Needs-based planning for the oral health workforce - development and application of a simulation model.

BACKGROUND: The World Health Organization's global strategy on human resources for health includes an objective to align investment in human resources for health with the current and future needs of the population. Although oral health is a key indicator of overall health and wellbeing, and oral diseases are the most common noncommunicable diseases affecting half the world's population, oral health workforce planning efforts have been limited to simplistic target dentist-population or constant services-population ratios which do not account for levels of and changes in population need. Against this backdrop, our aim was to develop and operationalise an oral health needs-based workforce planning simulation tool. METHODS: Using a conceptual framework put forward in the literature, we aimed to build the model in Microsoft Excel and apply it in a hypothetical context to demonstrate its operability. The model incorporates a provider supply component and a provider requirement component, enabling a comparison of the current and future supply of and requirement for oral health workers. Publicly available data, including the Special Eurobarometer 330 Oral Health Survey, were used to populate the model. Assumptions were made where data were not publicly available and key assumptions were tested in scenario analyses. RESULTS: We have systematically developed a needs-based workforce planning model for the oral health workforce and applied the model in a hypothetical context over a 30-year time span. In the 2017 baseline scenario, the model produced a full-time equivalent (FTE) provider requirement figure of 899 dentists compared with an FTE provider supply figure of 1985. In the scenario analyses, the FTE provider requirement figure ranged from 1123 to 1629 illustrating the extent of the impact of changing parameter values. CONCLUSIONS: In response to policy makers' recognition of the pressing need to better plan human resources for health and the scarcity of work in this area for dentistry, we have demonstrated the feasibility of producing a workable, practical and useful needs-based workforce planning simulation tool for the oral health workforce. In doing so, we have highlighted the challenges faced in accessing timely and relevant data needed to populate such models and ensure the reliability of model outputs.

Interventions for enhancing the distribution of dental professionals: a concise systematic review.

BACKGROUND: A spatially unequal distribution of dentists or dental care professionals (D/DCPs), such as therapists or hygienists, could reduce the quality of health services and increase health inequities. This review describes the interventions available to enhance this spatial distribution and systematically assesses their effectiveness. METHODS: Electronic databases (Cochrane CENTRAL, Medline, Embase, CINAHL) were searched and cross-referencing was performed using a standardised searching algorithm. Randomised and non-randomised controlled trials, controlled before-and-after studies and interrupted time series were included. Studies investigating a minimum of one of four interventions (educational, financial, regulatory and supportive) were included. The primary outcome was the spatial distribution of D/DCPs. Secondary outcomes were access, quality of services and equity or adverse effects. This review was registered (CRD42015026265). RESULTS: Of 4,885 articles identified, the full text of 201 was assessed and three (all investigating national policy interventions originally not aiming to change the distribution of D/DCPs) were included. In one Japanese study spanning 1980 to 2000, the unequal spatial distribution of dentists decreased alongside a general increase in the number of dentists. It remained unclear if these findings were associated. In a second Japanese study, an increase in the number of dentists was found in combination with a postgraduate training programme implemented in 2006, and this occurred alongside an increasingly unequal distribution of dentists, again without proof of cause and consequence. A third study from Taiwan found the introduction of a national universal-coverage health insurance to equalise the distribution of dentists, with statistical association between this equalisation and the introduction of the insurance. CONCLUSIONS: The effectiveness of interventions to enhance the spatial distribution of D/DCPs remains unclear.

Envisioning an oral healthcare workforce for the future.

Health is critical to human well-being. Oral health is an integral component of health. One is not healthy without oral health. As health is essential to human flourishing, it is important that an oral healthcare delivery system and workforce be developed and deployed which can help ensure all citizens have the potential to access oral health care. As such access does not generally exist today, it is imperative to advance the realization of this goal and to develop a vision of an oral healthcare workforce to functionally support access. Public funding of basic oral health care is an important element to improving access. However, funding is only economically feasible if a workforce exists that is structured in a manner such that duties are assigned to individuals who have been uniquely trained to fulfill specific clinical responsibilities. An essential element of any cost-effective organizational system must be the shared responsibility of duties. Delegation must occur in the oral health workforce if competent, cost-effective care is to be provided. Desirable members of the oral health team in an efficient and effective system are as follows: generalist dentists who are educated as physicians of the stomatognathic system (oral physicians), specialist dentists, dental therapists, dental hygienists, dually trained hygienists/therapists (oral health therapists), oral prosthetists (denturists), and expanded function dental assistants (dental nurses).

Field survey of dental manpower in Taiwan's hospitals.

BACKGROUND/PURPOSE: In Taiwan, dental manpower in hospitals plays an important role in dental education other than clinical service. Questionnaires, as well as a field survey, were conducted to understand the situation of dental manpower in 2007 and 2008. METHODS: During the period from 2007 to 2008, questionnaires about dental administration, clinical dental practice, dental education, dental manpower and dental facilities were mailed to the dental departments of 165 hospitals located around Taiwan; 134 completed the questionnaire and mailed it back. The field survey was also carried out by visiting hospitals, to collect and gather information at the local level. There were 102 hospitals within the 134 hospitals which accepted the field survey; the rate was 62.0%. RESULTS: In 2008, the number of dentists working in the hospitals was 1,421, which was approximately 13% of the number of total dentists in Taiwan (9672). Within the 1,421 dentists, 675 were attending staffs and 745 dentists were training residents. Within the 675 attending dentists, 510 (75.6%) had dental specialist certificates and 272 (40.3%) had teaching positions in dental schools. There were 382 dental interns (6(th) year undergraduate students) taking the training programs in hospitals, most of whom were trained in medical centers (342/382, 89.5%). Moreover, there were 888 dental assistants, 338 of whom were nurses and the other 550 were hospital self-trained personnel. CONCLUSION: Comparing the dental manpower of different types of hospitals in Taiwan, the medical center was the best, followed by the regional hospital and the district hospital was last. When comparing 2008 with 2002, the numbers of both dentists and auxiliary personnel in Taiwan's hospitals increased with years. Although there were still only 13% dentists working in the hospital, they were responsible for teaching young dentists and doing research in hospitals. In other words, the quality of clinical service, teaching, and research in hospitals would influence the development of young dentists.

Dental therapists and dental hygienists educated for the New Zealand environment.

New Zealand has a long history of dental care provided by school dental nurses, now known as dental therapists. The nature of their training courses, although delivered in different centers, had remained relatively constant until 1999 when educational responsibility was transferred to the universities. Dental hygienists were not trained in New Zealand until 1994, with the exception of the New Zealand Army hygienists. Since 2001, the education of both dental therapists and dental hygienists has been the responsibility of the universities. Significant and progressive changes in educational delivery have occurred since then, which have culminated in three-year degree qualifications for dual-trained oral health professionals. Factors influencing this change included increased professionalism associated with the new legislative requirements for registration, workforce shortages, and enhanced educational and clinical practice requirements. The Bachelor of Oral Health degree at the University of Otago has an added emphasis on social sciences and incorporates aspects of learning relating to New Zealand's cultural heritage. We explore in this article the rationale for the introduction of a Bachelor of Oral Health in New Zealand and how it is designed to equip graduates as professionals in oral health.

How do we measure shortages of dental hygienists and dental assistants? Evidence from California: 1997-2005.

BACKGROUND: The authors examined the labor market for registered dental hygienists (RDHs) and dental assistants (DAs) in California from 1997 to 2005 to determine whether there was a shortage in either market. METHODS: This analysis used economic indicators interpreted within an economic framework to investigate trends in labor force numbers and market-determined wages for RDHs and DAs. Rising inflation-adjusted mean wages indicated a labor shortage, while declining inflation-adjusted mean wages indicated a labor surplus. RESULTS: From 1999 to 2002, the wages for RDHs increased 48 percent and then stabilized, indicating a shortage had occurred, after which the market achieved equilibrium. Wages for DAs increased 13.9 percent from 1997 to 2001, but then declined from 2001 to 2005, indicating a shortage that then became a surplus. The market for DAs may not have stabilized. CONCLUSIONS: Wages increased for RDHs and DAs, suggesting that labor shortages occurred in both markets. The large supply response in the market for DAs resulted in wages declining after their initial rise. PRACTICE IMPLICATIONS: Tracking the local labor markets for RDHs and DAs will enable dental professionals to respond more efficiently to market signals.

Recruitment and retention of dental nurses and dental hygienists in general practice.

PURPOSE OF STUDY: To explore the recruitment and retention of dental nurses and dental hygienists working in general dental practice in West Kent, and to identify training needs. BASIC PROCEDURE: Questionnaire survey of 195 general dental practices in West Kent. MAIN FINDINGS: Problems with turnover of staff were reported by 19% of practices. Some 49% of practices reported difficulties in recruiting dental nurses, 6% had experienced difficulties recruiting dental hygienists, and 15% had difficulties recruiting both nurses and hygienists. The median length of service for both dental nurses and dental hygienists was five years. Approximately 39% of practices had advertised single posts three or more times. Difficulties in recruiting were related more strongly to ensuring the right person for the job, than to a shortage of applicants. PRINCIPAL CONCLUSIONS: Difficulties in the recruitment and retention of dental nurses and dental hygienists were reported by dental practices in West Kent. These are likely to be exacerbated by the requirement that all dental nurses be registered with the General Dental Council.