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Gupta N, Miah P. Imbalances in the oral health workforce: a Canadian population-based study. BMC Health Serv Res 2024; 24:1191. [PMID: 39375673 PMCID: PMC11457345 DOI: 10.1186/s12913-024-11677-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 09/27/2024] [Indexed: 10/09/2024] Open
Abstract
BACKGROUND In Canada, a new federal public dental insurance plan, being phased in over 2022-2025, may help enhance financial access to dental services. However, as in many other countries, evidence is limited on the supply and distribution of human resources for oral health (HROH) to meet increasing population needs. This national observational study aimed to quantify occupational, geographical, institutional, and gender imbalances in the Canadian dental workforce to help inform benchmarking of HROH capacity for improving service coverage. METHODS Sourcing microdata from the 2021 Canadian population census, we described workforce imbalances for three groups of postsecondary-qualified dental professionals: dentists, dental hygienists and therapists, and dental assistants. To assess geographic maldistribution relative to population, we linked the person-level census data to the geocoded Index of Remoteness for all inhabited communities. To assess gender-based inequities in the dental labour market, we performed Blinder-Oaxaca decompositions for examining differences in professional earnings of women and men. RESULTS The census data tallied 3.4 active dentists aged 25-54 per 10,000 population, supported by an allied workforce of 1.7 dental hygienists/therapists and 1.6 dental assistants for every dentist. All three professional groups were overrepresented in heavily urbanized communities compared with more rural and remote areas. Almost all dental service providers worked in ambulatory care settings, except for male dental assistants. The dentistry workforce was found to have achieved gender parity numerically, but women dentists still earned 21% less on average than men, adjusting for other characteristics. Despite women representing 97% of dental hygienists/therapists, they earned 26% less on average than men, a significant difference that was largely unexplained in the decomposition analysis. CONCLUSIONS Accelerating universal coverage of oral healthcare services is increasingly advocated as an integral, but often neglected, component toward achieving the health-related Sustainable Development Goals. In the Canadian context of universal coverage for medical (but not dentistry) services, the oral health workforce was found to be demarcated by considerable geographic and gendered imbalances. More cross-nationally comparable research is needed to inform innovative approaches for equity-oriented HROH planning and financing, often critically overlooked in public policy for health systems strengthening.
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Affiliation(s)
- Neeru Gupta
- University of New Brunswick, Tilley Hall room 20, Fredericton, E3B 5A3, Canada.
| | - Pablo Miah
- New Brunswick Institute for Research, Data and Training (NB-IRDT), Keirstead Hall suite 304, Fredericton, E3A 5A3, Canada
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Marques Dos Santos SQ, Andrade RVS, Galvão MHR, da Costa Oliveira AGR. Oral health approach in universal health coverage. BMC Public Health 2024; 24:2633. [PMID: 39334093 PMCID: PMC11438094 DOI: 10.1186/s12889-024-19874-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 08/26/2024] [Indexed: 09/30/2024] Open
Abstract
OBJECTIVE This study aimed to map how oral health is addressed within the universal health coverage (UHC). METHODS This scoping review followed the Joanna Briggs Institute methodology. Searches included the WHO Library and PubMed, Scopus, Embase, LILACS, and Cochrane databases. Quantitative and qualitative studies were included without publication date and language restrictions. RESULTS A total of 486 studies were retrieved, of which 292 were excluded in the title and abstract screening phase; 121 full-texts were assessed. After the removal of duplicates and unavailable documents, 50 studies were included in the review and categorized according to the level of scientific evidence. CONCLUSION Few studies discussed oral health within the UHC, mostly because this coverage does not include oral health adequately. When offered, oral health packages are limited and include specific populations. Access and use of oral health services remain guided by economic factors, exposing the theoretical financial protectionism that perpetuates health inequalities.
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Affiliation(s)
| | | | - Maria Helena Rodrigues Galvão
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Davda LS, Radford DR, Scambler S, Gallagher JE. A typology of internationally qualified dentists in the United Kingdom. J Migr Health 2024; 9:100232. [PMID: 38826513 PMCID: PMC11141152 DOI: 10.1016/j.jmh.2024.100232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 08/11/2023] [Accepted: 05/05/2024] [Indexed: 06/04/2024] Open
Abstract
Introduction The Global Strategy for Human Resources for Health 2030, requires member states to half their dependency on an international workforce by 2030. In order to design policies towards that goal, country-specific research on migration motivations of the health workforce is required. The United Kingdom (UK) is a net importer of health professionals and whilst there is a body of research on doctors' and nurses' migration, there is no research on the migration motivations of migrant dentists in the UK. This research explored the migration motivations of internationally qualified dentists (IQDs) in the UK and presents a typology to understand the global migration of dentists in the context of oral health workforce. Methods The paper presents qualitative data from semi-structured interviews conducted between August 2014 and October 2017, of IQDs working in the United Kingdom. The topic guide for interviews was informed by the literature, with new themes added inductively. A phenomenological approach involving an epistemological stance of interpretivism, was used with framework analysis. Results A total of 38 internationally qualified dentists (M = 18, F = 20), migrating from the five World Health Organization regions, and working in general practice, NHS hospitals and in community dental services across the four nations of the UK were interviewed. Seven types of internationally qualified dentists were identified working in the UK. They were livelihood migrants, career-orientated migrants, dependant migrants, backpacker migrants, commuter migrants, undocumented migrants, and education-tourist migrant. The categories were based on their migration motivations, which were complex, multifactorial, and included personal, professional, national, and international drivers. The typology, based on their migration motivations, offered a structured, comprehensive understanding of the migrant dental workforce. This typology involving dentists provides additional dimensions to commuter and undocumented migrants described in the context of other health professionals. The education-tourist migrant is a new category proposed as an extension to existing typology in health professional migration. Conclusions The typology of internationally qualified dentists has congruency with other health professionals' typology in categories previously described and demonstrates that each of these categories are complex, fluid and change in response to policy changes. The new category of education-tourist migrant along with oral health dimensions of commuter and undocumented migrants adds to the existing typology in health professional migration.
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Affiliation(s)
- Latha S Davda
- Ministry of Defence, Bulford SP4 9AD, UK
- University of Portsmouth Dental Academy, Portsmouth, PO1 2QG, UK
| | - David R Radford
- University of Portsmouth Dental Academy, Portsmouth, PO1 2QG, UK
- King's College London, Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, Denmark Hill Campus, London SE5 9RS, UK
| | - Sasha Scambler
- King's College London, Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, Denmark Hill Campus, London SE5 9RS, UK
| | - Jennifer E Gallagher
- King's College London, Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, Denmark Hill Campus, London SE5 9RS, UK
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Davda LS, Radford DR, Scambler S, Gallagher JE. Accreditation and professional integration experiences of internationally qualified dentists working in the United Kingdom. HUMAN RESOURCES FOR HEALTH 2022; 20:7. [PMID: 35012564 PMCID: PMC8744036 DOI: 10.1186/s12960-021-00703-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/14/2021] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Regulatory processes for Oral health care professionals are considered essential for patient safety and to ensure health workforce quality. The global variation in their registration and regulation is under-reported in the literature. Regulatory systems could become a barrier to their national and international movement, leading to loss of skilled human resources. The General Dental Council is the regulatory authority in the UK, one of the nine regulators of health care overseen by the Professional Standards Authority. AIM The aim of this paper is to present the professional integration experiences of internationally qualified dentists (IQDs) working in the UK, against the background of regulation and accreditation nationally. METHODS Registration data were obtained from the General Dental Council to inform the sampling and recruitment of research participants. Semi-structured interviews of 38 internationally qualified dentists working in the United Kingdom were conducted between August 2014 and October 2017. The topic guide which explored professional integration experiences of the dentists was informed by the literature, with new themes added inductively. A phenomenological approach involving an epistemological stance of interpretivism, was used with framework analysis to detect themes. RESULTS Internationally qualified dentist's professional integration was influenced by factors that could be broadly classified as structural (source country training; registration and employment; variation in practising dentistry) and relational (experiences of discrimination; value of networks and support; and personal attributes). The routes to register for work as a dentist were perceived to favour UK dental graduates and those qualifying from the European Economic Area. Dentists from the rest of the world reported experiencing major hurdles including succeeding in the licensing examinations, English tests, proving immigration status and succeeding in obtaining a National Health Service performer number, all prior to being able to practice within state funded dental care. CONCLUSION The pathways for dentists to register and work in state funded dental care in UK differ by geographic type of registrant, creating significant inconsistencies in their professional integration. Professional integration is perceived by an individual IQD as a continuum dictated by host countries health care systems, workforce recruitment policies, access to training, together with their professional and personal skills. The reliance of the UK on internationally qualified dentists has increased in the past two decades, however, it is not known how these trends will be affected by UK's exit from the European Union and the COVID-19 pandemic.
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Affiliation(s)
- Latha S Davda
- University of Portsmouth Dental Academy, Faculty of Science and Health, University of Portsmouth, PO1 2QG, Portsmouth, United Kingdom.
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London, Denmark Hill Campus, SE5 9RS, London, United Kingdom.
| | - David R Radford
- University of Portsmouth Dental Academy, Faculty of Science and Health, University of Portsmouth, PO1 2QG, Portsmouth, United Kingdom
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London, Denmark Hill Campus, SE5 9RS, London, United Kingdom
| | - Sasha Scambler
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London, Denmark Hill Campus, SE5 9RS, London, United Kingdom
| | - Jennifer E Gallagher
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London, Denmark Hill Campus, SE5 9RS, London, United Kingdom
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Marcus K, Balasubramanian M, Short S, Sohn W. Culturally and linguistically diverse (CALD): terminology and standards in reducing healthcare inequalities. Aust N Z J Public Health 2021; 46:7-9. [PMID: 34902191 DOI: 10.1111/1753-6405.13190] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kanchan Marcus
- Population Oral Health, School of Dentistry, Faculty of Medicine and Health, The University of Sydney, New South Wales
| | - Madhan Balasubramanian
- Menzies Centre for Health Policy and Economics, School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales
| | - Stephanie Short
- Discipline of Behavioural & Social Sciences in Health, Faculty of Medicine and Health, The University of Sydney, New South Wales
| | - Woosung Sohn
- Population Oral Health, School of Dentistry, Faculty of Medicine and Health, The University of Sydney, New South Wales
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Ghotane SG, Don-Davis P, Kamara D, Harper PR, Challacombe SJ, Gallagher JE. Needs-led human resource planning for Sierra Leone in support of oral health. HUMAN RESOURCES FOR HEALTH 2021; 19:106. [PMID: 34470631 PMCID: PMC8411531 DOI: 10.1186/s12960-021-00623-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 06/17/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND In Sierra Leone (SL), a low-income country in West Africa, dental care is very limited, largely private, and with services focused in the capital Freetown. There is no formal dental education. Ten dentists supported by a similar number of dental care professionals (DCPs) serve a population of over 7.5 million people. The objective of this research was to estimate needs-led requirements for dental care and human resources for oral health to inform capacity building, based on a national survey of oral health in SL. METHODS A dedicated operational research (OR) decision tool was constructed in Microsoft Excel to support this project. First, total treatment needs were estimated from our national epidemiological survey data for three key ages (6, 12 and 15 years), collected using the 'International Caries Classification and Management System (ICCMS)' tool. Second, oral health needs were extrapolated to whole population levels for each year-group, based on census demographic data. Third, full time equivalent (FTE) workforce capacity needs were estimated for mid-level providers in the form of Dental Therapists (DTs) and non-dental personnel based on current oral disease management approaches and clinical timings for treatment procedures. Fourth, informed by an expert panel, three oral disease management scenarios were explored for the national population: (1) Conventional care (CC): comprising oral health promotion (including prevention), restorations and tooth extraction; (2) Surgical and Preventive care (S5&6P and S6P): comprising oral health promotion (inc. prevention) and tooth extraction (D5 and D6 together, & at D6 level only); and (3) Prevention only (P): consisting of oral health promotion (inc. prevention). Fifth, the findings were extrapolated to the whole population based on demography, assuming similar levels of treatment need. RESULTS To meet the needs of a single year-group of childrens' needs, an average of 163 DTs (range: 133-188) would be required to deliver Conventional care (CC); 39 DTs (range: 30-45) to deliver basic Surgical and Preventive care (S6P); 54 DTs for more extended Surgical and Preventive care (S5&6P) (range 38-68); and 27 DTs (range: 25-32) to deliver Prevention only (P). When scaled up to the total population, an estimated 6,147 DTs (range: 5,565-6,870) would be required to deliver Conventional care (CC); 1,413 DTs (range: 1255-1438 DTs) to deliver basic Surgical and Preventive care (S6P); 2,000 DTs (range 1590-2236) for more extended Surgical and Preventive care (S5&6P) (range 1590-2236); and 1,028 DTs to deliver Prevention only (P) (range: 1016-1046). Furthermore, if oral health promotion activities, including individualised prevention, could be delivered by non-dental personnel, then the remaining surgical care could be delivered by 385 DTs (range: 251-488) for the S6P scenario which was deemed as the minimum basic baseline service involving extracting all teeth with extensive caries into dentine. More realistically, 972 DTs (range: 586-1179) would be needed for the S5&6P scenario in which all teeth with distinctive and extensive caries into dentine are extracted. CONCLUSION The study demonstrates the huge dental workforce needs required to deliver even minimal oral health care to the Sierra Leone population. The gap between the current workforce and the oral health needs of the population is stark and requires urgent action. The study also demonstrates the potential for contemporary epidemiological tools to predict dental treatment needs and inform workforce capacity building in a low-income country, exploring a range of solutions involving mid-level providers and non-dental personnel.
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Affiliation(s)
- Swapnil Gajendra Ghotane
- Faculty of Dentistry, Oral & Craniofacial Sciences At King’s College London, Centre for Host Microbiome Interactions, Denmark Hill Campus, Bessemer Road, London, SE5 9RS United Kingdom
| | - Patric Don-Davis
- College of Medicine and Allied Health Sciences, Connaught Hospital, Freetown, Sierra Leone
| | - David Kamara
- Oral Health Department, Connaught Hospital, Freetown, Sierra Leone
| | - Paul R. Harper
- School of Mathematics, Cardiff University, Cardiff, CF24 4AG UK
| | - Stephen J. Challacombe
- Faculty of Dentistry, Oral and Craniofacial Sciences At King’s College London, Centre for Host Microbiome Interactions, Guys Campus, London, SE1 9RT UK
| | - Jennifer E. Gallagher
- Faculty of Dentistry, Oral & Craniofacial Sciences At King’s College London, Centre for Host Microbiome Interactions, Denmark Hill Campus, Bessemer Road, London, SE5 9RS United Kingdom
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Balasubramanian M, Hasan A, Ganbavale S, Alolayah A, Gallagher J. Planning the Future Oral Health Workforce: A Rapid Review of Supply, Demand and Need Models, Data Sources and Skill Mix Considerations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062891. [PMID: 33808981 PMCID: PMC7999471 DOI: 10.3390/ijerph18062891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/24/2022]
Abstract
Over the last decade, there has been a renewed interest in oral health workforce planning. The purpose of this review is to examine oral health workforce planning models on supply, demand and needs, mainly in respect to their data sources, modelling technique and use of skill mix. A limited search was carried out on PubMed and Web of Science for published scientific articles on oral health workforce planning models between 2010 to 2020. No restrictions were placed on the type of modelling philosophy, and all studies including supply, demand or needs based models were included. Rapid review methods guided the review process. Twenty-three studies from 15 countries were included in the review. A majority were from high-income countries (n = 17). Dentists were the sole oral health workforce group modelled in 13 studies; only five studies included skill mix (allied dental personnel) considerations. The most common application of modelling was a workforce to population ratio or a needs-based demand weighted variant. Nearly all studies presented weaknesses in modelling process due to the limitations in data sources and/or non-availability of the necessary data to inform oral health workforce planning. Skill mix considerations in planning models were also limited to horizontal integration within oral health professionals. Planning for the future oral health workforce is heavily reliant on quality data being available for supply, demand and needs models. Integrated methodologies that expand skill mix considerations and account for uncertainty are essential for future planning exercises.
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Affiliation(s)
- Madhan Balasubramanian
- Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide 5005, Australia
- Faculty of Dentistry, Oral & Craniofacial Sciences, Kings College London, London SE5 9RS, UK; (A.H.); (S.G.); (A.A.); (J.G.)
- Correspondence: ; Tel.: +61-410-993-893
| | - Aliya Hasan
- Faculty of Dentistry, Oral & Craniofacial Sciences, Kings College London, London SE5 9RS, UK; (A.H.); (S.G.); (A.A.); (J.G.)
| | - Suruchi Ganbavale
- Faculty of Dentistry, Oral & Craniofacial Sciences, Kings College London, London SE5 9RS, UK; (A.H.); (S.G.); (A.A.); (J.G.)
- Dental Academy, William Beatty Building, Hampshire Terrace, University of Portsmouth, Portsmouth PO1 2QG, UK
| | - Anfal Alolayah
- Faculty of Dentistry, Oral & Craniofacial Sciences, Kings College London, London SE5 9RS, UK; (A.H.); (S.G.); (A.A.); (J.G.)
| | - Jennifer Gallagher
- Faculty of Dentistry, Oral & Craniofacial Sciences, Kings College London, London SE5 9RS, UK; (A.H.); (S.G.); (A.A.); (J.G.)
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Forsyth C, Short S, Gilroy J, Tennant M, Irving M. An Indigenous cultural competence model for dentistry education. Br Dent J 2020; 228:719-725. [PMID: 32385467 DOI: 10.1038/s41415-020-1480-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Reorientation of education for health professionals is necessary to support future health workforce in meeting population needs. Dental graduates must be competent to effectively communicate with patients, their families and other health professionals involved in their care, regardless of social or cultural background. Indigenous people in Australia experience significant oral health disparities compared to non-Indigenous Australians. Cultural competence has evolved as the leading model to equip future clinicians to deliver culturally safe care. A case study conducted at the University of Sydney School of Dentistry examined the integration of Indigenous cultural competence into dental curricula using four data sources: a systematic review identifying intervention strategies to improve cultural competence; an online survey to provide a baseline analysis of Indigenous curricula practices; and two in-depth interview studies with academics and students to determine barriers and enablers to increasing Indigenous cultural competence among dental students. As a result, an Indigenous cultural model was developed for dentistry education, recognising three major constituents being critical to achieving cultural competence among dental students. Indigenous cultural competence in dentistry education requires stringent governance, adequate faculty resources and effective educational strategies, in order to increase students' knowledge, understanding and skills to achieve a minimum cultural competence standard upon graduation.
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Affiliation(s)
- Cathryn Forsyth
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Australia.
| | - Stephanie Short
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia
| | - John Gilroy
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia
| | - Marc Tennant
- International Research Collaborative, Oral Health and Equity, University of Western Australia, Australia
| | - Michelle Irving
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Australia
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Davda LS, Radford DR, Scambler S, Gallagher JE. Profiles of registrant dentists and policy directions from 2000 to 2020. BDJ Open 2020; 6:26. [PMID: 33298834 PMCID: PMC7695988 DOI: 10.1038/s41405-020-00054-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/04/2020] [Accepted: 10/16/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The National Health Service's reliance on overseas doctors and nurses, unlike dentists, has been widely reported. As the United Kingdom (UK) leaves the European Union, an understanding of the migration trends and possible influences are important to inform future planning. AIM To examine trends in the profile of UK registered dentists in the context of key events and policy changes from 2000 to 2020. METHOD Data were obtained from the General Dental Council via annual reports, and under 'freedom of information' communications; details of policy initiatives were obtained from the government and professional websites. RESULTS Over a 20-year period (2000-2019), the number of registered dentists increased from 31,325 to 42,469, a net increase of 36% (11,144 dentists), the majority of whom were international graduates (58%; n = 6,416) such that by December 2019, 28% of all registered dentists had qualified outside of the UK. Similarly, regarding new registrants, there were increases of graduates from UK (18%), EEA countries (214%) and, via the Overseas Registration Examination route (621%); and a decrease from countries with bilateral agreements for recognition (43%), in line with changes in health and immigration policies. CONCLUSIONS International dental graduates increasingly contribute to the UK dental workforce and there is an urgent need for research into dentist migration and retention in the UK in support of patient access to dental care. IMPACT The United Kingdom (UK) dental workforce is increasingly reliant on international dental graduates representing 28% of current registrants compared with 18% in 2000. Health policies and immigration policies were the main drivers that influenced dental workforce migration to the UK along with wider events, such as EU expansions, global recession and Brexit. Pre-existing lack of research into dental workforce could add to the uncertainties of post COVID-19 oral health care access and delivery.
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Affiliation(s)
- Latha S Davda
- University of Portsmouth Dental Academy, Portsmouth, PO1 2QG, UK.
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London,, Denmark Hill Campus, London, SE5 9RS, UK.
| | - David R Radford
- University of Portsmouth Dental Academy, Portsmouth, PO1 2QG, UK
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London,, Denmark Hill Campus, London, SE5 9RS, UK
| | - Sasha Scambler
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London,, Denmark Hill Campus, London, SE5 9RS, UK
| | - Jennifer E Gallagher
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London,, Denmark Hill Campus, London, SE5 9RS, UK
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Che Musa MF, Bernabé E, Gallagher JE. The dental workforce in Malaysia: drivers for change from the perspectives of key stakeholders. Int Dent J 2020; 70:360-373. [PMID: 32476143 DOI: 10.1111/idj.12575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The dental workforce is facing unprecedented change globally as a result of multiple influences. There is a need for research informed action to map possible drivers for change at the national level and examine their potential implications in order to shape the dental workforce to serve population needs. The objective of this study was to explore key stakeholders' views on the drivers for change for the Malaysian dental workforce and their potential implications. METHOD Stakeholders from key dental organisations/professions in Malaysia were purposively sampled and invited to participate in a semi-structured interview (n = 20) using a pre-tested topic guide. Interviews were recorded, transcribed verbatim and analysed using Framework Analysis. RESULTS Drivers for workforce were identified across four main domains: policy-politics; trends in demography; social and economic; and, technology-scientific development. The pace of change and possible interplay between drivers, most notably government policy, liberalisation of education and health services and challenges of workforce governance, followed by Malaysian demography and health trends. Implications for the future, including possible uncertainties, particularly in relation to specialisation and privatisation were identified, together in balancing and meeting public health needs/demands with professional career expectations. CONCLUSION Stakeholders' views on the high-level drivers for change broadly mirror those of high-income countries; however, specific challenges for Malaysia relate to rapid expansion of dental education and a young workforce with significant career aspirations, together with imbalances in the health care system. The impact of these drivers was perceived as leading to greatest uncertainty around specialisation and privatisation of the future workforce.
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Affiliation(s)
- Muhd Firdaus Che Musa
- Department of Paediatric Dentistry and Dental Public Health, Kulliyyah of Dentistry, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Eduardo Bernabé
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Centre for Host-Microbiome Interactions, Dental Public Health, London, UK
| | - Jennifer E Gallagher
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Centre for Host-Microbiome Interactions, Dental Public Health, London, UK
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Chen R, Irving M, Clive Wright FA, Cunich M. An evaluation of health workforce models addressing oral health in residential aged care facilities: A systematic review of the literature. Gerodontology 2020; 37:222-232. [PMID: 32478960 DOI: 10.1111/ger.12475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 03/20/2020] [Accepted: 05/03/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND In Australia and globally, there is an increasing problem of unmet oral health needs of older people above 65 residing in aged care facilities. Various workforce models have been trialled to implement oral health care programmes in aged care facilities, but the evidence behind these programmes and their underlying workforce models is not known. OBJECTIVE To systematically review the literature on the effectiveness, and economic feasibility of the current workforce models addressing oral care in aged care facilities. METHODS CINAHL, Cochrane CENTRAL, MEDLINE, EMBASE, EMB Reviews, NHS Economic Evaluation Database and grey literature were searched. Studies were included if they described an oral health workforce model with a clinical intervention and defined oral health outcome measures. Analysis was conducted using the NHMRC guidelines for scientific and economic evaluations. RESULTS Twenty-eight studies were included. Four distinct workforce models of care were identified. 60% of the studies demonstrated short-term effectiveness in clinical measures. Workforce models were similar in their effectiveness, with varying levels of quality within each model. Although three studies considered individual components of economic feasibility, only one provided a comprehensive economic analysis of both the costs and health outcomes. CONCLUSIONS IMPLICATIONS OF FINDINGS All workforce models of care had some positive impact on oral health for residents of aged care. Oral health should be included as a health focus in age care facilities. Future studies should include longer-term health outcomes with rigorous economic analysis to ensure sustainably delivered workforce models of care for oral health management within aged care.
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Affiliation(s)
- Rebecca Chen
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Michelle Irving
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - F A Clive Wright
- Centre for Education and Research on Ageing, Concord Clinical School, University of Sydney, Aged Care and Rehabilitation, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW, Australia
| | - Michelle Cunich
- Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Sydney Health Economics Collaborative, Sydney Local Health District, Camperdown, NSW, Australia
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Balaji SM. Oral health, universal health coverage, and dental research. Indian J Dent Res 2019; 30:486. [PMID: 31745039 DOI: 10.4103/ijdr.ijdr_825_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- S M Balaji
- Executive Editor, Indian Journal of Dental Research, Director and Consultant Oral and Maxillofacial Surgeon, Balaji Dental and Craniofacial Hospital, Chennai, Tamil Nadu, India
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Short SD, Hawal N, Albusaidi NS, Purwaningrum F. Streamlining and modernising medical workforce governance. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2019. [DOI: 10.1108/ijhg-12-2018-0074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to identify the elements of effective policies and processes to inform future health professional regulation reforms and practice in the Emirates.Design/methodology/approachThis study is based on qualitative exploratory methodology. Methods of data collection and analysis included document analysis of the relevant literature, newspapers (as featured on their online websites), policy documents and official statistics. In-depth semi-structured interviews were conducted with key stakeholders, including employers in the health and higher education sectors in Ras Al Khaimah, human resources managers, regulators and public health professionals and scholars.FindingsThis paper brings to light the issues of maldistribution of the medical workforce, Emiritisation and examines implications for more effective medical workforce governance in the United Arab Emirates (UAE).Originality/valueFirst, the study provides policy recommendations for medical workforce governance in the context of UAE. Next, empirical studies on health workforce governance in the Middle East’s Gulf Cooperation Council are lacking and primarily focus on the international mobility of expatriates. The study addresses the lack of empirical studies on this topic in the UAE. Third, the UAE is a fertile ground for research on medical workforce governance and, more broadly, the mobility of health professionals due to its economic diversification strategy and thriving medical tourism industry.
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Balasubramanian M, Brennan DS, Short SD, Gallagher JE. A strife of interests: A qualitative study on the challenges facing oral health workforce policy and planning. Health Policy 2019; 123:1068-1075. [PMID: 31362833 DOI: 10.1016/j.healthpol.2019.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 07/07/2019] [Accepted: 07/12/2019] [Indexed: 01/06/2023]
Abstract
Oral health workforce policy has often lacked systematic connections with broader health policy, and system-based reforms that would enable more effective responses to future needs of the population. The aim of the study was to better understand challenges facing oral health workforce policy and planning and identify potential solutions. In-depth interviews of 23 senior oral health leaders and/or health policy experts from 15 countries were conducted in 2016-17. Grounded theory principles using the Straussian school of thought guided the qualitative analysis. The findings identified: (i) narrow approach towards dental education, (ii) imbalances in skills, jobs and competencies, and (iii) geographic maldistribution as major challenges. An overarching theme -"strife of interests" - shed light on the tension between the profession's interest, and the needs of the population. A key aspect was the clash for power, dominance and authority within the oral health workforce and across health professions. This study argues that appreciating the history of health professions and recognising the centrality of the strife of interests is necessary in developing policies that both address professional sensitivities and are in line with the needs of the population. Integration and closer collaboration of oral health professionals with the mainstream medical and health professions has emerged as the key issue, but the solutions will be diverse and dependent on country- or context-specific scenarios.
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Affiliation(s)
- Madhan Balasubramanian
- The University of Sydney, Faculty of Health Sciences, Sydney, Australia; The University of Sydney School of Dentistry, Sydney, Australia; Western Sydney Local Health District, New South Wales Health, Australia; Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Australia; Faculty of Dentistry, Oral and Craniofacial Sciences, Kings College London, London, United Kingdom.
| | - David S Brennan
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Australia
| | - Stephanie D Short
- The University of Sydney, Faculty of Health Sciences, Sydney Australia; Sydney Asia Pacific Migration Centre, Faculty of Arts and Social Sciences, Sydney, Australia
| | - Jennifer E Gallagher
- Faculty of Dentistry, Oral and Craniofacial Sciences, Kings College London, London, United Kingdom
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