The career development and career satisfaction expressed by dental professionals is an area which has attracted much recent research [1-5]. Most studies have focussed on hygienists and dental practitioners. In the United Kingdom (UK) Evans &Blinkhorn [6] found that the majority of dental hygienists (87%) found their work fulfilling and interesting, while a more recent national survey carried out by the British Dental Hygienists Association [7] also found high levels of job satisfaction among respondents. Similar findings are reported in surveys of UK hygienists qualifying from one particular school of dental hygiene [8,9] and amongst dental hygienists working outside the UK [10-14]. Amongst dental practitioners expressed levels of job and career satisfaction have generally been lower than those reported for hygienists. Low levels of career satisfaction have been reported amongst UKdentists [15-17] and dentists working in the United States [18,19].
The expressed levels of job satisfaction among dental therapists working in the UK was described by Gibbons et al [3] who reported that the average level was high. Further Newton and Gibbons [4] compared the satisfaction levels of three professional groups using a single item measure, revealing that dental practitioners had the lowest levels compared to dental hygienists and dental therapists. The present study compares the job satisfaction of three comparable groups of dental professionals working in the UK, Trinidad & Tobago and New Zealand using the same measure.
Trinidad & Tobago is a twin island state situated at the southern end of the Caribbean chain of islands. It is a democratic republic within the British Commonwealth having gained independence in 1962. The country's dental needs are currently served by dental professionals working in government health centres and in private practices. The Dental Council of Trinidad & Tobago presently only recognises two categories of dental professionals: dentists and dental nurses (the equivalent of dental therapists in the UK and New Zealand), with 216 and 50 registered and enrolled respectively [20]. The Dental Nurse Training Scheme in Trinidad & Tobago was modelled on the New Zealand program and began operating in 1976, producing its first graduates in 1978. The aim of the programme was to improve the dental operator to population ratio, improve access to dental services, particularly in the rural areas of the country and provide oral screenings and health promotion in schools [21]. Under the 1980 Dental Profession Act of Trinidad & Tobago, "A dental nurse is permitted to treat children (under 12 years old) only and such treatment shall be carried out in facilities or services operated or conducted by government or under direct or indirect supervision of a dentist in private clinics" [22]. These healthcare professionals have expressed confidence in their ability to perform their duties but low job satisfaction, due to poor working conditions and lack of opportunities for career development [20].
Currently, most dental therapists in New Zealand work within the School Dental Service treating children up to the age of 13 years. School dental services have provided free treatment since 1945 and it is estimated that more than 95% of New Zealand children are enrolled [23]. A recent review of the dental therapy workforce indicated several difficulties facing this profession: the lack of career structure, a narrow scope of practice, outdated facilities and inadequate remuneration. These difficulties are believed to be contributing factors to the poor recruitment and retention of dental therapists in New Zealand [24].
The provision of dental services in New Zealand is undergoing a period of change, largely due to the implementation of the Health Practitioners Competence Assurance (HPCA) Act in September 2004. This act allows for an expansion of the scope of practice of dental therapists, and also enables these oral health providers to move into private practice for the first time, hitherto dental therapists in New Zealand have been restricted to working in the publicly funded health sector, where remuneration is low. It is not yet known how these changes will affect the dental therapy in New Zealand though it is anticipated that many therapists will choose to shift their practice to the private sector where their potential earnings are higher.
Following the report of the Dental Auxiliary Review Group and the subsequent publication of a consultation document concerning professionals complementary to dentistry by the General Dental Council, recent legislation in the UK has allowed Dental Therapists to work in all sectors of oral healthcare. Prior to this dental therapists in the UK were limited to working in hospitals, community dental services or the armed forces where they were employed in salaried posts. This situation parallels that in New Zealand, and it is again anticipated that UK therapists will seek to enhance their income by working in the primary care sector where their earnings are likely to be paid on an item of service basis.
Three issues arise from a review of the reported career satisfaction of dental professions. First, there are few data available on the perceptions of some groups. Second, different studies have used different measures, making comparisons both within and across professions difficult. Third, there are no studies which have compared similar professional groups across countries (and by implication health care systems). The aim of the present study is to compare the expressed levels of career satisfaction of three groups of comparable dental healthcare professionals, working in Trinidad & Tobago, the UK and New Zealand.
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