Abstract
Introduction
New Zealand’s oral health care system caters to adults who can pay out-of-pocket for dental services. The needs of vulnerable populations are neglected, supporting the presence of oral health inequities. Dentistry’s professional status is questioned by the unjust and unfair differences in the way dental care is accessed and provided meaning that if dentists want to maintain their professional status, they must work towards meeting the population’s needs. Internationally, where there is increased commercialism within the dental profession, dentists have reported reduced autonomy, collegiality, and status in society.
There is limited research in New Zealand that investigates how dentists view their profession and their professional roles, obligations, and social responsibilities. Little is known about how New Zealand dentists view commercialism and corporatisation within the profession and how they navigate commercial aspects while maintaining their professional obligations.
Aims
The aims of this study were: to investigate the extent to which New Zealand dentists identify as health care professionals and business-people; investigate dentists’ perceptions of their social responsibility; and explore dentists’ perceptions of commercial practices in dentistry and the effects of commercial practices on dental care provision.
Methods
A parallel convergent mixed-methods research design was used to investigate how New Zealand dentists perceive their professional role, the commercial aspects of dentistry and how they balance their professional obligations with commercial aspects.
For the quantitative component, a questionnaire was developed and deployed using the QualitricsTM Survey platform. A link to the online questionnaire was emailed to registered practising New Zealand dentists with valid email addresses listed on the 2022 Dental Council of New Zealand (DCNZ) register. Additionally, a link to the questionnaire was included in the DCNZ and New Zealand Dental Association (NZDA) newsletters. StataTM v.17.0 software was used to conduct statistical analysis.
Participants for the qualitative component were selected from respondents of the questionnaire using a maximum variation sampling method. Those who agreed to participate in the qualitative component were interviewed using a semi-structured question format. All interviews were recorded and transcribed by ZoomTM software. Thematic analysis was used to identify patterns and generate themes.
Results
There were a total of 309 respondents to the questionnaire. The participant demographic characteristics were similar to the 2022 New Zealand dentists’ demographic characteristics: therefore, the results were considered representative of New Zealand dentists.
Most dentists (88.7%) viewed themselves as both a health professional and a business-person. They rated their role as a health professional to be greater than their role as a business-person. Practice owners were more likely than other dentists to view themselves as a business-person, and to view commercialism as having either a positive effect or no effect on dentists’ professionalism.
Associate dentists working in privately-owned practices were more likely (P=0.004) to report actions that would be in the best interests of their patients and community. Associate dentists working in corporate-owned practices (P=0.004), and those being incentivised to generate more income (P=0.001) were more likely to report placing their personal or practice’s interests first. A majority considered it important to reduce oral health inequities in the population (82.1%), and to lobby the government on behalf of vulnerable people (76.9%).
There were 17 participants in the qualitative component. Through thematic analysis, the main themes were that dentists view their profession positively, commercialism is pervasive and influential, and dentists constantly navigate the pressures of commercialism and balance them with professionalism.
Conclusion
New Zealand dentists perceived that dentistry is becoming increasingly corporatised and commercialised, moving the profession away from patient-centred towards profit-centred care. This may exacerbate inequities in access to oral health care services and challenge the professional status of dentistry.