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From the Students' Corner |
Key words: diversity, access to care, underrepresented minority (URM), minority recruitment
Submitted for publication 03/01/06; accepted 05/18/06
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Abstract |
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The U.S. surgeon general’s report on oral health1 is the primary resource on the issue of access to care and the barriers to care related to diversity issues. Although the report is six years old, it remains relevant in its assessment of gross disparities in oral health care, particularly relating to minority groups. A study published by the American Dental Association (ADA) in 2000 demonstrated that U.S. dentists primarily treat patients of their own racial and ethnic background.2 An additional survey in 2001 showed that black dentists are likely to establish a practice where 41 percent of residents are black, compared to white dentists establishing practices where 9 percent are black.3,4 These data suggest that lack of diversity appears to be a link in a lack of health care access to minority groups. Minorities are more likely to select a health provider of their own race or ethnicity,5 so it follows that an increase in minority dentists would begin to address access problems. Indeed, annual surveys of senior dental students conducted by the American Dental Education Association (ADEA) show that minority students more frequently than their cohort peers plan to practice in urban areas and provide care to underserved populations.6
The ADA and ADEA both contend that, without minority dentists, access to care would be severely limited in minority communities nationally.7 The report of the ADEA President’s Commission on "Improving the Oral Health Status of All Americans: Roles and Responsibilities of Academic Dental Institutions" emphasizes that dental schools have an important role in recruiting minority students and training all students in diversity. As the producer of dentists, dental schools have an obligation to prepare an oral health workforce that can meet the increasing diversity that exists in our nation.8
Veal et al. conducted a survey in 2004 using student focus groups to determine why so few minority students matriculate to dental school.9 Results showed that while feelings of alienation, increased challenge due to race, and not fitting in were present in all groups, there were variations in severity among ethnic groups. African American students reported the most severe feelings, while Hispanic students were much less adversely affected by alienation or isolation. It was found that most students felt that a lack of diversity among faculty did not help their situation. When questioned as to why they entered dentistry, most stated that it was a respected position and a good job. When questioned as to how they learned about dentistry, the overwhelming response was through a family member or friend, not through a recruitment effort by a dental school. Contrary to other surveys, the majority of these students did not plan to practice in an underserved community because of a desire to obtain perceived stature in the larger community and due to financial obligations relating to student loans.
If the access issue is to be solved, it appears that increasing the numbers of minority dentists is critical. This begins by admitting more minority students. The U.S. Supreme Court in the University of Michigan Law School case of Grutter v. Bollinger ruled that it was "in the compelling interest" of our nation to increase diversity in higher education and that the practice of considering race in admissions was lawful because it was "narrowly tailored" to achieve a "critical mass" of diverse students.10,11 The implications of this pivotal ruling allowing admissions committees to consider race extend to dental schools. It has been documented that increased diversity not only improves the educational experience for all students,12 but that increasing diversity awareness also increases the likelihood that all students will treat multicultural populations when they are dentists.13,14 This court decision further raises the question: What is the "critical mass" of diversity needed in dental schools to achieve the goals of increasing diversity in our workforce and increasing access to care for all Americans?
Many programs have been implemented in recent years to address access to care and diversity. The Robert Wood Johnson Foundation Pipeline initiative, in which many institutions play a role, has been established to increase exposure to diversity and minority recruitment to dentistry.15 Conferences have been convened to address the issue, articles have been written, summer programs have been created, and gradually there has been an increase in minority involvement in dentistry.16 Increasing diversity must be tailored for each institution and its needs, but the process takes much effort and many years to succeed.17
What burden rests on dental school admission committees to accept students who not only represent diverse backgrounds, but also demonstrate a strong commitment to service? Dental schools utilize standardized figures, such as GPA and DAT scores, to draw comparisons among potential students. These measures have been shown to be statistically significant in predicting academic performance,18 but cannot account for many noncognitive attributes that are unique to each applicant. Methods such as essays and interviews assist in eliciting character traits specific to each applicant, but to a limited extent. Further, none of these methods measures the potential within each student for success as a clinician. It is a daunting task to devise new methods for looking at the whole experience that an applicant brings to the table, but dental schools must find new ways to analyze applicants that go beyond scores on standardized tests, particularly since minority applicants historically perform lower in these categories.11
With the attention given in recent years to diversity in dentistry, it is unclear whether the larger concern is the lack of diversity in the dental profession or the lack of access to care by diverse groups. I believe that the larger concern is access to care, and while increasing minority recruitment to dental school appears to be an answer, it is not the only solution. Increasing diversity awareness and dental student experience in minority communities will improve the likelihood that all students, not just minority students, will render care in underserved communities.13 Getting all dental students to mentally commit to improving access to care as students is paramount in obtaining this goal when they become dentists. Race by itself does not ensure that a dentist will serve in underprivileged communities, because that person may not have any connection to such a community. Access will be increased by the service of all and by implementing programs that place dentists in underserved communities, regardless of race and ethnicity.
Is there an access to care problem in the United States? A resounding yes. Is there a lack of diversity in the U.S. dental profession? Also, yes. These factors are interrelated, and increasing diversity in the dental profession will help increase access to care. The largest increase in access will occur, however, when all dentists agree that they have an obligation ethically and professionally to serve others and work together to solve the problem by serving their fellow human beings, regardless of any difference between them.
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REFERENCES |
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This article has been cited by other articles:
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  J. A. Horst Bootstrapping Student Publication in the JDE: An ADEA Council of Students Initiative J Dent Educ., October 1, 2007; 71(10): 1265 - 1266. [Full Text] [PDF]
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