Survey on Status of Prosthodontists in Nepal, Service Rendered and Their Level of Satisfaction

Purpose: This survey aims to gather cumulative data on Prosthodontists in Nepal, their academic, financial and work status, services rendered and satisfaction level on job, lab support, material availability and work place environment. Material and methods: Online form was developed for the purpose of survey regarding “Status of Prosthodontists in Nepal, Service rendered and their level of satisfaction”. The online survey form was sent to Prosthodontists as per data available in Nepalese Prosthodontic Society. Data analysis was done from response obtained from November 1st to December 25th, 2017. Results: Among the 77 Prosthodontists whom the survey form were sent, 65 Prosthodontists responded (85%).The male were 55% and female 45%, majority of age ranges from 31 to 40 years. 81.5% had Master of Dental Surgery (MDS) degree and 52.3% had post graduation from Nepal. 80% of Prosthodontists are practicing in private institute including dental colleges, hospital and clinics. Among the academic degree, 1 tutor, 36 Assistant Professor, 4 Associate professor and 5 professors were recorded. 50% of Prosthodontists had original research article and case report published. Regarding the job satisfaction, lab support, material availability and working environment, most of them were satisfied. Conclusion: Number of Prosthodontists in Nepal are in growing trend. Most of them are of young age. Prosthodontic services rendered are growing in diverse aspect and most of them were satisfied with their job and work


Introduction
P rosthodontic services were known to be started in Nepal as earlier as 1929 when few pioneers obtained training from India and provided dental services limited to high class Rana families. Dental treatment during those days was limited to extraction of mobile tooth and replacing with vulcanite partial and full dentures. In 1941, qualifi ed dentists with LDS, DDS degree started their practice using foot engine, kerosene stoves and making Vitallium dentures and soldered gold crowns 1 The fi rst dental surgeon to obtain Master in Dental Surgery (MDS) degree in Prosthodontics was from KGMC, Lucknow, India in the year 1982. 2 Number of Prosthodontists has tremendously increased since then with their involvement in academic, clinical and research activities. However, there is lack of data regarding the status of Prosthodontists in Nepal. This survey aims to gather the information of Prosthodontists in Nepal, their education status, work place, Prosthodontic Services rendered and satisfaction level of job, lab support, material availability and work place environment

Material and methods
Online form was developed in Jotform for the survey regarding "Status of Prosthodontists in Nepal, Service rendered and their level of satisfaction". The survey form contained personal information, education status, work place, Prosthodontic Services provided and satisfaction level on job, lab support, material availability and work place environment. The online survey form was sent to 77 Prosthodontists registered as specialist in Nepal Medical Council as per data in Nepalese Prosthodontic Society. Online form was sent to all the registered Prosthodontists including members as well as non-members of the Nepalese Prosthodontic Society. The survey was open for response from November 1 st to December 25 2017.

Results
The objective of the survey was to obtain current information regarding the Registered Prosthodontists practicing in Nepal, Services rendered and their level of satisfaction. Among 77 participants whom the survey form were sent, 65 participants responded (84.41 %). Following are the result derived from survey ( Figure 1

Gender of Prosthodontists
Data showed that 55% of Prosthodontists were male and 45% were female. (Figure 3)

Age of Practicing Prosthodontics
Survey showed that 11% of respondents were under the age of 30. 75% of them ranged from 31 to 40 years, 9% were from 41 to 50 years and only 5% were above 50 years ( Figure 4). Average age of practicing Prosthodontists was 35.6 years

Annual Income of Prosthodontists
Regarding the annual income, result of this survey showed that 60% of Prosthodontists generate annual income of Rs 5,00,000/to Rs 15,00,000/-while 26.15% of Prosthodontists annual income was less than Rs 5,00,000/-and 3% of Prosthodontists annual income was above Rs 25,00,000/-( Figure 15) were the most common followed by case report. 23% of Prosthodontists had original research publication, 12.3% had case report publication, 18.4% had publication on both original research as well as case report but 32.3% of Prosthodontists had no publication. (Figure 16) Regarding paper presentation, this survey showed that case report was the common presentation followed by original research paper. 16.9 % of Prosthodontists had case report presentation, 12.3% had presentation on original research, 15.38% had both original research as well as case report presentation but 36.9% of Prosthodontists had not done any presentation. (Figure 16)

Paper Publication and Presentation
Regarding the publication, this survey showed that original research articles

Rating of Satisfaction by Prosthodontists
In the survey, respondent were asked to rate the job satisfaction, lab support, material availability and working environment. This survey showed that around 50% of Prosthodontists had rated in ok state regarding the job satisfaction, lab support, material availability and working environment. 32.3% had rated better and 15.38 % had rated best score on job satisfaction with 33.8% better and 10.76 % best score on working environment. However, 24.6% responsed bad and 23 % better on lab support and 18.46% responsed bad on material availability.

Discussion
Formal post graduate education on Prosthodontics was started in Nepal with the establishment of dental colleges, institutes and commencement of MDS program in Nepal in 2008. All dental graduates had to go outside Nepal to do post graduation before that time. Number of Prosthodontists had increased tremendously after post graduation education started in Nepal after 2008. According to the survey, 14 Prosthodontists were registered in the year 2014 which is highest number among years. This survey showed 55% Prosthodontists were male and 45% were female despite the fact that 58% of dental surgeons were female in 2008 5 . This fact indicate male dominance in this fi eld ,which was also in harmony with results of a Survey published by American College of Prosthodontists where 78% of responding were male. 6 This survey showed that 11% of Prosthodontists were under or equal to the age of 30 years, 75% of age range from 31 to 40 and only 5% above the age of 50 indicating the dominance of late young population in Nepal. American College of Prosthodontists survey report showed 60.37 % of practicing Prosthodontists were above the age of 45years and only 39.64 % of Prosthodontists were below the age of 44 years. 6 This survey data showed 47.6% of Prosthodontists were involved in single institute (Dental college/ Dental Hospital / Dental Clinic) while 50.7% of Prosthodontists were associated with more than one work place. 67.9% of Prosthodontists were practicing within the Kathmandu Valley while 29.23% of Prosthodontists were practicing outside the Kathmandu valley. 15.3% Prosthodontists are working in Nepal government services while 80% of Prosthodontists were practicing in private institute. 6.1% of Prosthodontists were full time academician, 27.6% full time clinician, 33.8% as both academician and Clinician. This trend indicated that most of the Prosthodontists were academically involved along with private practice mainly in the capital kathmandu. The data of this survey also indicated that among academically involed Prosthodontists, majority were at the level of assistant professor. This survey showed most Prosthodontists involved in academic have paper publication and presentation. Numbers of Prosthodontists involved in research activities were comparatively less.
This survey also showed that 100% of Prosthodontists were rendering diff erent treatment modalities on removable and fi xed dental prosthesis along with implant supported prosthesis in their practise. However, maxillofacial prosthesis and full arch implant rehabilitation were less practised by most of them. This trend in Nepal is slightly diff erent from the trend in United States of America, according to Survey by Eckert et al which showed 82% Prosthodontists use implantsupported prostheses in their practice 7 .
Regarding the data on the job satisfaction, lab support, material availability and working environment, 50% of Prosthodontists had rated satisfactory, 32.3% better and 15.38 % rated best score on job satisfaction but 24.6% responded bad and 23 % better score on lab support and 18.46% bad on material availability. This showed job and working environment of Prosthodontists were in satisfactory condition but need improvement in lab support and material availability.

Conclusion
Within the limitation of this study, following conclusions has been done