Underrepresented Minority Dentists’ Contribution to Health Equity in the U.S.
Description and Policy Relevance: This project proposes to examine a 2012 nationally representative
sample survey data of underrepresented minority (URM) dentists in the U.S. to determine 1) the supply,
distribution and practice patterns of URM dentists, 2) the level of provision of dental care for minority
populations, and 3) the future scenarios for access to care for minority populations based on URM dentist
cohort practice patterns and projected inflows of new URM providers to dental practice.
In the field of dentistry, African Americans, Hispanics, and Native Americans have long been
underrepresented.1 Improving the diversity of the dentist population is a critical component of efforts to
reduce disparities in access to care and health outcomes, and to better address the oral health needs of
an increasingly diverse U.S. population.2 A large body of research indicates that underrepresented
minority groups (URM) face significant disparities and variation in oral health status, access to, and quality
of care.3 The increasing diversity of the country is likely to result in a worsening of racial and ethnic oral
health disparities if not paralleled by an increase in the diversity of the dental workforce.
Despite high-level and well-funded initiatives over the last decade aimed at increasing the cultural
competence of dentists and diversifying the profession, data on the outcomes of these efforts remains
scarce, and the number of minority providers remains significantly below parity. Many workforce solutions
are being proposed to improve access to care, and this study will provide the best evidence to date on the
social return on investment to diversification of the workforce. This research will inform educational and
health care policy at local, state and national levels as to critical issues of access to care in relation to the
pipeline of URM dentists in the workforce, with implications as to where and to what extent further
workforce investments are needed.
Hypothesis, Design and Analysis: Preliminary analysis of our survey data has profiled minority dental
practices among the three minority groups surveyed.4 URM dentists provide care for a high proportion of
minorities with whom they are racially and/or ethnically concordant, as well as for other minority groups.5
Further work is needed to understand the variance in practice patterns, including geographic location,
practice type, specialty, patient populations and educational background for URM dentists in the U.S., as
well as correlations with the oral health status of the minority populations in their communities. The
specific aims of this project are:
1. To examine the practice patterns of each URM group over time, in comparison to the average practice
patterns of all dentists in the U.S., and in comparison to socio-demographic characteristics of the local
communities in which they practice.
2. To determine the extent of disproportionate share of dental care provided to underserved and
minority populations in the communities in which they practice.
3. To ascertain the relationship between minority dentist supply and minority oral health outcomes.
4. To project future impact on access to care for minority populations based on cohort practice patterns
and projected inflows of new minority providers, and model access to care under different pipeline
scenarios.
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Analysis will include descriptive and multivariate statistics. GIS analysis will be used to link dentist practice
patterns to population oral health within and between geographic areas. Finally, projected changes in
access over time can be determined by comparing practice patterns of dentist cohorts by age to
population trends. The National & Hispanic Dental Associations as well as the Society for American Indian
Dentists will be asked to review preliminary findings and provide feedback on issues of relevance to this
analysis.
Data Sources: The dentist data will come from a nationally representative sample survey of URM dentists
in the U.S. that was conducted by co-investigator, Elizabeth Mertz, Ph.D.6 This comprehensive practice
survey included over 150 questions and was stratified by three criteria: race, geographic region, and ruralurban commuting areas. Data collection was completed in 2013 with a final adjusted response rate of
34% (n=1489). Full methodology is reported in the Journal of Public Health Dentistry (in press).7 The data
are cleaned, de-identified, and weighted, and linked with county demographic profiles from the 2010
Census. Oral health status data will be obtained from the National Health and Nutrition Examination
Survey, the Behavioral Risk Factor Surveillance System (BRFSS), and the Dental, Oral, and Craniofacial Data
Resource Center at the CDC. The BRFSS has a large representative sample of adult individuals at the state
level, with a sufficiently large minority sample population to conduct statistical analyses and to link URM
dentist characteristics to minority population oral health characteristics. Finally, dentist cohort
composition by race will be obtained from American Dental Education Association (ADEA) graduation data,
and professional practice data for all dentists will be obtained from published ADA reports and/or from
the Area Health Resource File (AHRF).
Human Subjects Research: Human Subjects were involved in the original research so IRB will
necessary for ongoing data analysis as exempt. IRB approval has already been obtained.
UCSF IRB Number: 11-07905.
be
Deliverables: The OHWRC will prepare a technical report and a research brief on the findings from this
project. OHWRC staff will work with the Project Officer to determine whether the findings from this project
merit the preparation of a peer reviewed journal article.
References:
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7.
Brown RS, Schwartz JL. Minority dentists. J Am Dent Assoc. Mar 2001;132(3):278
IOM (Institute of Medicine) and (NRC) National Research Council Improving access to oral health care for vulnerable and
underserved populations. 2011.
Oral health in America: A Report of the Surgeon General. (2000). Rockville, MD.: U.S. Department of Health and Human
Services, National Institutes of Health, National Institute of Dental and Craniofacial Research: NIH publication 00-4713.2.
National Center for Health Statistics.
Profile of American Indian / Alaska Native Dentists in the US. Profile of Black Dentists in the US. Profile of Hispanic Dentists
in the US. Publications in Draft.
Mertz, E. Wides, C. Cooke A. Gates, P. (2014) Surveying the Underrepresented Minority Dental Workforce in the US, 2013.
AcademyHealth Workforce Interest Group Meeting. Poster.
The survey development and data collection were funded by the following sources: NIDCR (P30DE020752), Bronx-Lebanon
Hospital Center & Dental Department, Dentaquest Foundation, UCSF Department of Preventive and Restorative Dental
Sciences, HealthPlex, Inc. & Henry Schein, Inc. The current funding allows only for cleaning and basic descriptive analysis
of the data, but not any advanced or comparative analytics.
Mertz, E., Wides, C. Cooke A., Gates, P. Tracking Workforce Diversity in Dentistry: Importance, Methods, and Challenges.
The Journal of Public Health Dentistry. In press.
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