Annual ADEA Survey of Dental School Seniors: 2004 Graduating Class

Parental Education and Income

The parents of dental students tend toward having higher levels of education than that reported for the U.S. adult population at large. Over 82 percent of fathers and over 75 percent of mothers of dental students have had some level of postsecondary education (Table 2⇓), compared with almost 53 percent of the U.S. adult population.¹ Almost 46 percent of fathers and over 26 percent of mothers of dental students hold graduate degrees or have had some level of graduate education. For comparison, a little over 9 percent of the adult U.S. population holds graduate degrees.¹

About 74 percent of seniors were from families whose total parental incomes are above $50,000 (Table 3⇓). The median family household income was $52,275 in 2003. There was a continuing slight increase, to almost 42 percent, of seniors from families with combined incomes greater than $100,000. Slightly more than 25 percent of the seniors were from households with total parental incomes above $150,000, and almost 18 percent were from families with combined incomes greater than $200,000.

Financial Independence and Marital Status

There has been little change over the past decade in the percentage of seniors reporting themselves to be financially independent from their parents, fluctuating between about 62 and 66 percent (Table 4⇓). During the 1980s and early 1990s, the percent of financially independent seniors fluctuated between about 52 and 59 percent.

The percentage of dental school seniors who were married remained rather constant at 40 percent from 1997 through 2000, trended up to over 43 percent in 2003, and fell to 40.9 percent in 2004 (Table 5⇓). During the early 1990s, the percent married fluctuated around 35 percent. The highest percent of married seniors was reported in 1978 at 57.4 percent. About 33 percent of the married seniors had one child; 15 percent had two children; 9 percent had three or more children.

Dentistry as a Career

Almost 11 percent of the seniors reported that they had made the decision to pursue dentistry as a career before high school; almost 21 percent made that decision while in high school (Table 6⇓). Almost 44 percent of the seniors reported making the decision in their third or fourth year of college or after graduation from college. These percentages are similar to those reported in previous years.

The dental school seniors were asked to rate, from low to high, the importance of nine reasons for pursuing dentistry as a career (Table 7⇓). Ranking the nine reasons by combining the high and somewhat high responses indicates that “Control of Time of Work,” “Self-Employed,” and “Service to Others” were the most important reasons for pursuing dentistry as a career, at 87.4, 83.4, and 82 percent respectively. These percentages have been most similar, year to year, for each of these reasons.

For a second year, “Service to One’s Own Race or Ethnic Group” and “Opportunity to Serve Vulnerable and Low-Income Populations” were included on the list of reasons. Service to one’s own race or ethnic group was rated somewhat high or high by only 22.8 percent of the seniors. The opportunity to serve vulnerable and low-income populations was rated somewhat high or high by 41 percent of the seniors. These percentages are also similar to those reported last year.

“Income Potential” and “Working with Hands” received combined ratings of 80.2 and 74.0 percent, respectively. “Variety of Career Options” and “Status and Prestige” were each rated somewhat high or high by about 55 percent of the seniors. As with the other percentages, these last four also have been most similar year-to-year.

Analyzing the importance of the reasons for pursuing dentistry as a career by race/ethnicity gave similar findings as last year. Control of time, service to others, and self-employment opportunities had similar response rates by race/ethnicity and in the same order of these three reasons. Income potential also had similar response rates. However there was, again in 2004, a marked difference as to the importance of service to one’s own race/ethnic group and opportunity to serve vulnerable and low-income populations (Table 8⇓). Over 72 percent of the black/African American respondents indicated that service to one’s own race/ethnic group was somewhat or highly important in their decision to pursue dentistry as a career. This was about 44 percent for Hispanic/ Latinos, 37 percent for Native Americans, and 34 percent for Asian/Pacific Islanders. It was rated somewhat or highly important by only 13 percent of white respondents. Opportunity to serve vulnerable and low-income populations was rated somewhat or highly important by almost 70 percent of the black/African American respondents and over 55 percent of the Hispanic/Latino respondents. Almost 55 percent of the Asian/Pacific Islander respondents indicated this was of somewhat or high importance to them in selecting dentistry as a career, followed by Native Americans at over 43 percent. Thirty-three percent of the white respondents indicated service to vulnerable and low-income populations was somewhat or highly important in their decision to pursue dentistry as a career.

The dental seniors were also asked to rate, from low to high, ten factors that influenced their decision to pursue dentistry as a career (Table 9⇓). The ten factors were ranked by combining the high and somewhat high percent responses. The factors of a “Family Member or Friend Who Is a Dentist” or “My Family Dentist” were the two most influencing factors in deciding to pursue dentistry as a career, at 49.1 and 46.1 percent respectively. Slightly more than 14 percent of the respondents indicated that one or both of their parents was a dentist. Awareness of dental workforce and market trends was rated as a “Somewhat High” to “High” influencing factor by 38.6 percent of the seniors, followed by a “Non-Dentist Family Member or Friend” at 32 percent. As reported in previous senior surveys, influence of the other factors fell off sharply. Sixteen percent of the respondents indicated a visit to a dental school was somewhat to highly influencing. “Opportunity to Participate in a Pre- or Post-baccalaureate Dental Career Development/School Admissions Program” was reported to have been “Somewhat High” or of “High” influence for almost 16 percent of the seniors. Almost 8 percent of the seniors reported that being recruited by a dental school was a “Somewhat” or “High” factor. The factors least often reported as influencing a decision to pursue dentistry as a career were high school or college counselors and brochures on careers in dentistry, at 6.8 and 5.7 percent respectively.

Dentists, whether a family member, friend, or personal dentist, continue to be the most influencing factor in the decision process of pursuing dentistry as a career. Continuing efforts must be made to strengthen the influence and guidance high school and college counselors can give to promoting careers in dentistry.

Analyzing the ten factors influencing dentistry as a career choice by race/ethnicity showed similarity by race/ethnicity for the influence of awareness of dental market trends and of family members or friends who were not a dentist. The influence of a family dentist was rated somewhat high or high by almost 51 percent of the responding white seniors, but less so by minority seniors at 47 percent by black/ African American seniors, 41 percent by Hispanic/ Latino seniors, and 35 percent by Asian/Pacific Islander seniors. A family member or friend who is a dentist was rated somewhat high or high by 53 percent of the white seniors, dropping to 46 to 44 percent of the Asian/Pacific Islander, Native American and Hispanic/Latino, and to 29 percent of black/African American seniors. Participation in a pre- or postbaccalaureate dental career development or school admissions program was rated somewhat to highly influencing by 20 to 31 percent of minority seniors, but only 12 percent of white seniors. Eighteen percent of the black/African American seniors reported that specific recruitment by a dental school had been of somewhat high or high influence. This was 17 percent for Native American and 12 percent for Asian/Pacific Islander seniors, 8 percent for His-panic/Latino, and 6 percent for white seniors.

School visits were reported more of an influence by minority seniors (17 to 25 percent) than by white seniors (14 percent). Minority seniors reported career days, career brochures, and career counselors to be of more influence (8 to 12 percent) than that reported by white seniors (3 to 6 percent). While dentists are a most influencing factor in making the decision to pursue dentistry as a career, the information regarding influencing factors begins to document the value of and needs in various strategies to improving the recruitment and enrollment of underrepresented minorities into dentistry.

Educational Debt

The average educational debt on entering dental school reported by the 2004 dental school seniors was $19,369 (Table 10⇓). The average graduating debt of dental students in 2004 was $122,263 (Table 10⇓). Graduating debt of individuals from public schools averaged $99,533. At private and private state-related schools, the average was $155,234. This was a 6.3 percent increase in debt for graduates of public schools and a 4.9 percent increase in debt for graduates of private and private state-related schools. Figure 1⇓ illustrates the trend of graduating debt by type of school from 1990 to 2004.

Figure 1.

Average graduating debt by type of school, 1990–2004

Educational Debt Upon Graduation from Dental School

The percentage of graduating students with educational debt of $100,000 or more continued to rise in 2004, with over 66 percent of students now reporting such levels of educational debt (Table 12⇓). Over 37 percent of graduates reported educational debt of $150,000 or more. The percentage of graduates with less than $50,000 educational debt continued its decline to 7.6 percent; and the percentage of seniors reporting to graduate with no educational debt has also continued to decline, standing now at 9.9 percent.

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Table 12.

Percent levels of educational debt after graduation from dental school, 1996-2004

Graduates of private or private state-related schools are more likely to have higher educational debt (Table 13⇓ and Figure 2⇓). In 2004, over 76 percent of graduates from private or private state-related schools had $100,000 or more in educational debt; just over 59 percent of graduates from public schools reported $100,000 or more of educational debt. A little over 19 percent of graduates from public dental schools had $150,000 or more in debt (13.1 percent in 2003), while 63.4 percent from private or private state-related dental schools had $150,000 or more in debt (59.4 percent in 2003).

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Table 13.

Percent levels of educational debt for the 2004 graduates by type of school

Figure 2.

Percent levels of educational debt by type of school, 2004

Table 14⇓ presents the average graduating educational debt of graduates who had debt, by type of school, for the last nine years. The average of all schools was $135,721 in 2004, an increase of 2.4 percent over 2003. Debt of seniors of public schools who had debt was $110,686 in 2004, an increase of 7.3 percent from 2003. And for indebted seniors of private and private state-related schools, the average graduating debt was $171,928, an increase of 2.5 percent over 2003. Between 1996 and 2002 (most current year of reported data), tuition and fees have increased 6 percent per year for residents and 6.4 percent for nonresidents. For this same period of time, overall, average graduating debt of graduates with debt has increased about 7.6 percent per year.

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Table 14.

Average graduating educational debt of graduates with debt by type of school, 1996-2004

Similar to 2002 and 2003, over 44 percent of seniors reported their educational debt was at the level they had anticipated and 45 percent indicated that they had “More” or “Much More” debt than anticipated. A little over 12 percent had “Much More” educational debt than anticipated. “Less” or “Much Less” debt than anticipated was reported by 10.6 percent of graduates, with 4.6 percent reporting “Much Less Debt.”

Nearly half (47.1 percent) of seniors reported that their educational debt was “Much” or “Very Much” a financial burden. Educational debt was reported as “Very Much” a burden by 25.4 percent of responding seniors. Educational debt was “Somewhat” of a burden to 36.8 percent of graduates. Debt presented “Very Little” burden to 8.5 percent and “No” burden to 7.6 percent of graduates. These percentages are also similar to those reported in 2002 and 2003.

Educational Debt by Race/ Ethnicity

Table 15⇓ and Figure 3⇓ illustrate percent levels of educational debt by race/ethnicity. At first glance, particularly with Figure 3⇓, there appears to be some similarity in the percent levels of debt by race/ ethnicity. But in tracking through each level of debt by race/ethnicity, it becomes evident that black/African Americans had lower percentages of seniors reporting no debt or debt less than $50,000 than His-panic, Asian/Pacific Islander, or white seniors. Black/ African American seniors were also the group with the largest percent of individuals with debt greater than $100,000 (75.6 percent) as compared to Asian/ Pacific Islander (68.2 percent), white (65.7 percent), and Hispanic/Latino (56.2 percent) seniors. The percent of seniors reporting graduation debt greater than $150,000 increased slightly in 2004 for Asian/Pacific Islander, Hispanic/Latino, and white seniors; but it increase by almost 15 percentage points for black/ African Americans, from 33.6 to 48.3 percent.

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Table 15.

Percent levels of educational debt for year 2004 graduates by race/ethnicity

Figure 3.

Percent levels of graduating debt by race/ethnicity, 2004

Financial Support for Meeting Dental Education Expenses

Almost 26.5 percent of the seniors reported that they had had “Much” or “Very Much” concern about being able to finance their dental education, with over 14 percent indicating that they had been “Very Much” concerned (Table 16⇓). A little over 28 percent reported having been “Somewhat” concerned about being able to finance their dental education. Over 45 percent indicated that they had had “Very Little” or “No” concern, with almost 27 percent reporting “No” concern. These percentages are very similar to those reported for 2002 and 2003.

The percentage of seniors reporting concern with financing their dental education was highest for black/African American and Hispanic/Latino students, at 39.9 and 31.1 percent, respectively, indicating “Much” or “Very Much” concern. Almost 28.5 percent of the Asian/Pacific Islander seniors reported these levels of concern with financing their dental education. White and Native American seniors reported these levels of concern at 24.4 and 20.0 percent, respectively.

Seniors were asked in the 2004 survey for an estimate of the percentages of financial support for their dental education that came from self and/or spousal earned income and/or savings; loans, grants, and scholarships; and gifts and/or support from parents and/or relatives (Table 17⇓). Almost 45 percent of the respondents indicated that they had no income and/or savings, either from self and/or spouse, from which to financially support their dental education. Another 32.4 percent indicated that only 1 to 10 percent of their education was financed through these sources. Just over 4 percent of the seniors reported financing more than 50 percent of their dental education through self and/or spousal income and/or savings. These percentages are similar to those reported in 2002 and 2003.

Almost 62 percent of the seniors indicated they financed over 75 percent of their education through loans, grants, and/or scholarships; with 43.9 percent indicating these sources financed over 90 percent of their educational costs. Just over 9 percent indicated that no loans, grants, and/or scholarships were used to help finance their educations. These percentages also are most similar to those reported in 2002 and 2003.

Almost 40 percent of the seniors reported receiving no gifts or financial support from their parents and/or relatives for support of their dental educations. Another 30.5 percent reported that between 1 and 10 percent of their educational costs were met through gifts and/or financial support of their parents and/or relatives. A little over 7 percent indicated that between 91 and 100 percent of their dental education was financed by their parents and/or relatives. Again, these percentages are most similar to those reported in 2002 and 2003.

The seniors were asked if they had applied for any public assistance (food stamps, WIC, Medicaid) while they were in dental school. Over 10 percent (319) indicated that they had. Ninety-two percent of those who applied received the public assistance requested.

Rating of Time Devoted to Areas of Instruction

The areas of instruction are reported in two sections: one pertaining to basic and dental sciences and the clinical disciplines; the other, to dental public health and community dentistry.

The instructional areas of basic and dental sciences and the clinical disciplines receiving the highest time ratings of “inadequate” or “excessive” have remained much the same from year to year (Figure 4⇓). Implant dentistry received the highest inadequate rating at 41.6 percent, down though from an inadequate rating of over 50 percent in 2001. Implant dentistry was, again, followed closely by orthodontics and practice administration, at 40 and 33.8 percent respectively. The percent ratings for these three areas of instruction are most similar to those reported in 2003. All of the other twenty-one course areas reported on had “appropriate” time ratings of over 70 percent.

Figure 4.

Percent ratings of time devoted to selected areas of instruction

While their appropriate time ratings were over 70 percent, pharmacology had an inadequate rating of almost 18 percent, followed by endodontics and geriatric dentistry, at 17.7 and 17.2 percent respectively. These three instructional areas have routinely been reported as inadequate by 16 to 18 percent of the seniors.

Several areas of instruction routinely receive relatively high ratings as being excessive. These again, for 2004, include basic science-medicine (18.3 percent), behavioral science (18.1 percent), periodontics (14.0 percent), dental materials (10.7 percent), and preventive dentistry (10.3 percent).

Figure 5⇓ presents the instructional areas grouped as dental public health and community dentistry. Health services organization and financing, hospital dentistry, and cultural competency, each received “appropriate” time ratings of less than 70 percent. In particular, health services organization and financing received an “appropriate” rating of less than 60 percent. While dental health policy and gender related issues were reported “appropriate” by over 70 percent of the seniors, over 21 percent of the seniors reported an “inadequate” time rated for these two instructional areas. While receiving an “appropriate” rating of over 81 percent, ethics was reported to be “excessive” by over 14 percent. Dental public health was reported “excessive” by 11.6 percent of the seniors.

Figure 5.

Percent ratings of time devoted to areas of instruction in dental public health and community dentistry

The 2004 senior survey has twenty-five subject areas for which the seniors were asked to indicate their sense of preparedness for entry into practice (Table 20⇓). There were nine areas in which 90 or more percent of the seniors indicated they were prepared to well prepared for practice. These were operative/restorative dentistry, preventive practices and patient education, radiology, diagnosis and treatment planning, patient evaluation, oral surgery, fixed and removable prosthodontics, periodontics, and oral health care for a diverse society. Three areas in which nearly 50 percent or more of the seniors indicated they sensed they were not well enough prepared for practice included practice administration (56.1 percent), orthodontics (50.8 percent), and implant dentistry (48.9 percent). Almost 35 percent of the seniors indicated they were not well enough prepared to provide oral health care for physically and mentally disabled patients. Almost 21 percent indicated they did not believe they were adequately prepared to interact with medical colleagues. Almost 20 percent of the seniors indicated they did not feel prepared to provide oral health care for patients with HIV/AIDS or in rural areas. Other areas in which between 15 to 20 percent of the seniors indicated they did not sense they were well enough prepared included therapeutics and prescription writing (19.3 percent), anesthesiology/sedation and pain control (18.5 percent), endodontics (17.4 percent), geriatric oral health care (17.3 percent), and adaptive treatment planning for low income populations/individuals (16.6 percent). Slightly more than 14 percent indicated they were not well enough prepared to integrating oral health care with medical care.

Practice Plans Immediately Following Graduation

While there was essentially no change in the percent of seniors in 2003 and 2004 with plans to immediately enter private practice (50.4 percent), there was a slight decline in the percent with immediate plans to pursue solo practice (4.4 to 4.1 percent), a slight decline in the percent with immediate plans to enter practice in partnership/group (7.4 to 6.0 percent), and a slight increase in the percent with immediate plans to enter practice as an associate or employee (38.5 to 40.3 percent), Figure 6⇓ and Table 21⇓. Regarding the seniors entering practice as an associate or in an employee arrangement (40.3 percent), 2.8 percent indicated they would be employed by a community clinic. This is up slightly from 1.9 percent in 2003. There was a continuing slight increase in the percent of seniors immediately pursuing advanced education, standing now at 38.6 percent. The percent of seniors with plans to enter government service was essentially unchanged at 7.5 percent. The percent of seniors reporting with immediate plans to pursue careers in academia fell back to its more usual level of 0.5 percent.

Figure 6.

U.S. dental school seniors’ immediate practice plans, 1980–2004

Influence of Educational Debt on Plans Following Graduation

Almost 37 percent of the year 2004 seniors reported that their levels of educational debt did not influence their immediate career plans following graduation. Twenty-two percent, however, indicated that their debt was a major factor influencing their career plans following graduation. The remaining 41 percent of seniors indicated educational debt was a factor, but of somewhat or little influence in making immediate career plans.

Table 24⇓ displays the percent responses to educational debt being a factor influencing immediate plans following graduation by type of immediate plan. About 36 percent of the individuals pursuing private practice solo and over 31 percent pursuing private practice in partnership/group arrangements reported that debt was not a factor in reaching this decision. Over 16 percent entering private practice solo and a little over 19 percent entering a partnership/group arrangement indicated their debt was a major influencing factor. Debt was more of a factor for individuals entering private practice as associates or employees, with over 30 percent indicating debt was a major factor and almost 27 percent indicating it was not. Debt was also more of an influencing factor for the individuals who indicated they would be entering practice employed by community health clinics, since only about 20 percent indicated debt was not a factor. All of these percentages approximate those reported in 2003.

Fifty-two percent of the seniors pursuing advanced education reported that their level of educational debt was not a factor in making that decision. Less than 9 percent indicated that it was a major factor in making that decision. For the seniors with plans to immediately pursue careers in academia, over 53 percent indicated debt was not a factor in this decision; a little over 13 percent reported it was a major factor. For individuals pursuing government service, debt was a major factor for almost 51 percent of them; it was not a factor for about 19 percent. These percentages are also similar to those reported in 2003.

While the influence of debt on immediate career decisions undoubtedly varies from individual to individual, looking at levels of debt by graduation plans (Table 25⇓) shows that, overall, varying levels of debt affect graduation plans and the trends by level of debt correlate with the influences of debt expressed by the seniors. As the levels of debt increased, an increasing percentage of the seniors with the higher levels of debt planned to immediately enter private practice, rising from 36.2 percent of seniors reporting no debt to 56.8 percent of seniors with debt greater than $150,000. Also as debt increased, the percentage entering private practice as an associate or in some employee arrangement increased, from 25.3 percent of seniors with no debt to 44.8 percent of seniors with debt greater than $150,000. Entering private practice solo or in a partnership/group arrangement showed some fluctuation along the continuum of debt levels; but the overall tendency for these individuals was that, as debt increased, so did the percentage entering private practice.

Prior to 2000, seniors with high debt pursued advanced education at about the same rate as individuals with no or low debt. This year, as well as for the past four years, seniors reporting no debt pursued advanced education at a higher rate than seniors with debt. This year, for the first time, the percentages of individuals with debt of $80,000 or more pursuing advanced education were less than the percentages of individuals with debt less than $80,000. Previously, the percentages of individuals pursuing advanced education were similar regardless of level of debt.

Levels of debt did appear to have an inverse influence on decisions to enter government service. As debt increased, the percentage of seniors entering government service decreased, from about 21 percent of seniors with low debt to 4 to 6 percent of seniors with high debt. The higher percentages of individuals entering government service that have lower levels of debt is undoubtedly related to the fact that many of these individuals were recipients of uniformed services scholarships. Of the relatively few seniors immediately pursuing academia, it appears that the level of debt was not an overly influencing factor.

The survey asked respondents to indicate the primary activity they would have pursued upon graduation if it were not for their amount of educational debt, having reported that their level of debt did influence their immediate plans upon graduation (Table 26⇓). Of those immediately pursuing solo private practice, 80 percent would still have pursued solo private practice; with almost 6 percent indicating that, if not for their amount of debt, they would have pursued advanced dental education. A little over 1 percent reported they would have pursued academia (teaching/research/administration); 5.9 percent would have pursued private practice in a partnership/ group arrangement and 2.4 percent as an associate.

Almost 58 percent of the individuals immediately entering private practice in a partnership/group arrangement would have continued to do so, regardless of their debt. About 17 percent reported they would have entered solo private practice; 11.6 percent would have pursued advanced dental education; 1.5 percent would have pursued academia.

Large changes would have occurred in plans following graduation for individuals with immediate plans to enter private practice as associates/employees. Only 42.1 percent would have remained entering private practice as associates/employees, if not for debt. Over 17 percent would have entered solo private practice, and another 16 percent would have entered in partnership/group arrangements. Over 15 percent would have pursued advanced dental education, and 1.6 percent would have pursued academic careers. Likewise, large changes would have occurred in plans following graduation for individuals with immediate plans to enter practice as employees in community clinics. Only a little over 26 percent of the individuals with this plan would have continued to do so, if it hadn’t been for their debt; 11.5 percent indicated they would have entered private practice solo, 16.4 percent would have entered private practice in a partnership/group arrangement, and 21.3 would have entered private practice as an associate/employee. Another 5 percent would have pursued advanced education, and 3.3 percent would have gone into academia.

Of the seniors immediately pursuing advanced dental education and for whom their level of debt influenced that decision, 78.4 percent indicated that they still would have pursued advanced education. Less than 14 percent reported that they would have immediately entered private practice if it hadn’t been for their amount of debt; 3 percent solo, 6.4 percent in partnership/group arrangements, 3.4 percent as associates/employees, and 1 percent in community clinics. Almost 1 percent would have pursued academia.

Of the small number of individuals who reported plans to immediately pursue academia and for whom debt influenced that decision, almost 43 percent indicated they would have continued to do so, regardless of their debt. Over 28 percent indicated they would have immediately pursued private practice, in one manner or another. Almost 29 percent would have pursued advanced education. Immediately entering government service was another area where major changes in plans would have occurred if not for debt. About 30 percent would have continued with plans to enter government service; 17 percent would have pursued advanced education; and over 45 percent would have entered private practice, 11.8 percent solo, 18.5 percent in partnership/ group arrangements, 12.8 percent as associates/employees, and 2.1 percent in community clinics.

Again, it is evident that educational debt affects immediate plans following graduation and what those plans might have been if not for debt. This is particularly apparent for individuals whose immediate plans were to enter private practice immediately as associates/employees and those immediately entering government service. Likewise, after computing changes from one immediate plan to another, thirty-one more individuals would have pursued academia, and almost 200 more would have pursued advanced dental education. Four individuals who had plans to immediately enter academia indicated they would have done otherwise, if it hadn’t been for their debt; and eighty-nine individuals who had plans to immediately enter programs of advanced education indicated they would have done otherwise if not for their debt.

Future Practice and Location Plans

Seniors were asked to indicate their intended activity ten years after graduation (Table 27⇓). Over the last five years, intended future practice ownership, either as sole owner or as an owner in a partnership or group practice, has fluctuated between 86 and 89 percent. It was 86.6 percent in 2004. This continues to be up from 81 percent of the seniors during the early 1990s expressing such long-range plans. The increase primarily has come through plans for entering partnership or group arrangements, rather than the entering of solo practices. Four percent of the seniors indicated that they planned to be in a private practice associate or employee status ten years following graduation. While 2.8 percent of the seniors at the time of graduation indicated they would be employed at community clinics, this apparently was not a long-range plan for over three-fourths of these individuals. Only 0.6 percent of the seniors reported this as a long-term plan.

In the aggregate, future plans of ownership by today’s seniors are similar to actual ownership by today’s practitioners, as reported by the American Dental Association in its 2001 Survey of Dental Practice (92 percent own their practice; 78 percent as sole owner and 14 percent in partnership). However, as has been the tendency over the years of conducting the senior survey, a far larger number of seniors report plans to be in partnerships than what actually occurs.

Again, only 1.6 percent of the seniors indicated future plans in academia, up from the 0.5 percent who indicated such plans upon graduation. However, when asked whether their immediate or long-range plans included teaching on a part-time basis, 46 percent of the seniors indicated such plans, most similar to what has been reported since 2001.There were differences in long-term plans by gender (Table 28⇓). Almost 42 percent of the males indicated future plans of solo private practice; whereas 30 percent of the females did so. More females had future plans of partnership arrangements (53.8 percent) or remaining in an employee status (6.2 percent) than males (47.6 percent and 2.4 percent respectively). Of the individuals with long-range plans for academia, slightly more were females than males. These trends are similar to what has been reported in previous years.

As has been routinely reported in previous years, practice location plans of seniors entering practice continue to be predominately toward larger metropolitan and urban/suburban areas (Table 29⇓). Almost 56.5 percent of the practice settings were to be in metropolitan areas greater than 100,000 population; 12.8 percent in metropolitan areas with 50,000 to 99,999 population; and 18.9 percent in practice settings in urban/suburban areas of 25,000 to 49,999 population. Seven percent of the practice settings were to be in urban/suburban areas with populations of 10,000 to 24,000; and 5 percent were in urban/ rural areas with populations of less than 10,000.

Table 30⇓ presents seniors’ practice location plans by race/ethnicity. Caution should be used in interpreting the findings due to the small number of responses that comprise some of the cells. It appears that minority seniors had greater tendency to enter practice in larger metropolitan areas than white seniors; whereas white seniors indicated a slight tendency for entering practice in the smaller urban/suburban and rural areas.

Based on their planned practice location, seniors were asked to indicate the percent of patients they expected would be from underserved areas. Thirty-two percent of the black/African American seniors indicated they expected that over 50 percent of their patients would be from underserved areas (Table 31⇓). This was 20 percent for Native American seniors, 13.3 percent for Hispanic/Latino seniors, and 8.2 and 3.1 percent respectively for Asian/Pacific Islander and white seniors. These data continue to confirm the trend that underrepresented minority graduates tend to establish their practices in areas serving minority populations at a greater rate than white graduates, particularly for black/African American graduates.

Community-Based Dental Education

With increasing attention being given to roles and responsibilities in addressing issues of access to oral health care for underserved populations, a series of questions was added to the 2003 senior survey regarding community-based dental education and extramural clinical rotations. This series of questions was repeated in 2004. Plans are to continue the series of questions over the next five or more years to document changes occurring in the amount of time seniors are providing oral health care on extramural clinical rotations and, from student perspectives, their sense of the adequacy of the amount of time they spent on their extramural clinical rotations. Table 32⇓ presents the frequency, by week, for the reported time the seniors of 2003 and 2004 would be spending during their senior year on extramural clinical rotations, providing (not just observing) oral health care. Over 52 percent of the seniors reported they would be spending from one to four weeks providing care through one or more extramural clinical rotations, up from about 49 percent in 2003. There was a small increase in the percent of seniors with one week of extramural rotations; very small declines in the percent reporting two or three weeks of extramural rotations; and four weeks showing the largest increase, from 10.4 to 13.6 percent. Overall there was a small decline, to 34.2 percent, in the percent of seniors with five or more weeks of extramural rotations. There was a small decline to 13.5 in the percent of seniors reporting they would not be providing care at extramural clinics.

Table 33⇓ presents the opinions of the seniors regarding the adequacy of the time spent on extramural rotations for the years 2003 and 2004. In 2003, the marked decline in the percent of seniors reporting their time to be inadequate was between the three and four weeks. This was also the time when the percent reporting excessive began to increase. In 2004, the marked decline in the percent reporting their time to be inadequate occurred between two and three weeks, with excessive also beginning to increase at that time period. Still of those seniors with five or more weeks at extramural settings, usually only between 12 and 15 percent reported the time to be excessive. For both years, almost 80 percent of the seniors reporting twelve or more weeks at extramural settings indicated the time was appropriate. Over 63 percent of the seniors who reported no extramural rotations in 2003 indicated that having no such time was inappropriate. This was 57.4 percent in 2004.

Over 63 percent of the seniors judged that, for comparable periods of time, they provided more treatment in their extramural clinical rotations than they did in the main school clinic; 41 percent judged they were much more productive. Almost 17 percent judged that the amount of treatment was comparable. Twenty-one percent judged themselves less productive at extramural rotations, providing less care in those settings, for comparable periods of time, than at the main school clinic. Eleven percent judged themselves to be much less productive.

The seniors were asked to rate their perception of technical quality and how patients were treated as people at the main school and extramural clinics (Table 34⇓). Overall, the technical quality of care was perceived to be better at the main school clinic, with slightly more than 80 percent of the seniors reporting technical quality was more than satisfactory at this setting. Technical quality was reported more than satisfactory at extramural settings by slightly more than 62.4 percent of the seniors. There was a slightly higher rating of how patients were treated as people at main school clinics than at extramural clinics. These findings are similar to those reported last year.

There were great differences expressed in levels of participation in quality assurance activities between main school and extramural clinics (Table 35⇓). Over 46 percent of the seniors reported they never participated in quality assurance activities (such as chart audits and critical incident reviews) at their extramural clinic rotations. This was 14 percent at their main school clinics. These percentages are similar to those reported last year.

Emphasis on preventive orientation and services provided (Table 36⇓) was higher at the main school clinics than at the extramural clinics, at 58 percent somewhat high to high at main school clinics versus 36.1 percent somewhat high to high at extramural clinics. This was reported low by 2.4 percent of the seniors for main school clinics and by 8.8 percent of the seniors for extramural clinics. These percentages, again, are similar to those reported last year.

Almost 77 percent of the seniors indicated that their extramural experiences somewhat to highly affected their ability to provide care to racially, ethnically, and culturally diverse groups; with almost 36 percent of the seniors reporting it was a high to very high effect (Table 37⇓). However, 56.6 percent of the seniors reported the extramural clinical experiences had little or no effect on their practice location plans. Slightly more than 11 percent indicated these experiences did highly affect their practice location plans, with 4 percent reporting the experiences very highly affected the plans. These percentages are also similar to those reported last year.

Almost 8 percent of the seniors reported that their extramural clinical rotations were a negative or very negative experience; 27.9 percent considered the experiences “neutral”; and 64.2 percent indicated the experiences were positive to very positive, with over 27 percent reporting them very positive. There was no change from last year in the percent of seniors reporting their extramural clinical rotations to be a negative experience and a slight increase in the percent reporting the rotations as positive experiences.

Seniors were asked to provide their perception of the cultural and social environment of their school promoting the acceptance and respect of students and patients of different races, ethnicities, and cultures (Table 38⇓). Almost 85 percent of the seniors reported that they thought their school had a cultural and social environment that did promote the acceptance and respect of students and patients of different races, ethnicities, and cultures. Over 15 percent disagreed or strongly disagreed with this statement. By race/ ethnicity, 27.6 percent of the Native American seniors and 25.6 percent of the black/African American seniors indicated that they thought their schools did not have an environment that promoted the acceptance and respect of students and patients of different races, ethnicity, and cultures. This was 20.3 percent for Asian/Pacific Islander, 13.8 percent for Hispanic/Latino, and12.6 percent for white seniors.

About two-thirds of the seniors indicated that they thought low-income individuals and populations were more challenging to serve because they presented with so many problems. By race/ethnicity, between 63 and 66 percent of Asian/Pacific Islander, Hispanic/Latino, and white seniors agreed or strongly agreed with this statement. However, only 43.4 percent of black/African American seniors agreed or strongly agreed with the statement. Eighty-three percent of the white seniors, 82 percent of the Hispanic/ Latino seniors, and 78.4 percent of Asian/Pacific Islander seniors agreed or strongly agreed that providing oral health care to underserved individuals or populations was challenging because they often lacked personal or public financial resources to pay for it. Less than 68 percent of black/African American seniors agreed or strongly agreed with the statement.

The 2004 senior survey included a series of questions regarding issues of access to oral health care. Over 77 percent of the respondents agreed or strongly agreed that access to oral health care was a societal good and right (Table 39⇓). Slightly larger percentage of the Asian/Pacific Islander, black/African American and Hispanic/Latino respondents agreed or strongly agreed (79 to 81 percent) than did white respondents (75.7 percent).

Over 71 percent of the respondents agreed or strongly agreed that access to oral health care was a problem in the United States (Table 40⇓). (In a similar question posed to senior medical students in their 2004 medical school graduation questionnaire administered by the Association of American Medical Colleges, over 86 percent of the respondents agreed or strongly agreed that access to medical care continued to be a major problem in the United States.) While there was similarity of agreement by Asian/Pacific Islander, Hispanic/Latino, and white respondents (between 70 to 72 percent), the black/African American respondents gave a higher percentage agreeing or strongly agreeing with the statement (80.5 percent).

Eighty-one percent of the respondents agreed or strongly agreed that ensuring and providing care to all segments of society is an ethical and professional obligation (Table 41⇓). By race/ethnicity, 20.5 percent of the white respondents disagreed or strongly disagreed with this statement. This was 16.3 percent for Asian/Pacific Islander, 15.4 percent for black/African American, and 13.4 percent for Hispanic/Latino respondents.

Seniors were asked whether they agreed or disagreed with the statement that everyone is entitled to receive basic oral health care regardless of his or her ability to pay (Table 42⇓). Over 71 percent of the respondents agreed or strongly agreed with the statement. (Almost 84 percent of senior medical students agreed or strongly agreed to a similar question on their 2004 graduation questionnaire.) By race/ethnicity, 32.5 percent of the white respondents disagreed or strongly disagreed with the statement. This was 21.4 percent for Asian/Pacific Islander, 20.9 percent for Hispanic/Latino, and 17.2 percent for black/African American respondents.

Plans for Postdoctoral Education

Table 43⇓ shows that 48.8 percent of the year 2004 survey respondents applied to one or more programs of postdoctoral dental education. There has been little change in this percentage over the last three years.

Over the past nine years, dental seniors have been asked their opinion of a required year of postdoctoral dental education (Table 44⇓). While almost 49 percent of the seniors applied for postdoctoral education, only 26.5 percent state that it should be required. This is the second year of decline following the high of 31.6 percent reported in 2002.

Almost 96 percent of the 2004 senior survey respondents indicated whether or not they had applied to one or more postdoctoral or advanced education programs. Of these respondents, 30.5 percent applied to a general practice residency (GPR) program or a program of advanced education in general dentistry (AEGD), continuing the slight increases that have occurred over the last several years (Table 45⇓ and Figure 7⇓). At the time of the survey, 26.6 percent of the seniors indicated they had been accepted to a GPR/ AEGD program. Thus 87.4 percent of the individuals who had applied to a GPR/AEGD program had been accepted. While this is similar to the percentages accepted in 2002 and 2003, it is down from the 90 to 92 percent acceptance rates seen prior to 2002.

Figure 7.

Percent of respondents applying and accepted to postdoctoral education programs

The percent of respondents applying to a specialty program in 2004 was 25.4 percent, continuing an overall upward trend that started in 1999 at 16.9 percent. At the time of the survey, 18 percent of the respondents indicated they had been accepted to a specialty program. The percent of the respondents indicating that they had not been accepted was 5.9. Thus at the time of completing the 2004 senior survey, of the seniors who had applied to specialty programs, 70.6 percent had been accepted, most similar to the acceptance rates of 2002 and 2003. The several years prior to 2002 had acceptance rates around 75 percent or higher.

Orthodontics continues to be the dental specialty most pursued by graduating seniors, with 29.4 percent of the seniors who applied to specialty programs in 2004 indicating this was their first preference (Table 46⇓). Following a decline in 2003, pediatric dentistry rose from 19.9 to 22.2 percent in 2004. Oral and maxillofacial surgery also showed an increase, from 17.8 to 19.7 percent. As a result of the increased in orthodontics, pediatric dentistry, and oral and maxillofacial surgery, the other specialty areas experienced slight declines.

Nearly 140 seniors indicated they had applied to dental school-sponsored advanced dental education programs that offer certificates or degrees, but are not accredited by the Commission on Dental Education. These include programs such as operative/restorative dentistry (twenty-nine applicants), oral biology (twenty applicants), oral science (six applicants), biomaterials (four applicants), and anesthesiology (four applicants). With such a variety of advanced dental education programs, the largest category was “Other,” with seventy-two applicants.

Thirty-eight seniors indicated they were pursuing education in nondental areas. Basic science had the largest number at twenty-four, followed by business administration and behavioral science (eleven each). Medicine had nine applicants, education had seven, and law had three.