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Llaneza AJ, Seward J, Holt A, Stephens LD. Oral Health Workforce and American Indian and Alaska Native Communities: a Systematic Review. J Racial Ethn Health Disparities 2024; 11:248-254. [PMID: 36692659 PMCID: PMC10781823 DOI: 10.1007/s40615-023-01515-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/02/2022] [Accepted: 01/04/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Understanding the oral health workforce representing and serving American Indian and Alaska Native (AI/AN) communities is vital to improving community dental health outcomes. No systematic review of recent published literature on the oral health workforce among this population has been completed. METHODS We conducted a systematic review of published literature examining the oral health workforce representing and serving AI/AN communities in the USA. We analyzed 12 articles according to the PRISMA Statement. RESULTS The studies suggested that AI/AN identity is an important aspect of routine and accessible oral healthcare. There are unique barriers and motivations that personnel in the oral health workforce face, let alone the distinctiveness of serving AI/AN communities. CONCLUSIONS This review provides evidence that expanded oral health positions aid in community members receiving more routine and preventative care and is an upstream public health approach that has diversified the dental workforce.
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Affiliation(s)
| | - Julie Seward
- Southern Plains Tribal Health Board, Oklahoma City, OK, USA
| | - Alex Holt
- Southern Plains Tribal Health Board, Oklahoma City, OK, USA
| | - Lancer D Stephens
- Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Shared Clinical and Translational Resources, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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2
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Fleming E. Author's Response. J Am Dent Assoc 2023; 154:459-460. [PMID: 37097273 DOI: 10.1016/j.adaj.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/01/2023] [Indexed: 04/26/2023]
Affiliation(s)
- Eleanor Fleming
- Assistant Dean for Equity, Diversity, and Inclusion, Clinical Associate Professor, Department of Dental Public Health, University of Maryland School of Dentistry, Baltimore, MD
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3
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Escontrías OA. The opioid epidemic and oral health inequities: Two parallel public health crises in historically underrepresented and racial/ethnic (HURE) groups. J Dent Educ 2022; 86:1249-1253. [PMID: 36165251 DOI: 10.1002/jdd.12957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 04/23/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Omar A Escontrías
- Office of Policy and Education Research, American Dental Education Association, Washington, D.C., USA
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4
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Poole T, Jura M, Taylor G, Gates P, Mertz E. Slipping through the cracks: Just how underrepresented are minorities within the dental specialties? J Public Health Dent 2022; 82 Suppl 1:53-62. [PMID: 35726471 PMCID: PMC9545059 DOI: 10.1111/jphd.12520] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 12/04/2022]
Abstract
Objective There is a lack of diversity in the dental workforce. Efforts to enhance underrepresented minority (URM) recruitment and retention within dental school exist, but little effort has been made to track URM providers through education and practice. This study assesses the status of workforce diversity in the dental specialties and the predictors of URM dentist specialization. Methods The primary data used were a 2012 national sample survey of Hispanic/Latino (H/L), Black, or American Indian/Alaska Native (AI/AN) dentists in the US, supplemented by publicly available workforce data. Descriptive and multivariate statistical analyses were performed to describe the demographic composition of URM clinical general and specialist dentists and analyze changes in proportions of URMs specializing among age cohorts, differences in specific type of specialization, and racial concordance between specialists and their patients. Results The pathway continues to winnow with fewer URM dentists in specialty practice. Among all URM clinical dentists being first in his/her family to obtain a college degree, having a strong desire to work in his/her own cultural community or joining a loan repayment program due to debt load independently predicted lower odds of specialization. Alternatively, being initially foreign trained as a dentist and valuing professional training were independently predictive of higher odds of specialization. Conclusion The lack of diversity within the dental specialties is a critical flaw in our education and care delivery systems demanding clear actions toward improving the pathway into residency programs for URM students.
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Affiliation(s)
| | - Matthew Jura
- Phillip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - George Taylor
- Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, USA
| | - Paul Gates
- Academy for Advancing Leadership, Atlanta, Georgia, USA
| | - Elizabeth Mertz
- Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, USA.,Healthforce Center, University of California San Francisco, San Francisco, California, USA
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5
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Bianchi T, Wilson K, Yee A. Undoing structural racism in dentistry: Advocacy for dental therapy. J Public Health Dent 2022; 82 Suppl 1:140-143. [PMID: 35014051 PMCID: PMC9303238 DOI: 10.1111/jphd.12499] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/10/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022]
Abstract
Like other areas of health, structural racism has a deep impact on oral health and is a key driver of racial inequities in access to care and outcomes. Racism also structures the relationship between oral health and access to economic opportunities. As a result, communities of color, American Indian/Alaska Native (AI/AN) communities, and low-income populations experience the highest rates of the health, social, and economic costs of dental disease. This is compounded by issues of community-level dental fear/trauma resulting from receiving itinerate care. Dentistry has long struggled to equitably distribute care and diversify its overwhelmingly white and affluent workforce, resulting in many communities not having access to providers who represent their identity and/or live in their community. While multi-generational lack of access to dental care is not unique to Alaska, Alaska Native communities are the home to a reimagined, community-centered care delivery system that is improving health outcomes. For almost two decades, AI/AN leaders have recruited and trained community members to serve as dental therapists-dental team members who offer routine and preventive care responsive to local geographic and cultural/community norms. As members of the communities they serve, dental therapists are fluent in the language and cultural norms of their patients, improving patient-provider trust, access to care, and oral health outcomes. The communities that dental therapists serve are also now investing money and training in their community members, building educational opportunities, and professional wage jobs and directly countering the economic impact structural racism has on oral health.
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Affiliation(s)
| | | | - Albert Yee
- Community CatalystBostonMassachusettsUSA
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6
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Fleming E, Mertz E, Jura M, Kottek A, Gates P. American Indian/Alaska Native, Black, and Hispanic dentists' experiences of discrimination. J Public Health Dent 2022; 82 Suppl 1:46-52. [PMID: 35726466 PMCID: PMC9543282 DOI: 10.1111/jphd.12513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Little is known about the scope and role of discriminatory experiences in dentistry. The purpose of this study is to document the experiences that American Indian/Alaska Native (AI/AN), Black, and Hispanic dentists have had with discrimination. METHODS This study reports data from a 2012 nationally representative study of dentists documenting experiences with discrimination during their dental careers or during dental school by the setting of the discrimination, the providers' education, and geographic location. This study does not differentiate between levels of discrimination and focuses holisticly on the experience of any discrimination. RESULTS Seventy-two percent of surveyed dentists reported any experience with discrimination in a dental setting. The experiences varied by race/ethnicity, with 49% of AI/AN, 86% Black, and 59% of Hispanic dentists reporting any discriminatory experiences. Racial/ethnic discrimination was reported two times greater than any other type. CONCLUSIONS Experiences with racial/ethnic discrimination are prevalent among AI/AN, Black, and Hispanic dentists, suggesting that as a profession work is needed to end discrimination and foster belonging.
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Affiliation(s)
- Eleanor Fleming
- Department of Dental Public HealthUniversity of Maryland School of DentistryBaltimoreMarylandUSA
| | - Elizabeth Mertz
- Healthforce Center, Affiliate FacultyPhilip R. Lee Institute for Health Policy Studies, UCSF School of DentistrySan FranciscoCaliforniaUSA
| | - Matthew Jura
- University of California San FranciscoPhillip R. Lee Institute for Health Policy StudiesSan FranciscoCaliforniaUSA
| | - Aubri Kottek
- Preventive and Restorative Dental SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Paul Gates
- Department of DentistryDurhamNorth CarolinaUSA
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7
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Neville P. The 'leaky' BAME pipeline in UK dentistry. Br Dent J 2022:10.1038/s41415-022-3930-6. [PMID: 35145241 DOI: 10.1038/s41415-022-3930-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/05/2021] [Indexed: 11/10/2022]
Abstract
Introduction There are growing calls for dentistry to debate, critique and analyse the role and place of racism in the profession. This article supports this debate and considers whether people from Black, Asian and Minority Ethnic (BAME) backgrounds experience barriers to progressing in the profession.Aims To create a BAME 'pipeline' model illustrating how ethnicity shapes the composition of the dental profession in the UK.Material and methods Publicly available datasets from UK higher education agencies and professional dental associations were identified, examined and collated to create a BAME pipeline model.Results Registrants from the BAME category do not share similar experiences within the dental profession compared to white registrants. The experiences of British Asian people appear to be more favourable, vis-à-vis access to dental schools and progression to the General Dental Council register, compared to Black British people and other UK minority ethnic groups. Black British registrants experience blockages at all stages of their career progression, most notably when accessing dental schools, with only 2% commencing dental studies. All BAME groups 'leak' out of the dental pipeline at clinical academia. There are insufficient data to ascertain whether there are additional 'leaks' at the career specialisation stage.Discussion and conclusion The UK BAME dental pipeline is a leaky one and is in need of urgent action and repair.
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Affiliation(s)
- Patricia Neville
- Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, UK.
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Simon L, Donoff RB, Friedland B. Dental therapy in the United States: Are developments at the state level a reason for optimism or a cause for concern? J Public Health Dent 2021; 81:12-20. [PMID: 32805762 DOI: 10.1111/jphd.12388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/03/2020] [Accepted: 07/02/2020] [Indexed: 01/18/2023]
Abstract
Access to dental care continues to be a challenge for millions of vulnerable Americans. In more than 50 nations worldwide, dental therapists (DTs), mid-level providers who deliver a limited scope of dental care under the supervision of a dentist, have helped increase access to needed care. Since 2003, when the Alaska Native Tribal Health System introduced DTs as part of the Federally authorized Alaska Community Health Aide Program, a total of 13 states have adopted the role. However, as of April 2020, there are fewer than 150 DTs in practice throughout the country, and educational and licensing requirements as well as scope of practice vary between each state. Such heterogeneity makes the training and recruitment of future DTs a challenge. This article summarizes the current state of the DT workforce in the United States and discusses the possible future of the profession as other states contemplate adopting the model in the face of ongoing oral health disparities.
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Affiliation(s)
- Lisa Simon
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - R Bruce Donoff
- Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, MA, USA
| | - Bernard Friedland
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
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Salsberg E, Brantley E, Westergaard S, Farrell J, Rosenthal C. Limited, uneven progress in increasing racial and ethnic diversity of dental school graduates. J Dent Educ 2021; 86:107-116. [PMID: 34545568 DOI: 10.1002/jdd.12793] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/03/2021] [Indexed: 11/12/2022]
Abstract
PURPOSE/OBJECTIVES To assess racial and ethnic diversity of graduates of each dental school compared to the diversity of populations they draw from and to assess changes over time nationally and by school. METHODS We calculated diversity of graduates by school and nationally between 2010-2012 and 2017-2019 using the Integrated Post-secondary Education Data System (IPEDS) and compared the diversity of each state's college age population using data from the American Community Survey. We accounted for differences between in-state and out-of-state students attending public and private schools based on data from the American Dental Association's Survey of Dental Education Series. A diversity index (DI) was calculated for each school. A DI of 0.5 means that the representation of Black or Hispanic individuals among the graduates is half of their representation in the benchmark population. RESULTS Among the 63 dental schools analyzed, only seven had a DI of greater than 0.5 for Black graduates (two of which were Historically Black Colleges and Universities) in 2017-2019. For Hispanic graduates, 20 schools had a DI above 0.5. Nationally, while the number of Black graduates increased between 2010-2012 and 2017-2019, the percentage decreased from 5.8% to 5.1%. The percentage of Hispanic graduates increased from 6.4% to 8.7%. CONCLUSIONS Black and Hispanic individuals are underrepresented among dental school graduates. Increasing the diversity of the dental workforce could help address significant oral health disparities experienced by Black and Hispanic people. More needs to be done by the dental education community to increase racial and ethnic diversity of dental graduates.
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Affiliation(s)
- Edward Salsberg
- Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Erin Brantley
- Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Sara Westergaard
- Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Jenee Farrell
- Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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10
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Wu YY, Zhang W, Wu B. Disparities in Dental Service Use among Adult Populations in the United States. JDR Clin Trans Res 2021; 7:182-188. [PMID: 33938303 DOI: 10.1177/23800844211012660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This article aims to examine the disparities in dental service utilization among 3 age groups: younger adults (20-49 y), middle-aged adults (50-64 y), and older adults (65+ y), among Whites, Hispanics, Blacks, Asians, American Indians or Alaska Natives (AIAN), and Native Hawaiian or other Pacific Islanders (NHOPI). METHODS Weighted logistic regression models were conducted to analyze 9 waves of cross-sectional survey data (2002-2018) from the Behavioral Risk Factor Surveillance System. We estimated age group- and race/ethnic-specific prevalences of dental service utilization adjusting sociodemographics and self-rated health for each wave and compared with crude analysis. Next, we performed linear regression analysis of the trend of adjusted prevalences over time and the average level by race/ethnicity and age groups. RESULTS Racial/ethnic disparities increased with age, even though the adjusted prevalences of dental service utilization were less apparent than the crude analysis. The all-wave average prevalence was 71%. Black older adults had the lowest level of dental service utilization (65%) as compared with the 2 highest groups: White older adults (79%) and Asian older adults (76%). The general younger adult populations had low prevalences, with the lowest among Asian younger adults (65%). AIAN and NHOPI individuals from all age groups tended to have average or below average prevalences. In addition, a decreasing trend of dental service utilization was observed among White individuals of all age groups (0.2%-0.3% lower per year, P < 0.01) and AIAN younger adults (0.5% lower per year, P < 0.01). CONCLUSION Health policy, federal funding, and community-based programs should address the needs of dental service utilization for racial/ethnic minorities including Blacks, AIANs, and NHOPIs. KNOWLEDGE TRANSFER STATEMENT Our study offers insights into our understanding of disparities in dental service utilization among minority racial/ethnic groups. As health policy, federal funding, and community-based programs seek to improve oral health, there is a need to address access to and utilization of dental service for Blacks, American Indians or Alaska Natives, and Native Hawaiian or other Pacific Islanders.
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Affiliation(s)
- Y Y Wu
- Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - W Zhang
- Department of Sociology, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - B Wu
- Rory Meyers College of Nursing, New York University, New York, NY, USA
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Burns LE, Pezzullo C, Mejia EE. Targeting the Pipeline to a Diverse Dental Student Body: Saturday Academy at New York University College of Dentistry. J Dent Educ 2019; 83:1057-1064. [DOI: 10.21815/jde.019.098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 11/27/2018] [Indexed: 11/20/2022]
Affiliation(s)
- Lorel E. Burns
- Department of Endodontics; New York University College of Dentistry
| | - Cheryline Pezzullo
- Department of Cariology and Comprehensive Care; New York University College of Dentistry
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12
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Mertz EA, Wides CD, Kottek AM, Calvo JM, Gates PE. Underrepresented Minority Dentists: Quantifying Their Numbers And Characterizing The Communities They Serve. Health Aff (Millwood) 2018; 35:2190-2199. [PMID: 27920306 DOI: 10.1377/hlthaff.2016.1122] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The underrepresentation of Blacks, Hispanics or Latinos, and American Indians or Alaska Natives among dentists raises concerns about the diversity of the dental workforce, disparities in access to dental care and in oral health status, and social justice. We quantified the shortage of underrepresented minority dentists and examined these dentists' practice patterns in relation to the characteristics of the communities they serve. The underrepresented minority dentist workforce is disproportionately smaller than, and unevenly distributed in relation to, minority populations in the United States. Members of minority groups represent larger shares of these dentists' patient panels than of the populations in the communities where the dentists are located. Compared to counties with no underrepresented minority dentists, counties with one or more such dentists are more racially diverse and affluent but also have greater economic and social inequality. Current policy approaches to improve the diversity of the dental workforce are a critical first step, but more must be done to improve equity in dental health.
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Affiliation(s)
- Elizabeth A Mertz
- Elizabeth A. Mertz is an associate professor in the Department of Preventive and Restorative Dental Sciences, School of Dentistry, and the Healthforce Center, both at the University of California, San Francisco (UCSF)
| | - Cynthia D Wides
- Cynthia D. Wides is a research analyst in the Department of Preventive and Restorative Dental Sciences, School of Dentistry, and the Healthforce Center, UCSF
| | - Aubri M Kottek
- Aubri M. Kottek is a research analyst at the Philip R. Lee Institute for Health Policy Studies and the Healthforce Center, both at UCSF
| | - Jean Marie Calvo
- Jean Marie Calvo is a student in the School of Dentistry at UCSF
| | - Paul E Gates
- Paul E. Gates is chair of the Department of Dentistry at the Bronx-Lebanon Hospital Center and the Dr. Martin L. King Jr. Health Center, and a clinical associate professor in the Department of Dentistry at the Icahn School of Medicine at Mount Sinai, all in New York City
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Garcia RI, Blue Spruce G, Sinkford JC, Lopez MJ, Sullivan LW. Workforce diversity in dentistry - current status and future challenges. J Public Health Dent 2017; 77:99-104. [DOI: 10.1111/jphd.12219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 03/29/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Raul I. Garcia
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine; Boston MA USA
| | | | | | - Michael J. Lopez
- University of California San Francisco, School of Dentistry; San Francisco CA USA
| | - Louis W. Sullivan
- The Sullivan Alliance to Transform the Health Professions; Alexandria VA USA
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