Gallagher Jennifer E, Colonio-Salazar Fiorella B, White Sandra
Dean for International Affairs, Newland-Pedley Professor of Oral Health Strategy/Honorary Consultant in Dental Public Health, King´s College London, Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, Denmark Hill Campus, Bessemer Road, SE5 9RS, London, UK.
Former Post-Doctoral Research Associate, King´s College London, UK.
Br Dent J. 2021 Jul 20:1-9. doi: 10.1038/s41415-021-3205-7.
Background Research has highlighted multiple determinants of dentists' health and wellbeing, and has raised concerns over workforce morale and retention. Limited research has been undertaken on possible solutions. Thus, the aim was to explore the coping strategies used or advocated by dentists to protect and support their health and wellbeing.Methods This qualitative study involved a purposive sample of dentists working in England taking account of age, gender, career stage, work sector, geographical area, position and route of entry to registration. Dentists were approached via gatekeepers across England to participate in semi-structured interviews. A topic guide, informed by past research, was used to guide the discourse. Informants' views were audio-recorded and field notes were made. Data were transcribed and analysed using an interpretative phenomenological approach to generate theory with the support of the framework methodology.Results Twenty dentists were interviewed from a range of backgrounds. Self-reported coping strategies included a range of strategies for 'taking control', including 'embracing self-care' and 'seeking professional support', while drawing on 'supportive personal and social networks'. Managing professional careers included diversifying through greater 'mixing' of NHS with private work, privatising, specialising, or combining dentistry with another role. Strengthening job security and facilitating diversity of experience remain important for supporting the health and wellbeing of dentists. Selling practices or, in the extreme, completely leaving the profession were considered practical options. At organisational level, building sustainable teams and transforming culture were advocated as important; while at systems level, reforming the NHS and bridging the gap between the profession and regulatory body were considered vital. Additionally, the need for strong professional leadership and wider societal debate was advocated as part of a whole systems approach to enable job satisfaction in delivering high-quality, patient-centred, evidence-based care in future.Conclusion While dentists demonstrated a range of coping mechanisms, multi-level action was advocated to enhance the health, wellbeing and retention of dentists. Systems reform at macro- and meso-levels is urgently advocated to enable fulfilling careers within dentistry, particularly for those at the front line of primary dental care in the public sector. Personal resilience alone will not suffice and recommendations for action are explored to avert a public health catastrophe. This is a time for reflection, debate and action.
背景 研究突出了影响牙医健康和福祉的多个决定因素，并引发了对劳动力士气和留用率的担忧。关于可能的解决办法的研究有限。因此，本研究旨在探索牙医采用或倡导的应对策略，以保护和支持他们的健康和福祉。
方法 本定性研究采用目的抽样法，选取在英格兰工作的牙医，考虑其年龄、性别、职业阶段、工作部门、地理区域、职位和注册途径。通过英格兰各地的把关人联系牙医，邀请他们参与半结构化访谈。使用一份基于以往研究的主题指南来引导谈话。对受访者的观点进行录音并做现场笔记。数据转录后，采用解释现象学方法进行分析，在框架方法论的支持下生成理论。
结果 采访了来自不同背景的20名牙医。自我报告的应对策略包括一系列“掌控局面”的策略，包括“接受自我保健”和“寻求专业支持”，同时利用“支持性的个人和社会网络”。管理职业生涯包括通过更多地将国民保健制度（NHS）工作与私人工作“混合”、私有化、专业化或将牙科与其他角色相结合来实现多元化。加强工作保障和促进经验多样性对于支持牙医的健康和福祉仍然很重要。出售诊所，或者在极端情况下，完全离开这个职业，被认为是可行的选择。在组织层面，倡导建立可持续的团队和转变文化很重要；而在系统层面，改革国民保健制度以及弥合该职业与监管机构之间的差距被认为至关重要。此外，倡导强有力的专业领导力和更广泛的社会辩论，作为整体系统方法的一部分，以便未来在提供高质量、以患者为中心、基于证据的护理时能够实现工作满意度。
结论 虽然牙医展示了一系列应对机制，但倡导采取多层次行动来增进牙医的健康、福祉和留用率。迫切倡导在宏观和中观层面进行系统改革，以使牙科领域拥有充实的职业生涯，特别是对于那些在公共部门初级牙科护理一线工作的人员。仅靠个人韧性是不够的，本文探讨了行动建议，以避免一场公共卫生灾难。现在是反思、辩论和行动的时候了。
