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Challenges Faced by Dentists and Dental Workforce in Australia

Introduction

The demographic shift is seen globally and Australia is no exception where the proportion of older age group is increasing. This is attributed to the success of medicine and vaccines as the prevalence and mortality due to communicable diseases is reduced resulting in increased life expectancy rate (Souza et al., 2018). This has affected the healthcare workforce as the workforce is also ageing which makes it difficult for them to cater to the ever-increasing patient flow. There are many factors that affect the healthcare workforce and to have a sustainable workforce in terms of number and infrastructure is a challenge (Jackson et al., 2019).

There are alternate occupations which have resulted in fewer people opt a career in healthcare. It is not a novel finding that people working in healthcare feel that they are overworked and underpaid as a result there is less retention. This along with the fact that there is less labour flow from in the market makes it more challenging. The aim of the present essay is to discuss the challenges faced by the dental workforce in Australia and the measures taken at the national, state and institutional level to address those challenges. Also, the essay discusses the adequacy of the current efforts and state recommendations for the same.

Current Distribution of The Dental Workforce in Australia

Dentists in Australia are required to be registered with the Australian Health Practitioner Regulation Agency to be able to practice dentistry in Australia (Jean et al., 2020). Under this, there are different levels of registration and most of the dentists have general registration. There are a total of 13 dental specialties in Australia. From 2013 to 2016, the number of registered dentists in Australia has increased from 15,479 to 16,549. The workforce ratio in healthcare is estimated by full-time equivalent rate. It is defined as the number of dental practitioner per 100,000 populations and it is a measure of supply and for the year of 2016, it was seen to be 57.7 (Australian institute health and welfare, 2019). This varied among the jurisdictions and also as per the specialty of the dental profession and it has increased from 55.4 in 2013. The full-time equivalent rate was seen to be high in major cities compared to rural and remote areas as FTE in the former was 64.6 while in latter it was just 25.1 (Australian institute health and welfare, 2019).

Current Distribution of The Dental Workforce in Australia Challenges Faced by The Dental Workforce

Australia is one such developed country where there the existent healthcare workforce is such that it is substantial and the maldistribution is less (Davis et al., 2017). The dental workforce in Australia has remained stable from 2013 to 2016 which ranged from 89% to 91% of dentists who remained employed (Pradhan et al., 2016). The challenges faced by dentists are also dependent on the sector of employment and it is seen that more dentists are employed in the private sector compared to the public sector which can be attributed to the remuneration given (Short, 2016).

The dental workforce consists majorly of dentists but it also includes dental assistants, technicians, hygienists, therapists and oral health therapists. It is seen that majority of the dentists practising in Australia are of international in origin or internationally qualified. The proportion of people from the indigenous origin is less in the dental workforce which is one of the many challenges that are faced by the dental workforce in Australia (Gabriel et al., 2018).

One of the main challenges that are faced by the dental workforce in Australia is that of migrant dentists. This is a challenge for the healthcare policymakers in both developing countries as well as developed countries. It is that Australia attracts dentists in large number from more than 120 countries worldwide. The main challenge that is faced by the dental workforce is increased migrating of dentists to Australia which perhaps brings the flow of knowledge and is a major contributor for global development but at the same time in the parent country, it causes brain drain (Cowan et al., 2019). This somewhere decreases the demand of native dentists in Australia and thereby reduced motivation to opt for the profession (Cowan et al., 2019).

The reason for migration from developed and developing countries are different. From developed countries, the reason is usually adventure but the migrants from developing countries state that there is a need for better opportunities (Balasubramanian et al., 2017). It is also attributed to the fact that the healthcare system in their parent countries is unstable and unfavourable for further personal and professional growth. The challenges faced by the dental workforce is such that they face cultural difficulties and there have been reports of discrimination, racism, isolation, stress and loss of identity while working within the system of Australia (Balasubramanian et al., 2017).

There are many studies which have explored the life story experience of other professions including that of the healthcare but less published documents are present with respect to the life story experience of the dental health workforce in Australia. The lived experiences show that there are factors which make them stay in Australia which is more inclined towards financial status and lifestyle (Balasubramanian et al., 2017). At the same time, they face challenges in integrating with the ways with that of Australian and to become a registered dentist in Australia is a costly and long affair and which often lead the aspiring dentists to change the career.

It is seen that one out of four dentists are either overseas qualified or international in origin and the challenges faced by them are profound which often results in them having a career change or migrating back to their home countries. Cultural adaption is the major challenge that is faced by the dentists and that affects the dental workforce. In a qualitative study conducted by Balasubramanian et al. (2016), it was seen that majority of the dentists reported that accent and slang of the colleagues and patients affected the cultural experience. Some of them reported it to be fascinating for the majority of them it was a cultural shock as it was drastically different compared to their home country.

Though the dental workforce of Australia has been stable for the last five to ten year but dentist to population is less and the difference is seen drastically when major cities are compared to the rural and remote areas (Brostek et al., 2016). This accounts for severe maldistribution of the dental workforce in rural and remote areas and leads to the underserved population. This difference is attributed to various things. First, the proportion of people from the indigenous background is less in the dental workforce (Curtis, 2018).

This is one of the major challenges that are faced by the dental workforce and it is either due to socioeconomic background or the discrimination that is faced by them influences their decision to be involved in the mainstream healthcare (McFadden et al., 2018). Another reason for this is, the concept of health by the indigenous population is such that it includes all the aspects of health and holistic in nature. This is not upheld by the medicine or healthcare of the mainstream this discourages people from Aboriginal or Torres Strait Islanders to pursue a career in dentistry.

The other reason for the maldistribution of the dentists or dental workforce in remote and rural areas is that there is less proportion of dentist who would want to practice dentistry in such areas (Graham et al., 2019). There are various factors which influence this decision. One is that if the dentist is not of a similar background, it becomes difficult for him/her to adapt to the cultural difference that is present. There is also the presence of linguistic barrier which can be seen and is difficult for the dentists to overcome and practice. The rural and remote areas in Australia are isolated in terms of geographic location and also have extreme climatic conditions which further discourage the dentists to set-up practice in such locations (Johnson et al., 2019).

During the course of education, the dental students are posted in a rural setting to get them accustomed so that they have an experience as to how the healthcare system work in the rural or remote environment. It is often seen that people are discouraged to pursue in a rural setting after the experience (Graham et al., 2019).

There are more dentists who opt for practice in the private sector when compared to the public sector and it is due to the fact that they would want to avoid being posted in a rural and remote setting. The other factor that governs this decision is that there is less remuneration that is expected in a rural setting. Dentists' perception of working in a rural and remote setting is that there is less opportunity for growth (Emami et al., 2016). This growth is attributed to both personal and professional growth and vertical and lateral growth. This is one of the most profound factors that are reported by the dentists. They have reported that there is less support to work in such a setting. In an attempt to close the gap, the state, territories and national government have made allocations for setting up of primary health centres (Penco et al., 2019).

These are to be set up in areas where the accessibility and affordability of healthcare facilities are less and will cater to the needs of the people belonging to rural and remote areas. In Australia, unlike many developing countries and even few developed countries, it is seen dental care is provided in primary health centres but dentists are reluctant to work in such settings (Butten et al., 2020). It is because of the lack of facilities and infrastructure that the dentists are reluctant to practice.

One of the major challenges that are faced by the dental workforce is ageing as it is faced by another healthcare workforce as well. There are new and innovative career options which are also lucrative in terms of monetary gain and other things (Penco et al., 2019). It is a major reason there is a deficiency in the workforce and less flow in the labour market. There is also less retention of the dentists from the international origin as well as those from the indigenous origin. The other challenge that is faced as a result of the reduction in the dental workforce is the labour cost which would increase to hire a dentist.

Measures Are Taken to Address the Challenges

The first challenge that requires attention is the migration of the dentists across borders which have influenced the balance of dental health workforce in Australia as well as the home country of the migrants as well. International consensus has focused on the integration of the dental workforce such that national policymakers can focus on the healthcare workforce issues in the country (Balasubramanian et al., 2017). The evidence from the life story experience of the dentists in Australia suggests that multi-level workforce is the solution to the workforce crisis that has settled in the nation.

To make the national dental workforce one that is multi-level, it is required that there is governance from the participating countries as well. Australia has taken examples of other multi-level approaches and included them in the national framework like that of the European Union, gulf cooperative council, and association of South-East Asian nations. Australia has included the global code that is provided by the World Health Organization which is taken as the core component for the bilateral, national, regional and global response to the dental healthcare workforce crunch (Balasubramanian et al., 2017).

Another measure that is taken to reduce the maldistribution of the dentists in the rural and remote areas is to produce more dentists. This has two aspects by which the government is working and it is to recruit and employ more dental students from a rural background and indigenous background. The adequacy of this strategy is unlikely to be a success as after qualifying to be dentist it more likely that people might migrate to the cities in search of better opportunities (Estai et al., 2016). This is already in place but the success of this can only be reflected in the future but is highly unlikely.

Another measure that is taken to tackle the maldistribution is workforce substitution. This is not a new concept where mid-level dental providers like oral health therapists or dental therapists who generally work under the supervision of dentist are given more autonomy. They can take instructions from dentists and provide care in rural and remote areas (Estai et al., 2016). The adequacy of this measure is an established one and is seen to be successful in the provision of oral healthcare to the children in a school setting in a rural and remote setting.

There is also an emerging model of team-based care which is being used in Australian healthcare for addressing the challenge of facing the ageing and reduced workforce and that is the use of skill-mix (Wong & Irving, 2020). Dental health care workforce in Australia also has included skill-mix after taking the success of seeing in another healthcare workforce like in nursing and medicine. From the models of the workforce, it is seen that skill-mix is dependent on the perception of employer-dentist of the dental team. In a setting where a dentist is not affordable or is not available, it is seen that oral health therapists have more autonomy (Wong & Irving, 2020). This is the reason they are at present being used in school dental setting. The adequacy of this measure is good as it is being already used in one aspect and can be used in other settings are well.

To decrease the turnover rate and increase the retention of the dentists and others in dental health professionals in the rural or remote setting of Australia is one of the major challenges which are faced by the healthcare system and policymakers. To make sure that more professionals are retained in the rural healthcare system at the national there is the development of ‘Whole-of- Person Retention Improvement Framework’ (Cosgrave, 2020). There are three main domains to this framework: workplace, career and community. It is a holistic concept in which the dental health professional is seen as a whole person and all the aspects of work and life are taken into account (Cosgrave, 2020). This is a proposed idea but when implemented properly it can help increase the retention and decrease the turnover rate. The adequacy of the framework is good as it takes all the aspects of the professional into account.

Recommendation

The main aim of oral healthcare is to make sure that all the citizens of a nation have good oral hygiene and oral healthcare. The challenges faced by the dentists and dental workforce and multi-faceted and the approach to the address them should also be similar and not just focused on one challenge or one problem. The policymakers and employers should work to tackle them and a needs-based workforce should be formed (Ahern et al., 2019).

Conclusion

Due to the demographic shift, the healthcare workforce is also ageing which is one of the major challenges faced by the workforce but the challenge faced by the dental workforce includes this among others. In the last decade, it is seen that the dental workforce has been stable in Australia but it is less and maldistributed in rural and remote areas of Australia. The challenge faced by the dentist of international origin is the cultural shock. It is seen that the dentists working in the rural and remote areas face social isolation and due to less personal growth and professional opportunity dentist do not opt for them. The current measures are to decrease the turnover and increase retention in rural areas for which there is a development of ‘Whole-of-Person Retention Improvement Framework’ and skill-mix. Another thing that is already in place is the utilization of mid-level oral health workers like therapists. These measures are feasible but it is recommended that the approach should be multifaceted.

References

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