Profile of dentists graduate from the Federal University of Pernambuco

The aim of this study was to evaluate the profile of dentists that graduated from the Federal University of Pernambuco, who graduated during the curricular model that was in force until 2009, called 6404. A convenience sample consisted of 233 dentists who graduated from 2003 to 2008 were individually interviewed using a specially-designed questionnaire for data collection. Data were tabulated and subjected to descriptive and inferential statistical analysis (Pearson's chi-squared test or Fisher exact test) (α = 5%). It was found that 30.9% of the dentists were self-employed, 15% worked only in public service and 40.8% combined being self-employed with teaching, and public service or private practice. The degree of satisfaction with the profession was directly related to income and not to the acquired knowledge. The income was influenced by the type of professional activity. It was concluded that the dentists were concerned about continuing education and generally combine being self-employed with another type of work in the dentistry setting. The longer the time that has passed since graduation, the better the monthly income for these professionals, but they have less confidence that the labor market will improve. Descriptors: Professional Practice. Surveys and Questionnaires. Dentists. Education, Higher. Profile of dentists graduate from the Federal University of Pernambuco Revista da ABENO • 18(3):93-104, 2018 – DOI: http://dx.doi.org/10.30979/rev.abeno.v18i3.567 94


INTRODUCTION
According to the Synopsis of Statistics of Higher Education 2016 of the National Institute for Educational Studies and Research Anísio Teixeira 1 , Brazil has a total of 269 Dental Schools distributed in public (n=53) and private (n=216) higher education system with 299 undergraduate Dentistry Courses registered, being 64 publics and 235 privates. Out of the 107.318 enrollments (22.418 in public and 84.900 in private systems), 14.545 graduated from public (n=3.411) and private (n=11.134) dental schools. The State of Pernambuco presented a total of 9 Schools of Dentistry, two publics and seven privates. Among these, ten Undergraduate Dentistry Courses were registered (3 public and 7 private). The total of enrollments was 3.947 (public schools = 1.290; private schools = 2.657) and 414 dentists graduated from the public (n= 171) and private (n=243) higher education system 1 .
The poor distribution of Dental Surgeons (DS) influences on income, and the North is the region with the highest percentage (19%) of professionals in the higher income class (greater than 72,000 BRL -Brazilian currency -per year), and it is also the region with the lowest percentage (4%) of dentists in the country, with the highest proportions of DS per capita (1 per 1,800 population). In contrast, the Southeast Region has 11% of DS in the highest income group, the largest percentage of professionals in the country (59%) and a lower proportion of DS per capita (1 per 601 population). For the State of Pernambuco, the proportion is one dentist per 516 people; Recife is the city with the lowest proportion (1 per 467 population), and Paudalho has the highest (1 per 45,777 population) 2 .
The Undergraduate Dentistry Course at the Federal University of Pernambuco (UFPE), located in Recife capital of Pernambuco, was founded 98 years ago and was the first in the North-Northeast of the country. From the years 2003 to 2008, 552 dentists graduated, a mean of 92 professionals per year. Since the first semester of 2010, the course adopted the National Curriculum Guidelines 3 as the basis for its education program, directing the education of dental practice towards to the attention to health, in consonance with the existing health policies in the country, the Brazilian epidemiological profile and regional and local needs, with the flexibility to review and update it according to the emergence of new demands of vocational training. This new curricular profile is called 6405, with the first group of students graduated in June 2014.
The previous curricular model (6404), which was in force until 2009, was divided into two subject cycles (general and vocational) and presented a weak integration of teaching between the two cycles, apart from the specialty clinical classes. Philosophically, these adjustments in the curricular profile will have a positive impact on the graduates. However, from a comparative perspective, it becomes necessary to measure this improvement, reassess the education and promote any necessary adaptations. In order to do this, it is essential to have information on the profile of the professional who graduated within the previous model of higher education.
The aim of this study was to evaluate the profile of dentists graduated from the UFPE, Brazil, within a curricular model based on specialty clinics, with little attention to the practice of public health policies.

METHODS
The Research Ethics Committee of the Health Sciences Center, UFPE approved this cross-sectional observational study (approval number: 209/09). The sample consisted of 233 dentists graduated from 2003 to 2008 under the 6404 curricular model (universe of 552 professionals). Their names were obtained by systematic sampling of office of records and registration.
The dentists signed a free and informed consent form and then answered a multiplechoice questionnaire on socio-economic and demographic aspects, occupational choice, satisfaction, teaching, and work. For those no longer working as dentists, there was an essaystyle question that asked what activity the professional was involved in and the reason for this choice.
The questionnaire was developed and previously tested to check its reliability, validity, and operability. Any questions that could be misinterpreted were altered, in order to make them clear and concise. Calculations were carried out to ensure that the number of graduates interviewed from each year was proportionate. The sample was divided into two groups: G1, dentists graduated from 2003 to 2005; and G2, dentists graduated from 2006 to 2008.
The data were organized and imported into the Statistical Package for the Social Sciences (SPSS) version 15 for descriptive and inferential statistical analysis. Absolute and percentage distributions (descriptive statistics) and Pearson's chi-squared test or Fisher's exact test were used for statistical associations, with a significance level of 5%.

RESULTS AND DISCUSSION
According to table 1, approximately twothirds of the sample were female, with no statistically significant difference between G1 and G2. In previous studies, there was a predominance of males [4][5][6][7][8] . There is currently a predominance of women in 25 of the 27 Brazilian States. Forty years ago, only 10% of all professionals were female, whereas the current figure is 56% 2 . The predominant age of the respondents was 26 to 30 years (65.2%).
Considering the period of enrollment in higher education (17 to 20 years old), added to the five years of the undergraduate course and the time after graduation, this result was expected.
Regarding marital status, 104 (44.6%) reported being married, 126 (54.1%) were single, 02 (0.9%) divorced and 01 (0.4%) widowed. The percentage of those who said they were single was higher in G2 with a statistically significant difference (p <0.001), which is an expected result because this group is composed of younger graduates. The majority of the dentists (91.4%) went to only private high schools, 4.3% only public schools and 4.3% went to a mixture of public and private schools. These data corroborate other studies 9,10 . Almost all respondents (98.7%) entered the university through the university entrance exam (the vestibular), 0.4% entered via a quota system and 0.9% by legal means, with no statistical difference between the periods surveyed.
When asked regarding the decisive factor for choosing the course, just over half (54.1%) marked the alternative: "For personal and professional fulfillment", followed by 18.9% of who replied that it was due to the "influence of relatives and friends". These results are similar to some studies in the literature 6,[11][12][13] . However, it differs from one study 8 , in which was observed that only 3.4% of respondents claimed it to be the reason for their career choice. These authors dissociated some variables that could be classified as "personal and professional fulfillment". If added, it would have resulted in a percentage of approximately 58.7%, similar to other studies.
In this study, more than a half of the respondents (57.1%) had no family member with the same profession, as reported by other authors [11][12][13] and there was no statistically significant difference between the groups. However, it was found that those who had a relative or friend, who was studying or had studied on the Dentistry course, were positively influenced to choose the same profession, with a statistically significant difference (p<0.001).
Of the respondents, 76.0% worked in the Recife Metropolitan Region (RMR), a result that is higher than those found in another study 12 , in which 58.33% of UFPE graduates worked in the RMR. No association was found between monthly gross income and the fact of working in the RMR, countryside or other State. However, it was reported that 45.5% of respondents also worked in a location other than where they lived to supplement their income, and there was no statistically significant difference between groups. It is important to note that 91.4% of respondents worked in Pernambuco, which shows the importance of teaching that is focused on the needs of local reality that the graduates face when leaving higher education so that they can be absorbed by the work market. Similar behavior was observed in another study 2 , in which a mean of 86% of national dentists reported that their main job was in the State where they had been graduated.  Table 2 shows that the dentists were mainly self-employed professionals (30.9%) or were associated with some other activity (40.8%), which is in line with other studies [14][15][16][17] . Changes were already taking place in professional practice. Although professionals had previously worked exclusively in their private practice, they were beginning to work both as a self-employed professional and an employee or teacher, and this is the trend with these professionals 18 . The lowest percentage corresponded to those who were only teachers (2.6%), a situation that was also observed in another study 17 . This may be explained given that the undergraduate dentistry courses focus on skills and abilities intended for the labor market and the conditions of general professional practice as well as activities to incentive dental students regarding the teaching practice. Table 2 also shows that the most frequently declared monthly gross income range for those in the profession was from 06 to 10 minimum wages (MW), for 43.8% of the sample. Other authors have reported similar results 12,17 . However, different results were found in another study 15 , where there was a higher frequency of those who earned from 11 to 20 MW (33%) followed by the range of 6 to 10 MW (25%). This difference can be explained by the fact that the population that was studied graduated between 1960 and 1997, and thus had a broader clientele in their private practices, and consequently a more significant financial stability. This study also found that the higher level of income was concentrated in the group where the longest time had passed since graduation (G1), with a statistically significant difference (p=0.005). This result is corroborated by other authors 16 .  Table 3 shows the association between the type of professional practice and the gross monthly income (p<0.001) and shows that there is a connection between them. In the same table, the association between job satisfaction and gross monthly income was analyzed. It was found that the percentage of those who would do the course again increased as their income level also increased (p<0.001). This result shows that in order to be satisfied, pleasure in carrying out the work must be accompanied by a high enough salary to acquire a desired standard of living.
This high demand for postgraduate courses is because the labor market requires professionals who are increasingly trained and up-dated continuously or due to the need to supplement a poor education received at the undergraduate level. These results were similar to dentists who graduated in Rio Grande do Sul 13 between 1965 and 1999, but differed from the results with dentists who graduated in Pernambuco 12 between 1997 and 2001. In this study, Pernambuco was the most chosen State for postgraduate courses for the vast majority of respondents (90.7%), followed by Paraíba (4.2%). This result was expected because it is simpler to attend a course in the State where one resides, and also due to the high number of courses offered.
When evaluating the association between the monthly gross income and the postgraduate course chosen, it was found that among the variables studied; the refresher course was the only one that had a significant association with income (p <0.001). It was also evident that the percentage with an income of 0 to 5 MW (39.6%) was highest among those who had not attended a refresher course (17.4%) The percentage with an income from 6 to 10 MW was 50.5% among those who had attended a refresher course and 39.6% when they had not. The percentage of those with an income of 11 MW or more was 32.1% among those who had attended a refresher course and 20.8% for those who had not.  Table 4 shows that the majority (76%) of the sample considered themselves adequately trained to practice the profession on graduation. The reasons related to this were also studied. Trainee experience was the most mentioned reason (76.3%) while the university course accounted for less than half (46.9%). More dentists who graduated between 2003 and 2005 (82.4%) considered themselves professionally capable than those who graduated from 2006 to 2008 (71.0%) and with a statistically significant difference (p = 0.044).
These data imply a greater demand from the current labor market, which leaves the more recently graduated professionals feeling more insecure. However, there was no statistically significant difference for the reasons between the periods of graduation. Results of a similar study 12 , which assessed the graduates from the same institution between 1997 to 2001, found that the reasons dental graduates considered themselves adequately trained, in descending order were personal interest (51.69%), trainee experience (30.34%), college/teaching experience (24.72%), refreshment courses during graduation (20.22%) and monitor experience (4.49%). Table 4 also shows that those who did not consider themselves capable stated that the main reasons were the poor quality of the university/professors, which was higher in G1 (77.8%) than in G2 (55.3%) and the poor quality of trainee programs, which was higher in G2 (26.3%) than in G1 (5.6%), both without a statistically significant difference. Although there was no statistically significant difference, these results indicate the need to improve the quality of education, especially the internship programs. When compared with another study, also with UFPE students 12 , it was found that the claim that lack of aptitude was related to teaching decreased with time. In the study with graduates from 1997 to 2001, this reason was mentioned by 80.9% of the UFPE graduates interviewed. However, in this study, it was reported by 62.5% of respondents. Teaching and learning cannot take place exclusively in the teaching clinics. It is important that knowledge is also built-up by contact with the field of work. The curricular model experienced by these graduates had an extramural internship requirement of just 150 hours in the final year of the course. The new 6405 curriculum places the student in trainee programs from the fourth semester with a total requirement of 840 hours of extramural internship, which provide more contact with the field of work.
Perhaps many reported that they felt unprepared due to the fact that in addition to knowing clinical procedures, dentists must also learn to manage their workplace and how to be entrepreneurial. They did not learn these skills during the course since this discipline was not mandatory in their curriculum. The current job market requires that the dental professional also has knowledge about administration, management, and marketing.
The dentists do not come out of a university course prepared to manage bills, select employees, or how and where to look for patients, in other words, how to run their own business. The education offered to the undergraduates is focused solely on the patient, which results in a professional who is removed from the reality of a market that is already saturated. Thus, the market is being supplied with high-quality professionals, but they are unable to combine professional expertise with financial success 20 .
Since 2005, the curricular model of these UFPE graduates has included an optional subject called Entrepreneurship 1 (IN 095) with a total requirement of 60 hours, in which the student acquires the basics of entrepreneurship, leadership, communication, and teamwork, forms of entrepreneurial thinking, creativity, and convergent and divergent thinking. This subject should have been compulsory and with a greater workload to meet the needs of academic education. Table 5 shows the classification of knowledge acquired. Even though the University was mentioned as the main reason for the lack of aptitude (62.5%), only 8 (3.4%) dentists considered that the education was insufficient; 30.5% considered it sufficient and 66.1% reasonable. This differs from another study of graduates from the same institution 12 , where it was observed that only 2.25% rated it as sufficient and 60.67% as reasonable, which demonstrates a greater satisfaction with teaching. Table 5 also shows that regarding satisfaction, 140 (60.1%) dentists reported that they would do the course again, with no statistical difference between the periods, a result similar to some other studies 12,17 but that differs from a study by other authors 21 with graduates between 1998 and 2006 in the countryside of São Paulo State.
Regarding the labor market forecast, 47.2% believe it will improve, 31.8% that it will worsen and 21.0% that it will not change. When comparing the periods for this variable, it was found that graduates who had graduated earlier are less optimistic about the profession, with a statistically significant difference between them (p = 0.007), as shown in table 5.
The profession itself has suffered a steady decline of its prestige among high school students 22 . Previously, dentistry was one of the most competed for subjects during the entrance exam. It seems that the high prestige that dentists have traditionally enjoyed in Brazilian society is currently under threat. At UFPE, there were 11.1 candidates competing for each place in 2003 while in 2011 there were only 7.5 candidates per place. According to Table 6, the percentage of those who considered themselves prepared to practice after graduation decreases when the professional believes they have acquired less knowledge, with a statistically significant difference (p = 0.021). This table also shows that the origin of the lack of preparedness and the degree of satisfaction with the course does not have a statistically significant difference with the knowledge gained. When data were collected, 5.57% were no longer working as a dentist, a result similar to other authors 23 which was 6%.
They were asked what activities they were now carrying out and the reason for withdrawal from the course. The main responses were that they were currently traders/entrepreneurs (46.16%), civil servants (30.76%) or were enrolled (or graduated) in Medicine or Law courses (23.08%).
Chart 1 shows the reasons for abandoning the profession, which are mainly due to low pay, lack of worker rights (13th salary, paid vacations, maternity leave, payroll, job security) and the appearance of a better opportunity in a commercial field. According to the Brazilian Institute of Geography and Statistics (IBGE), 55.3% of the Pernambuco State population have a monthly household nominal income per capita from ¼ to 1 minimum wage, which shows the need to invest in public policies in the region, to meet the real needs of the State's population 24 (table 2).

CONCLUSIONS
The profile observed was of a professional concerned about continuing education, and that usually combines self-employed work with another form of employment in the dentistry field. The degree of satisfaction with the profession was directly related to income and not to the acquired knowledge. The income was influenced by the type of professional activity, which was lower in teaching activities. It was concluded that the dentists were concerned about continuing education and who generally combine being self-employed with another type of work in the dentistry setting. The longer the time that has passed since graduation, the better the monthly income for these professionals, but they have less confidence that the labor market will improve.