A.D.A.- all of the data, all of the conflicts

an open letter to the A.D.A.
Author: Dr. Charley Levy

A paper entitled, ‘A closer look at disparities in earnings between white and minoritized dentists’ by Kamyar Nasseh (Health Economist, Health Policy Institute, A.D.A.), Bianca Frogner (Dept of Family Medicine, University of Washington School of Medicine) and Marko Vujicic (Chief Economist & Vice President, Health Policy Institute, A.D.A.) was recently published in the Health Services Research Journal.  The objective of this paper was to look at the various factors that account for differences in dentist earnings between White and minoritized dentists.  They found that White dentists earned more ($254,860) than Asian ($202,967), Black($170,097), and Hispanic ($198,565) dentists.

In an effort to explain this wage disparity, the authors looked at many different factors that could affect a dentist’s earnings.  These include dentist age, gender, experience (years since graduation), patient mix(percent insured by Medicaid), specialty (GP or specialist), primary practice zip code, and foreign vs. domestic dental school.  They concluded that these ‘observable’ characteristics explained 58% of the earnings gap between White and Asian dentists, 55% of the difference between White and Hispanic dentists, and 31% of the difference between White and Black dentists.  Accordingly, there was a large ‘unexplained’ component of this wage disparity that still existed after accounting for these factors.  The authors concluded that, “Persistent income disparities could discourage minoritized dentists from entering the profession.”   

While the authors made efforts to explore many different variables that could contribute to this wage disparity, they noticeably didn’t examine which dental school each dentist graduated from.  They acknowledge that they had access to this information in the A.D.A. masterfile, but defended their decision by saying, “we do not have a universally accepted measure of the quality of domestic and foreign schools such as a dental school ranking”.   

While it is true that there is no ‘universally accepted’ ranking system, they failed to consider any of the objective information that we have available. There are many objective measures that are publicly available that can help to ‘rank’ the dental schools.  These include DAT averages, GPA averages, Acceptance Rate, and Enrollment Rate for every dental school for the duration of this study.  Additionally, the A.D.A. undoubtedly has access to residency matching data that can help to access the strength of each dental school.  At Path32, we did our best job at ranking the schools using this publicly available objective data.  While no ranking system is perfect, I strongly feel Path32 has a fair, transparent, and objective algorithm.   

It should be noted that 2 of the 3 authors of this article are employed by the A.D.A. Their decision to not explore this variable may be dictated by their employment.  The A.D.A. likely is disincentivized from labeling a dental school, ’60th out of 67’.  Some dental schools are better than others.  The 4 years that a student spends in dental school will have an extraordinary influence on their career trajectory.

The authors state that “Persistent income disparities could discourage minoritized dentists from entering the profession.”  They emphasize the importance of this by saying, “studies have found that racial and ethnic concordance between providers and patients reduces health care disparities.”  If the author’s true intention is to examine factors that lead to these wage disparities and ultimately a less diverse workforce and inferior dental care utilization by the minoritized population, they should examine all factors.  

At Path32, we wanted to look at the different racial composition of graduates from each dental school.  Using raw data from the A.D.A., we compiled a data set for all U.S. Dental Schools that has the racial composition of graduates from 2010 to 2021.  This includes data on almost 70,000 Dentists. We broke down the data in 2 different ways.

For each dental school, the percent of their graduating class that is Asian, Black, and Hispanic (Figure 1).  This allows us to look at the racial composition of all U.S. Dental Schools over the last 12 years.

We also looked at which Dental Schools our minoritized dentists are graduating from (Figure 2).  While similar to our first inquiry, this also factors in a school’s class size and ultimately their impact on the dental workforce.  Enjoy!  

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