Valé Gough Whitlam

“Our Spirit walks with you”

Kev Carmody 5 November 2014

American Region

European Region

South East Asian

Region

Western Pacific

Region

African Region

Eastern Mediterranean

Region

How should we respond to policy challenges posed by the

international mobility of dentists?

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Professor Stephanie D Short

Head, Discipline of Behavioural and Social Sciences in Health

Faculty of Health Sciences

Outline

• Background on the migrant dentists’ study

• Policy challenges

A. Workforce surveillance

B. Research evidence

C. Political advocacy

• On reflection

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Background

• ‘Migrant dentists’ comprise a growing proportion of the dental

workforce in Australia. Overseas primary dental qualification

(e.g. BDS, DDS).

• In 1980s majority from the United Kingdom, Ireland and New

Zealand

• Last decade, Increased dentists migrating from developing

countries

• Diverse cultural and professional backgrounds.

• Likely to differ in treatment philosophies.

• Currently, 1/4 dentists in Australia is a migrant dentist. 4

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• Current evidence mainly anecdotal

• National dental workforce surveys do not collect or report

data that can differentiate migrant dentists.

• Prior longitudinal studies on dentist practice activity differed

on how they collect data on primary dental qualification –

• Need to obtain a systematic understanding of the

demographic, residence characteristics, and practice profiles

• 2013 first national survey of migrant dentists in Australia.

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Background

Australia popular destination for OECD dentists.

• ‘North-North’ phenomenon of migration between

industrialised.

• Migration of health professionals to Australia causes shortage

of workforce in industrialised countries | Brain drain in low-

and middle income countries.

• Policy positions | Australian Dental Association view that

migration from New Zealand should cease. Reasons for

migration are deep rooted | Australian-trained dentists

emigrate as well.

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Background

A Workforce surveillance

• The collection of migrant dentist workforce data by

government organisations for monitoring, planning &

reporting purposes.

• Relevant organisations include immigration departments,

dentist registration authorities, and workforce agencies.

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Inconsistencies

• Similar to the prevailing opinion on migrant physician and

nursing workforce, we recognize inconsistencies in the

collection and reporting of migrant dentist data.

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B Research evidence

• Future research will need to address the consequences of

dentist migration, especially questions that address loss in

educational investment to source countries, health

system effects due to loss of migrating dentists, and

effects on economic development due to remittances and

knowledge transfer.

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C Political advocacy

• Vital due to the nascent nature of workforce surveillance

& migration research in many low & middle income

countries.

• Necessary to translate research evidence into policy, as

well as to stimulate research interest & activity.

• Advocacy can also extend to improve migrant workforce

surveillance.

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National-level advocacy

• An integrated system for collecting dental workforce data

that includes migration data, in addition to key issues such

as motivations, job satisfaction, practice patterns and

internal movement is important for dental workforce

planning.

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Global-level advocacy

• Focussed on improving the comparability of dentist

migration data, strengthening collaboration between state

(national governments) and non-state players (dental

associations, research groups and thought leaders), and

possibly in developing a nodal agency for dentist migration

research.

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WHO Code of Practice

• The WHO global code for international recruitment for

health personnel is a crucial global advocacy tool.

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Minimum data set approach

• Recent reports point towards the designation of a national

authority for facilitating information exchange on health

personnel for monitoring and implementation of the Code.

• This is based on a minimum dataset approach and involves

mandatory collection of key health professional

characteristics.

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Implementing the Code

• More efforts are required to strengthen implementation of

the Code: greater collaboration among state and non-

state players.

• This is particularly relevant in a privately-driven dental

profession (where the majority of dental practitioners work

in private practices).

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On reflection

• While we understand that effective policy-making requires

research evidence, we also argue that political advocacy

is vital.

• Global organisations such as the FDI Word Dental

Federation have a significant role to play in advocating for

improved migrant dentist workforce surveillance and

research evidence, especially in the low- and middle-

income countries.

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American Region

(AMR)

European Region

(EUR)

South East Asian

Region (SEAR)

Western Pacific

Region (WPR)

African Region

(AFR)

Eastern Mediterranean

Region (EMR)

42% of dentists in Australia are foreign-born

About 20,000 new dentists graduate every year in India - Many migrate

2/3rd of the dentists who graduate in Philippines migrate elsewhere

Nearly 40 African countries have less than 10 dentists per 100,000 people

Many dentists who graduate in an European dental school can practice across the EU

Canada and Australia have mutual recognition of qualifications

Brazil has one dentist for every medical doctor.

“Global responsibility must be shared, because no country is an

island in workforce development”

Lincoln Chen

Human Resources for Health: Overcoming the Crisis. Lancet, 200417

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Acknowledgements

Co-authors

Dr Madhan Balasubramanian, Associate Professor David Brennan and

Emeritus Professor A John Spencer, School of Dentistry, the University of Adelaide.

Dr Keith Watkins. (Rtd.) Chair of Examinations, the Australian Dental Council.

Research Grants

Australian Dental Research Foundation Grants 2011 and 2012.

NHMRC Centres for Research Excellence in Dental Health Services Research Support.

Key collaborators

Australasian Council of Dental Schools and Emeritus Professor Johann de Vries.

Australian Dental Association Inc. (Federal) and Mr Mathew Connor.

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References

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2004. 82(8): 587-594.

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http://heapol.oxfordjournals.org/content/early/2014/05/10/heapol.czu032.full

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policy in Australia. Melbourne: Oxford University Press; 1997. p. 65–82.

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