ADRF RESEARCH REPORT Australian Dental Journal 2006;51:(1):6-10 Dental therapy in Western Australia: profile and perceptions of the workforce E Kruger,* K Smith,* M Tennant* Abstract Background: In 2002, the Centre for Rural and Remote Oral Health (CRROH) completed a rural oral health workforce survey which indicated that a high number of therapists, although registered, were not working as therapists. The aim of the present study was to develop a profile of the dental therapy workforce and analyse the perceptions of therapists. Methods: In 2004, a postal questionnaire survey was undertaken amongst all registered dental and school dental therapists for 1999, 2000, 2001, 2002 and 2003. Results: Valid information was obtained from 253 therapists (55 per cent response rate). The therapy workforce are almost exclusively female, have an average age of 40 years, are working in urban areas, obtained their qualification on average 20 years ago, work for the School Dental Service and qualified in Western Australia. More than a quarter no longer worked as therapists. Perceptions regarding the advantages and disadvantages of dental therapy as a career were identified. Conclusions: When trying to promote dental therapy and school dental therapy as a career, retain therapists and recruit new graduates, the opportunities identified in this survey should be embraced. A clear focus on the issues will be required to facilitate meeting the workforce objectives as outlined in Australia s National Oral Health Plan. Key words: Dental therapy, workforce profile, workforce perceptions. Abbreviations and acronyms: CRROH = Centre for Rural and Remote Oral Health; DTHA = Dental Therapy and Hygience Association; WAIT = Western Australian Institute of Technology. (Accepted for publication 13 May 2005.) INTRODUCTION In Western Australia, school dental therapists are able to examine, diagnose, do treatment plans and provide services to school children under employment in the School Dental Service while dental therapists *The Centre for Rural and Remote Oral Health, The University of Western Australia. provide treatment services under prescription of a dentist to all age groups in private practices. Because there remains a distinction in title in Western Australia, the terms school dental therapist, dental therapist and therapist will be used. The term therapist will be used collectively to refer to both school dental therapists and dental therapists. From 1971 to 1995, the Western Australian Institute of Technology (WAIT, now Curtin University of Technology) offered Western Australia s first dental therapy training programme (Associate Diploma in Dental Therapy). At the time the main employment destinations for therapists were private practice or the Health Department s School Dental Service programme. In 1996, Curtin University commenced the current Associate Degree in Dental Hygiene. An Associate Degree in School Dental Therapy has been offered since 2000. The 2004 intake for dental therapy was eight students and the 2005 intake was 10 students. In parallel to the Curtin University programme, the Labor Government started a course at the Mount Henry Clinic in 1974 to provide more school dental therapists for employment into the school dental service. This in-service programme leading to a Certificate of Dental Therapy was continued until 1983. The school dental therapy course educated students to undertake specific duties on school children and did not include dental hygiene (adult periodontics) training. Therapists are registered with the Dental Board of Western Australia to provide a specific set of duties. School dental therapists were not always required to register as they were trained to work in the public service only. For a period of time the school dental therapists trained at Mount Henry could also register as private practice therapists without having to prove their skills in periodontics. After 1996, the registration board decided to look at the individual training of the person who applied for registration for private practice therapy. Currently in Western Australia there are approximately 150 registered dental hygienists, 200 school dental therapists and 350 private practice therapists. 1 In 2002, the Centre for Rural and Remote Oral Health (CRROH) completed a rural oral health 6 Australian Dental Journal 2006;51:1.
workforce survey. 2 The survey was only limited to the rural workforce but results indicated that a high number of therapists, although registered, were not working as therapists. The aim of the present study was to develop a profile of the therapy workforce and analyse the perceptions of therapists. METHODS In 2004, a postal questionnaire survey was undertaken with the support and assistance of the Dental Therapy and Hygiene Association (DTHA) of Western Australia. Ethics approval for this study was obtained from the Ethics Committee of The University of Western Australia. Lists of all registered dental and school dental therapists for 1999, 2000, 2001, 2002 and 2003 were obtained from the Dental Board of Western Australia. A standardized anonymous questionnaire expanding on the previous study 2 was sent to every person who currently is, or has been, registered since 1999. The questionnaire was piloted on a sample of therapists and refined before use. The questionnaire included sections containing questions on demographic characteristics, current working situation, working situation history and perceptions regarding the profession and career options. The questionnaires were sent out in July 2004 and reminder postcards were sent out in August 2004. Data were analysed using SPSS version 11.0. RESULTS A total of 493 questionnaires were posted and 293 responses were received. Of these, 38 were no longer working at their registered address and/or had changed address. Therefore only 455 remained in the survey frame. Valid information was obtained from 253 therapists (55 per cent response rate). A further two therapists refused to take part. Demographics Most respondents (n=250, 98.8 per cent) were female and three (1.2 per cent) were male. The mean age of respondents were 40.6 years (sd 7.4), with the youngest 20 years and the oldest 55 years. Just more than a quarter of respondents are currently living in rural areas, with 73.1 per cent living in urban areas (Table 1). Qualifications Most respondents (n=128, 50.6 per cent) had an Associate Diploma qualification, 123 (48.6 per cent) had a Certificate in Dental Therapy, two (0.8 per cent) stated they had an Associate Degree in School Dental Therapy and two (0.8 per cent) had other qualifications (Table 1). Qualifications were obtained on average 20.3 years ago, with the most recent two years ago and the longest 34 years ago. Most qualifications were obtained in Western Australia (Table 1). Table 1. The profile of respondents N (%) Currently living Rural 68 (26.9) Urban 185 (73.1) Qualification Associate Diploma in Dental Therapy 128 (50.6) Certificate in Dental Therapy 123 (48.6) Associate Degree in School Dental Therapy 2 (0.8) Other 2 (0.8) Where qualified Western Australia 227 (89.7) Interstate 13 (5.1) Overseas 13 (5.1) Type of registration Private Practice Dental Therapist (PPDT) 78 (30.8) School Dental Therapist (SDT) 69 (27.3) Dental Hygienist 2 (0.8) PPDT and SDT 59 (23.3) PPDT and other 13 (5.1) SDT and other 4 (1.6) Other 3 (1.2) Not registered 25 (9.9) Registration Depending on qualifications, experience and previous legislation therapists can be registered as private practice therapists, school dental therapists or both. In this survey 78 (30.8 per cent) were registered as private practice therapists, 69 (27.3 per cent) were registered as school dental therapists and 59 (23.3 per cent) were registered as both private practice therapists and school dental therapists. Almost 10 per cent (n=25) were no longer registered (Table 1). Current activity non-working subgroup At the time of the survey 71 respondents indicated that they were not working as therapists, although most of them (n=46) were still registered. Current activity working subgroup The group that was currently employed in their profession (n=182) were mostly working in urban areas (n=142, 78 per cent), with only 40 (22 per cent) working in rural areas. The majority of employed respondents were with the school dental service (n=95, 52 per cent) and 76 (42 per cent) were in private practices (Table 2). Most in this subgroup (n=171, 94 per cent) have been working for more than six years. In this subgroup, only 74 (40 per cent) were full-time employees while 108 (60 per cent) were part-time employees. In general, the therapists were satisfied with their hours of employment (n=140, 76 per cent). Those not satisfied with their hours included 13 who wanted more hours per week and 28 wanting less hours (Table 2). The main reasons stated for working part-time included family commitments (n=84, 44.9 per cent), lifestyle choice (n=21, 11.2 per cent), job sharing (n=2, 1.1 per cent) and clinic hours (n=2, 1.1 per cent). Perceptions Most respondents (58.1 per cent) recommended dental therapy as a career, whilst 37 per cent indicated Australian Dental Journal 2006;51:1. 7
Table 2. Working situation of respondents Others School dental service Private practice Total N (%) N (%) N (%) N (%) Currently working 11 (6)11 95 (52).1 76 (42).1 182 (100) Work where Rural 3 (27) 22 (23.1) 15 (19.7) 40 (22) Urban 8 (73) 73 (76.8) 61 (80.3) 142 (78)1 For how long >6 years 11 (100) 87 (91.6) 73 (97.0) 171 (94)1 3-5 years 0 2 (2.1) 1 (1).1 3 (1.6) 0-2 years 0 6 (6.3) 2 (2.6) 8 (4.7) Work time Full-time 5 (45) 53 (55).1 16 (21).1 74 (40). Part-time 6 (55) 42 (45).1 60 (79).1 108 (60).1 Satisfied with hours 9 (81) 65 (68).1 66 (86).1 140 (76).1 Not satisfied with hours 2 (19) 30 (32).1 10 (14).1 42 (24). Wants longer hours 6 (6).1 7 (9).1 13 (8).. Wants shorter hours 2 (19) 23 (24).1 3 (4).1 28 (15) No response 9 (81) 66 (70).1 66 (87).1 141 (77)1 they would not, leaving 11 (4 per cent) unsure (Table 3). The most mentioned advantages of dental therapy as a career included flexible hours (49 per cent), helping other people (34.7 per cent), working with children (20.9 per cent), variety in work (18.5 per cent), work availability (17.4 per cent), and being able to choose between public and private work (12.6 per cent) (Table 3). The most mentioned disadvantages included low pay (62 per cent), no promotion or career options (49.8 per cent), no or low recognition of profession and skills (35.9 per cent), stress (17.7 per cent), illness or injury (14.6 per cent) and inflexibility (10.2 per cent) (Table 3). Career perspectives The majority of respondents (n=194, 76.7 per cent) considered that dental therapy should be a three-year graduate programme in Western Australia (Table 4). Reasons provided included: (1) it would lead to more recognition (46.6 per cent); (2) more time is necessary as two years is insufficient for learning and practical experience (36.8 per cent); (3) more clinical skills are needed for expanded duties (27.3 per cent); (4) higher salaries would ensue (21.7 per cent); and (5) specialization in some skills, e.g., periodontal, orthodontic and cosmetic, would be possible (17 per cent) (Table 4). Among those who did not believe a three-year graduate programme was required, the most common reasons given included: (1) the two-year course is sufficient (10.7 per cent); (2) more HECS fees would need to be paid (3.2 per cent); (3) sufficient time in current course (2.4 per cent); and (4) the shorter course interests some students (2.4 per cent) (Table 4). There were no differences between the groups regarding career perspectives. Those who were registered and trained as school dental therapists could not work in private practice Table 3. Perceptions of the workforce Other and non-working SDT PPDT Total N (%) N (%) N (%) N(%) Total in group 82 95 76 253 Recommend dental therapy 48 (58.5) 46 (48.4) 53 (71.0) 147 (58.1) Do not recommend dental therapy 32 (39.0) 45 (47.4) 18 (23.7) 95 (37.5) Advantages: Flexible working hours 38 (46.3) 42 (44.2) 4 4(57.9) 124 (49.0) Helping others 27 (32.9) 30 (31.6) 31 (40.8) 88 (34.7) Working with children 16 (19.5) 30 (31.6) 7 (9.20) 53 (20.9) Work variety is good 17 (20.7) 17 (17.9) 13 (17.1) 47 (18.5) Work availability 11 (13.4) 14 (14.7) 19 (25.0) 44(17.4) Appropriate pay 13 (15.8) 3 (3.2) 16 (21.0) 32 (12.6) Differences working public or private 10 (12.2) 3 (3.2) 13 (17.1) 26 (10.2) Autonomy 0 9 (14.7) 1 (2.6) 10 (3.9) Disadvantages: Inadequate pay 43 (52.4) 81 (85.2) 33 (43.4) 157 (62.0) No career/promotion opportunities 39 (47.5) 52 (54.7) 35 (46.0) 126 (49.8) No/low recognition of position 26 (31.7) 40 (42.1) 25 (32.9) 91 (35.9) High stress levels 15 (18.2) 17 (17.9) 13 (17.1) 45 (17.7) High illness/injury probability 16 (19.5) 8 (8.4) 13 (17.1) 37 (14.6) Inflexible hours 8 (9.7) 12 (12.6) 6 (7.9) 26 (10.2) Repetition of work, restricted duties 6 (7.3) 7 (7.3) 7 (9.2) 20 (7.9) Difficult dentists, not appreciating skills 2 (2.4) 4 (4.2) 10 (13.2) 16 (6.3) Better technology and equipment needed 0 16 (12.6) 0 16 (6.3) Increased workload and responsibility 1 (1.2) 15 (6.3)1 0 16 (6.3) Unable to become self-employed 1 (1.2) 3 (3.2) 9 (11.8) 13 (5.1) Need more support, better unions 4 (4.8) 8 (8.4) 0 12 (4.7) Limited/no opportunity to do more training 0 10 (10.5) 9 (11.8) 11 (4.3) 8 Australian Dental Journal 2006;51:1.
Table 4. Career perspectives Total N (%) DT should be a 3-year course 194 (76.7) DT should not be a 3-year course 33 (13.0) Unsure 15 (5.9) Reasons for 3-year course: More recognition 118 (46.6) More time 93 (36.8) More skills 69 (27.3) Higher salaries 55 (21.7) Special skills 43 (17.0) Reasons against a 3-year course: Two years is enough 27 (10.7) Increase in HECS fees if 3 years 8 (3.2) Sufficient time in current course 6 (2.4) Students do it because of short time 6 (2.4) Would do Internet CE courses 193 (76.3) Not interested in online CE course 49 (19.4) Unsure 11 (2.0) Functions should be expanded 171 (67.6) Functions should not be expanded 54 (21.3) Unsure 30 (2.8) Reasons for expanded functions: Be able to treat all ages 70 (27.7) Increased duties and skills 49 (19.4) More employment opportunities 24 (9.5) Less or no supervision necessary 12 (4.7) because their training did not include periodontics. A question was asked about interest in a periodontics bridging course in order to enable registration as a private practice therapist. A total of 139 respondents answered this question and 97 (70 per cent) of them indicated that they were interested in such a programme. A total of 25 respondents indicated that they were not registered, and the question was asked if they would be interested in doing a re-registration course to work as therapist again. Only 10 respondents (40 per cent) indicated that they would do such a course, with 13 (52 per cent) not interested and two (8 per cent) unsure. Continuing education Respondents were asked if they would consider doing web-based continuing education courses and more than three-quarters of respondents agreed (Table 4). Duties Most respondents (n=171, 67.6 per cent) indicated that the functions of therapists should be expanded, while 54 (21.3 per cent) disagreed and 30 (11.8 per cent) were unsure (Table 4). Reasons for expanded duties included: (1) being able to treat all ages, including adults and younger children (n=70, 27.7 per cent); (2) with increased training, increased duties should occur (n=49, 19.4 per cent); (3) allows the opportunity for more employment (n=24, 9.5 per cent); (4) being able to work with less or no supervision, especially on basic cases (n=12, 4.7 per cent) (Table 4). There were no differences between the groups regarding duties. DISCUSSION The decreasing numbers of dental therapists, high numbers leaving the profession and the ageing of the current workforce all indicate that the profession of dental therapy is experiencing difficulties. 3 With shortages in the dental labour force predicted strategies are needed to reverse this trend. 4,5 The dental therapy workforce is almost exclusively female, has an average age of 40 years, is working in urban areas, obtained qualifications on average 20 years ago, works for the School Dental Service and qualified in Western Australia. More than one-quarter no longer worked as therapists, one-third of those registered paid double registration fees and most working therapists were happy with the hours they work. This profile confirms the ageing of the workforce and is similar to that of dental therapists in the United Kingdom. 6 The ageing of the therapy workforce is confirmed by a previous survey that indicated that Australia-wide the percentage of therapists 40 years and older had increased from 25 per cent in 1997 to 47.8 per cent in 2000. 3 The proportions of dental therapists working part-time are much higher in the private sector than in the government sector and the greater flexibility in work hours between the private and public sector results in more private practice therapists satisfied with their hours of employment. A similar survey in the UK indicated that about half of respondents worked part-time, but in that study no respondents worked in the private sector. 6 Whilst the majority of dental therapists would recommend dental therapy as a career, more than a third (37.5 per cent) indicated that they would not. Most of those in private practice, as well as the nonworking group, would recommend therapy as a career but only half of the school dental therapists would recommend it. Several advantages of the profession were identified and these included helping others, working with children and flexible working hours. There were differences in responses between groups. This might be a reflection of the different employment conditions between groups. More of the dental therapists stated flexible working hours, helping others, work availability and appropriate pay as advantages, while more of the school dental therapists stated working with children and autonomy as advantages. Disadvantages were also identified and included inadequate pay, no career or promotion opportunities, no or low levels of recognition of position and high stress levels. Differences between groups indicated that far more school dental therapists than dental therapists indicated inadequate pay as a disadvantage, as well as no career or promotion opportunities, poor or low recognition of position, inflexible hours, better technology and equipment needed, and increased workload and responsibility. More dental therapists, however, indicated that high illness or injury probability, difficult dentists and inability to become self-employed were disadvantages. These factors Australian Dental Journal 2006;51:1. 9
highlight opportunities to design efforts to promote the profession and enhance career retention. The majority of respondents (76.7 per cent) wanted dental therapy in Western Australia to be a three-year programme. Almost half of the respondents thought that this would lead to more recognition. All the other jurisdictions in Australia have or are offering three-year degree programmes, and this is in keeping with international developments where many countries offer three or four-year programmes awarding bachelor degrees. 7 The majority of therapists were in favour of expanding therapist functions, especially to be able to treat other age groups and to include other duties. The reasons highlight opportunities to provide a wider service to a larger part of the population. In coming years, an increasing population and anticipated dental workforce shortages will require more clinical professionals and the opportunities to better utilize an existing workforce group may be advantageous to address this shortage. 8 CONCLUSION At the same time when dental workforce shortages are predicted, this study has found some areas where dental therapists appear dissatisfied with their career and opportunities exist to ameliorate this dissatisfaction. The increased utilization of dental therapists as part of the multi-disciplinary team has been clearly identified as an approach to improve dental service delivery. 9-11 When trying to promote dental therapy as a career, retain therapists and recruit new graduates, the opportunities identified in this survey should be embraced. A clear focus on the issues will be required to facilitate meeting the workforce objectives as outlined in Australia s National Oral Health Plan. 12 ACKNOWLEDGEMENTS The authors would like to thank the Australian Dental Research Foundation for funding this study, Hellene Platell (President of the DTHA) and Dr Russ Kendall for their valuable contributions, as well as all the therapists who took the time to take part in the survey. REFERENCES 1. Western Australian Government Gazette 2004, No. 138, Perth, 11 August. Dental Act 1939. List of Registered Dentists 2004. 2. Kruger E, Tennant M. A baseline study of the demographics of the oral health workforce in rural and remote Western Australia. Aust Dent J 2004;49:136-140. 3. AIHW Dental Statistics and Research Unit. Dental Therapist Labour Force Data Collection 2000. Research Report No. 7. AIHW Cat. No. DEN 110. Adelaide: AIHW Dental Statistics and Research Unit, The University of Adelaide, 2002. 4. Teusner DN, Spencer AJ. Projections of the Australian dental labour force. Population Oral Health Series No. 1. AIHW Cat. No. POH-1. Canberra: Australian Institute of Health and Welfare, 2003. 5. Teusner DN, Spencer AJ. Dental Labour Force, Australia 2000. Dental Statistics and Research Series No. 28. AIHW Cat. No. DEN 116. Canberra: Australian Institute of Health and Welfare, 2003. 6. Gibbons DE, Corrigan M, Newton JT. The working practices and job satisfaction of dental therapists: findings of a national survey. Br Dent J 2000;189:435-438. 7. Blitz P, Hovius M. Towards international curriculum standards. Int J Dent Hygiene 2003;1:57-61. 8. Nuffield Foundation. Education and training of personnel auxiliary to dentistry. London: Nuffield Foundation, 1993. 9. World Health Organization. Educational imperatives for oral health personnel: change or decay? WHO Technical Report Series. Geneva: World Health Organ Tech Rep Ser 1990;794:1-43. 10. Jones DE, Gibbons DE, Doughty JF. The worth of a therapist. Br Dent J 1981;151:127-128. 11. Douglass CW, Lipscomb J. Expanded function dental auxiliaries: potential for the supply of dental services in a national dental program. J Dent Educ 1979;43:556-567. 12. Healthy Mouths Healthy Lives: Australia s National Oral Health Plan 2004 2013. National Advisory Committee on Oral Health (NACOH). August 2004. Address for correspondence/reprints: Dr Estie Kruger The Centre for Rural and Remote Oral Health The University of Western Australia 35 Stirling Highway Crawley, Western Australia 6009 Email: ekruger@crroh.uwa.edu.au 10 Australian Dental Journal 2006;51:1.