From Walmart to Amazon to Meta, American companies are abandoning previously made commitments to diversity, equity, and inclusion (“DEI”) in their workforce. It seems they cannot pull the plug on these programs fast enough.

Certainly, some in Canada are happy to see an end to the so-called “woke agenda” and a “return” to what they consider “merit based” hiring and promotions.

So how does this impact our world of dentistry? Given most dental offices are smaller employers, can dentistry really have an impact on improving representation? More fundamentally, does representation in dentistry even matter to the community at large?

These are difficult questions to address in the short space of a blog. With so many nuances to the issues, a full dissertation is what is really required. So, I apologize up front if I appear to gloss over or ignore factors some consider worthy of more discussion.

To begin with, let’s consider some statistics. I did find it easier to track down relevant numbers from the US compared to Canada…so here they are. Recent U.S. estimates indicate only 3.7% of the dentists in America are black. Similarly, only 4.2% are Hispanic.¹ Those are very low numbers!

Some might think “so what…people from these communities can go see white, male dentists. Nobody is refusing to treat them.”

While this may be true, the reality is members of the BIPOC community visit the dentist less often than white community members. They have higher levels of periodontal disease, tooth decay, and even higher mortality rates from oral cancer compared to the white community.²

Obviously, we cannot conclude there is a perfect correlation between low levels of representation and poor oral health outcomes. Other variables do come into play. But it is difficult to underestimate the importance of providers who truly understand and relate to their patients because the patients see a bit of themselves in those providers.

Think about it—all of us who coach in dentistry emphasize the importance of building relationships with patients as a means to improve case acceptance. And it is much easier to build those relationships with people with whom you share a cultural or other experience.

That is a simple reality. People associate more with people they relate to.

The lack of cultural understanding has proved fatal far too often in the healthcare field. Canada has seen too many tragic outcomes in situations where healthcare workers simply could not empathize with the experiences of their indigenous patients, situations that might have been avoided with greater levels of representation.³

All that being said, are DEI initiatives a viable solution or would we be better off to abandon them in favour of traditional “merit based” systems?

In theory, this sounds appealing. After all, how can one truly debate the merit in…well…merit?

However, this assumes we can assess “merit” in an objective fashion using criteria that is universally agreed upon. In reality, determining which skills or characteristics are “merit” based is a value judgement. And values are inherently subjective.⁴

To add to the overall subjectivity, how do you measure which person possesses more of those “merit” based skills?

The answer to that may seem obvious. However, there have been studies wherein a group of test subjects were asked to pick the best potential leaders simply by reviewing a group of resumes. When all indications of gender were removed, resumes corresponding to female candidates were selected more often than their male counterparts.

However, when those same resumes were resubmitted to the exact same reviewers with gender now identified, the reviewers suddenly favoured the male candidates in leadership roles. Even the female reviewers were more likely to select a male as a better leadership candidate.⁵

The objective “merit” of all the candidates was unchanged. Yet introducing gender resulted in a different outcome. Clearly subjective bias about men being better leaders played a role in superseding objective “merit”.

And it is not just gender where we can see this impact. Despite our best intentions, we also bring our biases about race, culture, religion, gender preference and gender identity with us every day.

Those biases can impact our assessments of “merit” in ways we may not even be aware of. And it can definitely impact how we assess patients from diverse communities.

These are the situations that DEI initiatives are intended to correct.

Now, perhaps it can be argued that some of these initiatives are too aggressive. Some feminist authors, for example, have argued that the recent trend in western society has ignored the needs of straight, white, able-bodied men.⁶

I can agree that I have seen some examples of this, situations where you could argue the pendulum swung too far.

However, does that mean DEI initiatives should be abandoned? That somehow, DEI initiatives be universally equated with a reduction in competency?

I would argue strongly NO! Not for society in general—and definitely not for dentistry.

DEI initiatives often force people to see potential in candidates who do not fall into the traditional perspectives of “merit”. If anything, they expand the talent pool and allow us to incorporate team members who have more “merit” than we may have given them credit for in the past.

They are not perfect. There will be instances when the outcome of adhering to a DEI program will seem unfair to some individuals. We do need to be vigilant to ensure our desire to address historical wrongs does not impose too great a burden on those who are not the beneficiaries of DEI programs.

But cancelling DEI outright is like using a sledgehammer to correct a problem when a scalpel would do. Our world will be better served by being more representative. And the oral health of some community members may suffer if we refuse to acknowledge this fact.

References

1. https://www.deltadentalinstitute.com/news/expert-voices-blog/advancing-diversity-within-the-dental-industry-and-addressing-inequities-in-oral-health/; Clearly there are numerous other demographics worthy of discussion, but time and space is limiting the extent of statistical analysis at this time.
2. https://www.deltadentalinstitute.com/news/expert-voices-blog/advancing-diversity-within-the-dental-industry-and-addressing-inequities-in-oral-health/
3. https://www.nationalobserver.com/2023/04/11/investigations/anti-indigenous-racism-health-care; https://www.theguardian.com/world/2020/sep/30/joyce-echaquan-canada-indigenous-woman-hospital
4. https://justincolletti.com/2016/03/07/objective-merit-subjective-values-and-arguing-about-taste/
5. Joanne Lipman; That’s What She Said: What Men Need to Know (and Women Need to Tell Them) About Working Together, 2018, Harper Collins Publishers
6. https://www.cbc.ca/radio/sunday/caitlin-moran-feminism-men-overlooked-1.6982762; https://www.telegraph.co.uk/news/2023/08/21/school-underperforming-boys-ignored-focus-on-girls/?ICID=continue_without_subscribing_reg_first