A peer-reviewed journal that offers evidence-based clinical information and continuing education for dentists.

How Educational Debt Influences Practice Choices

Combined with an overall tightening in lending practices, this burden of debt has restricted graduates’ ability to obtain credit for starting their own offices.


Student debt is one of the hot button issues in the 2016 presidential election — and for good reason. Across the U.S., student loan debt has nearly quadrupled in the past 10 years to more than $1 trillion.1 The problem is particularly acute in dentistry. According to the American Student Dental Association, three out of four dental students will have more than $100,000 of debt, with the average student graduating with $241,097 in debt.2


Combined with an overall tightening in lending practices, this burden of debt has restricted graduates’ ability to obtain credit for starting their own offices. It has also raised concerns that debt may be influencing young dentists’ career choices. Between 2001 and 2012, average dental student debt doubled. 2 In roughly the same period, market share for dental firms with 20 or more employees increased more than any other segment, while dental firms with fewer than five employees saw declines in market share.3 It is hard to believe these trends — rising student debt and more large practices and dental service organizations employing dentists — are unrelated. Yet correlation is not the same as causation.

Taking a closer look, a study published in the Journal of the American Dental Association found that an additional $60,000 of debt at the time of graduation increased the likelihood a dentist would choose private practice by 4.2 percentage points. This figure was also associated with a 2-point decrease in the likelihood of accepting a government position, such as the armed services, and an 0.8-point decrease in the likelihood of accepting a faculty post.4

That said, among graduates who entered private practice, the team found no association between educational debt and how likely a dentist was to choose to be an employee or practice owner. Debt also did not appear to influence the percentage of Medicaid and charity care patients the dentist saw, or the number of hours worked.4

So, what influenced the decision to be a practice owner or an employee? Gender and race. Female and nonwhite dentists are less likely to be practice owners, according to researchers, who also report these practitioners see more Medicaid and charity care patients than white male dentists. In addition, female dentists work roughly 20% fewer hours than their male counterparts.4

The researchers concluded that while student loans influence some career decisions — with individuals with heavy debt being more attracted to high-paying jobs after graduation — educational debt was neither the largest factor nor a primary driver of growth in the number of dentists choosing to be employees rather than owner/operators.


  1. Haughwout A, Lee D, Scally J, van der Klaauw W. Student Loan Borrowing and Repayment Trends. Federal Reserve Bank of New York. April 16, 2015. Available at: newyorkfed.org/medialibrary/media/newsevents/mediaadvisory/ 2015/Student-Loan-Press-Briefing-Presentation.pdf. Accessed September 1, 2016.
  2. American Student Dental Association. The Issues: Dental Student Debt. Available at: asdanet.org/debt.aspx. Accessed September 1, 2016.
  3. Wall T, Guay AH. Very large dental practices seeing significant growth in market share. Health Policy Institute Research Brief. Chicago: American Dental Association; 2015.
  4. Nicholson S, Vujicic M, Wancheck T, Ziebert A, Menezes A. The effect of education debt on dentists’ career decisions. J Am Dent Assoc. 2015;146:800–807.

From Decisions in Dentistry. October 2016;2(10):54.

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