Key words:
Dentists - job satisfaction - quality of life
Introduction
Quality of life (QOL) is an increasingly deliberated topic; it can be defined as a
subjective attitude toward the outcome of mental, physical, and social well-being,
which in turn, is part of cultural, social, and environmental welfare. It has been
generally agreed that job satisfaction among physicians is declining and that affects
the quality of working life.[[1]] All health-care workers (HCWs) are recognized as a vulnerable group, due to their
exposure to a number of hazards, namely ergonomic, physical, chemical, biological,
and psychosocial at the workplace. Moreover, HCWs were selected as a priority group
for improvement of safety and health at work in the World Health Organization (WHO)
work plan 2009-2012 (priority 1.4).[[2]] Since the 21st century, dentists’ QOL has become a major concern due to the fact that dentists nowadays
need to exert an enormous amount of physical and mental effort in order to keep up
with patients’ increasing demands for precise and efficient treatment, along with
rapidly progressing stream of knowledge and technology.
Dentistry is a profession where several occupational factors affect dentists’ well-being.
Physical and psychological disorders were found to be of high prevalence in dental
practice as shown in several studies.[3]-[5] Some of the consistent predictors of mental health were time and scheduling demands
such as working under time pressure and negative patient perceptions, such as being
underrated by patients and lack of their appreciation.[[3]] Income-related issues such as working hard to meet lifestyle demands and conflicts
between profits and professional ethics are other factors affecting dentists’ mental
well-being.[[6]] The repetitive nature of the job, uncooperative patients, long working hours, and
unsatisfactory staff and auxiliary help have also been included as stressors among
dentists.[7],[8] Furthermore, the relationship of four traits such as self-esteem, generalized self-efficacy,
locus of control, and emotional stability with job satisfaction and job performance
are found to significantly affect both job satisfaction and job performance.[[9]]
Job stress is known to have a deleterious effect on general health and has been associated
with a range of health disorders such as psychological difficulties, coronary heart
disease, and signs and symptoms of musculoskeletal disorders. Work-related musculoskeletal
disorders (WRMDs) contribute to approximately 40% of all treatment costs of work-related
injuries.[[10]] These are the most costly type of work disability which negatively affects QOL and
reduces productivity. Due to the multifactorial nature of WRMDs, it was found that
the most frequently reported risk factors include working for long periods of time
in the same position, working in uncomfortable or restricted positions, and treating
a large number of patients per day.[[11]]
There is a paucity of studies focusing on the QOL of dentists in general. The aim
of this study is to evaluate the perception of QOL of dental professionals working
in the private sector and to determine the factors that affect their QOL.
Materials and Methods
The WHO for QOL Assessment-BREF (WHOQOL-BREF),[12],[13] an abbreviated version, addresses four domains of QOL (social relationships, environmental
factors, physical health, and psychological health) and two items which measure overall
QOL and general health. This self-administered questionnaire uses a 5-point Likert
scale ranging from 1 (not at all) to 5 (completely), measuring intensity (not at all
to an extreme amount), capacity (not at all to completely), frequency (never to always),
and evaluation (very satisfied to very dissatisfied and very poor to very well).[[14]] The general QOL was determined from the response to the question of the WHOQOL-BREF,
“How would you rate your QOL?” The five response options include very poor, poor,
neither poor nor good, good, and very good. The responses were grouped into two levels:
good QOL (very good and good) and poor (neither poor nor good, poor, and very poor).[[13]] Due to cultural considerations, a question related to the dentists’ sexual life
was eliminated (Q no. 21). The participants were instructed to answer the questions
according to what they felt in the last 2 weeks.
A total of 290 surveys were administered to general practitioners (GPs) and specialists
working in private sector in the Emirates of Abu Dhabi, Dubai, and Sharjah. Written
consent to carry out this study was obtained from each participant prior to commencement.
Each participant was instructed to answer the entire questionnaire at a single go
while in a calm state after finishing their daily duties in order to avoid bias due
to the dentists’ mood being affected by daily stresses. The completed questionnaires
were collected after a week in order to give ample time for completion. The study
was conducted in full accordance with the World Medical Association Declaration of
Helsinki and received ethical approval from the Research and Ethics committee of College
of Dental Medicine, University of Sharjah. Data were entered and the scores of the
26-item questions were initially measured on a scale of 4-20, and these were converted
to a scale of 100 in order to make the results comparable to studies which employ
the WHOQOL-100 questionnaire. Data were analyzed using SPSS IBM version 21 (IBM SPSS
Statistics for Windows, Version 21.0, IBM Corp: Armonk, NY). Descriptive statistics
were utilized, and frequencies, means, and standard deviations were reported. Independent
i-tests were used to assess the association between each of the domains and the independent
variables. Multivariate regression analysis was conducted to assess the association
between each of the domains and the independent variables in the study (age, sex,
marital status, and type of practice). For all analyses, P value used for statistical significance was 0.05 (two tailed).
Results
Out of the 290 questionnaires distributed to dentists, 135 questionnaires were answered
and returned. The response rate was 46%. Maintaining high response rates is always
desirable in a survey. However, a review of literature shows that survey response
rates among physicians tend to be lower than the general population owing to their
demanding work schedules.[[15]] Nearly 51% of the study participants were females and the majority were married
(80.14%) [Table 1]. No significant differences were observed in the four QOL domains according to sex
[Table 2]. On the other hand, significant differences were observed in the QOL domains according
to dentists’ practice. Specialists had significantly better QOL than GPs on all the
four domains of the WHO-BREF questionnaire [Table 3], P < 0.05], with the largest difference observed in the psychological domain (76.48
± 8.71 vs. 66.54 ± 11.83, P < 0.05). In addition, married dentists appeared to express significantly better QOL
compared to single/widowed dentists on the social and environmental domains [Table 4], P < 0.05]. Multivariate regression analysis [Table 5] shows that specialists expressed better QOL in the psychological and environmental
domains after adjustment for age, sex, and marital status (B = 8.75, 95% confidence
interval [CI]: 4.96-12.52: P =0.00; B = 4.73, 95% CI: 0.81-8.66, P = 0.02).
Table 1:
Characteristics of the study participants
|
Variable
|
n (%)
|
|
SD: Standard deviation
|
|
Sex
|
|
|
Male
|
70 (48.61)
|
|
Female
|
74 (51.39)
|
|
Age
|
|
|
Mean±SD
|
38.26±10.96
|
|
Practice
|
|
|
General practice
|
64 (52.14)
|
|
Age
|
|
|
Specialist
|
59 (47.86)
|
|
Marital status
|
|
|
Single/widow
|
28 (19.86)
|
|
Married
|
113 (80.14)
|
Table 2:
Quality-of-life domains according to sex
|
Mean±SD
|
P
|
|
Male
|
Female
|
Total
|
|
QOL: Quality of life, SD: Standard deviation
|
|
Overall QOL
|
77.32±16.66
|
75.00±12.92
|
76.13±14.85
|
0.35
|
|
Physical
|
69.13±15.03
|
67.47±11.50
|
68.28±13.31
|
0.46
|
|
Psychological
|
72.32±13.14
|
69.82±10.18
|
71.04±11.74
|
0.20
|
|
Social
|
77.50±17.37
|
72.13±17.13
|
74.74±17.40
|
0.06
|
|
Environmental
|
67.19±13.53
|
66.47±10.34
|
66.82±11.96
|
0.72
|
Table 3:
Quality-of-life domains according to dentists’ practice
|
Mean±SD
|
P
|
|
GP
|
Specialist
|
|
*P-value significant at p<0.05. QOL: Quality of life, SD: Standard deviation, GP:
General practitioner
|
|
Overall QOL
|
73.05±14.47
|
80.30±14.72
|
0.01*
|
|
Physical
|
66.52±13.06
|
71.55±11.35
|
0.02*
|
|
Psychological
|
66.54±11.83
|
76.48±8.71
|
0.001*
|
|
Social
|
72.27±16.44
|
78.60±15.58
|
0.03*
|
|
Environmental
|
63.77±10.22
|
69.76±11.63
|
0.001*
|
Table 4:
Quality-of-life domains according to marital status
|
Mean±SD
|
P
|
|
Single
|
Married
|
|
QOL: Quality of life, SD: Standard deviation
|
|
Overall QOL
|
77.23±11.81
|
76.11±15.54
|
0.67
|
|
Physical
|
66.33±11.52
|
68.93±13.84
|
0.36
|
|
Psychological
|
69.05±12.50
|
72.05±11.20
|
0.22
|
|
Social
|
66.07±19.20
|
77.43±16.01
|
0.001*
|
|
Environmental
|
63.17±9.37
|
68.06±12.30
|
0.05**
|
Table 5:
Mutilinear regression analysis for the association between each of the quality-of-life
domains and gender, age, marital status, and practice
|
Variables
|
Domains
|
|
B
|
P
|
9S% CI
|
|
Overall QOL
|
|
Reference categories: aMale, bMarried, cSpecialist. QOL: Quality of life, CI: Confidence interval
|
|
Sexa
|
-2.44
|
0.33
|
-7.33-2.45
|
|
Age
|
0.04
|
0.72
|
-0.18-0.27
|
|
Marital” status
|
-1.59
|
0.12
|
-3.60-0.43
|
|
Practice1
|
-0.23
|
0.61
|
-1.15-0.69
|
|
Physical domain
|
|
Sexa
|
-3.48
|
0.11
|
-7.86-0.88
|
|
Age
|
0.19
|
0.05
|
-0.002-0.39
|
|
Marital” status
|
-0.26
|
0.76
|
-1.96-1.45
|
|
Practice1
|
3.95
|
0.08
|
-0.5-8.41
|
|
Psychological domain
|
|
Sexa
|
-2.88
|
0.13
|
-6.58-0.81
|
|
Age
|
0.12
|
0.15
|
0.05-0.29
|
|
Marital” status
|
-1.30
|
0.08
|
-2.75-0.15
|
|
Practice1
|
8.75
|
0.00
|
4.96-12.52
|
|
Social domain
|
|
Sexa
|
-5.60
|
0.05
|
-11.06-0.06
|
|
Age
|
0.12
|
0.36
|
-0.14-0.38
|
|
Marital” status
|
-2.19
|
0.05
|
-4.64-0.02
|
|
Practicec
|
4.59
|
0.12
|
-1.23-10.31
|
|
Environmental domain
|
|
Sexa
|
-0.14
|
0.56
|
-4.67-2.24
|
|
Age
|
0.20
|
0.02
|
0.02-0.38
|
|
Marital” status
|
-1.17
|
0.13
|
-2.68-0.34
|
|
Practice1
|
4.73
|
0.02
|
0.81-8.66
|
Discussion
There is a link between dentists’ job satisfaction and patients’ experiences;[[16]] therefore, assessment of dentists’ QOL is important to understand. Arguably, dentists’
QOL could affect the delivery of care as well as the communication with patients and
consequently, patients’ satisfaction with the treatment received. Previous studies
that assessed job satisfaction of dentists[3],[7],[17],[18] reported that several factors such as work-related environment, personal life, clinic
location, years of practice, and income were positively associated with job satisfaction
among dentists. Other factors such as patient relations and years in practice were
also found to affect job satisfaction[19],[20]
Stress and job satisfaction have a complex interrelation and stress could be a significant
feature of a dentists’ job.[[21]] Working in a dental practice is recognized to be a physically and mentally demanding
activity and the possible consequences of chronic occupational stress are professional
burnouts.[[22]] As professional burnout affects all aspects of life including marital problems,
emotional disorders, and problems with alcohol and drug abuse, this has a devastating
effect on the patients, resulting in medical errors and reduced compliance to medical
advice.[23]-[25] Although several studies addressed job satisfaction among dentists, the literature
is scarce regarding QOL of dentists in general.
The majority of dentists, in our study, rated their QOL as “very satisfied,” and the
highest mean scores were obtained in the social domain. The social domain could be
influenced by the marital status, where married dentists had better social life and
superior social relationships. Our study revealed that married dentists, when compared
to single dentists, seem to have better QOL on the social domain and this relationship
persisted after adjustment for gender and age. These results are consistent with the
findings of studies by Doshi et al.,[[26]] Wig et al.,[[27]]
and Barua et al.[[28]] Married couples in general had increased social, emotional, and financial backing
and thus a better secure life. Their combined network of colleagues, professional
relations, and associates would be larger and would bring increased opportunities
to interact with people in different or similar fields. On the contrary, in a study
on dentists of local public health services,[[29]] the physical domain had the highest scores. The authors explain that there was a
contrast of information on the health evaluation and reports of presence of actual
disease in the participants. This implies that even though there were health issues,
this did not prevent a majority of these professionals from performing their daily
activities.
Different age groups showed variations in satisfaction levels. The results of studies
done by Luzzi et al.,[[17]] Nunes Mde and Freire Mdo,[[29]] and Kaipa et al.[[30]] showed low job satisfaction levels with age. The authors attribute these findings
to greater responsibilities and family commitments, which may explain the negative
association between age and job satisfaction. However, consistent with some reports,[7],[31],[32] the results in our study show that QOL of the dentists improved with age. This could
be explained by the fact that experienced dentists have already proven practices,
administrative responsibilities and established relationships with colleagues, patients,
and staff, and manage their personal time well; consequently they can handle the demands
of their career.
Specialists in our study rated their QOL higher when compared to GPs in the environment
domain. Possible factors such as financial resources, security, health and social
care, opportunities for acquiring new information and skills, and opportunities for
recreation/leisure activities could contribute to this. Poor satisfaction in GP dentists
may be related to their fear about career goals and the feeling of being unable to
improve themselves.[3],[33] In a study on dentists’ QOL in teaching hospitals, results show that being a specialist
dentist positively influenced the QOL as reflected in the psychologic domain.[[25]] However, in a QOL study among dentists of a local public health service in 2006,
there was no difference between dentists with or without a graduate degree in any
aspect of the QOL.[[28]] In the UAE, specialists are assessed in their area of expertise and are licensed
by the authorities to secure a job more easily when compared to a GP. They are usually
limited to treating specialty cases, have job satisfaction focusing on their specialty,
and have the opportunity to collaborate with specialists in their field in various
forums and associations. The financial compensations and benefits are also higher
for specialists.
A limitation of this study was that only dentists in private practices were included,
thereby limiting the generalization of study findings to all dentists in the UAE.
Although differences were observed in the QOL between specialists and GPs, a casual
association cannot be concluded given the cross-sectional design of this study. Furthermore,
the respondent rate could affect the study results as the decision to respond or not
to the survey could be related to their perceptions regarding their QOL. The results
are based on responded surveys; this low response rate might change the final outcome
(bias).
Conclusion
Although our findings suggest that specialists have better QOL than GPs, additional
research is needed to expose other factors not measured in this study and their impact.
Our findings could provide dentists with some important insights into possible factors
which affect their QOL and may be considered when choosing their practice settings,
as scientific evidence has shown that low job satisfaction is linked with low performance,
suboptimal health-care delivery, and clinical outcomes of primary care providers,
which can lead to loss of continuity of care.[19],[34]
Financial support and sponsorship
Nil.
