May 19 2011
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A Q/A with RWJF's Denise Davis: Diversity and Oral Health

Denise Davis, Dr.P.H., is an RWJF program officer, and the guiding force behind RWJF’s Pipeline, Profession & Practice: Community Based Dental Education program (the Dental Pipeline program). The program ran from 2001 to 2010, working to increase diversity in the dental profession and to increase access to oral health care among underserved populations. Davis gave the following interview to the Human Capital Blog on May 16, 2011, as part of our RWJF Leaders series of blog posts.

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Human Capital Blog: Now that RWJF’s Dental Pipeline program has been completed, how would you assess its impact?

Denise Davis: One focus of the program was to expand the pipeline of diverse applicants to dental schools. Among the most important things we did was to look carefully at admissions committee processes. We hoped to discover how we could retool and retrain admissions committees. And, in fact, we’re still funding the work of the American Dental Education Association in that area, even after the Dental Pipeline program has ended. In any event, we succeeded in this first goal of extending access to a more diverse group of applicants. Quite simply, the number of minority students went up.

The other thing we focused on was expanding the clinical rotations of dental students. Dental schools have their own clinics, and they typically require students in their junior and senior years to practice what they’ve learned there. But they rarely extend those rotations to community clinics. So we required schools participating in the program to create contractual relationships with community clinics, and extend the time that students were engaged in these rotations.

Not only did the schools and the students get more exposure and more experience with community clinics, but they reached a lot of patients who might never have been seen otherwise. In fact, even after the program ended, many of the schools have retained these relationships with the community clinics, and many of the students who went through the program have decided to focus on public health dentistry, essentially continuing to treat low-income, vulnerable patients with little or no access to care.

So I’d say we were successful on both objectives. That doesn’t mean the job is completed, of course. Clearly it’s not. But I think we did important work, and accomplished a lot of what we set out to do.

HCB: You mentioned that RWJF continues to support the ADEA in its work with admissions committees. What are they doing?

Davis: As part of the program, ADEA devised a framework to train individuals who were part of the admissions committees in dental schools. We’re still funding their work in that area, and we’ve tried to augment it by creating a web presence to disseminate their materials beyond the schools that were in the original project. And that also includes some medical schools, I should point out, because many of them suffer from the same lack of diversity and exposure and are in need of a boundary-expanding experience.

HCB: As you know, the Institute of Medicine (IOM) has just issued a new report on oral health issues, “Advancing Oral Health in America.” What do you think the impact has been?

Davis: It’s probably too soon to judge, in part because IOM has a second report coming out later in the year. This most recent one looks at 10 broad areas related to oral health, and the next one will deal more specifically with access to oral health. So probably we should reserve judgment until both are out. A lot will depend, of course, on how much the federal government does to follow up on the reports’ recommendations. To be honest, it’s not clear that Congress will be willing to make the resources available to allow the government to really lead in this area.

So, as often happens, it’ll be up to foundations, professional organizations and other key stakeholders to take the recommendations and act on them. We’re certainly looking at what other funders in the field are doing and where their work may align with the IOM recommendations. So I think there are certainly opportunities for funders to take up some of these recommendations and move on them.

HCB: More generally, how do you think the dental profession is doing on diversity issues and on health disparities?

Davis: In general, the profession isn’t doing very well on either diversity or disparity issues. When we look at diversity in the workforce, from dental education to practitioners, and compare with the medical and nursing professions, the simple truth is that dentistry has the worst record on diversity. It has the fewest minority faculty and fewer women in leadership positions, to name just a couple problems. That’s all part of why we wanted to develop programs to address it. Similarly, when you look at health disparities relative to other professions, dentistry has a very poor record. Of course, access is particularly important here, because if people don’t have insurance, they don’t typically go to the dentist. If it is really an emergent situation, many of these patients end up in the emergency room seeking care and relief from persistent dental pain. When we have economic downturns, dental insurance is often the first thing to go—when people lose a job, when employers are looking to trim costs, and even when state governments are looking to save on Medicaid. So we’re not doing as well as we could, and the reason is that the resources have never really been there.

HCB: You’ve just recently created a new series of videos on the Dental Pipeline program. What are the plans for them?

Davis: Over the life of the Dental Pipeline program, we funded almost half of the nation’s dental schools. But all along during the program, we heard from schools that weren’t part of the project that they wanted to learn from it, too. The videos are a way to accomplish some of that—to broadly share our lessons learned. They’re an opportunity to go beyond our stakeholders to show what the Dental Pipeline program was about, and what changes it made for faculty, students and patients.

HCB: And what’s on the long-term horizon for this issue?

Davis: There has certainly been a lot of discussion lately about the need for health care to be provided in a more team-based approach. But despite those conversations and despite all the transformation in health care that’s under way, it still appears that we’re on track to continue having one system for medical care and another for dentistry. We really need a robust conversation about how we move dental providers into a team so that oral health becomes part of the overarching health of an individual. If we can make progress on those conversations, we might be able to create systems for referrals, and to really begin to take a team-structured approach to oral care. Until we do that, a lot of these disparities in oral health care will persist.

Tags: Dental schools, Diversity, Medical, dental and nursing workforce, Human Capital, Dental, Dental Pipeline, RWJF Leaders