DENTIST: OCCUPATIONAL SKILL SHORTAGE ASSESSMENT

NOVEMBER 2005 DENTIST: OCCUPATIONAL SKILL SHORTAGE ASSESSMENT Current Situation: No shortage Short-term Outlook: No shortage 1 Executive Summary 1.1 Results from the 2004 Survey of Employers who have Recently Advertised, show that 60% of advertised vacancies included in the survey were filled within eight to ten weeks of advertising. There was, on average, only one suitable applicant per advertised vacancy. Although these rates are low, the Department of Labour does not believe this is Table 1: Employer Survey Indicators, 2004 Fill Rate Average Suitable Applicants Dentists 60% 1.0 All Professionals Surveyed 56% 1.7 Source: Survey of Employers who have Recently Advertised, Department of Labour. evidence of a genuine shortage of dentists in New Zealand. The survey results may not be representative of the profession as a whole as it only covered the minority of the labour force as three-quarters of dentists in 2003 were selfemployed. While we conclude that there is not a nationwide shortage of dentists, there are some regions in New Zealand where shortages do exist. 1.2 There is other evidence available which indicates that there is not a shortage. This includes the fact that supply growth has been moderate and has probably outstripped slow growth in demand. Further, the average number of hours worked by dentists per week is relatively low (33.5), especially compared to general practitioners (44.7). The proportion of dentists working 40 hours or more is low (less than 15%) and has been declining over the past decade. 1.3 Growth in the demand for dentists has been driven by a number of factors including: population growth, ageing of the population, rising income levels, and increased demand for more complex dental procedures. The Census has measured a slow growth in demand (as measured by employment) for dentists of about 1.4% per annum between 1991 and 2001. The drivers behind this growth are likely to persist in the future and slow employment growth is expected to continue. Unisys House, 56 The Terrace, PO Box 3705, Wellington, New Zealand. Tel +64 4 915 4400 Fax +64 4 915 4015 www.dol.govt.nz

2 1.4 Over the past few years an average of about 60 students have graduated in New Zealand with a Bachelor of Dental Surgery each year. This is a moderate level of training which equates to a training rate of 3.4%. While a sizeable proportion of these graduates are not practising dentistry within New Zealand in the first four years after graduation, the losses are more than compensated for by the inflow of overseas-trained dentists. There has thus been moderate growth (2.7% per annum) in the supply of dentists in the decade to 2003. 1.5 Current supply and demand trends are likely to continue and the Department of Labour does not expect a shortage of dentists over the next 1-2 years.

3 2 Introduction 2.1 The purpose of this report is to investigate skill shortages in the dental profession in New Zealand. The report aims to assess whether there is a shortage of dentists, and to provide an insight into demand and supply factors contributing to this situation. It also offers a short-term outlook for shortages in this occupation group. 2.2 Dentists (code 22221 in the New Zealand Standard Classification of Occupations [NZSCO]) provide oral health services to the general public, using a range of preventive, diagnostic and restorative dental services. They carry out a range of oral surgery, using various instruments, materials and medications. They may work alone or as part of a wider oral health team, where they may be involved in supervising dental hygienists and dental therapists. About 75% of dentists are self-employed either in group or sole practice, and the remaining 25% are employees 1. In 2003, there were 1,662 dentists active in the workforce in New Zealand, according to the Dental Council of New Zealand. 2.3 Further background to this occupational report, including a discussion of the methodology; a glossary of terms; and an overview of the Department s Survey of Employers who have Recently Advertised (SERA), including the survey questionnaire, can be found in the Background and technical note at http://www.dol.govt.nz/publications/jvm/job-ad-professionals.asp. 3 Demand for Dentists 3.1 Historical Demand 3.1.1 A number of factors have influenced the demand for dentists, including: 3.1.2 Growth in the New Zealand adult population is a major driver of demand for dentists, as most adults require some degree of dental treatment. Growth in the school-age population is a smaller contributor as much of their dental needs are catered for by state-provided dental therapists. The adult population grew at an annual average rate of about 1.1% over the period 1991 to 2001, as measured by the Census. In addition to the adult population growing in number, it is also ageing 2, with the proportion of individuals aged 65 and over increasing. The ageing population is likely to lead to increased demand as the elderly seek to retain their teeth into their old age. Complicated dental work will be required in many cases in order for people to avoid the need for dentures 3. 3.1.3 Real per capita disposable income has risen by almost 30% over the past decade 4 and this is likely to have increased per capita expenditure on dental services and hence the demand for dentists. Data from the Household Economic Survey shows 1 2 3 4 New Zealand Health Information Services, New Zealand Workforce Statistics, 2003. 2004 Statistics New Zealand Population Projections indicate that the number of people in New Zealand aged 65 and over is expected to be 1.33 million by 2051, 2.7 times the 2004 total. The largest growth will occur between 2011 and 2037 as the baby-boomers move into this 65+ age group. From 2039, the 65+ age group will make up about one-quarter of all New Zealanders, compared with 12% in 2004. Chalmers JM, Oral Health Promotion for our ageing Australian Population, Australian Dental Journal 2003;48:(1):2-9. Statistics New Zealand, Real Gross National Disposable Income, 2003.

4 that expenditure on dental services is sensitive to personal income levels. The survey shows that in June 2004, households in the lowest income decile spent on average only $105 per annum on dental services, whereas households in the top income decile spent $582, or 5.5 times as much. 3.1.4 Australian research has shown that there is growing demand for more complex dental services, such as root canal therapy, and crown and bridge work, leading to individual visits to the dentist becoming longer 5. If each patient visit is gradually requiring more of a dentist s time, throughput slows - contributing to growth in demand. 3.1.5 The above factors have contributed to growth in demand that has slightly exceeded adult population growth. The Census measured a slow growth in the employment of dentists (1.4% per annum) between 1991 and 2001 (see Table 2). This growth rate is somewhat slower than that for all professionals (3.4%), for all health professionals (2.1%) and for all occupations (2.1%). Table 2: Employment of Dentists, 1991-2001 Annual Growth in Employment 1991-1996 1996-2001 1991-2001 Dentists 0.8% 2.0% 1.4% Health Professionals 0.6% 3.6% 2.1% All Professionals 2.7% 4.0% 3.4% All Occupations 3.1% 1.2% 2.1% Source: Census of Population and Dwellings, Statistics New Zealand. 3.2 Future Demand 3.2.1 The historical drivers of demand for dental services discussed above are likely to persist in the future. Continued growth and ageing of the population, combined with a rising per capita income, means that growth in demand for dentists is likely to continue. 3.3 Summary 3.3.1 Demand for dentists in New Zealand has grown. This has been driven by a number of factors including: population growth, ageing of the population, rising income levels, and increased demand for more complex dental procedures. The Census has measured a slow growth in demand (as measured by employment) for dentists of about 1.4% per annum between 1991 and 2001. The drivers behind this growth are likely to persist in the future and employment growth for dentists is expected to continue. 5 Teusner DN & Spencer AJ, Projections of the Australian dental labour force, 2003, AIHW cat. no. POH 1. Canberra: Australian Institute of Health and Welfare (Population Oral Health Series No. 1).

5 4 Supply of Dentists 4.1 Tertiary Education 4.1.1 A Bachelor of Dental Surgery (BDS) from Otago University or an equivalent overseas qualification that is recognised by the Dental Council of New Zealand is required to practise as a dentist in New Zealand. 4.1.2 The number of students enrolled for and graduating with a BDS remained fairly constant between 2000 and 2003 (see Table 3). This is due to enrolment restrictions in place at the Otago University Dental School. An average of 62 students graduated each year over this period. Table 3: Enrolments and Number Achieving Degrees in Dentistry 2000 2003 Year Total Students Enrolled Degree Achievements 2000 249 63 2001 247 61 2002 251 64 2003 255 59 Source: Ministry of Education. 4.1.3 The training rate indicator for dentists is given in Table 4. The training rate is a measure of the number of degree achievements relative to total employment in the occupation and is a rudimentary measure of the rate at which supply can potentially grow through training. The training rate for dentists is estimated to be 3.4% in 2003. Although this is below the average for all professionals (5.5%) surveyed by the Department of Labour (the Department), it is noticeably higher than the training rate for dentists measured in New South Wales, Australia, which was 1.6% 6. Table 4: Training Rates for Dentists, 2003 Indicator Explanation Dentists (NZ) All SERA Professionals Surveyed (NZ) Dentists (NSW, Australia) 2003 Training Rate (BDS Otago) persons achieving a relevant qualification expressed as a percentage of employment in that occupation 3.4% 5.5% 1.6% Source: Department of Labour (New Zealand), Department of Employment and Workplace Relations (Australia). 6 In this report, comparisons are made between New Zealand and New South Wales, Australia to contextualise the findings. No national level estimates of training rates are available for Australia, so statelevel data have been used. New South Wales is Australia s most populous state with the largest economy and its economy most closely resembles the structure of the New Zealand economy. It was thus deemed to provide the most suitable jurisdiction for labour market comparisons.

6 4.2 Registration 4.2.1 All dentists must be registered with the Dental Council of New Zealand (DCNZ). Once registered, those dentists wishing to practice must obtain a practising certificate on an annual basis from the DCNZ. 4.2.2 The number of dentists holding annual practising certificates constitutes the practising dental workforce in New Zealand. Changes in the size of this workforce reflect all the factors influencing supply, including migratory flows, retirement and occupational change. There were 1,662 practising dentists in 2003 according to the DCNZ. 4.2.3 Table 5 shows that the total number of dentists practising in New Zealand is steadily increasing and grew by an average of 2.7% (36) per annum in the decade to 2003. This growth in supply comfortably exceeds population growth, which averaged about 1.1% per annum over this period. This means that the ratio of practising dentists to the total population has increased over this decade. Table 5: New Registrations and Estimated Dentists Practising in New Zealand 1990-2003 New Registrations Practising Dentists Year New Zealand Overseas New Zealand Overseas Total Percentage Overseas 1990 n/a n/a 1148 78 1226 6.4% 1991 n/a n/a 1177 85 1262 6.7% 1992 n/a n/a 1199 88 1287 6.8% 1993 n/a n/a 1209 97 1306 7.4% 1994 n/a n/a 1214 98 1312 7.5% 1995 48 20 1228 118 1346 8.8% 1996 57 26 1249 115 1364 8.4% 1997 56 63 1295 178 1473 12.1% 1998 53 44 1300 196 1496 13.1% 1999 60 45 1332 226 1558 14.5% 2000 76 53 1335 256 1591 16.1% 2001 38 45 1330 271 1601 16.9% 2002 80 45 1346 299 1645 18.2% 2003 66 58 1335 327 1662 19.7% Source: Dental Council of New Zealand. 4.3 Occupational Detachment 7 and Migration 4.3.1 Data collected by the DCNZ shows that there is a considerable loss of New Zealand graduates from the practising workforce. Figure 1 shows that, on average, 31% of New Zealand graduates are not practising in the country one 7 Occupational detachment refers to individuals who choose not to continue practising in their occupation but retain a connection to the occupation (e.g. move into a management or supervisory role, or retain professional registration), or who leave the occupation entirely (e.g. by changing occupation or withdrawing from the labour market).

7 year after graduation. A number of employers interviewed from the Survey of Employers who have Recently Advertised (SERA) believed that many graduates are going overseas. The remainder either change occupation or withdraw from the labour market. The level of non-participation peaks at four years after graduation, when an average of 56% are not practising in New Zealand. Thereafter, the proportion drops and stabilises after eight years when approximately onethird are not practising. Figure1: Average Percentage of Graduates Not Practising in New Zealand by Graduation Cohort Average % of graduates NOT active in NZ 60 50 40 30 20 10 0 0 1 2 3 4 5 6 7 8 9 10 11 years since graduation Source: Estimated from data from the Dental Council 4.3.2 The Department has estimated from data obtained from the Dental Register and the Workforce Survey conducted by the DCNZ, that fewer than one out of five New Zealand trained dentists is living abroad. This loss to the country is counterbalanced by the inflow of overseas dental graduates, who represent an increasing proportion of practising dentists in New Zealand. Table 5 shows that the proportion of practising dentists that are overseas-trained more than tripled between 1990 and 2003, rising from 6.4% to 19.7% over that period. Overseastrained dentists have comprised a little under half (45%) of new registrations with the DCNZ over the last seven years. While the Department has no data on net migratory flows of dentists, our own reconciliation of flows suggests that net migration has contributed to supply growth. 4.4 Retirement 4.4.1 Based on 2001 Census data, it is estimated that approximately 2.4% of the dental workforce retires each year (assuming a retirement age of 65). This equates to about 40 dentists per annum. This is higher than the average retirement rate for all health professionals (1.8%), and considerably higher than the average retirement rate for all professional occupations (1.3%). Census data shows an ageing of dentists occurred between 1991 Figure 2: Age Profile of Dentists, 1991-2001 300 250 200 150 100 50 0 1991 1996 2001 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-65 65+ Source: Census of Population and Dwellings, Statistics New Zealand. and 2001 (Figure 2). The percentage of dentists in the 20 to 24 years age group decreased from 16% in 1991 to 12% in 2001, while the proportion in all age groups over 35 increased. By 2001 nearly one-third of all dentists were 50 years of age or older. Although a high proportion of dentists remain in work through to (or beyond) 65 years of age, the impact of retirement on the dental workforce is expected to increase over time. This is likely to place constraints on supply in the future.

8 4.5 Summary 4.5.1 Over the past few years an average of 62 students have graduated in New Zealand with a Bachelor of Dental Surgery each year. This is a moderate level of training which equates to a training rate of 3.4%. This is considerably higher than the equivalent rate of 1.6% measured in New South Wales, Australia. While a sizeable proportion of these graduates are not practising dentistry within New Zealand in the first four years after graduation, the losses are more than compensated for by the inflow of overseas-trained dentists. There has thus been moderate growth (2.7% per annum) in the supply of dentists in the decade to 2003. 5 Employer Recruiting Experiences the Survey of Employers who have Recently Advertised 5.1 Is There a Shortage of Dentists? 5.1.1 Results from the 2004 SERA show that 60% of vacancies included in the survey were filled within eight to ten weeks of being advertised (see Table 6). This was similar to the overall fill rate for all surveyed health professional occupations (57%) and all surveyed professional occupations (56%). There was an average of only 1.0 suitable applicant for each dentist vacancy compared with an average of 1.1 for all health professionals surveyed and 1.7 for all professionals surveyed. Table 6: SERA Results for Dentists and All Professionals Surveyed, July 2004 Employers Vacancies Vacancies Filled Fill Rate Suitable Applicants Average Suitable Applicants per Vacancy Dentists 9 10 6 60% 10 1.0 All Health Professionals Surveyed All Professionals Surveyed 69 101 58 57% 115 1.1 231 296 167 56% 503 1.7 Source: Survey of Employers who have Recently Advertised, Department of Labour. 5.1.2 While a relatively low fill rate and a low number of suitable applicants usually indicate that there is a shortage, these results should be interpreted with caution. There is a high degree of self-employment amongst dentists in New Zealand - about 75% of dentists are self employed 8 - and are therefore unlikely to consider applying for advertised positions. 5.1.3 The SERA results do not provide a strong basis for concluding that a shortage in dentists exists. Indeed, the Department believes that there is not a shortage. This conclusion is based on the following considerations. 8 New Zealand Health Information Services, New Zealand Workforce Statistics, 2003.

9 5.1.4 Firstly, growth in supply has been relatively high compared to growth in demand. The supply of dentists grew by approximately 2.7% per annum in the decade to 2003 whereas the size of the adult population, which is probably the major driver behind growth in demand, only grew by about 1.1% per annum. Demand grew by approximately 1.4% per annum between 1991 and 2001, as measured in the Census by employment growth for dentists. 5.1.5 Secondly, the average number of hours worked per week by dentists would suggest an absence of shortage. Practising dentists worked on average 33.5 hours per week in 2003 9. This is low compared with other medical professionals, most notably general practitioners who worked an average of 44.7 hours per week in the same year 10. It is also significantly below the average number of hours worked by practising dentists in Australia in 2000 (39.3 hours per week) 11. Furthermore, there is no sign of an upward trend in hours worked, as the proportion of practising dentists in New Zealand working 40 hours or more per week has fallen from 15.9% in 1994 to 14.4% in 2003 12. 5.1.6 While we conclude that there is not a nationwide shortage of dentists, there are regions in New Zealand where shortages do exist. Some District Health Board areas such as Counties-Manukau, Tairawhiti, Wairarapa, Wanganui, and the West Coast have a low number of dentists per 100,000 population 13. 6 Outlook 6.1 The drivers behind the demand for dentists are likely to continue in the shortterm. Current supply trends are also expected to continue, and the Department predicts the absence of a shortage to persist over the next 1-2 years. For queries regarding this report please contact info@dol.govt.nz. Disclaimer: The Department of Labour has made every effort to ensure that the information contained in this report is reliable, but makes no guarantee of its accuracy or completeness and does not accept any liability for any errors. The information and opinions contained in this report are not intended to be used as a basis for commercial decisions and the Department accepts no liability for any decisions made in reliance on them. The Department may change, add to, delete from, or otherwise amend the contents of this report at any time without notice. The material contained in this report is subject to Crown copyright protection unless otherwise indicated. The Crown copyright protected material may be reproduced free of charge in any format or media without requiring specific permission. This is subject to the material being reproduced accurately and not being used in a derogatory manner or in a misleading context. Where the material is being published or issued to others, the source and copyright status should be acknowledged. The permission to reproduce Crown copyright protected material does not extend to any material in this report that is identified as being the copyright of a third party. Authorisation to reproduce such material should be obtained from the copyright holders. 9 10 11 12 13 WM Thomson, Dental Council of New Zealand, Workforce Analysis 2003, February 2004. New Zealand Medical Association, An Analysis of the New Zealand General Practitioner Workforce, May 2004. Teusner DN & Spencer AJ, Dental Labour Force, Australia 2000, 2003, AIHW cat. no. DEN 116. Canberra: Australian Institute of Health and Welfare (Dental Statistics and Research Series No. 28). WM Thomson, Dental Council of New Zealand, Workforce Analysis 2003, February 2004. Dental Council of New Zealand Workforce Analysis 2004.