The Dental Workforce in Malaysia

Muhd Firdaus Che Musa


















IIUM
Press
Gombak • 2020

First Print, 2020
© IIUM Press, IIUM

IIUM Press is a member of the Majlis Penerbitan Ilmiah Malaysia - MAPIM
(Malaysian Scholarly Publishing Council)
Persatuan Penerbit Buku Malaysia - MABOPA
(Malaysian Book Publishers Association)
No. of Member - 201905

All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise,
without any prior written permission of the publisher.
Perpustakaan Negara Malaysia Cataloguing-in-Publication Data


Muhd. Firdaus Che Musa
THE DENTAL WORKFORCE IN MALAYSIA : CAREER
MOTIVATION AND EXPECTATIONS AMONGST SENIOR DENTAL
STUDENTS / Muhd Firdaus Bin Che Musa.
Mode of access: Internet
eISBN 978-967-491-062-4
1. Dentistry--Research--Malaysia.
2. Dentists--Research--Malaysia.
3. Employee motivation--Research--Malaysia.
4. Education, Higher--Research--Malaysia.
5. Government publications--Malaysia.
I. Title.
617.600720595
Published in Malaysia by
IIUM Press
International Islamic University Malaysia
P.O. Box 10, 50728 Kuala Lumpur, Malaysia

Contents






Preface vii
Acknowledgements ix
List of Tables xi
List of Figures xiii
Abbreviations xv

Chapter 1: Introduction 1
Chapter 2: Research Background 13
Chapter 3: Aims and Objectives 30
Chapter 4: Methods and Methodology 31
Chapter 5: Findings 42
Chapter 6: Discussions 71
Chapter 7: Conclusions and Recommendations 83

References 87
Appendices 103
Appendix 1:
Top five ‘very important’ motivations in multiple
response items, based on the students’ characteristics 103
Appendix 2:
Top five ‘very important’ motivations in multiple
response items based on schools’ characteristics 104
Index 105



Preface






The dental workforce globally is facing unprecedented change as a
result of multiple influences. Malaysia, a high-middle-income country,
has expanded the number of dental schools in the last decade to ensure
that there are a sufficient number of health workers to meet the needs
and demands of the population. As the volume of dentists entering the
workforce has increased, concerns about the long-term implications of
these policies and how this expensively trained dental workforce will be
utilised in the future are emerging. There is a need for research informed
action in relation to understanding workforce influences, and examining
their potential implications and the shape of the future workforce in
relation to population need. An understanding of the motivation of current
dental students for choosing to study dentistry and their subsequent career
expectations may assist with harnessing and retaining their skills.
This is the first book in a series of three planned to be published
concerning the dental workforce in Malaysia. The aim of this series
is to present findings on motivation and short- and long-term career
expectations of dental students in the selection of dentistry as a
professional career in relation to individual (demographic and socio-
economic factors) and school characteristics and make recommendations
for the future in relation to serving the population. Senior dental students
from 11 schools were invited in early 2013 to complete a questionnaire
survey of the Gallagher Motivation Instrument (GMI) to examine career
motivation and expectations. Univariate and multivariate analyses of the
responses, including confirmatory factor analysis of career motivation,
were undertaken followed by descriptive analysis of their career
expectations.
Three hundred and fifty six final year dental students (83%) across
eight schools (73%) responded, comprising 66% of final years in Malaysia
in 2013. Five motivational factors were reported with ‘academic’ factors
emerging as students’ main motivation to study dentistry. There were
some differences in motivation by school sector; either public or private

viii |



and ethnicity. There was however no variation by sex, family income, age
or the school type (established or new). Career expectations focused on
specialisation in the short-term (46%) and long-term (59%) for students,
with a desire to achieve financial stability and work/life balance. The
majority of all respondents (64%) reported a desire to work in the private
sector. Only 66.9% of respondents considered working full-time in the
long-term with significant difference by sex [male (77.7%) and female
(62.5%); (p=0.036)].

Acknowledgements






I am indebted to many people for their help, advice and support provided
during the process of completing this book. I would like to dedicate this
work to my family, colleagues, sponsors, and respondents, who have
always given me the inspiration and craving for continuous learning.
They have been and will always be the motivators in my pursuit of
knowledge.
I would like to express my gratitude to Professor Jenny Gallagher
and Dr Eduardo Bernabe from King’s College London for their
continuous encouragement, support and guidance. I am extremely
grateful for their direction and timely advice that has enlightened me
throughout the process of compiling this work. I have appreciated the
patience and mentoring that both of them have given me throughout my
postgraduate study. Thanks must also go to both Professor Ivor Chestnutt
and Professor Louise Barriball for having patiently read this document
and giving me constructive feedback.
I am most grateful to the Kulliyyah of Dentistry, International
Islamic University Malaysia and all staff for their continuous ‘moral
support’. To the editor staffs, I particularly want to thank you for being
very supportive, offering great assistance and always being there for me.
I would like to especially thank my dear parents, Che Musa Jusoh
and Azizah binti Salleh, and my siblings who have always believed in
me, supported me and encouraged me throughout my education.
I would like also to acknowledge permission for copyright given by
Kings College London, BMC Human Resources for Health and Wiley
publication (International Dental Journal) to produce this piece of work.
Finally, I would like to acknowledge myself as being courageous
enough to produce this book in this field of Health Services Research and
Dental Public Health. I also look forward to continuing my dream towards
making a positive impact on peoples’ lives through my education. I thank
God for His guidance always.



List of Tables



Table 1.1: Volume of new dental registrants across 16 local
institutions in both public and private schools from 2011-2018. 11
Table 4.1: List of potential participants for questionnaire survey
from 11 dental schools which had final year dental students in 2013. 36
Table 5.1: Characteristics of Malaysian senior dental student
(final year) respondents, 2013/14 (n=356). 43
Table 5.2: CFA results for the Indices of Fit for both the original
model and 50
Table 5.3: CFA results on the Indices of Fit for the revised
second-order factor. 52
Table 5.4: Comparison of domains and overall scores for motivation
by students demographic and school characteristics (n=356). 55
Table 5.5: Two-way interaction between students’ characteristics
and school sector. 56
Table 5.6: Two-way interactions between students’ characteristics
and school type. 56
Table 5.7: Future preference on mode of working pattern
(full-time/part-time) amongst Malaysian dental students by sex. 64
Table 5.8: Future preference on mode of working pattern amongst
Malaysian dental students by sex, level of care
(generalists/specialists) and sectors. 64
Table 5.9: Future preference on mode of working days per week as
dentists and specialists by sex and sectors. 65
Table 5.10: Future preference amongst students who wish to work
as public practitioners and working part-time in the private sector
by sex. 67



List of Figures



Figure 1.1: The Current Dental Workforce in Malaysia 6
Figure 2.1: A Multi-dimensional Interactive Allied Health Workforce
Recruitment and Retention Conceptual Model (Schoo et al., 2005). 25
Figure 4.1: Original Model Five-factors (Gallagher et al., 2007b). 39
Figure 5.1: Motivating Items to Study Dentistry Based on Multiple
Responses Items 45
Figure 5.2: Major Influences to Study Dentistry in Single Response
Items 47
Figure 5.3: Second Order of Five-factors Model. 49
Figure 5.4: Comparison of Corresponding Items across Two Models:
Second-order Factor Model (A) and Modification Model (B). 51
Figure 5.5: Final Factor Model for Malaysian Dental Students
Describing 23 Specific Motivations Items to Study Dentistry
According to their Corresponding Factors 53
Figure 5.6: Short-term Career Expectations/Professional Goals in
the First Five Years of Malaysian Final Year Dental Students 2013/14
(n=305 respondents). 58
Figure 5.7: Influencing Factors on Short-term Career Expectations
Amongst Malaysian Final Year Dental Students, 2013/14. 59
Figure 5.8: The Influencing Factors for the Participants’ Choice of
Location to Start Their Practice (n=356). 60
Figure 5.9: Reasons for Travel amongst Malaysian Dental Students
2013/14 (n=353). 61
Figure 5.10: Area of Interest for Dental Specialities Chosen by the
Participants (n=210). 62
Figure 5.11: Perceived Influences on the Future Number of
Working Sessions. 66
Figure 5.12: The Participants’ Perceived Attraction Factors in
Working with the MOH (n=356). 68
Figure 5.13: Overall Influences on Long-term Career Expectations
(n=356) Amongst Malaysian Final Year Dental Students 2013/14. 69



Abbreviations



APC: Annual Practicing Certificate
AIMST: Asian Institute of Medicine, Science and Technology
ANOVA: Analysis of Variance
ASEAN: Association of Southeast Asian Nations
AUCMS: Allianze University College of Medical Sciences
BDM: Biomedical & Health Sciences, Dentistry, Medicine
CFA: Confirmatory Factor Analysis
CfWI: Centre for Workforce Intelligence
CFI: Comparative Fit Index
DCPs: Dental Care Professionals
Df: Degree of Freedom
Dft: Decayed and Filled Teeth
DMFT: Decayed, Missing, and Filled Teeth
DSAs: Dental surgery assistants
EFA: Exploratory Factor Analysis
GDC: General Dental Council
GMI: Gallagher Motivation Instrument
GHWA: Global Health Workforce Alliance
GPA: Grade Point Average
HEE: Health Education England
HRH: Human Resources for Health
HSC: Higher School Certificate
HSR: Health services research
IMU: International Medical University
LUC: Lincoln University College
MAHSA: Malaysian Allied Health Sciences Academy
MANOVA: Multivariate analysis of variance
MDA: Malaysian Dental Association
MDC: Malaysian Dental Council
MFCM: Muhd Firdaus Che Musa (researcher)
MFDS: Membership of the Faculty of Dental Surgery
MJDF: Membership of the Joint Dental Faculties
MMMC: Melaka-Manipal Medical College

MOH: Ministry of Health Malaysia
MOHE: Ministry of Higher Education
MQA: Malaysia Qualification Agency
NHS: National Health Service
NSR: National Specialist Register
OHD: Oral Health Division, Malaysia
PIDC: Penang International Dental School
PSD: Public Service Department
RESC: Research Ethics Subcommittee
RM: Ringgit Malaysia
RMSEA: Root Mean Square Error of Approximation
SEGI: SEGi University and Colleges
SPSS: Statistical Package for Social Sciences
UHC: Universal health coverage
UiTM: Universiti Teknologi Mara
UK: United Kingdom
UKM: University Kebangsaan Malaysia
UM: University of Malaya
USM: Universiti Sains Malaysia
VMIUC: Vinayaka Missions International University College
WHO: World Health Organization
WP: Wilayah Persekutuan

Chapter 1


Introduction



The first chapter of this book will discuss the background context and
set out scenes of workforce issues for Malaysia, before it moves into the
subsequent literature section.

Overview


This study is part of a health services research (HSR) study involving a
multidisciplinary arena of scientific investigation. It focuses on the effects
of sociocultural, economic, organizational structures, health technologies
and personal behaviours on the accessibility, quality, and cost of health
care, and eventually, people’s health and well-being (Academy Health,
2000). This study primarily focuses on researching and examining a
human resource for health given that they are the backbone and have
always been associated with the overall performance of health systems
(Dubois et al., 2006).
In this light, this study used Malaysia in a case-study approach
for as a middle income country in the South-East Asia region that has
responded by increasing the production of dentists by opening 13 new
dental schools in the past decade. As a result, there are now concerns
about the long-term implications of these policies, particularly on how
the expensively trained workforce will be utilised (Malaysian Dental
Association, 2014, Malaysian Dental Council, 2014b, Oral Health
Division Malaysia, 2013a) in meeting the new needs and demands of
the Malaysian population. This is particularly due to the challenges
surrounding the use of this workforce during the period of compulsory
service in the public sector. Therefore, it is timely to examine the dental
workforce in Malaysia, as there is insufficient evidence of research on the
local dental workforce.

2 | The Dental Workforce in Malaysia

Malaysia



This study is focused on the South-East Asian country of Malaysia. The
country is made up of three federal territories and thirteen states which
are situated in two different geographical areas: Peninsular Malaysia
and East Malaysia. These areas are separated by the South China Sea
(Ministry of Tourism, 2013, Department of Survey and Mapping
Malaysia, 2013). Malaysia is an upper middle-income country that enjoys
political and economic stability. In this regard, Malaysia has fostered
various collaborations and partnerships with international associations
such as the WHO, Association of Southeast Asian Nations (ASEAN) and
others in an effort to improve health (WHO, 2013, Malaysian Dental
Council, 2013).

Demographic profile


In 2018, the estimated population in Malaysia was 32.4 million and the
country had an average annual growth rate of 1.1 per cent (Department of
Statistics Malaysia, 2018). According to the national census, the majority
of Malaysians (79.9%) live in Peninsular Malaysia and the rest in East
Malaysia (Department of Statistics Malaysia, 2011).
The Malaysian population is ageing, despite the statistics that
indicate only 6.5% of the population to be aged 65 years and above in
2018 (Department of Statistics Malaysia, 2018), the volume of senior
citizens is predicted to increase 11.4% by 2040 (Department of Statistics
Malaysia, 2012). This mimics the ageing population trend experienced
by many other countries (Calache and Hopcraft, 2011, Abi Nahed, 2006,
Arnett and Forde, 2012).
In the meantime, the male to female ratio was 107:100 in 2018 (World
Bank, 2018) and about 89.7 % of the population are Malaysian citizens
coming from a range of many ethnic groups, such as the Bumiputera
(69.1%), Chinese (23.0%), Indians (6.9%) and others (1.0%) (Department
of Statistics Malaysia, 2018). In this regard, it can be observed that the
Malaysian population is young, growing or ageing based on the past and
current trends of local contexts.

Introduction | 3


Oral health needs



Children’s and adult oral health status in Malaysia has been monitored
through epidemiological surveys that are conducted every 10 years.
Based on these surveys, dental caries remains a significant oral health
problem in Malaysia. However, there is evidence that reported dental
caries cases might be falling. The mean number of cases for decayed and
filled teeth (dft) for six-year-olds, was 3.6 in 2007 compared to 4.1 in
1997 while the occurrence of dental caries declined from 80.8% in 1997
to 74.5% in 2007 (Oral Health Division Malaysia, 2009, Oral Health
Division Malaysia, 1998). This is comparable to the mean number in
England (1.55) and Scotland (2.76) amongst five-year-old children in the
2002/03 period (Pitts et al., 2005). Similarly, the cases of caries among
the adult population also showed reductions from 94.6% in 1990 to
90.3% in 2000. Furthermore, the mean numbers of decayed, missing and
filled teeth (DMFT) cases for all age-bands in the population were also
reduced (Dental Service Division Malaysia, 1990, Oral Health Division
Malaysia, 2013b, Oral Health Division Malaysia, 2004). Similar trends
can also be observed in other countries, such as Australia (Calache and
Hopcraft, 2011), the UK (Gallagher and Wilson, 2009, Chesnutt, 2016),
and Canada (Abi Nahed, 2006).
However, the level of periodontal health is still considered poor;
1.5% of 16-year-olds had periodontal pockets of 4mm or more in 2007
while 28.5% of 35-44 year-olds had periodontal pockets of 4-5mm in
2000 (Oral Health Division Malaysia, 2010b, Oral Health Division
Malaysia, 2011, Oral Health Division Malaysia, 2013b). Over all, it was
recorded in 2010 that nearly 90% of adults need periodontal treatment in
the country. Meanwhile, past surveys have suggested that oral cancer is
not a major problem in Malaysia (Ng and Siar, 1992) as only 16 cases
were referred to oral surgeons under the national programme for cancer
in 2011. However there is evidence from health services that the majority
of cases were detected at later stages (Oral Health Division Malaysia,
2011). Moreover, about 5.4% of 12-year-olds had injuries to anterior
teeth in 2007 (Oral Health Division Malaysia, 2010a).
The global burden for oral conditions seems to have increased
unevenly in the past two decades, due to an increase of untreated caries and

4 | The Dental Workforce in Malaysia


severe periodontitis, following a declining rate of tooth loss (Marcenes et
al., 2013). There are changing patterns of oral diseases for high-income/
western countries with low incidences of dental caries (Arnett and Forde,
2012, Gallagher and Wilson, 2009, Abi Nahed, 2006) which has promoted
the transition from treatment to providing for conserving (Prakash et al.,
2006) and preventive orientated care (Wilson et al., 2013). Therefore, a
lower proportion of children have traditional treatment needs (Gallagher
and Wilson, 2009), and this could be seen in Malaysia, too (Oral Health
Division Malaysia, 2013a). All of these factors might influence the
requirements for students’ enrolment into dental schools (CfWI, 2013,
CfWI, 2012), training and education (Pyle et al., 2006, Haden et al.,
2006), retention of workforce (burden of workload) (Hall et al., 2007,
Kroezen et al., 2015) and the future model of care (Segal et al., 2008).
The declining trend in dental diseases, however, does not diminish
the demand for dental care whether in the UK (Steele et al., 2012) or
Malaysia (Institute for Health System Research, 2013). Specific sections
of society, such as the middle-aged and older people still experience
caries due to a lack of fluoride in water or toothpaste in their earlier years
(Steele et al., 2000). Following global mobility by the population and the
dental professionals (Chen et al., 2004, WHO, 2014), the patient base is
progressively diverse, presenting with much higher disease levels and
a culture of only seeking care in acute need (HEE, 2015, Gallagher and
Wilson, 2009). Moreover, there are inequalities in seeking dental care
where a recent study in Canada showed that higher income individuals
have more access to preventive care (Grignon et al., 2010). Given this,
workforce planning should encompass strategies from the educational
sector and health sector by ensuring the volume of skilled workforce
is sufficient and appropriate to deliver the needed and required dental
treatments, based on the suitable model of care.
The advancement and development of technology has had a close
relationship with medicine and dentistry, as seen in the introduction
of biomaterials, nanotechnology and 3D imaging (Eaton et al., 2008,
Ministry of Higher Education Malaysia, 2010, Gallagher, 2008).
Innovation and technology seem to alter how the profession and the
public observe and manage their healthcare and services (HEE, 2015).
More people are adopting technologies at a rapid rate (Glick et al., 2012),

Introduction | 5



and using the internet to seek health information has become a global
trend (Eysenbach and Jadad, 2001, Chestnutt and Reynolds, 2006, Baker
et al., 2003), putting pressure on services (Matthew, 1973). However,
not everyone has access to the internet. Furthermore, technology will
improve the quality of training in schools for the benefit of patients (Eaton
et al., 2008). Advances in science and technology might have improved
treatment efficiency in dentistry (Gallagher and Wilson, 2009, Eaton et
al., 2008); such as implant and veneer for aesthetic reasons. Fluoridation
has also improved the rate of dental caries in many countries (Chikte et
al., 2000) and a recent innovation is the introduction of a vaccine against
dental caries (Taubman and Nash, 2006), which might reduce the level of
the dental care demand. The current model of care also has the potential
to become outdated as new technology emerges (HEE, 2015); however,
a social concern appears with the level of compassion that the workforce
must provide the best of care to the patients.
Nowadays, society in most high-income countries is characterised
by individualism, consumerism, and possessing their own philosophy of
learning and rules based on their previous experience (Clarke, 2003). They
have a better understanding of health awareness and are well-informed
about the health services, although not always accurately (Gallagher
and Wilson, 2009). This has led patients and the general public to place
greater demands on health professionals (Glick et al., 2012, Wilson,
2003, Chestnutt and Reynolds, 2006) such as aesthetic and orthodontic
treatments, and this is something that professionals must acknowledge
and respond to.
In summary, the findings suggest that there are significant levels of
oral diseases, albeit a decrease in dental caries cases. Furthermore, the
Malaysian population is growing and ageing demanding a longer length
of treatment time and more complex dental care.


The dental workforce in Malaysia


The current dental workforce in Malaysia comprises dental health
professionals, namely general dentists and specialists, and dental
auxiliaries. The dental auxiliaries, known as Dental Care Professionals
(DCPs) in the United Kingdom (UK), consist of dental therapists, dental

6 | The Dental Workforce in Malaysia


technicians and dental surgery assistants (DSAs) (Oral Health Division
Malaysia, 2005), as shown in Figure 1.1.
In Malaysia, both dental health professionals and dental therapists
are operating clinicians, and consequently, their job scopes are varied,
based on the age groups of the patients and the complexity of dental
treatment which they offer (Ministry of Health Malaysia, 2014). Sixty-
five percent of the operating clinicians are dental health professionals,
and a majority of them reported as working full-time in the public sector
in 2016. Meanwhile the remainder (35%) are dental therapists (Ministry
of Health Malaysia, 2017), who at the time of writing, were recently
allowed to work in the private sector, up to the age of 18 years old under
newly tabled Dental Act 2018 (Malaysian Dental Council, 2018).

















Figure 1.1: The Current Dental Workforce in Malaysia.

Dental health professionals



i) Dentists


Practising dentists in the country must be registered with the Malaysian
Dental Council (MDC) and hold an Annual Practicing Certificate (APC)
to legalise their practices as dentists (Oral Health Division Malaysia,
2005).
After Malaysian independence in 1957, there was an acute shortage
in the dental workforce, which resulted in the inadequacy of trained dental
health professionals to deal with the significant number of caries cases
that occurred among the population of only seven million. At that time,

Introduction | 7



there were only 20 dentists working in the public sector and around 50
working in the private sector, and a majority of these dentists were based
in urban areas (Oral Health Division Malaysia, 2003). To overcome the
shortage of dentists, many dental schools were opened in an attempt to
modernise the health care system. In 2016, there were 7,210 registered
dentists across Malaysia; in this regard the Malaysian Dental Council
(2017) stated that the dentist to population ratio in Malaysia was 1: 4,297
based on Division 1 Dental Practitioners with APCs only.
Given the current ratio and the rapid growth of the dental school, the
aim of 1:4,000 dentists to population ratio set by the Oral Health Division
(OHD), Ministry of Health (MOH) to be reached by 2020 has been
revised to 1:3,000 (Ministry of Health Malaysia, 2011, Malaysian Dental
Council, 2015a). However, there are still disparities in the distribution of
dentists as their numbers vary from state to state, and it was reported that
most dentists are concentrated in Peninsular Malaysia and urban areas
(Ministry of Health Malaysia, 2010, Malaysian Dental Council, 2015a)
as private practitioners.
In 2016, the majority of dentists were working in the public sector
(63.7%); mainly under the MOHs while the remainder were serving the
Ministry of Higher Education and the Malaysian Dental Corps (Malaysian
Dental Council, 2017). On the other hand, as the volume of dentists in
the public sector increased, insufficiencies of dental chairs began to
surface; the latest statistics suggested that 2 dentists shared a dental
chair (Ministry of Health Malaysia, 2017); and this volume however is
expected to probably decrease on the next few years following the newly
introduced contract-based dental officer in the country (Fong, 2017). In
the meantime, more than two-thirds of Malaysian dentists are female
(Malaysian Dental Council, 2017), which follows the similar trend
with other countries (Stewart et al., 2004); however, no information is
available on private practitioners’ working patterns to determine whether
the dentists are working full or part-time.
In summary, the dentist to population ratio in Malaysia is improving
gradually. However, there are disparities in workforce distribution and
dental facilities between the area (rural or urban) and the sector (public
or private) served. There is also little evidence on the impact of the
increasing volume of female dentists on the capacity of the workforce.

8 | The Dental Workforce in Malaysia

ii) Dental specialists


The role of a dental specialist is to provide a high level of care and to
treat more complex procedures which are referred from both the private
and public primary care clinics; however, there are some private clinics
that provide direct access to such treatments. Meanwhile, the previous
Dental Act of 1971 has no provision on the registration for Malaysian
dental specialists (Commissioner of Law Revision Malaysia, 1971). It is
imperative to note that previously all of these specialists were registered
as dentists with the MDC. Therefore, the dentists’ database published
by the MDC also represents the volume of specialists in the country.
Previously, the MDC strongly recommended qualified specialists to be
registered with the National Specialist Register (NSR). As a result, the
accurate total volume of dental specialists in the country is unknown.
However, following the newly tabled Dental Act 2018 comprises several
major amendments to the previous acts such as market changes for dental
therapists, the introduction of divisions for dental specialists and dental
therapists. With the provision for a specialist division under the newly
tabled Dental Act 2018 (Malaysian Dental Council, 2018), the accurate
number of specialist will be revealed soon. This registration with the
MDC can be a self-regulation practice that can help maintain the high
standards of specialist practices in the country as well as safeguarding the
Malaysian public (Malaysian Dental Council, 2018).
At the moment, only nine dental specialities are recognised by
the Public Service Department (PSD), namely, oral surgery, paediatric
dentistry, oral pathology/oral medicine, orthodontics, periodontology,
restorative dentistry, special needs dentistry, forensic dentistry and
dental public health. Consequently, the total volume of specialists is
reported to be increasing over time considering constant expenditure on
postgraduate training (Oral Health Division Malaysia, 2013a, Malaysian
Dental Association, 2014). Nevertheless, only the MOH publishes the
volume of working specialists through the type of speciality, and the most
recent volume was reported in 2016 with 325 specialists (Oral Health
Programme Malaysia, 2018). In terms of the specialists’ workloads, the
available MOH data only revealed specialist workload as reflected by the
ratio of patients seen and treated by these specialists; the number ranged

Introduction | 9



from 1:869 for oral pathology and oral medicine to 1:2,730 for paediatric
dentistry, which was recorded in 2016. Trained MOH specialists are also
allowed to perform care at the tertiary level in one-stop centre clinics
after they have undertaken a short or structured course (Oral Health
Programme Malaysia, 2018).


Development of Malaysian dental education


The aim of training and education in Malaysia is to supply the workforce
for the healthcare provision system and to ensure they are well equipped
with sufficient skills, abilities, knowledge and competencies to deliver a
good quality of service.


Educational training for dentists


The first Malaysian dental school was established in 1972, at the
University of Malaya in Kuala Lumpur. The University of Malaya is
one of the oldest universities in the country and their first intake under
the dentistry programme consisted of 32 students. The second dental
school was established in 1997 and subsequently, the third dental school
was opened in 1998 (Oral Health Division Malaysia, 2003). These
schools were established following the full approval of the MOH. The
expansion has continued rapidly with the approval of 13 more dental
schools across Malaysia in the past 10 years, which brings the number of
approved dental schools to 16 (Table 1.1). Presently in 2016, local dental
students are enrolled and trained in 13 schools; six public universities
and seven private institutions of higher learning (Malaysian Dental
Council, 2017). The three remaining approved dental schools have not
yet recruited any students (Malaysian Dental Council, 2014a), and one
of them was reported as facing financial crisis and might be closed down
(Ramachandran, 2014).
All public dental schools (n=6) in Malaysia are fully subsidised
by the government, whereas, private dental schools (n=10) are funded
either by private organisations, family businesses or corporate entities,
as shown in the Table 1.1. Nevertheless, both private and public dental
sectors are regulated by the same authorities, the MDC and the Malaysia

10 | The Dental Workforce in Malaysia


Qualification Agency (MQA) (Commissioner of Law Revision Malaysia,
1971). The Table also reports that eight more recent operating schools are
all private; which reflects government action to increase the volume of
graduates with some support from the private sector. This was reinforced
by the introduction of a more liberal services sector in the country since
2011, including involving private universities (Ministry of International
Trade and Industry Malaysia, 2014). This mimics the global trend of
making education a source of a country’s economy, as part of the main
national agenda (Torres, 2009).
In addition, there is an ongoing concern about the volume of foreign
dental graduates who return to Malaysia with a majority of them educated
in India, Indonesia, the Middle East and the UK (Malaysian Dental
Council, 2017). Regarding the tuition fees, students in the public sector
are reported to pay an annual fee of approximately US$450 per year as the
government provide highly subsidised tuition fees. Meanwhile, students
in private institutions spent from US$71,518 (Penang International Dental
School, PIDC) to US$142,703 (International Medical University, IMU)
for their tuition fees in 2019, as reported by the respective institutions’
websites (PIDC, 2019, IMU, 2019). The tuition and fees increase every
year and similar to the policy of other countries, international students
are required to pay higher fees than home students.


Postgraduate Training


In regard to postgraduate training and workforce development for
specialists, since the 1950s, dental officers in Malaysia were sent abroad
to attend postgraduate programmes in various fields, namely oral surgery,
orthodontics, and dental public health (Oral Health Division Malaysia,
2013a). Over time, the training for specialisation has been conducted
locally, by only four to five local institutions; with some of them having
alternate years of student recruitment (Malaysian Dental Council, 2014b).
Because of that, many dentists are still sent to foreign universities in
comparison to their medical counterparts due to the limited number of
places for postgraduate training in Malaysia, given there is a high volume
of applicants from the large volume of dentist pools in the country. Most
of these dental officers are sent to universities in the UK and US, but they

Introduction | 11



are also sent to universities in Australia, New Zealand and Hong Kong
to promote versatility and diversity in the profession (Ministry of Higher
Education Malaysia, 2010). Currently, due to the country’s financial
restrictions, overseas training is sponsored only for sub-specialities, PhD
and sabbatical leave.
In the meantime, the MOH allocated about 38 scholarships to its staff
in 2016, for both local and international training (Oral Health Programme
Malaysia, 2018). The MOH also offers scholarships for tertiary dental
education for its staff to fulfil the needs for more complex oral care (Oral
Health Division Malaysia, 2013a). Once specialists have completed their
training, they will be placed at one-stop centres that provide tertiary-
level oral healthcare. These newly graduated specialists will undergo a
probation period under the supervision of senior specialists or consultants
to ensure they are competent enough to practise in an area of speciality
before being allocated to the appropriate service centre and to receive an
upgraded salary (Ministry of Higher Education Malaysia, 2010). Besides
the MOH, both the Ministry of Higher Education (MOHE) and the Dental
Corps provide their own funding to send their trainees for postgraduate
training. The allocation is 40 dentists for MOHE and 5 dentists for the
Dental Corps.
Thus, there is an opportunity for career development for young
dentists in regard to places and funding, however it is limited and the rate
of opportunity is not the same as the rate of growth of the dentists.


Table 1.1: Volume of new dental registrants across 16 local institutions
in both public and private schools from 2011-2018.

Year of graduation
Year
No Schools Sectors
established 2011 2012 2013 2014 2015 2016 2017 2018
University of
1 1972 Public 64 79 83 75 75 70 65 55
Malaya, (UM)
The National
2 University of 1997 Public 45 76 51 42 35 71 52 50
Malaysia, (UKM)
Science University
3 1998 Public 40 42 54 74 50 46 60 46
of Malaysia (USM)
AIMST Dental
4 2005 Private 43 49 52 62 73 72 77 70
Hospital
Penang International
5 Dental College, 2006 Private 35 52 73 28 73 75 75 76
(PIDC)

12 | The Dental Workforce in Malaysia


Table 1.1: Volume of new dental registrants across 16 local institutions
in both public and private schools from 2011-2018. (continued)

Year Year of graduation
No Schools Sectors
established 2011 2012 2013 2014 2015 2016 2017 2018
Dental Faculty,
6 2006 Public 30 29 23 31 37 61 43 59
UiTM
Kulliyyah
of Dentistry,
7 International Islamic 2007 Public - 26 48 37 37 60 47 64
University of
Malaysia
Islamic Science
8 University of 2007 Public - 29 21 28 24 35 37 30
Malaysia, (USIM)
MAHSA University
9 2007 Private - 17 38 25 39 45 67 70
College
International
10 2008 Private - - 9 28 10 22 31 32
Medical University
Melaka Manipal
11 Medical College 2009 Private - - - 19 45 73 62 77
(MMMC)
12 SEGI University 2011 Private - - 24 44 47
Lincoln University
13 2012 Private - - - - 33
College (LUC)
Vinayaka Missions
International Programme being reviewed.
14 2015/16 Private -
University College No student intake yet.
(VMIUC)
Quest International
15 University Perak 2015/16 Private - Programme being reviewed.
No student intake yet.
(QIUP)
Allianse University
16 College of Medical Private - Programme being reviewed.
Sciences (AUCMS)
Total 257 399 452 449 498 654 660 709
Sources: Ministry of Higher Education (2010) and Malaysian Dental
Council (2019).