Dentist blog from Delta Dental

Tag: women in dentistry

Improving access to care for underserved communities

How do we as a country start improving access to oral health care? How can we better serve the hard-to-reach populations who need it most? These are difficult questions, but there are few better places to start talking about answers than with Lisenia Collazo, DMD.

Dr. Collazo was born in Pennsylvania but spent her childhood and college years in Puerto Rico. She returned to the States to attend Penn Dental Medicine, where she pursued her DMD alongside a master’s in public health. During her time at Penn Dental, she was awarded a Delta Dental Community Scholarship, which provides students who demonstrate a strong commitment to improving access to care with sizeable scholarship assistance.

We reached out to Dr. Collazo to discuss how the scholarship helped to shape her current work and her perspective on the future of improving access to care.

How and when did you decide to become a dentist?

Growing up, I spent a lot of time with two of my older cousins who happened to be dental assistants. I visited them a few times at the clinic where they used to work, and I got to see how a dental practice was run behind the scenes. By the time I was getting ready to graduate high school in Puerto Rico, I was lucky enough to visit the University of Puerto Rico’s Medical Sciences Campus and get an introduction to the different programs. Visiting the dental school, seeing how hands-on the training was, the blend of medicine and art, along with the experience I already had, it all really solidified my interest in dentistry as a career.

How did your interest in improving access to care develop?

Once I decided to pursue dentistry as my career, that’s when I started to notice how few people seek out dental care. They just let their oral health deteriorate. That’s due to a lot of factors, but I believe the main issue is the disconnect between dentistry and the rest of the medical field. Insurance plans are segregated from medical insurance, and there’s low oral health literacy in the general population and a lack of diversity among providers. Once I learned about those issues, I wanted to help patients become more comfortable with coming to the dentist and to educate myself about how to best improve access to care from an administrative standpoint.

How did being named a Delta Dental Community Scholar help you on your journey?

While I was in dental school, I was also in the community service honors program. I learned about the Delta Dental Community Scholarship during that time. The scholarship just helped me to solidify my commitment to working in underserved communities. That kind of scholarship helps to bring providers to patient populations that need them the most.

Coming from a low socioeconomic and minority background myself, I’m appreciative of the assistance those programs give because it helps students who are already committed to giving back to their communities, and it eases the burden that comes with student loan debt. As education becomes more and more expensive, it’s difficult to get providers to work in those underserved areas. Scholarship programs like the Delta Dental Community Scholarship truly help to get care to the people who need it the most.

You completed your DMD along with a master’s degree in public health. Why did you decide to pursue both degrees and could you describe how having both has shaped your career and outlook?

One of the reasons I chose to attend Penn Dental was because I was already aware of their dual degree program. I was very happy to be selected as one of the students they gave the opportunity to receive additional education alongside their DMD. Completing the master’s in public health during my time at Penn Dental basically helped me learn more about the policies that affect our patients’ health and what strategies we can use to make an impact at a higher level beyond what we can do chairside.

Can you describe your work since graduation?

During my senior year of dental school, I applied to the National Health Service Corps’ Students to Service Loan Repayment Program. I was awarded a significant amount of money to use towards my student loans. In exchange, I’ll work three years in an underserved area.

Dr. Lisenia Collazo
Dr. Lisenia Collazo grew up in Puerto Rico. She says she finds the winters in the Upper Peninsula very cold but beautiful.

During my residency, I began to look for available sites. I got an offer in my current location, which is Upper Great Lakes Family Health Center in the Upper Peninsula of Michigan. It’s an underserved area, so a lot of our patients are either on Medicaid or do not have insurance.

The Upper Peninsula is extremely rural, and a lot of our patients drive hundreds of miles just to get care. The family health center I work with has about eight sites; two have dental clinics, and they’re in the process of opening more to make travel easier for our patients. It’s the same issue when they seek specialist care. If there’s a case where we have to refer to an oral surgeon or an endodontist, that’s very difficult for these patients. There just aren’t many providers here.

The population I work with is also located in a food desert. There’s mostly convenience stores that don’t have the most nutritious options. We see a high incidence of caries, and we see a lot of patients without any teeth at a very young age. Our mission is to educate patients — especially those with children — early on so we can prevent them from getting to that state later on in their life.

How far along are you in your three years of service? What are your plans after?

In July, it will be two years. I plan to stay here longer. I’m not exactly sure how long yet. I want to continue working in public health and to get my student loans forgiven through the government’s public service loan forgiveness program. I would have eight more years to go with that. I’ve considered staying here the remainder of those eight years, but as an Afro-Latina woman, I would also eventually like to go to a community with more Hispanic patients.

What do you love most about being a dentist?

Empowering patients through education is one of the most rewarding things that comes with the career. The most difficult thing when it comes to patients receiving health care is that there’s low health literacy.

I also love helping patients feel at ease in the dental chair and learn to trust health care providers by building those relationships. Diversity and representation truly matter. As a dentist who is a woman and also Afro-Latina, I’m happy to see more women and people of color entering the medical field because that does make a difference when it comes to patients coming in to receive care.

The Delta Dental Community Care Foundation has endowed in perpetuity the awarding of two Community Scholarships each year to Penn Dental students who desire to work in an underserved area after graduation. The Foundation works with nonprofit partners across our 15-state and Washington, D.C. enterprise to increase access to oral health care, fund oral health education and support organizations that serve vital needs in our communities. The Foundation is the philanthropic arm of Delta Dental of California and its affiliated companies, including Delta Dental Insurance Company, Delta Dental of Pennsylvania and Delta Dental of New York, Inc.

Meet Dr. Jessica Buehler, Director of Dental Affairs

Whether she’s motorcycling through the Alps or hiking through Southeast Asia to bring aid where it’s needed most, Dr. Jessica Buehler approaches what she does with passion, courage and commitment. That includes her work rewriting Delta Dental’s Quality Improvement Plan and bettering the oral health of members through her wellness webinars as Delta Dental’s Director of Dental Affairs.

We recently caught up with Dr. Buehler to discuss her work at Delta Dental, her time as a frontline provider during the early days of COVID and her dual passions for traveling and musical theater.

I think a lot of people, including even some dentists, might be surprised to learn that a dental insurance company like Delta Dental has dentists on staff. Can you tell us about the work you do for Delta Dental?

My work is to support our quality program. Insurance plans are regulated by the Department of Insurance and other regulatory bodies to ensure that the care is appropriate. It takes clinicians to be a part of that process so that key decisions about care and quality aren’t made by laypeople. They’re made by clinicians who have practiced and treated patients just like our dentists.

What initially led you to dentistry as a career?

I was overseas on the San Blas Islands off the coast of Panama working with an indigenous tribe on a summer mission trip. I volunteered to help a Panamanian dentist who was assigned by the government  to do health work on the island. I saw severe infections — people who had no access to care. It opened up my heart to this way to impact the world; it showed me how much dentists can improve people’s lives, not only in the U.S. but also overseas where people don’t have access to care.

What are the biggest rewards of your work now?

I feel my ability to impact oral health in this country is much bigger working for a plan. When you’re working as a chairside dentist, your impact is limited to only those patients you touch or the community events you volunteer at. Right now, I’m giving enrollee wellness webinars that are live-cast across the country to hundreds of enrollees at once. Having an impact on a stage that’s much bigger is really fun for me.

What do you miss most about being a chairside dentist? What do you miss least?

I miss the connection with my patients. You don’t realize when you go into dental school as a young person that your patients follow you for years and years. I saw couples get married and have babies. I saw babies grow into high schoolers. I saw couples get divorced and people pass. You are an intimate part of people’s lives over time. It feels like you’re checking in with old friends every time you see these patients. And when I went through those big life events like getting married and having a baby, my patients were there for me. I’m separated from that now, and I miss that.

In terms of what I miss the least: staffing. Staffing is impossible right now. Overall, dentistry is one of the hardest jobs in the world. It’s not for the faint of heart. 

I was so impressed to learn that you were a frontline provider during the early days of the COVID pandemic. It’s only been a couple years since then, but many of us have forgotten (or blocked out!) how very scary that time was, how many unknowns there were. Can you tell me about your work during that time?

When COVID hit, I was a regional clinical director supervising over 80 clinicians and specialists in Seattle. We were the epicenter of when it was first blowing up. Things were happening very fast, and there was very little guidance at that time, but we knew we had to do something to help. We had to make tough decisions about closing our offices: We had around 30 offices, and we went down to four.

The government was coming into dental offices and taking PPE, but we were expected to care for patients. My husband’s in construction, so he got a welding face shield for me and a construction and painting P100 respirator with a mask over the end. It wasn’t just about keeping myself safe. I was dealing with a lot of anxiety trying to keep my team safe. Some of my colleagues who worked for me had at-risk relatives at home. Some of them had health conditions. I was driving around the state to gather whatever supplies I could find in the construction world to provide to my doctors who were working those frontlines. It was a really scary time.

What do you think are some of the most important things Delta Dental can do to help maintain strong, positive relationships with dentists?

I think being empathetic to how hard dentistry is. It’s easy to go into a dental office and think a dentist is just a “tooth-counter.” I’ve had people say to me, “You make way too much money for what you do.” But a lot of people have no idea what dentists do! It’s a really hard job. It’s even hard on your body, too. You have to manage the emotions of your patients; you have to manage your staff. It’s challenging to be a business leader and a clinician and everything else.

Speaking of playing multiple roles, I was interested to learn that you have a background in musical theater. Can you tell me a little bit about that? Do you feel that your work in theater and performance helped inform your daily work as a dentist at all? Do the two pursuits have anything in common?

My parents always said, “Do whatever you want. We know you’ll succeed at whatever you decide.” So, I got really involved in musical theater and lighting design when I was in college. I loved the theater, but I realized I was a bit too organized and Type A to hang forever in that world…

I still love and appreciate the theater, but I come from a science family, and I almost felt dentistry was a calling. Once I got it into my brain, I couldn’t get it out. But, the things I learned in the theater — to ground yourself, to speak and perform with confidence — are really important and have helped me grow a lot as a provider.

What do you like to do in your free time?

I’m an avid reader. I run a book club for a community inclusion group at Delta Dental, Women@Delta. I love everything outdoors: stand-up paddleboarding, snow skiing, camping, hiking, wakeboarding, all of it. Just put me outdoors and I’m a happy girl! I love to travel. I did a motorcycle tour through the Alps, hitting seven countries in Europe with my dad. He’s passed now, so that’s one of my favorite memories… I love Thailand. I love Australia. I’ve done work in Southeast Asia in countries that aren’t even open to Western aid. I backpacked in and brought dental tools and taken teeth out, all sorts of crazy stuff. I have a family now, so I don’t do as many risky things now, but I still love to travel!

Pandemic disproportionately affects women dentists’ income

While all dentists’ incomes took a hit during the height of COVID pandemic, women fared far more poorly than men did, according to research by the American Dental Association. These finding serve as yet another reminder that while women are making many gains in the dental profession, equal pay so far isn’t among them.

A research brief from the ADA’s Health Policy Institute (HPI) found that female dentists’ salaries in 2020 decreased by 12 percentage points more than their male counterparts’ salaries did. Women dentists’ net income also dropped significantly more than men’s did, with a 27% drop for women compared to only 15% for men the same period.

Why was there such a large difference? One of the reasons for the disparity was a much larger decline in hours worked by women dentists than by men during 2020. The study found that while men’s work hours declined by about 15%, women dentists’ work hours declined by more than 22%.

The HPI brief didn’t speculate what caused the difference in work hours. However one of its authors, Marko Vujicic, Chief Economist and Vice President of the HPI, did note in a related video presentation that child care challenges have come up frequently in research about how the pandemic has affected women differently from men.

 “But even if it is explained by child care, is that OK? Are we OK with that as a profession?” Vujicic said. “That’s an important question to ask and discuss, because we’ve certainly seen professional women’s careers be disrupted to a much bigger extent than our male colleagues’ have.”

Child care issues may have also contributed to a decline in the number of dental hygienists, according to a study published in The Journal of Dental Hygiene.

The study found that the pandemic has led to an estimated 8% reduction in dental hygienist employment when compared to pre-pandemic levels. Among the hygienists surveyed for the study, more than 10% said that they left their job specifically due to child care concerns.

“Dental hygiene has traditionally been a female-dominated profession,” the study’s authors said, “and these results provide another example of how child care issues are playing an exaggerated role during the COVID-19 pandemic in driving career choices.”

Unfortunately, the results of these studies confirm that the gender pay gap between men and women in the dental profession is both significant and ongoing. For instance, while women’s incomes dropped more than men’s did during the pandemic, those incomes weren’t equal to begin with. 

While studies disagree on precisely how much the pay gap is between male and female dentists, they all agree on one point ― it’s a lot. For instance, male dentists may earn as much as 37% more than their female peers, according to ADA research. And it’s useful to note that researchers arrived at this figure after adjusting for hours worked, years of experience, specialty, and whether the dentist owned a practice. Another study found that dentists had the third-highest gender pay gap among all professions.

As the percentage of women dentists steadily climbs, they bring with them a younger and more diverse workforce. Female dentists are more likely to be Hispanic, Black, Native American or foreign trained. Women dentists are also much more likely to serve younger patients and those covered by public dental insurance.

The history and future of women in dentistry

It’s undeniable that the landscape of the American workforce has changed since 1866, when Lucy Hobbs Taylor became the first woman to earn a degree in dentistry. As women have become legally equal to men and financially independent, the demographics of labor have shifted in many fields.

In honor of International Women’s Day and Women’s History Month, here’s a look at the changing role of women within the field of dentistry.

Early women in dentistry

Dentistry has been around since the earliest days of human civilization and has always been practiced in some form. It took until the 1700s for dentistry as we know it today to became more prominent. In all likelihood, women have always been performing dentistry, but it wasn’t until the mid-1800s that we see the first cases of women practicing in Sweden, the United States and Belgium.

Emeline Roberts Jones

In the United States, Emeline Roberts Jones was the first practicing female dentist, having taught herself basic fillings and extractions in secret. She joined her husband’s dental practice in 1855 and, after his passing, continued to practice on her own. She was elected to the Connecticut State Dental society in 1883 and was made an honorary member of the National Dental Association in 1914.

In the early 1900s, some dental schools started experimenting with allowing female students, while others tacitly refused to accept them. During this period, there were only a few dozen female graduates from dental schools every year. Female dentists started professional groups to connect with each other. One of these groups was the American Association of Women Dentists, formed in 1921 and still active today.

During World War II, female dentists offered their skills to the U.S. Army but were flatly denied. Some dentists, like Sara G. Krout, got around this by joining volunteer emergency services. The wartime economy created job opportunities for women in heavy industry and other roles thought to be masculine. Female dentists were able to fill the roles left open by men joining the armed forces. In fact, women’s presence in the workforce during World War II is considered by many historians to be a key factor in the changes that were to come.

A shift: demographic changes after the 1960s

In the 1960s, the first generation of baby boomers turned 18 and the baby boom was taking a toll. Women who had multiple children by the time they were 25 still had 15 to 25 years of fertility to go. Some families were tucked into small homes, unable to afford larger spaces. Being able to contribute financially and control fertility was becoming more important than ever.

Growing alongside the civil rights and anti-war movements, the women’s liberation movement aimed to address inequality faced by women in legal and social contexts. Some of the many goals of the movement were to grant women reproductive rights, increase opportunities in the workplace and redefine familial roles. The Civil Rights Act of 1964 helped make it possible for women to go into professional fields by prohibiting discrimination based on sex.

After oral contraceptives were introduced in the 60s, women of all ages and marital statuses were able to postpone children or space out births. Birth control allowed them to pursue higher education and careers they may not have had in the past and social concepts of women as secondary earners were replaced by a two-income family model. Women also gained the right to apply for credit without a male co-signer in 1974, granting single women more financial freedom. The passing of the Pregnancy Discrimination Act in 1978 protected pregnant women from hiring discrimination.

Many fields have seen steady changes in their demographic breakdowns that coincide with these changes, and dentistry is no exception. Women accounted for only 11% of dental school graduates in 1978, according to the American Dental Association (ADA). In 2018, half of dental school graduates were women.

Women aren’t just getting their degrees in dentistry at higher rates; they’re also becoming leaders in dental education and professional associations. In 2010, there were 111 female assistant deans in dental schools, nearly seven times more than the 16 assistant deans in 1990. Kathleen T. O’Loughlin became the first female president of the ADA in 2009.

Women also represent a large portion of oral health–related jobs beyond dentistry. Of the 150,000 registered dental hygienists in the United States, 98% are female. Women make up 97% of dental office managers, according to a survey from 2019. About 93% of dental assistants are female. Half of dental laboratory technicians and medical appliance technicians are female.

Looking towards the future

Among the 201,117 dentists working in dentistry as of 2020, only 32% are female. That may seem low, but that figure is expected to rise as the number of women graduating from dental school and entering the workforce increases. In fact, women make up 60% of dentists under the age of 44 and show no signs of stopping.

It’s important to note that the overall change might be slow since the average age of retirement is rising. Americans age 50 and older hold over 20% of all student debt, which is affecting the rate at which they retire. Dentists are some of the most indebted professionals and their debt-to-income ratio is rising faster than other health care workers. The average dental school debt for the class of 2019 was $292,169. Assuming a 7% interest rate on a 10-year repayment plan, the average loan would require monthly payments of $3,390. Those student loans may cause delays in retirement savings and ultimately a higher percentage of dentists in their 70s.

Still, there are remain disparities in the field. Female dentists make 17.5% less than their male counterparts, according to the Department of Labor’s Women’s Bureau. And female dental assistants make 5% less than their male counterparts, despite making up almost 93% of their profession.

The formation of professional groups like Women in Dentistry and the American Association of Women Dentists gives female dentists a place to come together. With more women becoming mentors and take on leadership roles, the disparities are likely to shrink as dentistry becomes a more diverse and inclusive field.

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