Diversifying the Dental Workforce and Maximizing Community Care

Diversifying the Dental Workforce and Maximizing Community Care: Summer Health Professions Education Program (SHPEP) 2006–2015

NOVEMBER 2018

ADEA Office of Policy, Research and Diversity | Sonya G. Smith, Ed.D., J.D., Sonja G. Harrison, M.S.W., and Franc J. Slapar, M.A.

Increasing the racial and ethnic composition of the dental workforce through preprofessional and stu­dent pipeline programs is critically important. A more diverse dental profession ties to improved patient satisfaction, increased access to quality oral health care, reduced oral health disparities, and elevated responsiveness to the needs of a society with rapidly changing demographics.1

Additionally, research points to the benefits of diver­sity for all higher education students, particularly in terms of contributions made to the learning environ­ment, improvement of compositional diversity, better intercultural interactions, and shaping opportunities and experiences for all students engaged in a demo­cratic society.2 Increasing racial/ethnic student matric­ulation and graduation rates at dental schools fosters students’ development of better social and cognitive skills and ethical dynamics associated with successful participation in a global society.3

This policy report provides a brief discussion of dental school applicant and enrollment trends by race/ethnicity. Dental provider shortages in under­served geographic areas are also explored, along with underrepresented minority (URM) dentists and U.S. racial/ethnic population parity data. The report also highlights the Summer Medical and Dental Education Program (SMDEP), a program that is posi­tively impacting the number of students interested in serving underserved communities and URM dentists entering dental school and graduating.

During the 2015−16 application cycle, 12,058 individ­uals applied to dental school.4 Applications to dental schools by underrepresented students (i.e., American Indian/Alaska Native, Black/African American, and Hispanic or Latino) for the most part have continued to rise.5 After a low in 2013−14, applications by most racial/ethnic categories increased during the last two years.6 In the past decade, Black/African American applicants alone, or in combination with another race, wavered, but reached a high during the 2015−16 application cycle.7 Individuals identifying as Black/ African American in 2016 accounted for 694 appli­cants, and 308 Black/African American were first-time enrollees, or 5.8% of all applicants and 5.0% of all first-time enrollees. Black/African American appli­cants to dental school had a 44.4% enrollment rate in 2016. (See Table 1.)

Table 1:  Applicants and First-time Enrollees by Race and Ethnicity, 2016


Source: American Dental Education Association, U.S. Dental School Applicants and Enrollees, 2016 Entering Class
Note: ADEA adheres to revised federal guidelines for collecting and reporting race and ethnicity data.

In the 2015−16 application cycle, White applicants represented the largest group. Whites accounted for twice as many applicants as Asians, the next larg­est group.8 American Indian/Alaska Native applicants and enrollees have nearly doubled when viewed in combination with other groups. During the last five years, more than 50% of White applicants ultimately enrolled in dental school.9 The upward trend contin­ued in 2016 for Whites, Asians, and Hispanic or Latino accepted applicants. In 2016, Asian applicants had a dental school enrollment rate of 49.8%, and the Hispanic or Latino applicants had an enrollment rate of 50.7%, nearly equaling the 54.5% enrollment rate of accepted White applicants. However, the number of Latino applicants (1,098) was significantly lower than White applicants (5,752). (See Table 1.)

As we explore ways to improve access for under­served areas and provide culturally competent oral health care, it is helpful to examine provider access in these locations. The Bureau of Health Workforce of the Health Resources and Services Administration (HRSA) tracks the characteristics of dental under­served geographic areas and locations designated as Health Professional Shortage Areas (HPSAs). HPSAs are associated with “shortages of primary medical care, dental or mental health providers. A HPSA may be a geographic area such as a county or service area; represent a specific demographic, such as a low-in­come population; or are a designated institution such as a federally qualified health center.”10 Dental HPSAs also have slightly higher percentages of younger individuals (26.9%), older persons (14.8%) and under­represented minorities (36.6%).11 As of December 2017, there were 5,866 Dental HPSAs and almost 63 million persons living in these dental underserved areas.12 (See Figure 1.) Based on HRSA data, only 35.28% of residents’ dental needs were met in these areas, with an additional 10,802 dental practitioners required to meet the total oral health care demands of Dental HPSA populations. Similar shortages have been noted for medicine and mental health.13

Figure 1:  Dental Health Professional Shortage Areas and Dental Needs


Source: Colby S, Ortman JM. Projections of the size and composition of the U.S. population: 2014 to 2060, current population reports, P25-1143. Washington, DC: U.S. Census Bureau, 2014; U.S. Department of Health and Human Services, Health Resources and Services Administration. First quarter of fiscal year 2018 designated HPSA quarterly summary. Washington, DC: HRSA Bureau of Health Workforce, January 2018.

In comparing the percentage of URM dentists with the percentage of U.S. racial/ethnic minorities, 2015 American Dental Association (ADA) data showed that Blacks/African Americans accounted for 12.4% of the U.S. population but only 3.8% of U.S. dentists. Similarly, Hispanics or Latinos comprised only 5.2% of dentists but 17.7% of the population, compared with Whites, who represented 74.2% of dentists and 61.7% of the U.S. population.14 Asians composed 5.3% of the population in 2015 and 15.7% of dentists.15 (See Figure 2.) Additionally, the U.S. Census Bureau projects that by 2044, more than half of all Americans will belong to a minority group (any group other than non-Hispanic White alone). Projections by the Bureau indicate that by 2060, nearly one in five of the nation’s total population will be foreign born.16

As Figure 2 demonstrates, URM dentists are in short supply, with the URM dentists’ workforce dispro­portionately smaller and more unevenly distributed in comparison to U.S. minority populations.17 To bring the share of URM dentists into parity with their share of the U.S. population would require an addi­tional 19,714 Black/African American dentists, 31,214 Hispanic or Latino dentists, and 2,825 American Indian/Alaska Native dentists.18Research also shows that minority dentists and health care providers are more likely to serve underserved communities and have a strong interest in reducing health disparities.19 Therefore, the lack of parity between underrep­resented minority dentists and underrepresented minority groups in the United States makes the need to remedy these disparities even more crucial.

Figure 2: Underrepresented Minority Dentists and Population Parity

Reprinted with permission. American Dental Association (ADA). Health Policy Institute. “The Dentist Workforce – Key Facts.” hpi@ada.org

Although the number of underrepresented appli­cants and enrollees in the 2015−16 application cycle increased at dental schools, their numbers fall short of U.S. population parity.20 Developing strategies to create a more diverse dental school pipeline and increase the number of URM dentists to better serve the oral health care needs of underserved populations is a complex, multidimensional issue. As shifting demographics impact market forces and dental care demands, the need to provide culturally competent and accessible oral care to racial/ethnic communities is not solely an issue for URMs but is a business imperative and a social justice necessity. Therefore, it is essential that dental educators, policymakers, health care organizations, and the policymakers, health care organizations, and the dental profession continue to invest in pipeline/preprofessional programs to recruit and graduate more culturally competent and racially and ethnically diverse students. One such program, which increases the number of underrepresented dental students entering and graduating from dental school and promotes interests in serving underresourced communities, is the Summer Health Professions Education Program (SHPEP).

SHPEP is a free, six-week academic enrichment program for rising college sophomores and juniors interested in the health professions. SHPEP focuses on strengthening the academic proficiency and career development of students underrepresented in the health professions to prepare them for successful application and matriculation to health professions schools.

Students in the SHPEP program include, but are not limited to, individuals who identify as Black/African American, American Indian/Alaska Native, and Hispanic or Latino, and who are from communities of socioeconomic and educational disadvantage.21 To be eligible for SHPEP, a student must:

• Be a college freshman or sophomore at the time of application.
• Have a minimum overall college GPA of 2.5.
• Be a U.S. citizen, a permanent resident, or an individual granted Deferred Action for Childhood Arrivals (DACA) status by the U.S. Citizenship and Immigration Services.
• Not have previously participated in the program.

Other factors include:

• Identifies with a group that is racially/ethnically underrepresented in the health professions.
• Comes from an economically or educationally disadvantaged background.
• Has demonstrated an interest in issues affecting underserved populations.
• Submits a compelling personal statement and a strong letter of recommendation.22

SHPEP is the evolution of three predecessor pro­grams, all funded by the Robert Wood Johnson Foundation (RWJF). The first program was the Minority Medical Education Program (MMEP), launched in 1989 as the result of a RWJF internal study to address the challenges, opportunities and solutions associated with increasing diver­sity in medicine.23 MMEP began with six program sites and a cohort of 684 undergraduate students. In 2003, the MMEP was changed to the Summer Medical Education Program (SMEP), and the scope was broadened to include students from low socio­economic backgrounds, regardless of race/ethnic­ity. The American Dental Education Association (ADEA) became a partner in 2005, and the name was changed to the Summer Medical and Dental Education Program (SMDEP). SMDEP enrolled its first predental participants in 2006, with 12 program sites enrolling 80 students each.

As part of the RWJF Advancing Change Leadership, an initiative to strengthen and diversify the health care workforce and develop leaders as part of their Culture of Health, RWJF announced a call for proposals to expand the summer enrichment program. The goal of the expansion was to increase the number of health professions programs beyond medicine and dentistry. To recognize the broadened health care focus, the program’s name changed to the Summer Health Professions Education Program (SHPEP). The Association of American Medical Colleges and ADEA provide direction and tech­nical assistance to the program sites and staff the National Program Office. Figure 3 lists the 13 SHPEP sites and their career pathways.24

Figure 3: Participating SHPEP Sites and Career Pathways, 2017–2018


SMDEP Participants at the University of California, Los Angeles.

Columbia University 
Career Pathways: Medicine, Dentistry, Nursing and Physical Therapy

Howard University 
Career Pathways: Medicine, Dentistry, Nursing and Pharmacy

Louisiana State University Health Sciences Center–New Orleans 
Career Pathways: Medicine, Dentistry, Nursing and Public Health

Rutgers University 
Career Pathways: Medicine, Nursing, Dentistry and Pharmacy

University of Alabama at Birmingham 
Career Pathways: Medicine, Dentistry, Optometry and Physician Assistant

University of California, Los Angeles 
Career Pathways: Medicine, Dentistry and Nursing and Charles R. Drew University School of Nursing

University of Florida 
Career Pathways: Medicine, Dentistry, Pharmacy and Public Health

University of Iowa 
Career Pathways: Medicine, Dentistry, Pharmacy and Public Health

University of Louisville 
Career Pathways: Dentistry, Medicine, Nursing and Pharmacy

University of Nebraska 
Career Pathways: Medicine, Dentistry, Nursing, Public Health and Physical Therapy

University of Texas Health Science Center at Houston 
Career Pathways: Medicine, Dentistry, Nursing and Public Health

University of Washington 
Career Pathways: Medicine, Dentistry and Public Health

Western University Health Science Center 
Career Pathways: Medicine, Dentistry, Physical Therapy and Optometry

Source: SHPEP NPO, January 17, 2018

During the six-week summer program, SHPEP students participate in a variety of academic and career expe­riences, such as:

• Academic enrichment in the basic sciences and quantitative topics.
• Learning and study skills development, includ­ing methods of individual and group learning.
• Clinical exposure through small-group rotations in health care settings, simulation experiences and seminars. This is limited to 5% of program time for all the sites.
• Career development sessions directed toward exploration of the health professions, the admis­sions process and the development of an individu­alized education plan.
• A financial literacy and planning workshop that informs students of financial concepts and strategies.
• A health policy seminar series to expose scholars to a larger view of health care, health systems and the social determinants of health.
• An introduction to interprofessional education that addresses effective collaboration across
• the health professions.25

A 2015 impact study by Mathematica Policy Research showed that SMDEP increases the likelihood of students applying and matriculating to medical and dental school. The data show that SMDEP partici­pants are about 8 percentage points more likely to apply to medical or dental school and 10 percentage points more likely to matriculate than nonpartici­pants.26Program sites with both medical and dental components have an impact on dental outcomes and are effective in increasing dental school applications and enrollment. Participants from medical-only sites are 12 percentage points more likely to apply to med­ical school than comparison students.27 Additionally, an earlier MMEP and SMEP study showed a signif­icant impact on the diversity of the medical school applicant and matriculant pools.28

According to the Mathematica research, SMDEP participants from sites with a dental component are 14 percentage points more likely to apply to dental school than comparison students and participants from sites that focus solely on medicine.29 The esti­mated matriculation for SMDEP students to dental school for sites with a dental component are 10.5 percentage points and 9 percentage points (for medical school) for sites with and without dental programs.30 (See Table 2.)

Table 2: SMDEP Impacts (Sites Offering a Dental Program), 2006–2008 


Source: Source: NPO program data, AAMC warehouse data, ADEA warehouse data, and NSC data. All data were withdrawn between fall 2012 and summer 2013.
Note: Outcomes for each cohort are for the period up to 2012. Sample sizes vary by outcome due to missing data on outcome.
*Difference between SMDEP participant and comparison group is statistically significant at 5 percent, two-tailed test.
**Difference between SMDEP participant and comparison group is statistically significant at 1 percent, two-tailed test.
Source: Adapted from Cosentino C, Speroni C, Sullivan M, Torres R. Impact evaluation of the RWJF Summer Medical and Dental Education Program (SMDEP) [document on the internet] Mathematica Policy Research; 2015.

Data trends demonstrate the positive impact that SMDEP is having on diversifying the dentistry pipe­line and increasing the number of dentists interested in helping underserved communities. From 2006 to 2015, 64.4% of SMDEP predental participants applied to dental school, and 69.8% of these applicants matriculated.31 (See Table 3.) As of 2015, 498 SMDEP participants have graduated from dental school.32 In terms of URM graduates:

• 134 (26.9%) were Blacks/African Americans.
• 80 (16.1%) were Hispanics or Latinos.
• 2 (0.4%) were American Indians/Alaska Natives.
  
  

Table 3: SMDEP Participants, Applicants, Acceptants, Matriculants and Graduates, 2006–2015 


* Dental school applicants/predental SMDEP participants
** Dental school acceptants/dental school applicants
$$ Dental school graduates/dental school matriculants
± Graduate data as of 2018.
Source: Application and Matriculation data as of August 23, 2018
© 2017 American Dental Education Association

From 2006–2015, there were also 90 (18.1%) White, 129 (25.9%) Asian, 45 (9.0%) Two or More Races, and 17 (3.4%) Unknown race/ethnicity SMDEP dental school graduates. (See Table 4.) These data demonstrate SMDEP’s positive impact on the number of URM stu­dents entering and graduating from dental school.

Table 4: SMDEP Dental School Graduates by Race and Ethnicity, 2006–2015 


Source: American Dental Education Association

SMDEP is also generating a more diverse group of dental practitioners prepared to address a myr­iad oral health care needs in rural, urban, and other geographical areas. Richard W. Valachovic, D.M.D., M.P.H., ADEA President and CEO and SHPEP Co-Project Director, stated, “The demonstrable, data-driven success of our ADEA Summer Health Professions Education Program is a sign of the power and potential of this effort to bridge the oral health care gap in America’s underserved communities.”

More preprofessional, summer enrichment and health career pipeline programs are needed to increase the number of underrepresented minority and socioeconomically disadvantaged students in dental schools.35These programs offer institutions an opportunity to engage diverse talent while sup­porting their career development. Such programs not only address academic disparities among racial/ ethnic groups, but also the social complexities often associated with being underrepresented, such as isolation and overcoming stereotyping.36

As dental educators and state and national organi­zations compete for funds to support educational enrichment programs, it is vital that these programs demonstrate the impact of initiatives such as SHPEP. The 2015 Mathematica Research Policy Study exem­plifies the necessary evaluation and assessment protocols.37 Additionally, longitudinal participant research is essential for determining additional impact on URMs and underserved communities. This research incorporates periodic surveys and tracking of SHPEP scholars, in combination with other agen­cies and associations, to determine the dental prac­tice characteristics of SMDEP participants.

The 2015 Mathematica SMDEP study found no single component contributed to SMDEP outcomes; instead, impact stemmed from a combination of program components. However, it would be benefi­cial to conduct additional critical analysis and review of individualized program components to gauge the degree to which student outcomes are impacted. Components proposed for further examination include curriculum, academic support, staff and faculty engagement, clinical exposure, career devel­opment, health policy, interprofessional education and collaboration, and other program characteristics. Measuring these components and outcomes will help to detect and develop best practices for health pro­fessions academic enrichment programs and allow such best practices to be applied to other programs.

SHPEP continues to support institutional efforts to increase the diversity of dental students and impact the dental career pathway for URM students and others interested in serving disadvantaged com­munities. SHPEP is an excellent program model for other preprofessional and pipeline initiatives. Key stakeholders must continue to study the educational characteristics of URMs in terms of high school graduation rates, college recruitment, undergrad­uate and graduate/professional persistence and graduation rates, and the participation of URMs in the STEM (science, technology, engineering and mathematics) fields. These efforts are necessary to develop purposeful pipeline initiatives that increase the number of students interested in providing cul­turally competent dental care to underrepresented communities and reduce educational barriers for URM students. Creating more diverse applicant pools and increasing the number of URMs entering and graduating from dental schools strengthens not only the workforce, but also dental care for genera­tions of Americans and our global community.

1. Smedley BD, Stith Butler A, Bristow LR, editors. In the nation’s compelling interest: ensuring diversity in the health-care workforce. Washington (DC): National Academies Press (US), 2004; U.S. Department of Health and Human Services. Oral health in America: a report of the surgeon general. Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000; Sullivan, LW. Missing persons: minorities in the health professions, a report of the Sullivan Commission on Diversity in the Healthcare Workforce, 2004. At: http://med.fsu.edu/ userfiles/file/FacultyDevelopment_SullivanReport.pdf. Accessed: January 12, 2018.
2. Hurtado S. Preparing college students for a diverse democracy: final report to the U.S. department of education, OERI, Field Studies Program. Ann Arbor, MI: Center for the Study of Higher Education and Postsecondary Education, 2003.
3. Milem JF, Chang MJ, Antonio AL. Making diversity work on campus: a research-based perspective. Washington, DC: Association of American Colleges and Universities, 2005.
4. Wanchek T, Cook BJ, Valachovic RW. U.S. dental school applicants and enrollees, 2016 entering class. J Dent Educ 2017;81(11):1373-1382.
5. Id.
6. Id.
7. Id.
8. Id.
9. Id.
10. HRSA Data Warehouse, Glossary. At: https:// datawarehouse.hrsa.gov/resources/glossary.aspx#H. Accessed: January 31, 2018.
11. Voinea-Griffin A, Solomon ES. Dentist shortage: an analysis of dentists, practices, and populations in the underserved areas. J Public Health Dent 2016;76(4): 314-319.
12. U.S. Department of Health and Human Services, Health Resources and Services Administration. First quarter of fiscal year 2018 designated HPSA quarterly summary. Washington, DC: HRSA Bureau of Health Workforce, January 2018. At: https://ersrs.hrsa.gov/ ReportServer?/HGDW_Reports/BCD_HPSA/BCD_ HPSA_SCR50_Qtr_Smry&rs:Format=PDF. Accessed: January 31, 2018.
13. Id.
14. American Dental Association. The dentist workforce—key facts. Chicago, IL: ADA Health Policy Institute, 2015. At http://www.ada.org/~/ media/ADA/Science-and-Research/HPI/Files/ HPIgraphic_0716_1.pdf?la=en. Accessed: January 24, 2018.
15. Id.
16. Colby S, Ortman JM. Projections of the size and composition of the U.S. population: 2014 to 2060, current population reports, P25-1143. Washington, DC: U.S. Census Bureau, 2014. At: https://census.gov/ content/dam/Census/library/publications/2015/demo/ p25-1143.pdf. Accessed: January 13,
17. Mertz EA, et al. Underrepresented minority dentists: quantifying their numbers and characterizing the communities they serve. Heath Aff (Millwood) 2016; 35(12): 2190-2199; Lacy ES, et al. Achieving student diversity in dental schools: a model that works. J Dent Educ 2012;76(5): 523-533.
18. Id.
>
19. Smedley BD, Stith AY, Nelson AR. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academy P
20. Id.
ress
21. Id at 4 and 17.
22. Summer Health Professions Education Program. At: http://www.shpep.org/about. Accessed: January 16, 2018.
23. Id.
24. Cantor JC, Bergeisen L, Baker LC. Effect of an intensive educational program for minority college students and recent graduates on the probability of acceptance to medical school. JAMA 1998;290(9): 772-6; Summer Health Professions Education Program National Program Office. Summer Health Professions Education Program: policies and procedures quick reference. Washington, DC: Association of American Medical Colleges, 2017.
25. Id at 21.
26. Id.
27. Cosentino C, Speroni C, Sullivan M, Torres R. Impact evaluation of the RWJF Summer Medical and Dental Education Program (SMDEP). Princeton, NJ: Mathematica Policy Research, 2015.
28. Id.
29. Cantor JC, Bergeisen L, Baker, LC. Effect of an intensive educational program for minority college students and recent graduates on the probability of acceptance to medical school. JAMA 1988;280(9):772-76.
30. Id. at 26.
31. Id.
32. American Dental Education Association. SMDEP participants, dental school applicants, acceptants, matriculants and graduates, 2006–2015. Washington, DC: ADEA, 2018.
33. Id.
34. Summer Health Professions Education Program. 25th anniversary celebration. At: http://www.shpep. org/about/25th-anniversary-celebration. Accessed: January 16, 2018.
35. Id.
36. Alexander C, Chen E, Grumbach K. How leaky is the health career pipeline? minority student achievement in college gateway courses. Acad Med 2009: 84(6): 797-802.
37. Alexander CJ, Mitchell, DA. The role of enrichment programs in strengthening the academic pipeline to dental education. J Dent Educ Supplement 2010; 74(10): S110-S120.
38. Id at 24. 

The Access, Diversity and Inclusion portfolio of the ADEA Office of Policy, Research and Diversity promotes information about innovative programs and practices aimed at diversity and inclusion strategies in dental education that advance a robust and diverse learning environment. These efforts focus on increasing the diversity of students, faculty and administrators in allied, predoctoral and advanced dental education programs.