¹BDS, MSD, P.G. Cert., PhD. Department of Prosthetic Dental Science. College of Dentistry, King Saud University, Riyadh, Saudi Arabia.

²BDS, MSD, DABP. Department of Prosthetic Dental Science. College of Dentistry, King Saud University, Riyadh, Saudi Arabia.

³BDS, MSc. Department of Prosthetic Dental Science. College of Dentistry, King Saud University, Riyadh, Saudi Arabia.

⁴BDS, MSc, PhD. Department of Prosthetic Dental Science. College of Dentistry, King Saud University, Riyadh, Saudi Arabia.

⁵BDS, MSD,PhD. Department of Periodontics and Community Dentistry. College of Dentistry, King Saud University. Riyadh, Saudi Arabia.

⁶BDS, MClinDent. Department of Periodontics and Community Dentistry. College of Dentistry, King Saud University. Riyadh, Saudi Arabia.

⁷BDS, MS, Cert Ortho. Division of Orthodontics. Department of Paediatric Dentistry and Orthodontics, College of Dentistry, King Saud University.

Corresponding author email: labbanny@yahoo.com

Article Publishing History

INTRODUCTION

Sustained high stress levels with poor job satisfaction causes burn out syndrome in dental care professionals (DCP) (Myers and Myers, 2004). Poor job satisfaction reduces dentist’s commitment and dedication to organization and increases intention to leave the job (Kay and Scarrott, 1997). Evidence suggests dentists experience highest stress levels (Moore and Brødsgaard, 2001; Stack, 2001). It is important to understand job satisfaction among dentists and how work environment, facilities, staff have an impact on it. Studies have revealed that lowered job satisfaction among healthcare workers is directly linked to increased stress level (Cooper et al., 1988).Measuring job satisfaction is important as it may influence physical and mental health and may affect job related behavior and performance (Bergström et al., 2010). Job satisfaction in dentistry motivates a dentist, provides improvement, satisfaction and pleasure at work, increasing the efficiency, (Puriene et al., 2007,  Lo Sasso et al., 2015a, Alqahtani et al., 2018, Nash and Benting 2019).

This indirectly improves patient care and satisfaction, benefiting dental auxiliaries, patient and dentists. Henceforth, enhancing the success and progress of oral health care and practice (Judge et al., 2001).High suicidal rate associated with poor job satisfaction makes dentistry a hazardous profession (Stack, 2001). However, studies have reported that job satisfaction in dentists can be improved due to flexible working hours, better salary packages, medical insurance and appreciable attitudes of senior faculty (Judge et al., 2001; Lo Sasso et al., 2015a). There are ample job satisfaction surveys done already on dentists, (Goetz et al., 2012; Wells and Winter, 1999) but satisfaction surveys on dental specialities such as prosthodontists, orthodontics, periodontists are very limited and scarce.

Recently, job satisfaction survey on orthodontists have been performed by Alqahtani et al., (2018) in Saudi Arabia yielding high satisfaction rate in the region. Similarly, a study Al-Mudaf et al., (2003) conducted survey among three different dental specialities oral surgery, periodontics and fixed prosthodontics in city of Kuwait claiming all specialities to have high job and patient satisfaction. To our knowledge from indexed literature, evidence related to job satisfaction and motivation factors among prosthodontist working in the Kingdom of Saudi Arabia (KSA) is not available.

Therefore, the aim of the present study, was to evaluate overall job satisfaction among prosthodontist highlighting the significance of intrinsic and extrinsic factors and their satisfaction level with patients, facilities and workplace when working in KSA. The data gathered can give a glimpse of quality of life (QoL) of prosthodontist working in KSA.

MATERIAL AND METHODS

The study was approved by the ethical committee of King Saud University Riyadh Saudi Arabia under ethical number (E18-3360). The study was in accordance to STROBE statement of reporting cross sectional surveys. The duration of the study was three months i.e. from April 2019 to July 2019. A literature review was performed to validate the present cross-sectional survey, which revealed that there was no available data on assessment of job satisfaction amongst prosthodontists. Contact details of registered prosthodontists were requested from the office of Saudi Dental Society. A questionnaire was formulated consisting of total 38 questions in seven domains. Research team of statistician along with authors reviewed the content of each question to make sure that the survey reflected appropriate phrasing and understanding and validation. A total sample size of 100 prosthodontists were well-thought-out but since dropouts, invalid responses were anticipated so a sample size of 150 prosthodontists were considered appropriate. Using power calculation sample size was assessed from a study by Alqahtani et al., (2018) A link containing details of the questionnaire using survey monkey instrument was sent to prosthodontists from the office of Saudi dental Society. Reminder email were sent periodically to improve response rate.

The seven domains of the cross-sectional survey consisted of questions related to socio-demographic characteristics, academic, professional qualifications, motivation behind choice of prosthodontist as a specialty, satisfaction as a prosthodontist, satisfaction with the workplace environment facilities and staff and their satisfaction with their relationship with patients. The questions of the survey were sourced from a study by Alqahtani et al., (2018) and were included in the study with some modification. The responses were measured using a five-point Likert Scale coded as, 1 strongly disagree; 2 disagree; 3, neutral; 4 agree; 5 strongly agree.

Out of the total 150 emails sent to the prosthodontists. 78 (52%) responses were attained. All the responses were evaluated by a single investigator to minimize bias. Statistical Package for the Social Sciences (SPSS Inc., software version 21 Chicago, IL, USA) was used for tabulation of descriptive analysis. Standard deviation (SD), percentages and means were calculated. Comparison between the demographic, academic, professional qualification variables and other domains were explored by comparing mean scores by applying ANOVA.

RESULTS AND DISCUSSION     

The results of 78 respondents revealed highly significant difference among responses to different included questions (p < 0.05). Socio-demographic characteristics, academic and professional qualifications and other demographic factors exhibited that 91.0% (71) were Saudi national. Whereas, 8.9% (7) were non‑Saudis. Gender analysis indicated 53 respondents (67.9%) were male, whereas 25 (32%) were females. Forty-two (53.8%) of the participants had age between 31-40 years. (Table 1)

Table 1: Sociodemographic Characteristics of respondents

Characteristics	Frequency	Percent (%)	Significance
Age of the respondents
< 30 years	10	12.8
31-40 years	42	53.8
41- 50 years	20	25.6
51-60 years	2	2.5
> 60 years	4	5.12
Gender of the respondents
Male	53	67.9	<0.001
Female	25	32.0
Nationality of the respondents
Non-Saudi	7	8.97
Saudi	71	91.0

Table 2 presents the academic qualifications of the respondents. 38 (48.7%) of the dentists had their qualification from Saudi commission of health sciences, by completing the Prosthodontic Saudi board specialist training and examination. While, 15 (19.2%) of the responders completed a master’s degree and certificate in prosthodontic; and only 11(14.1%) had a doctorate degree. The results further revealed that amongst the total respondents, 47 (60.2%) completed their residency program within Kingdom of Saudi Arabia (KSA) while, 28 approximately (35.8%) completed their residency program in a foreign country.

Table 2: Academic qualifications and training of respondents

Education and Training	Frequency	Percent (%)	Significance
Qualifications of the respondents
Certificate in endodontics	14	17.9	<0.001
M.Sc. & Certificate endodontics	15	19.2
Ph.D.	11	14.1
Board	38	48.7
Where did you attend a residency program?
Saudi Arabia	47	60.2	<0.001
Europe	7	8.9
North America (USA & Canada)	21	26.9
Other	3	3.8

Details regarding length of work experience and place of work is enumerated in Table 3. Majority 38 (48.7%) of the participants fall within professional experience of 3–8 years. Followed by 9 respondents who possessed 9-15 years of work experience and only 5 participants had professional experience between 16–25 years.

Table 3: Respondents work experience and related information

Work Experience	Frequency	Percent (%)	Significance
Total length of experience
<3 years	22	28.2	<0.001
3-8 years	38	48.7
9-15 years	9	11.5
16-25 years	5	6.4
> 25 years	4	5.1
Where do you work?
Academic (university based)	37	47.4	<0.001
Private practice	15	19.2
Ministry of health	14	17.9
University clinics	4	5.1
National guard	5	6.4
Armed forces	3	4.5

Moreover, amongst 78 respondents, 37 (47.4%) participants were engaged in academics-based practice, followed by 14 respondents (17.9%) employed by the Ministry of Health (MoH) and 15 (19.2%) were working in a private dental practice.

Motivation for choosing prosthodontic as a speciality: Majority of the respondents, 48 (61.6%), reported “challenging profession” as the main reason for choosing prosthodontic. This was followed by “professional growth,” “financial gains,” “prestigious specialty,” and “family influence.” (Table 4)

Table 4: Respondents motivation for choosing prosthodontics

Reason for choosing periodontics	Frequency	Percent (%)	Significance
Motivation for opting prosthodontics
Professional growth	16	20.5
Prestigious specially	6	5.35
Challenging profession	48	61.6	<0.001
Family influence	2	1.78
Financial gains	6	5.45

Respondents’ satisfaction with the prosthodontist profession:Majority of the participants, 70.3% stated that prosthodontic was their primary choice among all dental specialities. Followed by 49.3% claiming to be satisfied with working quality of auxiliary staff. Furthermore, 63.7% of the subjects were pleased with overall, quality of life as a Prosthodontist. Moreover, 65.5% of the participants were gratified with facilities and resources in the clinics for adequate delivery of quality oral health care. However, 27.3% of the respondents were not content with the income from their prosthodontic practice. In addition, nearly 49.3% of the dentists were unhappy with medical facilities provided to them as job benefits. (Table 5)

Table 5: Satisfaction factors related to the Prosthodontic profession

Satisfaction Factor	Strongly agree +agree	fair	Strongly disagree+ disagree	Significance
Prosthodontic specialty being first choice	70.3	15.5	14.2
My job description and responsibilities where I work are well- defined and clear	67	16	17
Satisfied with working quality of my auxiliary staff	49.3	27.6	23.1
Satisfied with working quality of my technicians	28.2	59.8	12
Facilities and resources in the clinics are adequate for delivery of quality care to patients	65.5	10.1	25.4	<0.001
My current practice situation is what I envisioned when I chose to be a Prosthodontics	68	15	17
Satisfied with the salary/ wages and other financial benefits	49	23.6	27.4
Satisfied with the medical and dental treatment services provided to me as job benefits	31	19.7	49.3
Overall, I am satisfied with quality of life as Prosthodontist	63.7	27.2	9.1

Respondents’ satisfaction of the workplace environment: Eighty four percent of the participants affirmed that they are content with working environment within the practice team because it was conducive. Likewise, 90.8% of the participating subjects agreed that their professional senior colleagues were kind and they enjoyed working as team. Moreover, 60.8% of the participants stated that their organization was supportive for professional development and quality of work (Table 6). The results presented in Table 7 show that 49.1% of the dentists were satisfied with practice management and care delivery system.

Table 6: Respondents satisfaction with the workplace environment

Satisfaction Factor	Strongly agree +agree	fair	Strongly disagree+ disagree	Significance
I am treated respectfully by the Head of my department	89.1	7.3	4.5
Support from administrative offices, secretaries and clerical staff is adequate	63.1	22.4	14.5
In general, I am treated respectfully by my senior colleagues	90.8	7.3	1.9	<0.001
My organization supports professional development for improvement of their efficiency and quality of work	60.8	20.1	19.1
I am satisfied with working environment within the practice team because it is conducive and professional	84.0	12.7	4.0

Table 7: Respondents satisfaction with staff and facilities

Satisfaction Factor	Strongly agree +agree	Fair	Strongly disagree+ disagree	Significance
I have adequate time for my professional development activities	43.6	27.6	26.6
I have adequate time for my personal and family life	50	30	20	<0.001
I am satisfied with the practice management and care delivery system	49.1	28.6	22.1

Respondents’ satisfaction with their relationship with their patients:Analysis of the results presented in table 8 showed that 90% of the prosthodontist were of the view that they have good relations with their patients. Although, 36.4% of the respondents stated that amount of workload was too much on prosthodontist. Moreover, 35.5% of the participants agreed that their patients were not punctual and did not adhere to the appointment schedule. Likewise, 85.4% of the respondents agreed that overall they were satisfied with their job as a prosthodontist. In contrast, a significant percentage (33.6%) of their patients had unrealistic expectations regarding the outcome of their prosthodontic treatment. (Table 8)

Table 8: Respondents satisfaction about their relationship with patients

Satisfaction Factor	Strongly agree +agree	fair	Strongly disagree+ disagree	Significance
I have good relations with my patients	90	6.4	3.6
My colleagues are courteous, and we enjoy working in a team	68.2	12.7	10.0
My work is recognized and appreciated by my colleagues and seniors	74.5	10	6.3
Patients are always on time and adhere to the appointment schedule	31.8	32.7	35.5
I feel no problem while communicating with staff	74.5	10.9	5.4
I feel no problem while communicating with my patients	70	10.9	10.0
The load of paperwork and administrative duties affect my professional capabilities	45.5	17.3	28.2
Patients’ unrealistic expectations burn me out	33.6	30.9	35.5	<0.001
Amount of workload is too much	36.4	30	33.6
I face too much pressure from my seniors	12.7	13.6	64.5
I can freely utilize my potentials and capabilities	48.2	26.4	16.3
I have a liberty to choose appropriate working methods and materials	64.5	17.3	9.1
Overall, I am satisfied with my job as a prosthodontist	85.4	7.3	7.3

The present cross-sectional survey displayed a unique assessment of prosthodontists job satisfaction in the region of KSA. To our understanding this is one of the distinctive surveys done in KSA on prosthodontists job satisfaction. The response rate in the present study was 78 (52%) which was quiet less then expected, despite reminder emails. The low response rate can be due to busy schedule of prosthodontist, inability to follow up with emails regularly, hectic clinical hours and other office obligations. Low response rate was also observed in other studies but from different dental specialities (Al-Jewair et al., 2016; Alqahtani et al., 2018).

Moreover, fewer response rate were reported from females 25 (32%) which may indicate their family commitment (Shigli et al., 2012). Furthermore, 67.9% male responses show male dominancy in this field this finding was found to be in concurrent with studies by Maharjan and Mathema, (2018) and Nash and Benting, (2019).

In the present study most of the respondents belonged to age group 31-40 years (53.8%) had experience between 3-8 years 38 (48.7) and were from academic universities 37 (47.4%) this may give a reflection that postgraduate institution provides better avenues to young faculty for academic development (Shigli et al., (2012). Moreover, when inquired about postgraduate qualification 38 (48.7%) subjects completed their postgraduation from Saudi Boards. This trend directs that Saudi students after graduation didn’t waste time efforts to fly abroad for postgraduation and were content with postgraduate opportunities within the country. This tendency also specifies that students were motivated, eager and enthusiastic in obtaining lifelong education. This finding was found to be in harmony with a study by Al-Dlaigan et al., (2011)

The survey consisted of seven domains and thirty-eight item questions. A cross sectional type study design was used as it is easy, simple and cost-effective to perform, it may help in generating a hypothesis for a more complex investigation and possibilities of loss to follow up are minimum (Sedgwick, 2014). In addition, responses were gathered through survey monkey instrument. The survey has an advantage of usability, comprehensive feature set and security. Moreover, it gives real time results for quick and easy analysis (Buchanan and Hvizdak, 2009).

The overall job satisfaction among prosthodontist in the present study was 85.4%. This high percentage of job satisfaction corelates with prosthodontic speciality being the first choice among the respondents (70.3%). Evidence suggests job satisfaction is one of the foremost attitude that predicts job performance, and it can affect customer satisfaction and health care delivery inside and outside the health care services (Lo Sasso et al., 2015b). Moreover, quality of life satisfaction among prosthodontist in the current study was 63.7%. Choosing profession and specialty of first choice helps a lot in balancing QoL and also may reduce occupational stress levels (DiMatteo et al., 1993).

48(61.8%) respondents were of the view that they specialized in prosthodontics as they felt it’s a challenging profession. This attitude reflects a mature, professional and highly motivated mind set of the respondents as challenging profession was by far advanced by other motivational factors (Alqahtani et al., 2018). This finding also relates that professional growth along with challenging profession were given priority over financial gains. This finding contradicts the findings of a study by Noble et al., (2010) where financial motives were prime indicator for choosing dental profession. Overall satisfaction of respondents with workplace environment and prosthodontics was more than 60%. Conducive work environment plays a major role in providing job satisfaction and decreasing work related stress. Work related factors contribute to job gratification and organizational commitment. Henceforth, enhancing the success and progress of organization and dental practice (Khalighi et al., 2018).

Furthermore, almost 50% of the respondents were not satisfied in giving time to their family members. These findings were found to be in concurrent with work from Alqahtani et al., (2018); Soma et al., (2012) Comfortable family life and support plays a major role in job satisfaction of dentist. Prosthodontics working in KSA regret in not spending adequate time can be due to work related pressure, non-flexible clinical hours and other clinical commitments (Alqahtani et al., 2018).

Most of the respondents were not satisfied and were unhappy with patients coming late to the dental practice i.e., being not punctual. These results are parallel to a study by Rada et al., indicating that such act by the patients causes high level of stress and anxiety among dentists (Rada and Johnson-Leong, 2004). Furthermore 45.5% of the respondents were of view that load of paperwork and administrative duties affect professional capabilities. This finding is in line with a study by Jari et al., explaining office and administrative issues hampers performance of a dentists, increases stress and anxiety issues which indirectly affects job satisfaction (Hakanen et al., 2005).

From the results of this study it can be inferred, that though job satisfaction among prosthodontist working in KSA was satisfying. More, studies with better study designs should be executed with comparison between different dental specialty. This is the first study among prosthodontist job satisfaction in KSA and more studies should be performed to validate the findings of the present study. The study has limitation based on its small sample size. More studies with increase sample size and prosthodontists from other parts of KSA should be taken in account to get a better representation of the population. For future studies, a comparison between Saudis and Non-Saudis job satisfaction as prosthodontists should be also performed.

CONCLUSION

Prosthodontists working in KSA are content and satisfied with their job. Moreover, improvements in administrative responsibilities of prosthodontists should be enhanced to further boost their professional capabilities.

Conflict of interest: The authors declare that they have no conflict of interests for the present study and all authors have read and approved the final draft.

FUNDING AND ACKNOWLEDGEMENT:

The authors would like to thank the College of Dentistry Research Centre and Deanship of Scientific Research at King Saud University, Saudi Arabia, for funding this research project (#FR 0507).

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