We owe, we owe so off to work we go

THE BIG PICTURE Debt We owe, we owe so off to work we go Background.—Every month new dental school graduates face the dilemma of how to make a living and pay their bills given their mountain of student debt obligations. In 2010 the American Dental Education Association (ADEA) reported that over 90% of all graduating seniors needed a loan to complete their education. Over 44% of those in private schools had accrued more than $200,000 in debt, and over 20% of public dental school graduates owed $250,000 or more. Even though the cost of dental education is rising, the number of dental school applicants also rises each year. What can be done to improve this situation? Education.—The American Dental Association (ADA) has sponsored the Smart-Start SUCCESS program, which presents seminars in California dental schools. Among the topics covered in seminars on debt are the financial principles of student loans, the ramifications of compounded interest, how to calculate a realistic amount to borrow, how to consolidate student loans, the use of graduated repayment programs, and service-connected repayment programs. Managing the Debt.—Debt management tips are offered by dentists, dental school administrators, and current dental students on studentdoctor.net. Other options include moving to a practice location where there is less competition and taking advantage of programs that provide grants to new dentists in exchange for serving in an underserved area. Adverse Effects of Debt.—Most of the foundation grants that are available can help just one dentist a year. In addition, larger debt is correlated with delayed practice

ownership. As educational debt increases, the duration from graduation to the onset of starting or acquiring a practice also increases. It is now more difficult to have a 5-day-aweek job during the first 5 years after graduation. Marriage and children are also being delayed because of debt obligations. Debt pressure can influence practice decisions, which means that ethical concerns enter the picture. It is possible that debt may cause the dental profession to encroach on boundaries that should not be breached.

Clinical Significance.—The root cause of debt in dental education is being widely studied, but we must all admit that the marketplace has changed. New dentists are struggling to make a living, and we currently have no sustainable solutions. Those who have been in practice for some time need to see how debt affects the entire profession and seek solutions that will help all dentists manage the debt problem and avoid negative outcomes.

Sahota RK: Dental school debt: Swimming to the surface or drowning. J Calif Dent Assoc 40:101, 104, 2012 Reprints not available

Dental Delivery Systems Solo versus corporate practice models Background.—Increased debt for dental school graduates, changes in reimbursement models, competition, and direct marketing demands are several of the influences that are changing dentistry (Table 1). The impact of new

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Dental Abstracts

expensive technologies is also placing burdens on the solo practice model that has been the standard for modern dental practices. Having a single dentist practicing in a facility not shared with other general practitioners (GPs) allows