Report of the National Advisory Council on Dental Health

Dental Workforce

The National Advisory Council on Dental Health (the Council) was established as a time-limited group to provide strategic, independent advice on dental health issues, as requested by Minister for Health and Ageing, to the Government. The Council’s priority task was to provide advice on dental policy options and priorities for consideration in the 2012-13 Budget.

Page last updated: 03 September 2012

      Dental workforce characteristics62

      The dental workforce is comprised of dental practitioners who are categorised by registration into dentists, dental hygienists, dental therapists, oral health therapists and dental prosthetists. There is also a category of specialist registration for dentists only. Table 2.1 below outlines the role of the various dental practitioners and the number of practising workers (based on 2006 data).

      62 All data cited in this section of the report is from the following source, unless noted otherwise: Balasubramanian M, Teusner D (2011), Dentists, specialists and allied practitioners in Australia: Dental Labour Force Collection, 2006. AIHW Dental Statistics and Research Series, No. 53.

      Table 2.1: Dental workforce – roles and numbers of practising professionals (2006).


      Dental Practitioners

      Role Description

      Number Practising

      Dentists

      Diagnose and treat diseases, injuries and abnormalities of teeth, gums and related oral structures; prescribe and administer restorative and preventive procedures; and conduct surgery or use other specialist techniques. Dentists are responsible for the supervision of hygienists, therapists and oral health therapists.

      10,404

      Dental therapists

      Provide oral health care, including examinations, treatment and preventive care, mainly to school aged children. Must practice within a structured professional relationship with a dentist.

      1,171

      Dental hygienists

      Use preventive, educational and therapeutic methods to help prevent and control oral disease and maintain oral health. Must practice within a structured professional relationship with a dentist.

      674

      Oral health therapists

      May practice in both clinical capacities or may be working principally as a hygienist or as a therapist. Must practice within a structured professional relationship with a dentist.

      371

      Dental prosthetists (a)

      Independent practitioners who make, fit, supply and repair dentures and other dental appliances.

      921

      TOTAL


      13,541

      (a) No data were available for prosthetists practising in the NT.
      Source: Balasubramanian M, Teusner D 2011. ‘Dentists, specialists and allied practitioners in Australia: Dental Labour Force Collection, 2006’. Dental statistics and research series no. 53. Cat. no. DEN 202. Canberra: AIHW.

      The total number of the practising dental workforce was 13,541 in 2006. In addition, there were 15,381 practising dental assistants, who support dental professionals by preparing patients for dental examinations and assisting dental practitioners in providing care and treatment, and 2,558 dental technicians, who construct and repair dental appliances under the direction of a dentist.

      Dentists make up 77 per cent of the dental workforce (excluding dental assistants and technicians). Of these, 84 per cent are in general dental practice and 12 per cent are registered dental specialists.

      More recent data have become available from the Dental Board of Australia (DBA) based on the 2010–11 registrations of dental practitioners through the Australian Health Practitioner Registration Agency (AHPRA). The total number of registrants was 18,319 comprising; 13,830 dentists; 1,206 dental therapists; 1,148 dental hygienists; 610 dual qualified dental hygienists and dental therapists; 362 oral health therapists; 1,160 dental prosthetists; and a very small number of practitioners otherwise categorised.63 These numbers are higher than those presented above for the dental workforce in 2006 because it covers all registrants, not just those actively practising dentistry. Active participation rates vary across different practitioners. For instance the participation rate among dentists is approximately 94 per cent.

      63 Australian Health Practitioner Registration Agency and the National Boards, Annual Report 2010–11, p.49.

      Time series data suggests that the numbers of practising dentists have increased over the past decade – from 8,338 in 1996 to 10,404 in 2006 (a 24.8 per cent increase). However, relative to the population, the numbers of practising dentists have only increased slightly over this same period – from 46.6 to 50.3 dentists per 100,000 population.

      In addition, the dental workforce was projected to grow across the later part of the 2000 decade. For instance, the number of practising dentists was projected to grow from 10,067 in 2005 to 11,551 in 2010. However, when DBA and AHPRA data have been reconciled against the existing data across the 2000 decade they indicated that the dental workforce may have grown a little more rapidly than projected.

      Gender

      Males make up the majority of the dental workforce – 71.0 per cent of dentists; 82.5 per cent of dental specialists; and 90.0 per cent of dental prosthestists. However, women make up the majority of dental hygienists (96.7 per cent), dental therapists (98.8 per cent) and oral health therapists (94.8 per cent). The number of females entering dental study is increasing, with around 53 per cent of commencing students and 58 per cent of dental graduates.

      Age

      In 2006, the average age of the dental workforce was around the mid 40s. The dental profession with the oldest workers on average was dental prosthetists (50.1 years), followed by dentists (45.1 years – with 37 per cent of dentists over the age of 50 years), dental therapists (42.9 years) and dental hygienists (37.7 years).

      Internationally born dentists

      Forty–seven per cent of practising dentists in Australia were born overseas. Some of these dentists completed their qualification overseas whilst others obtained their initial or specialist qualification in Australia.

      Hours worked

      Dentists have been practising roughly the same hours per week over the last decade. Females practise fewer hours on average than men (34.1 hours per week compared to 40.2 hours). The hours worked decreased on average for dentists aged 60 years and older.

      Indigenous dental workforce

      The most current recognised source of data for Indigenous dental workers indicates there were 18 Indigenous dentists, 15 oral dental workers and 171 dental assistants in 2006. It should be noted that not all Indigenous health professionals choose to identify as Indigenous or practice in Indigenous regions.64

      64 Australian Bureau of Statistics, Census of Population and Housing, 2006.

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      Workforce distribution

      Private and public employment

      Based on their main area of practice, the majority of the dental workforce is employed in the private sector: 84.2 per cent of dentists; 92.7 per cent of dental hygienists; around 62 per cent of oral health therapists; and 90.5 per cent of dental prosthetists.

      Dentists employed in the private sector tend to work in ‘solo’ and ‘solo with an assistant’ practices, as shown in Figure 2.2 below.

      Figure 2.2: Practising dentists by practice type at main location.
      Figure 2.2 shows the practising dentists by practice type at main location. D

      Source: Balasubramanian M. and Teusner, D. (2011), Dentists, specialists and allied practitioners in Australia: Dental Labour Force Collection, 2006. AIHW Dental statistics and research series, no. 53.

      Dental therapists have the highest proportion of employees in the public sector, with 81.9 per cent working predominantly in public school dental services (60.4 per cent) and in public community dental clinics (16.2 per cent).

      A number of dental practitioners also engage in volunteer or philanthropic work, such as providing clinical services to vulnerable and disparate people in society as well as volunteer teaching. (Refer to Appendix J on pro–bono services provided by dental practitioners).

      The state governments are the main employers of public sector dentists. The Commonwealth Government only employs 94 dentists for the Australian Defence Force. Further, while the Commonwealth may fund the services of general medical practitioners through payments made under the Medicare Benefits Schedule (MBS), the Commonwealth’s funding role through the MBS for dentists is quite limited (with the exception of payments for the CDDS program).

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      Geographic location

      The geographical distribution of the dental workforce is concentrated in urban areas. The majority of the dental workforce practise in Major Cities: 81.0 per cent of dentists; 87.4 per cent of dental hygienists; 62.2 per cent of dental therapists; 74.7 per cent of oral health therapists; and 67.5 per cent of dental prosthetists.

      There are three times as many dentists practising per 100,000 population in Major Cities (59.5 per 100,000) than in Remote/Very Remote areas (17.9 per 100,000). However, there are more dental therapists practising per 100,000 population in Outer Regional areas (7.5 per 100,000) areas than in Inner Regional areas (6.7 per 100,000) and in Major Cities (5.1 per 100,000). Table 2.2 below shows the distribution of the dental workforce by remoteness area.

      Table 2.2: Dental workforce per 100,000 population by Remoteness Area, 2006.

      Dental Professional Major cities Inner regional Outer regional Remote/Very remote Australia
      Dentists 59.5 33.1 27.5 17.9 50.3
      Dental therapists 5.1 6.7 7.5 4.3 5.7
      Dental hygienists 4.1 1.5 1.2 –– 3.3
      Oral health therapists 2.0 1.4 1.8 0.6 1.8
      Dental prosthetists(a) 4.4 5.9 2.8 0.9 4.4

      (a) No data is available for prosthetists practising in the NT.
      Source: AIHW/DSRU Dental Labour Force Survey 2006.

      A comparison with the distribution of medical practitioners – specifically primary care clinicians – highlights the relative maldistribution of dental practitioners in Remote/Very remote areas. Data from AIHW’s 2009 Medical Labour Force Survey shows that the number of primary care clinicians per 100,000 population is 118.4 in major cities and 125.8 in remote and very remote areas.

      The maldistribution of the dental workforce, between sectors and geographically, can impede timely and affordable access to services for certain groups, including rural and remote communities, Indigenous peoples, low socio–economic groups and those with special needs.

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      Regulation of the dental profession

      Historically, the regulation of health professionals was undertaken by states and territories. In July 2006, the Council of Australian Governments (COAG) agreed to implement a National Registration and Accreditation Scheme (NRAS) for health professionals. The NRAS was established on 1 July 2010 to align the state and territory registration schemes for certain health practitioners, including dental practitioners.

      The scheme operates independently of the Commonwealth Government under the Health Practitioner Regulation National Law Act 2009. Oversight of the NRAS is provided jointly by state, territory and Commonwealth Health Ministers through the Australian Health Workforce Ministerial Council.

      Under the NRAS, the DBA is responsible for: registering dental professionals and students; developing standards, codes and guidelines for the dental profession; handling notifications, complaints, investigations and disciplinary hearings; approving accreditation standards and accredited courses of study; and assessing the skills and qualifications of overseas trained dental practitioners who wish to practice in Australia.

      The DBA is supported by an independent statutory agency, AHPRA, which administers the receipt and processing of applications for registration and maintains a public register of registered health practitioners. The DBA has appointed the Australian Dental Council (ADC) as the accreditation agency responsible for accrediting education providers and programs of study for the dental profession as well as assessing international dental practitioners.

      Registration process

      Students of accredited Australian dental courses are granted student registration under the NRAS. Students seeking to work as dental practitioners in Australia following graduation must gain general registration under the NRAS before practising in the workforce (with the exception of dental technicians and dental assistants). To register as a dental practitioner, individuals must complete a DBA approved program of study (list of studies are in Table 2.3) and have their application assessed and registration confirmed by AHPRA. New graduates are registered and eligible to start working as soon as their name is published on the Register of Practitioners by AHPRA.

      A notable difference between dental practitioners and general medical practitioners seeking general registration is that dental practitioners are not required to complete a mandatory approved internship in addition to their approved course of study in order to practise in their own right.65

      65 Medical Board of Australia (as at 18 October 2011).

      Registration standards developed by the DBA further define the requirements that dental practitioners must meet to practise in their field and maintain registration. These include scope of practice registration standards, continuing professional development and recency of practice standards.

      Table 2.3: Approved programs of study – qualifications which lead to general registration as a dental practitioner.

      Institution Dentists Programs of study Allied dental practitioners Programs of study Dental prosthetists and technicians Programs of Study
      Griffith University Bachelor of Oral Health in Dental Science
      Graduate Diploma of Dentistry
      Oral health therapists - Bachelor of Oral Health Masters of Dental Technology (Dental Prosthetics)
      Dental technician - Bachelor of Oral Health (DentalTechnology
      University of Adelaide Bachelor of Dental Surgery Oral health therapists - Bachelor of Oral Health
      Charles Sturt University Bachelor of Dental Science Oral health therapists - Bachelor of Oral Health
      James Cook University Bachelor of Dental Surgery
      La Trobe University Bachelor of Health Sciences in Dentistry
      Master of Dentistry
      Oral health therapists - Bachelor of Oral Health
      University of Melbourne Bachelor of Dental Science
      Doctor of Dental Surgery
      Oral health therapists - Bachelor of Oral Health
      University of Queensland Bachelor of Dental Science Oral health therapists - Bachelor of Oral Health
      University of Sydney Bachelor of Dentistry
      Doctor of Dental Medicine
      Oral health therapists - Bachelor of Oral Health
      University of Western Australia Bachelor of Dental Science
      Doctor of Dental Medicine
      Curtin University Oral health therapists - Associate Degree
      University of Newcastle Dental therapists - Graduate Diploma
      Dental hygienist - Bachelor of Oral Health
      TAFE - South Australia Dental hygienists - Advanced Diploma Advanced Diploma of Dental Prosthetics
      Dental Technician - Diploma of Dental Technology
      Baxter Institute (VIC) Dental Technician - Diploma of Dental Technology
      Central Institute of Technology (WA) Advanced Diploma of Dental Prosthetics
      Dental Technician - Diploma of Dental Technology
      Charles Institute of Technology (NSW) Dental Technician - Diploma of Dental Technology
      DNA Kingston (WA) Dental Technician - Diploma of Dental Technology
      Holmesglen (VIC) Dental Technician - Diploma of Dental Technology
      RMIT University (VIC) Advanced Diploma of Dental Prosthetics
      Dental Technician - Diploma of Dental Technology
      Southbank Institute of Technology (QLD) Advanced Diploma of Dental Prosthetics
      Dental Technician - Diploma of Dental Technology
      Sydney Institute, Randwick College, TAFE Advanced Diploma of Dental Prosthetics
      Dental Technician - Diploma of Dental Technology

      The majority of dental professions require tertiary education qualifications, which have varying course durations. Dental and oral health therapy students typically gain their clinical experience in the public sector and university facilities.

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      Table 2.4: Dental professions – course durations.


      Dental Practitioners

      Study Time (full time)

      Dentists

      5 years of university education (or 4 years if commencing dental program with an applicable undergraduate degree). Specialisation – an additional 3–5 years at dental schools accredited by the Australian Dental Council and the Dental Board of Australia.

      Dental therapists

      1 year postgraduate program accredited by the Australian Dental Council and the Dental Board of Australia. Previous dental therapist education was a 2 year certificate or diploma course delivered by some state governments – these have been acknowledged by the DBA as registrable qualifications.

      Dental hygienists

      2 or 3 years of education accredited by the Australian Dental Council and the Dental Board of Australia.

      Oral health therapists

      Generally 3 years of education and accredited by the Australian Dental Council and the Dental Board of Australia.

      Dental prosthetists

      Generally 2 years of training prior to registration, following 2 years of dental technician training. Accredited by the Australian Dental Council and the Dental Board of Australia.

      Dental assistants

      Generally complete a certificate level qualification or in service training.

      Source: Dental Board of Australia.

      Demand and supply

      Australia entered the 2000 decade with a projected shortfall in its dental workforce relative to the expected demand for dental visits and services. As a result, one of the action areas in the National Oral Health Plan 2004–13 was the development of the dental workforce. In the decade since, there have been substantial changes in the recruitment to and loss of dental providers from the workforce and to the expected demand for dental services from the Australian population.

      Over the last decade there has been excess demand for the services of dentists in both the public and private sector.

      • In the public sector, approximately 400,000 people are currently estimated to be on waiting lists. This indicates that there is more demand for services than the public sector is able to supply.
      • Private sector patients also can experience difficulty accessing treatment and getting ‘on the books’ for private clinics. This is exacerbated by the variation between areas in the rate of supply of dentists, for instance the low supply rate in rural and outer metropolitan areas of capital cities. In addition, the significant price differential in the private sector sends a price signal to consumers to moderate demand – although patients may have a high willingness to pay for services, their relatively lower ability to pay may mean they have to consume fewer dental services than they would prefer.

      The demand for services across Australia is likely to increase in the future in response to a range of factors including population growth, an increasing proportion of adults who are dentate (i.e. have some natural teeth), and rising consumer expectations.

      Further, new policy options are likely to add stimulated demand for dental visits and services from ‘target’ groups that have formerly been low users of dental services.

      Domestic supply of dentists

      The number of dentist graduates in Australia has increased, from 228 in 2006 to 469 in 2009, a doubling in three years. This reflects the addition of a new dental school graduating dentists in this period as well as increases in the intake and graduate numbers from the five long–standing dental schools. The number of international students has been increasing within the intakes of dentist students in Australian universities.

      In 2007 and 2008 around 85 per cent of graduates were domestic students and in 2009 this increased to 89 per cent. The number of dentist graduates between 2003–2009, including domestic and international students is shown below.

      Table 2.5: Dentist graduates, 2003–2009(a).


      2003

      2004

      2005

      2006

      2007

      2008

      2009

      227

      220

      230

      228

      193

      349

      469

      (a) 2007 to 2009 data sourced from Department of Education, Employment and Workplace Relations administrative data, 2009; may include postgraduate course completions.
      Source: 2003 to 2006, ARCPOH, based on data sourced from the then Department of Education, Science and Technology on graduates from dental schools offering Bachelor of Dental Studies or Bachelor of Health Science with Master in Dentistry.

      International supply of dentists

      The ADC administers assessments to allow overseas trained dentists gain registration in Australia. There are three pathways to general registration in Australia for dentists with overseas qualifications:
      1. dentists who are registered to practice in New Zealand under Trans–Tasman mutual recognition;
      2. dentists with eligible qualifications from the United Kingdom, Republic of Ireland, New Zealand and Canada; or
      3. dentists with other qualifications (administered by the ADC).

      Dentists who meet the requirements of pathway one or two are eligible for general registration in Australia and can apply directly to the DBA for registration.

      Dentists with qualifications that do not meet the automatic registration requirements need to either complete an Australian qualification or undertake the examination procedure conducted by the ADC, which involves clinical practice in the public sector.66 In 2006, 158 overseas trained dentists successfully completed the ADC final examination. This increased to 204 in 2009. The ADC can also provide similar services for the assessment of dental therapists, dental hygienists and oral health therapists.

      66 Dentists may undertake the following limited practice options while they work towards General Registration under pathway 3:
      - Public Sector Dental Workforce scheme: The scheme was introduced in 2005 to help alleviate workforce shortages in the public sector, with a particular emphasis on rural and remote areas. Graduates with certain degrees from Canada, Hong Kong, Ireland, Malaysia, Singapore, South Africa, United Kingdom and the United States are granted an exemption from the ADC Preliminary Examination and must complete the Final Examination within three years of first becoming registered. Participants must undertake supervised practice and be employed in a public sector facility.
      - Limited Registration of Dentists for postgraduate training or supervised practice – Other international graduates: An alternative pathway for graduates not eligible for the PSDWS. These dentists must complete the ADC Preliminary Examination within one year of gaining limited registration in order to apply and then must also work under supervised practice employment in a public sector facility.

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      Projected workforce to 2020

      The latest published dentist labour force projections were made in 2008 by AIHW DSRU. The ‘best estimate’ projections indicate that the number of practising dentists is forecast to increase between 2005 and 2020 by 49.4 per cent, to over 15,000 by 2020.67 The study also predicts that the number of dentists per 100,000 population is expected to increase by 27.9 per cent, to 63.2 dentists per 100,000, by 2020. Capacity to supply dentist visits is projected to increase by 28.6 per cent by 2020 – from approximately 31.5 million visits in 2010 to 36.6 million visits in 2020.

      67 AIHW Dental Statistics and Research Unit (2008), Dentist labour force projections, 2005–2020, DSRU Research Report, No. 43, and AIHW Dental Statistics and Research Unit (2008), Projected demand for dental care to 2020. DSRU Research Report, No. 42.

      The numbers of oral health practitioners is also projected to grow, but this reflects varying trends among the component occupations. Dual qualified dental therapists and dental hygienists are increasing rapidly from a very low base of some 591 in 2010 to an anticipated 2,117 in 2020. The numbers of dental hygienists are also projected to increase from 1,065 in 2010 to 1,458 in 2020. However, the numbers of dental therapists are expected to decrease from 1,023 in 2010 to 443 in 2020. Total numbers of dental hygienists, dental therapists and oral health therapists are almost doubling from 2,404 in 2010 to 4,017 in 2020. Dental prosthetist numbers are projected to be slowly decreasing. The capacity of these oral health practitioners to provide visits and services to the Australian population is increasing.

      The latest published projections for effective demand between 2005 and 2020 show that visits could increase to 33.6 million visits in 2020 when only population growth and increasing proportion of adults being dentate were considered.68 However, there has been a long–term historical trend of an increasing use of dental services by the adult population and an increasing average number of dental visits made in a year. If even a modest continuation of this trend were to occur, then the expected demand for visits at 37.9 million visits would slightly exceed the projected capacity of the dental workforce to provide visits and services.

      68 Teusner, D.N. Chrisopoulos, S. and Spencer, A.J. (2008), Projected demand and supply for dental visits in Australia: analysis of the impact of changes in key inputs, AIHW Dental Statistics and Research Series, No. 38.

      When these projections were made in 2008 by the AIHW DSRU, the comparison of projected supply with projected demand for total aggregate dental visits indicated an approximate shortfall of 800 to 900 dental practitioners by 2020.

      The recent publication of workforce related data have highlighted the need for ongoing monitoring of the dental workforce and the periodic revision of dental workforce supply (e.g. projections of the DBA and AHPRA data on dental practitioner registrations in 2010–11; the data on intakes in the Australian dental schools; and the numbers of candidates sitting and successfully passing the ADC examinations process in 2011). A reconciliation of this new data on registrations in 2010–11 with the projected number of practising dentists for the year 2010 has indicated a faster rate of growth of the number of practising dentists than expected between 2005 and 2010.

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      Although some caution is required in interpreting the AHPRA data (i.e. it may include multiple registrations and may not accurately reflect employment rates of registered professionals), some general observations could be made, including:

      • the number of domestic graduates has increased faster than expected (through increases in graduate numbers in the long–standing dental schools);
      • the full extent of international students remaining in Australia to practice may not be captured in the migration assumptions in existing models; and
      • the number of successful ADC candidates is larger than expected (although the proportion who take up active practice of dentistry in Australia remains little understood).

      There has been some discussion that the expected number of dentist graduates across the 2010 decade will continue to exceed that assumed in 2008 and the number of dentists recruited from overseas actually taking up practise in Australia will also be higher than expected. This may result in dentist numbers exceeding the existing projections for 2020. Actual employment rates, recruitment of internationally qualified dentists, retirements and workforce participation of dental professionals in the future are not known and may impact, positively or negatively, on overall dentist supply. The impact will not be known without further research into and analysis of dentist supply projections.69

      69 It needs to be recognised that uncertainty also exists around effective demand for dental services. For instance, since the 2008 study, the Australian Bureau of Statistics has revised the population projection for the year 2020, increasing the forecast total number of visits by nearly two million. In addition, policies to improve access to dental services would also stimulate demand. Overall growth in supply is expected to outpace population growth through to 2020 allowing for new demand. A crucial issue is whether that new demand will come from groups in the population marginalised from regular dental services or not.

      While the number of dentists is increasing there are concerns over the number of dentists going on to procedural specialties and with the distribution of those specialists across the various speciality areas. Further, the increase in capacity to supply dental visits is somewhat tempered by changes in work hours and in the number of visits supplied in that work time.

      Factors affecting workforce supply

      Education and training

      In 2007, three new dental schools were established and are expected to increase the supply of dental graduates – Charles Sturt University, James Cook University, University of Newcastle and La Trobe University. These schools are expected to graduate their first intakes by 2013. Griffith University also started a new dental program and graduated its first cohort of oral health therapists in 2006 and dentists in 2008. Additionally, Charles Sturt University and La Trobe University each graduated their first cohorts of oral health therapists in 2011. Other Australian universities are considering establishing dentist and oral health practitioner courses.

      Further, the broader move towards a demand–driven university system from 2012 may affect the supply of domestically educated dentists. The Government will be funding Commonwealth Supported Places for all undergraduate domestic students accepted into an eligible higher education course, including for dentistry (but excluding medicine). Higher education providers will decide how many places they will offer, and in which disciplines, in response to employer and student demand. While the impact of this will not be known for some years, the numbers of dental graduates may increase due to uncapped demand or decrease if potential students are lost to other professions.

      The continuing growth in student uptake is having an impact on clinical training capacity and will be a challenge in the future if clinical training capacity cannot be maintained. Further, increasing Australian educated graduate numbers may also have flow on impacts to the number of international dental graduates recruited into Australia. Australia’s National Oral Health Plan 2004–13 emphasised a sustainable self–sufficiency for the dental workforce and supported the recruitment of international dental graduates as a short–term measure to boost supply.

      Dental academics in universities and complementary workforces

      The supply of complementary workforces affects the ability of the dental workforce to provide services – i.e. the availability and quality of supervisors and dental academics influences the potential numbers of new dental students as well as the quality of their education at university and once they commence practice.

      Forty–two per cent of dental academics were aged 50 years or older in 2006,70 which could potentially lead to high retirement rates in coming years. The gap between academic salaries and remuneration for privately practising dental practitioners makes it difficult for dental schools to attract and retain teaching staff.

      In addition, an adequate supply of dental assistants and dental technicians are required to support practising dental professionals to efficiently provide services.

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      Workforce demographics

      The dental workforce is also ageing, which may lead to more dental practitioners retiring or reducing the hours they work in coming years. Younger dental practitioners may also choose to work fewer hours due to lifestyle choices. Female dentists are more likely to work part time and have career breaks than male dental practitioners, which may also impact future supply if the proportion of female graduates increases.

      Registration and accreditation controls

      The registration and practise of dental practitioners is controlled by the registration and accreditation standards set by the DBA. Any future changes to the standard, either relaxing or tightening, could result in an increase or decrease in the supply of dental practitioners.

      70 Council for the Humanities, Arts and Social Sciences (2008), Occasional Paper No. 6, November 2008.

      Infrastructure and capital

      There are several issues related to infrastructure for dental services that can affect the supply of dental services and the incentives and ability for dental practitioners to provide these services in various locations and practices:

      • capital infrastructure – buildings and clinics, dental chairs and equipment, mobile dental facilities for remote locations etc; and
      • social infrastructure (especially relevant for remote locations) – student accommodation in rural areas for clinical placements, social support structures, transport, professional networks etc.

      The availability of these different types of resources varies considerably between jurisdictions. Rural areas face pronounced infrastructure constraints impacting the ability of regional centres to attract and retain dental professionals.

      Public sector issues

      There is a significant difference in expected salaries for the public and private workforce – average salaries for all dental professions in the private sector are almost double that of those in the public sector. This discrepancy makes working in the public dental sector less attractive and is one factor that inhibits the workforce supply in the public sector. Other factors include a perceived lack of a defined career path compared to the private sector, clinical support and continuing professional development opportunities as well as risks around deskilling. Ergo, measures to increase general workforce numbers may not necessarily correlate with an increase in public dentistry workforce numbers.

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      Government measures to affect workforce supply

      As mentioned earlier in this chapter, the Commonwealth Government has several measures which affect the workforce supply:

      • government partly funds university education of dental practitioners through Commonwealth supported places through HELP (however, the context for such support may change with the introduction of an uncapped system of university training places);
      • over the next three years from 1 July 2011, the Government will continue to support six Australian dental faculties to extend or maintain the DTERP program, in order to encourage dental students to take up a career in rural practice;
      • government funds the Puggy Hunter Memorial Scholarship Scheme to support the training of Indigenous people studying in health disciplines, including dentistry and oral health fields;
      • most recently, Government agreed to fund up to 50 voluntary dental internship places per year, which will potentially increase the capacity of dental services, particularly in the public sector; and
      • there are also various broader education and training scholarships and locum support activities.

      State governments also run the Public Sector Dental Workforce Scheme which enables graduates from some overseas dental programs to practice in the public sector for a period up to three years while they work towards completing the ADC Final Examination to gain Australian dental registration.

      However, dental workforce measures supported by government have generally been ad hoc. They tend to be short term and lack co–ordination with broader health workforce planning. For example, there are numerous Health Workforce Australia (HWA) projects that currently do not, but arguably should consider dentistry, including, but not limited to:

      • Workforce Profile Reports and Data Recourses;
      • Aboriginal Torres Strait Islander Health Worker Project;
      • Rural and Remote Health Workforce innovation and reform strategy;
      • Aged care reform;
      • Inter–professional learning and practice program;
      • Integrated regional clinical networks;
      • International Health professionals; and
      • Nursing and allied health recruitment for rural and regional Australia.

      In 2011, HWA completed the Dental Therapy, Dental Hygiene and Oral Health Therapy Scope of Practice Review. The report of the review was approved by HWA on 21 October 2011 and is yet to be considered by the Health Ministers.

      HWA is undertaking analysis of the dental workforce in 2012, as part of the National Training Plan Mark II. HWA’s analysis will examine issues around nationally agreed data on the supply and demand of the dental workforce and will project the number of professionals and dental students that would be required for a range of planning scenarios. HWA aims to also facilitate a greater degree of dialogue and co–ordination between the dental schools regarding training and clinical placements. The results of this analysis are not expected before the end of 2012.