By Rick Valachovic, DMD, MPH, Clinical Professor and Director of the NYU Dentistry Center for Oral Health Policy and Management
This past June, the Supreme Court issued its long anticipated ruling placing strict limits on the consideration of race in college admissions. Though not unexpected, the Court’s decision is concerning, not least of all for the effect it will have on efforts to diversify the health professions.
In 2004, the Sullivan Commission on Diversity in the Healthcare Workforce released a landmark report: Missing Persons: Minorities in the Health Professions. The report asserted that the increasing diversity of the U.S. population had been accompanied by “glaring disparities in the quality of care, especially for racial and ethnic minorities,” leading to “thousands of premature deaths each year and incalculable hours of lost productivity, pain, and suffering.” The report laid a significant portion of the blame on “the imbalance in the makeup of the nation’s health care workforce” and called diversity among health professionals “a key to excellence in health care.”
Progress
Over the past three decades, the American Dental Education Association (ADEA) and its sister organizations have devoted tremendous energy and resources to addressing this imbalance. While I was president and CEO of ADEA, we built on the work of the Association of American Medical Colleges (AAMC) to promote the use of holistic review in admissions at our member institutions and provide them with technical assistance. We also worked to integrate dentistry into the nation’s leading pre-medical preparation program for students from demographic groups underrepresented in the health professions. Known today as the Summer Health Professions Education Program (SHPEP), the Robert Wood Johnson Foundation funded program currently includes five additional health professions.
Since dentistry’s inclusion in 2006, 929 SHPEP participants have graduated from dental school. Two-thirds are women, and almost half come from underrepresented minority (URM) groups. According to a report ADEA issued last year, the enrollment rate at U.S. dental schools in 2020 was 14.5% higher for URM students who took part in SHPEP than for those who did not. ADEA data also suggest that efforts to recruit and prepare more URM students for dental careers are paying off, at least for some groups. The number of Black first-time, first-year enrollees rose steadily from 300 in 2015 to 435 in 2021, and the number of Hispanic enrollees grew at a notably faster pace, from 318 in 2009 to 695 in 2021.
Many dental schools, including NYU, have their own programs to expose young people to the health professions and help them understand what it will take to apply and gain admission to a program in their chosen field. Throughout the United States, numerous programs at the college, high school, and even elementary school levels also strive to interest students in health careers and prepare them to be successful applicants to college or professional schools. These so-called pipeline programs will be critical tools for diversifying the healthcare workforce in the wake of the Supreme Court’s decision, but we will need additional tools to accelerate change.
More Is Needed
Even prior to this summer, when admissions teams were still able to consider race as one factor in admissions in order to build diverse classes, the proportion of URM enrollments in dental schools lagged behind these groups’ representation in the population. Black students made up 6.4% of 2022 dental school enrollees, and Hispanic students made up 10.1%—roughly half of their representation in the U.S. population as a whole. The situation for American Indian/Alaska Native and Native Hawaiian/Pacific Islander students was even worse, with fewer than two dozen students from each of these groups even applying to dental school in 2022.
As someone who spent two decades at ADEA working on this issue, I too am troubled and searching for strategies that can allow us to continue to advance the work of building a more representative healthcare workforce. ADEA continues to be concerned about the dearth of Black men in dentistry and the health professions and hosted a summit in 2022 and a webinar this past February to inform members about ways schools can support Black men pursuing careers in the health professions. I’m also heartened by a recent partnership between AAMC and the National Medical Association (NMA): the Action Collaborative for Black Men in Medicine. Together, these organizations are developing measurable solutions to reduce barriers to medical school enrollment and boost Black men’s interest in a medical career starting in high school.
Similarly, nursing has focused on diversifying its workforce as a strategy for advancing health equity. With support from the Robert Wood Johnson Foundation, AARP, and the AARP Foundation, the Future of Nursing: Campaign for Action launched a series of workshops in 2019 to train faculty at minority-serving academic institutions in mentoring best practices. The goal is to ensure more URM students graduate from nursing school and pass their licensure exams. The Campaign has also established learning collaboratives to assist participants in establishing or strengthening their mentorship programs and student supports.
One additional strategy we might adopt comes from the Action Collaborative. It has suggested that training pre-health advisors could open the door to a more diverse applicant pool. These professionals lack standardized preparation or credentials for their role, yet they often function as conduits to our professions. Some observers believe that advisors trained to focus more on students’ strengths than their deficits could encourage more Black men to pursue health careers. They could also be instrumental in getting URM students to apply earlier to dental school.
A Historical Perspective
To get a historical perspective on the current situation, I reached out to Lisa Tedesco, PhD, a psychologist who has focused her career on promoting oral health. Lisa became associate dean for academic affairs at the University of Michigan (U-M) School of Dentistry. She was moved to join the faculty in part by the university president’s commitment to diversifying U-M’s faculty, administration, and student body. Subsequently, Lisa led a team evaluating campus outcomes related to diversity, which included a focus on the advancement of women.
Lisa shares my disappointment with the recent Supreme Court ruling, but I was pleased to learn that she is feeling “resolved” rather than demoralized. “We just can’t lose sight of what the goals are,” she told me. “As licensed representatives of the learned professions with a mandate to advance the health of the public, we have a professional obligation to advance equity and social justice, and we need to hold ourselves accountable.”
Lisa has seen challenges to diversity initiatives before. She was U-M vice president and secretary when U-M’s affirmative-action admissions practices met with resistance in the form of two lawsuits that made their way to the U.S. Supreme Court. The Court’s decision in Grutter v. Bollinger affirmed the legality of the university’s consideration of race in admissions, calling student body diversity “a compelling state interest.” In the second case, the Court found the practice at one U-M college of awarding points to URM applicants unconstitutional, reminding institutions to pay close attention to the details of their admissions processes, as well.
Three years later, Michigan voters amended the state constitution to “ban public institutions from discriminating against or giving preferential treatment to groups or individuals based on their race, gender, color, ethnicity, or national origin in public education, public employment, or public contracting.” The university responded by trying a variety of race-neutral approaches to achieve diversity, but over the next 16 years, the enrollment of URM students at U-M fell precipitously, according to an amicus brief the university filed with the Supreme Court last summer. California universities, and their medical schools in particular, observed a similar decline in URM enrollments following that state’s 1996 ban on considering race in admissions.
Moving Forward
Now that the Justices have ruled on the latest challenge to affirmative action, the ball is in our court. What more can we do to advance diversity in the health professions and dentistry in particular? The Department of Education released some guidance in August, but the document is far from comprehensive and offers no new, bold ideas for advancing diversity in higher education.
Whatever happens with undergraduate admissions, recruiting URM students to dental schools will continue to pose its own set of challenges. Lisa, who is now dean emerita of the James T. Laney School of Graduate Studies; vice provost emerita for academic affairs, graduate studies; and professor emerita of the Rollins School of Public Health at Emory University, suggested lowering the cost of a dental education when we spoke. Such a move might improve access and boost URM enrollment, but as Lisa readily acknowledged, it would require a complete overhaul of curriculum and the structure of clinical education.
A less disruptive way to achieve the same end might be to reduce the amount of education required for entry into dental school. Other countries produce competent dentists without requiring four years of undergraduate education—something U.S. schools might consider.
In the meantime, we need to rally our communities to remain committed to the cause of diversifying the health professions. When Justice Sandra Day O’Connor authored the Grutter decision, she wrote that the “Court expects that 25 years from now, the use of racial preferences will no longer be necessary.” Like Justice O’Connor, the Sullivan Commission believed its vision of a diverse American healthcare workforce could be achieved within the next two decades—in other words, by today. Sadly, neither of these predictions has come to pass. Let’s hope we find the will to realize them before another two decades elapse. The well-being of all Americans in our diverse society depends upon it.
