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

Table 3.1 summarises the working hours results by dental type for Scotland in 2019/20. Results for 2018/19 are shown in the Results Across the UK section.

Table 3.1: Summary table for working hours analysis, Scotland, 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 37.8 hours per week in dentistry in 2019/20, with 29.5 hours (78.2 per cent) devoted to NHS dental services. The remaining dental activity time – 21.8 per cent – was spent on private dentistry.
• On average, Principal Dentists worked more weekly hours (42.0 hours) than Associate Dentists (36.0 hours). Principals reported spending 72.3 per cent of their time on NHS dentistry (30.4 NHS weekly hours); for Associates this was 81.1 per cent (29.2 NHS weekly hours).
• Overall, dentists reported that their time spent on dentistry was split into 83.4 per cent on clinical work and 16.6 per cent on non-clinical work. Associate Dentists spent more of their dental time on clinical work compared to Principal Dentists at 86.6 per cent compared to 76.8 per cent, respectively.

Tables 3.2 and 3.3 compare the working patterns of dentists according to their NHS/Private share. 

Table 3.2: Principal dentists, summary table of working hours analysis by NHS/Private Share, Scotland, 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).}

Table 3.3: Associate dentists, summary table of working hours analysis by NHS/Private Share, Scotland, 2019/20

^{Note: Further explanatory notes can be found in the Glossary (Annex B) and Methodology  The ‘Mainly private’ 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 NHS work compared to those who spend more time on private work. Mainly NHS dentists tend to:

• Work longer weekly hours
• Take fewer weeks’ annual leave

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

Table 3.4 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 3.4: Percentage response (%) to each motivation question by dental type, Scotland, 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. Over 60.0% of Principals either ‘disagree’ or ‘strongly disagree’ when asked if they feel their pay is fair, which compares to just over a half (50.5%) for Associates.

Table 3.5 and figure 3.1 consider the results for Strongly Agree and Agree combined.

Table 3.5: Percentage of dentists (%) that answered ‘strongly agree’ or ‘agree’ by question and dental type, Scotland, 2019/20

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

Figure 3.1: Percentage of dentists (%) that answered ‘strongly agree’ or ‘agree’ by question and dental type, Scotland, 2019/20

^{Note: Please see table 3.5 for source data}

Table 3.5 and Figure 3.1 show that where there are bigger differences in how dentists answer each motivation question, Principal dentists tend to respond more negatively; to questions (A) on feelings, (C) on pay and (F) on progression which means that, overall, Principals are less motivated than Associates.

Figures 3.2a and 3.2b shows distribution plots of average ‘motivation index’ by dental type with the figures in brackets showing the overall average score for each cohort; 51.6% for Principals and 53.1% for Associates. Please see the Introduction for how the average ‘motivation index’ is calculated.

Figures 3.2a and 3.2b: Distribution plots of average ‘motivation index’, by dental type, Scotland, 2019/20

Whilst the distribution in the Principal plot appears more normal, the Associate plot exhibits a notable positive skew (at 62.5 to <75%) meaning they have an average ‘motivation index’ greater than that for Principals, which mirrors results from the preceding section.

Table 3.6 shows results for each motivation band (described in the Introduction) against the variables of age, weekly hours of work, annual leave, NHS share (%) and clinical work (%). 

Table 3.6: Relationship between ‘motivation band’ and variables from the Dental Working Patterns Survey by dental type, Scotland, 2019/20 

^{Note: Some of results shown in the table are based on small sample sizes (<100 by count and <75 per cent of population).  NHS share (%) and clinical work (%) 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.}

Table 3.6 shows that for both dental types over 75% of the estimated full-year population 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’). The results suggest relationships between the motivation bands and some of the measured variables. For example:

• Principal dentists exhibit a negative relationship between both weekly hours of work and NHS share (%) and their average ‘motivation index’; those dentists who work longer hours or conduct more NHS work report a lower ‘motivation index’ than those who do the opposite. Principal dentists also appear to have a positive relationship between weeks of annual and motivation.
• There appear to be similar trends for Associates, albeit to a lesser degree.

Such potential relationships are more easily visualised when considered graphically.

Figures 3.3a and 3.3b: Principal dentists, plot of average working pattern variables by motivation band, Scotland, 2019/20

Figures 3.4a and 3.4b: Associate dentists, plot of average working pattern variables by motivation band, Scotland, 2019/20

^{Error bars for each of the variables have been omitted to aid interpretation (as some error bars would overlap making the chart more difficult to read). The omitted error bars are the same length as those shown. Please see table 3.6 for source data.}

Figure 3.4b also suggests a negative relationship between motivation and age for Associate dentists, with those in the ‘very low’ motivation band almost 4 years older on average than those in the ‘high’ motivation band. However, generally figures 3.4a and 3.4b show that such relationships are harder to identify for Associate dentists, which can sometimes be the case when considering several variables at the same time.

Table 3.7 shows multiple linear regression results by dental type for the average ‘motivation index’. Variable results that are not statistically significant are in italics in the table. 

Table 3.7: Parameter estimates¹ for ‘motivation index’ by dental type using multiple linear regression, Scotland, 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 variable results indicate the relationship between each variable and the average ‘motivation index’. For both sets of dentists, increases in NHS work correspond with a decrease in motivation, whereas an increase in clinical work (%) has the opposite effect.

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 NHS work (from 0% to 100% NHS share) the ‘motivation index’ of Principal dentists would decrease by 16.6 percentage points and by 20.9 for Associates. Conversely, clinical work has a positive relationship with motivation for both dental groups. In both cases the effect appears larger for Associate dentists which is not always clear from the univariate analysis presented earlier and is why multivariate analysis can be useful.

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 NHS share (%) and motivation, it is not possible to determine if more private work motivates staff or whether motivated staff tend to do more private work.

Table 3.8 and figure 3.5 show how dentists answered the question (H) ‘How would you rate your morale as a dentist?’. 

Table 3.8: Level of self-reported morale (%) by dental type, Scotland,2019/20

Figure 3.5: Level of self-reported morale (%) by dental type, Scotland, 2019/20

Figure 3.5 highlights a negative skew for the morale results, particularly for Principal dentists with over half (54.3%) reporting their morale as ‘low’ or ‘very low’, which compares to 41.4% for Associates. Associate dentists rate their morale higher than Principals with nearly a third (30.9%) reporting their morale as either ‘very high’ or ‘high’ compared to 21.1%. 

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