As reported by the ADA News, May 26, 2006.

Forum Looks at Increasing Diversity in Dental Profession

By Karen Fox

Change was the central focus of the ADA's April 26 Outreach Forum: Increasing Diversity in the Dental Profession.

Several promising models for recruiting underrepresented minorities into dental careers and helping them succeed were highlighted at the meeting.

"We're committed to changing the profile of practicing dentists to better reflect the overall population of the United States," said Dr. Peter Robinson, chair of the ADA Council on Dental Education and Licensure's Ad-Hoc Committee on Diversity to Attract Qualified Underrepresented Minorities Into Dentistry.

Cosponsored by the divisions of Membership and Education, the forum included representatives from 10 state and local dental societies seeking guidance on initiatives to increase recruitment of minority dental students. The program's focus was to stimulate practical programs that can be implemented by dental societies and individual dentists.

Presenters included experts from the Robert Wood Johnson Foundation, the American Dental Education Association, ADA Institute for Diversity in Leadership, Student Hispanic Dental Association, Student National Dental Association, the Student Society of American Indian Dentists and American Student Dental Association.

"As evidenced by the initiatives at the forum, we're finally getting some traction," said Dr. Robinson. "It won't happen overnight, but we have a lot of committed people involved and some excellent plans."

Data presented at the forum showed a high correlation between dentists' race/ethnicity and the race/ethnicity of the majority of their patients.

"We don't know all the reasons for this, but there is ample evidence that black dentists treat a much higher percentage of black patients and Hispanic dentists treat a much higher percentage of Hispanic patients," said Dr. Robinson. "Part of the answer is where practices are located, and that there is a tendency for black dentists and Hispanic dentists to open their practices in areas that are more accessible to people of color."

Currently, 61 percent of black dentists' patients are black and 76 percent of white dentists' patients are white, Dr. Jeanne Sinkford, director of ADEA's Center for Equity and Diversity, told the forum.

"We know that the percentage of the population that is white in the United States is declining while the percentages that are black and Hispanic are growing," said Dr. Sinkford. "This shift necessitates growth in minority dental school admissions."

Statistics confirm there is wide variability regarding the number of dentists per 100,000 population, both geographically and from the standpoint of racial/ethnic background. For example, data from the ADA Health Policy Resource Center and U.S. Census show a dentist-to-population ratio around 74 dentists per 100,000 population for states including New Jersey, Massachusetts, Hawaii and New York, while the ratio for states including Mississippi, Arkansas, North Carolina, Nevada and New Mexico is in the 35-40 dentists per 100,000 range.

When looking at how well dentistry mirrors the population as a whole, data reveals an overall ratio of 54.1 dentists per 100,000 population.

When looking just at white dentists and white population, the ratio is similar: 55.3 per 100,000. For dentists and populations of minority racial/ethnic background, the data shows 113 Asian dentists per 100,000 Asian people, 11.5 Hispanic dentists per 100,000 Hispanic people, 12 American Indian dentists per 100,000 American Indian people and 15.1 African-American dentists per 100,000 African-American people.

To equalize the dentist-to-population ratio for underrepresented minorities, it would require 13,830 more African-American dentists to enter the profession, 16,383 more Hispanic dentists and 925 more American Indian dentists.

What steps are needed to increase the number of minorities in the profession? Forum participants recognized it's a complicated issue but there were opportunities for many to contribute positively to the outcome. speakers unveiled large- and small-scale initiatives, and considered ways to institutionalize these efforts for lasting effect. (See story, this page.)

"There are a lot of qualified underrepresented minority candidates," said Dr. Howard L. Bailit, a professor at the University of Connecticut Health Center and co-director of the Pipeline, Profession and Practice: Community-Based Dental Education Program. "But these students need to be identified early in their college careers, counseled on how to prepare for dental school and provided with enrichment opportunities."

In 2002, the Robert Wood Johnson Foundation and California Endowment began the five-year Pipeline initiative in which 15 dental schools received grant monies to establish clinical rotations for students and residents in community clinics that provide care to underserved populations and increase the number of underrepresented minority and low-income students.

To increase diversity, the Pipeline schools developed programs to educate college-based pre-professional health advisors about careers in dentistry, recruitment materials, and expanded summer enrichment and post-baccalaureate programs.

The efforts have proven successful—almost all participating schools have significantly increased minority student enrollment, and in four schools, minorities now comprise 20 percent or more of the first-year class. These four schools are perhaps the toughest academically, said Dr. Bailit.

"It shows what can be done if schools have the will and management capabilities to get the job done," he added.

One, the University of Connecticut School of Dental Medicine, went from a minority enrollment of 5 to 7 percent to well over 20 percent. Student rotations in community clinics are also influencing the career choices of students, said Dr. Robinson, who is also dean of the Connecticut dental school.

"Ninety percent of our students go into advanced programs when they graduate, and this year a full 10 percent are going to community clinics where the majority of patients are of color," said Dr. Robinson. "All of the students are white. They have such a sense of responsibility—it's phenomenal. If we didn't have the Pipeline program, they wouldn't even know about career opportunities in community clinics."

"We got into the Pipeline program as an access issue but became concerned about equality," said Judith Stavisky, senior program officer of the Robert Wood Johnson Foundation.

Through its early research of minority dental students, the RWJF found that "early and frequent exposure to dentists and dentistry is important to minority dental students," said Ms. Stavisky. Without mentors or outreach programs, minority college students often found themselves isolated from other pre-dental students.

"As a result, they didn't know about the application process, recommended undergraduate coursework, resources available, debt load," she said. "Few knew about funding opportunities and thought loans were the only possibility to finance education."

Added Ms. Stavisky: "We have to be more intentional about outreach and show young minority college students that dental careers are possible."

Last year the Robert Wood Johnson Foundation granted additional funding to nine dental schools for Summer Medical and Dental Education Programs. Administered by ADEA and the Association of American Medical Colleges, SMDEP enables dental and medical schools to provide six-week enrichment programs for freshman and sophomore college students in an effort to create a more diverse workforce.

"The number of students applying to dental schools has gone up 30 percent in recent years, along with higher grade point averages and dental admissions test scores," said Dr. David Brunson, associate director of the ADEA Center for Equity and Diversity. "Summer enrichment programs give schools ways to look at students outside the application process."

The program also provides help with the admissions process and study skills, and can often be a significant confidence boost.

The ADA pledged its support for the SMDEP program by sponsoring $25,000 in travel scholarships for scholars. Almost all the positions are filled for this summer. However, there are still some pre-dental spaces at Case Western Reserve University, University of Louisville, University of Nebraska Medical Center and the University of Medicine and Dentistry of New Jersey. (Do you know a good candidate for one of these summer programs? Contact Dr. Brunson at brunsond@adea.org.)  

With the Pipeline program due to conclude in about a year, Ms. Stavisky is confident that changes implemented will be long lasting.

"We're trying to relieve access problems now and lay the groundwork for the future," she said. "It's important to get these program changes inculcated into the culture of dental schools."

The ADA Council on Dental Education and Licensure and Council on Membership cosponsored the Outreach Forum.

Next steps include developing a list of action items for the CDEL to consider pursuing with all stakeholders in 2006-07.

"We need to distribute materials and have a network and portfolio of best practices available," said Dr. Robinson. "So if a dental school or dental society wants to really commit itself to doing this they have something to use."

This year's annual session in Las Vegas will also feature a half-day program on developing minority outreach activities. Watch for more information on that program in upcoming issues of the ADA News.