[Show abstract][Hide abstract] ABSTRACT: Background: Migrants occupy a significant proportion of the dental workforce in Australia. The objectives of this study were to assess the level of job satisfaction of employed migrant dentists in Australia, and to examine the association between various migrant dentist characteristics and job satisfaction.
Methods: All migrant dentists resident in Australia were surveyed using a five-point Likert scale that measured specific aspects of job, career, and satisfaction with area and type of practice.
Results: A total of 1022 migrant dentists responded to this study; 974 (95.4%) were employed. Responses for all scales were skewed towards strongly agree (scores ≥4). The overall scale varied by age group, marital status, years since arrival to Australia, and specialist qualification (Chi square, p<0.05). In a multivariate logistic regression model, there was a trend towards greater satisfaction amongst older age groups. Dentists who migrated through the examination pathway (mainly from low- and middle-income countries) had a lower probability of being satisfied with the area and type of practice (OR=0.71; 0.51 – 0.98), compared with direct-entry migrant dentists (from high income countries).
Conclusion: The high-level of job satisfaction of migrant dentists reflects well on their work-related experiences in Australia. The study offers policy suggestions towards support for younger dentists and examination pathway migrants, so they have appropriate skills and standards to fit the Australian health care environment.
Australian Dental Journal 08/2015; DOI:10.1111/adj.12370 · 1.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The migration of dentists is a major challenge contributing to the oral health system crisis in many countries. This paper explores the origins of the dentist migration problem through a study on international dental graduates, who had migrated to Australia. Life-stories of 49 international dental graduates from 22 countries were analysed in order to discern significant themes and patterns. We focused on their home country experience, including stories on early life and career choice; dental student life; professional life; social and political life; travels; and coming to Australia. Our participants exhibited a commitment to excellence in earlier stages of life and had cultivated a desire to learn more and be involved with the latest technology. Dentists from low- and middle-income countries were also disappointed by the lack of opportunity and were unhappy with the local ethos. Some pointed towards political unrest. Interestingly, participants also carried prior travel learnings and unforgettable memories contributing to their migration. Family members and peers had also influenced participants. These considerations were brought together in four themes explaining the desire to migrate: ‘Being good at something’, ‘Feelings of being let down’, ‘A novel experience’ and ‘Influenced by someone’. Even if one of these four themes dominated the narrative, we found that more than one theme, however, coexisted for most participants. We refer to this worldview as ‘Global interconnectedness’, and identify the development of migration desire as a historical process, stimulated by a priori knowledge (and interactions) of people, place and things. This qualitative study has enriched our understanding on the complexity of the dental migration experience. It supports efforts to achieve greater technical co-operation in issues such as dental education, workforce surveillance and oral health service planning within the context of ongoing global efforts on health professional migration by the World Health Organization and member states.
Health Policy and Planning 05/2015; 30(4):442-450. · 3.00 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The international migration of dentists is an issue of pressing significance that poses several complex policy challenges. Policy-making is mainly constrained by the lack of workforce surveillance, research evidence and political advocacy - all three are required to work together, yet with different purposes. We first discuss the inconsistencies in migrant dentist surveillance in major country-level governmental systems (immigration departments, dentist registration authorities and workforce agencies). We argue that the limitations in surveillance collections affect independent research and in turn scholarly contributions to dental workforce policy. Differences in country-level surveillance collections also hinder valid cross-country comparisons on migrant dentist data, impeding global policy efforts. Due to these limitations, advocacy, or the political process to influence health policy, suffers, but is integral to future challenges on dentist migration. Country-level advocacy is best targeted at improving migrant dentist surveillance systems. Research interest can be invigorated through targeted funding allocations for migration research and by improving the availability of dentist surveillance data for research purposes. At the global level, the WHOs global code of practice for international recruitment of health personnel (a crucial advocacy tool) needs to be strengthened. Global organisations such as the FDI World Dental Federation have an important role to play in advocating for improved migrant dentist workforce surveillance and research evidence, especially in low- and middle-income countries.
British dental journal official journal of the British Dental Association: BDJ online 03/2015; 218(6):329-331. DOI:10.1038/sj.bdj.2015.195 · 1.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Australians outside state capital cities have greater caries experience than their counterparts in capital cities. We hypothesized that differing water fluoridation exposures was associated with this disparity.Methods
Data were the 2004-06 Australian National Survey of Adult Oral Health. Examiners measured participant decayed, missing and filled teeth and DMFT Index and lifetime fluoridation exposure was quantified. Multivariable linear regression models estimated differences in caries experience between capital city residents and others, with and without adjustment for fluoridation exposure.ResultsThere was greater mean lifetime fluoridation exposure in state capital cities (59.1%, 95% confidence interval=56.9,61.4) than outside capital cities (42.3, confidence interval=36.9,47.6). People located outside capital city areas had differing socio-demographic characteristics and dental visiting patterns, and a higher mean DMFT (Capital cities=12.9, Non-capital cities=14.3, p=0.02), than people from capital cities. After adjustment for socio-demographic characteristics and dental visits, DMFT of people living in capital cities was less than non-capital city residents (Regression coefficient=0.8, p=0.01). The disparity was no longer statistically significant (Regression coefficient=0.6, p=0.09) after additional adjustment for fluoridation exposure.This article is protected by copyright. All rights reserved.
Australian Dental Journal 03/2015; DOI:10.1111/adj.12315 · 1.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives
The aims were to assess the joint effects of oral health and general health functional problems on self-ratings of general and oral health among adults.Methods
Data were collected from adults aged 30–61 years in Australia by mailed survey in 2009–2010. Self-rated health of ‘very good/excellent’ was analysed by oral health impact (OHIP-14) and number of health problems (EQ-5D) controlling for socio-demographics.ResultsResponses were collected from n = 1093 persons (response rate = 39.1%). General health self-ratings were higher in the high-income group (prevalence ratio [PR] = 1.06, 1.00–1.12) but lower for those with a higher number of health problems (PR = 0.84, 0.76–0.93). The interaction of health problems with oral health impact indicated that self-rated general health was worst when both the number of health problems and OHIP score were higher. Oral health self-ratings were lower for males (PR = 0.92, 0.87–0.98), those aged 50–61 years (PR = 0.92, 0.85–0.99), for those with more health problems (PR = 0.82, 0.71–0.95) and higher oral health impact scores (PR = 0.54, 0.46–0.64).Conclusions
For working age adults, oral health impact was associated with general health for those with more health problems indicating those in worse health suffer more impact from oral health problems.
Community Dentistry And Oral Epidemiology 02/2015; 43(3). DOI:10.1111/cdoe.12152 · 1.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives
To assess income-based life-course models between the age of 13 and 30 years and caries in young adults.Methods
In 1988–89, n = 7673 South Australian school children aged 13 years were sampled with n = 4604 children (60.0%) and n = 4476 parents (58.3%) returning questionnaires. In 2005–06, n = 632 baseline study participants aged 30 years responded (43.0% of those traced and living in Adelaide). Life-course models representing critical period, cumulative risk and social mobility were constructed using income tertiles at ages 13 and 30 years. Critical period was evaluated by comparing the low tertile with the middle and higher tertiles at age 13. Cumulative risk was evaluated by coding the low tertile as 2, the middle tertile as 1 and highest tertile as 0, and summing to produce a cumulative risk score categorized into lower (score 0–1), moderate (score of 2) and higher risk (scores 3–4). Social mobility was classified using tertiles into stable disadvantaged, downwardly mobile, stable middle income, upwardly mobile and stable advantaged.ResultsModels adjusting for sex, visiting and toothbrushing at age 30 showed no association between caries at age 30 and low income at age 13 years (critical period model). Compared to the low cumulative risk group based on income, decayed teeth (RR = 1.6) and missing teeth (RR = 7.2) were higher (P < 0.05) in the higher risk group, and missing teeth (RR = 6.0) were higher in the moderate risk group (cumulative risk model). There were more (P < 0.05) decayed teeth in the disadvantaged (RR = 3.1) and stable middle income groups (RR = 2.2), more missing teeth for those classified as disadvantaged (RR = 6.4), stable middle (RR = 6.3) and downwardly mobile (RR = 2.8), and higher DMFT for the disadvantaged group (RR = 1.5) compared to the upwardly mobile group (social mobility model).Conclusions
Socioeconomic advantage and upward mobility were associated with fewer decayed and missing teeth at age 30 years. Life-course models of cumulative risk and social mobility influenced oral health outcomes across childhood to adulthood.
Community Dentistry And Oral Epidemiology 02/2015; 43(3). DOI:10.1111/cdoe.12150 · 1.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives. Overseas-qualified dentists constitute a significant proportion of the Australian dental workforce (approximately one in four). The aim of the present study was to provide a better understanding of the cultural adaptation process of overseas-qualified dentists in Australia, so as to facilitate their integration into the Australian way of life and improve their contribution to Australian healthcare, economy and society. Methods. Life stories of 49 overseas-qualified dentists from 22 countries were analysed for significant themes and patterns. We focused on their settlement experience, which relates to their social and cultural experience in Australia. This analysis was consistent with a hermeneutic phenomenological approach to qualitative social scientific research. Results. Many participants noted that encounters with 'the Australian accent' and 'slang' influenced their cultural experience in Australia. Most of the participants expressed 'fascination' with the people and lifestyle in Australia, primarily with regard to the relaxed way of life, cultural diversity and the freedom one usually experiences living in Australia. Few participants expressed 'shock' at not being able to find a community of similar religious faith in Australia, as they are used to in their home countries. These issues were analysed in two themes; (1) language and communication; and (2) people, religion and lifestyle. The cultural adaptation process of overseas-qualified dentists in Australia is described as a continuum or superordinate theme, which we have entitled the 'newness–struggle–success' continuum. This overarching theme supersedes and incorporates all subthemes. Conclusion. Family, friends, community and organisational structures (universities and public sector) play a vital role in the cultural learning process, affecting overseas-qualified dentist's ability to progress successfully through the cultural continuum. What is known about the topic? Australia is a popular host country for overseas-qualified dentists. Migrant dentists arrive from contrasting social and cultural backgrounds, and these contrasts can be somewhat more pronounced in dentists from developing countries. To date, there is no evidence available regarding the cultural adaptation process of overseas-qualified dentists in Australia or elsewhere. What does this paper add? This study provides evidence to support the argument that the cultural adaptation process of overseas-qualified dentists in Australia can be viewed as a continuum state, where the individual learns to adapt to the people, language and lifestyle in Australia. The ongoing role of family and friends is primary to a successful transition process. Our research also identifies the positive role played by community and organisational structures, such as universities and public sector employment schemes. What are the implications for practitioners? A potential implication for policy makers is to focus on the positive roles played by organisational structures, particularly universities and the public sector. This can inform more supportive migration policy, as well as strengthen the role these organisations play in providing support for overseas-qualified dentists, thus enabling them to integrate more successfully into Australia's health care system, economy and society.
Australian health review: a publication of the Australian Hospital Association 01/2015; DOI:10.1071/AH15040 · 1.00 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The characteristics of the work environment and relationships with family roles may impact on health and be of public health significance.
The aims were to investigate the cross-sectional association of work-family conflict with oral- and general health-related quality of life, and well-being.
A random sample of 45-54-year olds from Adelaide, South Australia, was surveyed by self-complete questionnaire in 2004-2005 (n = 879, response rate = 43.8 %). Health-related quality of life was measured with the OHIP-14 and EQ-VAS instruments, and well-being by the Satisfaction With Life Scale.
In adjusted analyses controlling for sex, income, education, tooth brushing frequency and social support, the higher Family Interferes with Work (FIW) tertile and the middle tertile of Work Interferes with Family (WIF) were associated with more oral health-related impacts as measured by OHIP-14 in relation to problems with teeth, mouth or dentures (Beta = 1.64, P < 0.05 and Beta = 2.85, P < 0.01). Both middle and higher tertiles of WIF were associated with lower general health (Beta = -4.20 and -5.71, P < 0.01) and well-being (Beta = -1.17 and -1.56, P < 0.01).
Work-family conflict was associated with more oral health impacts and lower general health and well-being among employed middle-aged adults. This supports the view of work-family conflict as a psychosocial risk factor for health outcomes spanning function, health perceptions and well-being, and encompassing both oral health and general health.
International Journal of Behavioral Medicine 11/2014; DOI:10.1007/s12529-014-9454-y · 2.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Improving the productivity of the healthcare system, for example by taking advantage of scale economies or encouraging substitution of expensive specialist personnel with less expensive workers, is often seen as an attractive way to meet increasing demand within a constrained budget. Using data on 558 dentists participating in the Longitudinal Study of Dentists' Practice Activity (LSDPA) survey between 1993 and 2003 linked to patient data and average fee schedules, we estimate production functions for private dental services in Australia to quantify the contribution of different capital and labour inputs and identify economies of scale in the production of dental care. Given the challenges in measuring output in the healthcare setting, we discuss three different output measures (raw activity, time-, and price-weighted activity) and test the sensitivity of results to the choice of measure. Our results suggest that expansion of the scale of dental services is unlikely to be constrained by decreasing returns to scale. We note that conclusions about the contribution of individual input factors and the estimated returns to scale are sensitive to the choice of output measure employed.
Social Science & Medicine 11/2014; 124. DOI:10.1016/j.socscimed.2014.11.020 · 2.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective
To investigate time trends in dental service provision.MethodsA random sample of Australian dentists was surveyed by mailed questionnaires in 1983–1984, 1993–1994, 2003–2004, and 2009–2010 (response rates 67–76%). The service rate per visit was collected from a log of services.ResultsThe rate of service provision per visit [rate ratio (RR)] increased from 1983–1984 to 2009–2010 for the service areas of diagnostic (RR = 1.8; 1.6–1.9), preventive (RR = 1.9; 1.6–2.1), endodontic (RR = 2.1; 1.7–2.6), and crown and bridge (RR = 2.9; 2.3–3.8), whereas prosthodontic services decreased (RR = 0.7; 0.6–0.9).Conclusions
The profile of services provided by dentists changed over the study period to include less emphasis on replacement of teeth and more on diagnosis, prevention, and retention of natural dentitions.
[Show abstract][Hide abstract] ABSTRACT: Objectives: To date there is little evidence of minimum intervention in relation to treatment patterns, particularly for initial carious lesions. The objective of this study was to investigate treatment provided to patients with a main diagnosis of coronal caries in relation to the severity of the caries lesion. Methods: A random sample of Australian dentists was surveyed by mailed questionnaires in 2009-2010 (response rate 67%). Data on services, patient characteristics and main diagnosis were collected from a service log. Results: Models of service rates adjusted for age, sex, insurance status and reason for visit showed that compared to the reference category of gross caries lesions, there were higher rates [rate ratio, 95% CI] of restorative services for initial [1.63, 1.31-2.03] and cavitated [1.69, 1.39-2.05] lesions, higher rates of prophylaxis for initial [3.77, 2.09-6.79] and cavitated [3.88, 2.29-6.58] lesions, lower rates of endodontic services for initial [0.07, 0.02-0.30] and cavitated [0.11, 0.04-0.30] lesions, and lower rates of extraction for initial [0.15, 0.06-0.34] and cavitated [0.15, 0.07-0.31] lesions. Conclusions: Treatment of coronal caries was characterized by high rates of restorative services, but gross lesions had lower restorative rates and higher rates of endodontic and extraction services. There was little differentiation in treatment of coronal caries between initial and cavitated lesions, suggesting scope for increased management of initial carious lesions by the adoption of more minimum intervention approaches.
Journal of Dentistry 11/2014; 43(1). DOI:10.1016/j.jdent.2014.10.009 · 2.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective. The Australian Dental Council is responsible for the assessment of overseas-qualified dentists seeking to practice dentistry in Australia. The aim of this paper is to reflect on the Council's assessment and examination process through the experiences and perceptions of overseas-qualified dentists in Australia. Methods. Qualitative methods were used. Life stories of 49 overseas-qualified dentists from 22 nationalities were analysed to discern significant themes and patterns. We focused on their overall as well as specific experiences of various stages of the examination. The analysis was consistent with a hermeneutic phenomenological approach to social scientific research. Results. Most participants referred to 'cost' of the examination process in terms of lost income, expenses and time. The examination itself was perceived as a tough assessment process. Some participants seemed to recognise the need for a strenuous assessment due to differences in patient management systems in Australia compared with their own country. Significantly, most of the participants stressed the importance of support structures for overseas-qualified dentists involved in or planning to undertake the examination. These considerations about the examination experience were brought together in two themes: (1) 'a tough stressful examination'; and (2) 'need for support.' Conclusion. This paper highlights the importance of support structures for overseas-qualified dentists. Appropriate support (improved information on the examination process, direction for preparation and training, further counselling advice) by recognised bodies may prevent potential exploitation of overseas-qualified dentists. Avenues that have been successful in providing necessary support, such as public sector schemes, offer policy options for limited recruitment of overseas-qualified dentists in Areas of Need locations. Such policies should also be in line with the local concerns and do not reduce opportunities for Australian-qualified dentists.
Australian health review: a publication of the Australian Hospital Association 07/2014; 38(4). DOI:10.1071/AH14022 · 1.00 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The migration of dentists is a major challenge contributing to the oral health system crisis in many countries. This paper explores the origins of the dentist migration problem through a study on international dental graduates, who had migrated to Australia. Life-stories of 49 international dental graduates from 22 countries were analysed in order to discern significant themes and patterns. We focused on their home country experience, including stories on early life and career choice; dental student life; professional life; social and political life; travels; and coming to Australia. Our participants exhibited a commitment to excellence in earlier stages of life and had cultivated a desire to learn more and be involved with the latest technology. Dentists from low- and middle-income countries were also disappointed by the lack of opportunity and were unhappy with the local ethos. Some pointed towards political unrest. Interestingly, participants also carried prior travel learnings and unforgettable memories contributing to their migration. Family members and peers had also influenced participants. These considerations were brought together in four themes explaining the desire to migrate: 'Being good at something', 'Feelings of being let down', 'A novel experience' and 'Influenced by someone'. Even if one of these four themes dominated the narrative, we found that more than one theme, however, coexisted for most participants. We refer to this worldview as 'Global interconnectedness', and identify the development of migration desire as a historical process, stimulated by a priori knowledge (and interactions) of people, place and things. This qualitative study has enriched our understanding on the complexity of the dental migration experience. It supports efforts to achieve greater technical co-operation in issues such as dental education, workforce surveillance and oral health service planning within the context of ongoing global efforts on health professional migration by the World Health Organization and member states.
Health Policy and Planning 05/2014; 30(4). DOI:10.1093/heapol/czu032 · 3.00 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Previous studies have reported that socioeconomically disadvantaged Australians have poorer self-rated dental health (SRDH), are less likely to be insured for dental services and are less likely to have regular dental visits than their more advantaged counterparts. However, less is known about the associations between dental insurance and SRDH. The aim of this study was to examine the associations between SRDH and dental insurance status and to test if the relationship was modified by household income.
A random sample of 3,000 adults aged 30-61 years was drawn from the Australian Electoral Roll and mailed a self-complete questionnaire. Analysis included dentate participants. Bivariate associations were assessed between SRDH and insurance stratified by household income group. A multiple variable model adjusting for covariates estimated prevalence ratios (PR) of having good to excellent SRDH and included an interaction term for insurance and household income group.
The response rate was 39.1% (n = 1,093). More than half (53.9%) of the participants were insured and 72.5% had good to excellent SRDH. SRDH was associated with age group, brushing frequency, insurance status and income group. Amongst participants in the $40,000- < $80,000 income group, the insured had a higher proportion reporting good to excellent SRDH (80.8%) than the uninsured (66.5%); however, there was little difference in SRDH by insurance status for those in the $120,000+ income group. After adjusting for covariates, there was a significant interaction (p < 0.05) between having insurance and income; there was an association between insurance and SRDH for adults in the $40,000- < $80,000 income group, but not for adults in higher income groups.
For lower socio-economic groups being insured was associated with better SRDH, but there was no association for those in the highest income group. Insurance coverage may have the potential to improve dental health for low income groups.
Health and Quality of Life Outcomes 05/2014; 12:67. DOI:10.1186/1477-7525-12-67 · 2.10 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess the association of income-related social mobility between the age of 13 and 30 years on health-related quality of life among young adults.
In 1988-89 n = 7,673 South Australian school children aged 13 years were sampled with n = 4,604 children (60.0%) and n = 4,476 parents (58.3%) returning questionnaires. In 2005-06 n = 632 baseline study participants responded (43.0% of those traced and living in Adelaide).
Multivariate regressions adjusting for sex, tooth brushing and smoking status at age 30 showed that compared to upwardly mobile persons social disadvantage was associated (p < 0.05) with more oral health impact (Coeff = 5.5), lower EQ-VAS health state (Coeff = -5.8), and worse satisfaction with life scores (Coeff = -3.5) at age 30 years, while downward mobility was also associated with lower satisfaction with life scores (Coeff = -1.3).
Stable income-related socioeconomic disadvantage was associated with more oral health impact, and lower health state and life satisfaction, while being downwardly mobile was associated with lower life satisfaction at age 30 years. Persons who were upwardly mobile were similar in health outcomes to stable advantaged persons.
Health and Quality of Life Outcomes 04/2014; 12(1):52. DOI:10.1186/1477-7525-12-52 · 2.10 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Understanding dentists' capacity to supply dental services over time is a key element in the process of planning for the future. The aim was to identify time trends and estimate age, period and cohort effects in patients' visits supplied per dentist per year.
Mailed questionnaires were collected from a random sample of Australian private general practice dentists. The response rates were 73%, 75%, 74%, 71%, 76% and 67% in 1983, 1988, 1993, 1998, 2003 and 2009, respectively. The time trends in the mean number of patient visits supplied per dentist per year (PPY) was described by using a standard cohort table and age-period-cohort analyses applying a nested general linear regression models approach.
The mean number of PPY decreased across most age groups of dentists over the time of study. The age-period model showed that younger dentists (20-29 years) and older dentists (65-74 and 80-84 years) had lower PPY than middle-aged dentists, and the age-cohort model showed higher PPY among earlier cohorts, and lower PPY among more recent cohorts.
The study found a period effect of declining PPY over the observation period. More recent cohorts of dentists provide lower numbers of PPY than earlier cohorts at similar ages, but the provision of PPY among these younger cohorts appeared to be stable as they moved into middle age.
BMC Health Services Research 01/2014; 14(1):13. DOI:10.1186/1472-6963-14-13 · 1.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives
To determine the extent to which age, period and cohort factors have contributed to variation in problem-oriented dental visiting over time. Methods
Data were obtained from four National Dental Telephone Interview Surveys of Australian residents aged 5 years and over conducted in 1994, 1999, 2004 and 2010 (response rates 48–72%). The trend in the percentage of persons usually visiting the dentist for a problem was analysed by means of a standard cohort table and by a nested models framework for age–period–cohort analyses. ResultsThe percentage of persons usually visiting the dentist for a problem generally decreased over the periods examined (from 42.5% in 1994 to 31.5% in 2010). Problem visiting tended to be lower for children and adolescents compared with adult age groups at each point in time. Model fit tests revealed that the age–period–cohort model provided the best fit for the data (Hosmer–Lemeshow test statistic = 5.3; d.f. = 8; P-value = 0.72), indicating that both period and cohort factors were influential in problem visiting. Conclusion
This study found similar, consistent stories for both the age–period and age–cohort models, with usually visiting for a problem tending to be higher in older age groups and older cohorts. Problem visiting tended to decline over time for most age groups and most age cohorts. Understanding patterns of dental service use over time can be used to help inform service delivery policies that promote and facilitate appropriate use of dental services.
Community Dentistry And Oral Epidemiology 12/2013; 42(4). DOI:10.1111/cdoe.12088 · 1.94 Impact Factor