Institutional racism is a form of racism that is embedded as a normal practice within society or an organization. It leads to discrimination in criminal justice, employment, housing, healthcare, political power, education, economics, and dentistry.
The term "institutional racism" was first coined in 1967 by Stokely Carmichael and Charles V. Hamilton in their book Black Power: The Politics of Liberation. Carmichael and Hamilton wrote, “while individual racism is often identifiable because of its overt nature, institutional racism is less perceptible because of its less overt, far more subtle nature.”
It is nearly undetectable in dentistry, but when you look through the lens of institutional racism, it’s there.
Institutional racism originates in the operation of established and respected forces in our society, like dentistry, and therefore receives far less public condemnation than individual racism.
Institutional racism was defined by Sir William Macpherson in the U.K.'s Lawrence report as: "The collective failure of an organization to provide an appropriate and professional service to people because of their color, culture, or ethnic origin.” Dentistry fits this description. Take away Medicaid and State payments, and what percentage of people of color would ever get
Dentists need to recognize that dental practices and the dental industry is perfectly structured to deliver institutional racism. One of my teachers once told me, “a business is perfectly designed to get the results it’s getting.” That truism is valid in multiple industries. Dentistry is perfectly designed to get the results it’s getting and one of those results is institutional racism.
To change something, you must first recognize it, then be responsible for its existence. But then comes the hard part, you need to make a choice. Dentists in practices and DSOs would have to ask, are we going to do anything about institutional racism in dentistry at both the individual and collective levels? If yes, the most challenging step is next. That step is to make legitimate commitments in time and money, followed by establishing structures and generating accountabilities to make change happen.
Throughout dentistry’s long history, dentist-owned, office-based practices, which make-up 70 percent of the delivery system today, have been owned and operated primarily by white people. This will certainly change in the future with the steady growth of women in dentistry and the aggressive growth of DSOs. Nevertheless, the established legacy context and structures in dentistry, unless altered, will continue to sustain institutional racism.
For most dentists, their circle of concern doesn’t reach far beyond their professional community, familial group and physical location – where most of the occupants often share the same ethnicity and values as the dentist. All you need to do is look at the numbers to see that dentistry is perfectly designed to get the results it’s getting.
Ethnic and racial diversity among dentists does not mirror that of the U.S. population. In terms of race and ethnicity, white and Asian dentists are proportionally far more represented in the profession when compared to the U.S. population. Hispanic and black dentists, and those who identify themselves as another race or ethnicity, are proportionally less represented in the profession when compared to the U.S. population.
THE DISTRIBUTION OF U.S. POPULATION TO DENTIST POPULATION
TYRANNY OF THE OBVIOUS
Who is in the most need of treatment? Where is the greatest need?
When you talk about racial barriers, you can’t avoid talking about economic obstacles. I think increasingly today, as historically racial barriers are being broken down on some levels, the economic barriers continue to persist.
Simply put, most black and Hispanic populations cannot get nearly the same level of dental care as white populations because they can’t afford it.
And remember, dentistry exists in a for-profit context. This adds a lot of push to focus on what makes money. And what makes money is treating people with money.
In a recent New York Times guest column, psychiatrist Damon Tweedy wrote, “As a general rule, black patients are more likely to feel comfortable with black doctors. Studies have shown that they are more likely to seek them out for treatment, and to report higher satisfaction with their care.”
Although not well documented, most African American dentists’ practices are mostly in or very near communities of color. The ADA points out that African American and Hispanic dental providers disproportionately serve African American and Hispanic patients. “It is important to note that the increasing costs of care delivery, coupled with low Medicaid reimbursement rates, continues to challenge our members’ efforts to deliver quality dental care to those most in need.”
Are state-supported schools doing any real outreach and program adjustments to recruit minority students? Even if they are, who can afford a loan of $300,000 anyway? Add that onto the money borrowed just to get through college.
No solution to this ongoing dilemma is possible until dentistry acknowledges that the way it is structured supports institutional racism. Obviously, the way the system is now set up, the underserved will continue to be underserved and their dental health will continue to worsen.
Does dentistry want to believe it has an institutional racism problem?
It is hard to admit but the evidence is clear and there can be no denying that the system is rigged. Does dentistry want to do something about it or not, is the question to be asked – and at some point, answered.
Author’s Note: This piece is not meant to be an accusation. I am as guilty as everyone else. I didn’t write this piece to blame or shame dentists to feel
guilty. All of us in dentistry, and that’s me included, must ask now that we recognize institutional racism, do we want to do something about it or not?