Dentist migration: A forgotten perspective

Free movement of labour is considered an eventual objective of globalisation.[1] Regional trade agreements, such as the European Union free movement of workers and the Trans-Tasman agreement between Australia and New Zealand, provide avenues for health professionals, including dentists, for international migration. Nevertheless, movement of labour between countries of different economic levels of development, such as a low-income country to a high-income Organisation for Economic Co-operation and Development country, makes brain drain prominent, also raising ethical questions on international migration.[2,3]

Many developed countries continue to face an increase in the demand for dental care.[4] The inability to meet this demand through the local supply of dentists has in some way contributed to policies that encourage dentist migration (e.g. public sector schemes that provide a pathway for migrant dentists to work in areas of need, or additional points for immigration as a means for permanent residency). Dentists who arrive from countries with diverse cultural and professional backgrounds are likely to differ in their dental treatment philosophies and competencies, creating the necessity to examine their suitability to practise in the new country.

A major shortcoming of both of these broad policy perspectives is the lack of understanding of migrant dentist experiences, mainly with regard to the reasons for migration and settling experiences abroad. Such an understanding can provide us with a human aspect, complementing efforts by the World Health Organization in the international recruitment of health workers.[5]

Our research, based in the Australian Research Centre for Population Oral Health at the University of Adelaide, on migrant dentists has explored this policy issue from the perspective of the individual, the migrant dentist. We focused on the experiences of migrant dentists in Australia mainly to understand their motivations behind emigrating to and settling experiences in Australia. We have also explored practice activity patterns of migrant dentists (home country, Australia and elsewhere) and other key issues, such as push–pull factors, job satisfaction and future intentions. This study included qualitative fieldwork on the life stories of migrant dentists in 2011–2012, followed by the first national survey of all migrant dentists in Australia.

Migration of dentists into Australia
Australia now has the largest proportion of foreign dentists in the world.[6] Historically, the country has been an attractive destination for dentists from high-income Organisation for Economic Co-operation and Development countries, mainly the UK, Ireland and New Zealand.[7] In recent years, the number of dentists migrating from low- and middle-income countries (mainly India, Egypt, the Philippines, Iran, Iraq, South Africa and Malaysia) has increased however.[8] To date, one in every four dentists in Australia, both born and trained overseas, is a migrant dentist.[9] Prior research suggests that nearly 30% of the migrant dentists in Australia are from the Western Pacific Region, followed by Europe (28.8%).[9]

Migrant dentists seeking to practise dentistry in Australia are assessed for their suitability to practise by the designated accreditation authority, the Australian Dental Council. This usually entails a four-stage process that includes an initial assessment, an English proficiency test, a written test and a clinical test.[10] Migrant dentists from Canada, Ireland, New Zealand and the UK can obtain direct registration to practise in both the public and private sector. Migrant dentists from approved institutions in Hong Kong, Malaysia, Singapore, South Africa and the US are permitted to practise in the public sector scheme, mainly in regional/remote areas, where there is a recognised need for dental care.

Study- and work-based migration in the university sector can provide migrant dentists with limited registration to practise. In order to practise independently in the private sector, these migrant dentists need to fulfil the requirements of the Australian Dental Council.

Understanding the origins of dentist migration
Our research on the life stories of migrant dentists in Australia provided some important insights into the origins of migration. Many migrant dentists, primarily those from low- and middle-income countries, exhibited a desire to work with the latest technology, as they were disappointed by the lack of such opportunities in their home countries. Dentists also told us that prior travel experiences and unforgettable memories contributed to their decision to migrate to Australia, as did the influence of family members and peers.

The conceptual framework of the study was guided by four subordinate themes: “Being good at something”, “Feelings of being let down”, “A novel experience” and “Influenced by someone”.[11] We observed that some combination of these themes was the case for most migrant dentists. We call this superordinate theme or world-view “global interconnectedness” and described the development of migration desire as a historical process stimulated by a priori knowledge (and interactions) of people, place and things.[11]

Our study added to the argument that the issue of dentist migration dwells deep in a dentist’s life story and has several interlacing factors that contribute to the dentist’s desire to migrate to a foreign country. Therefore, we suggest that policy efforts to address the dentist migration problem begin from this very basic understanding.[11]

Migrant dentists' study
Our research on the settling experience of migrant dentists in Australia (mainly on the assessment and examination process) has pointed towards the importance of support structures for migrant dentists in Australia. The study described support according to three areas, information, training and counselling,[10] similar to what has been reported in studies on the migration of nurses. More importantly, migrant dentists highlighted that a streamlined mentoring programme (such as the public sector scheme or training in a university) had improved their settling experience in Australia.[10] Further research was recommended to understand more about different programmes that can improve the settling experience of migrant dentists, and address the concerns of the regional population and the Australian dental workforce.[10]

Overall, the qualitative component of the migrant dentist study has made a modest contribution by providing evidence to streamline dentist migration policy alongside the mainstream health professional migration dialogue. Owing to the nature of complexity in transnational flows, we argue that successful national policy strategies will depend highly on appropriate international reinforcement. Addressing dentist migration policy at a national or local level also requires that kind of commitment. Low- and middle-income countries can address individual issues, such as dental education, oral health care service delivery, and professional and social ethos. Policies that address the problem as a whole, however, require a global effort.[11]

The World Health Organization Global Code of Practice on the International Recruitment of Health Personnel stresses the need for partnerships in addressing health professional migration. Considering the vast number of private sector companies in the dental industry in many countries, partnerships with non-state players and organisations such as the FDI World Dental Federation are vital.

Editorial note: A complete list of references is available from the publisher.