Skip Navigation

Transform the
Health Professions

Connect Connect with the Sullivan Alliance

Saturday April 15, 2017

Dental Therapy Gains Steam in the U.S. as Model Curriculum Becomes Available

By Jane Koppelman, Research Director, Pew Charitable Trusts’ Dental Campaign

Dental TherapistDental therapy is an emerging profession in the United States helping to address critical gaps in care for the tens of millions of Americans who have difficulty finding a dentist to treat them. Dental therapists—performing a caregiving role similar to physician assistants—are supervised by dentists and work as part of a team to deliver routine preventive and restorative care, including preparing and filling cavities and performing simple extractions.

Dental therapists have practiced internationally for nearly a century and now work in more than 50 countries. There are 1,100 studies of dental therapists in over 26 countries, along with evaluations in Alaska and Minnesota demonstrating that they provide care at the same level of quality as dentists for those procedures they have in common.

The U.S. is a relative newcomer to this model, yet interest at the state and national levels is growing. In 2004, Alaska began using dental therapists to provide care to Native Alaskans, many of whom live in remote villages that dentists visit infrequently. Minnesota authorized their use in 2009, and Maine and Vermont followed suit in 2014 and 2016, respectively. About a dozen state legislatures are considering similar proposals to improve care for underserved populations, including Arizona, Kansas, Maryland, Massachusetts, Michigan, New Mexico, and Ohio.

Dental TherapistTribal activity is also growing. In 2016, Oregon approved pilot programs allowing two federally recognized tribes to employ dental therapists. That same year the federal Indian Health Service (IHS) invited comments on a proposed policy to allow dental therapists to practice in IHS facilities across the nation. And in early 2017 Washington became the first state to pass legislation to allow dental therapists to practice in Indian country.

Dental therapists are being used in a variety of ways in Minnesota to improve care access. Dentists are hiring dental therapists to serve more Medicaid patients, finding that the lower cost of employing them makes accepting Medicaid’s discounted payment rates more palatable. Minnesota Federally Qualified Health Centers are using the savings from employing dental therapists to serve more patients and provide more free or low-cost care to uninsured people, while other clinics are deploying dental therapists to schools, nursing homes, and rural hospitals to deliver care in more convenient locations.

While legislative change is necessary to allow dental therapists to practice in states, training institutions are essential to build this workforce. To that end, early this year a model dental therapy curriculum was unveiled for community colleges and universities interested in launching such training programs. This sample curriculum, developed with input from the American Association of Community Colleges, the W.K. Kellogg Foundation and The Pew Charitable Trusts, was designed to meet dental therapy guidelines issued in 2015 by the Commission on Dental Accreditation (CODA), the accrediting body for the nation’s dental education programs.

Dental TherapyFor a number of reasons, curriculum developers are particularly interested in boosting the role of community colleges in providing this training. CODA’s dental therapy guidelines call for at least three academic years of training, without prescribing a specific degree requirement, such as a bachelor of science. Dental hygienists and assistants are also given credit for the education they have already received. This opens the door for community colleges to play a central role in training dental therapists. Community colleges are committed to addressing the educational and workforce needs of their communities and to offering affordable training for some of the nation’s most economically challenged students. Their participation could go a long way toward expanding the diversity and cultural competency of the oral health professions. Community colleges have educated the majority of the nation’s dental hygienists and are a logical home for training dental therapists—especially given that about half of community colleges are located in or near rural areas where the shortage of dentists is most acute.

As more states strengthen and modernize their oral health delivery systems by authorizing dental therapy, schools have gained an important resource to develop high quality training programs to educate this emerging workforce. Progress on both fronts is certain to benefit millions of underserved Americans.

Comments: 0 | Reply

Wednesday March 15, 2017

Want to help diversify the biomedical workforce? Start with mentoring

By Amanda Butz, PhD, Emily Utzerath, MS, Angela Byars-Winston, PhD, University of Wisconsin

In an opinion article for the New York Times published in August 2016, Drs. Daniel Colón Ramos and Alfredo Quiñones-Hinojosa expressed that trainees from racial/ethnic groups historically underrepresented (HU) in the biomedical sciences are exhausted, not from the research, but from the “constant bombardment of narratives and stereotypes that compromise their ability to focus on their training.” The question of how to reduce the prevalence of such deleterious narratives and stereotypes in order to support the persistence and success of HU trainees has been raised many times over in the past few decades. Yet, the philosophy of science as an objective endeavor can make it difficult for some mentors to understand how a trainee’s identity might have an impact on their research performance. Research shows that HU trainees are interested in talking about issues of race and ethnicity with their mentors, but these conversations are often avoided. How can we better prepare mentors to effectively talk about cultural diversity and sensitive topics with all scholars, especially those from HU groups?

The National Institutes of Health (NIH) has called for scientific, evidenced-based approaches to training that will broaden participation in the sciences. To answer this call, the National Research Mentoring Network (NRMN), a collaborative research effort funded by the NIH, was launched in 2014 to better prepare mentors, often white and more advanced in their careers, for effective research mentoring relationship with their mentees, who are coming from increasingly diverse racial, ethnic, gender, and socioeconomic backgrounds.

CAM Group PhotoNRMN’s Mentor Training Core has worked extensively for the past few years on implementing established as well as new mentor training interventions designed to improve research mentoring relationships. Within the Mentor Training Core, we formed the Culturally Aware Mentoring (CAM) subgroup, an interdisciplinary group of individuals from varied racial and ethnic backgrounds. Our charge was to develop an advanced mentor training intervention designed to equip mentors with the skills and knowledge necessary to support a diversifying scientific workforce. We developed the CAM training content predicated upon the assumption that everyone is a cultural being and that theoretically-informed training can facilitate mentors’ cultural awareness and capacity to effectively respond to diversity matters in their research mentoring relationships.

The past two years of work have culminated in a six-hour intensive training and an introductory online module that is completed prior to the training. The training is designed to be an advanced workshop for mentors who have already completed some form of mentor training. Training participants are invited to look inward and examine their own racial and ethnic identity; this awareness-raising helps participants to identify their personal assumptions, biases, and privileges that may operate in their research mentoring relationships. Through a combination of activities including group discussion, case studies, and role play, mentors have the opportunity to learn and practice culturally aware mentoring skills. At the conclusion of the workshop, mentors are encouraged to think of one thing that they can do in their mentoring relationships to be more culturally aware and respond better to cultural diversity matters in those relationships.

The training has been pilot tested at four separate sites with 82 mentors and 30 facilitators from a range of disciplinary backgrounds and career stages. Data from our workshop evaluation survey suggest that mentors experience significant gains in several skill areas, including their perceived ability to intentionally create opportunities for their mentees to talk about their lived experiences as they relate to research. Specifically, mentors who participated in our workshops have reported significant perceived skill gains in several areas relating to culturally aware mentoring:

  • intentionally creating opportunities for mentees to bring up issues of race/ethnicity;
  • thinking about how the research experience might differ for mentees from different racial and ethnic groups;
  • knowing when it is appropriate to raise the topic of race or ethnicity in mentoring relationships; and
  • having strategies to address racial and ethnic diversity in mentoring relationships.

Perceived Skill Gains from CAM Participants

In open-ended responses, mentors noted that “This topic is important and worth the time it takes in meeting (e.g., building in time in meeting for discussion)” and that “This type of training is doable! (I doubted it before).” Such responses convey that mentors perceive this training as a step beyond the typical diversity training, with the potential to have a lasting impact on mentors’ perceptions and actions with respect to mentoring relationships. The CAM training shows promise as a strategy for reducing the negative stereotypes and narratives that can challenge the research experiences of historically underrepresented trainees.

The CAM subgroup is led by Angela Byars-Winston (University of Wisconsin-Madison) and includes Amanda Butz (University of Wisconsin-Madison), Rick McGee (Northwestern University), Sandra Quinn (University of Maryland College Park), Carrie Saetermoe (University of California Northridge), Stephen Thomas (University of Maryland College Park), Emily Utzerath (University of Wisconsin-Madison), and Veronica Womack (Northwestern University). Individuals interested in having the CAM workshop come to their institutions should contact the Mentor Training Core at

Comments: 0 | Reply

Wednesday February 15, 2017

North Carolina Alliance going strong, holding health professions diversity conference

By Peggy Valentine and Jacqueline Wynn, Co-Founders and Co-Directors of the North Carolina Alliance for Health Professions Diversity (NCAHPD)

NCAHPDEach of our State Alliances has been developed by leaders who understand the unique strengths and particular needs of their state’s citizens as well as the varied educational, business, governmental and local communities’ priorities. Yet, for the many differences in state and regional environments, we find there are many common interests and barriers experienced by our leaders. This month we highlight some of the activities of our North Carolina Alliance, NCAHPD. The enthusiasm, activities and continued expansion of this community of leaders is making a difference in our collective efforts to improve the diversity and equity within our nation’s health workforce. Thank You!

We are happy to report that the North Carolina Alliance is going strong. We hold quarterly meetings at member schools, which are preceded with a 2-hour continuing education session that informs us of the diversity work happening on that campus. During the past two years, we have visited Western Carolina, High Point, East Carolina, UNC Wilmington, UNC Greensboro East Carolina, and Duke University. Our shared commitment to a diverse health professions workforce is strong, emanating from the President/Chancellor level, Chief Academic Officers, Chief Diversity Officer, faculty and staff. On average, 25 to 30 alliance representatives attend our meetings where we have learned how each institution is creatively responding to the desire to increase diversity among their student body and faculty. In some cases, alliance members have offered advice on addressing problems encountered. In addition to quarterly meetings, the NC Alliance has maintained an up-to-date website which features state-wide Summer Enrichment Programs for High School and College students who are interested in pursuing a health career. If you are interested in a career in healthcare, please check out our site to plan your summer!

We are pleased to announce an exciting conference being planned by our active alliance members. The fourth biennial conference of the NC Alliance will be held on March 22-24, 2017 at the Grandover Hotel in Greensboro, NC. We hope you can join us! The theme of this year’s conference is “Closing the Gaps: Exploring Evidence-Based Practices to Enhance Health Professions Diversity.” This three-day event will showcase best practice models and strategies that have proven successful in recruiting and retaining students in health professional programs as well as maintaining a diverse workforce setting. The audience is expected to include faculty of state-wide higher education institutions, state-wide health officials, and representatives from various health organizations, as well as college students who desire to network and increase their knowledge on health professions diversity.

The first day of the conference is dedicated to a recruitment seminar for health professions students and advisers. Community-college students will attend and meet faculty of various university health programs to learn more about admission requirements. The following two days will include keynote presentations and panel discussions by leaders in higher education and the healthcare industry. There will be a competitive poster presentation session for students with prizes and opportunities for networking and collaborating with others around the state. All conference participants will receive a copy of the Journal of Best Practices in Health Professions Diversity: Research, Education and Policy. During the conference, we will be signing additional organizations to the alliance. We could potentially reach 25 members.

The work of the NC Alliance continues to be important. The racial/ethnic diversity of North Carolina’s health care professionals falls short of matching the state’s population diversity. According to 2014 report on Diversity in the Health Professions by researchers at the Sheps Center, white providers made up more than 80% of licensed health professionals in the state, yet they represented 64% of the population. The underrepresentation was worse for blacks who comprised 22% of the state’s population. Only in the LPN workforce is the group overrepresented. As the AAMC noted in 2015, fewer blacks enrolled in medical school that year than in 1978. It is concerning to note the slower growth especially among black physicians. While we celebrate the increase among African American female physicians, it is important to encourage the growth among males. There is also the opportunity to promote health professions diversity among the growing Hispanic groups which now comprises 9% of the population. Although relatively young, this population represents less than 3% of all health professionals in the state.

We appreciate this opportunity to highlight work of the North Carolina Alliance and invite interested parties to attend our quarterly meetings -- and the upcoming biennial conference. We hope to see you in March!

Diversity Overview of Population and Selected Health Professions, NC, 2014

Comments: 0 | Reply

Sunday January 15, 2017

Nurse Practitioners can transform primary care NOW

By Greer Glazer, PhD, RN, CNP, FAAN and Karen Bankston, PhD, RN, MSN, FACHE

A commitment to primary care has long been established as a way to begin to close the healthcare disparities in the United States; specifically to move from an illness model of care delivery to a framework that supports wellness. However, despite the legislative changes, such as the Affordable Care Act (ACA, 2010) and social movements across the nation promoting health and wellness, we continue to see gaps in quality and disparities in health outcomes that impact the individual and their families. Unfortunately we also continue to see challenges directly related to access. Despite the improvements to the system, there remains a lack of access of providers in certain regions of the country and to certain demographic populations. While there are an estimated 20 million more Americans gaining health insurance coverage under the ACA, it created a challenge to an already fragile primary care system, especially for vulnerable populations in already medically underserved communities (U.S. Department of Health and Human Services, 2016).

In its 2010 National Healthcare Disparities Report, the Agency for Healthcare Research and Quality (AHRQ) concluded that there was a need to increase the progress of achieving better quality of care and more equitable care for all.

Specifically, the report outlined the following:

  • Healthcare quality and access are suboptimal, especially for minority and low-income groups.
  • Quality is improving, access and disparities are not.
  • Urgent attention is warranted to ensure improvements in quality and progress in reducing disparities with respect to certain services, geographic areas, and populations
  • Disparities in preventive services and access to care
  • Progress is uneven with respect to eight national priority areas:
    • Two are improving in quality: 1) palliative and end-of-life care and 2) patient and family engagement
    • Three are lagging: 3) population health, 4) safety and 5) access
    • Three require more data to assess: 6) care coordination, 7) overuse and 8) health system infrastructure
    • All eight showed disparities related to race, ethnicity and socioeconomic status.

This report, among others, provides support that there is a need for graduates of healthcare professions to choose to serve people in underserved communities that have a shortage of primary care providers. Nurse Practitioners are one such provider that is prepared to meet those growing needs.

Nurse Practitioners Infographic

Nurse Practitioners (NP) are primary care providers with graduate (masters and doctoral) academic and clinical preparation to provide care to individuals and populations that includes health promotion, disease prevention, diagnosis of disease and management of chronic conditions. Drs. Loretta Ford and Henry Silver (interestingly enough a nurse and physician) developed the first NP program at the University of Colorado in 1965. The Massachusetts General Nurse Practitioner Program, also directed by a nurse and physician team began in 1968. Since that time, NP programs have increased to meet the demand for access to quality healthcare and currently there are approximately 350 NP programs in the U.S. For over 50 years, research has consistently shown that NPs provide high quality, cost effective primary, acute and long-term care.

Here are the facts:

National rural health snapshot

Statistics used with permission from “Eye on Health” by the Rural Wisconsin Health Cooperative, from an article entitled “Rural Health Can Lead the Way,” by former NRHA President, Tim Size: Executive Director of the Rural Wisconsin Health Cooperative

In the 2015 Assessing Progress on the IOM Report, The Future of Nursing, there is continued emphasis regarding the importance of ensuring that the nursing workforce be fully involved in the transformation that will ultimately shift the care delivery system. In fact, the promotion of the use of Advanced Practice Registered Nurses (APRNs) or Nurse Practitioners to the full extent of their education and training, along with collaborative practice models is foundational to the report. Despite the consistent and convincing evidence that leads to the logical conclusion to expand the use of NPs to improve access to high quality, cost effective primary care, one major impediment addressed in the IOM report, is the restriction of full practice for NPs in many states. Currently, only 19 states and the District of Columbia allow for full independent practice. The remaining states have reduced (19) or restricted (12) practice.

Nurse Practitioner State Practice Environment

In addition to the Institute of Medicine, other prestigious groups such as the Federal Trade Commission, VA System, Robert Wood Johnson Foundation, National Governors Association and American Association of Retired Persons have advocated for reduced barriers for NPs. In spite of this support the American Medical Association and American Academy of Family Physicians continue to oppose full independent practice for NPs citing concerns about safety and quality (which is unsupported by data).

The enrollment and graduation rates in NP programs has continued to increase with approximately 14,000 new NPs graduating in 2014 compared to 6,556 graduates in 2005-2006 (AANP, 2016). Conversely, 50% of medical students chose primary care in the 1990s, whereas only 20-25% choose primary care now (West and Dupras, 2012). This change in graduating medical students choosing primary care is believed to be attributed to a perceived unfavorable lifestyle with being a primary care physician (Haver et. al, 2008). However, today there are more than 205,000 NPs practicing in the U.S., 87% of whom are prepared in primary care.

To contribute to the needs outlined in the 2010 AHRQ report, NPs have increased access to care by treating those with Medicaid, Medicare and without any source of payment. Specifically, 85% of NPs treat people with Medicare, 84% treat people with Medicaid, and approximately 60% of Family Nurse Practitioners and Advanced Practice Nurses treat people without a source of payment (AANP, 2016).

NPs are more likely than other primary care disciplines to practice in underserved rural and urban communities. Both settings have similar healthcare disparities and barriers to healthcare. Periyakoil (2010) provides a national picture of urban and rural health that illustrates the need for a better distribution of primary care providers who can address barriers and reduce health disparities.

We believe that we must return to the roots of the NP movement which was started and supported by physicians and get beyond “long-simmering disputes over ‘turf’” (NIHCM, 2014) to allow NPs (and others like Physician Assistants) to practice to the full extent of their education and training all over the United States. No one disputes that there are not enough primary care physicians, an increased demand for primary care services and a projection for both situations to worsen. NPs are a viable, evidenced based solution to this current and impending crisis. Let’s all forget our professional self-interests and focus on the real goal: Every American deserves high quality, cost-effective healthcare by their provider of choice. Acceptance of the critical role of Nurse Practitioners in primary care’s time has come.

Nurse Practitioner State Practice Environment

Full Practice
State practice and licensure law provides for all nurse practitioners to evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments—including prescribing medications—under the exclusive licensure authority of the state board of nursing.
This is the model recommended by the Institute of Medicine and National Council of State Boards of Nursing.

Reduced Practice
State practice and licensure law reduces the ability of nurse practitioners to engage in at least one element of NP practice. State law requires a regulated collaborative agreement with an outside health discipline in order for the NP to provide patient care or limits the setting or scope of one or more elements of NP practice.

Restricted Practice
State practice and licensure law restricts the ability of a nurse practitioner to engage in at least one element of NP practice. State requires supervision, delegation, or team-management by an outside health discipline in order for the NP to provide patient care.

Source: State Nurse Practice Acts and Administrative Rules – © American Association of Nurse Practitioners

Greer Glazer is on the Board of Directors of The Sullivan Alliance. She is the Dean and Schmidlapp Professor of Nursing and Associate Vice President of Health Affairs for the College of Nursing at the University of Cincinnati.

Karen Bankston is Associate Dean of Clinical Practice, Partnership and Community Engagement for the College of Nursing at the University of Cincinnati.

Comments: 0 | Reply

Read past Leadership Blog posts