A question of value: a qualitative study of vocational dental practitioners' views on oral healthcare systems and their future careers.
BACKGROUND
New dental graduates in England and Wales spend one year as vocational dental practitioners (VDPs) preparing for independent clinical practice. In recent years, they have entered a state-funded healthcare system undergoing the greatest period of change since the inception of the National Health Service (NHS) and a profession in which there has been a significant shift of care to the private sector. Against this background, the objectives of this study were to investigate VDPs' vision of their future professional career and the influences that will impact on their choice of state-funded (NHS) and/or private dentistry, and to identify what factors may attract graduates to work for the NHS.


METHODS
In 2004/2005, purposive sampling of a range of VDP training schemes across England and Wales was used to select the VDPs from ten schemes to take part in focus groups. To standardise data collection, a topic guide was used. Respondents' views were recorded on tape and field notes. The data were transcribed and analysed using framework methodology.


RESULTS
Ninety-nine VDPs from all parts of England and Wales participated in ten focus groups. They identified three main categories of future practice: private, state-funded (NHS), and mixed. Private practice was perceived as providing 'professional independence', 'financial reward', 'time with patients' and 'clinical freedom'. NHS practice was associated with 'providing access to specialist training' and 'gaining clinical experience', often as preparation for private practice. Providing NHS care was attractive for VDPs who valued the ethos of public service. The VDPs considered that NHS practice could be made more attractive to young dentists by a range of factors, involving the funding, culture and philosophy of the system and the degree of fit with their personal and professional vision. They reported that they would welcome 'incentives to work in areas of high need', 'assistance with debt' and a 'culture of valuing NHS dentists'.


CONCLUSIONS
The findings suggest that the commitment to healthcare systems of the VDPs who took part in this study was associated with being true to their values and being valued within the system. They perceived a tension between state-funded and private practice, considering the latter more likely to meet personal and professional expectations. However, they remained open to working in an enhanced and supportive state-funded system, should it correspond with their values, and demonstrate that they were valued healthcare professionals.
Gallagher
Jennifer E
JE
Head of Oral Health Services Research & Dental Public Health, King's College London Dental Institute at Guy's, King's College and St Thomas' Hospitals, London, UK. jenny.gallagher@kcl.ac.uk
Clarke
Wendy
W
Eaton
Kenneth A
KA
Wilson
Nairn H F
NH
D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002321:Career Choice; D003695:Delivery of Health Care / Q000458:organization & administration*; D004497:Education, Dental / Q000592:standards*; D004739:England; D004990:Ethics, Dental; D005380:Financing, Government; D017144:Focus Groups; D005544:Forecasting; D006301:Health Services Needs and Demand; D006801:Humans; D007182:Income; D007396:Internship and Residency / Q000592:standards*; D007588:Job Satisfaction; D009042:Motivation; D015279:Organizational Culture; D010685:Philosophy, Dental; D011331:Private Practice; D017009:Professional Autonomy; D011636:Public Health Dentistry / Q000941:ethics; D011787:Quality of Health Care; D013039:Specialties, Dental / Q000193:education; D013218:State Dentistry / Q000941:ethics / Q000458:organization & administration*; D013997:Time Factors; D014852:Wales