Analysis of staffing of the regional health system by dental surgeons in 2019–2021

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BACKGROUND

The provision of specialized dental care requires adequate staffing with qualified dental professionals, including oral surgeons, in accordance with Order No. 707n of the Ministry of Health of the Russian Federation dated October 8, 2015 (as amended on September 4, 2020), On the Approval of Qualification Requirements for Medical and Pharmaceutical Workers with Higher Education in the Field of Health Care and Medical Sciences¹ [1]. According to Article 10 of the Federal Law “On the Fundamentals of Health Protection of Citizens in the Russian Federation” (No. 323-FZ, November 21, 2011, with amendments and supplements),² one of the key components of accessibility and quality of medical care is the availability of an adequate number of health care professionals and the level of their qualifications, which are ensured through the processes of medical licensure, professional certification, and accreditation [2].

Access to and quality of dental care are influenced by oral-surgeon workforce metrics, including the number of authorized and filled positions, the headcount of individual specialists, staffing adequacy, and the proportion who are board-certified. In this regard, an up-to-date analysis of the staffing adequacy of oral surgeons in medical institutions under the jurisdiction of the Ministry of Health of the Krasnodar Territory was conducted [1].

This study aimed to analyze the staffing adequacy of oral surgeons in medical institutions under the jurisdiction of the Ministry of Health of the Krasnodar Territory for the period 2019–2021.

MATERIALS AND METHODS

Study Design

An original research study was conducted.

Eligibility Criteria

Inclusion criteria: The primary inclusion criterion for the collection of statistical data was its correspondence to the fundamental multidimensional patterns of workforce availability in the dental specialty, specifically oral surgeons, within medical institutions of the Krasnodar Territory. The analysis of staffing adequacy of oral surgeons in medical institutions under the jurisdiction of the Ministry of Health of the Krasnodar Territory for the period 2019–2021 was carried out on the basis of statistical reports from these institutions.

Non-inclusion criteria: Datasets that did not conform to the fundamental multidimensional patterns of workforce availability in the dental specialty—oral surgeons—within medical institutions of the Krasnodar Territory were excluded.

Study Setting

The study was performed in accordance with the research framework of the Department of Public Health, Health Care Management, and History of Medicine, Kuban State Medical University.

Study Duration

The present study was conducted over the period 2019–2021.

Intervention

No interventions were performed.

Ethics Approval

Ethical approval was not required for this study.

Statistical Analysis

Sample size calculation: The sample size was not calculated in advance.

Methods of statistical analysis: data processing was performed using Microsoft Office software. Analytical, logical, and statistical methods were applied for data analysis.

RESULTS

Participants

The object of this study was the workforce composition of oral surgeons employed in state medical organizations of the Krasnodar Territory between 2019 and 2021. The present investigation was based on statistical data obtained from the official reporting forms of medical organizations in the Krasnodar Territory, namely Information on the Medical Organization (Form No. 30), for the analyzed period. As a result of a comprehensive assessment, the staffing adequacy of oral surgeons in medical organizations of the Krasnodar Territory were analyzed for 2019–2021. The analysis included the following metrics: the number of authorized and filled positions; the headcount of individuals employed in these positions as primary workers; the number of those holding a qualification category, a specialist certificate, or an accreditation certificate; staffing adequacy by headcount and by filled positions; and the part-time employment ratio.

Primary Results

In medical organizations of the Krasnodar Territory, oral provide dental care to the population in both outpatient and inpatient settings. The number of positions of pediatric oral surgeons providing dental care in medical organizations of the Krasnodar Territory during 2019–2021 is presented in Fig. 1.

 

Fig. 1. Dynamics of the number of full-time equivalent and filled positions of oral surgeons in state medical organizations of the Krasnodar Territory, 2019–2021.

 

The total number of authorized positions of oral surgeons across medical organizations of the Krasnodar Territory increased by 1.25 full-time equivalents (0.5%) over the study period: from 231.75 positions in 2019 to 233.75 positions in 2020, and 233.0 positions in 2021. At the same time, the number of filled positions decreased by 8.75 full-time equivalents (4.7%), from 187.25 in 2019 to 178.50 in 2021 (with 185.0 positions in 2020).

The number of authorized positions of oral surgeons in departments providing outpatient dental care in the Krasnodar Territory increased by 3.5 positions (1.6%) between 2019 and 2021: from 215.75 in 2019 to 217.50 in 2020, and 219.25 in 2021 (Fig. 2).

 

Fig. 2. Number of authorized and filled positions of oral surgeons in outpatient departments of state medical organizations of the Krasnodar Territory, 2019–2021.

 

At the same time, the number of filled positions of oral surgeons providing outpatient care decreased by 5.75 positions (3.4%), from 171.75 in 2019 to 166.0 in 2021 (with 172.25 positions in 2020).

The number of authorized positions of oral surgeons in departments providing inpatient medical care across medical organizations of the Krasnodar Territory decreased by 2.25 full-time equivalents (14.0%) during 2019–2021: from 16.0 positions in 2019 to 16.25 in 2020 and 13.75 in 2021 (Fig. 3).

 

Fig. 3. Number of authorized and filled positions of oral surgeons in inpatient departments of medical organizations of the Krasnodar Territory, 2019–2021.

 

At the same time, the number of filled positions of oral surgeons in departments providing inpatient medical care across medical organizations of the Krasnodar Territory decreased by 3.0 full-time equivalents (19.4%): from 15.50 in 2019 to 12.50 in 2021 (with 12.75 positions in 2020).

The number of individual staff members—full-time employees in filled positions of oral surgeons with an assigned qualification category—in medical organizations of the Krasnodar Territory during 2019–2021 is presented in Table 1.

 

Table 1. Number of physical persons employed as dentists-surgeons, qualified in medical organizations of Krasnodar Territory for 2019–2021

Year	No. of full-time oral surgeons in authorized (filled) positions	Of these, in departments providing medical care		Holding a qualification category (from col. 1)
		Outpatient care	Inpatient care	Highest	First	Second
	1	2	3	4	5	6
2019	188	173	15	39	11	7
2020	185	174	11	35	9	6
2021	172	162	10	35	14	10

 

The number of individual staff members—full-time employees in filled positions—decreased by 16 persons (8.5%) over the study period, both in outpatient departments (by 11 persons [6.4%]) and in inpatient departments (by 5 persons [33.3%]).

The number of oral surgeons employed as full-time staff with a qualification category was as follows: 57 (30.3%) in 2019, 50 (27.0%) in 2020, and 59 (34.3%) in 2021. During the reporting period, the number of oral surgeons with the highest qualification category decreased by 4, whereas the number of surgeons holding the first category increased by 3 and the second category also increased by 3.

The number of individual staff members in filled positions holding a specialist certificate, an accreditation certificate, and those on maternity or long-term leave is presented in Table 2.

 

Table 2. Number of full-time oral surgeons in authorized (filled) positions with a specialist certificate, an accreditation certificate, or on maternity/extended leave in state medical organizations of the Krasnodar Territory, 2019–2021

Year	No. of full-time oral surgeons in authorized (filled) positions	Holding a specialist certificate (from col. 1)	Holding an accreditation certificate (from col. 1)	On maternity or extended leave (from col. 1)
	1	2	3	4
2019	188	184	3	5
2020	185	180	4	4
2021	172	164	8	5

 

The number of oral surgeons employed as full-time staff with a specialist certificate was 99.5% in 2019, 97.3% in 2020, and 95.3% in 2021, decreasing by 23 in absolute numbers over the three-year period. Conversely, the number of oral surgeons with an accreditation certificate increased by 5. Both in the baseline and reporting periods, 5 surgeons were on maternity or long-term leave. Throughout the study period, 100% of oral surgeons were accredited, holding either specialist certificates and/or accreditation certificates.

Staffing adequacy of established positions by headcount and the part-time employment ratio for oral surgeons in medical organizations of the Krasnodar Territory in 2019–2021 are presented in Table 3. Staffing adequacy by headcount decreased by 7.3% during the study period, amounting to 73.8% in 2021. This reduction occurred both in outpatient departments (6.3% decrease) and inpatient departments (21.2% decrease). The part-time employment ratio over the three years did not change overall and remained at 1.0 in outpatient care, but in inpatient care it increased from 1.0 in 2019 to 1.3 in 2021.

 

Table 3. Staffing adequacy and part-time employment ratio of oral surgeons in state medical organizations of the Krasnodar Territory, 2019–2021

Parameter		Year
		2019	2020	2021
Total	Staffing adequacy, %	81.1	79.1	73.8
	Part-time employment ratio	1.0	1.0	1.0
Outpatient care	Staffing adequacy, %	80.2	80.0	73.9
	Part-time employment ratio	1.0	1.0	1.0
Inpatient care	Staffing adequacy, %	93.8	67.7	72.7
	Part-time employment ratio	1.0	1.2	1.3

 

Staffing adequacy of filled positions by oral surgeons in medical organizations of the Krasnodar Territory decreased by 4.2% during the study period, with a 3.9% reduction in outpatient care and a 6.0% reduction in inpatient care (Fig. 4).

 

Fig. 4. Dynamics of staffing adequacy with filled positions of oral surgeons in state medical organizations of the Krasnodar Territory, 2019–2021, %.

 

The availability of oral surgeons per 10,000 population during 2019–2021 did not change and remained at 0.3 annually.

According to statistical data, the shortage of individual oral surgeons amounted to 44.0 in 2019, 49.0 in 2020, and 61.0 in 2021. Of these, in the outpatient–polyclinic sector: 42.8 in 2019, 43.5 in 2020, and 57.3 in 2021; in inpatient care: 1.0 in 2019, 5.0 in 2020, and 3.8 in 2021.

On average, the shortage of individual oral surgeons increased by 17.0 between 2019 and 2021, including 14.5 in the outpatient–polyclinic sector and 2.8 in inpatient care.

Secondary Results

The study did not assess secondary outcomes.

Adverse events

No adverse events were reported in the study.

DISCUSSION

According to Article 10 of Federal Law No. 323-FZ², one of the key components of accessibility and quality of medical care is the availability of an adequate number of health care professionals and the level of their qualifications. This is ensured through procedures of licensing of medical activities, certification, and accreditation of medical personnel [2].

Dental professionals who have received higher education in Dentistry; completed residency training in Oral Surgery or professional retraining in Oral Surgery provided they previously completed internship/residency training in General Dentistry or Dentistry; and who have undergone certification, primary specialized accreditation, or periodic specialized accreditation for professional development and career advancement must comply with the requirements for the relevant dental specialties according to regulatory documents, including:

• Order No. 984 of the Ministry of Science and Higher Education of the Russian Federation dated August 12, 2020, On Approval of the Federal State Educational Standard of Higher Education—Specialist Degree “31.05.03 Dentistry” (with amendments and additions)³ (hereinafter, Order No. 984);
• Order No. 1083n of the Ministry of Health of the Russian Federation dated November 22, 2021, On the Procedure and Timing for Medical Workers and Pharmaceutical Workers to Undergo Certification for Obtaining a Qualification Category⁴ (hereinafter, Order No. 1083n);
• Order No. 1043n of the Ministry of Health of the Russian Federation dated December 22, 2017 (as amended on August 4, 2020), On Approval of the Terms and Stages of Specialist Accreditation, as well as the Categories of Persons with Medical, Pharmaceutical, or Other Education Subject to Specialist Accreditation (Registered with the Ministry of Justice of the Russian Federation on January 19, 2018, No. 49696)⁵ (hereinafter, Order No. 1043n).

In accordance with Order No. 1043n, specialist accreditation is conducted.⁵ According to Order No. 1083n,⁴ the certification of medical and pharmaceutical professionals is carried out to ensure their right to obtain a qualification category, as regulated by Article 72 of this order. The rights of medical and pharmaceutical professionals, as well as measures for their professional incentives, are outlined in Federal Law No. 323-FZ.² Based on the results of certification, a second, first, or highest qualification category may be awarded. Specialists undergo certification once every five years, except for certification to obtain a higher qualification category. Certification for a higher qualification category may be undertaken no earlier than two years after the issuance of the act conferring the previous qualification category.⁵ The primary pathways for professional development of specialists include continuing professional education programs, professional retraining, clinical internships, training in simulation centers, education through modern distance learning technologies (educational portals and webinars), and participation in congresses, scientific conferences, and master classes [1].

In the course of their professional activities, oral surgeons provide highly qualified, specialized dental care in accordance with the established regulations and standards of medical care:

• Order No. 786n of the Ministry of Health of the Russian Federation dated July 31, 2020, On Approval of the Procedure for the Provision of Medical Care to the Adult Population for Dental Diseases (as amended;⁶ hereinafter, Order No. 786n).
• Order No. 910n of the Ministry of Health of the Russian Federation dated November 13, 2012, On the Approval of the Procedure for Providing Medical Care to Children with Dental Diseases (as amended).⁷

According to Order No. 786n,⁶ the staffing standard for oral surgeons is recommended at 1.5 full-time positions per 10,000 adults.

By Order No. 478 of the Ministry of Health of the Krasnodar Territory dated February 16, 2023, On the Improvement of Medical Care for Dental Diseases in the Adult Population of the Krasnodar Territory, a “Routing Scheme for the Provision of Medical Care for Dental Diseases in the Adult Population of the Krasnodar Territory” was approved.⁸ This routing scheme helps to ensure accessibility and certain quality criteria of dental care in the context of a shortage of dental personnel in the Krasnodar Territory.

The analysis of staffing adequacy of oral surgeons providing care to the population in state medical organizations of the Krasnodar Territory demonstrated an increase in the number of authorized positions both overall across organizations and in those providing outpatient care. At the same time, there was a reduction in the number of positions in inpatient settings, as well as a decline in the number of filled positions overall across organizations, including both outpatient and inpatient facilities. A decrease was also observed in the number of individuals—full-time staff members in filled positions—both overall and in those providing outpatient and inpatient care. Furthermore, there was a reduction in the number of oral surgeons holding the highest qualification category, accompanied by an increase in the number of dentists with the first and second categories. Additionally, the number of individuals—full-time staff members in filled positions—holding a specialist certificate decreased, while the number of those holding an accreditation certificate increased. Staffing adequacy of both established and filled positions for oral surgeons in medical organizations of the Krasnodar Territory declined in both outpatient and inpatient settings. During the study period, the availability of oral surgeons in the Krasnodar Territory remained virtually unchanged, amounting to 0.3 per 10,000 population.

As of 2019, workforce requirements were calculated according to Order No. 322 of the Ministry of Health of the Russian Federation dated June 26, 2014, On the Methodology for Calculating the Need for Medical Personnel, which was repealed following the adoption of Order No. 974 dated November 29, 2019, On the Approval of the Methodology for Calculating the Need for Medical Personnel.⁹ Consequently, different methodologies were applied to calculate the demand for medical personnel (including oral surgeons) over the study period. When determining the need for medical personnel in a constituent entity of the Russian Federation, the following factors are taken into account: morbidity patterns stratified by sex and age; territorial characteristics; the presence of localities more than 300 km from medical organizations providing specialized care; the age structure of physicians employed in medical organizations; data contained in federal statistical form No. 30 Information on the Medical Organization; and planned volumes of medical care established by the territorial program of state guarantees for free medical care for the population, as approved in the constituent entity of the Russian Federation.

On average, the shortage of oral surgeons increased by 17.5 individuals from 2019 to 2021, including an increase of 14.5 in the outpatient-polyclinic sector and 2.8 in inpatient care.

The population growth in the Krasnodar Territory during the study period, largely driven by migration, created the need for an expanded medical workforce. However, the ratio of oral surgeons per 10,000 population did not change due to the reduction in the number of individuals—primary staff members in filled positions [3].

Scientific studies by other authors addressing key issues of contemporary health care—including workforce shortages, specialists outmigration, the increasing demand for health professionals in parallel with overall population growth, and the need for efficient utilization of medical workforce resources in accordance with the potential needs of the population for dental care—together with the findings of the present study demonstrating insufficient staffing of oral surgeons, confirm the necessity for further improvement of workforce support within the state health care system of the Krasnodar Territory [1, 3–6].

The main supplier of medical personnel in the Krasnodar Territory is Kuban State Medical University. One of the strategic directions of its activities is the training of qualified, competitive specialists, supporting young professionals in employment, and facilitating their professional adaptation to the conditions of a constantly changing labor market. These efforts contribute to providing medical organizations of the Krasnodar Territory with specialists, including those in dentistry. The demand for specialists in medical organizations of the Krasnodar Territory is confirmed annually through job fairs, career days, and employment assistance seminars organized by the Center for Graduate Employment Assistance of Kuban State Medical University for students, graduates, residents, and doctoral candidates. Through interagency collaboration between Kuban State Medical University, the Ministry of Health of the Krasnodar Territory, the Ministry of Labor and Social Development of the Krasnodar Territory, and the Ministry of Education, Science, and Youth Policy of the Krasnodar Territory, medical organizations in the region are provided with new medical personnel [7–9].

Summary of Primary Results

The staffing adequacy of state medical organizations in the Krasnodar Territory with oral surgeons demonstrated the necessity for further improvement of workforce provision in this specialty within the regional public health care system. Overall, medical organizations in the Krasnodar Territory exhibited an increase in the number of authorized and filled positions for oral surgeons, a decrease in the number of individual full-time employees occupying these positions, and a reduction in the staffing ratio of filled positions by individual practitioners.

Discussion of Primary Results

The conducted analysis of staffing adequacy in the regional health care system, using the example of oral surgeons in the Krasnodar Territory between 2019 and 2021, revealed the following trends: an increase in the number of a authorized positions both overall and in outpatient settings; a decrease in the number of authorized positions in inpatient units; a reduction in the number of filled positions overall, both in outpatient and inpatient settings; a decrease in the number of individual full-time employees occupying positions overall in medical organizations of the territory, as well as in outpatient and inpatient care; a reduction in the number of individual full-time employees holding the highest qualification category, alongside an increase in the number holding the first and second categories; a decrease in the number of individual full-time employees with a specialist certificate, with a simultaneous increase in those holding an accreditation certificate; and a reduction in the staffing ratio of individual employees and filled positions for oral surgeons in the medical organizations of the Krasnodar Territory, attributable to declines in both outpatient and inpatient units.

Study Limitations

No limitations were identified at any stage of the study.

CONCLUSION

The analysis of staffing adequacy of oral surgeons in state medical organizations of the Krasnodar Territory revealed an increase in the number of authorized and filled positions for oral surgeons, a reduction in the number of individual full-time employees occupying these positions, and a decrease in staffing ratios of individual practitioners and filled positions. These findings underscore the necessity for further improvement in the workforce provision of oral surgeons within the public health care system of the Krasnodar Territory.

ADDITIONAL INFORMATION

Funding sources: The authors report no external funding for this study or its publication.

Conflict of interests: The authors declare no explicit or potential conflicts of interests associated with the study and publication of this article.

Author contributions: T.A. Shiltsova, S.K. Akhedzhak-Naguze—concept and implementation of research, data collection, analysis and interpretation, text writing and editing; A.A. Naguze—research design, statistical analysis, data collection and analysis of literary sources, preparation and writing of the text of the article.

All authors affirm their compliance with the international ICMJE criteria (all authors made substantial contributions to the conceptualization, research, and manuscript preparation, and reviewed and approved the final version prior to publication).

 

¹ Order No. 707n of the Ministry of Health of the Russian Federation dated October 8, 2015 (as amended on September 4, 2020), On the Approval of Qualification Requirements for Medical and Pharmaceutical Workers with Higher Education in the field of Health Care and Medical Sciences (registered by the Ministry of Justice of the Russian Federation on October 23, 2015, No. 39438). Available at: https://base.garant.ru/71231064/ Accessed on April 12, 2023. Appendix: Amendments to Order No. 707n. Available at: https://base.garant.ru/406891404/53f89421bbdaf741eb2d1ecc4ddb4c33/#block_1001https://base.garant.ru/406891404/53f89421bbdaf741eb2d1ecc4ddb4c33/ - block_1001 Accessed on February 27, 2024.

² Federal Law of the Russian Federation No. 323-FZ dated November 21, 2011 (as amended on December 25, 2022), On the Fundamentals of Health Protection of Citizens in the Russian Federation (with amendments and additions effective March 5, 2024). Available at: https://www.consultant.ru/document/cons_ Accessed on April 7, 2023.

³ Order No. 984 of the Ministry of Science and Higher Education of the Russian Federation dated August 12, 2020, On Approval of the Federal State Educational Standard of Higher Education—Specialist Degree “31.05.03 Dentistry” (as amended). Available at: https://internet.garant.ru/#/ Accessed on October 13, 2022.

⁴ Order No. 1083n of the Ministry of Health of the Russian Federation dated November 22, 2021, On the Procedure and Timing for Medical Workers and Pharmaceutical Workers to Undergo Certification for Obtaining a Qualification Category. Availible at: https://internet.garant.ru/#/document/403137045/paragraph/14/ Accessed on: October 13, 2022. Amended by Order No. 458n of the Ministry of Health of the Russian Federation dated August 31, 2023, On Approval of the Procedure and Terms for Medical and Pharmaceutical Workers to Undergo Certification for Obtaining a Qualification Category. Available at: https://base.garant.ru/407780878/#block_2 Accessed in 2024.

⁵ Order No. 1043n of the Ministry of Health of the Russian Federation dated December 22, 2017 (as amended August 4, 2020), On Approval of the Terms and Stages of Accreditation of Specialists, as well as Categories of Persons with Medical, Pharmaceutical, or Other Education Subject to Accreditation (registered by the Ministry of Justice of the Russian Federation, January 19, 2018, No. 49696). Available at: https://base.garant.ru/71859808/ Accessed on April 12, 2023.

⁶ Order No. 786n of the Ministry of Health of the Russian Federation dated July 31, 2020, On Approval of the Procedure for Providing Medical Care to the Adult Population for Dental Diseases (as amended). Available at: https://internet.garant.ru/#/document/74710260/paragraph/59:4 Accessed on October 13, 2022.

⁷ Order No. 910n of the Ministry of Health of the Russian Federation dated November 13, 2012, On the Approval of the Procedure for Providing Medical Care to Children with Dental Diseases (as amended). Available at: https:// Accessed on October 13, 2022.

⁸ Order No. 478 of the Ministry of Health of the Krasnodar Territory dated February 16, 2023, On Improving the Provision of Medical Care for Dental Diseases in the Adult Population of the Krasnodar Territory (including the “Routing scheme for providing medical care for dental diseases to the adult population of the Krasnodar Territory”).

⁹ Order No. 974 of the Ministry of Health of the Russian Federation dated November 29, 2019, On Approval of the Methodology for Calculating the Demand for Medical Personnel. Available at: https://minzdrav. Accessed on April 27, 2023.

About the authors

Tatyana A. Shiltsova

Kuban State Medical University

Email: TShiltsova@yandex.ru
ORCID iD: 0000-0002-5541-7570
SPIN-code: 4642-0729
ResearcherId: ABC-7411-2021

Cand. Sci. (Economics), Associate Professor

Russian Federation, Krasnodar

Saida K. Akhedzhak-Naguze

Kuban State Medical University

Author for correspondence.
Email: naguzesk@mail.ru
ORCID iD: 0000-0002-1573-9970
SPIN-code: 7242-1101
Scopus Author ID: 57220934004
ResearcherId: AAВ-7865-2022

MD, Cand. Sci. (Medicine), Associate Professor

Russian Federation, Krasnodar

Adam A. Naguze

Russian State University of Justice

Email: naguze2014@yandex.ru
ORCID iD: 0000-0003-3474-4203
SPIN-code: 6104-9412
ResearcherId: GYE-2969-2022
Russian Federation, Krasnodar

References

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