Is the leadership of the American Dental Association representative of its membership?

I seem to be hearing this question more frequently of late, especially by female ADA members and members-to-be. I don’t think they doubt the ability or willingness of the trustees to represent their constituencies’ interests. Rather, they wonder why the makeup (in this case, by sex) of this very visible body doesn’t seem to reflect what they see closer to home. After all, almost one-half of their classmates probably were women. Why is the ratio so much lower in the leadership ranks?

A fair question, and an important one if we mean to pay more than lip service to the ideal of diversity. Today’s entering dental school classes are roughly one-half female. By contrast, the voting members of the current ADA Board of Trustees are 90 percent male. This certainly looks like cause for concern.

But wait just a minute. What about the time factor? The membership isn’t static, and so we can’t make sense of the statistics without taking into account the passage of time. Today’s dental school graduates are 40 to 50 percent female, true, but the typical ADA Trustee didn’t graduate today. For the most part, they have been in practice for 20 or more years, during which time they have gradually become more widely known to their peers and taken on gradually more responsibility in ADA’s "tripartite" structure. Their graduating classes were more likely to have been 5 to 10 percent female, and entered a profession that was as little as 2 percent female. By this measure, the present 10 percent figure doesn’t look so bad, does it?

Professional leadership, like education, is dominated by a "pipeline" effect. Actions taken now go into the pipeline now, but their effects (for good or ill) will not be felt for years or decades. In times of crisis, it is sometimes possible to bypass this normal process of slow maturation, but the result is rarely satisfactory and never inexpensive. Better to keep the pipeline full and flowing freely.

At the risk of straining the metaphor to the breaking point, I want to emphasize how important it is to repair leaks in our leadership pipeline. Every year, a small percentage of ADA members leave the organization, or cease to play an active part in it, for reasons ranging from time pressures to disenchantment with some Association policy. And while we want to keep this attrition low, it’s ultimately a matter of personal choice. We must be alert, though, for any pattern suggesting that women are over-represented among those who opt out of the organization. Even small differences in the rate of attrition can translate into large disparities later on.

Getting a handle on a group’s relative representation is trickier than some would have us believe. Beyond any doubt, the greatest challenge is to make a fair apples-to-apples comparison. To what should we compare the target group—the general population? The entire profession? The same group at an earlier time? There’s no cut-and-dried way to choose the reference group, yet the choice often dominates the result. At best, these simple population ratios can give only a crude impression of general trends. They are silent as to underlying causes and cures.

If we want to be a truly inclusive institution, therefore, we need to get past the statistics and generalities and concentrate on individual people and particular cases. It is simply wrong to frustrate a colleague’s professional growth by prejudice, conscious or otherwise. We shouldn’t do it ourselves, and we should do whatever is in our power to stop others from doing it.

In reality, the ADA is today a more diverse and welcoming group than ever before. At its center, the Board of Trustees comprises two women and a fair cross-section of ethnic groups. If our leadership is not a precise reflection of society as a whole—how could it ever be?—it nevertheless represents dentistry today. As long as members continue to get involved and stay involved, there will be no basis even to think about underrepresentation.