Special report: drive for independent practice caused joint practice demise.
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OBJECTIVE: To describe current patterns of employment, career intentions and factors that influence career choice in young graduates. DESIGN: A cross-sectional postal survey. SUBJECTS: Graduates from the years 1991 and 1994 were selected to provide cohorts before and after the introduction of mandatory vocational training. A total of 232 graduates were sent questionnaires and 183 replied (77%): 90 men (49%) and 93 women (51%). SETTING: The cohorts all came from Scottish dental schools. When surveyed in 1996/1997, 66% were working in Scotland and 28% were in England. The rest were elsewhere in the UK or abroad. MEASURES: A questionnaire which had been piloted, applied to medical graduates and then adapted for dentists, was used. RESULTS: The most common post held was that of Associate in General Dental Practice (61% of the sample) and the majority (85%) were working full-time. Only small numbers indicated that they wished to undertake a career in academia (6) or the hospital dental service (17). In choosing a career, males were more influenced by financial factors (P = 0.009) and women by the availability of part-time employment (P = 0.000). CONCLUSION: Despite the recent adverse publicity about general dental practice, most young dentists see their future in this sector of the profession. More worrying is the comparatively small number who wish to work within the hospital service or in academia. Results also indicate the need to develop schemes to retain women in the workforce.
The practice of medicine as we have known it is rapidly becoming a "dinosaur" giving way to more complex business and legal relationships among physicians. Quality medical care, however, does not have to become obsolete. As physicians begin to collaborate with each other to survive and thrive in an increasingly competitive environment, their collective influence over payors and other guardians of the cost of health care should focus on ensuring the preservation of quality medical care. By minimizing the adverse consequences of administrative burdens on individual practices, physicians should be able to maximize their practice efficiency and earning potential while preserving their goal of providing quality medical care.
Public health nurses (PHNs) have been attached to family doctors' offices as one mode of organizing the delivery of nursing services in the community. However, different nurses function in different roles on a continuum from generalist to liaison. A descriptive study was undertaken to determine the most effective role for PHNs attached to family physicians' offices. Outcomes for both physicians and nurses were satisfaction with the role of the PHN, appropriateness of referrals, and accessibility for consultation. These outcomes were compared relative to the rating of PHNs of their role. A cohort of physicians without attachment PHNs were also surveyed to compare responses on the same criteria. The majority of nurses described their role generalist. This role was related to greater satisfaction for nurses and the physicians with whom they worked. Satisfaction with PHN service, ease of arranging consultation with PHN, and appropriateness of referrals from PHNs was greater for physicians who had the attachment than those who used the usual service.
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BACKGROUND: Stress, burnout, substance abuse and suicide among dentists have been studied, yet no study in the United States has specifically addressed depression in e dentists. The objective of the authors' study was to determine if sex and dental specialty were correlated with depression in dentists. METHODS: The authors conducted a survey of a sample of dentists chosen randomly from the American Dental Association's mailing list of member dentists. The survey, stratified by sex and specialty, resulted in 560 responses, for a 53 percent response rate. The authors used the Zung Self-Rating Depression Scale to measure depression. The authors examined the respondents' sex, age, number of children, marital status, specialty, practice type, location of practice, years in practice and hours worked per week. RESULTS: The rate of depression in the overall sample was 9 percent. Sex was associated with depression (P < .001), but specialty was not. However, multiple regression analysis found that sex was significantly related to depression in only two specialties: periodontics and pediatric dentistry. Overall, the regression model explained an unimpressive 6 percent of the variance in depression scores. The most important finding of the study was that only 15 percent of depressed dentists were receiving treatment. CONCLUSIONS: The survey results showed that only female pediatric dentists and periodontists were more depressed than their male counterparts. None of the other variables studied contributed significantly to the understanding of depression in dentists. Depressed dentists, like other depressed people, tend not to seek treatment. CLINICAL IMPLICATIONS: Depression and serious depression occur among dentists, and much of it is untreated. Because depression is harmful to dentists and raises quality-of-care issues, they should be educated to help them recognize depression and encouraged to seek treatment.
BACKGROUND: Within dentistry, a limited body of literature exists regarding the referral relationships between general practitioners (GPs) and specialists. The purpose of this study was to investigate the referral relationship between GPs and periodontists within the state of Virginia. METHODS: A survey was developed that focused on the demographic variables in the referral relationship between GPs and periodontists. The survey was mailed to 800 dentists throughout the state of Virginia. Descriptive statistics were completed along with multivariate logistic regression analysis comparing the responses with the number of patients referred per month to periodontists. RESULTS: Female respondents were more likely to refer three or more patients per month to a periodontist than a male respondent (P<0.02). Those dentists who practiced with one other dentist were twice as likely to refer more frequently when compared to solo practitioners or larger group practices (P<0.03). Dentists employing two hygienists were more likely to refer patients than those with fewer hygienists (P<0.02). Those whose practices were >5 miles from the nearest periodontist were more likely to refer patients compared to dentists geographically closer to a periodontist (P<0.02). No other variables had a significant effect on the referral of more patients per month to a periodontist. CONCLUSIONS: This study indicates that four demographic variables have a statistical influence on the number of referrals per month from a GP to a periodontist. These variables are as follows: female gender, practicing with one other dentist, employing two or more hygienists, and being >5 miles away from the nearest periodontist.
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Longitudinal data on two cohorts of Canadian dental students are examined in order to determine the nature of the changes in attitudes and aspirations which students experience during their undergraduate dental training and the extent to which attitudes and aspirations which students hold on graduation are consistent with subsequent attitudes and behavior in practice. Data are presented on three dimensions of career-related attitudes and behavior: (1) aspirations toward and actual involvement in alternative practice settings, (2) attitudes and behavior related to selected professional and community activities, and (3) attitudes toward specific issues in dentistry. The results indicate that the dental school has little influence on students for the dimensions considered and suggest that analysis of both student backgrounds and the early practice experience of dental graduates may be the key to understanding the career behavior of dental graduates.
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The nurse-physician relationship is the major dyad of the health care delivery system. The integration of the clinical nurse specialist (CNS) role in collaboration with physicians is an evolving style of practice reflecting collegial relationships. Various issues are associated with collaborative practice. Obstacles to collaboration between CNSs and physicians are addressed, followed by strategies to promote collaborative practice. Essential components of collaboration are identified. The impacts of collaborative practice on health care professionals and consumers are explored. Support for CNS and physician collaboration is validated by reports of CNS and physician collaborative practices.
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