage gap”

Given that, first of all, just seeing them pays less than the same procedure I would give to you or someone who has [private] insurance, I don’t get the same fees. And if I’ve scheduled an hour for restorations and he doesn’t show up, plus, you know, in addition to losing the fees I would have had with a normal patient, I lose the hour as well. [CL2]

People on social assistance are a threat to financial sustainability

Currently, I have very few. I don’t mind at all. It’s not like I have a big clientele of only them… [CB2]

Dentist: I like my work. Except for the fact that my colleagues make more money than I do, and they’re always rubbing my face in it, and I have to live with it. […] The only thing… society judges success according to how much money we make, so psychologically it has an effect [on me], to see that I am below average, I guess, compared to other dentists. [AL4]