Associates and their working environment: a comparison of corporate and non-corporate associates

How and why do health system factors influence general dentists' participation in publicly funded, contracted primary dental care services: A realist review

OBJECTIVES

To identify health system contexts and mechanisms influencing general dental practitioners' (GDPs) participation in state funded, contracted primary oral healthcare.

METHODS

Peer-reviewed articles and other sources were identified via EMBASE, Medline (OVID), Web of Science and Google Scholar databases, grey literature search, citation tracking and expert recommendations. Studies meeting the inclusion criteria were assessed for rigour, relevance and richness, and coded to identify data relating to contexts, mechanisms and outcomes. Inductive and deductive coding was used to generate context-mechanism-outcome configurations (CMOCs) and develop the final programme theory.

RESULTS

Database searching identified 1,844 articles of which 29 were included. A further 33 sources were identified through adjunctive searches. Analysis identified key systems contexts influencing GDP participation. These include system emphasis on treatment over prevention, low priority for oral healthcare, funding constraints, and change implementation with minimal clinician consensus. At operational level, contracts can restrict GDP decision-making and ability to deliver high quality and holistic patient care. Key underlying mechanisms were feelings of ceded clinical and entrepreneurial control, stress and demoralisation, mistrust of the system and feeling undervalued.

CONCLUSIONS

The factors influencing GDP participation in state-funded, contracted dental care over private dental care are complex. The findings presented in this review have the potential to act as a good place to start leveraging health system change including better GDP engagement and increase participation in publicly funded systems.

Problem-based learning curriculum disconnect on diversity, equitable representation, and inclusion

Diversity, equity, and inclusion (DEI) mission statements continue to be adopted by academic institutions in general, and by dental schools around the globe in particular. But DEI content seems to be under-developed in dental education. The objectives of this study were two-fold: to extract information from all the PBL cases at University of British Columbia's Faculty of Dentistry curriculum in terms of the diversity, equitable representation, and inclusion of patient and provider characteristics, context, and treatment outcomes; and; to compare these findings with the composition of the British Columbia census population, dental practice contextual factors, and the evidence on treatment outcomes within patient care. Information from all the 58 PBL cases was extracted between January and March 2023, focusing on patient and provider characteristics (e.g., age, gender, ethnicity), context (e.g., type of insurance), and treatment outcomes (e.g., successful/unsuccessful). This information was compared with the available literature. From all the 58 PBL cases, 0.4% included non-straight patients, while at least 4% of BC residents self-identify as non-straight; there were no cases involving First Nations patients although they make up 6% of the British Columbia population. Less than 10% of the cases involved older adults who make up almost 20% of the population. Only Treatments involving patients without a disability were 5.74 times more likely to be successful compared to those involving patients with a disability (p<0.05). The characteristics of the patients, practice context, and treatment outcomes portrayed in the existing PBL cases seem to differ from what is known about the composition of the British Columbia population, treatment outcome success, and practice context; a curriculum disconnect seems to exist. The PBL cases should be revised to better represent the population within which most students will practice.

It's not just about the money: recruitment and retention of clinical staff in general dental practice - part 1: dentists

Increasing difficulties in recruitment and retention of dentists and dental care professionals in general dental practice in the UK is affecting delivery of NHS dental services. Reports of dissatisfaction among the general dental practice workforce indicate there is a significant risk to the future dental workforce supply which will affect access to dental care and worsen oral health inequalities. Understanding the factors related to job satisfaction and dissatisfaction of dental professionals would be useful in managing recruitment and retention issues and ensure a dental workforce exists which is able to meet the needs of the population. The aim of this literature review was to identify factors which contribute to job satisfaction and dissatisfaction of clinical staff in general dental practice. Database searching was conducted systematically through PubMed/Medline, Scopus, Ovid, and the National Grey Literature Collection. Part 1 of this two-part series discusses the factors relating to dentists. Twenty-two relevant articles were identified, which were qualitatively analysed using Herzberg's motivation-hygiene theory as an analysis tool. Target-driven and restrictive contractual arrangements are a major factor contributing to dissatisfaction of dentists, as well as time pressures, poor quality equipment, and unfair remuneration. Dental contract reform should aim to minimise factors contributing to dissatisfaction and increase factors which increase satisfaction, if sufficient numbers of dentists are to be persuaded to continue to provide state-funded dentistry.

Rationalisation and 'McDonaldisation' in dental care: private dentists' experiences working in corporate dentistry

Introduction This study examines how dentists experience the corporatisation of dentistry and the impacts of rationalisation. The emergence of corporate dentistry in the early twenty-first century has introduced greater competition into the dental marketplace. Ritzer's theory of 'McDonaldisation' explores the rationalisation of services through corporatisation and provides an apt framework with which to understand the qualitative insights gathered through this project.Methods Semi-structured interviews and reflective journals were used to collect insights from dentists who were working in private practice. Data were then subjected to thematic analysis.Results A total of 20 private dentist participants provided 22 separate interviews and multiple reflective accounts. Following analysis, three key themes emerged: 1) opportunities provided by corporate dentistry; 2) balance between professionalism and commercialism in corporate dentistry; and 3) competition between independent and corporate dentistry.Conclusions The participants' insights demonstrate how Ritzer's four dimensions of rationalisation - efficiency, predictability, calculability and control - have been encapsulated by corporate dentistry in Australia. Corporate interests in Australian dentistry are perceived to improve competition and offer opportunities for younger and less experienced dentists, but the findings also suggest that those leading corporate dentistry need to ensure that rationalisation does not diminish the caring relationship between dentists and patients.

Commissioning in the community dental services: what do dentists think?

Aims This study aims to elucidate the thoughts and experiences of community dental service (CDS) dentists on procurement. Interviews were conducted and accompanied by secondary analysis of census data.Methods Demographics and working conditions were examined and interview participants discussed the tendering process.Results CDS dentists were motivated by their patients and overall enjoyed their work. Interviews identified three key themes relating to commissioning: 1) process - dentists' experience of the tendering process; 2) effects - what dentists believe their service looks like after tendering; and 3) results - how dentists believe tendering has affected patients. The point of commissioning was questioned. It was perceived to negatively affect the working environment and the care provided to patients, and was seen to cause a shift in service priorities. It was suggested that providers entered into a state of stasis during commissioning, leaving services to decay.Discussion This paper, the second in a series examining the community and public dental services, highlights the effects that commissioning has on staff and patient care, and builds on the understanding developed in the first paper of this series.Conclusions Further work is needed to examine the place of competitive commissioning in dentistry and, given its ubiquitous use, it is of importance to all dentistry stakeholders.

The community and public dental services: a mixed-method exploration of the workforce

Aims This exploratory study is the first in a series of two examining the working conditions of the community and public dental services in the UK to provide insight, context and understanding on their current status.Methods Secondary analysis of census data was supplemented by qualitative analysis of interview data from community and public dental service dentists. Demographic and working conditions data were examined and interview participants discussed their role, service and patients, potential service improvements and how they saw the services developing.Results Overall, dentists were satisfied with their role but did not feel secure in their job and worked more hours than they were contracted to. Interviews identified three key themes: 1) personal - aspects affecting the interviewee on a personal level; 2) patients - aspects affecting patients; and 3) service - aspects relating to the service. Services had changed and were seen, in part, to have become more efficient, but some clinicians thought the focus had moved away from patients.Conclusions Overall, clinicians enjoyed their role, but while services were seen to provide good patient care, dentists felt under pressure. Changes to general dental practice, management practices and increased funding were believed likely to improve the services.

Career Prospects of Young Dentists in Switzerland

The observational cross-sectional study was aimed to obtain information on the promotion and development of young professionals in Switzerland. An online survey with 20 questions was sent out. Data was collected on participants’ demographic data, including age, gender, level of qualification, place of work, information on employment, future perspectives, and career prospects. The survey was sent out to 1920 practitioners, of which 440 (22.9%) responded (37.1% males and 62.9% females). Of them, 76.6% were members of the Swiss Dental Association (SSO) 15.9% students, and 7.5% non-SSO members. Most participants had parents with a dental education (80.9%), and 19.8% did not. Young dentists in Switzerland most often saw their career prospects as neutral (39.8%) or rather positive (39.3%). Whereas significantly fewer dentists had a negative view of their professional future (16.8%), including more women than men, the fewest dentists of both sexes (4.1%) saw their career prospects as positive by far. The majority of young dentists were satisfied with their career prospects. Within the limitations of the current study, the reasons for this need further investigation. Despite good career prospects, there is a desire among young colleagues for cantonal practice assistance and mentoring programs, as well as support in finding a job and in taking the plunge into self-employment.

Clinical and academic recommendations for primary dental care prosthodontics

Prosthodontic practice includes a large proportion of dental care provision, mostly undertaken in primary dental care (PDC) in the UK. However, there is limited research evidence in prosthodontic practice, necessary to tackle key questions to improve oral and dental health. In addition, many overarching challenges exist within the NHS system relevant to prosthodontics. For example, demands on healthcare services from increasing patient expectations, the ever-ageing and growing population, risks of litigation, availability of appropriate care, difficulties with access to care, rapidly emerging treatments and technologies, and ongoing needs for education. This article develops clinical and academic recommendations to improve oral health improvements in PDC prosthodontics, further to recommendations determined by the James Lind Alliance, a non-profit making initiative to tackle treatment 'uncertainties' (http://www.jla.nihr.ac.uk/), and the overarching challenges, which are mentioned above. Considerable clinical and academic author experiences from primary, secondary and tertiary care as well as education and research in prosthodontics are employed. We consider management of networks involving patients, carers, healthcare professionals, industry and academics, in order to increase access to improve oral and general health and help drive dental research, education and communication. We investigate how to manage dental disease and intervene to improve the longevity of restorations and the dentition. Finally, we review how rapidly developing digital technologies can best be utilised, in conjunction with industry, in order to improve oral health.

Key determinants of health and wellbeing of dentists within the UK: a rapid review of over two decades of research

Aim To review the key determinants of health and wellbeing among dentists working in the UK.Methods Rapid review of the literature (1996-2018) across seven health and social science databases through OVID and the Cochrane Library, professional and health system sources. Records were screened according to agreed inclusion and exclusion criteria by title, abstract and full text. Data extraction and qualitative synthesis of the included studies were performed. Quality assessments for risk of bias were made using a mixed methods appraisal tool.Results Thirty-eight studies met the criteria for inclusion. Fourteen were assessed as high, 22 as medium and two of low quality, most involving cross-sectional research in the form of questionnaire surveys. Whereas overall, the health and wellbeing of dentists within the UK is reported as 'good', recently published evidence suggests a less positive view may be emerging. The health and wellbeing of dentists is associated with a wide range of factors: personal, professional career, relationships, job specification, workplace and system. Emerging evidence suggests additional concerns about the regulation of dentistry. Workplace characteristics were most often explored among researchers and reported as being a key issue.Conclusion Evidence highlights multiple determinants of health and wellbeing, most notably related to workplace characteristics; however, while there is a relative lack of well-founded prospective research investigating the nature and direction of the relationships and comparison across UK health systems, there is increasing evidence of health and wellbeing concerns that require further investigation.