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Career profile of dentists in Saudi Arabia
Nahid Y. Ashri,* BDS, MSc Norah Al Ajaji, § BDS Mayyadah Al Mozainy,** BDS
Rasha Al Sourani,*** BDS
OBJECTIVES: The aims of the present survey were to determine whether differences existed between male and female dentists in Saudi Arabia in career development, positions occupied within their employment, and to analyze the effect of different variables on their career development in some of the provinces in Saudi Arabia. METHODS: A self-conducted questionnaire was distributed among male and female dentists, general practitioners as well as specialists, working at several governmental hospitals in Saudi Arabia. The questionnaires consisted of 40 questions in the format of multiple choices and yes/no answer. Data were analyzed by gender with the significant difference level set at (P < 0.05). RESULTS: The response rate was 40.8% of which 51.9% were females and 48.1% males with 70% of them below 45 years of age. No significant difference was found between males and females in having higher education or additional degrees. The specialty that was highly reported among females was pedodontics and in males, orthodontics. Males were more likely to hold authorized administrative positions (63%), while females held administrative positions which were internally arranged by their departments (57%). Eighty-three percent of female respondents thought that there was favouritism towards males in appointment to administrative positions, while only 5.5% of male respondents reported that there was favouritism to females in occupying the same positions. CONCLUSIONS: There was no significant difference between male and female dentists in Saudi Arabia with respect to job opportunities, working hours and relationships with their colleagues. In addition, there is evidence of an intensifying determination of female dentists in Saudi Arabia, to pursue their chosen career while coping with the diverse demands of being a professional, a wife and mother.
The Kingdom of Saudi Arabia is a rapidly developing country. According to the 1974 survey, the Kingdom's population was just over 7 million. Since then, the population has grown dramatically.1 In 2007, the Central Department of Statistics' Demographic Survey put the population of the Kingdom at 27,601,038 million. Of the Saudi national population, 54.3% are males and 45.7% are females.2
This rapid rate of growth is relevant to all aspects of life in Saudi Arabia including education. One of the first objectives of the Ministry of Higher Education has been to establish new institutions of higher education throughout the country and to expand existing ones. By 1994, there were seven major universities and 83 colleges.3
Now, there are more than 142,000 students at Saudi universities and colleges, a remarkable improvement over the 7,000 students enrolled in 1970.3 Of 142,000 students, more than 60,000 are females studying at five of the universities: King Saud, King Abdul Aziz, King Faisal, Imam Muhammad Bin Saud and Umm Al-Qura.3
College of Dentistry is a fundamental part of King Saud University (KSU), as it is the first university-based dental training institution in the Arabian Gulf. The first groups of students enrolled in the College at the beginning of 1975-1976 were seven (7) males who graduated in 1981.4 The first female group (14) enrolled in the College in 1978-1979 and graduated in 1983.5 The number of females entering the dental profession has increased during the past few decades. By the end of 2006¬2007, seven hundred and sixty seven (767) females had successfully obtained their Bachelor degree of Science in Dental
Surgery (BDS) from KSU.5
The rapid increase of females in the profession has been the most noticeable demographic trend in dentistry over the past twenty years. Between 1983 and 2006 female graduates of KSU, College of Dentistry, increased from 3.6% to 11.4%.5
It is expected that the number of female dental graduates will increase greatly in the future due to the increase in the number of dental colleges that have been newly established in the Kingdom.6 With the increase in the number of females enrolling for dental profession, more jobs will be occupied by females than before. As more women become dental professionals, there will be changes in the dental workforce pattern because women do have different and sometimes competing priorities in areas such as childcare and maternity arrangements, which may influence working patterns and career choices and/or ambition.
A number of studies7-9 have examined differences between male and female dentists in their work patterns and reported that males and females differed in their working hours and their practice settings. In addition, females holding administrative positions or working as managers are few and they are reluctant to have their own practice.
The American Dental Association found that male dentists were significantly more likely to own or have a share in ownership of their practice.10 Other studies suggested that male dentists earn more money than female dentists.11 A number of studies supported this point, focusing on issues such as age, gender distribution of dentists, time devoted to professional activity,12-15 student orientation, practice preferences,7,12 career development, and academic contribution of female
dentists.12,16,17
To our knowledge, studies to evaluate career development of dentists in Saudi Arabia according to gender are not available. Accordingly, the aims of the present study were to determine whether differences existed between male and female dentists in Saudi Arabia in career development, positions occupied within their employment and to analyze the effect of different variables on their career development.
A questionnaire-based survey model was used. The survey was conducted in different provinces of the Kingdom: Central, Western and Eastern provinces. A random sample was obtained of dentists working in different governmental sectors such as Ministry of Health, Military Hospital, National Guard Hospital, Security Forces Hospital and College of Dentistry in KSU, Riyadh and King Abdulaziz University, Jeddah. The questionnaire was also distributed during a dental meeting that was held between June and December 2007.
Methods used to encourage response included personal communication and personal distribution by the researchers. The measurement instrument was four-pages, 40 item-questionnaire developed by the authors according to the present requirements of the investigation and based upon the original questionnaire used by McEwen and Seward in 1988. The questionnaire was pilot-tested on a sample of 20 dentists and modifications were then done accordingly to improve the clarity and wording. Questions were arranged in a yes/no response and multiple choice formats.
The first page indicated the purpose of the survey and the confidentiality statement. The first part of the questionnaire was assigned to collect the socio-demographic data of respondents, their qualifications and year of graduation. The second part of the questionnaire was about their current working places, if they worked in private sectors in addition to working in governmental sectors, and which sector had better income in their opinion. They were also asked about the number of working hours per week.
The third part included questions about their working title and/or working positions, speciality, job satisfaction, bias in getting promotion, career breaks (including number of breaks, duration and reason for taking breaks), relations with their colleagues and an inquiry about their future plans.
The data was entered and analyzed using SPSS version 15, Microsoft Excel version 2003 and Primer of Biostatistics version 5. Respondents were analyzed by gender for significant differences, using Pearson's Chi-square tests of significance difference. All differences quoted in the text are significant at the 5% level.
The third part included questions about their working title and/or working positions, speciality, job satisfaction, bias in getting promotion, career breaks (including number of breaks, duration and reason for taking breaks), relations with their colleagues and an inquiry about their future plans.
The data was entered and analyzed using SPSS version 15, Microsoft Excel version 2003 and Primer of Biostatistics version 5. Respondents were analyzed by gender for significant differences, using Pearson's Chi-square tests of significance difference. All differences quoted in the text are significant at the 5% level.
The third part included questions about their working title and/or working positions, speciality, job satisfaction, bias in getting promotion, career breaks (including number of breaks, duration and reason for taking breaks), relations with their colleagues and an inquiry about their future plans.
The data was entered and analyzed using SPSS version 15, Microsoft Excel version 2003 and Primer of Biostatistics version 5. Respondents were analyzed by gender for significant differences, using Pearson's Chi-square tests of significance difference. All differences quoted in the text are significant at the 5% level.
From a total of 510 forms randomly distributed, 208 replies were received. This was a 40.8% response rate. There was little or no difference in the proportion of 108 (51.9%) female respondents and 100 (48.1%) male respondents. The geographic distributions of participants is presented in Table 1.
Twenty-seven (27%) male respondents had no children compared to 43 (39.8%) females, 52 (52%) male respondents had 1-3 children compared to 45 (41.7%) female respondents, 21 (21%) male respondents had more than 4 children compared to 20 (18.5%) females. The majority of our respondents were in the age group of 25-30 years. More than 70% of our respondents were younger than 45 years (Table 2).
Respondents' qualifications included 48 (48%) males and 54 (50%) females who had Bachelor degree. Thirty-nine (39%) males and 35 (32.4%) females had Master degree while 13 (13%) males and 19 (17.6%) females had PhD. Twenty-seven percent of all respondents had additional qualifications, 2.9% were Saudi Board certified (2% males and 3.7% females), 7.7% had diploma of Advanced Education in General Dentistry (9% males and 6.5% females). A small number, 1.9% had Saudi Fellowship (2% males and 1.9% females), 5.7% American Board Certification (8% males and 3.7% females), and 8.9% were board certified from other countries (12% males and 4.6% females).
The respondents were 87 (46.3%) general practitioners and 101 (53.7%) specialists. Fifty-one (52%) of the general practitioners were females and 36 (39.6%) were males. Of the specialists, 46 (47.4%) were females and 55 (60.4%) were males. Thirteen percent of the respondents specialized in Prosthodontics which was the highest reported specialty among participants, followed by Pedodontics (12.9%), Operative Dentistry (11.2%), Orthodontics (9.4%), Periodontics (8.6%), Endodontics (7.7%), Oral Surgery (3.4%), Community Dentistry (1.9%), Oral Medicine (1.7%), Oral Radiology (1.7%), Oral Pathology (0.86%), and other specialties such as AEGD (13.5%).
Within the specialties, 5% were male pedodontists while 9.3% were female pedodontists, this being the highest reported specialty among female respondents. Eight percent of the respondents were male prosthodontists whereas 7.4% were female prosthodontists. Nine percent of male respondents were orthodontists which was the highest reported specialty among male respondents compared to 1.9% females. Five percent of the respondents were male periodontists and 4.6% were females. Six percent of respondents were male endodontists while 2.8% were females. In Community Dentistry, 1% of the respondents were males and 2.8% were females.
In respect of the current working place, 43 (20.7%) respondents were employees at the University where 7 (7%) were males and 36 (33.3%) were females. Twenty percent of all the respondents worked in the Ministry of Health of which 25 (25%) were males and 17 (15.7%) were females. Fifty-eight (27.9%) of all respondents service in the Military Hospital with 31 (31%) males and 27 (25%) females.
In Security Forces Hospital, the total respondents were 20 (9.6%) of which 11 (11%) were males and 9 (8.3%) were females. Thirty-nine (18.8%) of all respondents were at the time working in the National Guard Hospital of which 26 (26%) were males and 13 (12%) were females and only 5 (2.4%) of all respondents reported that they started working directly in the private sectors and all were females.
Working hours varied between 25 and 50 hours per week in the governmental sectors compared to a maximum of 45 hours in the private sectors. There was no significant difference between males and females in their working load (Table 3).
Female (7.1%) dentists were less likely to be partners in a dental practice compared to males (47.1%) (P= 0.002) while the majority of females (92.9%) preferred to work in private clinics on part time basis compared to males (52.9%) (P=0.003). Seventeen percent of male respondents believed that working in private sectors gave better income than governmental sectors compared to 10.2% of females.
Seventy (34%) of respondents reported that they were holding administrative/ manager positions of which 39 (41.9%) were males and 31 (31.6%) were females. Male respondents who held recognized administrative positions were 24 (63.1%) while only 14 (36.8%) female respondents were given the same position (P=0.03). Females (57%) held more positions which were set by their department as an internal arrangement compared to males (42.8%). Males (62.8%) were more significantly satisfied (P=0.05) with their administrative position compared to females (39.5%).
Ninety-five percent of female respondents believed that there was favouritism to males (P=0.000) in getting administrative appointments (83.5%), academic positions (35.3%), governmental jobs (32.9%), and jobs in the private sectors (17.6%), respectively. On the other hand, 52.9% male respondents believed that there was favouritism to females in obtaining governmental jobs (20%), academic positions (20%), private sector jobs (18.2%), and administrative positions (5.5%), respectively.
Ninety-one percent of female respondents and 91.6% of male respondents reported that they were working in reasonably comfortable environments. Sixty percent of male respondents reported that they had excellent relations with their colleagues and staff members, at the same time 56.1% of female respondents reported comparable relation.
When the gender of their colleagues was specified, 64.6% of male respondents reported excellent relation with their male colleagues and staff, 31.3% indicated good relation, 3.1% reported fair relation and 1% reported poor relation, respectively. Conversely, 39.6% of female respondents reported excellent relation with their male colleagues (P=0.000) while 46.2% reported good relation (P=0.04), 11.3% stated fair relation (P= 0.05) and 2.8% reported poor relation. On the other hand, relation with female colleagues and staff were reported as excellent (44.8%), good (38.5%), fair (12.5%) and poor (4.2%) by male respondents and as excellent (57%), good (52%) and fair (0.9%) by female respondents.
About 13% of female respondents reported that they had work breaks for more than 6 months in our study. Reasons for having work break included maternity, sabbatical, accompanying sick relation and accompanying husband.
According to their future plans, 29.5% of male respondents were planning to obtain their own private practices (P= 0.003) compared to 7.2% of female respondents. Females (52.6%) were significantly planning (P= 0.01) to get higher levels of education than males (33%). In addition, females (17.5%) were significantly planning to retire early compared to males (10.2%) (P=0.01).
Within the specialties, 5% were male pedodontists while 9.3% were female pedodontists, this being the highest reported specialty among female respondents. Eight percent of the respondents were male prosthodontists whereas 7.4% were female prosthodontists. Nine percent of male respondents were orthodontists which was the highest reported specialty among male respondents compared to 1.9% females. Five percent of the respondents were male periodontists and 4.6% were females. Six percent of respondents were male endodontists while 2.8% were females. In Community Dentistry, 1% of the respondents were males and 2.8% were females.
In respect of the current working place, 43 (20.7%) respondents were employees at the University where 7 (7%) were males and 36 (33.3%) were females. Twenty percent of all the respondents worked in the Ministry of Health of which 25 (25%) were males and 17 (15.7%) were females. Fifty-eight (27.9%) of all respondents service in the Military Hospital with 31 (31%) males and 27 (25%) females.
In Security Forces Hospital, the total respondents were 20 (9.6%) of which 11 (11%) were males and 9 (8.3%) were females. Thirty-nine (18.8%) of all respondents were at the time working in the National Guard Hospital of which 26 (26%) were males and 13 (12%) were females and only 5 (2.4%) of all respondents reported that they started working directly in the private sectors and all were females.
Working hours varied between 25 and 50 hours per week in the governmental sectors compared to a maximum of 45 hours in the private sectors. There was no significant difference between males and females in their working load (Table 3).
Female (7.1%) dentists were less likely to be partners in a dental practice compared to males (47.1%) (P= 0.002) while the majority of females (92.9%) preferred to work in private clinics on part time basis compared to males (52.9%) (P=0.003). Seventeen percent of male respondents believed that working in private sectors gave better income than governmental sectors compared to 10.2% of females.
Seventy (34%) of respondents reported that they were holding administrative/ manager positions of which 39 (41.9%) were males and 31 (31.6%) were females. Male respondents who held recognized administrative positions were 24 (63.1%) while only 14 (36.8%) female respondents were given the same position (P=0.03). Females (57%) held more positions which were set by their department as an internal arrangement compared to males (42.8%). Males (62.8%) were more significantly satisfied (P=0.05) with their administrative position compared to females (39.5%).
Ninety-five percent of female respondents believed that there was favouritism to males (P=0.000) in getting administrative appointments (83.5%), academic positions (35.3%), governmental jobs (32.9%), and jobs in the private sectors (17.6%), respectively. On the other hand, 52.9% male respondents believed that there was favouritism to females in obtaining governmental jobs (20%), academic positions (20%), private sector jobs (18.2%), and administrative positions (5.5%), respectively.
Ninety-one percent of female respondents and 91.6% of male respondents reported that they were working in reasonably comfortable environments. Sixty percent of male respondents reported that they had excellent relations with their colleagues and staff members, at the same time 56.1% of female respondents reported comparable relation.
When the gender of their colleagues was specified, 64.6% of male respondents reported excellent relation with their male colleagues and staff, 31.3% indicated good relation, 3.1% reported fair relation and 1% reported poor relation, respectively. Conversely, 39.6% of female respondents reported excellent relation with their male colleagues (P=0.000) while 46.2% reported good relation (P=0.04), 11.3% stated fair relation (P= 0.05) and 2.8% reported poor relation. On the other hand, relation with female colleagues and staff were reported as excellent (44.8%), good (38.5%), fair (12.5%) and poor (4.2%) by male respondents and as excellent (57%), good (52%) and fair (0.9%) by female respondents.
About 13% of female respondents reported that they had work breaks for more than 6 months in our study. Reasons for having work break included maternity, sabbatical, accompanying sick relation and accompanying husband.
Ninety-one percent of female respondents and 91.6% of male respondents reported that they were working in reasonably comfortable environments. Sixty percent of male respondents reported that they had excellent relations with their colleagues and staff members, at the same time 56.1% of female respondents reported comparable relation.
When the gender of their colleagues was specified, 64.6% of male respondents reported excellent relation with their male colleagues and staff, 31.3% indicated good relation, 3.1% reported fair relation and 1% reported poor relation, respectively. Conversely, 39.6% of female respondents reported excellent relation with their male colleagues (P=0.000) while 46.2% reported good relation (P=0.04), 11.3% stated fair relation (P= 0.05) and 2.8% reported poor relation. On the other hand, relation with female colleagues and staff were reported as excellent (44.8%), good (38.5%), fair (12.5%) and poor (4.2%) by male respondents and as excellent (57%), good (52%) and fair (0.9%) by female respondents.
About 13% of female respondents reported that they had work breaks for more than 6 months in our study. Reasons for having work break included maternity, sabbatical, accompanying sick relation and accompanying husband.
According to their future plans, 29.5% of male respondents were planning to obtain their own private practices (P= 0.003) compared to 7.2% of female respondents. Females (52.6%) were significantly planning (P= 0.01) to get higher levels of education than males (33%). In addition, females (17.5%) were significantly planning to retire early compared to males (10.2%) (P=0.01).
This study is a preliminary study to evaluate differences, if any, between male and female dentists in their practice, characteristics and career development pattern in Saudi Arabia.
The response rate (40.8%) for a questionnaire survey of this type was comparable to other similar studies.18-20 None of those studies gave reasons for the low response. However, the length of the questionnaire could be one reason, as those types of survey need detailed information which could be considered time consuming by respondents.
The respondents varied in age and qualifications. However, 33.7% of respondents were in the younger age group (25-35 years of age) and 70% were younger than 45 years. This indicated the youth of the dental profession in Saudi Arabia. Female dentists represented 51.9% of the total and this percentage is expected to persist and increase at least for the next two decades, based on the percentage of increase of female undergraduates in addition to the increase in the number of new government and private dental colleges.
Of the male respondents, 85% were married whereas 76% of the females were married. This was in close agreement with the results of Matthews and Scully study.21 The proportion of females without children in the present study was much less at 39.8% compared to 61% in Matthews and Scully study21 and in comparison to Seward and McEwen study22, though the percentage of married females (76%) was slightly greater compared to 67% in their study. This reflects the impact of the cultural background of the Saudi society as they prefer to get married and start a family at a younger age.
The number of male (52%) and female (50%) respondents who obtained postgraduate qualifications such as Master degree or PhD were equal. In addition, no significant differences were found between males and females in their employment positions as general practitioners or specialists. Other studies reported that women dentists lacked additional qualifications and degrees compared to males. They also reported that significant differences between the males and females in the work title and specialization were evident, as more men were found to have a higher education, additional degrees and specialization than females,7,17,23-25 a situation that could be explained by the additional responsibility of the female with the family and the household.7,9,17,23,25 This was not the condition in the present study which could be due to strong family support where care of children was assisted by grandmothers and siblings. In addition, most families have full time helpers at home.
Several studies reported that if female dentists had the opportunity to continue higher education and specialize, they most frequently would specialize in Pediatric Dentistry while males were reported more as orthodontists or prosthodontists.23,25-28 These results are similar to our results as more females (9.3%) were pedodontists compared to males (5%), whereas males (9%) were practicing orthodontics compared to females (1.9%).
In this survey, males and females were equally distributed among the different governmental sectors which indicated the presence of equal job opportunities between genders. Other studies have reported that female dentists working in the government sectors were usually given lower positions in the employment hierarchies, lower prestige job opportunities, were paid less than men, were less likely to hold consultant positions and were usually clustered at the lower end of the employment ranking especially at universities.12, 13, 17, 23, 25, 27, 29-31 In our study, the equality of female dentists in obtaining jobs in the dental profession and obtaining balanced employment positions in different sectors was assured in Saudi Arabia.
The present study showed that both males and females worked similar number of hours per week, a finding that is in disagreement with other studies where they reported less working hours by the females.7,9,12,13,16,17,21,23,26,27,29,30 Although the part time system does exist in Saudi Arabia, none of the female respondents in this survey reported working as part timer in the goverment sector. This could be related to the presence of a full time helper at home which makes it easier for females to work full time working hours.
In the present study, females were more likely to work as part time (92.9%) in the private sector, than be a sole owner or partner (7.1%). Other studies have reported similar results where females were less likely to be a partner or a sole owner of a private practice.9,12,13,17,21,23, 25-27,29,30,32 They suggested that female dentists were influenced by conflict of trying to balance their professional careers with the competing responsibilities of marriage, homemaking and child rearing. In addition, females are reluctant to take on the responsibility of practice ownership and they prefer the relative financial security of a non-partner position.13,14,25
Differences between males and females in occupying administrative/manager positions were reported in the present study. This difference was also reported in other studies 17, 25, 31 from different developed countries where they stated that the majority of female dentists were not assigned administrative/manager positions and the employment status of female dentists did not improve during the last decades as the proportion of female dentists acting as principals in practice has remained relatively low. The career pathways were still based on traditional male working patterns where positions carrying high status and prestige were
still held by men.12,17,25,27,31
Discrepancy among male and female dentists in getting administrative/ manager positions, and higher positions in the employment hierarchies are still reported after 140 years of female existence within the dental work force in developed countries. This gives an indication on the situation of female dentists in other countries including developed countries. As it seems, they are undervalued contrary to the promotion of guaranteed equality between men and women in all aspects of life.
There seems to be very little difference between males and females in the perceived working relationship with their colleagues as both males and females reported excellent relation. However, when gender of colleagues was specified, differences were noted as females reported 57% excellent relation to female colleagues compared to 39.6% excellent relation with male colleagues. On the other hand, males reported 64.6% excellent relation with their male colleagues compared to 44.8% excellent relation with female colleagues. Consequently, a slightly greater percentage of female to female and male to male relationships were described as excellent, other studies have reported similar results,26,32-35 where they stated that female dentists were at a marked disadvantage as their participation with male colleagues in professionally related social activities too frequently lended itself to social and sexual misinterpretation.
Previous published studies have shown that women were more likely to take work breaks after they had children and if men took breaks, it was due to personal illness.7,9,21, 22, 35 In the present survey, only female dentists (12.9%) were reported to have a career break for more than six months compared to males. Reasons given for having breaks included maternity, accompanying sick relation and/or husband and sabbatical leaves. It is clear that child rearing and family responsibilities have a great impact on women's working life. It is also much harder for men to account for career breaks for domestic responsibilities as they are considered the main supporter of the family.7
Future plans for female dentists included higher education (52.6%), ownership of private practice (7.2%) and retirement (17.5%), whereas males were planning to have their own private practice (29.5%), higher education (33%) and retirement (10.2%). These results are in agreement with other studies as Katrova12 reported that females showed greater interest than males in continuing higher education. In addition, she reported that more males were hoping to start their own practice. Newton et al.7 reported that males were less likely to continue higher education and related this to their ability to succeed as a sole owner and partner in general practice.
| Conclusion and Recommendations |
The findings of this study gave an insight into the practice profiles of male and female dentists in Saudi Arabia. The main finding was that there was no significant difference between male and female dentists in job opportunities, working hours and relation with their colleagues in Saudi Arabia. It demonstrated an increasing determination of female dentists in Saudi Arabia to actively pursue their chosen career and cope with the diverse demands of a profession, wife and mother.
With the continuing increase in the number of females in the dental workforce, this type of survey should be repeated to include a larger population.
Since biological differences between males and females are unavoidable, women will continue to bear children and assume the primary responsibility for their care. Programs such as flexible practice time, job sharing and childcare centers that integrate family care with professional needs are likely to guarantee that the talent and the productivity of female dentists are not lost.
Another proposal is ownership sharing by female dentists of private practices as it may provide an ideal solution for females to integrate family with their career more readily. As owner of individual practice, females can set the regulations to their needs.
This research was funded by the College of Dentistry Research Center research No. F-1093, King Saud University. The authors would also like to thank King Faisal Specialist Hospital and Research Center for the use of their Microbiology Laboratory and its resources.
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* Associate Professor
Department of Preventive Dental Science
**Demonstrator
Department of Restorative Dental Sciences ***Intern
College of Dentistry, King Saud University §Resident, National Guard Hospital Riyadh, Saudi Arabia
Address reprint requests to: Dr. Nahid Ashri
Division of Periodontics, PDS Department College of Dentistry, King Saud University P.O. Box 60169, Riyadh 11545, Saudi Arabia Email:
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