Talking With Women Who Are Forging New Paths In Dentistry

Things really changed in the 1970s, when there was a 20% increase in the number of women entering dental schools—a trend largely associated with societal changes arising from both the women's and civil rights movements.² By 1980, women comprised just under 20% of the students of first-year dental school classes; however, this number increased to 38% by 1990 and approached 50% by 2015. In just the last 18 years, the number of women practicing dentistry in the United States has more than doubled from 26,870 in 2001 to the current figure of approximately 60,000.^2-4

The most recent data reveal that 32.2% of practicing US dentists are women, and this figure is expected to rise as the increasing number of female dental students in the educational pipeline graduate and enter into practice.^5,6 If this trend continues as expected, within a decade, the number of women practicing dentistry will outnumber the men as the dentists of the baby boomer generation retire and are replaced by younger practitioners.^4,5 "The boomers are retiring at a high rate of close to 10,000 per year," notes Kathleen T. O'Loughlin, DMD, the current (and first female) executive director of the American Dental Association (ADA). "We are seeing a significant exodus of white males and a huge influx of women, and diverse women and millennials (ie, 30- to 40-year-olds) will become the majority of ADA members in the next 5 to 10 years," she says. ADA statistics show that close to half (ie, 49%) of US dentists who are under the age of 35 are women.⁵

How will the profession be changed by a female-dominated workforce? There are already signs that the latest generation of dentists (both women and men) is more concerned about quality of life and work/life balance than previous generations of dentists were, which promises to change the culture and practice organization of the dental profession long-term.⁴ As a whole, women are 11% less likely to specialize than men, are 22.5% less likely to own private practices, work an average of 20% fewer hours per month than their male counterparts, and are more likely to work in group practices because they offer flexible hours and reduced administrative responsibilities.^2,3,5,7 Women of all races and ethnic groups also may be more likely than their male colleagues to place more importance on service to vulnerable and low-income patients.⁷ In fact, gender has been shown to be a more important determinant of career choices than student debt load.⁷

As a profession, dentistry appeals to the caring and creative sides of many women, and they perceive that it offers the opportunity to balance family and work commitments. "Many women perceive that dentistry gives them the flexibility to work full-time or part-time, if they want to, or to work more than full-time, as I did, but I think you have all of these options available to you," says Maria Ryan, DDS, PhD, vice president and chief dental officer at the Colgate Palmolive Company in Piscataway, New Jersey, and former associate dean, professor, and chair of Oral Biology and Pathology at Stony Brook University's School of Dental Medicine. "Clearly, the feedback from women in dentistry must be positive or there wouldn't be so many younger women entering the profession."

"There are just so many opportunities for women in dentistry," agrees Lily T. García, DDS, MS, who was recently appointed dean of the School of Dental Medicine at the University of Nevada, Las Vegas. "Although there are many opportunities, it is important to know yourself well enough to determine if and when it is best for you to pursue them." According to García, only the individual can determine her own personal and professional timing; however, individuals still need to align their own experiences so that their credentials make them competitive. "When I see a junior faculty member who is pregnant, I tell her to take the time that she can because she's in a field that allows a little forgiveness," García says. "With that being said, planning for transitions whenever possible ensures that any changes are smoother." García adds that her work as a prosthodontist also allowed her to have the kind of intense one-on-one contact with patients that she found very fulfilling. She could improve each patient's quality of life and, at the same time, be engaged in complex work that the community regards as having a high level of integrity.

But even though dentistry allows more flexibility than some other professions, young women in dentistry are still struggling with work/life issues. "These are the real-life issues they're facing," says O'Loughlin. How can they balance their family responsibilities with those of their practices? How do they decide who stays home with the kids and who works? Who takes the day off for a sick child? Who does most of the cooking and cleaning? Who attends the parent-teacher meetings?

It's ironic, but the number one reason women dentists give for not taking on the extra obligations that are involved in assuming a leadership position in the profession is work/life balance-the very same reason that many women are attracted to dentistry in the first place.

Yes, women have a come a long way since the days when female dental students were routinely told that they were "taking a man's seat" in dental school, asked by loan officers if they would be able to work while menstruating, and told that their husbands or fathers had to cosign loans (See The Bad Old Days).³ With an increasing number of female dentists and an overall increase in women enrolled in postdoctoral dental programs, the goal of having a pipeline of women in dentistry has been realized to a certain degree,⁸ but women are still underrepresented among deans and tenured faculty in US dental schools, in the leadership of local and state dental societies and organizations, and among the ranks of CEOs and other executives at US oral care companies.⁹ "It's definitely a trend to see more women in dentistry," agrees Irina Dragan, DDS, DMD, MS, who is an assistant professor of periodontology and the director of faculty education and instructional development in the Department of Periodontology at the Tufts University School of Dental Medicine, "but you see more women at the student level than at the administrative level."

"Women don't have equal representation among dental school deans and department chairs," O'Loughlin states, "and there are also fewer women among tenured faculty." There are now female deans at 15 of the 66 US dental schools,² and according to American Dental Education Association survey data from 2017 to 2018, 36.8% of dental school faculty members nationwide are female.¹⁰ However, women have a hard time competing for tenured positions in part because of structural barriers in academia. "Women tend to occupy the lower tier of the academic ladder as adjunct faculty or clinical faculty," O'Loughlin explains. "You don't get credit for taking time out for children in academia. So, you often see women lose a decade or more as they move up the tenure ladder."

Women are also underrepresented in leadership positions in organized dentistry. "For example, this year, there are no women in ADA's entering class of five trustees," O'Loughlin notes. "And the fact that we're not recruiting enough women to be viable trustee candidates elected from different districts is troubling. I know they're out there, but they're just not getting elected."

"There are very few women in leadership positions in the oral care industry," Ryan states. However, her employer, Colgate Palmolive, is a standout because there are many women in positions of leadership within the company. "I am the chief dental officer, and my chief technology officer is also a woman, as is our chief communication officer and our chief legal officer," she notes. But, that is not the typical scenario in corporate dentistry. About 26.5% of executives and senior-level managers at the nation's S&P 500 companies are women¹¹; in biotechnology, fewer than 10% of CEOs are women, and among the Fortune 500, only 4.2% of CEOs are women.^12,13 "I suspect that the representation of women at the highest levels of corporate dentistry is much lower; however, comparable statistics for corporate dentistry are hard to find," Ryan explains.

"Having diversity in the industry is important because women have a different take on patient care-maybe a gentler side," Ryan says. "In industry, you're sitting around a table and thinking about innovation and new product development as a woman, a daughter caring for aging parents, a mother caring for children, and a professional, which makes a woman's perspective on consumer- and professionally-based products essential." Women are more likely to be thinking about the issues that women face during pregnancy, menopause, and throughout life. Just from a marketing perspective, dental product companies should have more women in leadership positions because they will increasingly be marketing and selling their products to women of all ages and to an increasing number of women dentists and hygienists whose engagement with patients and strategies for optimal patient care may be somewhat different than their male counterparts.¹⁴

"We are facing the biggest age gap between leadership and the ‘rank and file' that's ever been seen," O'Loughlin states. "The vast majority of our current leaders are baby boomers, and the majority of the leaders in this age group are white males."

The current average age of our dental educators is around 60, so in the next couple of years, we will have a gap in who will educate the next generation of dentists, agrees Dragan. "To fill that impending gap, we must make sure that we identify very good female student leaders and try to mentor them so that they can support the next generation of students," she says. Unfortunately, one of the things holding back promising students from going into academic positions in dentistry is their student debt load. The average debt burden of US dental school graduates in 2019 was more than $292,000.¹⁰ Dragan received her DDS in Bucharest, Romania, before coming to Tufts for postgraduate training and afterwards, her DMD degree. She points out that internationally trained dentists who come to the United States to specialize and then pursue careers as dental educators can more easily do so because of their reduced rate of indebtedness when compared with their colleagues trained in the United States. "The increased student debt of dentists trained in the United States is the number one limitation for our dental graduates who are interested in pursuing full-time careers as educators," she explains.

On its own, the existence of the pipeline of women dental students is not going to increase the number of women in the profession's leadership positions. In an article published by the Journal of the California Dental Association, former ADA president Carol Gomez Summerhays, DDS, notes that the problem of gender disparity in leadership positions in dentistry will not "work itself out over time."⁹ She believes that it is important to acknowledge that the traditional paths to leadership that work for men might not work as well for women.^9,14 "Women may not find traditional networking approaches as appealing because of home and family commitments and responsibilities. It's time to be more intentional about developing pathways to leadership for women and helping them develop leadership skills and the confidence to assume leadership roles within the profession," she states.⁹

How do we become more intentional about gender equality and finding and supporting talented female leaders in dentistry? García recalls attending a unique women speakers invitational conference in October 2004, where Heliane Canepa, the former CEO of dental implant manufacturer Nobel Biocare, asked the audience, "Where are the women?"

Many are busy working and are not always good at self-promotion, and we are not doing enough to develop them. "We have to highlight the women who are doing a good job. They may be doing it quietly, but we have to give them an opportunity," García says. "Women need to see other women in positions of leadership so that they learn what possibilities even exist."

It's not just about who gets a seat at the table. In an article published by The Chronicle of Higher Education, Valerie Kinloch, the first black female dean at the University of Pittsburgh explains that it's also about the "people who feel that they can't be a part of conversations because they don't belong in those narratives, in those meetings, or in those stories. When in fact, they do."¹⁵

"Having more successful women in leadership positions fosters a sense of possibility, which results in curiosity, trial, and change," says Julie Charlestein, the president, CEO, and fourth-generation leader at Premier Dental Products Company in Plymouth Meeting, Pennsylvania.

"Just seeing women in leadership positions opens the door for other women to imagine themselves in leadership positions," says Betsy Bakeman, DDS, who is the president of the American Academy of Cosmetic Dentistry (AACD), a faculty member of the Kois Center in Seattle, Washington, and a private practitioner of cosmetic dentistry in Grand Rapids, Michigan. "When you see other women in leadership roles, the seed of doing more and contributing more is planted in your brain."

That's why Bakeman is optimistic. "The number of women getting into leadership is growing more slowly than we'd like to see, but it's only a matter of time until that changes," she says. Women are very accepting of different "seasons" in their lives. Their work careers are important to them, but they also weigh the importance of raising children or caring for an ailing family member and are willing to work fewer hours to achieve work/life balance. "But as their children grow and the practice is up and running, they're willing to invest more time in the profession and move into leadership roles," Bakeman says. She notes that dentistry tends to attract people who are perfectionists and want to do well at whatever they take on, so they tend to wait for the right time in their lives to take on more, which is a healthy decision.

"When I was at the University of Michigan School of Dentistry in 1983, I had very few female instructors," Bakeman recalls. "There were rarely women at the podium at conferences, and when there were, they were rarely in clinical dentistry. But, we see more women leaders and educators in the profession now, and they are amazingly inspiring. We will see more in the future."

An even bigger change is on the horizon: among dental school faculty who are 39 years old and younger, women outnumber men. In the 30- to 39-year-old age group, the ratio of women to men is 56.1% to 43.9%, and for those under age 30, the ratio of women to men is 65.3% to 34.7%.¹⁰

There is definitely more awareness of the issue of gender balance at the Tufts University School of Dental Medicine, Dragan confirms. There are amazing women in the dental school's leadership, including assistant/associate deans and department chairs. "We have so many representatives, and they embody diverse backgrounds and experiences. I believe it is very easy for female students to find a role model among the current leadership," she says. The previous dean, Huw F. Thomas, BDS, MS, PhD, made tremendous efforts to encourage more women from all levels to go into leadership positions. "He was adamant about supporting women in many capacities, and his support was aimed in various directions, from professional development to day-to-day mentoring and the creation of opportunities for us at local, national, and global levels," Dragan says. She is confident that the new dean, Nadeem Karimbux, DMD, MMSc, will continue that legacy.

Leadership programs can open up pathways for the very explicit training of leadership skills, helping women leverage their strengths and compensate for what they're not as strong in, O'Loughlin notes. For example, some women are not as confident about negotiating for higher salaries. "I tell my new employees this all the time: when you come in, you should always negotiate that offer. And almost 100% of the time, the men do, but the women do not. They start off behind the eight ball because they are lacking in confidence. If they learn how to be leaders, it will help them gain the confidence to get in there and fight for higher compensation or positions," she says. There are executive Master of Business Administration (MBA) programs available to help women develop strong leadership skills, and the ADA offers a leadership development program for women during our annual meetings and year-round (See Leadership & Networking Resources). The ADA also has the ADA Institute for Diversity in Leadership, which offers a diverse group of participants opportunities to enhance their leadership skills and gain leadership experience.

"I was very fortunate to have entered a leadership program called the Hedwig van Ameringen Executive Leadership in Academic Medicine^® (ELAM), which is like a mini-MBA program," Ryan states. D. Walter Cohen, DDS, started ELAM when he was chancellor of the Drexel University College of Medicine precisely because he recognized that there were very few female deans and chairs in medical schools. As a dentist, he opened ELAM up to women in dentistry as well.¹⁶ "If you look at the deans and chairs around the country who are women, many are graduates of the ELAM program," Ryan says. "So, leadership programs clearly work."

"We may just be tapping in at the right time to the things that women tend to have as natural strengths that the workplace is looking for and values," says O'Loughlin, "because millennials and centennials (ie, the group coming out of college now) consider the things that women are classically strong in-emotional IQ, nurturing, social awareness and responsibility, inclusiveness, flat hierarchy, and shared decision-making-things they are looking for when choosing a job."

Ryan stresses the importance of creating networks of women in leadership. It's not only about recruiting and retaining women but also sustaining the networks of women. "Sustainability comes from the networks that are created as more and more women assume leadership positions," she says. "I can say from my own experience as president of the American Association for Dental Research, that the previous women presidents-and there aren't many of them-reached out to me and said, ‘Maria, you really need to run for this; go for it, we'll be here to support you.' That was very helpful. And as I said before, even in my own company, having other women in leadership positions is very helpful."

Mentorship is a strong tool for encouragement and example, says Charlestein. It's critical to understand the importance of mentoring. Mentors can come in many different forms, whether they be male or female or for work, life, or school.

"After becoming accredited by the AACD, peers encouraged me to publish and lecture," says Bakeman. "John Kois, the founder of the Kois Center, has been very influential in my life. He sees the best in others and encourages people to take the next step in their careers and stretch themselves a little further. His encouragement and example of leadership has been very powerful in my life. There is nothing like having someone say to you personally, ‘I think you should do this because you will grow, and it will be a good thing.' We all need to extend a hand, not only to pull people up but also give them a little push now and then. I have watched John Kois encourage and motivate but then allow the mentee to take the initiative."

After García began dental school at Baylor in 1980, where she was one of perhaps only 18 women in a class of 140 students, most of her mentors were men who recognized her drive and wanted to encourage it. "We need our brothers in academic dentistry to have the foresight to help all of those around them-even the quiet ones with their noses to the proverbial grindstone-who do their jobs well," she says. They can be young women or young men who are early in their careers and haven't thought about leadership yet. "I feel compelled to showcase this new generation of women of different backgrounds to highlight them and give them a stage," García says. As each woman moves up, she should try to encourage others. "Encourage the heart and model the way for all the things women need to learn in leadership to help those around them."

Dragan believes that she was able to move into leadership because she had both male and female mentors who were very supportive of her, specifically because they started to see the current shift to more female dental students. "They encouraged me constantly, highlighting that I could provide support for these students who were coming to the school and needed to have more female role models."

"A lot of people ask me how I found mentors," Ryan says. "I just kind of knocked on doors and asked for help, and people were actually very willing to help." Sometimes women think that asking for help is a sign of weakness, but that is not true. "I've had many male mentors," she points out. "In fact, the person who preceded me as chief dental officer at Colgate, Anthony R. Volpe, DDS, MS, has been my mentor for many, many years."

Ryan points out that it's not just talking the talk; it's walking the walk. Colgate Palmolive provides mentorship to young women coming into the profession with a number of different programs. For example, through the American Association for Women Dentists, the company awards 10 scholarships per year to female third-year students.

Mentorship even happens "in reverse" as Bakeman has discovered. "There is a group of younger women dentists in my life whom I have been fortunate to know. In the past, I have encouraged several of them, pushing them to grow and celebrating their achievements. Now, when we get together to chat and talk about things, they also push and inspire me. They might encourage me to be more active on social media, try a new online communication system, or advance my photography skills. It's been a positive thing that keeps me in touch and engaged. It's powerful to have relationships that are mutually enriching, and it's meaningful to have these women in my life—I didn't have that before, and I really enjoy it."