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rocÏnõÂk 20 cÏ. 1. 2011

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ORTODONCIE

PocÏet ortodontistuÊ v CÏeskeÂ republice: veÏkovaÂ a regionaÂlnõÂ struktura Number of orthodontists in the Czech Republic: age and regional distribution

MUDr. Martin Kotas, Ph.D., prof. MUDr. Milan KamõÂnek, DrSc. OrtodontickeÂ oddeÏlenõÂ Kliniky zubnõÂho leÂkarÏstvõÂ LF UP v Olomouci Department of Orthodontics, Clinic of Dental Medicine, Medical Faculty of PalackyÂ University, Olomouc Souhrn Studie se zabyÂvaÂ aktuaÂlnõÂm stavem pocÏtu specialistuÊ v ortodoncii v CÏeskeÂ republice, jejich veÏkovyÂm rozlozÏenõÂm a relativnõÂ dostupnostõÂ ortodontickeÂ peÂcÏe v jednotlivyÂch regionech. Je provedeno srovnaÂnõÂ s jinyÂmi evropskyÂmi zemeÏmi. V roce 2010 pracovalo v CÏeskeÂ republice celkem 332 ortodontickyÂch specialistuÊ. VeÏkoveÂ rozlozÏenõÂ je nerovnomeÏrneÂ, jejich pruÊmeÏrnyÂ veÏk byl 51,5 roku. Na jednoho ortodontistu prÏipadaÂ v CÏeskeÂ republice 32.000 obyvatel. To odpovõÂdaÂ evropskeÂmu pruÊmeÏru. Je patrnaÂ nerovnomeÏrnaÂ distribuce dostupnosti ortodontickeÂ peÂcÏe v jednotlivyÂch regionech (Ortodoncie 2011, 20, cÏ. 1, s. 40-47). Abstract The current situation regarding the number of orthodontists in the Czech Republic, their age structure and availability of orthodontic care in individual regions of the Czech Republic are discussed. The situation is compared with that in other European countries. In 2010 there were 332 orthodontic specialists in the Czech Republic. The age distribution within the country is uneven; the mean age of orthodontists was 51.5 years. There is one orthodontist for 32 000 inhabitants. The number corresponds to the European countries average. However, the distribution of orthodontic practices in individual regions is rather uneven (Ortodoncie 2011, 20, No. 1, p. 40-47). KlõÂcÏovaÂ slova: pocÏet ortodontistuÊ, ortodontickaÂ peÂcÏe Key words: number of orthodontists, orthodontic care UÂvod

Introduction

PocÏet specialistuÊ v ortodoncii byl v historii nasÏõÂ specializace neÏkolikraÂt mapovaÂn. VzÏdy byl takovyÂ pruÊzkum motivovaÂn snahou zjistit mõÂru dostupnosti ortodontickeÂ peÂcÏe pro pacienty obecneÏ i v ruÊznyÂch regionech nasÏõÂ zemeÏ.

The number of orthodontic specialists has been mapped several times already. The reason has been always the same: to find out about the availability of orthodontic treatment for patients in general, and in individual regions of our country.

PrvyÂ takovyÂ pruÊzkum provedla ortodontickaÂ sekce ÏCeskeÂ stomatologickeÂ spolecÏnosti v roce 1973. OrtodonciõÂ se v tehdejsÏõÂch zdravotnickyÂch zarÏõÂzenõÂch zabyÂvalo 187 zubnõÂch leÂkarÏuÊ, zdaleka ne vsÏichni na plnyÂ uÂvazek. Pro ortodoncii bylo vycÏleneÏno 104,7 uÂvazku

The first survey was carried out by the Orthodontic Section of the Czech Stomatological Society in 1973. At that time 187 dentists provided orthodontic care, however, not all of them were full-time orthodontists. There was the equivalent of 104.7 full-time job positions for

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[1]. Specializaci v ortodoncii meÏlo 23,5 %, ostatnõÂ byli veÏtsÏinou ve specializacÏnõÂ prÏõÂpraveÏ. DalsÏõÂ pruÊzkum byl proveden ke konci roku 1982. K tomuto datu pracovalo v ortodoncii 231 zubnõÂch leÂkarÏuÊ. Situace se poneÏkud zlepsÏila v tom, zÏe jizÏ 60 % meÏlo pro ortodoncii plnyÂ uÂvazek a pro ortodoncii bylo vycÏleneÏno 163,5 leÂkarÏskeÂho uÂvazku. SpecialistuÊ bylo 86, ostatnõÂ veÏtsÏinou ve specializacÏnõÂ prÏõÂpraveÏ [2, 3, 4, 5]. V druheÂ polovineÏ roku 1991 pracovalo v ortodoncii 265 zubnõÂch leÂkarÏuÊ a bylo vycÏleneÏno 226,25 uÂvazku. SpecializacÏnõÂ atestaci meÏlo 169 leÂkarÏuÊ [6]. Ve vsÏech teÏchto pruÊzkumech se ukazovaly velkeÂ regionaÂlnõÂ rozdõÂly v pomeÏru ortodontistuÊ a deÏtskeÂ populace. V pruÊbeÏhu devadesaÂtyÂch let minuleÂho stoletõÂ prosÏlo celeÂ zdravotnictvõÂ velkyÂmi zmeÏnami. MõÂsto rozpocÏtoveÂho financovaÂnõÂ prÏes OkresnõÂ uÂstavy naÂrodnõÂho zdravõÂ, kde vsÏichni leÂkarÏi byli zameÏstnanci, bylo zavedeno financovaÂnõÂ prÏes zdravotnõÂ pojisÏt'ovny. Nastala rychlaÂ privatizace v ambulantnõÂch oborech a kromeÏ toho naÂsledovaly zmeÏny v systeÂmu specializacÏnõÂ prÏõÂpravy v ortodoncii. PrÏevlaÂdajõÂcõÂ systeÂm samouka kryteÂho vzdaÂlenyÂm sÏkolitelem prÏestal byÂt uÂnosnyÂ, takeÂ proto, zÏe zdravotnõÂ pojisÏt'ovny po roce 1995 prÏestaly stomatologuÊm bez specializace v ortodoncii hradit ortodontickeÂ vyÂkony. Trvalo rÏadu let, nezÏ se podarÏilo vybudovat na ortodontickyÂch oddeÏlenõÂch stomatologickyÂch klinik soucÏasnyÂ systeÂm sÏkolõÂcõÂch pracovisÏt', kteryÂ odpovõÂdaÂ principuÊm tzv. Programu Erasmus podle pozÏadavkuÊ EvropskeÂ ortodontickeÂ spolecÏnosti a EFOSA (European Federation of Orthodontic Specialists Associations) [7, 8]. VelkeÂ regionaÂlnõÂ rozdõÂly v pocÏtu ortodontistuÊ na populaci prÏetrvaÂvajõÂ. Z podneÏtu vyÂboru CÏeskeÂ ortodontickeÂ spolecÏnosti byl proveden tento pruÊzkum, jehozÏ cõÂlem je zmapovat veÏkoveÂ i regionaÂlnõÂ rozlozÏenõÂ ortodontickyÂch specialistuÊ v CÏeskeÂ republice. MateriaÂl a metodika Podkladem ke zjisÏteÏnõÂ veÏkoveÂho rozlozÏenõÂ cÏeskyÂch ortodontistuÊ byla internõÂ databaÂze rÏaÂdnyÂch cÏlenuÊ CÏeskeÂ ortodontickeÂ spolecÏnosti - ortodontickyÂch specialistuÊ [9]. Podkladem ke zjisÏteÏnõÂ dostupnosti ortodontickeÂ peÂcÏe v jednotlivyÂch krajõÂch a okresech CÏeskeÂ republiky byla internõÂ databaÂze rÏaÂdnyÂch cÏlenuÊ CÏeskeÂ ortodontickeÂ spolecÏnosti a rocÏenka CÏeskeÂho statistickeÂho uÂrÏadu [10]. Situace v evropskyÂch zemõÂch byla prÏevzata z sÏetrÏenõÂ organizace EFOSA z r. 2009 [11]. VyÂsledky 1. VeÏkoveÂ rozlozÏenõÂ ortodontistuÊ Podle databaÂze CÏeskeÂ ortodontickeÂ spolecÏnosti pracovalo v CÏeskeÂ republice v roce 2010 celkem 332 ortodontickyÂch specialistuÊ. VeÏkoveÂ rozlozÏenõÂ cÏeskyÂch www.orthodont-cz.cz e-mail: [email protected]



orthodontics [1]. The orthodontic specialists up 23.5%, the others were only in the specialized training. Another survey was held in the fall of 1982. There were 231 practitioners at the time; 60% working fulltime (equivalent of 163.5 full-time job positions for orthodontics overall); 86 orthodontic specialists, the rest were undergoing specialized postgraduate training [2, 3, 4, 5]. In the second half of the year 1991, 265 dentists worked in orthodontics (equivalent of 226.25 full-time job positions), 169 out of them were specialists in orthodontics [6]. All the surveys suggested great differences between regions in terms of the rate between the number of orthodontists and children's population. During the 90s of the last century the whole system of health care underwent profound changes. Instead of budget funding through District Health Service Institutions (OkresnõÂ uÂstav naÂrodnõÂho zdravõÂ), the employers of all physicians, a new system of health insurance funding was introduced. Outpatient's departments underwent fast privatization, and there were also changes in the system of postgraduate specialized study program in orthodontics. The old system of an ,autodidact` in fact, which was covered by a distant preceptor, could not continue also due to the fact that since 1995 the health insurance companies stopped to pay nonspecialists for orthodontic treatment. A number of years passed before we established the current system of training centers at the orthodontic departments in university hospitals that meets the principles of the Erasmus Program based on the requirements of the European Orthodontic Society and EFOSA (European Federation of Orthodontic Specialists Associations) [7, 8]. However, the great regional differences in the number of orthodontic specialists remain. Therefore, the Czech Orthodontic Society initiated the current survey that focused on the age as well as regional distribution of orthodontists in the Czech Republic. Material and methods The main source of relevant data was the internal database of full members of the Czech Orthodontic Society - specialists in orthodontics [9]. The availability of orthodontic treatment in individual regions and districts of the Czech Republic was assessed according to the internal database of full members of the Czech Orthodontic Society and a year-book of the Czech Statistical Bureau [10]. The source of the survey of the situation in European countries was the survey executed by EFOSA in 2009 [11]. Results 1. Age structure of orthodontists According to the Czech Orthodontic Society, in the Czech Republic in 2010 there were 332 specialists in 41



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Tab. 1. VeÏkoveÂ rozlozÏenõÂ cÏeskyÂch ortodontistuÊ Tab. 1. Age structure of Czech orthodontists

Věk/Age

Počet ortodontistů/Number od orthodontists

35-

42

36-40

38

41-45

26

46-50

13

51-55

57

56-60

80

61-65

49

65+

27

Obr. 1. VeÏkoveÂ rozlozÏenõÂ cÏeskyÂch ortodontistuÊ Fig. 1. Age structure of Czech orthodontists

ortodontistuÊ v roce 2010 se nachaÂzõÂ v Tab. 1 a na Obr. 1. Jejich pruÊmeÏrnyÂ veÏk byl 51,5 roku, veÏkovyÂ mediaÂn (strÏednõÂ hodnota) byl 55 let. NejstarsÏõÂmu ortodontistovi bylo 73 let, nejmladsÏõÂmu 29 let. VeÏkoveÂ rozlozÏenõÂ je nerovnomeÏrneÂ. Z grafu je mj. patrnyÂ velkyÂ propad produkce novyÂch specialistuÊ po zmeÏneÏ spolecÏenskyÂch pomeÏruÊ v 90. letech, kdy byla specializacÏnõÂ vyÂchova provaÂdeÏna privaÂtnõÂmi leÂkarÏi - sÏkoliteli. Je zrÏetelnyÂ naÂslednyÂ naÂruÊst pocÏtu novyÂch specialistuÊ v mladsÏõÂch veÏkovyÂch rocÏnõÂcõÂch vychovanyÂch jizÏ na klinickyÂch sÏkolicõÂch pracovisÏtõÂch podle principuÊ evropskeÂho trÏõÂleteÂho vzdeÏlaÂvacõÂho programu Erasmus. 2. PocÏet obyvatel na ortodontistu Na jednoho ortodontistu prÏipadaÂ v CÏeskeÂ republice 32.000 obyvatel. V Tab. 2 se nachaÂzõÂ pocÏet obyvatel prÏipadajõÂcõÂch na jednoho ortodontistu v celeÂ CÏeskeÂ republice a v jednotlivyÂch krajõÂch, v Tab. 3 a na Obr. 2 po42

orthodontics. The age structure is given in Table 1 and Figure 1. The mean age was 51.5 years, median = 55 years (the range between 73 and 29 years). The age distribution is not even. The figure shows a significant drop in the number of newly trained specialists in orthodontics since the political changes in the 90s when the new orthodontists were educated by private specialists - preceptors. We can see the increase in number of new specialists of younger generation - they were already trained in university training centers in accordance of the principles of Three-year Postgraduate European Program - Erasmus. 2. The proportion of orthodontists and population There are 32 000 inhabitants for one orthodontist. Table 2 shows the number of inhabitants per one orthodontic specialist in the whole Czech Republic and in individual regions; Table 3 and Figure 2 illustrate www.orthodont-cz.cz e-mail: [email protected]




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Tab. 2. PocÏet obyvatel na ortodontistu v celeÂ CÏR a v krajõÂch Tab. 2. Number of inhabitants to the orthodontist in Czech republic and in regions

Počet obyvatel Number of inhabitants

Ortodontisté Orthodontists

Obyvatel/Ortodontistu Inhabitants/Orthodontist

10 491 000

332

32 000

Praha

1 243 000

76

16 000

Středočeský

1 240 000

19

65 000

Jihočeský

637 000

19

34 000

Plzeňský

571 000

23

25 000

Karlovarský

308 000

7

44 000

Ústecký

836 000

20

42 000

Liberecký

438 000

9

49 000

Královéhradecký

555 000

18

31 000

Pardubický

516 000

9

57 000

Vysočina

515 000

11

47 000

1 150 000

47

24 000

Olomoucký

642 000

26

25 000

Zlínský

591 000

15

39 000

1 249 000

33

38 000

Česká republika

Jihomoravský

Moravskoslezský

< 20.000,

20.000 – 30.000,

30.000 – 40.000,

40.000 – 50.000,

> 50.000 obyv./ortodontistu

Obr. 2 PocÏet obyvatel na ortodontistu v okresech Fig. 2. Number of inhabitants to the orthodontist in districts



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cÏet obyvatel prÏipadajõÂcõÂch na jednoho ortodontistu v jednotlivyÂch okresech. Z tabulek a z grafu je patrnaÂ nerovnomeÏrnaÂ distribuce dostupnosti ortodontickeÂ peÂcÏe. Je patrnaÂ tendence leÂkarÏuÊ setrvaÂvat v univerzitnõÂch meÏstech podmõÂneÏnaÂ zejmeÂna vybudovanyÂm rodinnyÂm a sociaÂlnõÂm zaÂzemõÂm, naopak existujõÂ oblasti, kde je dostupnost peÂcÏe pro obyvatelstvo neuspokojivaÂ. SÏpatnaÂ situace je zejmeÂna v okresech Chrudim, HavlõÂcÏkuÊv Brod, Cheb a Nymburk, kde prÏipadaÂ 90 -100 000 obyvatel na jednoho ortodontistu, naopak v Praze, Plzni, Olomouci a v BrneÏ je meÂneÏ nezÏ 20 000 obyvatel na jednoho ortodontistu.

the number of inhabitants per one orthodontist in individual districts of the Czech Republic. The tables and figures clearly show uneven distribution of orthodontic care. Specialists tend to stay in university towns depending on their family and social backgrounds. On the other hand there are regions where the situation is unsatisfactory for their population. Particularly unfavorable situation is in districts Chrudim, HavlõÂcÏkuÊv Brod, Cheb and Nymburk, in particular, where there are 90 000 - 100 000 inhabitants per one orthodontist, while in Prague, PlzenÏ, Olomouc and Brno, there is less than 20 000 inhabitants per one specialist.

3. Stav v EvropeÏ PocÏet obyvatel na ortodontistu se v jednotlivyÂch zemõÂch Evropy podstatneÏ lisÏõÂ. Tab. 4 ukazuje situaci v evropskyÂch zemõÂch podle sÏetrÏenõÂ organizace EFOSA z r. 2009 [11]. PruÊmeÏrnyÂ pocÏet obyvatel na ortodontistu v EvropeÏ je 42 000 obyvatel, mediaÂn (strÏednõÂ hodnota) prÏiblizÏneÏ 35 000 obyvatel, modus (hodnota s nejvysÏsÏõÂ cÏetnostõÂ) prÏiblizÏneÏ 32 000 obyvatel. Za optimaÂlnõÂ lze povazÏovat pocÏet 30 000 - 35 000 obyvatel na jednoho ortodontistu. Z tohoto hlediska se CÏeskaÂ republika nachaÂzõÂ na pruÊmeÏrnyÂch evropskyÂch hodnotaÂch.

3. The situation in Europe In Europe, there are great differences in a number of potential patients for one orthodontic specialist. Table 4 illustrates the situation in European countries based on the 2009 report of EFOSA [11]. The average number in Europe is 42 000, median is approx. 35 000, modus (the value appearing most frequently) is approx. 32 000. The optimum number is considered 30 00035 000 inhabitants per an orthodontist. With regard to that, the Czech Republic represents the average European values.

Diskuse V nasÏõÂ studii jsou zahrnuti jen leÂkarÏi - atestovanõÂ specialisteÂ, nejsou zahrnuti leÂkarÏi ve specializacÏnõÂ prÏõÂpraveÏ, kteryÂch pracovalo na 7 klinickyÂch sÏkolicõÂch pracovisÏtõÂch v CÏR ke konci roku 2010 celkem 46. VeÏkoveÂ rozlozÏenõÂ je nerovnomeÏrneÂ. Za prÏedpokladu, zÏe by prÏesluhujõÂcõÂ ortodontisteÂ ukoncÏili cÏinnost a leÂkarÏi nizÏsÏõÂch rocÏnõÂkuÊ odchaÂzeli do duÊchodu v 65 letech a zÏaÂdnyÂ z nich neprÏesluhoval, bylo by trÏeba k prosteÂ reprodukci stavu nahradit v peÏtileteÂm vyÂhledu 76 ortodontistuÊ (27+49), tj. pruÊmeÏrneÏ cca 15 rocÏneÏ, v desetileteÂm vyÂhledu dalsÏõÂch 80 ortodontistuÊ, tj. pruÊmeÏrneÏ 16 rocÏneÏ. SoucÏasnaÂ kapacita klinik produkuje v pruÊmeÏru 12-14

Discussion In our survey only orthodontic specialists are included. Postgradual students - residents in the specialist postgraduate program (by the end of 2010 there were 46 at 7 university training centers in the Czech Republic) are not included. The age distribution is rather uneven. On condition that orthodontists serving beyond retirement age leave their work, and orthodontists of a younger generation go to retirement at the age of 65 (and no one of them would serve beyond the retirement age), to maintain the current situation we need - within 5 years - 76 new specialists in orthodontics (27+49), i.e. approx.15

Tab. 3. PocÏet obyvatel na ortodontistu v okresech Tab. 3. Number of inhabitants to the orthodontist in districts

Okres District

Počet obyvatel Ortodontisté Obyvatel/Ortodontistu Number of inhabitants Orthodontists Inhabitants/Orthodontist

Praha 1 Středočeský kraj Benešov Beroun Kladno Kolín Kutná Hora Mělník 1

1 500 900

76

19 700

94 100 83 800 158 700 95 200 74 900 101 300

2 2 3 2 1 2

47 100 41 900 52 900 47 600 74 900 50 700

Součet Hlavního města Prahy a okresů Praha-západ a Praha-východ

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Okres District


Mladá Boleslav Nymburk Příbram Rakovník Jihočeský kraj České Budějovice Český Krumlov Jindřichův Hradec Písek Prachatice Strakonice Tábor Plzeňský kraj Domažlice Klatovy Plzeň 2 Rokycany Tachov Karlovarský kraj Cheb Karlovy Vary Sokolov Ústecký kraj Děčín Chomutov Litoměřice Louny Most Teplice Ústí nad Labem Liberecký kraj Česká Lípa Jablonec nad Nisou Liberec Semily Královéhradecký kraj Hradec Králové Jičín Náchod Rychnov nad Kněžnou Trutnov Pardubický kraj Chrudim 2


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123 100 91 300 112 100 55 000

2 1 2 2

61 600 91 300 56 100 27 500

186 700 61 600 93 300 70 600 51 600 70 900 103 000

7 1 3 1 1 2 4

26 700 61 600 31 100 70 600 51 600 35 500 25 800

60 600 88 700 322 000 47 400 53 200

1 1 19 1 1

60 600 88700 16 900 47 400 53 200

95 300 119 400 92 900

1 4 2

95 300 29 900 46 500

135 700 126 400 118 000 87 300 117 300 130 000 121 500

3 4 4 2 3 2 2

45 200 31 600 29 500 43 700 39 100 65 000 60 800

104 100 90 400 169 800 74 700

2 2 3 2

52 100 45 200 56 600 37 400

163 000 79 600 112 300 79 200 120 200

8 1 3 1 5

20 400 79 600 37 400 79 200 24 000

104 400

1

104 400

Součet okresů Plzeň-město, Plzeň-sever a Plzeň-jih



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Okres District


Pardubice Svitavy Ústí nad Orlicí Vysočina Havlíčkův Brod Jihlava Pelhřimov Třebíč Žďár nad Sázavou Jihomoravský kraj Blansko Brno 3 Břeclav Hodonín Vyškov Znojmo Olomoucký kraj Jeseník Olomouc Prostějov Přerov Šumperk Zlínský kraj Kroměříž Uherské Hradiště Vsetín Zlín Moravskoslezský kraj Bruntál Frýdek-Místek Karviná Nový Jičín Opava Ostrava-město 3

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167 500 105 200 139 200

4 2 2

41 900 52 600 69 600

95 800 112 500 73 000 113 800 119 800

1 3 1 3 3

95 800 37 500 73 000 37 900 39 900

106 500 572 300 113 600 156 900 88 700 113 700

3 35 3 2 2 2

35 500 16 400 37 900 78 500 44 400 56 900

41 300 231 800 110 200 134 300 124 400

1 16 2 5 2

41 300 14 500 55 100 26 900 62 200

108 000 144 400 145 700 192 900

3 3 4 5

36 000 48 100 36 400 38 600

97 600 211 500 273 100 152 600 177 100 335 400

4 4 4 3 5 13

24 400 52 900 68 300 50 900 35 400 25 800

Součet okresů Brno-město a Brno-venkov

novyÂch specialistuÊ rocÏneÏ. ProtozÏe lze duÊvodneÏ ocÏekaÂvat, zÏe cÏaÂst leÂkarÏuÊ bude i po dovrsÏenõÂ 65. roku veÏku byt' v redukovaneÂ mõÂrÏe - daÂle leÂcÏbu provaÂdeÏt, lze konstatovat, zÏe staÂvajõÂcõÂ kapacita klinickyÂch pracovisÏt' je schopna v dostatecÏneÂ mõÂrÏe nahrazovat leÂkarÏe odchaÂzejõÂcõÂ do duÊchodu. Vzhledem ke konkurencÏnõÂmu prostrÏedõÂ v nejveÏtsÏõÂch meÏstech lze daÂle ocÏekaÂvat, zÏe se budou zmensÏovat i regionaÂlnõÂ disproporce. Podkladem ke zjisÏteÏnõÂ dostupnosti ortodontickeÂ peÂcÏe v jednotlivyÂch krajõÂch a okresech CÏeskeÂ republiky byla internõÂ databaÂze rÏaÂdnyÂch cÏlenuÊ CÏeskeÂ ortodontickeÂ spolecÏnosti - ortodontickyÂch specialistuÊ a ro46

a year; in ten years another 80, i.e. 16 a year. Nowadays, the clinical training centres produce 12-14 new specialists a year. On condition that some orthodontists continue their work after the age of 65, we can say that the current capacity of clinical training centres is able to substitute retiring specialists with newly trained orthodontists. With regard to the competition in large cities we may expect that the differences between individual regions will reduce. The source of our survey aimed at the availability of orthodontic care in individual regions and districts of the Czech Republic was the internal database of full www.orthodont-cz.cz e-mail: [email protected]



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OdbornaÂ praÂce

cÏenka CÏeskeÂho statistickeÂho uÂrÏadu. PocÏty obyvatel i pocÏty obyvatel na jednoho ortodontistu jsou v prÏehledech za celou CÏR a za kraje zaokrouhleny na celeÂ tisõÂce, v prÏehledech za okresy zaokrouhleny na sta. PrÏehled nezohlednÏuje satelitnõÂ praxe, kdy jeden leÂkarÏ pracuje ve võÂce okresech a maÂ cÏaÂstecÏneÂ uÂvazky. PrÏestozÏe drtivaÂ veÏtsÏina rÏaÂdnyÂch cÏlenuÊ CÏeskeÂ ortodontickeÂ spolecÏnosti [12] - specialistuÊ v oboru ortodoncie - duÊsledneÏ informuje sekretariaÂt spolecÏnosti o podstatnyÂch zmeÏnaÂch provozovaÂnõÂ sveÂ praxe, nachaÂzejõÂ se v internõÂ cÏlenskeÂ databaÂzi i neÏktereÂ zastaraleÂ neaktualizovaneÂ uÂdaje. Vzhledem k teÏmto obeÏma faktuÊm jsou si autorÏi veÏdomi mozÏnyÂch neprÏesnostõÂ uvaÂdeÏneÂho stavu v neÏkteryÂch okresech. Je patrnaÂ tendence leÂkarÏuÊ setrvaÂvat ve velkyÂch meÏstech na uÂkor blõÂzkyÂch okresuÊ. Tento jev vsÏak je do urcÏiteÂ mõÂry prÏirozenyÂ, pacienti z venkova v raÂmci svobodneÂ volby leÂkarÏe cÏasto do nevelkeÂ vzdaÂlenosti ke specialistuÊm dojõÂzÏdeÏjõÂ. To nic nemeÏnõÂ na zatõÂm maÂlo uspokojiveÂ situaci ve vzdaÂleneÏjsÏõÂch, hlavneÏ pohranicÏnõÂch okresech. ZverÏejneÏnõÂm faktickeÂ situace chceme poslouzÏit mladyÂm koleguÊm, kterÏõÂ vstupujõÂ do specializacÏnõÂho sÏkolenõÂ a jesÏteÏ nejsou rozhodnuti kde budou budovat svou ortodontickou praxi. AutorÏi nemajõÂ komercÏnõÂ, vlastnickeÂ nebo financÏnõÂ zaÂjmy na produktech nebo spolecÏnostech popsanyÂch v tomto cÏlaÂnku.


members of the Czech Orthodontic Society - specialists in orthodontics, and the yearbook of the Czech Statistical Bureau. The number of inhabitants as well as numbers of citizens per one orthodontist are rounded to thousands (regions and the Czech Republic), or hundreds (districts). The survey does not take into account the so-called satellite practices, i.e. the situation when one and the same orthodontist works in different districts as a part-time orthodontist. Despite the fact that vast majority of the Czech Orthodontic Society full members [12] - specialists in orthodontics - inform the office of secretary on the important changes in their practices, there are also some obsolete and non-up-to-date data. Therefore, the authors are aware of possibly incorrect information regarding some districts. Specialists in orthodontics - tend to work in larger cities at the expense of nearby districts. As patients have free choice of doctor, they often prefer to commute and visit the specialist in a nearby city. However, that does not mean that the situation in more distant, especially border districts, is satisfactory. This survey mapping the actual situation aims to serve our young colleagues who start their postgraduate training in orthodontics and have not decided yet where they establish their future orthodontic practice. Authors have no commercial, proprietary or financial interest in products or companies mentioned in the article.

Literatura/References 1. KamõÂnek, M., HoraÂkovaÂ, A., BednaÂrÏ, V.: PruÊzkum ortodontickeÂ peÂcÏe v CÏeskeÂ socialistickeÂ republice. Prakt. zubnõÂ LeÂk. 1975, 23, cÏ. 8, s.225-230. 2. KamõÂnek, M., HoraÂkovaÂ, A., KonecÏnaÂ V., BednaÂrÏ, V.: SbornõÂk vyÂsledkuÊ pruÊzkumu ortodontickeÂ peÂcÏe v CÏSR k 31.12.1982. KUÂNZ SMK, Ostrava 1983. 3. KamõÂnek, M., HoraÂkovaÂ, A., KonecÏnaÂ, V.: OrtodontickaÂ peÂcÏe v CÏeskeÂ socialistickeÂ republice. I. leÂkarÏi. Prakt. zubnõÂ LeÂk. 1984, 32, cÏ. 3, s. 65-69. 4. KamõÂnek, M., HoraÂkovaÂ, A., KonecÏnaÂ, V.: OrtodontickaÂ peÂcÏe v CÏeskeÂ socialistickeÂ republice. II. ortodontickaÂ pracovisÏteÏ. Prakt.zubnõÂ LeÂk. 1984, 32, cÏ. 6, s. 170-173. 5. KamõÂnek, M., HoraÂkovaÂ, A., KonecÏnaÂ, V.: OrtodontickaÂ peÂcÏe v CÏeskeÂ socialistickeÂ republice. III. okresy. Prakt. zubnõÂ LeÂk. 1984, 32, cÏ. 8, s. 247-249. 6. PruÊzkum ortodontickeÂ peÂcÏe v CÏeskeÂ republice. Ortodoncie 1992, 1, cÏ. 1, s. 47-59.

7. Three Years Postgraduate Programme in Orthodontics. Final Report Erasmus Project. Ortodoncie 1992, 1, cÏ. 1, s. 10-27. 8. EFOSA - European Federation of Orthodontic Specialists Associations/ Documents/ Erasmus program. http://www.efosa.eu 9. CÏeskaÂ ortodontickaÂ spolecÏnost: Seznam cÏlenuÊ. http://www.orthodont-cz.cz 10. CÏeskyÂ statistickyÂ uÂrÏad: DemografickaÂ rocÏenka CÏR 2009. http://www.czso.cz 11. EFOSA: Survey European Orthodontics in 2009 (¹Sydney Posterª). 7th International Orthodontic Congress, Sydney 2010. 12. CÏeskaÂ ortodontickaÂ spolecÏnost: Stanovy CÏeskeÂ ortodontickeÂ spolecÏnosti. http://www.orthodont-cz.cz.

MUDr. Martin Kotas, Ph.D. Klinika zubnõÂho leÂkarÏstvõÂ LF FN PalackeÂho 12, 772 00 Olomouc



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OdbornaÂ praâce ORTODONCIE

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