UCSF

INTRODUCTION: Minority populations within the US have been growing more rapidly than in the dentist population leading to the underrepresentation of African American, Hispanic and American Indian/Alaska Native dentists. This lack of diversity in the dental workforce has been linked to disproportionately inadequate delivery of dental care to minority populations in the United States. Furthermore, the current diversity-focused efforts in place primarily focus on understanding and enhancing underrepresented minority (URM) recruitment and retention within dental school. While these programs are critical, little effort has been made to track URM providers through education and practice; leaving a major gap in our knowledge of the extent to which the documented disparities worsen beyond professional school and into residencies and specialization. The purpose of this study is to assess the status of workforce diversity in the dental specialties and to understand the pipeline of URM dental specialists. Understanding the current state and pathways of URM dental specialists will inform pipeline efforts and policies to address access to specialty care.

METHODS: Our study used mixed methods to identify and assess the status of workforce diversity in the dental specialties and to understand the pipeline of URM specialist dentists. The approach includes a literature review, quantitative analysis of practice patterns, and qualitative interviews.

RESULTS: This study elucidates the challenges that URMs face in their pursuit of specialization within the dental profession. The pipeline continues to winnow with fewer URM dentists in specialty practice, indicating a small and leaky pipeline. Further, among all URM clinical dentists being first in his/her family to obtain a college degree, having a strong desire to work in his/her own cultural community or joining the NHSC due to debt load independently predicted lower odds of specialization. Alternatively, being initially foreign trained as a dentist and valuing professional training were independently predictive of higher odds of specialization. The geographic distribution of specialist dentists by race mirrors trends seen on previously published race/ethnicity dentist population maps, with African American specialist more densely populated in the South Central and Southern Atlantic regions (53.9%) and H/L specialists more populated in the Mountain, Pacific and some of the Southern Atlantic regions (58.9%). Qualitative findings reveal further details about the challenges URM dentists face along the pipeline including personal attributes (i.e first generation and rural upbringing), inadequate institutional resources (i.e. diversity within the institution and debt repayment options for specialists) and lack of access to mentoring and support.

CONCLUSION: The pipeline that prepares students for careers in health professions continues to leak, and despite individual program successes, cumulative impacts are not enough to improve the disparity that exist. This study shows despite efforts aimed to improve the pipeline of URM students into dental school, there is still a significant disparity that exist as URM dentists continue on to specialize. Further, this disparity has not changed much over time and our quantitative results show continued exacerbation of this gap. The lack of diversity within the dental specialties continues to be a critical factor in our educational system and unless, clear actions centered around this topic are initiated improving the pipeline into residency programs for URM students from beginning to end will continue to be unsuccessful.