The dental workforce fights for its life


The dental workforce fights for its lifeWhile the number of overseas-qualified dentists practising in Australia has been restricted, Tracey Porter investigates what impact, if any, this has had on graduates looking for work.

If the Australian Dental Association [ADA] has anything to do with it, the finger of blame will be pointed squarely at the feet of our Trans-Tasman cousins. Not content with landing Australians with the likes of the tempestuous actor Russell Crowe and the colourful Queensland politician Joh Bjelke-Petersen, now New Zealand is also being blamed—at least partially—for the oversupply issues facing the dental sector here.

A widely circulated 2014 report prepared by Health Workforce Australia [HWA], whose functions have since been incorporated into the Department of Health, found that over the next ten years the nation will face an oversupply of dentists. The HWA report provided a comprehensive review of the dental workforce in Australia, taking evidence from all stakeholders, including the dental profession. The report concluded there would be a persistent workforce oversupply until at least 2025.

The release of the report subsequently prompted the ADA to step up its lobbying about the issue, with repeated requests that dentistry and dental specialists be removed from the Skilled Occupations List [SOL], which allows overseas-trained doctors special visas to work in Australia. In its submission to the Department of Industry regarding the removal of dentistry from the 2015/16 SOL, the ADA claimed dental workforce projections undertaken in 2008 estimated that approximately 15,000 dentists would be required by 2020. Registration figures as at June 2014 already exceeded these projections, showing Australia has 15,638 dentists.

The submission also noted that the ADA’s own studies found that about 460 new dentists were required to enter the Australian dental workforce each year to meet demand and attrition. Estimates suggested that around 580 dentist students graduated in 2013, with the number rising to 620 graduates the following year.

The ADA argued there was an even greater growth in the number of allied dental practitioners being trained. Based on previous years, around 200 dentists who qualified overseas would successfully complete the requirements to register as dentists in Australia through the Australian Dental Council assessment pathway for overseas-trained dentists.

“The problem here is that New Zealand has much less stringent requirements, and so the result is that the high quality Australian standards will dilute over time.”—Dr Rick Olive, Australian Dental Association

According to the Australian Workforce and Productivity Agency, 307 dentists were granted visas [137 permanent, 170 temporary] in 2011/12, in addition to those entering the dental workforce through Australian university programmes. It is clear from this data that the supply of dentists annually far outweighs the requirements to meet demand, growth and attrition combined.

The lobbying was successful. In June 2015, then Assistant Minister for Immigration, the Hon. Senator Michaelia Cash, removed dentists and specialist dentists from the SOL.

But while the changes have gone some way in addressing oversupply concerns facing the Australian dental sector, the issue is far from resolved, says Dr Rick Olive, the federal president of ADA. Dr Olive says an increase in “shopping and hopping” has led to overseas dentists being assessed and registered in New Zealand, effectively gaining back door entry into Australia.

“The problem here is that New Zealand has much less stringent requirements, and so the result is that the high quality Australian standards will dilute over time and potentially compromise the quality of patients’ dental care.” Previously Australia and New Zealand had very similar approaches to assessing and examining overseas-qualified dentists, but the Kiwis have changed their standards, he says. “Now we see this avenue exacerbating the dental workforce oversupply situation and at the same time posing risks to the quality of dental care provided to patients.”

So concerned is Dr Olive he has also sent a letter to the chair of the Dental Board of Australia, slamming automatic recognition of Overseas Qualified Dentists [OQDs]. Currently, dentists from the UK and Ireland are eligible to apply for automatic recognition of their qualifications to practice in Australia. The arrangement was previously reciprocated by the General Dental Council, which also permitted Australian-qualified dentists to register in the UK without restriction. The privileges were removed for all Australian graduates from 1996, however, Australia still allows OQDs to register here.

Dr Olive says that to continue to allow OQDs from these countries to register in Australia without the need for assessment and examination compounds the problem with dentist supply here. “There is absolutely no need for this privilege to be accorded to dentists from these countries. There is an international phenomenon in dentistry—namely the training of excess numbers of dentists in each country. With the retention of the privilege that allows OQDs to become registered here without the need for formal examination, Australia has become the overseas destination of choice for those dentists who cannot secure employment for themselves. The preferential treatment of UK and Irish graduates is discriminatory and cannot be justified.”

With the increase in the number of dentists able to provide services, the workload to supply those services is being spread more thinly across the dental workforce, says Dr Olive, with the consequence that dentists in practice are finding it more difficult to maintain the economic viability of their dental practice.

“The impact of this is twofold. Some practices are being required to close, thus making it more difficult in some cases for patients to access care,” says Dr Olive. “Also, the ADA can see that this may also cause some GP practitioners, who may otherwise have referred some services to specialists, now undertaking those services themselves to keep their practice viable. While this may not be a problem in itself, the risk of adverse consequences is increased.”

Dr Olive says while he is encouraged by statements made by new Prime Minister Malcolm Turnbull that the government will be more agile and responsive to changes under his leadership, the problem is being exacerbated by other government policies, including those that facilitate the excess number of dentist places being offered by universities. He says the latest Graduate Careers Survey shows the continuing downward trend of dental students able to find full-time work [79.6% in 2014]. “This is gravely concerning considering the amount of time and personal investment students put into learning to become a dentist.”

Yet not everyone agrees with Dr Olive that oversupply is the biggest concern for those in the dental workforce presently. Professor Boyen Huang, the head of Charles Sturt University’s dental school, which produces an average of 40 graduates each year, says distribution is a bigger issue than supply, with most graduates preferring to remain in metropolitan areas owing to the isolation, fewer further educational pathways and a lack of opportunities for spouse and other family members in remote and rural regions. In addition, the bulk of dental schools in Australia are based in metropolitan cities with no dental schools in the Northern Territory or Tasmania, he says.

Professor Huang says this situation applies to not only graduates but also dental academics.

His concern is backed up by research conducted by Professor Marc Tennant of the University of Western Australia [UWA] in his report, Geographic redistribution of practice location of graduation dentists: a six year retrospective analysis (2004-2009), whose research concluded that an apparent association exists between year of graduation and practice location, with more experienced dentists working in urban and higher socio-economic areas.

Professor Tennant discovered that of the 228 UWA graduates, 83 per cent continued to practice in Western Australia, with 78 per cent of the practice locations alone in ARIA 1 [highly accessible areas] and 22 per cent of the graduates distributed among the remaining ARIA regions. 51 per cent of graduates practised in the 30 per cent most affluent suburbs, and only 11.5 per cent practised in the most socio-economically disadvantaged suburbs. In the least disadvantaged areas, the highest numbers of practising dental graduates were also from the earliest graduates, with numbers steadily declining over the year of graduation from 2004 to 2009, indicating a decline in dentists relocating to rural areas to work after graduation.

Melbourne Dental School’s Professor Mike Morgan says research being carried out by the University of Melbourne and others continues to find that certain population groups—lower income groups, those living in rural areas, people in aged-care facilities, and Indigenous people —have difficulty accessing appropriate dental care. “These findings indicate that for the community it is more than just
a matter of supply and that there remains issues of access and some level of mal-distribution of oral health professionals throughout the community.”

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