By Jeanne C. Sinkford, DDS, PhD
Associate Executive Director and Director
Center for Equity and Diversity
American Dental Education Association
Several relatively recent major national reports* have emphasized the need for the health professions to become aligned with the increasing diversity of the US population. But in spite of increased national attention, major efforts, and promising successes, dental school enrollments continue to be out of sync with the growth of Underrepresented Minorities (URMs) in the US population. As a result, annual graduation rates of dentists barely replace those that are dying and retiring. This is creating a crisis in dentistry that especially affects underserved and minority groups.
At the present time, the US Public Health Service recognizes 3600 Dental Health Professions Shortage Areas (DHPSAs) in the US, where access to dental care is inadequate or lacking. Forty-six million Americans live in these shortage areas! At the same time, the American public is becoming increasingly aware of the relationship of oral health to general health as research documents the value of oral health to general health and treatment outcomes.
The role of dental schools both as "safety nets" for those who lack access to care in the private sector and as training environments for tomorrow's dentists cannot be overestimated. With the changing demographic in the US population wherein, by 2050, the now majority is expected to be minority, it is imperative that we continue to make progress from lessons learned utilizing a variety of partnerships and strategies that support the diversity objectives of our dental education institutions.
ADEA is taking the lead in assisting dental education institutions in their diversity and access strategies. A significant national effort is underway to improve the recruitment and retention of URM students in US dental schools. Partnerships continue to be sought that are necessary for continued progress toward this objective. Undergirding each of the successful recruitment ventures is an institutional culture that values diversity and a leadership that inspires, supports, and rewards diversity efforts.
The Power of Diversity
Diversity in dental education is essential to achieving equity in health care. But diversity also has the power to achieve excellence in health care; or to put it another way, the power to exceed the sum of its parts. This is the power that comes from including a range of perspectives in problem solving, the power that enables people with different backgrounds and life experiences to outperform groups of like-minded people.
New York City, the world's capital of human diversity, teaches us this lesson: The more diverse the city and the more frames of reference people bring to situations, the greater the potential for sparking an exciting and dynamic cross-pollination of ideas. This is as true for dental education as it is for a great metropolis. To harness this power in dentistry, we have to go forward on many fronts, including the following.
Strengthening Infrastructure Building and Support
Health Career Professions Opportunity (HCOP) and Center of Excellence (COE) Grants. The Health Career Professions Opportunity and Center of Excellence grants are major federal programs that help schools build capacity through skills development, faculty development, and infrastructure development. These federally sponsored, Title VII grant awards have been reduced in recent years. Four dental schools have HCOP funding through 2008 (Baylor College of Dentistry, University of California San Francisco, University of Michigan, and University of Alabama). Two dental schools have COE funding through 2008 (University of Oklahoma and Meharry Medical College School of Dentistry). Discontinued HCOP funding for schools such as Michigan is causing them to seek other resources to sustain their traditional commitment to diversity and inclusion.
Pipeline Programs. These programs attempt to remove barriers that limit access and to enhance student performance. Since 2002, 15 US dental schools have participated in the Pipeline, Profession & Practice: Community-Based Dental Education (Dental Pipeline) program, supported collaboratively by the Robert Wood Johnson Foundation (RWJF), The California Endowment, and the W.K. Kellogg Foundation. URM/LI (lower income) student recruitment has been a major objective of the Dental Pipeline program. Prior to the Dental Pipeline program starting in 2000, the national first-year URM enrollment was 499. In 2007, the URM first-year enrollment was 632 (27% increase).
Summer Medical and Dental Education Program (SMDEP). ADEA is partnering with the Association of American Medical Colleges (AAMC) on this $18.4 million grant from RWJF to attract undergraduate students to careers in medicine and dentistry. Twelve schools have been awarded grants for these summer programs. Nine of the grants include both medical and dental students. SMDEP is expected to increase the applicant pool of URMs in the future.
Bridging the Gap (BTG). ADEA received developmental funding from the Josiah Macy, Jr., Foundation to create three pilot educational projects to implement a seven-year dental curriculum. BTG is expected to create academic partnerships between undergraduate colleges and dental schools that will expand the applicant pool of URM students to careers in dentistry. Three grants (Georgia, New Mexico, New York) have been awarded totaling $550,457. If successful, we will be able to reduce the length of time and cost of training that will boost URM recruitment without an expansion of the number of new dental schools.
New York State Academic Dental Centers (NYSADC). This alliance, established in 1996, includes the five dental institutions in the state of New York: Columbia, New York University, Stony Brook, Buffalo and Rochester/Eastman. NYSADC was formally established to enhance the role of deans in state dental health policymaking through joint advocacy and cooperative working relationships that improve the health of all New Yorkers. Their collaborative activity involving minority faculty recruitment and community practice programs is currently supported with funding from W.K. Kellogg through ADEA. The collaborating schools, through their mentoring and community-based programs, have the potential for both underrepresented student and faculty recruitment.
Student Financial Support
The cost of a dental school education, which currently exceeds $150,000, is a deterrent to the pursuit of a career in dentistry for URM/LI students. Financial resources are necessary to make dentistry an attractive career option and to lessen the inevitable debt burden. Surveys of dental practice conclude that minority practitioners tend to deliver services in minority communities and for minority patients. Increased scholarships for both need and merit have proven to be effective recruitment tools. Scholarships for disadvantaged students, similar to those for military, Indian Health Service and NIH Research Fellowships, are needed. Recipients of these funds have service and/or teaching obligations in return for funds received.
Regional Recruitment and Web-Based Strategies
Regional Predental Advisors Workshop. Since 1998, ADEA has sponsored seven Predental Advisors Workshops in tandem with the ADEA Annual Sessions. These regional workshops have created a forum for exchange among predental advisors, admissions, financial aid, student affairs and recruitment officers. Regional recruitment strategies build capacity by reaching larger numbers of interested parties who benefit from best practices, lessons learned, shared resources and values.
Explore Health Careers (EHC). This recruitment strategy is funded by RWJF and implemented by ADEA. EHC is a Web-based recruitment tool that is intended to enhance student recruitment. It is a free, multidisciplinary, online, user-friendly career information network that now includes more than 100 health careers. Its content includes admissions, financial aid, mentoring, enrichment and other resource data. EHC has more than 1000 visitors to the site daily. EHC also has a free directory of more than 7000 academic programs in the US.
Realizing the Power of Diversity
We continue to seek additional resources and new opportunities that will expand the applicant pool of qualified underrepresented students. These efforts will strengthen the organizational capacity and program
sustainability of our dental schools and will produce an oral health work force that is greater, more productive, and more responsive to society's needs.
While we continue to implement strategies with short-term outcomes, we are also guided by a vision that supports long-term goals aimed at overcoming existing barriers to diversity and inclusion. We will continue to increase the evidence base for the value of diversity and redefine meritocracy in the admissions process in support of whole-file reviews for applicants. These and other measures to increase recruitment of underrepresented students will continue to require multiple and sustained commitment strategies designed to demonstrate diversity's ability to improve the health of the public we serve.
*The Institute of Medicine's reports, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (2002) and In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce (2004), and the Sullivan Commission Report, Missing Persons: Minorities in the Health Professions, A Report of the Sullivan Commission on Diversity in the Healthcare Workforce (2004), all indicate that diversity of the health professions is woefully inadequate and has severe consequences, including the promulgation of health disparities.