Dentists these days are graduating with ever increasing amounts of debt as a result of loans needed to graduate from dental school. This topic has been covered before on this site such as in the post Will Dental School Debt Lead to Future Counseling?. Such debt may take a heavy toll on dentists and the patients they serve.
One way debt from dental school can adversely impact a dentist is in his or her romantic relationships. This is touched on in the post Divorce and Dentistry: Repairing Broken Relationships. In this post one of the common contributors to divorce for dentists is their spouse not having clear expectations about work and finances. A new dentist may take many years of paying down debt before there is money left over for nice houses and fancy vacations. Perhaps if the spouse or future spouse of the dentist comes into the relationship not being aware of this, it may set the stage for a future divorce.
Another way debt from dental school can adversely impact a dentist is in his or her career choices. This has been further explored in an article by Nicholson et al. titled “The effect of education debt on dentists’ career decisions,” appearing the November 2015 edition of JADA (vol. 146, no. 11, pp. 800-807). In the article the authors state
Rising education debt and the accompanying pressure to repay it raises concerns that debt may affect important career decisions such as whether to seek advanced training within a profession, whether to select a high-paying position within a profession, what types of patients to serve, how much to work, and when to retire… the education debt balances among students graduating in 2011 from dental, medical, and law schools were $203,000, $162,000, and $125,000, respectively.
For physicians, previous studies have shown those coming from middle income families are less likely to pursue primary care. To better determine what is occurring in a dental setting, the authors attempted to contact 17,734 students who graduated from United States of America dental schools in 1996, 2001, 2006, and 2011. These specific years were chosen because of the authors knowledge about rising student indebtedness over time. The authors only were able to get responses from 1,842 of these dentists, or just 10.4%, because a valid phone number was unknown to them for a large number of them. The survey asked the dentists numerous questions including their total education debt on completion of dental school, the current balance on education debt, their annual income, the average number of hours worked weekly, sex, race, and parental income when they were completing dental school. The researchers examined five career choices including pursuing advanced or specialized training, entering private practice, accepting a position with a government organization, accepting a position with a public health organization, or accepting a position with a dental school.
The authors found that an average of $214,000 in education debt at the time of completing dental school was reported across all four graduation groups with an average of $164,000 for those who graduated in 1996, an average of $183,000 for those who graduated in 2001, an average of $223,000 for those who graduated in 2006, and an average of $254,000 for those who graduated in 2011, with all dollar amounts here converted to 2013 dollars (adjusted for inflation – CPI All Urban Consumers). At the time of the survey in February 2013, the authors found that an average of $185,000 in education debt remained across all four graduation groups with an average remaining of $82,000 for those who graduated in 1996, an average of $108,000 for those who graduated in 2001, an average of $164,000 for those who graduated in 2006, and an average of $248,000 for those who graduated in 2011, with all dollar amounts here converted to 2013 dollars (adjusted for inflation – CPI All Urban Consumers). For those who graduated in 1996, 65.4% were completely free of educational debt, for those who graduated in 2001, 33.6% were completely free of educational debt, and for those who graduated in 2006, 12.6% were completely free of educational debt. The authors found that those who graduated with a relatively large amount of education debt were more likely to enter private practice than to enter a government organization, public health organization, or dental school and these dentists were less likely to pursue specialized training. However, based on their regressions analysis the authors found no evidence that debt affected career decisions differently across those who graduated in the different time periods from 1996, 2001, 2006, and 2011. The authors predicted a 4.2% increase in the probability of entering private practice when there was a corresponding $60,000 increase in debt, predicted a 2% decrease in the probability of accepting a government position with a corresponding $60,000 increase in debt, and predicted 0.8% decrease in the probability of accepting a faculty position with a corresponding $60,000 increase in debt. The authors point out that those dental students with higher debts than on average may have been inclined to respond to their survey.
The authors state
“…dentists who graduated in 2011 devoted almost as much money annually to paying off the principal on their student loans as did dentists who graduated in 2001, but this amount is a much smaller portion of their total education debt burden. If recent graduates continue to pay off their loans at similar rates, we can anticipate that it will take them far longer than the current average of 17 years to pay off their loans.
The authors also presented results of career choices of dentists based on gender and race and felt that career choices of dentists is more dependent on gender and race than on debt levels. It is also noteworthy that the average hours worked per week for all four groups combined was 36.5 hours.
Based on the results from this study, it seems that while dental students may have a rigorous workload with many hours needed to graduated, once becoming dentists the actual number of hours worked per week is not more than other professions and appears to be actually less. This study reported the average number of hours worked per week by dentists to be 36.6 hours while another study exploring divorce among physicians and dentists reported the average number of hours worked per week by dentists to be 37.6 hours (see Divorce Among Dentists and Physicians: Is More Couples Therapy Needed?). Even so it is clear from this study that the debt burden on dentists is extremely high and even more so than on doctors and lawyers. The authors found that the debt burden motivates career choices which may have an underlying role due to wanting a better life for their family. Thus it would seem critical that in order to avoid future couples counseling, young dentists in romantic relationships engage their partners in meaningful conversations about their debt and realistic scenarios about when it can be paid off. This might entail even showing a spouse results of studies such as the one above by Nicholson et al. highlighting the dental debt facing dentists. This appears to be of particular importance for those dentists with a high debt load and who do not enter private practice as their primary occupation. By doing so dentists and their spouses will hopefully have clearer expectations and this will potentially even transfer to better patient care.