Full text of DOI:10.1038/sj.bdj.4800418a

EDUCATION
career development
Views of academic dentists about careers
in academic dentistry in the United
Kingdom.
1
1
1
2
3
M Goldacre, P Lee, S Stear, E Sidebottom , R Richards
In brief
The aim of this paper is to report the views of academic dentists
about careers in academic dentistry assessed by method of a
postal questionnaire survey. The subjects of the survey were
dentists in academic posts in the United Kingdom.
ꢀ A national Task Force has recently
reported on concerns that careers in
academic medicine and dentistry
are becoming unattractive in the
United Kingdom.
The incentives in pursuing an academic career which
respondents rated most highly were the opportunity to teach
and the variety of work in an academic career. The greatest
disincentives were competing pressures from service work,
teaching and research, and the difficulty of getting research
grants. Many would like to spend more time on research and
less on service work and teaching. The length of time required
for training, and the quality of training, was a concern,
particularly for junior academics. Most respondents rated the
enjoyment of their job highly but scored much lower on
satisfaction with the time their job left for domestic and leisure
activities. By contrast with academic medicine, in academic
dentistry there is typically greater emphasis on teaching and
less on research.
In conclusion, the balance of activities in academic posts,
particularly between service work, teaching and research,
needs to be regularly reviewed. The development of a more
structured training programme for junior academics, which does
not disadvantage academic dentists when compared with their
NHS colleagues, may be required.
ꢀ As background to its work, we
undertook a survey of the views of
academic dentists about their work.
ꢀ Most respondents rated the
enjoyment of their job highly, but
many would like to spend more time
on research and less on service work
and teaching.
ꢀ By contrast with academic medicine,
there is typically greater emphasis
on teaching and less on research in
dentistry.
ꢀ The balance of activity in academic
posts in dentistry needs to be
regularly reviewed.
Method
Content of the Questionnaire
The topics covered in the questionnaire
included pressures of work, training oppor-
tunities, and incentives and disincentives in
pursuing a career in academic dentistry.
Respondents were asked to indicate the
extent to which they agreed or disagreed
with each of a series of statements on a five-
point scale ranging from strong agreement
here is current interest in the United to seek the views of doctors and dentists in to strong disagreement. We also asked
Kingdom in the possibility that acade- academic posts. Members of the Task respondents to estimate their allocation of
T
mic careers within medicine and dentistry Force invited all medical and dental time at work based on the number of hours
are becoming unattractive. In 1995 the schools in the United Kingdom to partici- they worked in particular activities during
House of Lords Select Committee on Sci- pate in focus group discussions, to obtain an average week; to specify the number of
ence and Technology expressed disquiet participants’ views on academic careers. hours they would like to spend on each
1
about this, and in 1996 the Committee of Transcript samples of these sessions were activity; to rate levels of enjoyment of their
Vice Chancellors and Principals invited an analysed to identify the main themes job; and to rate levels of satisfaction with
2
independent Task Force, chaired by Sir Rex raised by the discussants. Because the their time available for domestic and leisure
2
Richards, to investigate these concerns.
doctors and dentists who participate in activities. Questions used were closed
As part of its work, the Task Force decided focus group discussions may not be typical response format questions, with the excep-
of their colleagues, we decided to seek tion of the question on hours worked, which
1
UK Medical Careers Research Group, Unit of
views more systematically on the main was a restricted response open format ques-
themes raised. The themes raised by dis- tion. The questionnaire sought demo-
cussants in the focus groups were there- graphic information (e.g. sex, age, year of
fore developed as statements which were qualification) and information about cur-
incorporated into a postal questionnaire. rent employment (e.g. specialty within den-
We report the results of our national sur- tal surgery, job title, full-time or part-time,
Health-care Epidemiology, Institute of Health
Sciences, University of Oxford, Oxford. OX3 7LF
2
Merton College, Oxford. OX1 4JD.
St Hilda’s College, Oxford. OX4.
3
Correspondence to M Goldacre.
REFEREED PAPER
received 12.03.99; accepted 15.09.99
© British Dental Journal 2000; 188: 154–159
vey of academic dentists here.
funding source). The questionnaire was
154
BRITISH DENTAL JOURNAL, VOLUME 188, NO. 3, FEBRUARY 12 2000

EDUCATION
career development
Percentage of respondents in each specialty
Table 1
Specialty
Male
(n=284)
Female
(n=88)
Total
(N=372)
Dental Public Health
Oral and Maxillofacial Surgery
Oral Medicine
3.5
10.6
6.3
8.1
5.6
12.5
5.7
5.6
9.4
7.0
7.8
9.1
piloted among a sample of academic den-
tists in the Sheffield region and revised in
the light of piloting.
9.1
Orthodontics
6.8
Population
The British Dental Association provided
us with a list of dentists in its membership
who worked in academic departments in
the United Kingdom in 1997. Our original
intention was to survey dentists who had
not yet reached consultant-equivalent
level (to parallel our survey of doctors in
medical academic posts with specialist
Paediatric Dentistry
20.5
Restorative Dentistry
Other
49.3
16.5
31.8
13.6
45.2
15.9
2
registrar status ). However, career details
Total
100.0
100.0
100.0
available to us were not sufficient to do
this. We excluded dentists designated on
the list as professors or heads of depart-
ments from our mailing but included all dentists in consultant-status posts. Wallis non-parametric test was used to
others. This gave us 519 dentists to whom Accordingly we have included data from compare mean scores.
we sent a questionnaire, with a covering all respondents in this paper, specifying
letter from Sir Rex Richards. A follow-up such differences as were found.
Results
questionnaire and letter was sent to non- Analysis
Response Rates
respondents. In fact, as our responses Comparisons between groups of respon- 390 of the 519 dentists replied (75.1%). Of
revealed, our mailing included dentists at dents were made using chi-square tests these, 13 chose not to participate, which gave
all levels of seniority, including some pro- where responses to questions or statements a usable response rate of 72.6% (377/519).
fessors and heads of departments. were within set categories (e.g. strongly 287 respondents were men (76%) and 90
Detailed analysis showed that there were agree, agree, and so on). For the questions (24%) women. 323 were employed full time
generally few differences in patterns of on enjoyment of the job and satisfaction (86%). 29 of the 287 men described them-
responses between these and other with time available for leisure, the Kruskal- selves as working part-time (10%), as did 21
2
of the 90 women (23%; χ (1), comparing
men and women=10.1, p<0.01).
Table 2
Allocation of time at work: actual and preferred numbers of
hours worked per week, respondents working full-time
Employment Profile
Senior Dentists
N=185
Juniors without NTN
N=19
Activity
(hours)
Juniors with NTN
N=33
Sixty six and a half per cent of respondents
specified that their position was ‘wholly or
mainly academic’, 27.1% specified half
academic and half service, and 6.4% speci-
fied that their roles were mainly service
but had an academic component. The spe-
cialties reported by the respondents are
shown in Table 1 (excluding 5 repondents
who did not report a specialty). Almost
half of the men and a third of the women
were in restorative dentistry.
The respondents were asked for their
job titles and, for junior dentists, whether
they had a National Training Number
(NTN). Initially we analysed the
responses comparing different job titles
without grouping them, with individual
titles including professor, reader, senior
lecturer, lecturer and so on. Differences
in responses between the various cate-
gories of dentists with consultant status
Mean
Median
Mean
Median
Mean
Median
Service
actual
preferred
17.9
11.8
16
10
10.4
8.4
6
7
20.2
13.9
17
11
Teaching
actual
preferred
16.7
12.2
15
12
20.2
13.7
20
12
14.1
9.5
14
9
Learning
actual
preferred
4.3
6.4
3
5
4.4
7.6
1
5
5.3
7.6
5
7
Research
actual
preferred
12.6
16.1
10
15
15.8
19.9
13
20
13.0
16.9
12
16
Total
actual
preferred
51.6
46.5
50
45
50.7
49.6
52
50
52.6
47.9
50
45
Total N excludes respondents who did not complete bith 'actual' and 'preferred' hours questions for each category
of activity; and only includes respondents who indicated they were working full time
BRITISH DENTAL JOURNAL, VOLUME 188, NO. 3, FEBRUARY 12 2000
155

EDUCATION
career development
Table 3
Percentage of respondents agreeing or disagreeing with statements about work,
training, research and academic careers: all respondents
Strongly
disagree
Total N
Strongly
Agree
Neither
Disagree
Statement
(=100%)
agree
agree nor
disagree
%
< 1
1
%
%
5
9
6
%
5
6
5
%
36
37
36
293
81
374
seniors
juniors
Total
54
47
52
It is very difficult to combine
the competing demands of
my job
1
1
1
1
292
80
372
seniors
juniors
Total
55
51
55
7
13
8
5
4
4
Dentists in clinical academic posts
tend to be under greater pressure than
their colleagues in service posts
32
31
32
1
4
2
289*
80*
369
seniors
juniors
Total
64
57
62
3
4
3
3
10
5
When under pressure from competing
demands, the research aspect of my
job is usually the first to suffer
29
25
28
4
1
4
289
81
370
seniors
juniors
Total
19
42
24
17
12
16
16
8
14
Training in clinical academic posts
should be more tightly structured
44
37
42
3
6
4
292*
81*
373
seniors
juniors
Total
34
13
29
11
20
13
12
25
15
All dentists should complete some
research at some stage of their career
40
36
39
8
11
2
71‡
218‡
45
professors/heads
other seniors
juniors with
NTN
48
25
27
10
12
11
6
21
16
If I had the choice again, I would
choose to be in an academic
dental post
28
31
44
9
34
juniors without
NTN
21
29
21
12
17
17
32
32
10
368
Total
Totals in final column vary because some dentists did not provide a view on some statements.
* difference between senior and junior dentists, p< 0.01
‡ difference between professors/heads of departments and other seniors (data only shown separately where differences were significant), p<0,01
2
were fairly small. For the purpose of this heads of department undertook a little senior dentists (Table 3; χ (2), comparing
paper, we therefore grouped respondents more research and service work, and a little the two groups=10.2, p<0.01).
into three groups: junior dentists with less teaching, than other senior dentists.
Senior dentists were more likely than
National Training Numbers (NTNs), Typically, dentists in all grades reported that juniors to agree that all dentists should
junior dentists without NTNs, and senior they would like to work slightly fewer hours do research at some stage in their career
dentists. In some tables, for items where overall (Table 2), that they would like to (74% and 49%, respectively, agreed or
2
responses from the first two groups were spend less time on service work and teach- strongly agreed: χ (2)=18.0, p<0.01).
similar, the two are combined as a single ing, and that they would like to spend more
group of juniors.
There were 296 respondents in non-
training grade posts as lecturers, senior Views on work, training and research
lecturers, readers or professors, of whom (Table 3)
time on research and personal study.
Junior dentists’ views on training (Table 4)
About one third of all juniors said that they
frequently had to stand in for a senior acad-
emic and about half of those with Addi-
42 described themselves as part-time or Most respondents agreed that, when under tional Duty Hours (ADHs) said that they
other than full-time workers. There were pressure from competing demands, the frequently exceeded these (Table 4). A
46 junior dentists in training with NTNs, research aspect of their job is usually the first majority of juniors were dissatisfied - about
of whom two were part-time. There were to suffer (91% agreed); that it is difficult to one-third very dissatisfied - with the train-
35 junior dentists without NTNs, of combine the competing demands of their ing programme designed to help them
whom 10 were part-time.
job (88% agreed); and that, in their view, obtain their Certificate of Completion of
dentists in clinical academic posts are under Specialist Training (CCST; Table 4). Two-
greater pressure than service colleagues thirds were concerned about the length of
Number of hours worked and the number
of hours preferred
(87% agreed).
their training. Juniors without NTNs were
The predominant activities of respondents
The majority of respondents agreed more likely to disagree that they were satis-
were service work and teaching (Table 2), that training in clinical academic posts fied with training to enable them to obtain
which each accounted for about one-third should be more tightly structured (Table their CCST (83% disagreed or strongly dis-
of working time. Research accounted for 3). This view was more strongly held by agreed) than juniors with NTNs (34%;
2
about a quarter. The differences between junior than by senior dentists. Only 61%
χ
(2), comparing juniors with and without
grades in these respects were fairly small, of the senior dentists strongly agreed or NTNs=17.7, p<0.01). A greater proportion
except that juniors without NTNs did less agreed that they would choose an acade- of juniors without NTNs than those with
service work and more teaching than the mic dentistry post, given the choice also strongly agreed that they were con-
other grades. Detailed analysis of the senior again. Professors/heads of departments cerned about the longer period required for
dentists showed that the professors and were more likely to agree than other training. Only 32% of juniors agreed that
156
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EDUCATION
career development
Table 4
Percentage of respondents agreeing or disagreeing with statements about work and
training: junior dentists only
Statement
Strongly
agree
%
Agree
%
Neither agree
nor disagree
%
Disagree
Strongly
disagree
%
Total N
(=100%)
%
My service sessions are often exceeded
because I have to stand in for a senior
academic
17
23
26
27
7
77
41
I frequently exceed my contracted number
of Additional Duty Hours (ADH's)
34
15
39
7
5
I am satisfied with the training programme
devised to enable me to obtain CCST:
juniors with NTN
16
0
34
10
16
6
18
37
16
47
44*
30*
juniors without NTN
Total
10
24
12
26
28
74
I am concerned about the longer period
of training I shall require than my NHS
colleagues
28
39
21
12
0
80
The training I am receiving for the
research aspect of my job is good
8
24
37
25
9
20
2
23
0
79
A career in academic dentistry is my long
term goal:
52
46*
juniors with NTN
juniors without NTN
Total
34
44
23
31
20
14
9
5
14
6
35*
81
Totals in final column vary because some dentists did not provide a view on some statements.
*differences between juniors without NTN and juniors with NTN (data shown separately where differences were significant), p<0.01.
training for the research side of their job 4 or less (where 0=not at all satisfied, highest by juniors without an NTN (4.4:
was good. 10=extremely satisfied), with a mean rating of Kruskal-Wallis chi-square=9.8, p=0.02). Part-
When questioned about their future 3.4. Detailed analysis showed that there were time academic dentists were more satisfied
careers, 48% of junior dentists planned a no major differences between holders of dif- than full-timers with leisure time available
wholly or mainly academic career, 25% ferent posts in their rating of enjoyment but (Kruskal-Wallis chi-square=16.4, p<0.01).
intended a half academic/half service there were differences in rating of satisfaction
career, 2% wished to enter a predomi- with leisure time afforded by work. The lowest Incentives and Disincentives in Pursuing a
nantly service career in the NHS and 16% mean rating for the latter was given by profes- Career in Academic Dentistry
were undecided. Nine percent of respon- sors and heads of departments (2.8) and the As shown in Table 5, the stimulation of
dents indicated ‘other’ intended careers
which included entering private dental
80
70
60
50
40
30
20
10
0
practice. A higher percentage of juniors
with NTNs were intending either a
mainly academic career or half academic/
half service career (78%) compared with
juniors without an NTN (65%).
Job Satisfaction & Leisure Time
The majority of respondents indicated they
were enjoying their current position (Fig. 1):
71% rated enjoyment at 6 or greater (on a scale
where 0=not enjoying it at all, 10=enjoying it
greatly). The mean rating was 6.5. However,
when asked how satisfied they were with the
amount of time their current position
afforded them for domestic and leisure activi-
ties (Fig. 2), 69% of respondents gave scores of
0
1
2
3
4
5
6
7
8
9
10
Fig. 1 Respondents’ ratings of enjoyment
of job. Green, senior dentists; red, junior
dentists
Rating (0 = no enjoyment, 10 = great enjoyment)
BRITISH DENTAL JOURNAL, VOLUME 188, NO. 3, FEBRUARY 12 2000
157

EDUCATION
career development
Fig. 2 Respondents’ ratings of satisfaction
with time afforded by work for domestic
and leisure activities. Green, senior
dentists; red, junior dentists
60
50
40
30
20
10
0
be wholly representative of all academic
dentists.
Most respondents at all levels of senior-
ity indicated that they enjoyed their job.
The majority of junior dentists indicated
that they intended pursuing academic
dentistry as a long-term career. Concerns
were expressed, however, about hours of
work and the pressures of the job. The lat-
ter included pressure of being assessed on
several areas of work, difficulties resulting
from competing demands within their
job, and research suffering as a conse-
quence of competing demands. The data
on working hours were self-reported esti-
0
1
2
3
4
5
6
7
8
9
10
Rating (0 = no satisfaction, 10 = great satisfaction)
teaching was rated as the strongest single between different dental schools. These mates and, no doubt, are not wholly reli-
incentive in pursuing a career in academic comparisons probably exclude some den- able. However, some useful general
dentistry, followed by the opportunity ‘to tists below consultant-equivalent level patterns emerge in the relative distribu-
have a more varied and stimulating career (because they are unlikely to appear in lists tion of work activities. Many respondents
than that of a full-time NHS dental consul- of permanent academic staff in the Medical would prefer slightly shorter hours and
tant’. The challenge of research was rated as Register): membership of the BDA in this would prefer to spend more time on
a strong incentive by 54% of respondents. In group may be lower. We think that it is research and less time on teaching.
contrast, only about 30% of respondents unlikely that BDA membership is a source Despite views on reducing teaching time,
regarded the opportunity to travel, and of much bias; but the possibility remains and problems with competing demands
recognition by peers for achievements in that dentists in our sampling frame may not for time, teaching and the variety of work
research, as strong incentives.
Competing pressures of service work,
teaching and research, and pressures of
Table 5
Incentives when considering a career in academic dentistry
being assessed in each of the three areas,
were seen as strong disincentives by the
majority of respondents, as was the diffi-
culty in obtaining research grants (Table
6). The majority did not regard ‘less
favourable conditions of employment
when compared with NHS colleagues’
and ‘limited opportunities for private
practice’ as strong disincentives.
Statement
Strong
Some
No
Total N
incentive incentive
incentive (=100%)
%
%
%
The stimulation of teaching students and
young dentists
70
28
2
373
The opportunity to have a more varied and
stimulating career than that of a full time NHS
dental consultant
65
57
27
38
7
363
The intellectual environment in an
academic unit
5
370
Discussion
The challenge of research
54
51
42
46
4
3
370
367
Our sampling frame comprised academic
dentists who were members of the British
Dental Association (BDA). No reliable fig-
ures are available on the percentage of den-
tists who are members of the BDA in
different branches of dentistry, or indeed
overall. We compared lists of academic staff
from dental school entries in the British
Medical Directory (though not all are den-
tists) with the British Dental Register
(which does not specify the dentist’s job). As
an approximation we believe that at least
80% of academic dentists are members of
the BDA with only small differences
The opportunity to make discoveries which
may ultimately be of benefit to patients
The stimulation of supervising research teams:
seniors
juniors
Total
37
26
34
40
61
45
23
13
21
279*
70*
349
The opportunity to travel to overseas meetings
and to meet with foreign colleagues
30
48
22
356
Recognition by peers for achievements in
research:
19
29
356
52
Totals in final column vary because some dentists did not provide a view on some statements.
* difference between senior and junior dentists (data only shown separately where differences were significant), p<0.01.
158
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EDUCATION
career development
Table 6
Disincentives when considering a career in academic dentistry
Strong Some No Total N
Statement
disincentive disincentive disincentive (=100%)
%
%
%
The pressures of being assessed on all three
of clinical service, research and teaching
59
33
8
368
369
355
5
6
Competing pressures from service, teaching
and research
58
57
37
37
The difficulty of obtaining research grants
more dominant role, and research a lesser
role, in academic dentistry than in acade-
mic medicine. However, while 54% of
dentists rated the challenge of research as
a strong incentive, many were dissatisfied
with their time available for research and
wished to spend more time on research
activities. Comparing doctors and den-
tists, disincentives were broadly similar.
Uncertainty about pay parity with the
NHS was rated a potential disincentive by
both; but limited opportunities for pri-
vate practice was not generally regarded
as a strong disincentive by either.
Overall, the academic dentists surveyed
appeared to have a broadly favourable
opinion of their chosen career, but had
concerns over practical and organisa-
tional features such as time allocation,
dealing with competing demands, and
inadequate training. It is also disquieting
that only 61% of the senior dental acade-
mics, and only 56% of those below the
The small number of senior academic
appointments available:
seniors
juniors
Total
41
58
45
42
30
40
17
12
15
285*
77*
362
The likelihood of a significantly longer
training period to CCST when compared
with NHS colleagues
43
43
14
329
Any uncertainty regarding pay parity
with the NHS
41
29
44
47
15
24
361
339
Less favourable conditions of employment
on appointment when compared with NHS
colleagues (in respects other than salary)
The limited opportunities for private practice:
seniors
juniors
Total
18
32
21
31
26
30
51
42
49
269*
74*
343
Few opportunities for Additional
Duty Hours (ADH's)
11
24
65
253
Totals in final column vary because some dentistsdid not provide a view on some statements.
* difference between senior and junior dentists (data only shown separately where
differences were significant), p<0.02.
in an academic career were also regarded on research (25 hours a week reported by level of professor or head of department,
as the strongest incentives in pursuing an the doctors without fellowship and 41 agreed that, given the choice again, they
academic career (Table 5). Taken together, hours a week reported by the fellows) and would choose an academic dentistry post.
these findings suggest that the hours much less time on teaching (typically Improvements in training in research,
worked in academic careers, and the bal- about four hours per week). Among the improvements in the structuring of train-
ance between activities, rather than the junior doctors the modal value for job ing programmes, and in the distribution
work itself, are the main concerns. Prob- enjoyment was 8, compared with 7 for of duties within academic work, should
lems with training for academic dentistry junior dentists. Like the dentists, a major- help to make careers in academic den-
were also apparent, including the length ity of junior doctors (65%) agreed that tistry more attractive to academically-
of training required to complete specialist their training should be more tightly minded young dentists.
training, the perceived need for more structured than it currently is. Many of
We thank all the dentists who participated in the
structure to training (which was particu- the doctors were concerned, like the den-
study. The Unit of Health-Care Epidemiology receives
larly expressed by the junior dentists), tists, that they would take longer than
core funding from the Anglia and Oxford Regional
and junior dentists’ dissatisfaction with their NHS colleagues to train to consul-
their training programmes. tant status. A higher percentage of junior
We have reported elsewhere the find- doctors (83%) than junior dentists (63%)
ings of our survey of junior doctors in said that, given the choice again, they
Office of the NHS Executive.
1. House of Lords Select Committee on Science
and Technology. Medical research and the NHS
reforms. London: 1995, HMSO:HL Paper 12.
2. Richards R. (Chairman). Clinical Academic
Careers: Reports of an Independent Task Force.
London: Committee of Vice-Chancellors and
Principal,. 1997.
3. Goldacre M, Stear S, Richards R, Sidebottom E.
Junior doctors’ views about careers in academic
medicine. Medical Education, 1999, 33, 318-26
academic posts below the level of the con- would choose an academic post.
3
sultant grade. Their responses can be
There were differences between the
compared with those reported here from doctors and dentists in their rating of
the junior dentists. The junior dentists incentives in pursuing an academic
reported working an average of just over career. The strongest incentive rated by
50 hours per week (Table 2); academic the doctors was the challenge of research:
specialist registrars in medicine without 76% rated this as a strong incentive com-
fellowships reported an average of 59 pared with 54% of dentists. Only 34% of
hours and Medical Research Council and the doctors rated the stimulation of teach-
Wellcome Foundation training fellows ing as a strong incentive compared with
reported an average of 64 hours per 70% of dentists. Thus, both judged by
3
week. Compared with the academic den- work profile and the rating of incentives,
tists, the doctors spent much more time it is evident that, typically, teaching has a
BRITISH DENTAL JOURNAL, VOLUME 188, NO. 3, JANUARY 22 2000
159