MYTH: Loan forgiveness helps rural communities attract and retain dentists.
FACT: Loan forgiveness is an expensive strategy that isn’t large enough to attract and recruit enough dentists to impact access to care in rural communities.
Loan forgiveness is a VERY EXPENSIVE strategy for Florida. Consider that currently, 1 in 4 Florida residents –nearly SIX million — live in areas designated by the federal government as having a shortage of dentists. And 66 of 67 counties in Florida (94%) have at least one shortage area. With the average education debt of dental school seniors in 2022 being $239,000, according to the American Dental Association, this would be cost prohibitive. In 2019, dentistry was identified as the fourth most debt heavy graduate degree relative to income with a monthly debt-to-income ratio of 11.5% ($1,434).
There is always a limited number of newly graduating dentists interested in working in rural and underserved areas. The burden of increasing student debt is contributing to the influx of newly graduating dentists in urban or suburban areas. The incentives must be large enough to influence a new graduate’s employment decision and recruit enough of the new graduates and then retain the graduates after the incentive program ends.
At most, a general dentist can see 15 patients per day. Seeing 15 patients/day and working 5 days a week, 48 weeks a year comes out to 3,600 patients a year. These are highly ambitious figures.
The current Dental Student Loan Forgiveness Program in Florida, which passed in 2019 and has not been funded, can accept up to 10 dentists per year at $50,000/dentist annually for a maximum of 5 years.
Assuming that 10 dentists recruited in year one saw 3,600/patients/year for 5 years, they would see a total of 180,000 patients. This is assuming no patient is ever seen twice which is highly unrealistic. This would cost the state 2.5 million dollars and only serve 3% of the nearly 6 million residents living in dental shortage areas.
Let’s assume that 10 new dentists were recruited each year for 5 years (Table 1). At the end of 5 years, a total of 50 dentists would serve 540,000 patients which is only 9% of the need in the designated shortage areas. This is assuming patients are only seen once every 5 years which is unrealistic. Additionally, it would cost the state $7.5 million.
Table 1: Loan Forgiveness is an Expensive Strategy to Impact Dental Access
|Year 1||Year 2||Year 3||Year 4||Year 5||Total|
|10 dentists||36,000 patients||36,000 patients||36,000 patients||36,000 patients||36,000 patients|
|10 new dentists||36,000 patients||36,000 patients||36,000 patients||36,000 patients|
|10 new dentists||36,000 patients||36,000 patients||36,000 patients|
|10 new dentists||36,000 patients||36,000 patients|
|10 new dentists||36,000 patients|
Loan forgiveness is an expensive strategy that isn’t large enough to attract and recruit enough dentists to impact access to care in rural communities. Additionally, loan forgiveness programs do provide a short-term solution for some graduates working in rural and underserved areas but there is very little published evidence supporting the long-term effectiveness of loan forgiveness to keep dental practitioners in rural underserved areas. The likelihood that a provider who grew up in a rural area will practice there is higher than a provider deployed to a rural area for an allotted time.