J Dent Educ. 71(9): 1228-1253 2007
© 2007 American Dental Education Association
Annual ADEA Survey of Dental School Seniors, 2006 Graduating Class
Jacqueline E. Chmar, M.P.H.;
Amy H. Harlow, B.S.;
Richard G. Weaver, D.D.S.;
Richard W. Valachovic, D.M.D., M.P.H.
Key words: senior survey, students, graduates
Each year the American Dental Education Association (ADEA) conducts a survey of graduating dental school seniors. The survey seeks information regarding the reasons students pursued a career in dentistry, how students financed their dental education, students’ educational debt and percent levels of debt, their practice and postdoctoral educational plans following graduation, and their opinions of the time spent on instruction in various areas.
ADEA distributes the survey instrument and response sheet to each dental school. Each dental school then uses its own distribution and collection system to obtain responses from their seniors. Once completed, the surveys are returned to ADEA for analysis. In 2006, the overall response rate to the survey was 84 percent. The gender and race/ethnic distribution of the respondents is displayed in Table 1
. The results of the 2006 survey, including historical trends where appropriate, are contained in this report.
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Parental Education and Income
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Dental students generally come from families in which the parents’ average education and income are greater than the U.S. population as a whole. In 2006, the fathers of nearly 83 percent of dental students and the mothers of over 76 percent of dental students were educated beyond high school (Table 2). Nearly half (47 percent) of students’ fathers and more than one in four (26 percent) students’ mothers had at least some graduate education. This compares to the just under 54 percent of the U.S. population at large with education beyond high school and just under 10 percent with a graduate degree.1
Almost three-quarters of graduates in 2006 were from families with a combined parental income of more than $50,000 (Table 3). Over 44 percent were from a family with a combined parental income of over $100,000, and nearly one in five graduates were from a family with an income of over $200,000. As in prior years, in 2006 the percentage of graduates from families with higher incomes rose slightly.
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Students’ Financial Independence and Marital Status
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In 2006, two-thirds of graduates reported financial independence from their parents (Table 4). The percentage of financially independent seniors has been between 62 and 66 percent since 1995. During the 1980s and early 1990s, the percentage fluctuated between 52 and 59 percent.
Approximately 44 percent of seniors in 2006 were married (Table 5). The percentage has fluctuated between 41 and 44 percent since 2000. The greatest percentage of seniors reporting that they were married was over 57 percent in 1978. During the 1990s, the percentage rose from 35 to over 40 percent. Over 45 percent of married seniors had at least one child. Twenty-five percent had two children, and 8 percent reported at least three children. About 3 percent of seniors were single parents with at least one child.
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Choice of Dentistry as a Career
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Two-thirds of dental school seniors did not decide to pursue a career in dentistry until after entering college (Table 6). More than two in five seniors (41.5 percent) did not make the decision to pursue dentistry until they had begun at least their third year of college, with over 16 percent making the decision after graduation from college. Twenty-one percent of dental school seniors decided to pursue dentistry during high school, and 12 percent made the decision before entering high school.
Dental school seniors were asked to consider the relative importance of a variety of factors in their decision to pursue a career in dentistry. A five-point Likert scale ranging from "Low" to "High" was used to rate each factor. The "High" and "Somewhat High" responses were combined in order to compare the importance of factors as shown in Table 7. The most influential factors were "Control of Time for Work" (88 percent), "Service to Others" (84 percent), and "Opportunities for Self-Employment" (82 percent). These three factors have historically been ranked as the most important factors, though the order of "Service to Others" and "Opportunities for Self-Employment" at times changes.
Seniors rated "Income Potential" (80.8 percent) the next most influential factor in the decision to enter dentistry, followed by "Enjoy Working with Hands" (74.9 percent), "Variety of Career Options in Dentistry" (60.2 percent), and "Status and Prestige" (54.4 percent). These percentages are quite similar to previous years. As in the past, the factors reported as least important were "Opportunity to Serve Vulnerable and Low-Income Populations" (50.5 percent) and "Service to Own Race or Ethnic Group" (27.9 percent).
When responses to importance of "Service to Own Race or Ethnic Group" and "Opportunity to Serve Vulnerable and Low-Income Populations" in the decision to pursue dentistry were assessed by race/ethnicity, differences became evident (Table 8). More than three-fourths of black/African American seniors reported service to one’s own race/ethnic group as a factor with "Somewhat High" or "High" importance in their decision to pursue dentistry. Students from other minority race/ethnicity groups were also likely to report service to own race/ethnic group as somewhat highly or highly important in choosing dentistry as a career, including 59.1 percent of Hispanic/Latino, 48.5 percent of Native American, and 40.7 percent of Asian/Pacific Islander students. White students were the least likely to report service to own race/ethnicity as a somewhat highly or highly important factor in their decision (15.8 percent).
The reported importance of care to the under-served also showed differences by race/ethnicity. Of black/African American respondents, 75 percent reported care to the underserved as of "Somewhat High" or "High" importance. The next highest percentage of respondents reporting "Somewhat High" or "High" importance were Hispanic/Latino respondents (68.6 percent), followed by 63.9 percent of Asian/Pacific Islander and 63.7 percent of Native American respondents. Slightly fewer than 42 percent of white respondents reported service to vulnerable and low-income populations as of "Somewhat High" or "High" importance in their decision to pursue dentistry as a career.
Seniors were asked to rate the influence of ten factors on their decision to pursue a career in dentistry on a five-point Likert scale ranging from "Low" to "High" (Table 9). In order to rank the overall influence of the factors, the percentages of respondents reporting "Somewhat High" or "High" importance were combined. Based on this scale, "A Family Member, Relative, or Friend Who Is a Dentist" (49.9 percent) and "My Family Dentist" (46.9 percent) were the most influential factors. These percentages indicate that current dental professionals can be influential by encouraging students to consider careers in dentistry. "Awareness of Workforce Supply and Demand Trends in Dentistry" and "A Family Member, Relative, or Friend Who Is Not a Dentist" were the next most influential factors, with 38.3 percent and 33.5 percent of students considering them of "Somewhat High" or "High" importance, respectively. These factors were ranked similarly in previous years.
Consistent with past years, the remaining six factors—"Participation in a Pre- or Post Baccalaureate Dental Career" development program (18 percent), "Visit to a Dental School" (17.2 percent), "Recruitment by a School" (9.4 percent), "Career Day" (9.1 percent), "High School or College Counselor" (8.3 percent), and "Brochures on Careers in Dentistry" (6.7 percent)—are each reported by a substantially lower percentage of students as having a "Somewhat High" or "High" importance in influencing their decision to pursue a career in dentistry.
It is important to consider that the reported influence of each of these ten factors represents a combination of both the influence of the factor when a student has exposure to it and the percentage of students not exposed to the particular factor. These two components that contribute to the rating of each factor cannot be separated. For example, many students do not participate in a pre- or post-baccalaureate dental career development or school admissions program or a specific recruitment program, but the students who do participate in these programs may be greatly influenced by them.
The reported influence of the ten factors was also evaluated by race/ethnicity of the students. The proportion of students rating the influence of factors as "Somewhat High" or "High" varied by race/ethnicity for many factors. The most substantial differences were in "Participation in Pre- or Post-Baccalaureate Dental Career Development or School Admissions Program" (23.9 percent of minority students; 14.4 percent of white students), "A Family Member, Relative, or Friend Who Is a Dentist" (43.8 percent of minority students; 53.5 percent of white students), and "My Family Dentist" (41.6 percent of minority students; 50.2 percent of white students). Visits to dental schools, recruitment by a dental school, career days, college counselors, and brochures on careers in dentistry were all factors reported by a larger percentage of minority students than white students as having a "Somewhat High" or "High" influence on their choice of dentistry as a career. The influence of awareness of workforce supply and demand trends and the influence of a family member or friend who is not a dentist were reported similarly among all race/ethnicity groups.
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Educational Debt
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Dental school graduates in 2006 reported an average of $23,365 in educational debt at the time that they entered dental school (Table 10). The average reported educational debt upon graduation from dental school was $145,465. The average debt upon graduation was lower at public dental schools ($124,700) than at private and private state-related dental schools ($174,241).
Between 2005 and 2006, educational debt at graduation increased 12 percent, with the debt of graduates from public schools increasing 19 percent and at private schools increasing 8 percent in one year. This compares to a 5 percent increase at public schools and a 4 percent increase at private schools between 2004 and 2005. Figure 1 displays the average graduating debt since 1990 by type of dental school.
Entering Educational Debt
Around 55 percent of 2006 dental school seniors reported entering dental school without educational debt. This is similar to the 56 percent who reported no entering debt in 2005 and 54 percent in 2004. In 2002, nearly 62 percent of dental school seniors reported no educational debt at the time that they entered dental school.
Among the 2006 graduates with entering debt, the average entering debt was $52,370 and the median was $20,000 (Table 11). Over the past decade, both the percentage of students entering dental school with educational debt and the mean and median debt upon entry into dental school have increased. In 1996, the mean educational debt of students with entering debt was $14,650, less than one third of the average in 2006. The median entering debt doubled between 1999 and 2006. The difference in the mean and median debt reflects that while the majority of students entered dental school with relatively low educational debt, some students entered with substantially more debt.
Educational Debt Upon Graduation
In 2006, for the first time, over half (53.5 percent) of dental school graduates reported at least $150,000 in educational debt (Table 12). This is an increase of over 9 percentage points since 2005 and 16 percentage points since 2004. Approximately 16 percent of seniors reported less than $50,000 in educational debt in 2005, and 10 percent reported no educational debt.
Higher tuition and fees at private and private state-related schools lead to substantially greater educational debt relative to the debt reported by students attending public dental schools (Table 13; Figure 2). Nearly four out of five (79 percent) seniors at private and private-state related schools reported at least $100,000 in educational debt in 2006, with nearly 69 percent reporting at least $150,000. Almost 72 percent of seniors at public dental schools reported at least $100,000 in educational debt at graduation, including 41 percent who reported at least $150,000.
The average educational debt of 2006 graduates with debt was $162,155, nearly 15 percent greater than reported by 2005 graduates (Table 14). Since 1996, educational debt of dental school graduates with debt has increased 92 percent from $84,247.
At public schools the average reported debt of indebted students was $137,792, nearly a 21 percent one-year increase. At private and private state-related schools, indebted students reported an average of $196,636 in educational debt, an increase of 12 percent. Educational debt continues to increase at a faster rate at public schools than at private and private state-related dental schools. Since 1996, the average debt of indebted students has increased over 108 percent at public schools and 69 percent at private and private state-related schools.
The ADEA senior survey included several questions that related students’ attitudes towards the amount of educational debt that they acquired. Senior dental students were asked to report whether their educational debt at graduation would be more or less than they had anticipated. Using a five-point Likert scale (1=Much Less; 5=Much More), nearly 50 percent of seniors reported "More" or "Much More" debt than anticipated, with over 15 percent reporting "Much More." An additional 41 percent of seniors reported debt equivalent to the amount they anticipated. The remaining 9 percent reported "Less" or "Much Less" debt than what they had anticipated when beginning dental school.
When asked whether they considered their educational debt to be a financial burden, over 50 percent reported that they considered it "Much" or "Very Much" a burden (Likert scale: 1=No; 5=Very Much), with 28 percent considering it "Very Much" a burden. A total of 16 percent reported that it was not a burden or only a "Very Little" burden. The remaining 34 percent of 2006 graduates reported that it was "Somewhat" of a financial burden. These percentages are similar to those reported in previous years.
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Educational Debt by Race/Ethnicity
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Table 15 and Figure 3 display the level of reported educational debt by race/ethnic background. With the exception of Native Americans, the percentage of students with $100,000 or more of debt was similar among the race/ethnicity groups; percentages reported by Hispanic/Latino, black/African American, Asian/Pacific Islander, and white students ranged from 68.3 to 76.9 percent, while 81.3 percent of Native American students reported $100,000 or more of educational debt.
Almost 20 percent of Hispanic/Latino seniors reported having less than $50,000 in education debt. Asian/Pacific Islanders had the next highest percentage at 18.2 percent. Just over 14 percent of white seniors had educational debt less than $50,000, followed by 12.2 percent of black/African American students. Only 3.1 percent of Native American seniors reported having less than $50,000 in educational debt, with all Native American seniors reporting having some debt. Asian/Pacific Islanders and Hispanic/Latinos had the highest percentages of students with no debt, 13.1 percent and 10.9 percent respectively. Of the race/ethnic background groups with some students reporting no debt, black/African Americans had the lowest percentage, 6.7 percent.
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Financial Support for Meeting Dental Education Expenses
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When asked if they had had concerns about being able to finance their dental education, more than 30 percent of 2006 seniors reported having "Much" or "Very Much" concern; 16.5 percent reported "Very Much" concern (Table 16). More than one-fourth (28.1 percent) of seniors reported that they had been "Somewhat" concerned about financing their dental education, while 17.4 percent had "Very Little" concern. The remaining 24.2 percent of seniors indicated that they had not been concerned about financing their dental education.
Among race/ethnicity groups, Hispanic/Latino seniors reported the highest percentage of students who experienced "Much" or "Very Much" concern about financing, at 39.1 percent. Asian/Pacific Islanders reported 34.7 percent, followed by 29.3 percent of black/African Americans, 28.1 percent of white students, and 18.2 percent of Native Americans who expressed having "Much" or "Very Much" concern about financing their dental education.
Asian/Pacific Islanders had the lowest percentage of students reporting "No" concern over financing their education. Nearly 24 percent of black/African American, 24.6 percent of Hispanic/Latino, and 25.6 percent of white seniors reported being unconcerned about their ability to finance their education. Native Americans reported the highest percentage of students with no concern about financing their dental education (27.3 percent).
The reported percentages of seniors’ dental education financed through self/spouse income/savings, loans/grants/scholarships, and gifts/financial support from parents/relatives are shown in Table 17. Almost half of the seniors reported that they did not use their own income or savings or that of their spouse to finance their dental education. An additional 29 percent financed 10 percent or less of their education through savings and income. The remaining 22 percent of students financed 20 percent or more of their dental education using savings and income; only 5 percent used their savings or income for more than 50 percent of their dental education.
Similar amounts were reported when seniors were asked to provide the percentage of their dental education that was financed through gifts or financial support from parents and/or relatives. Approximately 45 percent of seniors reported having financed none of their dental education through financial support of parents or relatives. Almost 28 percent of seniors financed 1 to 10 percent of their education through gifts and financial support received from their family. More than 19 percent financed more than 20 percent of their education through these means; 11.2 percent financed more than 50 percent of their education through gifts and financial support from parents or relatives.
Many students reported financing large portions of their dental education through loans, grants, and/or scholarships. Over three-fourths of dental school seniors (76.2 percent) financed more than 50 percent of their education through these means. And more than half of the students reported financing over 90 percent of their dental education through loans, grants, and/or scholarships. Approximately 8 percent of seniors financed between 21 and 50 percent, and 6.3 percent financed 1 to 20 percent of their dental education through these means. Less than 10 percent of 2006 seniors financed none of their dental education through loans, grants, and/or scholarships.
Student Loans
Of responding seniors, 93 percent reported financing part or all of their dental education through one or more types of loans. As in previous years, the subsidized and unsubsidized Stafford loan programs were the most widely used loan programs among 2006 dental school seniors: 84.1 percent used subsidized Stafford loans and 80.2 percent unsubsidized Stafford loans (Table 18). Health Professions Student loans and Perkins loans were each obtained by approximately 33 percent of seniors, an increase from nearly 32 percent in 2005. These percentages have continued to increase since 2002 when Health Professions Student loans were obtained by 28.8 percent and Perkins loans 26.3 percent of seniors. The use of ADEAL and other private lender loans decreased only slightly from 26.6 percent in 2005 to 26.5 percent in 2006. The percentage of seniors receiving family/ relative loans has decreased from 16.3 percent in 2005 to 15.9 percent in 2006.
This is a substantial decrease from 1980 when over two-thirds of seniors reported using loans from family/relatives to finance part of their dental education. The use of personal bank loans to finance dental education continues to increase from 6.7 percent in 2003, to 8 percent in 2004, to 9.1 percent in 2005, to more than 10 percent in 2006.
The use of other forms of loans was changed in varying ways from previous years. The percentage of students reporting the use of school loans dropped from 9.1 percent in 2005 to 8.3 percent in 2006. Just over 2 percent of seniors reported the use of state loan programs. The use of loans for disadvantaged students increased by 1 percent from 4.1 percent in 2005 to 5.1 percent in 2006. Almost 11 percent of seniors reported credit card debt.
Grants, Scholarships, and Loan Forgiveness
Nearly 48 percent of seniors reported having received one or more grants or scholarships in 2006, a decline from 49.9 percent in 2005. The percentage of seniors who received grants or scholarships from their dental school decreased from 33.2 percent in 2005 to 30.9 percent in 2006 (Table 19). Likewise, a smaller percentage of seniors received state grants/ scholarships in 2006 (10.9 percent) than in 2005 (11.6 percent).
Federal grants/scholarships were received by 11.3 percent of seniors. More than 4 percent of seniors received need-based federal grants and scholarships (Scholarships for Disadvantaged Students) in 2006. The remaining seniors who received federal support (approximately 7 percent) obtained scholarships from one of the uniformed services, the Indian Health Service, or the National Health Service Corps. Similar percentages were reported in 2005.
In 2006, 12 percent of seniors reported plans to participate in a repayment program that included partial or complete loan/scholarship/grant forgiveness in exchange for fulfillment of a service or placement obligation. This percentage increased from almost 10 percent in 2005.
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Rating of Time Devoted to Areas of Instruction
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Included in the 2006 ADEA survey of dental school seniors was a series of questions regarding the amount of time devoted to areas of instruction. The areas of instruction are divided into two primary categories, the first containing areas related to basic and dental sciences and clinical disciplines and the second pertaining to dental public health and community dentistry. Seniors were asked to rate the amount of time devoted to areas of instruction as "inadequate," "appropriate," or "excessive."
The areas with the highest percentage of students reporting "inadequate" time within basic and dental sciences and clinical disciplines were implant dentistry (38.7 percent), orthodontics (35 percent), and practice administration (34.8 percent) (Figure 4). The percentage reporting inadequate time in implant dentistry, 38.7 percent, had declined since 2005; in 2001, the percentage was higher than 50 percent. After practice administration, endodontics had the next highest percentage of students who felt the instruction in this area was inadequate (18.8 percent), followed by geriatric dentistry (17.1 percent) and pharmacology (16.4 percent). Similar percentages were reported for these areas in 2005.
Alternatively, several areas of instruction were reported to have been devoted an "excessive" amount of time by many students. These areas were basic sciences-medical (18 percent), behavioral sciences (17.8 percent), periodontics (13.1 percent), and prevention/oral health promotion (12.8 percent). The percentage of seniors who reported excessive time devoted to pharmacology was 10.4 percent. Each of the remaining areas of instruction was reported by less than 10 percent of students as having been given excessive time.
The ratings of time devoted to instruction in dental public health and community dentistry are displayed in Figure 5. Health services organization and financing is the area of instruction for which the most seniors (34.6 percent) reported inadequate instruction time. Inadequate instruction time was also reported by many seniors in hospital dentistry (29.5 percent), dental health policy (21.2 percent), gender-related issues (20.8 percent), and cultural competency (18.3 percent). Ethics and dental public health were the areas most often reported as receiving an excessive amount of time, in 2006, by 16.1 and 12.8 percent of responding seniors, respectively.
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Figure 5. Percent ratings of time devoted to areas of instruction in dental public health and community dentistry
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Preparedness for Practice
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Using a five-point Likert scale (1=Not well enough prepared; 5=Well prepared), seniors were asked to rate their level of preparedness to enter private practice in twenty-five subject areas. Practice administration was the most likely subject area for students to report being not well prepared (1 or 2 on the Likert scale) with nearly 57 percent of students. Many students also felt inadequately prepared for orthodontics (46.6 percent), implant dentistry (43 percent), and oral health care for disabled patients (31.1 percent) (Table 20). These percentages are very similar to 2005.
Close to 20 percent of seniors indicated they did not feel well enough prepared in anesthesiology/sedation and pain control (19.9 percent) or endodontics (19.5 percent). Between 17 and 19 percent of seniors reported that they did not feel well prepared in the following areas: oral health care for rural areas, oral health care for patients with HIV/AIDS, interacting with medical colleagues, and therapeutics and prescription writing. Nearly 17 percent of seniors did not feel well enough prepared for geriatric oral health care. Some students (16 percent) felt unprepared for adaptive treatment planning for low-income populations/individuals.
At least 90 percent of seniors reported that they felt prepared to well prepared in operative/restorative dentistry, preventive practices and patient education, radiology, diagnosis and treatment planning, fixed and removable prosthodontics, oral health care for a diverse society, oral surgery, and patient evaluation.
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Plans Immediately Following Graduation
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Seniors were asked a series of questions relating to their plans following graduation from dental school. Since 2003, the percentage of seniors who plan to enter private practice immediately after graduation has gradually increased from 50.3 percent in 2003 to 52.5 percent in 2006. This percentage includes those who plan to pursue solo private practice (3.8 percent), enter a partner or group practice (6.6 percent), or begin as an associate or employee (42.1 percent).
Nearly 6 percent of seniors plan to enter government service upon graduation, a slight decline from 6.1 percent in 2005. The percentage of seniors pursuing advanced degrees also declined from 38.6 percent in 2005 to 37.8 percent in 2006, as did the percentage of seniors pursuing teaching/research/administration from 0.8 percent in 2005 to 0.5 percent in 2006. (See Figure 6.)
Only minor differences between the activities pursued by males and females were evident when plans immediately following graduation were evaluated by gender. A slightly greater percentage of females (53.0 percent) than males (52.2 percent) reported plans to pursue private practice immediately upon graduation. A higher percentage of males (5.1 percent) planned to enter solo practice than females (2.4 percent). However, within this group a higher percentage of females (46.1 percent) had plans to enter practice employed than males (38.8 percent). Likewise, the percentage of males (8.3 percent) who planned to enter a partnership or group private practice exceeded that of females (4.5 percent).
The percentage of females (38.1 percent) planning to pursue advanced education was slightly greater than that of males (37.5 percent). Alternatively, a higher percentage of males (6.9 percent) than females (4.8 percent) will enter government service. Nearly equal percentages of males (0.5 percent) and females (0.6 percent) reported plans to pursue teaching, research, or administration.
As compared to 2005, these percentages remain generally similar. The percentage of females planning to pursue private practice increased from 50.8 percent in 2005 to 53.0 percent in 2006 while the percentage of males remained nearly unchanged (52.1 percent in 2005 to 52.2 percent in 2006). The percentage pursuing advanced education declined in 2006 for both males and females.
Plans immediately following graduation were also evaluated by race/ethnicity. The percentage of Native American/Alaska Native seniors planning to enter private practice immediately following graduation decreased in 2006 from 70.6 percent in 2005 to 56.3 percent, and the percentage of black/African Americans decreased from 35.3 percent to 30.3 percent. In 2006, 53 percent of Hispanic/Latino seniors reported plans to pursue private practice, an increase of 5.1 percent from 2005. Percentages of seniors entering private practice increased slightly among Asian/Pacific Islanders and whites from 2005 to 2006. More seniors of Native American/Alaskan Native descent reported plans to pursue advanced education in 2006 (25 percent) than in 2005 (17.6 percent). The percentage of Hispanic/Latinos fell from 42.6 percent in 2005 to 34.5 percent in 2006.
The percentage of seniors entering government service upon graduation increased among Native American/Alaska Natives (2.9 percent in 2005 to 15.6 percent in 2006), black/African Americans (7.5 percent in 2005 to 13.6 percent in 2006), and Hispanic/Latinos (4.7 percent in 2005 to 9.2 percent in 2006); the percentages decreased slightly among Asian/Pacific Islanders (3.8 percent in 2005 to 3.3 in 2006) and whites (6.9 percent in 2005 to 6.0 percent in 2006). The percentage of seniors pursuing teaching, research, or administration did not exceed 1 percent among any of the race/ethnic groups.
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Influence of Educational Debt on Plans Following Graduation
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In 2006, 22 percent of seniors reported that educational debt played a major role in determining their plans following graduation. Nearly twice as many seniors (41.7 percent) reported that educational debt had only "little" or "somewhat" of an influence on their plans upon graduation. The remaining 36.4 percent of seniors reported educational debt having no influence on their plans immediately following graduation. Responses from 2005 showed a similar distribution.
As shown in Table 24, the influence of educational debt on plans following graduation varied based on reported plans upon graduation. Just over 28 percent of seniors planning to enter private practice reported that debt was a major factor in their decision. The percent reporting debt as a major factor among those planning to enter private practice as an associate employee (30.6 percent) or in a community clinic (34.2 percent) was higher than those planning to start a private practice (15 percent) or to join a partner/group practice (18.8 percent). The percentage of 2006 seniors entering private practice who reported their debt as not playing a role in their decision about plans after graduation rose from 40.8 percent in 2005 to 42.1 percent in 2006.
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Table 24. Educational debt as a factor influencing immediate plans following graduation, by percentage of respondents
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Just over half of seniors (51.1 percent) planning to enter government service reported educational debt was a major factor influencing their plans following graduation. It is likely that many of these students participated in loan/scholarship programs associated with a service commitment following graduation. Just over 29 percent of those entering government service reported debt was not a factor, nearly equal to the 28.9 percent in 2005.
The least likely to report debt as playing a substantial role in their decision were those pursuing either advanced education or teaching/research/ administration: 8.8 percent and 9.5 percent, respectively. Among those pursuing advanced education, 70.8 percent reported debt was not a factor. Over 71 percent of seniors entering teaching/research/ administration in 2006 reported educational debt was not a deciding factor, an increase from 56.7 percent in 2005.
Students with higher levels of educational debt were more likely to plan to enter private practice upon graduation (Table 25). Of seniors $100,000 to $149,000 in debt, 53.3 percent planned to pursue private practice following graduation. Similarly, 55.6 percent of students $150,000 or more in educational debt planned to enter private practice. Over 46 percent of students without debt planned to enter private practice immediately. In general, the amount of educational debt appears to influence, in part, the decision to enter private practice.
Since the year 2000, seniors with debt have been less likely to report plans to pursue advanced education than those without debt. In 2006, among seniors who reported at least $150,000 of debt, 37.7 percent planned to obtain an advanced degree and 41.7 percent of students without debt planned to pursue advanced education. Similar to 2005, a lower percentage of seniors (30.3 percent) with debt under $30,000 reported plans to pursue an advanced degree than those with more than $30,000 in debt (42.3 percent).
Seniors were asked to identify the primary activity they would have pursued following graduation if not for their educational debt (Table 26). Of the responding seniors, one-third reported that they would have pursued a different activity were it not for their debt. Of the students with plans to enter solo private practice, 10.4 percent reported that if not for their educational debt, they would have entered a partnership/group practice, 7.6 percent would have pursued education, and 0.7 percent would have entered government service. Nearly three out of four seniors who planned to enter solo private practice reported that they would still pursue solo private practice even if not for their level of educational debt. Among students planning to enter a partnership/group practice, two-thirds (66.3 percent) reported they would have pursued the same activity regardless of their educational debt. Almost 7 percent of those with plans to enter a partnership/group practice would have pursued advanced education if not for their debt, 1.6 percent would have practiced at a community clinic, and 3.2 percent would have entered teaching/research/administration.
Students entering private practice as an associate/employee or as an employee at a community clinic were more likely to report they would have pursued a different activity upon graduation if not for their debt. Only 54.2 percent planning to be an associate/employee and 46.6 percent planning to be employed at a community clinic would not have changed their plans upon graduation. Approximately 13 percent of those employed as an associate/employee and 13.8 percent employed by a community clinic reported that, if not for their educational debt, they would have pursued advanced education. Of those with plans to pursue a position as an associate/employee, 13.9 percent would have pursued solo private practice, 11.4 percent partnership/group practice, 1.1 percent teaching/ research/administration, and 0.8 percent government service. Among those employed by a community clinic, 6.9 percent would have pursued solo private practice, 15.5 percent a partnership/group practice, and 13.8 percent a position as an associate/employee were it not for their educational debt. While 13.8 percent of students with plans to be employed at a community clinic would have continued their education were it not for their debt, 1.7 percent would have entered government service, and none would have pursued teaching/research/administration.
Only 14.4 percent of students pursuing advanced education reported they would have pursued a different option following graduation were it not for their level of debt. The majority of those students would have entered private practice upon graduation from dental school. Of students pursuing an academic career in teaching/research/administration, 28.7 percent would have entered private practice, half of whom would have pursued a solo practice, were it not for their educational debt. The remaining students who plan to pursue teaching/research/administration upon graduation would still pursue the same activity regardless of their debt. Only 39.6 percent of graduating seniors with plans to enter government service would still have pursued government service were it not for their educational debt. More than 15 percent would have pursued advanced education, and 40.6 percent would have entered private practice rather than government service if not for their educational debt.
Using the number of respondents rather than percent of respondents, based on the reported activities if not for level of debt, an additional 283 seniors would have pursued advanced education, and thirty-eight would have pursued a career in academia. Alternatively, 171 seniors pursuing advanced education and six seniors entering academia would have chosen other activities if not for their educational debt.
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Long-Term Plans
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Seniors were also asked to report the activity they intended to pursue ten years following graduation from dental school (Table 27). In 2006, the majority of responding seniors (86.2 percent) planned to begin a solo practice (36.6 percent) or enter a partner/group practice (49.6 percent) within ten years of graduation. This is a slight decrease from 87.3 percent in 2005, which can be attributed to the slight decrease in the percentage of seniors who plan to enter a partner/group practice in the future. However, historically, a far larger number of seniors report plans to be in partnership than actually practice in a partnership (14 percent).
The percentage of 2006 seniors who reported long-term plans to be employed in a private practice as an associate/employee or at a community clinic increased slightly from 4.1 in 2005 to 5.2 percent. These percentages fluctuate from year to year with no substantial change over the past few years.
The percentage of students who plan to practice at a community clinic immediately following graduation (3 percent) is noticeably greater than the percentage of those who plan to be employed at a community clinic ten years after graduation (0.9 percent). These percentages indicate that many seniors who plan to practice at a community clinic upon graduation do not intend to do so for a long period of time.
On the other hand, 1.7 percent of seniors reported long-term plans to be in academia, an increase from the 0.5 percent that report plans to enter academia immediately upon graduation. Similar to previous years, 45.5 percent of seniors report long-range plans that include teaching on a part-time basis.
Career plans for ten years beyond graduation were also analyzed by gender. A similar percentage of males and females reported long-range plans to be in private practice (92.2 percent of males and 89.9 percent of females), but a greater percentage of males (42.4 percent) planned to practice in a solo private practice than females (29.7 percent). Females were more likely than males to pursue private practice in a partner/group practice or as an associate/employee.
An equal percentage of males and females planned to pursue academia (1.7 percent). The percentages of students with long-range plans of government service were also equal among males and females at 1.3 percent. Similar differences between genders were reported in previous years.
When asked to report the intended location of their practice immediately following graduation, more than two-thirds of seniors reported plans to practice in a metropolitan area with a population of at least 50,000 people (Table 29). Similar to 2005, over 31 percent of those planned to practice in a metropolitan area with a population of at least one million in 2006, and 26 percent planned to practice in a metropolitan area with a population between 100,000 and 999,999. The remaining seniors (29.8 percent) planned to practice in an urban/suburban setting with a population of fewer than 50,000 people, with 18.6 percent in an area with 25,000 to 49,999 people and 6.4 percent in an area with 10,000 to 24,999 people. Less than 5 percent planned to practice in an urban/rural area with a population of fewer than 10,000.
Some variations were reported in practice location plans based on race/ethnicity (Table 30). When evaluating this data, it is important to take into consideration that some cells contain a small number of responses. Generally, minorities were more likely to report plans to practice in a metropolitan area with a population of at least one million. The percentages of Asian/Pacific Islander, black/African American, and white students planning to practice in an area with between 100,000 to 999,999 residents were higher than for Hispanic/Latino and Native American students. A higher percentage of Native Americans reported plans to practice in urban/suburban/rural areas than the other race/ethnicity groups.
Seniors were asked to estimate the percentage of their patients that they expected to be from underserved race/ethnic populations based on their intended practice locations. The responses are displayed by race/ethnicity of the respondents in Table 31. In this survey, 31.5 percent of black/African Americans, 28.1 percent of Native Americans, and 22.3 percent of Hispanic/Latinos reported that at least half of their patients would be from underserved minority populations, substantially higher percentages than Asian/Pacific Islanders (7.0 percent) and whites (4.0 percent). More than 50 percent of white students reported that they expected no more than 10 percent of their patients would be from underserved race/ethnic populations compared to 30.3 percent of Asian/Pacific Islanders, 25 percent of Native Americans, 23.3 percent of Hispanic/Latinos, and 9.1 percent of black/African Americans. The reported differences continue to support historical trends that the practice locations of minority graduates, particularly black/African Americans and Hispanic/Latinos, tend to be areas that care for a greater number of underserved minorities.
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Table 31. Percentage of patients expected to be from underserved race/ethnic populations by race/ethnicity of seniors, by percentage of respondents
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Plans for Postdoctoral Education
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The percentage of seniors in 2006 who reported having applied to a postdoctoral dental education program remains unchanged from 2005 at 47.5 percent, the lowest percentage since 2000. In 2003, the percentage peaked at 49 percent, dropping 1.5 percent by 2005.
Seniors were asked to report their opinion as to whether a year of postdoctoral dental education should be required for all dental students. A required year was supported by 27.8 percent of reporting seniors in 2006, only slightly higher than 27.5 percent in 2005. Since the question was first asked in 1996, the percentage has fluctuated between 25.6 and 31.6 percent. In 2006, the percentage of students who believe a postdoctoral year should be mandatory (27.8 percent) was substantially lower than the percentage of students who applied for postdoctoral training, indicating that many who choose to pursue advanced education do not believe such training should be mandatory.
Among students who reported they had applied to one or more postdoctoral dental education programs, 29.3 percent had applied to a general practice residency (GPR) program or advanced education in general dentistry (AEGD) program, and 24.2 percent applied to a specialty program (Table 34; Figure 7). Similar percentages were reported in previous years. The percentage of students applying to GPR or AEGD programs dropped slightly from 2005, while the percentage applying to specialty programs increased slightly. Based on the overall percentage of students applying for postdoctoral education, it is apparent that some studen
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