The Life Story Experience of “Migrant Dentists” in Australia: Potential Implications for Health Workforce Governance and International Cooperation

Document Type: Original Article

Authors

1 Australian Research Centre for Population Oral Health, School of Dentistry, The University of Adelaide, Adelaide, SA, Australia

2 Discipline of Behavioural and Social Sciences in Health, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia

3 Australian Dental Council, Melbourne, VIC, Australia

Abstract

Background
The migration of dentists is a major policy challenge facing both developing and developed countries. Dentists from over 120 countries migrate to Australia, and a large proportion are from developing countries. The aim of the study was to assess the life story experience (LSE) of migrant dentists in Australia, in order to address key policy challenges facing dentist migration.
 
Methods
A national survey of all migrant dentists resident in Australia was conducted in 2013. Migrant experiences were assessed through a suite of LSE scales, developed through a qualitative-quantitative study. Respondents rated experiences using a five-point Likert scale.
 
Results
A total of 1022 migrant dentists responded to the survey (response rate = 54.5%). LSE1 (health system and general lifestyle concerns in home country), LSE2 (appreciation towards Australian way of life) and LSE3 (settlement concerns in Australia) scales varied by migrant dentist groups, sex, and years since arrival to Australia (chi-square, P < .05). In a logistic regression model, migrants mainly from developing countries (ie, the examination pathway group) faced greater health system and general lifestyle concerns in their home countries (9.32; 3.51-24.72) and greater settlement challenges in Australia (5.39; 3.51-8.28), compared to migrants from well-developed countries, who obtained direct recognition of qualifications. Migrants also are more appreciative towards the Australian way of life if they had lived at least ten years in Australia (1.97; 1.27-3.05), compared to migrants who have lived for less than ten years.
 
Conclusion
Migrant dentists, mainly from developing countries, face challenges both in their home countries and in Australia. Our study offers evidence for multi-level health workforce governance and calls for greater consensus towards an international agenda to address dentist migration. Better integration of dentist migration with the mainstream health workforce governance is a viable and opportunistic way forward.

Keywords

Main Subjects


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  1. Balasubramanian M, Brennan DS, Spencer AJ, Short SD. The “global interconnectedness” of dentist migration: a qualitative study of the life-stories of international dental graduates in Australia. Health Policy Plan. 2015;30(4):432-441.
  2. Yamalik N, Ensaldo-Carrasco E, Cavalle E, Kell K. Oral health workforce planning part 2: figures, determinants and trends in a sample of World Dental Federation member countries. Int Dent J. 2014;64:117-126.
  3. Clemens MA. Do visas kill ? Health effects of African health professional emigration. Center for Global Development. Report No. 1142007. Report No. 114.
  4. Kangasniemi M, Winters LA, Commander S. Is the medical brain drain beneficial? Evidence from overseas doctors in the UK. Soc Sci Med. 2007;65(5):915–923.
  5. Balasubramanian M, Brennan DS. Dentist migration: a forgotten perspective [Internet]. International Dental Tribune. Geneva; 2014. http://www.dental-tribune.com/articles/news/australia/20708_dentist_migration_a_forgotten_perspective.html.
  6. Balasubramanian M, Short SD. The Commonwealth as a custodian of dental migratory ethics: views of senior oral health leaders from India and Australia. Int Dent J. 2011;61(5):281–286.
  7. Balasubramanian M, Spencer A, Short S, Watkins K, Chrisopoulos S, Brennan D. Characteristics and practice profiles of migrant dentist groups in Australia: implications for dental workforce policy and planning. Int Dent J. 2015;65(3):146–155.
  8. Hawthorne L. Health workforce migration to Australia: policy trends and outcomes 2004-2010. Health Workforce Australia; 2012.
  9. Watkins K, ADC. International Dental Graduates and Australian Dental Council Examination Process. Presentation made on Behalf of the Australian Dental Council. The University of Adelaide; 2011.
  10. Brennan D, Spencer A, Balasubramanian M, ARCPOH. Longitudinal Study of Dentists Practice Activity 2009-10: Sixth Wave of National Collection. Adelaide; 2010.
  11. Spencer AJ. Migration of dentists into Australia. Aust Dent J. 1982;27(1):11–5.
  12. Australian Health Practitioner Regulation Agency. Dental Board of Australia - Overseas Dentists. http://www.dentalboard.gov.au/Registration/Overseas-Practitioner-Registration.aspx. Published 2013.
  13. Australian Dental Council. Australian Dental Council - Overseas Qualified Dentists. http://www.adc.org.au/index.php?id=9. Published 2013.
  14. Balasubramanian M, Brennan DS, Spencer AJ, Watkins K, Short SD. Overseas-qualified dentists’ experiences and perceptions of the Australian Dental Council assessment and examination process: the importance of support structures. Aust Heal Rev. 2014;38(4):412–419.
  15. Mahal AS, Shah N. Implications of the growth of dental education in India. J Dent Educ. 2006;70(8):884–491.
  16. Parkash H, Duggal R, Mathur VP. Guidelines for meaningful and effective utilisation of manpower at dental colleges for primary prevention of oro-dental problems in the country. Delhi: Government of India and World Health Organisation; 2007.
  17. World Health Organization (WHO). Human Resources for Health Country Profile: Indonesia. World Health Organisation Regional Office for South-East Asia; 2011.
  18. World Health Organization (WHO). Human Resources for Health Country Profile: Thailand. World Health Organisation Regional Office for South-East Asia. 2010.
  19. Balasubramanian M, Brennan D, Spencer A, Short S. Newness-struggle-success continuum: a qualitative examination of cultural adaptation process of overseas-qualified dentists in Australia. Aust Heal Rev. 2016; 40(2): 168-173
  20. Ayers KM, Thomson WM, Al-Hassiny H, Rich AM, Newton JT. A qualitative investigation of the experiences of immigrant dentists working in New Zealand. N Z Dent J. 2008 Sep;104(3):97–103.
  21. Castles S, De Hass H, Miller JM. The Age of Migration: International population movements in the modern world. Fifth. The Gilford Press; 2014.
  22. Australian Institute of Health and Welfare. Dental workforce 2011. Canberra: Australian Government: Australian Institute of health and Welfare; 2013: 137.
  23. Balasubramanian M, Teusner DN. Dentists, specialists and allied dental practitioners: the Australian Dental Labour Force, 2006.  Dental Statistics and Research Series No 53. Cat No. DEN 202. Canberra: Australian Institute of Health and Welfare; 2011.
  24. Chrisopoulos S, Nguyen T. Trends in the Australian Dental Labour Force, 2000 to 2009: Dental labour force collection, 2009. Vol. Dental Sta. Canberra: Australian Institute of Health and Welfare; 2012.
  25. Brennan DS, Spencer AJ. Practice activity trends among Australian private general dental practitioners: 1983-84 to 1988-99. Int Den J. 2002;52:61–69.
  26. Brennan DS, Balasubramanian M, Spencer AJ. Trends in dental service provision in Australia: 1983-1984 to 2009-2010. Int Dent J. 2015;65(1):39–44.
  27. Luzzi L, Spencer AJ, Jones K, Teusner D. Job satisfaction of registered dental practitioners. Aust Dent J. 2005 Sep;50(3):179–185.
  28. Luzzi L, Spencer AJ. Job satisfaction of the oral health labour force in Australia. Aust Dent J. 2011;56(1):23–32.
  29. Balasubramanian M, Spencer A, Short S, Watkins K, Chrisopoulos S, Brennan D. Development of life story experience (LSE) scales for migrant dentists in Australia: a sequential qualitative- quantitative study. Community Dent Heal. 2016;33:225-231.
  30. Australian Bureau of Statistics. Australian Standard Geographical Classification. Australian Bureau of Statistics; 2006.
  31. Brennan DS, Spencer AJ. Development and testing of revised practice belief scales among private general dental practitioners. Aust Dent J. 2008;53(3):217-225.
  32. Sur H, Hayran O, Mumcu G, Soylemez D, Atli H, Yildirim C. Factors affecting dental job satisfaction: a cross-sectional survey in Turkey. Eval Health Prof. 2004;27:152–164.
  33. Hosmer D, Lemeshow S, Sturdivant R. Applied Logistic Regression. Hoboken: Wiley; 2013.
  34. SPSS Inc. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp; 2011.
  35. Glick M, Monteiro Da Silva O, Seeberger GK, et al. FDI Vision 2020: Shaping the future of oral health. Int Dent J. 2012;62:278–291.
  36. Ortiga YY. Social Science & Medicine Professional problems : The burden of producing the “global” Filipino nurse. Soc Sci Med. 2014;115:64–71.
  37. Kandelman D, Arpin S, Baez RJ, Baehni PC, Petersen PE. Oral health care systems in developing and developed countries. Periodontol 2000. 2012;60(1):98–109.
  38. Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Heal Organ. 2005;83(9):661–669.
  39. Parkash H, Mathur VP, Duggal R. Dental workforce issues: a global concern. J Dent Educ. 2006;70(11):22–26.
  40. Burnham GM, Lafta R, Doocy S. Doctors leaving 12 tertiary hospitals in Iraq, 2004-2007. Soc Sci Med 2009;69(2):172–177.
  41. Kingma M. Nurses on the move : migration and the global health care economy. The culture and politics of health care work. Ithaca, NY: ILR Press/Cornell University Press; 2006.
  42. Buchan J, Sochalski J. The migration of nurses : trends and policies. Bull World Health Organ. 2004;82:587–94.
  43. Chen L, Evans T, Anand S, et al. Human resources for health: Overcoming the crisis. Lancet. 2004;364:1984–1990.
  44. Mullan F. Doctors for the world: indian physician emigration. Health Aff. 2006;25(2):380–393.
  45. Epstein GS, Gang IN. The influence of others on migration plans. Bonn, Germany: IZA; 2004.
  46. Chiswick BR, Miller PW. Immigration, Language and Multiculturalism in Australia. Aust Econ Rev. 1999;32(4):369–385.
  47. The World Health Report. WHO 2006 Report: Chapter 5 Managing exits from the workforce. Geneva: WHO; 2006.
  48. Field MJ. Dental Education at the Crossroads: Challenges and Change. Washington DC: National Academy Press; 1995.
  49. Kuhlmann E, Batenburg R, Groenewegen PP, Larsen C. Bringing a European perspective to the health human resources debate: a scoping study. Health Policy. 2013;110(1):6–13.
  50. Kuhlmann E, Larsen C. Why we need multi-level health workforce governance: Case studies from nursing and medicine in Germany. Health Policy. 2015;119(12):1636–1644.
  51. Gallagher JE, Eaton KA. Health workforce governance and oral health: Diversity and challenges in Europe. Health Policy. 2015;119(12):1565–1575.
  52. Ognyanova D, Maier CB, Wismar M, Girasek E, Busse R. Mobility of health professionals pre and post 2004 and 2007 EU enlargements: evidence from the EU project PROMeTHEUS. Health Policy. 2012;108(2-3):122–132.
  53. Gulf Cooperative Council. Qualifications meta-frameworks : A report supporting the development of Gulf Cooperation Council’s Gulf Qualifications Framework ( GQF ). GCC; 2013.
  54. Association of South East Asian Nations. ASEAN Economic Community. http://www.asean.org/communities/asean-economic-community. Accessec January 15, 2015. Published 2015.
  55. World Health Organization (WHO). WHO Global Code of Practice on the International Recruitment of Health Personnel. Geneva: World Health Organisation; 2010:1–12.
  56. Siyam A, Zurn P, Rø OC, et al. Monitoring the implementation of the WHO Global Code of Practice on the International Recruitment of Health Personnel. Bull World Health Organ. 2013;91(11):816–823.
  57. Balasubramanian M, Brennan DS, Spencer AJ, Short S. The international migration of dentists: directions for research and policy. Community Dentistry and Oral Epidemiology. 2016;44(4):301–312. doi:10.1111/cdoe.12223
  58. Australian Health Practitioner Regulation Agency. Dental Board of Australia. http://www.dentalboard.gov.au/. Published 2010.
  59. About us – Membership. Australian Dental Association. (ADA) website. http://www.ada.org.au/About/default.aspx. Accessed May 29, 2014. Published 2015.
  60. Balasubramanian M, Brennan DS, Spencer AJ, Watkins K, Short SD. The importance of workforce surveillance, research evidence and political advocacy in the context of international migration of dentists. Br Dent J. 2015;218(6):329–331.  doi:10.1038/sj.bdj.2015.195
  61. Dustmann C, Weiss Y. Return migration: theory and empirical evidence from the UK. Br J Ind Relations. 2007;45(2):236–256.
  62. Dustmann C, Bentolila S, Faini R. Return Migration: The European Experience. Econ Policy. 1996;11(22):213–250.
  63. Gmelch G. Return Migration. Annu Rev Anthropol. 1980;9:135–159. doi:10.1146/annurev.an.09.100180.001031