Article 8 - AJOMS Vol. 1 2024 - "Survey of Australian & New Zealand Oral & Maxillofacial Surgeons"

AJOMS Vol One 2024

Australasian Journal of

ORAL AND MAXILLOFACIAL SURGERY Official journal of the Australian and New Zealand Association of

Editor

Oral and Maxillofacial Surgeons and the Oceania Region

Professor A Goss editorajoms@anzaoms.org Deputy Editors Professor A Heggie AM Professor D Wiesenfeld

+61 2 8091 0535 ISSN: 2982-0065

ajoms@anzaoms.org

Level 13, 37 York Street, Sydney NSW 2000

The Australasian Journal of Oral & Maxillofacial Surgery is the official scientific journal of the Australia & New Zealand Association of Oral &

F O U N D AT I O N E D I T O R

EDITORIAL BOARD

Alastair Goss

Business Manager Dieter Gebauer

• Emeritus Professor of Oral & Maxillofacial Surgery, The University of Adelaide • Emeritus Consultant Surgeon, The Royal Adelaide Hospital Adelaide, Australia

Perth, Australia

Maxillofacial Surgeons.

DEPUTY EDITORS Aim & Scope The Australasian Journal of Oral & Maxillofacial Surgery is the premier forum for the exchange of information for new and significant research in oral and maxillofacial surgery, promoting the surgical discipline in the Oceanic region.

Oceania comprises 19 countries, spread over one sixth of the globe, but with Australia and New Zealand being the dominant developed countries.

The Journal comprises peer reviewed scientific reports, reviews, case reports of rare of unusual conditions, and perspective all of value for continuing professional development.

Information for prospective authors, including author guidelines, publication ethics, malpractice statements and patient consent forms are available for download from the Australian & New Zealand Association Oral & Maxillofacial Surgery homepage. All correspondence with the Editor is via editorajoms@anzaoms.org.

Andrew Heggie, AM

• Clinical Professor, Department of Paediatrics, The University of Melbourne • Senior Consultant Oral & Maxillofacial Surgeon, Royal Children’s Hospital of Melbourne Melbourne, Australia

David Wiesenfeld

• Honorary Clinical Professor, The University of Melbourne • Lead in Head & Neck Research & Education, The Victorian Comprehensive Cancer Centre Melbourne, Australia

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The Australasian Journal of Oral & Maxillofacial Surgery Editors and Editorial Board cannot be held responsible for error or consequence arising from the information contained in the Journal. The views and opinions expressed there do not necessarily reflect those of the Australian & New Zealand Association of Oral & Maxillofacial Surgeons, AJOMS Editor or Editorial Board.

Neither does publication of advertisements constitute any endorsement of the products advertised. © Copyright 2024 ANZAOMS

Electronic Promotion Arun Chandu • Senior Consultant in Oral & Maxillofacial Surgery, Royal Dental Hospital of Melbourne • Clinical Associate Professor of Oral & Maxillofacial Surgery, The University of Melbourne Melbourne, Australia

Members Alexander Bobinskas • Consultant Oral & Maxillofacial Surgeon, The Canberra Hospital • Research Fellow, The John Curtin School of Medical Research Canberra, Australia

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• Senior Consultant in Oral & Maxillofacial Surgery, Royal Perth Hospital • Clinical Associate Professor in Oral & Maxillofacial Surgery, The University of Western Australia

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Darryl Tong • Professor of Oral & Maxillofacial Surgery, The University of Otago • Senior Consultant in Oral & Maxillofacial Surgery, Dunedin Public Hospital Dunedin, New Zealand

Ex Officio Members Jasvir Singh • President, Australian & New Zealand Association of Oral and Maxillofacial Surgeons • Consultant in Oral & Maxillofacial Surgery, Prince of Wales Hospital Sydney Australia

Patrishia Bordbar • Immediate Past President, Australian & New New Zealand Association of Oral & Maxillofacial Surgeons • Consultant in Oral & Maxillofacial Surgery, The Royal Children’s Hospital of Melbourne • IAOMS Executive Representative – Oceania Region Melbourne, Australia

John Harrison • Regional Councillor for Oceania, International Association of Oral & Maxillofacial Surgery • Senior Consultant in Oral & Maxillofacial Surgery, Auckland City & Middlemore Hospital Auckland, New Zealand

Jocelyn Shand • Clinical Associate Professor, Department of Paediatrics, The University of Melbourne • Chair, Australian & New Zealand Association of Oral & Maxillofacial Surgeons Research & Education Foundation • Head of Section of Oral & Maxillofacial Surgery, The Royal Children’s Hospital of Melbourne • Vice President Elect, International Association of Oral & Maxillofacial Surgery Melbourne, Australia

S C O P E A N D W O R K F O R C E ANZAOMS REPORT

SURVEY OF AUSTRALIAN AND NEW ZEALAND ORAL AND MAXILLOFACIAL SURGEONS 2020 Forty years on monitoring scope and workforce

Ricciardo PV (BSc, BDSc, MBBS, FRACDS (OMS), MRCPS)†

ABSTRACT

Vujcich NJ (BDSc (Hons), MBBS (Hons), FRACDS (OMS))†

Introduction:

Bobinskas AM (MBBS, BOH, GradDip (Dent), MPhil, FRACDS (OMS), FRCS (OMFS))‡ Goss AN (DDSc, FRACDS (OMS))§

† Department of Oral & Maxillofacial Surgery, Royal Perth Hospital, Perth, Western Australia, Australia

Australian and New Zealand oral and maxillofacial surgeons have conducted detailed scope and workforce studies over the last 40 years.

This paper presents the 2020 results and compares them to past results and the international scene.

Method:

‡ Canberra Hospital, Australian Capital Territory, Australia

An electronic survey consisting of over sixty questions was forwarded

§ Oral & Maxillofacial Surgery Unit, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia

Zealand.

to all registered oral and maxillofacial surgeons in Australia and New

Results: One hundred and ninety-five surveys were forwarded and complete

Corresponding author: PETER RICCIARDO Royal Perth Hospital Perth, Western Australia, Australia Email: petericciardo@hotmail.com

replies received for 116: a response rate of 59%.

Conclusion: After 40 years oral and maxillofacial surgery in Australia and New Zealand is achieving its goal of being a well-qualified surgical speciality with a wide scope delivering high quality services to the community. Its workforce privately is well balanced but with a need for more in public practice.

Keywords: Australia | New Zealand | oral and maxillofacial surgery | scope | workforce AJOMS Volume 1 2024 |

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INTRODUCTION

The specialty of oral and maxillofacial surgery (OMS) in Australia and New Zealand has undergone major changes in the last 40 years. Training in the 1960s and 1970s was individual, without standardisation, and this was subject of criticism from the medical surgical specialties. A full review of training by the education subcommittee of the Australia and New Zealand Association of Oral and Maxillofacial Surgeons (ANZAOMS) found that the training was predominantly university-based and built upon a dental degree. There was wide variation in not only qualifications but also duration of training. A review published in 1982 titled Oral surgery training in Australia and New Zealand: A plan for the eighties made three recommendations: a joint advisory committee should be set up to standardise training and specialist requirements across Australia and New Zealand; a survey of all current OMS specialist, trainees, and training programs should be performed; and the minimum requirement for training should be established.1 The process of implementing these recommendations has extended ever since.

In 1988, the Board of Studies in OMS of the Royal Australasian College of Dental Surgeons, (RACDS) was established and the requirements for the fellowship [FRACDS)(OMS)] were developed. This involved accreditation of training centres and trainees. Initially this was dentally based, but by 1994 training required registrable, medical and dental degrees, (dual degree) and hospital based surgical training for a minimum of four years, with the exit examination for Fellowship, the FRACDS(OMS).2 This model has been refined progressively since then. OMS received recognition as a principal surgical speciality in 1998 from the Commonwealth Government of Australia. The pathway has not been straightforward and has been driven by the leaders of the speciality. The full story is the subject of a book titled From extraction to reconstruction. The development of oral and maxillofacial surgery in Australia and New Zealand.3 Monitoring of progress has been a key component. The baseline studies were in the subcommittee report and a postal survey of all full members of ANZAOMS in 1986.1,4 The effect of training on scope from the same dataset was analysed separately. 5 In 1986, only eight registered specialists had the FRACDS, DOS – the Diploma in Oral Surgery which was the forerunner of the FRACDS(OMS) – and of these, six were dentally qualified and two were dually qualified. These studies showed that, in the 1980s, most oral and maxillofacial surgeons (89%) were dentally qualified with four years of postgraduate training (81%). A smaller subset had both medical and dental degrees (dual, 11%) and only 19% had less than three years of training. In general, the greater the training, the greater the scope of practice. Dentoalveolar surgery, particularly for those in full-time private practice, was the bulk of practice scope.6 The second group of studies relate to the period 1986-1995. During this period, the national dual degree program with a minimum of four years training was instituted.

These studies compared those who had recently completed their training and those who were currently in training. By 1996, 33% of recent specialists were dual degree FRACDS(OMS) and 84% of the trainees were on a dual degree FRACDS(OMS) track.7,8 An integrated logbook of surgical experience of trainees was also evaluated. 9

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The extent of continuing professional development (CPD) of the whole workforce was also investigated.10 A detailed workforce evaluation including the projected needs for

RESULTS

the OMS workforce was carried out by the Australasian Institute of Health and Welfare, Dental Statistics and

One hundred and sixteen useable replies were received

Research Unit, which is based at The University of

from the 195 questionnaires sent out. The response rate of

Adelaide.6 All of these studies were sponsored by

59% was less than previous studies which received 83%,

ANZAOMS and funded by its Research and Education

70%, and 77% responses.4,5,7,8

Foundation.11-13 The 2011 workforce study found a broadening scope of

Procedure

2011

2020

Orthognathic

67%

98%

Mandibular osteotomy

NQ

95%

Maxillary osteotomy

NQ

93%

Segmental maxillary osteotomy

NQ

81%

Although Australia and New Zealand are neighbouring

Subapical osteotomy

NQ

28%

countries with many similarities there are also some marked

Zygomatic osteotomy

NQ

47%

differences in the provision of health services. These have

Temporary Anchorage Device

NQ

80%

Ablative

53%

39%

and maxillofacial surgeons in Australia and New Zealand.

Neck Dissection

8%

18%

Comparison is made to past surveys and the international

Microvascular

3%

9%

literature.

Salivary gland

54%

87%

Submandibular

46%

72%

Sublingual

45%

77%

Parotid

10%

22%

Skin Pathology

60%

50%

Arthrocentesis

73%

72%

reference group, refined and forwarded by group email to

Open Joint Surgery

70%

47%

all full members of ANZAOMS. The survey was open for

Total Joint Replacement

4%

28%

a period of two months, and two reminders were sent to

Aesthetic Surgery

4%

28%

potential participants.

Blepharoplasty

NQ

8%

Facial Feminisation

NQ

3%

NQ

21%

practice related to the dual degree requirement. The study also confirmed that increased training numbers were required to keep up with the increase in population and the number of general health practitioners.14

been separately explored and documented in a recent study.15 The aim of the present study was to document the current training, scope, and workforce situation for oral

16-18

METHODS A detailed 60-question questionnaire was developed based on previous questionnaires. It was trialled by a small

Malignant Pathology

TMJ

Procedure

2011

2020

Facial Implants (alloplastic)

Dentoalveolar

99%

99%

Rhinoplasty

3%

11%

41%

Rhytidectomy

0%

3%

99%

Injectables

3%

15%

15%

28%

Tooth transplant Dental Implants

88%

Craniofacial Implants

56%

38%

Cleft Lip and Palate Surgery

Open sinus lift

NQ

94%

Primary Palate and Lip

4%

2%

Trauma

77%

89%

Secondary Grafting

27%

60%

Mandible

52%

89%

Secondary Growth/Orthognathic

27%

67%

Maxilla

66%

88%

Craniofacial

Nasal

61%

77%

Craniofacial Implants

30%

38%

Zygoma

51%

85%

Cranioplasty

7%

9%

Orbital

42%

80%

Distraction Osteogenesis

NQ

27%

75%

Facial implants (alloplastic)

NQ

28%

Frontal

33%

Table 1 Scope of surgery performed in 2020 is compared to 201115

NQ: Question not asked in the 2011 questionnaire.

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Female surgeons were slightly under-represented (10%)

37% in 2011. Orthognathic surgery included bimaxillary

in the survey compared to 13% ANZAOMS membership.

advancement surgery for obstructive sleep apnoea. There

This proportion is similar to the United Kingdom in 2020,

was also an increase in head-and-neck cancer surgery

recording 13.2% female OMS consultant workforce, while

including both ablative and reconstructive. A number of

a United States sample survey had a response of 20.5%

surgeons were trained in microvascular surgery.

female surgeons.16-18 There was an increase in temporomandibular joint Sixty-seven per cent of surgeons were born in either

replacement (from 4% in 2011) with surgeons across

Australia (53%) or New Zealand (14%), and 94% of

all states offering this procedure. Twenty-eight per

surgeons qualified in Australia or New Zealand. Eighty-four

cent of surgeons now perform TMJ replacement, with

per cent of surgeons have the FRACDS (OMS) qualification.

7% of surgeons operating on more than 10 cases per

This has increased from 77% in 2011, and correlates

year. This has led to ANZAOMS, in association with

with the retirement of surgeons with prior recognition of

the Australian Orthopaedic Association, establishing a

qualification – particularly Master qualifications. Eighty-

temporomandibular joint replacement registry comparable

eight (76%) surgeons had both medical and dental degrees

to the national hip and knee registries.

plus the FRACDS(OMS). Ten years prior, only 42% were dual-qualified. 8

There has been a marked increase in interest in aesthetic surgery with 33 (28%) surgeons being actively involved

This pattern is similar in the USA. OMS residency is

in placement of facial implants, dermal fillers, rhinoplasty,

accredited by the Commission on Dental Accreditation

rhytidectomy and liposuction. Only 13% of surgeons were

(CODA), dual-degree surgeons often practice under the

involved in aesthetic surgery in 2011.14

auspices of both Doctor of Dental Surgery/Doctor of Dental Medicine and Doctor of Medicine (MD) licensures. In 1986

The greatest number of surgeons were interested in

there were five dual-degree residency programs; 30 in

increasing their subspecialty skills in aesthetic surgery

1990; 46 today, along with 54 single-degree programs.

18

Sixty-four (54%) surgeons had post-training fellowships of at least one-year duration. These fellowship qualifications were in trauma (16%), temporomandibular joints (TMJ) (15%),

(21%). Other areas of interest (in descending order) were temporomandibular joint replacement, oncology, salivary pathology, cleft, skin, orthognathic, reconstruction and craniofacial surgery.

oncology (15%), orthognathic (14%), craniofacial/paediatric

Seventy-four per cent of respondents are comfortable

(11%), head and neck reconstruction (9%), salivary gland

performing tracheostomy, and 39% have performed this

disease (7%), cleft (4%), skin (4%), facial aesthetic surgery

procedure in a theatre emergency. Forty-eight per cent of

(4%), and dentoalveolar surgery (3%).

The scope of surgery performed as compared to 2011 is presented in Table 1.14 Dentoalveolar surgery remains the core scope of the speciality. Fifty-eight (50%) surgeons reported performing third molar surgery on more than 500 patients per year. Forty-eight (41%) surgeons placed more than 100 dental implants per year. Eighty-one (70%) surgeons received more than 80% of their referrals from dentists.

Generally, most oral and maxillofacial surgeons participating in the survey had a wider scope of practice, with 54% of respondents proceeding to postgraduate fellowship.

Eighty-one per cent of postgraduate fellowships were for one year or longer in duration, and 49% of postgraduate fellows attended two or more fellowships. Of the respondents, 54% attended a postgraduate fellowship in

respondents have performed CPR in theatre.

The projected number of oral and maxillofacial surgeons in different recruitment scenarios was first presented in the workforce study based on a consensus approach projection (Figure 1).6 The maximum number of newly qualified surgeons was put at 10 per year (from 2010) whereas the current actual number is 12 to 14 per year.

However, this projection stopped at 2011 when the population of Australia was projected to be approximately 20 million. The population of Australia has increased more than anticipated, with the population reaching 22.48 million in 2011 and had reached 26.3 million by 2020.19 Thus, the number of newly qualified surgeons is within the recommended limits.

A further consideration is length of time to retirement (Figure 2). This study found that 25% of currently practicing surgeons intended to retire within the next five years and

the UK, 37% in Australia, and 29% in the USA.

40% within 10 years. By then the OMS surgical workforce

Forty per cent of surgeons operate more than 20

retirement of all those dental-only qualified.

orthognathic surgery cases per year, compared with

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will be homogeneous as dual-degree fellows, with the

The typical hours of work per week are presented in

Figure 3. Sixty-two per cent of surgeons felt they were as busy as

Surgeons (number) 250

they wished to be, while 24% felt they were too busy. Ten per cent of surgeons regularly perform elective

f

200

operations on a Saturday. Most surgeons worked 41-50 hours per week, while one third worked more

x e x

150

than 51 hours per week. Thirty-four per cent of respondents felt they

x x

x

x

x x

x x

x d

x

c b a

100

were overworked. Sixty-two per cent felt that the number of surgeons in private practice was about right.

50

(Figure 4). The reverse was so for the perception of the number of surgeons in the public workforce with most respondents (53%) believing that there were too few (Figure 5). The number of surgeons in public employ is of particular concern in New

0 1991

1996

2001

2006

2011

2016

2021

Figure 1 Projection for the number of OMS in Australia under different recruitment models.

Superior line (f) expressed an incremental increase to 10 new surgeons per year from 2010.

Note: This is based on an underestimate of Australian population growth (20M) as compared to actual (22.48M) in 2010. The actual population in 2020 is 21.3M

Zealand, to the extent that a formal enquiry has been established.20 The issue in both Australia and New Zealand relates mainly to the declining number of full-time public, either academic or hospital, surgeons. There are multiple parttime public positions with 30 (26%) surgeons having academic titles and 80 surgeons (70%) being involved in OMS training.

Appropriate ratios of OMS to other health professionals have been

“This year” “1-5 years” “6 - 10 years” “11 - 15 years” “16 - 20 years” “21 - 25 years” “26 - 30 years” “> 30 years”

established (Table 2). The majority of surgeons are based in the capital

0%

5%

10%

15%

20%

25%

Figure 2 Response to question “When do you intend to retire?”

cities and regional areas, with 10 (9%) practising entirely regionally.

Overall, the majority of oral and

45

maxillofacial surgeons responding

40

– 98 (86%) – were happy with their

35

career and would recommend oral and maxillofacial surgery as a career to recent graduates in dentistry or medicine.

30 25 20 15 10 5 0 “0 - 10” “11 - 20” “21 - 30” “31 - 40” “41 - 50” “51 - 60” “61 - 70” “81 - 90”

Figure 3 Response to question “In a usual week, how many hours do you work?”

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81

60%

50%

40%

30%

20%

10%

0% “Too few”

“The right number”

“Too many” Figure 4 Response to question

“Regarding the number of OMS in the public workforce, there are:”

70% 60% 50% 40% 30% 20% 10% 0% “Too few”

“The right number”

“Too many” Figure 5 Response to the question

“Regarding the number of oral and maxillofacial surgeons in the private workforce there are:”

2020

2010

Australia

New Zealand

Australia

New Zealand

Population

26.3M

5.2M

22.7M

4.0M

Number GDP

16,550

3,330

10,437

1,715

Ratio of GDP to population

1:1,590

1:1,560

1:2,156

1:2,290

Number of GMP

37,785

18,700

43,000

13,883

Ratio of GMP to population

1:696

1:278

1:522

1:310

Number of OMS

238

39

185

36

Ratio of OMS to GMP

1:160

1:480

1:235

1:385

Ratio of OMS to GDP

1:70

1:85

1:57

1:48

Table 2 Workforce of health care practitioners in Australia and New Zealand 202015 GDP: General Dental Practitioners GMP: General Medical Practitioners

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DISCUSSION This study shows that, in the last 40 years, oral and

palates as well as oral and orthognathic surgery. In

maxillofacial surgery in Australia and New Zealand

Germany, a double qualification in medicine and dentistry is

has matured from a heterogeneous, individual dental-

required.22

based training which was non-standardised, to a homogeneous dual-degree hospital-based training

With its origins in dentistry, OMFS is established as one

program at a high standard. This is reflected in the wide

of the 10 United Kingdom surgical specialties. Training

scope of the speciality. Each step along the way has been

requires dual-degree qualification, successful completion of

carefully monitored and peer reviews published.

Core Surgical Training (CST) and passing the Membership

1-15

This

documentation is unique within the full range of surgical

of the Royal College of Surgeons (MRCS) exam. This is

specialities in Australia and New Zealand. It is also unique

followed by a five-year approved training program and exit

internationally in oral and maxillofacial surgery.21

fellowship (FRCS) examination.16,17

More than 80% of the worldwide OMS groups require only

Core OMS in practice is dentoalveolar surgery, orthognathic

a dental degree (North America, Nordic countries, South

surgery, OSA surgery, surgical airway, facial trauma,

East Asia, India, Africa, Latin America, Middle East), less

benign lesions, salivary surgery and TMJ.16,17 Workforce is

than 5% are medically qualified (France, Spain), and the

a balance between recruitment, retirement and community

rest require dual qualification (United Kingdom, Australia,

need, with potential concerns regarding workforce

New Zealand, North Eastern Europe).21

sufficiency when considering population growth, surgeon retirement, and evolving workforce shortages overseas.

Ninety per cent of surgeons in this study consider OMS to be a specialty of dentistry and medicine. In the United

This study shows that oral and maxillofacial surgery in

States, OMS is a specialty of dentistry that focuses on

Australia and New Zealand has evolved considerably

the treatment of injuries, disease and defects of the head,

from 40 years ago. It is now a mature, well-qualified

neck, face, and jaws. In Germany, Oral and Maxillofacial

surgical specialty with a broad scope delivering care to its

Surgery (OMFS) is primarily a medical specialty focused

community.

on the treatment of facial injuries, trauma, oncology, reconstruction, and malformations such as cleft lip and

Survey of Australian and New Zealand Oral and Maxillofacial Surgeons 2020. Forty years on monitoring scope and workforce.

Refe re n ce s 1.

Monsour FN, Goss AN. Oral surgery training in Australia and New Zealand. A plan for the eighties. Education Subcommittee Report. Australian & New Zealand Association of Oral & Maxillofacial Surgeons. 1982.

2.

OMS Training Handbook. Royal Australasian College of Dental Surgeons. https://racds.org/wp-content/uploads/2023/02/RACDS_EXT_ ACA_218_3.0_Accredited-Training-in-OMS-Handbook_March-2023.pdf (Accessed 17 January 2024)

3.

Goss AN, Linn R. Extractions to reconstruction. The development of oral and maxillofacial surgery in Australia and New Zealand. Historical Consultants Pty Ltd. Adelaide, Australia. 2015.

4.

Goss AN, Gerke DC. The scope of oral and maxillofacial surgery in Australia and New Zealand. A postal survey. Aust Dent J 1991;36(1):57-62.

5.

Goss AN, Gerke DC. Effect of training on the scope of oral and maxillofacial surgery. Int J Oral Maxillofac Surg 1990;19(3):184-189.

6.

Spencer AJ, Szuster FS, Brennan DS, Goss AN. A consensus approach to projections of the supply of oral and maxillofacial surgeons in Australia.

Int J Oral Maxillofac Surg 1993;22(5):314-317.

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7.

Szuster FS, Nastri AL, Goss AN, Spencer AJ. Survey of Australian and New Zealand Oral and Maxillofacial Surgery trainees and recent specialists-education and experience. Int J Oral Maxillofac Surg 2000;29(4):305-308.

8.

Szuster FS, Nastri AL, Goss AN, Spencer AJ. Survey of Australian and New Zealand Oral and Maxillofacial Surgery trainees and recent specialists-workforce issues. Int J Oral Maxillofac Surg 2000;29(3):227-30.

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Sambrook P, Smith A, Hewitt G, Goss A. Development of a national clinical logbook system for oral and maxillofacial surgery trainees--the RACDS, OMS system. Int J Oral Maxillofac Surg 1996;25(3):242-4.

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Sambrook P, Goss A. Continuing education for oral and maxillofacial surgeons--new expectations. Ann R Australas Coll Dent Surg 1996;13:1937.

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Brennan DS, Spencer AJ, Singh KA, Teusner DN, Goss AN. Service provision by patient and visit characteristics in Australian oral and maxillofacial surgery: 1990 to 2000. Int J Oral Maxillofac Surg 2004;33(7):700-8.

12.

Brennan DS, Spencer AJ, Singh KA, Teusner DN, Goss AN. Practice activity trends among oral and maxillofacial surgeons in Australia. BMC Health Serv Res 2004;4(1):37.

13.

Szuster FSP, Goss AN, Spencer AJ, et al. Oral and maxillofacial surgeons – 1996 study of trainees and recent specialists. AIHW Catalogue N, Dent 44. AIHW Dental Statistics and Research Unit. The University of Adelaide, Australia. 1998.

14.

Ricciardo P, Bobinskas A, Vujcich N, Nastri A, Goss A. Survey of Australasian oral and maxillofacial surgeons 2011--scope and workforce issues.

Int J Oral Maxillofac Surg 2015;44(12):1569-73.

15.

Bridgman JB, Fulton G, Lou SM-Y, Thomson WM, Goss AN. The New Zealand oral and maxillofacial surgeon workforce in 2017-18: characteristics, practice and prospects. N Z Med J 2020;133(1513):11-22.

16.

Magennis P, Begley A, Dhariwal DK, Smith A, Hutchison I. Oral and Maxillofacial Surgery (OMFS) Consultant Workforce in the UK: reducing consultant numbers resulting from recruitment issues, pension pressures, changing job-plans, and demographics when combined with the COVID backlog in elective surgery, requires urgent action. Br J Oral Maxillofac Surg 2022;60(1):14-19.

17.

Ilankovan V. Training in the United Kingdom: are we fit for purpose? Br J Oral Maxillofac Surg 2020;58(10):1225-1228.

18.

Roudnitsky E, Hooker KJ, Darisi RD, Peacock ZS, Krishnan DG. Influence of residency training program on pursuit of academic career and academic productivity among oral and maxillofacial surgeons. J Oral Maxillofac Surg 2022;80(2):380-385.

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ABS Data. 2012. https://www.abs.gov.au/ausstats/abs@.nsf/lookup/3101.0Media%20Release1Dec%202011

20.

Smith M, Ferguson CA, Thomson WM. Public sector oral health service provision for high needs and vulnerable New Zealanders. Wellington and Dunedin Health Promotion & Policy Research Unit. University of Otago. New Zealand. 2019.

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Goss AN, Helfrick JF, Szuster FS, Spencer AJ. The training and surgical scope of oral and maxillofacial surgeons: the International Survey 1994.

Int J Oral Maxillofac Surg 1996;25(1):74-80.

22.

Zeller AN, Thiem DGE, Bartella AK, et al. Training in oral and maxillofacial surgery in Germany - Residents’ satisfaction and future challenges. J Craniomaxillofac Surg 2021;49(5):415-421.

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