Monique Trice, 24, is a University of Louisville School of Dentistry student who will complete her studies in 2015. Trice completed the Summer Medical and Dental Education Program (SMDEP) in 2008 at the University of Louisville site. Started in 1988, SMDEP (formerly known as the Minority Medical Education Program and Summer Medical and Education Program), is a Robert Wood Johnson Foundation–sponsored program with more than 21,000 alumni. Today, SMDEP sponsors 12 sites, with each accepting up to 80 students per summer session. This is part of a series of posts looking at diversity in the health care workforce.

Diversity is more than ethnicity. It also includes geography, perspective, and more. I was raised in Enterprise, Ala., which is in Coffee County. The community’s demographic and geographic makeup set the stage for an oral health care crisis. Here’s how:

• Enterprise is a community of 27,000 and just 15 licensed general dentists, three Medicaid dental providers, and zero licensed pediatric dentists to service Coffee County, a population of 51,000. In 2011, Alabama’s Office of Primary Care and Rural Health reported that 65 of the state’s 67 counties were designated as dental health shortage areas for low-income populations.
• According to this data, more than 260 additional dentists would be needed to bridge gaps and fully meet the need. For some residents, time, resources, and distance figure into the equation, putting dental care out of reach. In some rural communities, an hour’s drive is required to access dental services.
• Lack of affordable public transportation creates often-insurmountable barriers to accessing dental care.

Growing up in a single-parent household, my siblings and I experienced gaps in dental care. Fortunately, we never suffered from an untreated cavity from poor oral health care, but many low-income, underserved children and adults are not so lucky.

Catherine J. Malone, MBA, DBA(c), is a program associate working in the areas of diversity and nursing for the Robert Wood Johnson Foundation. This is the first in a series of posts looking at diversity in the health care workforce.

As a member of the Robert Wood Johnson Foundation’s (RWJF) Human Capital team leading the group’s diversity efforts and the Foundation’s Diversity Team, I would like to share some of our work in this area. I must start by noting that “diversity” means different things to different people. At RWJF we recognize and value all types of diversity and therefore have a broad definition of the term which is described in the Foundation “Diversity Statement” below:

“Diversity and inclusion are core values of the Robert Wood Johnson Foundation, reflected in our Guiding Principles. We value differences among individuals across multiple dimensions including, but not limited to, race, ethnicity, age, gender, sexual orientation, physical ability, religion and socioeconomic status. We believe that the more we include diverse perspectives and experiences in our work, the better able we are to help all Americans live healthier lives and get the care they need. In service to our mission, we pledge to promote these values in the work we do and to reflect on our progress regularly.”

Michael R. Bleich, PhD, RN, FAAN, is Maxine Clark and Bob Fox dean and professor at the Goldfarb School of Nursing at Barnes-Jewish College in St. Louis, Mo. He is an alumnus of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program (2000-2002).

With help from co-authors Brent MacWilliams, PhD, ANP, and Bonnie Schmidt, PhD(c), RN, in our recent American Journal of Nursing article summarizing research on men in nursing—and further inspired by a manuscript by Dena Hassouneh, PhD, ANP, entitled Anti-Racist Pedagogy: Challenges Faced by Faculty of Color in Predominantly White Schools of Nursing in the July 2006 issue of the Journal of Nursing Education—I am in a reflective place. After a nearly 40-year journey as a male in nursing, I now realize the discipline was never designed for me.

"Why did the faculty not do more to buffer me from faculty who were overtly gender-disparaging? Why were the gloves in procedural kits always sized for smaller hands?"

That is not to say that I have not had a fabulous career, worked with the finest colleagues one could imagine, or had opportunities that provided continuous challenge and opportunity. But as a discipline, nursing has had its broad shifts.  Florence Nightingale was a master of evidence-based practice and spent a lifetime elevating nursing to a discipline in a world that was political, gender-biased against women, scientifically evolving, caste-oriented, and more. The gift of structure, process, and outcomes she gave nursing are irreplaceable.

Nurses play a critical role in expanding access, improving quality, and reducing the cost of health care for millions of Americans. But today’s nursing workforce is not nearly as diverse as the country.

Numerous studies find that a more diverse nursing workforce can provide care that is more culturally competent, offering benefits to patients, the health care system, and communities. As the Institute of Medicine's landmark report, The Future of Nursing: Leading Change, Advancing Health, notes, “Because nurses make up the largest proportion of the health care workforce and work across virtually every health care and community-based setting, changing the demographic composition of nurses has the potential to effect changes in the face of health care in America." 

Click the "Read More" link to see the infographic, or download it here.

Though it remains a predominantly female profession, a new study from the U.S. Census Bureau finds that the percentage of nurses who are male more than tripled from 1970 to 2011, from 2.7 percent to 9.6 percent.

The Census Bureau’s Men in Nursing Occupations also finds the proportion of male licensed practical and licensed vocational nurses increased, from 3.9 percent to 8.1 percent. Men's representation was highest among nurse anesthetists (41%).

“The aging of our population has fueled an increasing demand for long-term care and end-of-life services," said the report's author, Liana Christin Landivar, a sociologist in the Census Bureau's Industry and Occupation Statistics Branch, said in a news release about the study. “A predicted shortage has led to recruiting and retraining efforts to increase the pool of nurses. These efforts have included recruiting men into nursing.”

The study also found that men typically earn more in nursing fields than women, but not by as much as they do across all occupations.  Male nurses earned an average of $60,700 in 2011—16 percent more than the average earnings for female nurses, which was $51,100. The difference in earnings is due partly to the concentration of men in higher-paid nursing occupations, like nurse anesthetics. “Men have typically enjoyed higher wages and faster promotions in female-dominated occupations,” the study says, a phenomenon known as the “glass escalator” effect.

Read the study.
Read a news release about the study.

A report from the Association of American Medical Colleges (AAMC) documents an overall trend toward increased diversity among students applying to medical school.

AAMC’s Diversity in Medical Education: Facts and Figures 2012 finds that nearly half of the applicants to U.S. medical schools in 2011 were non-White. Whites were the largest group of applicants, followed by Asians. “Compared with 2010, in 2011 the percentage of Hispanic or Latino applicants increased by 5.7 percent and the number of Black or African American applicants grew by 5 percent,” the report says.

But only 2.5 percent of medical school applicants in 2011 were Black men. Twice as many Black women as men applied to medical school that year, creating the biggest gender gap in medical school applicants among all racial or ethnic groups.

“We have a major, major problem in this country,” Marc Nivet, EdD, AAMC’s chief diversity officer, told American Medical News. “There is just simply an enormous amount of indisputable evidence that we’re not intervening as effectively as we’d like as a society to increase the talent pool of African-Americans who are capable of taking advantage of the science curricula available up and down the pipeline.”

This is part of a series introducing programs in the Robert Wood Johnson Foundation (RWJF) Human Capital Portfolio.

The Harold Amos Medical Faculty Development Program
is on the verge of a milestone: it will observe its 30th anniversary this year.  In 2012, the program achieved another notable distinction, as a third alumnus was selected to lead an institute at the National Institutes of Health: Gary Gibbons, MD, (’88) is now director of the National Heart, Lung, and Blood Institute (NHLBI). He joined Griffin Rogers, MD, MACP, (’83) Director of the National Institute of Diabetes and Digestive and Kidney Diseases; and Roderic Pettigrew, MD, PhD, (’83) Director of the National Institute of Biomedical Imaging and Bioengineering.

Formerly known as the Minority Medical Faculty Development Program, the Harold Amos Medical Faculty Development Program (AFMDP) was created to increase the number of faculty from historically disadvantaged backgrounds who can achieve senior rank in academic medicine or dentistry, and who will encourage and foster the development of succeeding classes of such physicians and dentists. AFMDP offers four-year postdoctoral research awards to historically disadvantaged physicians and dentists who are committed to developing careers in academic medicine and to serving as role models for students and faculty of similar background.

Practices that work within a particular framework of goals and priorities can become engrained in the work of institutions. But what happens when the framework shifts?  Regular review of practices and the assumptions that support them offers one of the best opportunities to enhance diversity and inclusion, which can in turn improve the effective results of Scholar and Fellow programs. 

The Robert Wood Johnson Foundation (RWJF) Diversity Matters Podcast Series features host Jacinta Gauda in conversation with leaders and subject matter experts on practical ways to support diversity and inclusion.  In the podcast, available now, W. David Brunson, DDS, Senior Director of the Policy Center for Access, Diversity, and Inclusion of the American Dental Education Association (ADEA), and Marc Nivet, EdD, Chief Diversity Officer, Association of American Medical Colleges (AAMC), discuss the practice of holistic review. 

Increasingly adopted by medical and dental schools, holistic review is sometimes misunderstood as affirmative action or as an initiative designed solely to increase diversity.  Nivet and Brunson will clear up these misconceptions, and explain what it is and what it is not.  Listeners will learn how the practice evolved, how it is applied equitably across the entire applicant pool, and how it aligns admissions policies, processes, and criteria with institution-specific goals.  Nivet and Brunson will also describe ADEA- and AAMC-sponsored workshops in which admissions deans, staff, and committee members learn how to integrate holistic review into their admission processes.  

Holistic review can help institutions to achieve the true culture of diversity and inclusion that they will need if they are to effectively address the nation’s challenges in health and health care.

Visit the Diversity Matters Community to download podcasts and summaries for practices that are working to increase representation in health and health care.

This is part of a series introducing programs in the Robert Wood Johnson Foundation (RWJF) Human Capital Portfolio.

Raphael Travis, DrPH, knows the power of New Connections. For Travis, New Connections’ training events—such as symposiums and coaching clinics—were an important source for professional development in a welcoming atmosphere. He says, “I heard about the actual grants during the training workshop and knew I had to apply. The ambiance was inspiring, welcoming and needed. The combination of a supportive atmosphere and intellectual depth transcended what my home University offered. I was very excited to apply.”

Travis, a 2008 grantee, is an assistant professor at Texas State University- San Marcos. His New Connections project uses data collected in the 1997-2002 evaluation of Health Link, a program established to help reduce substance abuse among individuals returning to their New York City community after incarceration at Riker’s Island. The study explores: how positive youth development opportunities relate to recidivism; the relationships among mental health, substance use and recidivism across time points; and the potential cultural uniqueness between African-American and Latino youth.

Hector Rodriguez, PhD, MPH, knows the power of New Connections too. For Rodriguez, the program offered training and new research methods that powered his work. Rodriguez says, “New Connections is a fantastic opportunity for underrepresented junior faculty to pursue important public health and health care research, while being connected to a large network of prominent scholars.”

Susie Breitenstein, PhD, RN, PMHCNS-BC, is an assistant professor at the Rush University College of Nursing and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar.  Breitenstein is a child and adolescent psychiatric clinical nurse specialist; she works with children and families with developmental and intellectual disorders.

My Uncle Greg was born in 1947. He was the 5th of six children.  About six months after his birth, my grandparents were advised to place him in an institution. Greg had the genetic disorder, Trisomy 21, more commonly known as Down Syndrome. In 1947, there were few services for children and adults with intellectual disabilities and very little expectations for independence and cognitive and social abilities. In fact, institutionalization was considered the best option for the child and family. My grandparents rejected this option and chose to keep him at home and raise him with his siblings. This was not an easy decision as they were told that he would never walk, learn, or participate in society.

Throughout his life my grandparents, Greg’s siblings, their spouses, and his 25 nieces and nephews took great joy in his accomplishments and his personality. After he learned to walk, every evening my grandfather would take him on a walk in the neighborhood. When he learned new things, his family rejoiced. When he participated in family, religious and social events, we applauded. When he sang ‘Silent Night’ off key, we beamed.

Greg was full of life—the friendliest and happiest person I’ve known.

During Greg’s life, many changes occurred regarding understanding of Down Syndrome and treatment options for individuals with Intellectual Disabilities. In fact, in 1959, the chromosomal abnormality causing Down Syndrome was discovered. In the 1960s there emerged the field of developmental pediatrics and understanding that an enriched environment can support cognitive function. In the 1970s, the right of every child to a free and appropriate education was established.