Family ties

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Dr-Karin-Alexander-ADA2The ADA’s new federal president, Dr Karin Alexander, has taken on the job during interesting times. Kerryn Ramsey reports

Karin Alexander became president of the ADA last November, there was no-one more proud than her 89-year-old mother. But it was more than just motherly love—there was a professional bonding as well. That’s because Dr Alexander’s first position as a qualified dentist was at her mum’s practice, attached to the family home in Adelaide’s suburb of Royston Park.

“Sometimes she can’t understand why I accepted the presidency because of the travel and the extra work,” says Dr Alexander referring to her mum, Dr Vera Alexander who worked as
a dentist until she was a mighty 84. “At the same time, she loves the fact that I’m doing it.”

For Dr Alexander, it was her mum’s determination and fearlessness that inspired her to enter this profession. Vera moved to Australia from her home in Lithuania just after World War II with her husband, electrical engineer Victor, “with virtually nothing but the clothes on their backs”.

Although she was a qualified dentist, the overseas degree wasn’t accepted back then, so she had to restudy her degree in Adelaide. “They didn’t have the Australian Dental Council to run exams to check whether you were able to be registered here,” recalls Dr Alexander.

Undeterred, Vera passed her degree with flying colours, and opened her family practice in 1955. And now more than half a century later, it’s her daughter who has the same patience and doggedness, using these traits to move up the ranks as ADA’s first female president.

“If you had asked me if [I planned to be president] many years ago, I would have given you a very quizzical look,” says Dr Alexander, who still runs her much-beloved Royston Park surgery as well as a four-clinic practice in Adelaide’s CBD.

An invitation to join the Practice Management and Member’s Services Committee back in 1983 was her first involvement with the South Australian branch of the Australian Dental Association (ADASA). Learning about the machinations of the association and government piqued her interest, and later took a position on the Peer Review Committee.

“Working on various committees to see how the ADA works was almost addictive,” she admits. “When you get a reasonable result, it makes you want to do a little bit more. Very, very slowly, it draws you in.”

One of her most challenging—but satisfying—outcomes was a joint project in 2003 with the SA Dental Service (SADS) and ADASA to improve the dental care for aged residents at nursing homes, with nine dentists providing treatments for residents. “It was to see whether it improved their health, and whether it was possible to do,” says Dr Alexander who still visits her two nursing homes on a regular basis.

Under SADS’s Dr Martin Dooland, the dentists use portable equipment supplied by SADS at the various nursing homes. The service also became a Commonwealth-funded research project. “Even after the original project finished, SA Dental Service quarantined money for us to continue working in the nursing homes.”

“Like my mother, I really love working with people, love helping them out, love getting patients who come in scared and in pain and being able to have them walk out with a smile on their faces.” – Dr Karin Alexander, president, ADA

After 14 years working for the SA association on various committees, as well as managing her practices and having two toddlers, Alyssa and Paul (now aged 28 and 25), she decided to have some time out. But before she’d even drawn breath, she was offered the position of vice-president of the SA branch. Despite her slight trepidation, she took on the position and from there, she moved up the ranks, becoming president of the SA branch in 1999. After two terms as a federal councilor, she moved on to federal executive and then, as the highest accolade, national president, succeeding Dr Shane Fryer.

“I’ve done it because it adds another dimension to my clinical work,” says Dr Alexander, whose husband Robert Grima, a health service management accountant, also co-manages her two dental surgeries to free up her time. “I can understand why and how outside influences work in our profession and how they affect us and sometimes how we can change those for the better,” says Dr Alexander.

Dr-Karin-Alexander-ADAAs the media broke the news of her position by pointing out she was the ADA’s first female president, Dr Alexander found it “a little bit annoying”. As she explains, “People were saying, ‘You’ve broken through the glass ceiling’ but I actually consider I’ve just created a new pathway for people to follow.

“One needs to do the hard yards—understanding the issues and developing contacts around Australia. But, really, there’s no reason to stop anybody from becoming president. I would love to see other females take up the work—and there’s quite a lot of work involved—but the camaraderie of one’s colleagues on council and executive makes it fun. One has to remember that the council currently consists of all males apart from me—and they are the ones who voted me in.” This includes the newly appointed federal executives—Dr Carmelo Bonanno as vice-president, and Drs Rick Olive, Hugo Sachs and Terry Pitsikas.

With a new year, Dr Alexander is ready to tackle some of the most controversial issues with gusto. The country is on the cusp of a new dental deal, kicking off with the Dental Benefits Amendment Bill passed by both houses last November, allocating $2.7 billion for up to 3.4 million children to access dental services through Medicare, beginning in 2014.

According to Greens Senator Richard Di Natale in The Sydney Morning Herald, the legislation “is part of a broader package
I announced with the health minister in August, which will see
a $1.3 billion investment in the public dental system and further investment in the dental workforce and infrastructure”.

Despite the fanfare, Dr Alexander says the ADA is “a little guarded” about the legislation. “It would be a nice change if the government discussed the new scheme with the Dental Association before they had it fleshed out and ready to go.”

While the ADA has had a good working relationship with Di Natale, health minister Tanya Plibersek and shadow minister for health and ageing Peter Dutton, the fine details haven’t been released—and, as Dr Alexander says, “the devil is always in the detail”. The Bill means that children from ages two to 17 in Family Tax Benefits A can receive $1000 over two years. The ADA, however, is still waiting for specific details, including item numbers, administration paperwork, and specific services to be included, such as general anesthetics, especially for children with high needs—often from poorer socio-economic areas.

“We’re not asking them for high-cost items such as crowns but sensible things that will help people get those kids to good health,” explains Dr Alexander. “They have decay so we need to fix that and then get them into good oral health patterns. We want to provide quality treatment and not just a half-hearted mishmash of things we might be able to do.”

When it comes to issues on dental care for children, Dr Alexander is well versed, with her hands-on approach at her two practices. “With some families, I have four generations coming to see me,” she says. “One of the mums even said, ‘My kids cried because they couldn’t come in to see Dr Karin’.”

Compassion is undoubtedly another strong trait for Dr Alexander, whether she’s fixing kids’ fillings in the surgery or pushing governments to provide funding that will improve dental care for the disadvantaged. But as well as helping patients, she also has compassion for her own colleagues, particularly when broaching the touchy topic of 600-plus dentists who were under audit for suspected Medicare payment irregularities in 2010.

While Medicare had demanded repayment of $21.6 million from dentists in early 2011, most of these dentists claimed
they’d performed the specific services but just failed to fill in
all the paperwork.

When the retrospective changes to compliance arrangements were announced last May, the dentists were critical, finding the arrangements unfair. As a more rational approach, an amendment in October meant dentists who made purely clerical errors will now receive debt forgiveness.

According to Dr Alexander, the Medicare ‘misuse’ was an easy mistake by dentists. “This was a completely new system. Many practitioners are in single practices; they’re busy, it was another set of fees with different ways of doing it, so they often skimmed over it. It was a little foolish to not have read the fine print but it was such a different scheme. However, if any dentist has mishandled the scheme or committed any fraudulent behaviour, then there is no sympathy for that at all.”

When it comes to complex and contentious issues, she’s well aware that her position as president is “probably a bit more than the normal nine-to-five”. But whenever she needs a good sounding board, there’s one dentist she can always turn to—her dentist-savvy mum. “Even now, she still grabs Bite magazine or the Dental Journal and says, ‘Have you seen this microscope…have you seen this laser…what about this technique?’ She’s still completely with it and still interested.” Perhaps it’s a genetic trait that makes Dr Alexander ‘completely with it and still interested’ in even the most challenging issues.

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