title: Lead dentists in the public dental service in Finland during a major reform.
abstract: BACKGROUND
  A major reform of dental care was conducted in Finland in 2001-2002. As a result, care from the Public Dental Service (PDS) was for first time made available to adults born before 1956 and the reimbursement of basic dental care in the private sector by the National Insurance Institution was extended to cover all adult age groups.
  
  
  OBJECTIVE
  To survey how the position and role of the lead dentists in the PDS and their leadership role had changed during the eight years since the reform was introduced.
  
  
  METHODS
  Data on leadership qualities and styles and proceedings of the implementation process of the reform were collected from the lead PDS dentists (n=161) in 2011 using an e-mailed questionnaire. Comparisons were made with a previous study performed in 2003. The response rates were the same, 73%, in both years. Factor analysis, chi-square and non parametric tests were used in analysis.
  
  
  RESULTS
  The number of lead dentists had fallen by 39% as the sizes of the PDS units had increased. Only a third (30%) had applied for the leadership position and 17% were full-time lead dentists (usually in units having 40,000 or more inhabitants). Although most respondents (72%) felt that they were good goal-oriented managers, and almost all (94%) that they were good people-oriented leaders, they felt that a lead dentist's position in the municipal hierarchy had become weaker although the PDS after the reform had much larger population responsibility locally. Most lead dentists, 72%, claimed that they had been forced to work with insufficient staff in relation to the increased demand for care, especially lack of dentists.
  
  
  CONCLUSIONS
  Being a lead dentist in the PDS continued to be a rather lonely task and attracted male dentists more than female dentists. Over the years the lead dentists' self-confidence in their leadership role had improved but their independent decision-making power had decreased and their position in municipal decision making had stayed weak. Those who had applied for the leading post themselves worked in larger PDS units and had enough leadership education and were most satisfied with their work.
authors.forename: Paula
authors.initials: P
authors.lastname: Alestalo
authors.forename: Eeva
authors.initials: E
authors.lastname: Widström