key: cord-0019218-j8e5nung
authors: Gallagher, Jennifer E.; Colonio-Salazar, Fiorella B.; White, Sandra
title: Supporting dentists' health and wellbeing - workforce assets under stress: a qualitative study in England
date: 2021-07-20
journal: Br Dent J
DOI: 10.1038/s41415-021-3130-9
sha: d9764eceaef35f37ffa09b7938d898dd8e1a9422
doc_id: 19218
cord_uid: j8e5nung

Background Multiple determinants influence dentists' health and wellbeing. In light of recent concerns, the aim of this research was to explore contemporary influences on dentists' health and wellbeing in England, drawing on their lived experience. Methods Semi-structured interviews were conducted with a purposive sample of dentists working in England, taking into account age, gender, career stage, work sector, geographical area, position and route of entry to registration. A topic guide, informed by the literature, was used to guide the discourse. Dentists were approached via gatekeepers, supported by snowball sampling. Interviews were recorded and transcribed for analysis. Framework analysis was used, taking an interpretative phenomenological approach to develop theory. Results Twenty dentists, from a range of backgrounds, participated in this research. While health and wellbeing was reported to be more positive among dentists in their later career, those in their early career and/or with high NHS work commitments shared concerns about their physical, psychological and emotional health. Influences ranged from macro-level issues relating to professional regulation and health systems, through meso-level, notably their workplace and job specification, to micro-level issues relating to their professional careers, relationships and personal life. Dentists highlighted ethical concerns and feeling driven to deliver, together with being demoralised by a survival culture, all leading to perceived lack of control and reduced professional fulfilment. In contrast, being able to deliver quality care, innovate and effect change, as well as being valued for their delivery, were perceived to positively contribute to general health and wellbeing. Conclusion Dentists have a vital role in providing care for patients, so there are serious public health implications if urgent action is not taken to improve and sustain their health and wellbeing. This study confirms that dentists are affected by multiple contemporary influences, and although greater support is needed for individuals, organisational, system and policy changes may be required to fully address the challenges they face. SUPPLEMENTARY INFORMATION: Zusatzmaterial online: Zu diesem Beitrag sind unter 10.1038/s41415-021-3130-9 für autorisierte Leser zusätzliche Dateien abrufbar.

and cost of dental training, 17 the prevalence of oral disease with long-term sequelae 18, 19, 20 and the importance of supporting professionals in distress, 4 it is crucial to better understand contemporary influences on dentists' health and wellbeing, to ensure a sustainable healthcare system that is able to meet the needs and demands of patients.

England: dental care system Most dentistry is delivered in primary dental care settings by dental teams, in which dentists form the lynchpin. Dental care is increasingly provided by corporate bodies and larger organisations, rather than the traditional model whereby a practice is owned and managed by a principal dentist. England has a distinctive NHS dental care system, which in 2006 moved from a fee-per-item NHS payment system to 'units of dental activity' (UDA), delivered under 'contracts' between providers (one or more dental practices) and NHS England which, despite recommendations for change, 21 remains in place for the majority. There is significant reliance on dentists who have qualified outside the UK, both the European Economic Area (EEA) and more widely. 22 Health Education England, with its responsibilities for workforce development, is currently reviewing professional careers in dentistry. 23 Thus, in-depth exploration of the factors influencing health and wellbeing of dentists is timely.

The aim of this research was, therefore, to explore contemporary influences on dentists' health and wellbeing in England, drawing on their lived experience.

This qualitative study involved semi-structured interviews exploring the perceptions of dentists in England regarding their health and wellbeing, together with influences, positive and negative. Ethical approval for this research was obtained from King's College Research Ethics Committee (KCL RESCM-18 /19-4379) .

Participants were purposively sampled in relation to gender, route of entry to the General Dental Council (GDC) registration list (ORE UK exam, overseas-qualified, UK-qualified and EEA-qualified), position in the practice (for example, principal, performer/provider), work sector (NHS, private, mixed or other), geographical area (for example, city/town, suburban, rural, mixed, other) and length of time working since qualification (1-15, 16-25, 26+ years) . Initial subjects for interview were identified through research gatekeepers, ensuring geographical and organisational coverage. This was supported by snowball sampling. 24, 25 The interview topic guide (see online supplementary information) was informed by past research 1 and professional literature. 6, 10, 26, 27 Interviews were conducted by one female postdoctoral researcher (FCS) trained in qualitative research. While being a qualified dentist, the interviewer, employed as an academic researcher and tutor, was not part of the healthcare system. Interviews were held at a mutually convenient time in the participants' dental practice, or conducted by phone, with the emphasis on building rapport with the respondent and enabling free-flowing discussions.

Individual interviews allowed deep exploration of issues with a high degree of confidentiality, which was important given the possibility to explore personal influences on health and wellbeing. Interviews, lasting 30-75 minutes, were audio-recorded and transcribed verbatim using a confidential transcription service.

Framework methodology was used to facilitate rigorous and transparent data management in a systematic manner, 25 and was most suited to building on our previous research. 1 The initial framework was informed by the literature, then tested and grounded in the data derived from the study subjects based on the accounts and observations of participants. In doing so, we drew on systems theory, 28 involving macro-, meso-and microlevel factors, which have been shown to have wider relevance within dentistry. 28 NVivo and Microsoft Excel were employed as tools for organising the qualitative data, facilitating analysis, including comparisons and associations within (and between) cases. 25 Dual coding of the data was employed (FCS and JEG), with differences resolved by discussion. Quality was achieved and reported in line with COREQ standards. 29 Analysis commenced with familiarisation with the data, which involved reading and re-reading the transcripts and refining the initial thematic framework to ensure it was 'grounded in' (that is, reflected) the data collected. This was followed by application of the framework to the data, indexing and sorting the themes, reviewing quotes (data extracts) and leading to a descriptive summary which represented participants' views. Our analysis, taking an 'interpretative phenomenological approach' , explored the stories (lived experiences) of participants. 30 We produced a description of the themes (categories) and mapped them to allow explanation of the data and to build emerging theory which describes what is 'going on' in the data beyond mere facts. 25 

Twenty participants were interviewed, all of whom consented to participate and the majority of whom were women, qualified in the UK, at an early-career stage, working in primary dental care settings, holding mixed roles and based in London, as shown in Table 1 . While five other dentists provided consent to be interviewed, three cancelled without providing any reason and two withdrew because of illness, choosing not to reschedule. Participants talked freely about their experiences and those of their colleagues.

A wide range of factors reportedly influenced dentists' health and wellbeing, as shown in Figure 1 . Each one is reported in turn, starting with macro-level factors relating to professional regulation and system(s), through to meso-level influences including workplace and job specification, and finally micro-level involving relationships, professional careers and personal factors.

Quotations are used to illustrate the main findings. Each quotation is followed by participant demographic information relating to gender summarised as M (male) or F (female), the nature of their role, followed by the dental setting/service where they worked and interview number, limiting the descriptors for the purposes of anonymity. Current status of the dentist involved the following, recognising that some held more than one role: GDP (which may cover NHS and/or private practitioners); Principal; Associate; DO (Dental Officer); DCT (Dental Core Trainee); DFT (Dental Foundation Trainee); T (Teacher); SpT (Speciality Trainee); SP (Specialist). Descriptors also included the nature of their current service(s): CDS (community dental service); GDS (NHS general dental practice); Mixed (GDS and private); Private; HDS (hospital dental service); Acad (academia). All participants provided written consent to publication of this data.

Concerns focused on the impact of current regulation on dentists' health and wellbeing in response to demanding and litigious patients. There was universal agreement that increased scrutiny from the GDC, to whom patients can complain directly, and the Care Quality Commission (CQC), which monitors standards across all dental services, were sources of stress and pressure for everyone. This was especially evident among NHS associates (dentists who work in, but do not own, the practice) and those in the early stage of their professional careers: 

Target-driven culture Dentists currently inside, and those with former experience of, the system expressed strong discontent with the design and structure of the NHS dental contract in England, in place since 2006. Interestingly, senior staff were concerned about the pressures on earlycareer and frontline NHS dentists, regarding a system which was perceived to be primarily 'target-managed' and 'business-focused' rather than 'patient-centred' . Most associate dentists reported working under tremendous pressure when delivering care and this was confirmed by others, including senior colleagues. They reported feeling thwarted by the highervolume targets that they had to achieve within a limited timeframe in order to meet practice and personal financial commitments, with punitive sanctions (clawbacks) where they failed to do so and 'working for free' should they 'over-perform' . These were considered as major contributors to their demoralisation, demotivation, dissatisfaction and resulting stress, as outlined below: One mid-career stage practitioner reported selling his practice because, although he supported his female dentists' periods of maternity leave, the pressure of managing the NHS contract and engaging appropriate levels of cover was a logistical nightmare and left him 'burnt out' .

Concerns regarding the profitability and sustainability of NHS general dental services in the future, exacerbated by the uncertainties over Brexit and lack of progress with a reformed dental contract, were mainly reported by principal dentists. Dentists reported that NHS dental contract payments had remained the same for a long period of time, whereas the cost of running dental services had significantly increased and resources were being lost from NHS dentistry through financial 'clawback' when services couldn't be delivered in-year. In addition, practice principals from outside London reported that recruitment of associate dentists to deliver the contract was difficult. The ensuing financial pressures were a major source of stress, as illustrated below: Overall, there was the recognition that contemporary care involved managing ethical dilemmas on a day-to-day basis, with implications for dentists' health and wellbeing.

In response to the above issues, there was some concern that professional leadership did not reflect the demography of the profession and that younger dentists were not being engaged enough for their views on the future of dentistry.

Participants suggested that the sector of employment, together with the culture and quality of their working environment, influence dentists' health and wellbeing.

Most dentists reported that NHS associates were immersed in a 'culture of survival' within general dental practices, in which self-preservation was paramount in response to growing macro-level influences outlined above. This was resulting from the constant pressure within their organisation to protect themselves from litigation, as well as to achieve NHS contract targets and retain their jobs. This culture appears to be challenging dentists' principles, in which 'cutting corners' to achieve targets and practising 'pragmatic' or 'defensive' dentistry were becoming accepted practices. Examples ranged from staging treatment plans to withholding prevention, thus failing to place patients at the centre of care, as outlined below: 

Opportunities for continuing professional development differed across the sectors where dentists worked. Those working for NHS general dental services repeatedly reported their dissatisfaction and demotivation, and were keen to upskill or progress within this sector. For most, undertaking routine and simple dental treatments in primary dental care failed to challenge them intellectually and clinically and provide professional fulfilment. Additionally, early-career staff raised concerns that some senior colleagues in general practice did not maintain their knowledge base over time: 

Dentists' quality of working environment was fundamental to their professional satisfaction and resulted in the following dentist withdrawing from delivering NHS care. In relation to potential litigation from patients, NHS associate dentists' frustrations were exacerbated by feeling more vulnerable and unprotected in their workplace compared with their salaried colleagues working in larger organisations, as stated below: 

Participants from NHS general and community dental services reported feeling frustrated due to the lack of material resources limiting the opportunity to meet higher and more challenging targets and putting at risk the quality and standards of care, as suggested below:

• 

Handling very demanding, frustrated, aggressive and unhappy patients, with apparently high and unrealistic expectations, was reported as a common stressor among participants across services: mixed, private and NHS general dental services. Furthermore, action taken by patients discontent with any dental experience was a source of real concern, linking to professional regulation, as outlined below: 

Understaffing, resulting in dentists having to increase their workload to keep the system running, was a concern as it impacted on clinical care. Requirements to take over reception duties and certain nursing roles appeared to affect community dentists in particular and those working outside of London. 

Most dentists working in primary care are selfemployed; however, these terms of engagement, which historically were beneficial, are currently viewed by some as less favourable for health and wellbeing. There were clear implications for the health and wellbeing of salaried and self-employed dentists, as reported below. It appeared that self-employment and lack of permanent contracts were major stressors among those who had experienced these challenges. In contrast, early-career dentists without significant commitments or dependants reported that while their income may be lower, their preference for having a job they enjoyed which enabled them to be happy and healthy led to their decision to remain salaried, as indicated below:

• 

Absence of protective relationships was a perceived source of stress. Physical proximity to family and friends was particularly relevant for early-career dentists in salaried and non-salaried posts to feel reassured and re-energised. For some, working away from home produced a sense of loneliness and isolation, which was extremely stressful.

Dentists commented on the efforts to visit their close family and friends to maintain positive relationships and feel invigorated, as stated below:

• In contrast, members of the profession with strong family and social relationships reported being in a much better place in relation to their health and wellbeing. This was particularly apparent where dentists had a strong meaningful relationship with a stable partner.

Differences emerged between dentists working in NHS general dental services, including corporate bodies, and those working in hospital, community and private practices in relation to the nature of their relationships with workplace colleagues. NHS general dental practice was perceived as more isolating on a day-to-day basis, with little or no peer support: 

Dentists discussed how their stage of professional career influenced their health and wellbeing. Among middle-and late-career dentists, there was an apparent confidence in undertaking their daily clinical and non-clinical work, reporting positive morale. Later-career dentists generally associated with increased confidence in their knowledge and skills, but sometimes growing frustrations. Early-career dentists reported striving to build their confidence, skills and knowledge, including their knowledge of the wider health system, together with high aspirations in relation to quality: 

In relation to personal health and wellbeing, participants referred to physical, emotional and psychological dimensions of health, and a wide range of perspectives emerged. Several suggested that their perfectionist and highachieving personalities were a source of stress in different roles and settings. In terms of physical health, all late-career dentists interviewed reported enjoying a good lifestyle and health, and while they acknowledged having physical or medical conditions, these were considered 'normal' for their stage in life. Dentists working in salaried and private practice shared similar views, relating any conditions to the hazards of their practical work. Physical conditions were a matter of greater concern for early-career dentists working in different settings due to their long-term career implications. Some had sought various therapies to assist with practical challenges such as back pain: With regards to emotional and psychological health, most associate dentists holding significant NHS commitments, including early-career dentists in primary care, reported feeling unhappy, anxious and stressed. Some had personally been diagnosed with depression and were taking medication at the time of their interview, or reported low morale and acknowledged having had suicidal thoughts in the past. There was awareness too of dentists who had committed suicide. Nonetheless, there was evidence of these participating dentists seeking counselling and support: Others shared their stories, reporting feeling stressed, experiencing symptoms such as 'ringing in their ears' or were in a position where they 'broke down in tears' having 'had enough' . There was a recognition that personal issues such as relationship breakdown and bereavement compounded the situation where 'work' affected them. At these times, support from family members and partners was strongly acknowledged as important.

When health-related behaviours were explored, most participants reported adopting positive health-related behaviours such as physically exercising and consuming a healthy diet. Those who were diagnosed with depression tended to describe episodes of heavy regular alcohol consumption and disturbed sleep patterns, while others acknowledged heavy work commitments interfered with aspirations of a positive lifestyle where sport, music and other restorative elements had been squeezed out by professional life: When dentists were asked about influences on motivation and job satisfaction, altruism and passion for their profession were commonly reported. Making a difference to patients in need, and their organisations, was considered rewarding and fulfilling, and part of the stress was related to the fact that they cared about being able to care for patients through dentistry: 

Three important contemporary themes emerged for frontline NHS practitioners, as presented in Figure 2 . Participants reported either currently or previously experiencing these challenges or having witnessed others facing such challenges. First, frontline dentists, particularly juniors, were driven to deliver under the influence of the 'NHS national dental contract' and its implementation within the workplace culture of general dental practice, where the business of dentistry was perceived to be prioritised over patient care and fuelled by their personal financial aspirations or requirements. Second, many were ethically concerned as they moved from the supportive context of a dental school to work within NHS general dental practice where there was little support for delivery of patient-centred and evidence-based care. Third, participants felt they were demoralised by a survival culture influenced by the workplace characteristics and their job demands, where there was little opportunity for development. This was compounded by regulatory and systems factors, in a system and practices that placed business before care and a situation in which they were often just workers. Personal and social protective factors were considered insufficient to counteract these pressures; this resulted in perceived lack of control overall and impacted professional fulfilment in dentists, with implications for their health and wellbeing, particularly involving those at the NHS coalface. This was in marked contrast to senior dentists, who more often reported using their expertise, having risen to roles where they were using their highly refined skills, in systems where they were valued for their delivery. There was a strong emphasis on team effort with a collaborative ethos in delivering quality care and the ability to innovate and effect change within organisations for the benefit of patients and staff through direct patient care.

This research provides important insights into the health and wellbeing of the dental profession, drawing on the experiences of dentists in England. Our results amplify the findings of recent national surveys, 6, 7, 8, 9, 10, 26 and the range of macro-, meso-and microlevel influences identified in the literature, 1 which in combination affect dentists' health and wellbeing, as shown in Figure 1 . Evidence from this study confirms macro-level challenges including regulatory constraints, 31, 32, 33, 34 fear of litigation, 32, 33, 34, 35, 36 financial pressures, 35, 37 target-driven restrictive NHS contracts 9,10 and professional leadership. 4, 7, 27 Similarly, meso-level challenges such as: reduced opportunities for career progression, 23 particularly for those in contracted positions within the NHS; 38 increasing time constraints; regulatory obligations for practice owners; 39, 40 and professional isolation, 9, 36 are reinforced. Emerging meso-level limitations such as ethical dilemmas, financial constraints, lack of occupational stability and restrictive working arrangements in corporate organisations are also highlighted. It confirms known microlevel issues faced by dentists related to their physical, emotional and psychological health, as well as the influence of social and professional relationships, 9, 35, 41 while also presenting emerging perspectives on dentists' personal motivation to deliver high-quality, patient-centred care.

Importantly, this research provides further evidence that macro, meso and micro influences often compound one another, as suggested by our rapid review. 1 The problem of burnout and risk of suicide have long been recognised in dentistry, often as a result of multiple pressures. 5, 42, 43 We are not alone nationally or as a profession. Our findings confirm evidence emerging from dentists across the UK and beyond, 44, 45, 46 together with our medical counterparts nationally and in other high-income countries. 47, 48, 49, 50, 51 Such is the scale of the problem that it has been termed an emerging 'public health crisis' . 49 Interestingly, the National Academy of Medicine in the US, 52 has developed a conceptual model which appears remarkably similar in its components to Figure 1 . While the findings seem shocking, it is important that they are considered within the wider context of health services where clinician wellbeing is considered 'essential' for 'safe, high-quality patient care' .

Dentists are deeply discontent with the NHS primary care systems. Dental services, whether general or community, were perceived by most participants as being primarily 'businesscentred' , with pressure to meet practice contracts and targets under the current NHS system and little room for manoeuvre. Many dentists personally reported working in organisations where the culture emphasised the business of dentistry over meeting patients' needs, in which junior dentists were driven to deliver working under tight controls, leaving these early-career dentists without the time to deliver evidence-based dentistry such as preventive care. Challenges include corporatisation of primary dental care, together with practice culture where associates are heavily managed, often by non-clinicians, in relation to their productivity. This engendered feelings of hopelessness and frustration. When compounded by personal isolation or physical problems, it begins to create a 'perfect storm' . Senior colleagues raised concerns over the challenges being faced by early-career dentists, legitimating their views. These findings help to explain the level of discontent with NHS dental care, with recent reports of 58% of NHS dentists reporting their intention to leave or scale down their commitment in the next five years, 12 and 75% of practice owners struggling to fill vacancies. 13 Moreover, we found evidence that principal dentists particularly experienced challenges resulting from concerns about the profitability and sustainability of their practices, particularly in relation to the NHS. It is not surprising that many of the profession have sold their practices to corporate bodies as they move towards retirement. The impact of the type of NHS contract on the business of dentistry, together with Brexit, was of great concern for principal dentists. Given the current political situation nationally, there is a need to actively support and nurture dentists, recognising the changing context including corporatisation, the importance of access, 53 and the oral health needs of our ageing population. 54 As we finalise this paper for publication, the current COVID-19 pandemic, 55 is providing an unwelcome disruption for most of our profession and patients; yet, this must be an opportunity for change to enable long-term improvements in morale, health and wellbeing, and to refresh our assets. Our findings suggest that participants perceived private practice to be less stressful and thus more supportive of health and wellbeing. While COVID-19 has presented new challenges for NHS dental services, 56 it has also highlighted that private practice itself is not immune to challenges, when services generally are suspended and result in loss of earnings.

Although workplace characteristics, including understaffing and time pressure, are not new in the literature, 57,58,59 our findings suggest that limited opportunities for career progression and diversification were sources of particular job and career dissatisfaction. 23 Most dentists have traditionally worked in primary dental care, providing varying levels of NHS dental care under contract. Salaried positions whether in speciality, community or academic roles within dentistry have always been limited in number, as with opportunities for solely private practice. However, in the past, most dentists worked as an associate in an NHS dental practice for several years, consolidating their clinical skills and acquiring business acumen to enable them to set up their independent practice and control as well as manage it with their own distinctive approach. Such opportunities are now increasingly rare. Recent graduates, therefore, increasingly feel professionally constrained, as reflected in the participant responses discussed above. Furthermore, eligibility and affordability of financial loans to set up a practice are increasingly difficult given significant student fee debts, 60 which further limits graduates' future possibilities. Health Education England is currently exploring professional careers in dentistry, enhancing flexibility into training pathways and providing career development opportunities as mechanisms to improve job satisfaction and encourage retention. 23 In recent decades, dentistry, as with healthcare in general in England, has been aligned with a neoliberalist philosophy that sought to extend market mechanisms across the welfare state. 61 Th ere is now a move back towards the ethos and historical values of an NHS to re-embrace 'collaboration' and 'mutualism' , and build a future based on collaboration. 62 Given the challenges facing our profession, it would seem prudent to invest in radical reform at systems level and involve a wider societal debate. Furthermore, at organisation level, as with many large businesses, we should be working out how to engage younger generations in the workplace 63 and ensure implementation of solutions that work beyond mere 'productivity' . Dental practices require clear clinical leadership, particularly where they are part of larger organisations. The next paper in this series will explore possible strategies and solutions in a whole systems approach.

On a more positive note, despite the challenges, dentists achieve great satisfaction from 'making a difference to patients', particularly those with the highest needs, and this contributed to their sense of professional wellbeing. Although anxious and demanding patients were mentioned, they were much less of an issue than expected. 32 A significant part of dentists' frustration related to the fact that that they could not routinely provide high-quality contemporary care, practise ethically and gain sufficient financial reward to make the stress and risk worthwhile. Overall, however, dentists with close personal and good professional relationships, well-developed careers, clinical stability and expressing professional fulfilment tended to report better health and wellbeing. While these dentists recognised the negative aspects of their career, they had demonstrated the ability to work around the challenges they faced, often broadening their roles to find a niche with sufficient power and status to effect systems change, which may be termed resilience. 48 While many may have learned through experience how to manage pressure, negotiate change and build resilience, and achieve more positive outcomes as presented in Figure 2 , they also did so in a very different world which may no longer be realistic for the emerging workforce. This highlights the importance of supporting personal resilience in our younger colleagues which, although vitally important, is not the sole answer to our challenges.

Certain limitations of this research, however, must be acknowledged. First, it was pre-COVID-19, which has brought new stresses. 56, 64 Second, although purposive sampling was undertaken via gatekeepers nationally, dentists from London and the South East of England were overrepresented. The findings thus need to be treated with caution. The apparent differences between those working within and outside of London, as well as the improved resilience in senior dentists, will require further exploration. As we draw to a close, it may be helpful to recognise the purpose of qualitative research, which is to explore a range of perspectives and possible influences, and not to quantify or provide statistical generalisability; therefore, small well-designed samples are legitimate. Furthermore, with all the above limitations, the research findings merely amplify the findings of academic, 1,4,5 and health service literature nationally. 7, 8 We trust that this paper will be useful to stimulate debate, inform future research and result in timely action to protect the workforce -a valuable asset. 65

Evidence from this study confirms that dentists' health and wellbeing is affected by multiple contemporary influences and highlights challenges to be addressed. Therefore, we strongly recommend that as a profession, we take these issues seriously and consider potential solutions as a matter of urgency, particularly at systems and organisational level, together with ensuring greater support for individuals.

Key determinants of health and wellbeing of dentists within the UK: a rapid review of over two decades of research

Well, being a dentist

Dental associates' perceptions of their working environment: a qualitative study

A survey of stress, burnout and well-being in UK dentists

An analysis of stress and burnout in UK general dental practitioners: subdimensions and causes

Dental Working Hours

Experimental Statistics. London: NHS Digital

Dental Working Hours: 2016/17 and 2017/18 Working Patterns, Motivation and Morale

Dentists' Working Patterns, Motivation and Morale

The Psychosocial Working Conditions and Work-related stress among Community Dentists in the UK: Results from the 2014 Dentists' Wellbeing and Working Conditions surveys

The Mental Health and Well-being of UK Dentists: being of UK Dentists: A Qualitative Study

Dental Working Hours -Working Patterns

Available online at https:// bda.org/news-centre/press-releases/half-of-nhsyoungdentists-heading-for-the-exit

75% of NHS dental practices now struggling to fill vacancies

Is Government serious about the survival of NHS dentistry?

UK-trained junior doctors' intentions to work in UK medicine: questionnaire surveys, three years after graduation

Health and wellbeing is the most common reason for doctors to take a break from training

Adult Dental Health Survey 2009: implications of findings for clinical practice and oral health policy

Adult Dental Health Survey 2009: common oral health conditions and their impact on the population

Adult Dental Health Survey 2009 -Summary report and thematic series

Review of NHS Dental Services in England: an independent review. London: Department of Health

Advancing Dental Care (ADC) Education & Training Review

Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research

Qualitative research practice: A guide for social science students and researchers

NHS Dental Statistics England 2015/16. London: NHS Digital

The Financial Circumstances of Final Year Dental Undergraduates in the UK. London: BDA

Interprofessionality as the field of interprofessional practice and interprofessional education: An emerging concept

Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups

Interpretative phenomenological analysis: Theory, method and research

Morale of vocational dental practitioners in the United Kingdom

A study to explore specific stressors and coping strategies in primary dental care practice

New stressors for GDPs in the past ten years: a qualitative study

Dental associates' perceptions of their working environment: a qualitative study

It's difficult being a dentist': Stress and health in the general dental practitioner

Understanding emotionally relevant situations in primary dental practice. 3. Emerging narratives

Dental practitioners and ill health retirement: a qualitative investigation into the causes and effects

Levels of career satisfaction among dental healthcare professionals: comparison of dental therapists, dental hygienists and dental practitioners

Burnout and engagement in relation with job demands and resources among dental staff in Northern Ireland

An assessment of career satisfaction among a group of general dental practitioners in Staffordshire

A survey of stress levels, selfperceived health and health-related behaviours of UK dental practitioners in 2005

A review of occupationally-linked suicide for dentists

Stress in Irish dentists: developing effective coping strategies

Professional burnout among Dutch dentists

Selfperceived mental well-being among Malaysian dentists

Burnout and professional quality of life among Israeli dentists: the role of sensory processing sensitivity

Stressors and protective factors among regional and metropolitan Australian medical doctors: A mixed methods investigation

Resilience of primary healthcare professionals: a systematic review

School of Public Health and Harvard Global Health Institute. A Crisis in Health Care: a call to action on Physician Burnout. Boston: Harvard Global Health Institute, 2019. 50. Rimmer A. Covid-19: Doctors may quit without proper post-pandemic support, defence body warns

Action Collaborative on Clinician Well-Being and Resilience

Plymouth's NHS dentists crisis -experts demand action

The Future Oral and Dental Workforce for England: Liberating human resources to serve the population across the life-course

World Health Organisation. Coronavirus disease (COVID-19) pandemic. 2020

Bringing dentistry back from the brink

Perceived sources of occupational stress in general dental practitioners

Morale and Motivation of Dentists in the Salaried Primary Dental Care Service

Does student debt affect dental students' and dentists' stress levels?

Neoliberalism and health care

True Gen': Generation Z and its implications for companies

The dental profession's mental health crisis: what needs to happen

World Health Organisation. Global strategy on human resources for health: Workforce 2030