Background
Methods
Results
Dentist (N = 34) | Prosthetist (N = 8) | OHT (N = 8) | Total (N = 50) | Percentage % | |
---|---|---|---|---|---|
Location of practice | |||||
RA1-Major cities | (18/50) | 48 % | |||
RA1 male | 9 | 3 | 0 | 12 | |
RA1 female | 6 | 0 | 0 | 6 | |
RA2-Inner regional | (21/50) | 42 % | |||
RA2 male | 10 | 1 | 1 | 12 | |
RA2 female | 5 | 1 | 3 | 9 | |
RA3-Outer regional | (3/50) | 6 % | |||
RA3 male | 0 | 1 | 0 | 1 | |
RA3 female | 1 | 1 | 0 | 2 | |
RA4-Remote | (1/50) | 2 % | |||
RA4 male | 0 | 1 | 0 | 1 | |
RA4 female | 0 | 0 | 0 | 0 | |
RA5-Very remote | (4/50) | 8 % | |||
RA5 male | 2 | 0 | 0 | 2 | |
RA5 female | 0 | 0 | 2 | 2 | |
Unemployed | (3/50) | 6 % | |||
Unemployed male | 0 | 0 | 0 | 0 | |
Unemployed female | 1 | 0 | 2 | 3 | |
Classification of practice | |||||
Urban | 30 | 5 | 4 | (39/50) | 78 % |
Rural | 3 | 3 | 2 | (8/50) | 16 % |
Unemployed | 1 | 0 | 2 | (3/50) | 6 % |
Prior rural exposure | |||||
Yes | 25 | 6 | 6 | (37/50) | 74 % |
No | 9 | 2 | 2 | (13/50) | 26 % |
Age groups | |||||
20–34 | 10 | 0 | 2 | (12/50) | 24 % |
35–44 | 6 | 0 | 2 | (8/50) | 16 % |
45–54 | 4 | 4 | 2 | (10/50) | 20 % |
55–64 | 10 | 4 | 2 | (16/50) | 32 % |
65+ | 4 | 0 | 0 | (4/50) | 8 % |
Birthplace | |||||
Africa | 1 | 0 | 0 | (1/50) | 2 % |
Asia | 5 | 0 | 1 | (6/50) | 12 % |
Australia | 21 | 6 | 5 | (32/50) | 64 % |
Europe | 6 | 0 | 2 | (8/50) | 16 % |
North America | 1 | 0 | 0 | (1/50) | 2 % |
New Zealand | 0 | 2 | 0 | (2/50) | 4 % |
Business case
Sustainability of a rural practice
There are more issues than just the money to build a clinic. Um… such as how big is the patient base actually going to be and how sustainable is a dental practice going to be in a particular area. (Dentist, female, 40 yo, urban practitioner-has previous rural experience)
That’s an issue for rural areas in particular, in that they either don’t have the income to pay for a full time dentist in the area and because it costs so much to set up a dental practice, you need to make sure it’s going to be viable in that area. And that there might not be the population size to afford a rural practice. (Dentist, male, 31 yo, urban practice-has previous rural experience)
You go up there, and if you were to broke, nobody cares. You’ve gone broke. You’ve lost money, well that’s hard luck for you. (Dentist, male, 66yo, rural practitioner)
I think population, the number, just having the amount of work required to maintain a practice. (Prosthetist, male, 49 yo, urban practitioner-has previous rural experience)
The other thing is that whilst we can talk about shortages and numbers of people, there's still a lot of people who are not choosing to access care so, not all of these small communities can actually realistically sustain a full time practitioner there. (Dentist, female, 52 yo, urban practitioner-no previous rural experience)…And in agricultural areas like this, people compare the price of a crown to the price of an acre of land, and they say well I can make more money out of an acre of land than I can by putting a crown on a tooth [laughs] so they opt for the cheaper options. (Dentist, male, 59 yo, rural practitioner)
I recognised a need in those areas so, um yeah, I’m filling that need, and also a commercial thing. Um, while sometimes it’s not the best commercial decision it does return fairly well, but, fine. (Prosthetist, male, 56 yo, rural practitioner)I wonder whether, you know, it’s financially viable, and for dentists it’s more viable to stay in a central area and have people to come to you. To locate outside a central area, it’s a little bit like a reverse economy. You don’t get as much exposure and you don’t, yeah, you don’t get the same financial return. (Dentist, male, 44 yo, rural practitioner)
… you know that there's going to be an oversupply of graduates, which I think you're going to find its going to be a lot easier to get people to go and do country service, just because, they're going to have to because there's going to be too many unemployed ones in the city. (Dentist, male, 62 yo, urban practitioner-has previous rural experience)
I think it is becoming less of an issue with the oversupply of dentists in the metropolitan areas, that people finding, feeling the pressure that they don’t have the options of work in the city. Um, so they're being forced out into country areas anyway. (Dentist, female, 32 yo, urban practitioner-has previous rural experience)
…I, for 30 years used to struggle, I would advertise and I would get absolutely no interest. …[now] I was inundated with applications, you'd only just got to throw, the smallest amount of bait out and there are just kids everywhere just wanting a job. (Dentist, male, 59 yo, rural practitioner)
Oh, yeah it would certainly, certainly play into it, it would contribute to a positive decision to work in a rural area, but I think there are other intangibles which are, in my particular… which are more important than the financial incentives. (Dentist, male, 35 yo)… they are important, that’s why we go to work that’s why we do what we do, that’s part of the reason why we do what we do. …but that’s also, it’s a trade-off between lifestyle and the financial benefits. I would rather have less of a financial benefit but enjoy the lifestyle that I have. (Prosthetist, female, 49 yo, rural practitioner)
I don’t think money brings people to um, you know to areas. It certainly, it doesn’t retain them. I've employed you know various people over the years and paid them exceptionally well, but you know, you see them heading back to the city every second weekend to meet up with their mates and so on, and you know that they're not going to stay. So, you’ve really got to get somebody whose heart is in, in being where they want to be. (Dentist, male, 64 yo, rural practitioner)I think it’s important that you know rural areas that we least have the same earning capacity as metropolitan… I've worked in practices that I've had to go down almost $20 an hour and then in some cases I've moved states where I've had to go down nearly $30 an hour. OHT, female, 49 yo, urban practitioner-has previous rural experience)
Differences in clinical practices
Clinical development
That unfortunately dentistry via its nature is a, is a terminal profession. In that there's um not a lot of um opportunities for upward advancement, and that upward advancement is even less so in a rural area. (Dentist, male, 34 yo, rural practitioner, has previous rural experience)
… the graduates don’t tend to have had as much clinical experience as perhaps they once did. And their anxiety to me was “what if I start to do something and don’t know how I finish it?” because you know there's no one there who can help me.” (Specialist dentist, female, 52 yo, urban practitioner-has previous rural experience)
I guess the experience that I knew I was going to get when I moved out there [a rural area], my mentor, was really nice and really encouraging. (New graduate dentist, female, 25 yo, rural practitioner)
Job satisfaction
I went out to some really tiny Aboriginal communities for a week at a time, and I just had a ball, I really loved it and you can really tell, like you ask somebody in a small community if you're making a difference and I guess, that played a big part in me choosing to go rural. (New graduate dentist, female, 25 yo, rural practitioner)
I found it much more fun to practise in those areas, much more rewarding you’d have people with serious um dental conditions which were affecting their medical health rather than just a simple broken tooth. (Dentist, female, 32 yo, urban practitioner-has previous rural experience)
I would definitely make sure that there was an education, peer support network for rural practitioners, um, I'd make sure there was some sort of assistance for their greater out of pocket costs. (Dentist, female, 54 yo, urban practitioner-no previous rural experience)
Community
Lifestyle, I think, and family. I think just know where you like to live, I'd prefer to live in a rural area. (Prosthetist, male, 52 yo)
The lifestyle I think I was sort of itching to get back into the CBD [city area]. Um mainly because of you know being closer to friends and family. (Dentist, male, 59 yo, urban practitioner-has previous rural experience)
I live in a small town now and I don’t think I've ever lived somewhere so social in my whole life. It’s a lot more social because you end up making your own fun. (OHT, female, 58 yo, rural practitioner)
Individual factors
Rural background
I've got this bigoted view that rural people want to work in rural areas, and people who grew up in the metropolitan areas probably want to work in metropolitan areas. And the reason I think that is, you couldn’t pay me enough to get me to work in the metropolitan area and yet, yet we sort of, you get people going around saying, “so why won't they move to the country?” and I say oh well the same reason I won't move to the city.” (Dentist, male, 63 yo, rural practitioner)
Rural exposure
I think what they're doing at the moment that’s having universities in rural settings. It’s sort of giving the students the opportunity to actually be exposed during that 5 years training. And also that may give them the opportunity to sort of go, look maybe this isn’t that bad after all, it’s actually quite a nice experience personally. (Dentist, female, 33 yo, urban practitioner-has prior rural experience)
Family needs
…our son’s education, he was getting to 12 years of age and it was a choice either he went to boarding school or we would relocated. And we looked at the alternatives and boarding school was not one that we welcomed so we relocated. (Dentist, male, 70 yo, current urban practitioner-has extensive previous rural experience)
… The big thing that I would emphasis would be the lack of job opportunities for partners, because partners are likely to be educated and you know professionals and so, it’s certainly a major factor for a lot of people. (Dentist, female, 32 yo, urban practitioner, has previous rural experience)
Quality of life
…it’s mainly just lifestyle rather than work, where I, that determines where I live. (Prosthetist, male, 52 yo, urban practitioner-has previous rural experience)