Workforce Planning Models for Oral Health Care: A Scoping Review

BACKGROUND

For health care services to address the health care needs of populations and respond to changes in needs over time, workforces must be planned. This requires quantitative models to estimate future workforce requirements that take account of population size, oral health needs, evidence-based approaches to addressing needs, and methods of service provision that maximize productivity. The aim of this scoping review was to assess whether and how these 4 elements contribute to existing models of oral health workforce planning.

METHODS

A scoping review was conducted. MEDLINE, Embase, HMIC, and EconLit were searched, all via OVID. Additionally, gray literature databases were searched and key bodies and policy makers contacted. Workforce planning models were included if they projected workforce numbers and were specific to oral health. No limits were placed on country. A single reviewer completed initial screening of abstracts; 2 independent reviewers completed secondary screening and data extraction. A narrative synthesis was conducted.

RESULTS

A total of 4,009 records were screened, resulting in 42 included articles detailing 47 models. The workforce planning models varied significantly in their use of data on oral health needs, evidence-based services, and provider productivity, with most models relying on observed levels of service utilization and demand.

CONCLUSIONS

This review has identified quantitative workforce planning models that aim to estimate future workforce requirements. Approaches to planning the oral health workforce are not always based on deriving workforce requirements from population oral health needs. In many cases, requirements are not linked to population needs, while in models where needs are included, they are constrained by the existence and availability of the required data. It is critical that information systems be developed to effectively capture data necessary to plan future oral health care workforces in ways that relate directly to the needs of the populations being served.

KNOWLEDGE TRANSFER STATEMENT

Policy makers can use the results of this study when making decisions about the planning of oral health care workforces and about the data to routinely collect within health services. Collection of suitable data will allow for the continual improvement of workforce planning, leading to a responsive health service and likely future cost savings.

Recruiting and retaining dental labor in federal facilities: Harder than pulling teeth?

The U.S. Veterans Administration (VA) is a large publicly financed health system that has long struggled with provider shortages. Shortages may arise at the VA because it offers different compensation than private sector employment options or because of differences in the way that labor is supplied to public versus private employers. In the mid-2000s, the VA adopted a more generous and flexible pay schedule for its dentists. We exploit this salary schedule change to study the impact of a positive wage shock on dental labor supplied to the VA, within a difference-in-differences framework. We find limited effects on VA separation and new hire rates overall-though early career dentists appear more sensitive to the wage change. More generous pay has its clearest effects on employment type for VA dentists, reducing the likelihood of being part-time by roughly 10%.

Self-perceptions and actual employment patterns amongst recent Australian dental graduates

INTRODUCTION

With nine dental schools across Australia graduating over 500 dental students each year, in addition to nearly 200 overseas-qualified dentists entering the workforce, dental students are anecdotally advised that they are joining a profession ubiquitous with workforce oversupply. The aim of this study was to shed light on the employment patterns of recent dental graduates from Australian universities and their self-perceptions of the job market.

MATERIALS AND METHODS

This cross-sectional pilot study involved an online survey conducted in 2017 on recent dental graduates from all Australian dental schools. Graduates' demographics, their perception of the dental employment prospects, their employment-related behaviours and employment outcomes, and the relationships between these variables were explored.

RESULTS

Data on seventy-one survey respondents (approximately 12% of the total sampling frame) were analysed. They suggested that recent Australian dental graduates are seeking work (73.2%) and undertaking work experience (54.9%) prior to graduation, successfully finding employment within the first-year post-graduation (97%), yet not always in their perceived ideal workplace environment (42.2%). Relationships between age, perception of market competitiveness and job searching patterns were revealed. Graduates expressed a desire for more workplace mentorship. The small sample size of this study limits the generalisability of the results, indicating that further research is required.

CONCLUSIONS

The dental employment landscape appears to have adequate employment opportunities for recent dental graduates, yet not always in their perceived ideal workplace environment. Graduates are seeking more mentorship in the workplace.

Hours worked and patient visits provided by dentists in Australia

BACKGROUND

The aim was to examine the numbers of hours worked and patient visits provided by age and gender of dentists in Australia, and compare with previous estimates to describe trends.

METHODS

Data were collected from a random sample (N = 2961) of Australian dentists. Private sector dentists working in clinical practise were included in the analysis.

RESULTS

The response rate was 49% (N = 1345 dentists). Hours per year worked and number of patient visits per year were lower for dentists aged 65 years and older compared with younger dentists, and were higher for male compared with female dentists aged 35-45 to 55-64 years. Hours per year worked were lower in 2013-2014 than reported in 2009-2010, but the number of patient visits in 2013-2014 was similar to the previously reported estimate from 2009-2010.

CONCLUSIONS

Hours worked and visits provided were only lower among older dentists aged 65 years or more. Male dentists tend to work more hours per year and provide more patient visits per year than female dentists. Over the last decade, Australian dentists maintained a stable output of visits per year despite a trend towards fewer hours worked per year.

Dental Management Survey Brazil (DMS-BR): creation and validation of a management instrument

Questionnaires for the assessment of knowledge and self-perception can be useful to diagnose what a dentist knows about management and administration. The aim of the present study was to create and validate the Dental Management Survey Brazil (DMS-BR) scale, based on meetings with experts in the field. After having elaborated the first version, 10 audits were performed in dental offices in order to produce the final version, which included nine dimensions: location, patient, finance, marketing, competition, quality, staff, career, and productivity. The accuracy of the instrument was measured by intrarater and interrater reliability. In the validation phase, 247 Brazilian dentists answered a web-based questionnaire. The data were processed using Stata 13.0 and the significance level was set at 95%. The instrument had intrarater and interrater reliability (ICC-0.93 and 0.94). The overall average of respondents for the DMS-BR scale was 3.77 (SD = 0.45). Skewness and kurtosis were below absolute values 3 and 7, respectively. Internal validity measured by Cronbach's alpha was 0.925 and the correlation of each dimension with the final result of the DMS-BR ranged between 0.606 and 0.810. Correlation with the job satisfaction scale was 0.661. The SEM data ranged between 0.80 and 0.56. The questionnaire presented satisfactory indicators of dentists' self-perception about management and administration activities.

Projected future distribution of dentists in Japan

OBJECTIVES

Appropriate health policies for the supply of dentists have been an ongoing issue in many developed countries. The purpose of this study was to estimate the future distribution of dentists with different working statuses in Japan and to discuss policy implications about the supply of dentists in any country.

METHODS

This was a retrospective cohort study using data from the National Survey of Physicians, Dentists and Pharmacists for 1972-2012. Based on data from the 2010 and 2012 surveys, we calculated by means of a Markov model the future number of dentists with different working statuses until 2042 according to sex.

RESULTS

We estimated that the total number of active dentists will decrease from 2012 to 2042. The number of active dentists per 1,000 population was predicted to reach a peak in 2018, decrease by 4.2% from 2012 to 2038, and thereafter slightly increase. With regard to working status, the number of dentists with their own practices per 1,000 people was predicted to have reached a peak in 2014 and decrease by 22.0% until 2042. We estimated that the number of dentists used in dental clinics per 1,000 population will increase continuously between 2012 and 2042 by 20.0%.

CONCLUSIONS

Our study suggests that maintaining this supply of dentists may lead to maldistribution of their working status in the future.

Rural dentists: does growing up in a small community matter?

BACKGROUND

The aging of the dental work-force has implications for both patients and dentists, especially those in rural and underserved areas. Anecdotal information regarding dental workforce trends indicates that students from rural communities are more likely to practice in rural communities than are students from urban areas. Although the medical literature supports this premise relative to physicians, there are no data to verify this statement relative to dentistry. Therefore, the authors decided to study whether this premise applies to dentistry.

METHODS

The authors conducted a retrospective analysis of dental student records from a Midwestern dental school for the years 1980 through 2010 to determine if there was a statistical correlation between the size of a dental student's town of origin and the size of the community where he or she practiced after graduation. They also examined what role, if any, the student's sex played.

RESULTS

Dentists from rural areas were approximately six times more likely to practice in a rural area than were dentists from urban areas. Female dentists were only slightly less likely to practice in a rural community than were male dentists.

CONCLUSION

Dentists from rural communities were more likely to practice in rural communities than were dental students from urban areas.

PRACTICE IMPLICATIONS

To ensure future access to care in rural communities, rural dentists may want to recruit actively or work closely with dental students from rural areas when hiring associates or seeking purchasers for their dental practices.

Lack of access in healthcare delivery: a model for using dental hygienists in a cost effective manner to help address the oral healthcare problem

The healthcare delivery of the United States is confronted with many issues and problems. In an attempt to deal with them, the country has been engaged in a process of healthcare reform. Unfortunately, this reform has largely focused on who is going to pay, what is going to be covered, and how all of the constituencies are hopefully going to be satisfied. What have been largely unaddressed are new delivery paradigms or how the care will be distributed to the underserved. The authors attempt to seek solutions to these last two areas of concern. They spell out how the expansion of the scope of practice for dental hygienists will allow them to bridge the gaps in service and to help deliver dental coverage and elements of systemic healthcare to underserved populations. Finally, the authors provide the steps and mechanisms of how the scope of practice can be expanded. Policy and educational requirements are considered.

The challenge to delivering oral health services in rural America

OBJECTIVES

This review identifies the challenges to oral health in rural America and describes areas of innovation in prevention, delivery of dental services, and workforce development that may improve oral health for rural populations.

METHODS

This descriptive article is based on literature reviews and personal communications.

RESULTS

Rural populations have lower dental care utilization, higher rates of dental caries, lower rates of insurance, higher rates of poverty, less water fluoridation, fewer dentists per population, and greater distances to travel to access care than urban populations. Improving the oral health of rural populations requires practical and flexible approaches to expand and better distribute the rural oral health workforce, including approaches tailored to remote areas. Solutions that involve mass prevention/public health interventions include increasing water fluoridation, providing timely oral health education, caries risk assessment and referral, preventive services, and offering behavioral interventions such as smoking and tobacco cessation programs. Solutions that train more providers prepared to work in rural areas include recruiting students from rural areas, training students in rural locations, and providing loan repayment and scholarships. Increasing the flexibility and capacity of the oral health workforce for rural areas could be achieved by creating new roles for and new types of providers. Solutions that overcome distance barriers include mobile clinics and telehealth technology.

CONCLUSIONS

Rural areas need flexibility and resources to develop innovative solutions that meet their specific needs. Prevention needs to be at the front line of rural oral health care, with systematic approaches that cross health professions and health sectors.

Oral health disparities and the workforce: a framework to guide innovation

INTRODUCTION

Oral health disparities currently exist in the United States, and workforce innovations have been proposed as one strategy to address these disparities. A framework is needed to logically assess the possible role of workforce as a contributor to and to analyze workforce strategies addressing the issue of oral health disparities.

METHODS

Using an existing framework, A Strategic Framework for Improving Racial/Ethnic Minority Health and Eliminating Racial/Ethnic Health Disparities, workforce was sequentially applied across individual, environmental/community, and system levels to identify long-term problems, contributing factors, strategies/innovation, measurable outcomes/impacts, and long-term goals. Examples of current workforce innovations were applied to the framework.

RESULTS

Contributing factors to oral health disparities included lack of racial/ethnic diversity of the workforce, lack of appropriate training, provider distribution, and a nonuser-centered system. The framework was applied to selected workforce innovation models delineating the potential impact on contributing factors across the individual, environmental/community, and system levels. The framework helps to define expected outcomes from workforce models that would contribute to the goal of reducing oral health disparities and examine impacts across multiple levels. However, the contributing factors to oral health disparities cannot be addressed by workforce innovation alone.

CONCLUSION

The Strategic Framework is a logical approach to guide workforce innovation, solutions, and identification of other aspects of the oral healthcare delivery system that need innovation in order to reduce oral health disparities.