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Dental specialists in Australia

2010; Wiley; Volume: 55; Issue: 1 Linguagem: Inglês

10.1111/j.1834-7819.2009.01189.x

1834-7819

The U Australian Research Centre for Population Oral Health,

Primary Care and Health Outcomes

Australian Dental JournalVolume 55, Issue 1 p. 96-100 Free Access Dental specialists in Australia Australian Research Centre for Population Oral Health, The University of Adelaide, South Australia., Australian Research Centre for Population Oral Health, The University of Adelaide, South Australia.Search for more papers by this author Australian Research Centre for Population Oral Health, The University of Adelaide, South Australia., Australian Research Centre for Population Oral Health, The University of Adelaide, South Australia.Search for more papers by this author First published: 05 March 2010 https://doi.org/10.1111/j.1834-7819.2009.01189.xCitations: 9 Australian Research Centre for Population Oral Health AIHW Dental Statistics and Research Unit School of Dentistry Faculty of Health Sciences The University of Adelaide Adelaide SA 5005 Email: madhan.balasubramanian@adelaide.edu.au AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Introduction Dental specialists play a key role in maintaining clinical excellence and in providing leadership. According to Spencer et al., specialists provide exceptional services to 'special' patients, serving as a focal point for raising the quality of dental care, innovation and adoption of new procedures, clinical research and continuing education of general dental practitioners.1 In Australia, education and training is offered in 12 specialities, accredited by the Australian Dental Council.2 These include: orthodontics, oral and maxillofacial surgery, prosthodontics, periodontics, endodontics, paediatric dentistry, oral pathology, oral medicine, oral pathology and oral medicine, public health dentistry, dento-maxillofacial radiology, and special needs dentistry.2 Specialist training is offered by six dental schools throughout Australia,aa The Universities of Melbourne, Sydney, Queensland, Adelaide, Western Australia and Griffith offer specialist training programmes in Australia. but not all of these schools offer training programmes for all specialities.3 The training generally involves an additional three years of postgraduate education leading to specialist registration. Oral and maxillofacial surgery training is offered as a fellowship through the Royal Australian College of Dental Surgeons and requires completion of a medical degree.2 Monitoring and surveillance of dental specialists is important as it can inform decisions related to specialist training and improving the geographic reach of specialists, especially in supporting primary care.4, 5 This article presents a cross-sectional view of the 2006 dental specialist labour force in Australia and attempts to distinguish the key characteristics between specialist groups and between specialist and general practitioners. Methods Data for this article were from the 2006 National Dental Labour Force Data Collection.6 These data are routinely collected annually by the Australian Institute of Health and Welfare's Dental Statistics and Research Unit (AIHW DSRU) with the assistance of the state and territory health departments and dental boards.7-9 The scope of the data collection included all registered practitioners. Data items collected form part of a data set agreed by the Australian Health Ministers' Advisory Council. Items include information on demographic characteristics, practice status, practice type and hours worked. Dentists and specialists were asked to base their practice activity responses on their last week of work. Eight specialist categories were collected (orthodontics, periodontics, prosthodontics, dento-maxillofacial radiology, oral and maxillofacial surgery, endodontics, paediatric dentistry and oral pathology). Speciality groups not listed were categorized as 'Other'.bb The 'Other' category mostly included public health dentistry, special needs dentistry and geriatric dentistry. Previous labour force reports have estimated specialist numbers using responses to area of practice and type of speciality.7-9 Estimates for 2006 have been derived from the speciality type question only. Estimates for earlier collections have been recalculated to be consistent with 2006 estimates and hence may differ slightly from previous publications. The overall response rate for the survey was 79.6%. Response rates varied by state and territory, ranging from 33.1% in the Australian Capital Territory to 90.7% in New South Wales.cc Response rates: Vic (77.0%), Qld (73.8%), WA (67.5%), SA (86.9%), Tas (62.2%) and NT (49.5%). Estimates reported have been weighted for non-responses. Additional estimation for partially completed survey forms was based on the assumption that non-respondents had similar characteristics as respondents. Caution is advised when interpreting data from states/territories that have low response rates or small numbers. Results Overall numbers In 2006, there were an estimated 1502 registered dental specialists in Australia, comprising 12.3% of all dental registrations. Multi-state specialist registrations comprised 8%. Only small numbers were not working (0.5%) or retired (0.7%). Small percentages were on extended leave or reported that they were looking for work (1.5% and 0.2%, respectively). An estimated 1328 specialists (88.4%) were practising, comprising 12.8% of all practising dentists (10 404). Nearly all practising specialists (92.1%) reported working in clinical practice in their main practice location, and 3.6% were involved in teaching and research. Overall, there were 6.4 practising specialists per 100 000 population in Australia, and 7.4 full-time equivalent specialists.dd Full-time equivalent specialists per 100 000 population is calculated by multiplying the number of practising specialists by the average weekly hours worked and then dividing by a reference week (35 hours per week). Orthodontists were the largest speciality group (n = 518, 39%), followed by oral and maxillofacial surgeons (n = 206, 15.5%), prosthodontists (n = 171, 12.9%), periodontists (n = 146, 10.9%), endodontists (n = 116, 8.7%) and paediatric dentists (n = 100, 7.6%) (Fig 1). Oral pathologists, dento-maxillofacial radiologists and 'Other' specialists comprised only 5.3% of the specialist labour force (Fig 1). The rate of practising orthodontists was the highest among all specialist groups (2.5 per 100 000 population) (Fig 2). Figure 1Open in figure viewerPowerPoint Number of practising dental specialists, 2006. Figure 2Open in figure viewerPowerPoint Number of practising specialists per 100 000 population and full-time equivalent (FTE) rate by speciality group, 2006. Demographic characteristics The large majority of practising specialists were male (84.5%). In contrast, males comprised only 69.4% of the general practitioner labour force. With the exception of paediatric dentistry, the majority of practitioners in all specialities were male (Fig 3). Figure 3Open in figure viewerPowerPoint Percentage female, general practitioners and specialists, 2006. The average age of specialist practitioners was 49.1 years, compared to 44.5 years in the general practitioner group. Approximately 45% of specialists were 50 years of age or older. One-third (31.1%) were between 40–49 years and 18.7% were between 30–39 years. Very few specialists (2.8%) were below 30 years of age. Compared to specialists, a larger percentage of general practitioners were in the younger age groups: 13.7% below 30 years and 24.4% between 30–39 years (Fig 4). Figure 4Open in figure viewerPowerPoint Percentage of practising specialists, general practitioners and all dentists by age group, 2006. Average age varied by speciality. Prosthodontists and oral and maxillofacial surgeons were the oldest groups (51.0 years) and paediatric dentists were the youngest (45.2 years). Female specialists were comparatively younger than their male counterparts in all specialist groups (Table 1). Table 1. Practising specialists by speciality and selected characteristics, 2006 Orthodontics Periodontics Prosthodontics Oral and Maxillofacial surgery Endodontics Paedodontics Other All Specialists Average age Male 50.7 50.0 51.5 51.5 46.8 47.5 54.0 50.6 Female 41.6 41.5 44.3 46.4 42.9 43.5 39.1 42.5 Persons 49.5 47.9 51.0 51.0 46.3 45.2 49.5 49.2 Average total hours usually worked per week Male 40.3 42.7 42.5 45.4 42.9 44.7 35.7 41.9 Female 37.6 32.1 37.0 42.3 37.3 37.8 36.1 37.1 Persons 39.9 40.3 42.1 45.1 42.1 40.8 35.8 41.1 Average direct patient care hours worked per week Male 33.2 34.4 31.9 37.9 33.4 33.3 28.3 33.8 Female 31.1 26.0 27.7 34.5 25.1 30.2 26.0 29.4 Persons 32.9 32.5 31.6 37.5 32.2 31.5 27.5 33.0 Sector of practice (percentage of specialists) Public 6.3 6.8 17.1 8.7 8.5 37.0 33.8 12.1 Private 82.7 78.2 64.7 67.0 72.6 31.0 32.4 70.1 Public and private 11.0 15.0 18.2 24.3 18.8 32.0 33.8 17.9 Note: Sector of practice was determined by practice type of work performed at main, second and third practice locations. Practice characteristics The average hours worked by both specialists and general practitioners were highest in the 45–49 year age group (44.8 and 40.4 hours per week, respectively). While specialists in the younger age groups (30–34 years and below 30 years) had a shorter work week (37.4 and 35.3 hours) than general practitioners (37.7 and 38.8 hours), the pattern was reversed in all other age groups (Fig 5). Figure 5Open in figure viewerPowerPoint Average hours usually worked per week among practising specialists, general practitioners and all dentists by age group, 2006. Approximately 70% of all specialists worked only in the private sector, 12.0% worked only in the public sector and 17.9% worked in both public and private practice. The proportion of general practitioners working only in the private sector was slightly higher (79.3%) (Fig 6). With the exception of paediatric dentists and the 'Other' category specialists, a greater percentage of specialists worked only in the private sector (Table 1). Figure 6Open in figure viewerPowerPoint Percentage of practising specialists, general practitioners by sector of practice, 2006. Amongst the specialist groups, oral and maxillofacial surgeons worked the longest week (45.1 hours). Orthodontists on average worked approximately 40 hours per week and the 'Other' category specialists worked an average of 35.8 hours per week (Table 1). Oral and maxillofacial surgeons also dedicated more time to direct patient care than other specialities (37.5 hours per week). Geographic distribution In 2006, there were 6.4 specialists and 43.8 general practitioners per 100 000 people. The number of specialists and general practitioners per 100 000 people was the highest in the Australian Capital Territory (11.1 and 54.3, respectively) and the lowest in Tasmania (4.0 and 31.1, respectively) (Fig 7). Across Remoteness Areas the number of specialists per 100 000 people was 8.3 in Major City areas, 2.6 in Inner Regional areas, 1.8 in Outer Regional areas and 0.8 in Remote/Very Remote areas.ee Remoteness categories are based on the Accessibility/Remoteness Index of Australia (ARIA), where the remoteness index value of a point is based on the physical road distance to the nearest town or service. Due to a small number of specialists in Very Remote Areas, they have been combined together in Remote Areas. This pattern was similar for general practitioners, with the highest practising rate in Major City areas and lowest in the Remote areas (Fig 8). Figure 7Open in figure viewerPowerPoint Number of practising specialists, general practitioners and all dentists per 100 000 population by state/territory, 2006. Figure 8Open in figure viewerPowerPoint Number of practising specialists, general practitioners and all dentists per 100 000 population by Remoteness Area, 2006. Conclusions The Australian dental specialist labour force remains dominated (in terms of numbers) by orthodontists. This pattern was similar when compared to other developed countries.10, 11 'Feminization' of some specialist groups (paediatric dentistry and 'Other' specialist groups) may affect supply of services in the future. Since 2000, the number of females in these specialist groups has increased.8, 9 Male specialists in general show a more consistent working pattern until retirement, unlike females who show a more variable pattern.12, 13 Females tend to work more part-time and take career breaks.12 It is obvious that there is an inequitable distribution of specialists in Australia. The specialist labour force continues to be concentrated in the cities, with little or no availability in rural areas. Previous research in the United Kingdom has found a link between postgraduate training of orthodontists and their current place of work.14 The emergence of new regional schools in Australia may improve the geographic reach of dental specialists. However, as yet the new regional schools are not involved in specialist training. Many specialists provide services in regional clinics on a locum/rotational basis (i.e., work one week every three months in a regional centre). The dental labour force data collection is not explicitly designed to capture this ad hoc or short-term service provision and therefore may slightly underestimate the level of supply in regional areas. However, the opportunities for maintaining/advancing skills, access to research infrastructure and peer networking are limited in regional areas; these issues may be heightened for specialists in comparison to general dental practitioners, and need to be taken into consideration in labour force planning policy. Footnotes a The Universities of Melbourne, Sydney, Queensland, Adelaide, Western Australia and Griffith offer specialist training programmes in Australia. b The 'Other' category mostly included public health dentistry, special needs dentistry and geriatric dentistry. c Response rates: Vic (77.0%), Qld (73.8%), WA (67.5%), SA (86.9%), Tas (62.2%) and NT (49.5%). d Full-time equivalent specialists per 100 000 population is calculated by multiplying the number of practising specialists by the average weekly hours worked and then dividing by a reference week (35 hours per week). e Remoteness categories are based on the Accessibility/Remoteness Index of Australia (ARIA), where the remoteness index value of a point is based on the physical road distance to the nearest town or service. Due to a small number of specialists in Very Remote Areas, they have been combined together in Remote Areas. Acknowledgements The National Dental Labour Force Data Collection is supported by the Australian Institute of Health and Welfare. Surveys are conducted in collaboration with the state and territory dental boards. This manuscript was prepared by Madhan Balasubramanian, Dana Teusner and David Brennan. We acknowledge the editorial assistance offered by Lorna Lucas. References 1 Spencer AJ, Teusner DN, Carter KD, Brennan DS. The dental labour force in Australia: the position and policy directions. Population Oral Health Series No. 2. Canberra: Australian Institute of Health and Welfare, 2003. Google Scholar 2 Australian Dental Council. Consultation paper on the proposed arrangement of specialists. Submission on National Registration and Accreditation Scheme for Health Professionals. Canberra: COAG and Productivity Commission, 2009:13. Google Scholar 3 Department of Education, Science and Technology. Student completions for dental studies in all institutions 2006–07. 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