Dentists' Working Patterns, Motivation and Morale - 2018/19 and 2019/20

Table 2.1 summarises the working hours results by dental type for Northern Ireland in 2019/20. Results for 2018/19 are shown in the Results Across the UK section.

Table 2.1: Summary table for working hours analysis, Northern Ireland, 2019/20

^{Note: Further explanatory notes can be found in the Glossary (Annex B) and Methodology}

The main findings for 2019/20 are:

• Overall, dentists (full and part-time) reported working an average of 37.4 hours per week in dentistry in 2019/20, with 27.1 hours (72.6 per cent) devoted to Health Service dental services. The remaining dental activity time – 27.4 per cent – was spent on private dentistry.

• On average, Principal Dentists worked more weekly hours (42.6 hours) than Associate Dentists, at 33.9 hours. Principals reported spending 66.4 per cent of their time on Health Service dentistry (28.3 weekly Health Service hours); for Associates this measure was 77.7 per cent and likewise equates to 26.4 weekly Health Service hours.

• Overall, dentists reported that their time spent on dentistry was split into 80.8 per cent on clinical work and 19.2 per cent on non-clinical work. Associate Dentists spent more of their dental time on clinical work compared to Principal Dentists at 85.9 per cent compared to 74.7 per cent, respectively.

Tables 2.2 and 2.3 compare the working patterns of dentists according to their Health Service/Private Share.

Table 2.2: Principal dentists, summary table of working hours analysis by Health Service/Private Share, Northern Ireland, 2019/20

^{Note: Further explanatory notes can be found in the Glossary (Annex B) and Methodology  The results shown in the table are based on small sample sizes (<100 by count and <75 per cent of group population).}

Table 2.3: Associate dentists, summary table of working hours analysis by Health Service/Private Share, Northern Ireland, 2019/20

^{Note: Further explanatory notes can be found in the Glossary (Annex B) and Methodology  The ‘Mainly private’ and ‘Mixed’ results shown in the table are based on small sample sizes (<100 by count and <75 per cent of group population).}

The results highlight some trends when comparing dentists who spend most of their time on Health Service work compared to those who spend more time on Private work. Mainly Health Service dentists tend to:

• Work longer weekly hours
• Take fewer weeks’ annual leave
• Spend less time on clinical work

In addition, Associate dentists who spend more time on Health Service work tend to be younger compared to those with a higher private share.

Table 2.4 presents responses to the individual motivation questions by dental type with the ‘overall average’ figure showing the average of the individual percentage scores for each response category. Please refer to the Motivation and Morale Analysis section in the Introduction and Annex D in the Methodology, for more information on how the data is analysed.

Table 2.4: Percentage response (%) to each motivation question by dental type, Northern Ireland, 2019/20

^{Note: Dentists included in the analysis answered every motivation question}

Whilst it can be hard to distinguish trends from rows of figures, it is very clear that answers to question (C) ‘I feel my pay is fair’ score lowest in terms of agreement (i.e. ‘strongly agree’ or ‘agree’) for both dental types, with 73.5% of Principals and 68.4% of Associates disagreeing or strongly disagreeing when asked if they feel their pay is fair.

Table 2.5 and figure 2.1 consider the results for ‘Strongly Agree’ and ‘Agree’ combined.

Table 2.5: Percentage of dentists (%) that answered ‘strongly agree’ or ‘agree’ by question and dental type, Northern Ireland, 2019/20.

^{Note: Difference column is calculated by subtracting Associate results from Providing-Performer results}

Figure 2.1: Percentage of dentists (%) that answered ‘strongly agree’ or ‘agree’ by question and dental type, Northern Ireland, 2019/20

^{Please see table 2.5 for source data.}

Figure 2.1 shows that Principal dentists respond more positively to most of the questions compared to Associates, meaning they have a higher ‘overall average’ score as shown in table 2.5. The biggest difference is found for question (E) ‘My job gives me the chance to do challenging and interesting work’, with nearly 60% of Principals reporting they ‘strongly agree’ or ‘agree’ with the question compared to almost 50% of Associates. However, this question also scored the highest for both dental groups, which therefore appears the most positive aspect of their work from the questions asked.

In contrast, less than a fifth said they were happy with their pay (C) and, for the first time in Northern Ireland, the latest survey shows that Associate dentists were less satisfied with their pay compared to their Principal colleagues. This finding may provide further evidence to the drop in motivation of Associate dentists in Northern Ireland, discussed further in the Motivation and Morale Analysis.

Figures 2.2a and 2.2b show distribution plots of average ‘motivation index’ by dental type with the figures in brackets showing the overall average score for each cohort; 46.8% for Principals and 45.1% for Associates. Please see the Introduction for how the average ‘motivation index’ is calculated.

Figures 2.2a and 2.2b: Distribution plots of average ‘motivation index’ by dental type, Northern Ireland, 2019/20

Both plots exhibit negative skews when comparing the high and low motivated bands together. The negative skew is more pronounced in the Associate graph, which results in the lower ‘motivation index’ when compared to Principals, mirroring results in table 2.5.

Table 2.6 shows results for each motivation band (described in the Introduction) against the variables of age, weekly hours of work, annual leave, Health Service share (%) and clinical work (%).

Table 2.6: Relationship between ‘motivation band’ and different variables from Dental Working Patterns survey by dental type, Northern Ireland, 2019/20

^{Note: Results shown in the table are based on small sample sizes (<100 by count and <75 per cent of population).   c: Results have been supressed to ensure anonymity due to small sample size.  Health Service (%) and clinical (%) do not take account of the weekly hours of work of individual dentists but just the percentage values recorded in the DWP Survey. This methodology differs to that used in Working Hours Results chapters and these figures may differ.}

The full-year population counts in table 2.6 show that over 80% of Principals and almost 75% of Associates lie between the central motivation bands (i.e. ‘neutral & low’ and ‘high’) with the remaining dentists in either the most or least motivated bands (i.e. ‘very high’ or ‘very low’).

• Both groups of dentists appear to exhibit a relationship between Health Service share and average ‘motivation index’; those with a higher ‘motivation index’ do less Health Service work compared to those with a lower ‘motivation index’.
• Likewise, there appears to be a relationship between weeks of annual leave for both dental groups and their average ‘motivation index’; those taking more leave have a higher ‘motivation index’ than colleagues taking less time off.

Such potential relationships are more easily visualised when considered graphically. The error bars (displaying 95% confidence intervals) allow estimation of the statistical significance of observed changes, and the effect of the low sample size in the ‘very high’ motivation bands is apparent in the charts for both Principal and Associates.

Figures 2.3a and 2.3b: Principal dentists, plot of average working pattern variables by motivation band, Northern Ireland, 2019/20

Figures 2.4a and 2.4b: Associate dentists, plot of average working pattern variables by motivation band, Northern Ireland, 2019/20

^{Note: Error bars for some variables have been omitted to aid interpretation (as they would overlap making the chart more difficult to read). The omitted error bars are the same length as those shown. Please see table 2.6 for source data.}

Figures 2.3a and 2.3b illustrate possible relationships for Principal dentists between the ‘motivation index’ and Health Service share (%) and leave. However, clinical work (%) and age appear to have weaker relationships with Principal dentists’ ‘motivation index’.

The results for Associate dentists are hard to interpret because the low sample size of the ‘very high’ motivation group, meaning the error bars for this cohort are large. Looking at ‘very low’ to ‘high’ motivation bands suggests that the relationship between the ‘motivation index’ and weekly hours of work is different for Associates who have higher motivation with longer working hours. This may mean that Associates who are more motivated tend to spend longer at work than those who are less motivated and/or that as Associates work longer hours, the more motivated they become. Figure 2.4b suggests a negative relationship between age and the ‘motivation index’ compared to Principal dentists.

Table 2.7 shows linear regression results by dental type for the average ‘motivation index’. Variable results that are not statistically significant are in italics in the table. 

Tables 2.7: Parameter estimates¹ for ‘motivation index’ by dental type using multiple linear regression, Northern Ireland, 2019/20

^{1. Please see Annex E and F of the Methodology for descriptions of parameter estimate and intercept as well as all significance and adjusted R2 values relating to this table.}

The positive or negative values of the results indicate the relationship between each variable and the average ‘motivation index’. For both sets of dentists increases in the Health Service share correspond with a decrease in motivation.

This type of analysis allows the individual relationships between each measured variable and the ‘motivation index’ to be assessed. For example, the statistical model predicts that if all other working patterns remained unchanged, but dentists switched from all private to entirely Health Service work (from 0% to 100% HS share) the ‘motivation index’ of Principal dentists would decrease by 27.9 percentage points and by 37.2 for Associates. One weeks’ extra leave is also predicted to increase the ‘motivation index’ of Principals by 2.4%.

Finally, it is important to note that whilst regression analysis provides evidence for the existence of relationships between variables, it does not provide measures of causality. In other words, whilst there may well be a relationship between Health Service commitment (HS share %) and motivation, it is not possible to determine if a greater Health Service commitment demotivates staff or that demotivated staff tend to gravitate towards Health Service as opposed to private work.

Table 2.8 and figure 2.5 show how dentists answered question (H) ‘How would you rate your morale as a dentist?’.

Table 2.8: Level of self-reported morale (%) by dental type, Northern Ireland, 2017/18

Figure 2.5: Level of self-reported morale (%) by dental type, Northern Ireland, 2019/20

^{Please see table 2.8 for source data.}

Figure 2.5 shows that Associate dentists rate their morale more highly than Principal dentists with 15.9% reporting their morale as either ‘very high’ or ‘high’ compared to 12.9% of Principals. It is also noticeable that nearly 30% of Principals rate their morale as ‘very low’ compared to 25.7% of Associates. These results are in contrast with earlier sections that show Principals with marginally higher levels of motivation than Associates. A similar result is found for dentists in England (Chapter 2) and may reflect increased levels of responsibility that Principals face when running their practices.

The Motivation and Morale Analysis section  shows how the morale and motivation of dentists have changed since these measures were first collected in the Dental Working Patterns Survey.