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Tuesday
Jun032014

« Gender and Dentistry: A Conversation »

Editor’s note: We were merely lucky, or prescient? Last issue we covered race and dentistry, and weeks after the issue dropped, race and basketball became the number one topic of the nation, superceding even the mystery of Flight 370. 

Then, on May 14, the
Denver Post ran a piece stating that “An internal review at the University of Colorado School of Dental Medicine found a ‘generalized’ perception that the school climate is especially adverse to African-Americans. The perception, according to the report, may be so pervasive that it has affected the school’s reputation.” (http://www.denverpost.com/news/ci_25763028/cu-dental-school-report-admits-perception-its-adverse). 

Race equality, it would seem, still haunts us in the U.S. For this issue, we wanted to know what role, if any, gender plays in dentistry — factoring in school, practice, and professional social organizations in the state.

 

The Participants:

Dr. Jessica Bremerman
Bremerman graduated from the UWSoD, with a class comprised of 30 percent women and a good mix of minority students. She is the only member of her family to pursue higher education and was profiled in Issue 5. She says her class was diverse in every way – age, sex, ethnicity and educational background. Bremerman has worked in public health with the Indian Health Services for the past four years but is leaving IHS for private practice.

Dr. Jacqueline Bunce
Bunce began her professional career as an engineer at Boeing. Although she knew she wanted to be a dentist from an early age, her father discouraged her because of a bad experience he had as a medic in the Army. It was only when she was considering going back to school for a Masters in engineering that she decided to pursue dentistry. She attended the University of Washington, and later attended the University of North Carolina for orthodontics. Women comprised about 30 percent of her graduating class. She established her orthodontic specialty practice in 2001.

Dr. Beatrice Gandara
Like a number of the women we talked to for this article, Gandara was the first in her family to attend college. Gandara grew up in East Los Angeles and went to USC for both undergrad and dental school. There were 15 women in her class at dental school out of 125, and hers was the first big class of women – a landmark year. She graduated in 1978, completed a hospital dental residency with the Veterans Administration in La Jolla, Cal., then worked in a community clinic in LA County for two years. Following that she worked briefly in private practice, but she knew her heart was in academia. “I think I missed the broader aspects of dentistry that included more medical issues, so that’s why I went into oral medicine. I had done the residency, and I was in tuned into pathology and medicine, and I really enjoyed it.” In 1987, Dr. Gandara joined the faculty of the University of Washington Department of Oral Medicine. In 1990 she became a Diplomate in the American Board of Oral Medicine, and in 1992-93, participated in a research fellowship at the Fred Hutchinson Cancer Research Center in Seattle. She is currently appointed as Clinical Associate Professor in the Department of Oral Medicine.

Dr. Susan Hollinsworth
Hollinsworth attended Eastern Washington for her undergraduate studies, then graduated from the UWSoD in 1978, the first year that there were a large number of women in the class – 18 out of 92. There were four women the prior year, two the year before that, and then Doris Stiefel back in the 50s. Hollinsworth is a general dentist with a family practice in Kent that she opened from scratch when she graduated. Hollinsworth is no stranger to posts in organized dentistry, having served at both the state and local level — including the WSDA Board of Directors and as President of he Seattle-King County Dental Society, President of the SKCDS Foundation Board, and President of the Dean’s Club for the UWSoD. 

Dr. Regina Lam
Lam grew up in Honolulu, and is an associate in a multi-dentist general practice. Out of dental school for two years, Lam is currently floating in between two offices – one in Factoria, the other in Covington. Her graduating class at the UWSoD was nearly 50 percent women. Lam currently serves on the Committee on PNDC. 

Dr. Miki Suetsugu
Suetsugu is the first in her family to go to a four-year college — she graduated from Tufts 10 years ago, where her graduating class was nearly 50 percent women. Suetsugu works part time in her husband’s private practice, and fills in with temp and locum tenens work in order to take care of the couple’s 7-year-old daughter. She is currently participating in the Leadership Institute with the WSDA, is a member of the SKCDS’s Ambassador’s Committee, and serves on the Peer Review Committee. Suetsugu is also a core member of a new SKCDS Committee – the Women’s Dental Group. Her practice is in Bellevue.  

Dr. Ashley Ulmer
Ulmer went to Eastern Washington University, and later to the UWSoD, graduating in 2003. Her class was nearly 50 percent women. She owns her own practice in Spokane, and also serves as the Dental Director for the Spokane District Dental Society’s IDEA clinic, a non-profit dental clinic managed by SDDS, the Yakima Valley Farmworkers Clinic and Riverstone Family Health. Additionally, Ulmer sits on the Board of the WSDA. 

Dr. Kimberly Winton
Winton grew up in Jefferson City, Missouri. She did her undergraduate studies at Truman State University in Missouri, and went to dental school at University of Missouri in Kansas City, Mo. Her graduating class was 48 women and 52 men, and she notes that, “By this time women had been consistently half of the graduating classes for a while, so I didn’t feel like a groundbreaker.” Winton moved to Seattle to complete a GPR residency at the UWSoD, and decided to make the Puget Sound Her home. She splits her practice time between a community health clinic and a private practice, saying, “I was motivated for a career in public health, I do find it very rewarding, but it’s also nice to maintain perspective in a private practice setting. I work in a family dental setting where I get to see a wider variety of ages and needs, so I do find it incredibly rewarding to have my feet in both worlds in the same time.”

In the last WSDA News, we conducted a conversation about race with a number of WSDA member dentists, asking them about their experiences in dental school, the workplace and among colleagues, and the results were surprising. We found that, while greatly diminished, racism still exists even among dental professionals. We wondered: Is gender bias still an issue? After all, other than a very few pioneers along the way, women didn’t enter the dental workforce in significant numbers until the mid-1980s. Today, dental schools like the UWSoD matriculate nearly as many women as men. In 2011, nearly 41 percent of newly-licensed dentists in Washington were women. Recent polls on women in the workplace seem contradictory — a Gallup poll taken in April of 2013 noted that only 15 percent of women feel they were passed over for a promotion or raise because they are women1, while a Wall Street Journal poll conducted at the same time concluded that most women see bias in the workplace.2 

So which is it? And where do writings like the recent CNN op-ed about the firing of New York Times executive editor Jill Abramson fit into the equation? In it, author Frida Ghitis opined, “Any woman who has spent time in the workforce is familiar with the challenges of being judged and treated fairly by her peers and bosses, of obtaining the recognition she deserves, and of being an effective advocate for one’s own career. Women battle to break through the glass ceiling. After that, what comes is walking on broken glass.”3 

The women dentists we talked to largely rejected the notion of gender bias in dental school, in the workplace, or among peers. However, when pressed, nearly every woman we talked to for this article had an anecdote to share about a situation where gender played a frustrating role in the way they were perceived or treated — but all of the participants dismissed it as trivial. 

However, if we narrow our focus to leadership positions at the state and national level, you might be more inclined to admit that such a ceiling does exist — since 2000, there have been just eight women on the WSDA Board (two became president), and there is currently one woman on the WSDA Board. The ADA has had only three women presidents in its 155 year history, and only one female CEO. The question is, are women made to feel not welcome, or has something else caused the vacuum? That’s hard to know and the subject of a different story. For this piece, we wanted to focus on the individual experiences of our members in dental school, their practices, and among their peers.

How have things changed
Drs. Hollinsworth, Gandara and Bunce are the three most senior dentists we talked to —  Hollinsworth and Gandara graduated in the first class with a large number of women at UW and USC, respectively. Bunce graduated from the UWSoD in 1995, and by that time one third of her graduating class was women.  We were curious to know what they’d witnessed in the way of change over their decades in dentistry. Turns out, not too much, other than the cultural shift away from thinking of dentistry as a man’s dominion. Hollinsworth says, “Other than the sheer numbers of women entering the field, not a lot has changed. It’s not as much of a surprise to people that women are dentists. I know that when I first opened, my sign only had my first initial on it and I had a patient who came in who was not aware that I was a woman. I talked with him personally, and let him know that if it was an issue he was more than welcome to find another dentist, but he stayed.  I only had one patient who left, and it was because of his wife — she was not a patient, but she felt that her husband was having too much fun at the dentist’s office!”

Gandara noted that when she was in dental school, faculty often wondered about the true motives of female dental students, saying, “I do remember one faculty member remarking that we were there to look for a husband, not become dentists, because some of the hygiene students did marry dentists. He said that we were just going to get married, have babies, and not work.” Bunce recalls seeing a front page article in the Seattle Times around the time she was beginning her dental studies at the UW of a survey of the public that indicated that most people would rather see a male dentist, not a female dentist.  “Times change,” she says, “And I suspect that is no longer the case.”

The most talented assistant ever
So while people may be just as comfortable with a woman dentist, is gender bias a thing of the past? From what these women told us, mostly. And yet, nearly all had stories to tell about how, along the way, just being a woman was an issue. When Dr. Jacqueline Bunce tells her story, it’s with a huge laugh – clearly, it amuses her as much today as it did at the time. She relates, “When I worked at Harborview Medical Center as a dentist, I sometimes worked with a male dental assistant. Sure enough, most of the time, patients would initially assume that I was a dental assistant, and the male was the dentist — even though the patients were clearly told that the reverse was true. One hospital patient, after I had surgically extracted some of his teeth, removed bone, sutured the incision, and given him a prescription for narcotic pain relievers, exclaimed that I was the ‘most talented assistant’ he had ever seen!”  Bunce says it still happens today, noting that if she’s at a social gathering and meeting people for the first time, people will still ask her if she’s an assistant or dental hygienist, even after she’s told them she’s an orthodontist.

Hollinsworth dismisses the notion of real bias, noting that she’s always been a positive person who looks for the best in every situation. There was only one case of bias she could remember, and it was early on when she and her husband were pursuing financing so that she could set up her practice. She says, “They talked with us for a few minutes and then the loan officer said, “I would think that a woman in dentistry would be a negative.” We picked up our paperwork and went to another branch where the guy was great.”

But even more recent graduate dentists aren’t immune to slights based upon gender —Dr. Winton recalls a patient in dental school who she had been working with for a while. “She needed an extraction,” Winton explains, “And for that one procedure she requested a male dentist. She explained that she’d had a bad experience in the past, and she thought that it might have been because her female dentist did not have enough upper body strength to extract the tooth.  And while it didn’t feel good to hear that, my faculty was very supportive of me, knew and trusted my abilities, and gave her the option of having her tooth extracted by me, or seeking care elsewhere. The extraction went fine and the patient later apologized. I don’t think that the experience changed my perspective, but I hope that it changed hers.”

Dr. Bremerman from Yakima hasn’t felt a professional snub, but noted that personal remarks could sting just as easily  “I was at a Christmas party for my dental society, and one of the older dentist’s wife made a comment to me that I needed to slow down – that I should be with my family. I have a four-year-old, a two-year-old, and another on the way, and she told me that I had too much on my plate, and that I wasn’t making my family my priority. It hurt my heart a little bit, because if I had been a male that never would have been said.  I’ve had such great support from my mother-in-law and my husband, so I’ve never felt the guilt that some women do.” 

Impact of having a family on women in dentistry
But what of the old concern that women wouldn’t practice as long, or for as many hours, as their male counterparts? The practice model itself may be antiquated. Women will likely practice as long as their male counterparts — well into their 60s and early 70s, and may “stop out” or slow down their practice to accommodate families, but what of it? Suetsugu and her husband, who is also a dentist, have made it work for them. She says, “Women are already impacting the way dentistry is being practiced. We have the option to work part time, or have flexible working schedules, and I think it’s for the better for families – I have been able to have a family and have a career.” And while she would eventually like to have her own practice someday, splitting her time between a number of different practices works very well for her. For one, she’s able to select when and where she would like to work, but more importantly, she’s completely present in the rearing of the couple’s 7-year-old daughter. She relates, “I have a lot of female friends who are moms and own their practices who have support from in-laws or have hired nannies to help with child rearing, but I want to be more hands-on in raising my child. Once my daughter goes to high school, I would like to own my practice.”

Like Suetsugu, Gandara elected to work part time when she and her husband had children, with a significant impact on her career —one that she’s completely comfortable with. “It’s very difficult to build a strong academic career when you’re only working part time. I enjoy what I’m doing ­— I think if I had just hired a nanny and tried to get grants and do the whole academic thing, I could have done it.  I had several female colleagues who progressed that way. Some left, because it was a little to hard to balance both. In academia you have a track that you’re going through, so it’s a little bit harder later to be at the top of advancement if you haven’t been working on it all along. Time has a different weight in academia.”

Bremerman and her husband were determined to plan their pregnancies around her work and school breaks, and did so, with near military precision. “Having a family has definitely impacted career decisions – it’s one of the main reasons I’m leaving IHS.  I have dealt with crazy things in life, and I can handle all of that.  The part that is tough is going home and being part of the family – making my husband and kids a priority. There have been times when it has been a struggle for my husband to remain optimistic for me, so leaving IHS is a great example of putting my family first.” Bremerman doesn’t feel she’s unique in her planning abilities and says she marvels at what single mothers working two jobs can do. “I have it very easy,” she says, “I think there will be a shift – dentistry in general is changing. It’s no longer the solo practice with one dentist working, it’s moving more towards a group practice model which will include shared positions and adequate maternity leave.  I just talked with a dentist in Ellensberg with three kids who commutes a kid to a school in Yakima every day. Women have a knack for figuring stuff like that out. I don’t feel that it will ever have a negative impact on dentistry. There are a few women dentists here in Yakima and they work full time and have families – one has a husband who is a stay-at-home dad. The stigma behind that is going away.” 

Winton agrees, and says it’s the model that needs to be thrown out — “Honestly, it’s outdated. Having a family is a choice and a conscious decision shared by two people, and it’s a question just as relevant to men in dentistry as it is to women. Yes, women carry a baby for nine months and may take three months of maternity leave, but the burden of raising a child is a joint venture. A career in dentistry gives women the chance to support themselves financially, but also the freedom to choose a lifestyle as well. She can decide to have a family, and the role she fulfills in that family will likely be different than it was 50 years ago, but it creates an equal playing field for women at home as well as in the practice. A woman in dentistry might make more than her partner, and it could be the man who devotes more time to childcare, we’re seeing more of that. Or maybe the man and woman share the burden equally. You know, feminism is giving men and women equal opportunity, and that is applicable both at work and at home – be it changing or shifting.”

Others — like Lam and Ulmer — who have yet to start families, see the impact of families on women dentists from a different perspective – from the outside looking in, and see only options for women dentists and their families. Lam says, “I know colleagues who rely on their families, those who have hired outside help, and those who have coordinated really well with their spouses to manage their children’s care. I think people will find a way to make it work if they want to start a family. Husbands are playing a more active role in parenting, too.” Ulmer says that in Spokane, where she practices, many women step out of practice completely once they have children. Even in the tight economy, she doesn’t see women working a full schedule on their own – they mostly share time and space. “The new graduates I’ve seen just don’t seem to be working as much,” she shares, “I was shocked when I first bought my practice that I was only working four days a week, but in truth, my practice wasn’t built for more – I didn’t have the patient demand. So we stayed small which left me time to manage the IDEA clinic.”

Women in the field: opening the door to corporate practices?
It’s been speculated that the growing number of women dentists in the marketplace could make corporate practices more appealing to women who want to start a family by offering flexible schedules and less hassles. Possibly, but it doesn’t always work out as planned. Just ask Suetsugu, who worked at a large, multi-office practice when she became pregnant. Her position was filled with a male doctor when she took maternity leave. By law, her position had to be held for her until her return from leave — and it was — but Suetsugu was offered a part-time position in a practice much further from home, making it impractical. Was this a case of gender bias or coincidence? It’s hard to say, but in truth, practices with flexible working hours could just as easily benefit male dentists looking to share childcare responsibilities with their wives. Winton suggests a paradigm shift might be the better starting point, saying “Dentistry allows for incredible flexibility when it comes to raising a family, I just feel it is somewhat dangerous to place that burden entirely on a woman, or to assume that a woman in dentistry is also a family woman – there are multiple lifestyle choices that a woman can make and having a family is just one of them.” 

With so many models at play in the marketplace, the options are endless. Lam, for instance works with a mix of younger and older dentists in a multi-dentist/multi-office practice owned by a single doctor. She explains, “We run the type of practice where people don’t necessarily request the same dentist each time.” She continues, saying “This practice model is really working for me right now. The first couple of years out, it’s important to get a lot of experience in. I feel like it’s nice to have a steady patient base. In the setting I’m in right now, no one really fights for patients because we all have enough to go around.  In some smaller practices, the owner doctor gets to cherry pick the cases and patients she wants to see, leaving less for young associates. That’s not the case here — I get to do anything I want to do.  At the end of the day, of course, most people want to be in an owner position. I think it’s a good first job to get experience and build up confidence and speed. It makes for a well-rounded experience. I think this model could work very well for dentists planning to have a family – I have a friend who worked in a similarly-modeled practice, and when she got pregnant, it was easy for her to move and float and cut back on her hours. It’s definitely a consideration when it comes to working in a family. It can really affect a practice when a doctor has to be gone for three months.” 

Hollinsworth concurs, noting that the economics of corporate practices are what is going to drive that conversation, not gender, and that may force more young dentists to consider corporate practices or similar models that benefit from the economy of scale. “Between school loans and reduced insurance payments,” she says, “Many may be forced to consider a different practice model, just as some have chosen to go into military service. I think there are all kinds of options available to couples who want to raise a family and manage practices. I knew a husband and wife who graduated after I did who managed it by having her work part time while he worked full time when the children were little, and then when they were older she worked full time while he worked part time. It was a perfect set up that worked well for them.”

For her part, Bunce found the private practice model most flexible when her late husband was diagnosed with Lou Gherig’s disease. “Owning your own practice is as family friendly as you can possibly get — you set your own hours and have direct control over your work environment.  I know that owning my own practice was ideal for my own family situation.  My mother and I often comment to each other that my husband would not have been able to live the full life that he lived if I had not had my own dental practice.  My husband went to work with me each day, and my mother sat next to him, in a side office.”

Balancing practice, families and leadership
The women we talked to for this piece are no strangers to leadership positions. In addition to those outlined in the brief opening profiles, Bremerman is VP of the Yakima Valley Dental Society, while Bunce currently serves as the President for the Washington State Society of Orthodontists, and the Washington State Director for the Pacific Coast Society of Orthodontists. Like families, hobbies, and other outside interests, participating in leadership roles means performing a juggling act, but these women have found it’s entirely possible as long as it is a priority. At this point in her career, Hollinsworth is not looking for new ways to give back, saying, “Dentistry is changing. It is younger dentist’s turn in the sun, and they should be at the forefront of helping set the policies that they’re going to be affected by… and yet, so many young people don’t have the time to participate – they’re busy building their practices, just as I was.”

Most pressing issues
When asked whether gender affects practice choices, the respondents said that debt was a more influential factor than gender. As a faculty member at the UWSoD, Gandara understands student debt all too well — she knows that many other issues exist, too — specifically outreach to our communities, which today is a key part of her work with students. “When I started out in dentistry way back at USC,” she elaborates, “I was always involved in outreach and community service, and I loved it, but I never thought I was going into dentistry to do that.”

Now, 30 years later, she’s working with students out in the community and finds it as fulfilling as ever. “Obviously we have to teach the hand skills and the diagnostic skills, but also the altruistic part – that people lack access to care, and that we need to go out and work in diverse communities which include those who may not have insurance and figure out how to help with oral health.”  Gandara continues, “For example, we have a program in its second year working with homeless shelters. We go out, conduct screenings and work with Medical Teams International, the Union Gospel Mission, and sometimes set up directly in the shelters. Faculty members volunteer time to oversee students delivering care to populations who have high rates of dental problems but don’t have access to care. We’re building community relationships with our community partners – each one is unique.”

Ulmer added, “In the business of dentistry, everyone has the same issues across the board. There are a lot of challenges. We’re going through an identity crisis right now, and the question is what is a dental professional? Is it the sole practitioner, the corporate practice, the multi-partner practice? What does it mean to be a dentist? Is it becoming more of a commodity? Are we really just hiring a 1.2 FTE dentist? Ulmer says the shift is towards an efficiency model that may force women to be tenacious, more aggressive, assertive, and business minded — what could be seen as “traditionally male” characteristics. But in today’s society, even that label may no longer apply. And while Hollinsworth agrees that the issues facing dentists largely cross gender barriers, one does not — at least for her. “The only thing I have found that I think is different for women,” she explains, “And I have had discussions with male counterparts about this issue — is dealing with staff. You don’t have that obvious distinction – staff members look at us to be more empathetic because we’re women and have families/kids. They tend to want to be friends more than they want to have a boss/employee relationship.”

Hollinsworth laughs and continues, saying, “It’s something I haven’t personally managed well. I’ve had a lot of turnover. My male characteristics definitely come out when I’m practicing, I’m 100 percent focused on my patients, so I don’t do the best job of being empathetic and understanding to my staff. I was raised that you leave your personal life at home, and I’ve tried to vary my practice style to accommodate my staff. I tend to be a very collaborative type person, wanting to work as a team, but I’ve realized that team members don’t have the same ownership as dentists do.”  For Bremerman as well, there’s another challenge: being a leader. “I read Sheryl Sandberg’s book Lean In,” she says, “and it really hit a chord with me. There are more women graduating from college than men now, and the numbers are growing in dental school as well. I think that women have to step up and take a bigger role in leadership. I think that women can be their own worst critics, and we need to elevate each other, rather than compete with each other”

In conclusion
We’re hopeful that women in the state of Washington will thrive in a progressive state setting that’s fluid and changing along with the needs of doctors and patients alike. And while we may have a glass ceiling or two to eradicate when it comes to women in leadership positions at the state and national levels, it may well be that in the day to day practice of dentistry, the glass ceiling has never really existed for women.
 
1.http://www.gallup.com/poll/164024/women-feel-unfairly-denied-promotion.aspx
2. http://online.wsj.com/news/articles/SB10001424127887324695104578417020376740796
3. http://www.cnn.com/2014/05/15/opinion/ghitis-jill-abramson-firing/index.html

 

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