The effect of education debt on dentists' career decisions

Influences of Financial and Workplace Factors on Physical Therapist Job Satisfaction

OBJECTIVE

The physical therapist labor market has recently noted higher rates of turnover and job vacancies. An understudied factor contributing to these trends in the profession is job satisfaction. The profession continues to experience relatively low wages compared with other health professions, and graduates of Doctor of Physical Therapy programs face increasingly high student debt. This study used the labor-search model as a conceptual framework to understand associations between job satisfaction, income, and educational debt. The purpose of this study is to observe the financial and workplace factors that are associated with higher levels of physical therapist job satisfaction.

METHODS

Data from 4764 physical therapists in 1 state were captured retrospectively through the state's licensure renewal process from 2014 to 2020. A random effects panel analysis, with job satisfaction as the dependent variable, was used to evaluate the relationships between job satisfaction and income, educational debt, and a variety of work-related factors.

RESULTS

Job satisfaction was negatively correlated with educational debt, number of hours worked per week, and some practice settings. Conversely, job satisfaction was positively correlated with the expected age of retirement. The percentage of time spent in research and administration was also positively correlated with job satisfaction, though additional research in this area is needed to draw meaningful conclusions on this association.

CONCLUSION

The results support the conceptual framework, which suggests that early career physical therapists, motivated by high amounts of educational debt, may choose more financially advantageous practice settings and increased working hours to the detriment of job satisfaction.

IMPACT

High levels of job satisfaction among physical therapists are correlated with low levels of educational debt, working 45 hours or less per week, a longer time horizon until retirement, and practice settings other than home health and skilled nursing facilities.

Exploring dental faculty perceptions of current strategies and barriers to retention

PURPOSE

The aims of the study were to identify perceived strategies for and barriers to faculty retention and examine differences regarding age, gender, and race.

METHODS

Cross-sectional data was captured from the eight author-affiliated dental schools. A Qualtrics survey was emailed to all faculty members at these institutions (1467 possible participants) between November 2021 and February 2022. The survey was formulated from best practices listed in the American Dental Education Association Faculty Diversity Toolkit. It consisted of 18 questions, including demographic information and faculty perceptions of their respective workplaces. These responses were then evaluated with descriptive statistics, Chi-squared analysis, Pearson Correlation, and Fleiss' kappa.

RESULTS

The survey's response rate was 19.2%. There was no significant difference in perceived retention strategies across race, age, gender, practice tenure, practice type, or clinical versus tenure track. The top four barriers identified were inadequate financial compensation, workload, poor work environment, and burnout. There was a significant difference between racial groups and their perceived barrier of support for promotion (p = 0.048). This was more prevalent among clinical faculty (47.7%) than tenure track faculty (16.2%). The work environment was listed as a leading factor for both promoting retention and encouraging the exodus of faculty members.

CONCLUSION

Strategies aimed at improving financial compensation, career recognition, and transparency of the promotion process, along with those aimed at improving the work environment were shown to be vital to retaining faculty. Though the low response rate is a study limitation, these findings provide valuable information and a framework for future studies regarding dental faculty recruitment and retention.

Impact of Dental Institutions' Values on Students' Intent to Practice in Underserved Communities: A Cross-sectional Study

AIM

To evaluate how an institution's values can impact students' intent to practice in underserved areas.

MATERIALS AND METHODS

The values of 71 accredited dental schools in the United States were searched and tabulated. The American Dental Education Association (ADEA) survey results were used to tabulate the desire to serve the underserved population before entering dental school and upon graduation. Additionally, responses on the total amount of educational debt on graduation was compiled for LLUSD and all other dental schools. Fisher's exact test was performed to compare the difference between the two cohorts and Wilcoxon test was used to assess difference within the groups. Tests were conducted at an alpha level of 0.05 with SAS v 9.1.3 (SAS Institute, Cary, NC, USA).

RESULTS

The top five values of US dental institutions based on frequency were excellence, diversity/inclusion, integrity, innovation, and respect. There was no statistically significant difference between LLUSD and all other dental schools in their desire to serve the underserved community upon graduation (p > 0.05, in all instances). Overall, there was a trend that upon graduation, the desire to serve the underserved had less impact on students' decision-making on their career choices. This drop in the desire to serve the underserved was statistically significant within both cohorts in the year 2021 (p < 0.001).

CONCLUSIONS

Dental institutions should focus on better understanding of how their values impact their students' career choices so that they can develop strategies to better align their values with the mission of addressing the dentist shortage in underserved areas.

CLINICAL SIGNIFICANCE

Dental institutions' values play a major role in impacting students' career choices upon graduation and should be assessed using metrics that are measurable.

Impacts of educational debt on physical therapist employment trends

BACKGROUND

Newly graduated physical therapists have high amounts of educational debt. Educational debt may negatively affect job satisfaction, aspirations for professional development, and choice of workplace setting. Research has not shown this association directly, yet it is conceptually supported by the Labor-Search Model. The purpose of this study was to understand the role that educational debt has on additional factors related to job choice in the Labor-Search Model.

METHODS

Retrospective data were captured through the Virginia Longitudinal Data System (VLDS) for 12,594 licensed physical therapists within the Commonwealth of Virginia from 2014 to 2020. A fixed effects panel analysis, with inflation-adjusted educational debt as the variable of interest, was conducted to assess whether patterns of professional certifications, volume of work, workplace setting, and job satisfaction were related to educational debt.

RESULTS

Educational debt was positively correlated with higher professional degrees (p = 0.009), the number of hours worked per week (p = 0.049), and expected number of years until retirement (p = 0.013). Job satisfaction was statistically significant (p = 0.042) and negatively correlated with educational debt.

CONCLUSIONS

Those with higher educational debt appear to have the habit of working more hours per week and have a longer time horizon until retirement. Newly licensed physical therapists with higher amounts of educational debt are more likely to experience this trend. Income and job satisfaction demonstrated an interaction effect on educational debt, such that those with lower levels of income had a stronger, negative relationship between their debt and job satisfaction, as compared to those with higher income.

Salary and student loan debt for oncology social workers: Findings from the oncology social work competencies, opportunities, roles and expertise (CORE) survey

PURPOSE

To better understand the current salaries and student loan debt levels among oncology social workers (OSWs).

DESIGN

Cross-sectional study using online survey.

SAMPLE

OSWs across a variety of cancer care settings in the U.S. (n = 1055).

METHODS

Salary and debt were collected via single ordinal variables. Crosstabs and chi-square tests were used to examine whether salary and debt differ by demographic and work-related characteristics.

FINDINGS

Median OSW salaries ranged from $60,001 to $70,000. Three-fourths of OSWs reported having student loan debt. Younger and recently graduated OSWs and OSWs of color were more likely to have greater student loan debt than their counterparts.

CONCLUSIONS

Relative low salary and debt burden have important implications for securing a current and future OSW workforce.

IMPLICATIONS FOR PSYCHOSOCIAL POLICY

Adequate reimbursement and loan repayment opportunities for frontline OSWs will better secure this workforce. Advocacy efforts to identify OSWs qualified for loan forgiveness programs are warranted.

Leadership aspiration: An intersectional analysis of racial and gender equity in pharmacy

BACKGROUND

The glass ceiling is a metaphor used to describe an invisible barrier that prevents an underrepresented group from rising beyond a certain level. Among pharmacists, underrepresented groups face various barriers and limitations to their successes.

OBJECTIVES

The purpose of this study was to apply the intersectionality framework to data collected from the 2019 National Pharmacist Workforce Study (NPWS) to understand the association of gender and race with leadership aspiration among pharmacists, including differences in perceived barriers and attractors for pursuing leadership.

METHODS

The 2019 NPWS was conducted using an electronic Qualtrics survey. Three e-mails containing the survey link were sent to a systematic random sample of 94,803 pharmacists through the National Association of Boards of Pharmacy Foundation e-profile system. The 2019 NPWS had an overall response rate of 6% (5705/94,803). A total of 8466 pharmacists clicked on the survey link, resulting in a usable response rate of 67.3% (5705/8466). Data were analyzed in SPSS software using descriptive and Pearson's r and chi-square test statistics.

RESULTS

Black, Indigenous, and People of Color (BIPOC) pharmacists reported holding 10.7% of all leadership positions. Leadership positions included manager, assistant manager, executive, dean, director, chief pharmacy officer, owner or partner, and other leadership position types. White men and women reported the lowest interest in leadership (38.8% and 37.7%), whereas Black men (65.1%), Latinas (59.2%), Black women (58.5%), and Latinos (57.1%) had the highest interest in leadership. "The ability to make an impact" was the most frequently selected attractor for wanting to pursue leadership, selected by 92.5% and 79.6% of Black men and women, respectively, 77.8% of Other women, and 76.9% of Latinos. At graduation from pharmacy school, the student debt loan average of all graduation years ranged from $63,886 (± $73,701) for Other men to $112,384 (± $105,417) for Black women. Higher student loan debt was positively correlated with wanting to pursue a leadership position (r = 0.22, P < 0.001). Black women graduating 2011-2019 had the highest student loan debt at graduation ($194,456 ± $88,898).

CONCLUSION

Interest in leadership positions by BIPOC pharmacists compared with reported leadership roles were inversely correlated. Understanding the discrepancy in interest in leadership and reported leadership positions held, particularly with relation to race and gender, is essential to understanding equity in pharmacy leadership. Further research is warranted to understand the factors that impede the ascension of women and underrepresented pharmacists into leadership positions.

Assessment of Dentist Participation in Public Insurance Programs for Children in the US

Importance

Evaluating the availability of dentists to provide dental care services to children is important for identifying interventions for improving access.

Objective

To assess dental care availability for children in the US by public insurance participation, rural-urban setting, and dentist taxonomy (general, pediatric, or specialized).

Design, Setting, and Participants

This cross-sectional study analyzed the availability of dentists from matching 3 data sets: the 2020 National Plan and Provider Enumeration System, the 2019-2020 State Board of Dentistry information acquired from each state, and the 2019 InsureKidsNow.org database. Data on active dentists in most states (including the District of Columbia [combined hereinafter with states] and excluding Hawaii and Washington) were included in the analysis. The study was conducted from January 2019 to March 2022.

Main Outcomes and Measures

The number and percentage of dentists participating in public insurance programs (Medicaid and/or Children's Health Insurance Program [CHIP]) were aggregated at the dental office and stratified by the rurality of their practice and taxonomy. State-level comparisons were derived between this study and reports from the Health Policy Institute of the American Dental Association, along with maps and summary statistics disseminated through a data portal and state reports.

Results

Among 204 279 active dentists, participation in public insurance varied widely across states, especially for the states that manage the Medicaid and CHIP programs separately. Participation rates in Medicaid and CHIP varied substantially from those of the Health Policy Institute of the American Dental Association. Participation in Medicaid and CHIP was lowest among urban dentists (Medicaid, 26%; CHIP, 29%) and highest among rural dentists (Medicaid, 39%; CHIP, 40%), while urban dentists accounted for most of the dentist population (urban, 84%; rural, 5%). Similarly, participation in Medicaid and CHIP was substantially lower among general dentists (Medicaid, 28%; CHIP, 29%) vs pediatric dentists (57% in both programs), while each state's dentist population consisted of notably more general (84%) than pediatric (3%) dentists. Nearly half of the states revealed wide variations in Medicaid and CHIP participation between counties, ranging from no participation (21 states) to full participation (22 states).

Conclusions and Relevance

The findings of this study suggest that disparities in the availability of dentists for pediatric dental care are extensive, particularly for Medicaid- and CHIP-insured children, those living in rural communities, and those receiving specialized care. Lack of dentist availability for Medicaid- and CHIP-insured children appears to deter access to receiving dental care.

A retrospective study of the admission ways in the School of Dentistry of National Taiwan University from 2000 to 2021

Background/purpose

In Taiwan, dental schools have gradually become a popular choice for high school graduates to enter in the universities. This study mainly analyzed the various admission ways to enroll students into the School of Dentistry of National Taiwan University (SODNTU) from 2000 to 2021.

Materials and methods

The data on the numbers of enrollees and those enrollees who had completed registration in the SODNTU from 2000 to 2021 were available online to the public and included in this study.

Results

The total number of enrollees in the SODNTU over the past 22 years was 764 with an annual mean of 34.73. The registration rate ranged from 90.91% to 100% with a mean registration rate of 96.86% from 2000 to 2021. The examination admission, individual application admission, and numerous stars initiatives admission were the three main admission ways to enroll students into the SODNTU from 2000 to 2021 with a total of 662 enrollees (86.65% of a total of 764 enrollees). The number (proportion) of enrollees through examination admission showed a decreasing trend year by year from 26 (78.79%) in 2000 to 15 (45.45%) in 2021. On the contrary, those enrollees through individual application admission and numerous stars initiatives admission showed an increasing trend year by year from 4 (12.12%) in 2000 to 14 (42.42%) in 2021.

Conclusion

Although the examination admission is still the predominant admission way, the individual application admission and numerous stars initiatives admission gradually play pivotal roles to enroll students into the SODNTU recently.

Tuition and fees for medical education and dental education in Taiwan from 1993 to 2021

Background/purpose

In traditional Taiwan's society, attending medical school or dental school is usually the greatest aspiration of our students. This study tried to explore the evolution of the tuition and fees for medical education and dental education in Taiwan from 1993 to 2021.

Materials and methods

This study used the secondary data analysis to survey the changes in the actual amount of the tuition and fees from 1993 to 2021, and the association of tuition and fees with economic indicators.

Results

The one-year tuition and fees for medical education increased from 39,020 to 95,200 NT dollars in 1993 to 78,327 and 135,829 NT dollars in 2021 for public and private medical schools, respectively. On the other hand, the one-year tuition and fees for dental education increased from 35,700 to 87,100 NT dollars in 1993 to 71,607 and 130,682 NT dollars in 2021 for public and private dental schools, respectively. Because different increase rates between public and private schools, the gap between tuition and fees per gross domestic product per capita (capita GDP) and those per basic annual salary of labor for public and private schools was shortened year by year.

Conclusion

In addition to allowing reasonable increases of tuition and fees, the government should also consider to let the disadvantaged students pay less tuition and fees, assist disadvantaged students through school loans, school grants or scholarships, and improve the opportunities for disadvantaged students to enroll in medical and dental schools through the admission system.

Knowledge, Attitude, Practice, Motives and Barriers Towards Scientific Research among Dentists and Dental Students in Saudi Arabia

Background:

Research is crucial for the scientific progress of the health of individuals, communities, and systems. The aim of this study was to assess the knowledge, attitude, motives and barriers among dentists and dental students in the western region of Saudi Arabia.

Objective:

This study aims to assess the level of knowledge, attitude, motives and barriers toward scientific research among dentists and dental students in the western region of Saudi Arabia.

Methods:

We conducted a cross-sectional study of 467 dentists and dental students using a convenience sampling method from seven dental colleges, major governmental and private dental clinics in the Western region of Saudi Arabia. We used a validated self-report questionnaire to collect data and assess the knowledge of, attitude towards and barriers to scientific research.

Results:

The participants (who are dentists and dental students) have a total knowledge score of m=4.57, SD=2.46, which is slightly lower than the midpoint. Participants who work in governmental clinic were significantly (F (2,464) =13.71, p<0.001) more knowledgeable than those who worked in private clinic and the students. Most participants had positive general and personal attitudes toward scientific research. Of the participants, 40.5% to 60.4% were involved in research activities, and 37.3% have submitted or published scientific articles. The most common motive for scientific research was receiving credit for post-graduate application (58.46%). The most common organizational barrier to conduct a research was the difficulty of finding research supervisor (39.19%) and lack of time due to work overload (32.55%). While most common personal barriers were lack of knowledge/skills (38.76%), lack of personal time (36.83%) and receiving credit for postgraduate application.

Conclusion:

Saudi dentists and dental students had a moderate level of knowledge and practice in research, but their attitude was highly positive. More efforts are needed to facilitate scientific dental research including supervisors’ availability and time allocation for research. The study has some limitations including using convenience sample from one region and self-report questionnaire that decreases the external validity of the study and increases the potential for self-reported biases.

Should dentistry be a specialty of medicine? Two viewpoints

Dentistry and dental education are well-established domains with deep-rooted institutions, educational programs, organizational structures, and advanced specialty fields. Almost 100 years ago, Dr. William Gies, founder of the Columbia University College of Dental Medicine, stated that to best serve the oral health needs of the population, dentistry should be considered a specialty of medicine, and dental students should have the same solid foundation in the basic and clinical sciences as medical students. More recently, the report on "Advancing Dental Education in the 21st Century" recommends an increase in the integration of dental and medical education as a means to address 2 of its key challenges: "shrinking demand for dental services" and "shifting practice environment." However, it has also been argued that making dentistry and dental education a subspecialty of medicine and medical education will create logistical, structural, regulatory, and financial dilemmas. Instead of a drastic change to current dental educational, organizational, and institutional models, some argue a contemporary approach to dental education is required to ensure dentists are well prepared to address the healthcare needs of the population and future healthcare delivery systems and practice models. Recognizing the need for change in dental education to keep pace with changes in patient demographics and healthcare systems, the dental profession has the responsibility and opportunity to develop new models and paradigms that improve educational and clinical outcomes in our educational programs and future practice.

Attitudes and behaviors regarding public health of dental school graduates from A. T. Still University

PURPOSE

To survey A. T. Still University, Arizona School of Dentistry & Oral Health (ATSU-ASDOH) graduates and evaluate the impact of completing a Master of Public Health (MPH) degree during dental school on a dentist's practice behaviors, volunteerism, and attitudes toward dental education, practice preparedness, and the dental profession.

METHODS

In 2018, a 35-question survey was emailed to 637 (ATSU-ASDOH) graduates from 2007 to 2017. Questions were related to demographics, obtaining an MPH, postgraduate education, practice setting, and attitudes regarding dental education on practice preparedness and the dental profession.

RESULTS

One hundred and seven dentists completed the survey for a response rate of 16.8%. Of those, 40 respondents received an MPH from (ATSU-ASDOH) at the same time as graduating with a DMD or within 5 years following graduation. Dentists with an MPH were more likely to practice in public health settings (P = 0.028). However, the MPH did not appear to influence attitudes toward the dental profession.

CONCLUSION

Dentists from (ATSU-ASDOH) who obtained an MPH and those who entered dental school wanting to work with the underserved are more likely to practice within public health settings. This study begins to paint a picture of a dual degree graduate. Future studies should explore which variables are more likely to result in a graduate working within a public health setting.

Physiotherapy education is a good financial investment, up to a certain level of student debt: an inter-professional economic analysis

QUESTIONS

What is the economic value of a physiotherapy career relative to other healthcare professions? Is the graduate debt reported for physiotherapy manageable according to recommended salary-weighted debt service ratio benchmarks?

DESIGN

Net present value (NPV) is an economic modelling approach that compares costs and benefits of an investment such as healthcare education. An economic analysis using the NPV approach was conducted and reported in US dollars for the Doctor of Physical Therapy degree. Comparable calculations were made for a range of other healthcare qualifications. Debt service ratios were also calculated under a range of scenarios.

OUTCOME MEASURES

Entry-level salaries and rate of salary growth were obtained from government databases. Student debt levels were obtained from published sources. Because no national estimate exists for physical therapy student debt, debt was modelled for recent Doctor of Physical Therapy (DPT) graduates and for several hypothetical debt tiers. The NPV modelled future physical therapy earnings less the cost of education and the opportunity cost of foregone earnings from alternate careers.

RESULTS

At the debt level reported by recent graduates (US $86563), physical therapy NPV was higher than occupational therapy, optometry, veterinary medicine, and chiropractic but lower than dentistry, pharmacy, nurse practitioner, physician assistant, and all medical specialties. At $150000 debt, physical therapy NPV falls below all careers except veterinary medicine and chiropractic. Students with>$200000 debt may not achieve recommended repayment benchmarks. At high debt levels (>$266000), physical therapy NPV no longer exceeds that of a bachelor's degree.

CONCLUSION

Physiotherapy education is a good financial investment, up to a certain level of student debt. Students should carefully consider the amount of debt they are willing to incur in order to pursue a physiotherapy career. Likewise, physiotherapy education programs should consider the role they may play in bolstering the economic value of their graduates' future careers. [Shields RK, Dudley-Javoroski S (2018) Physiotherapy education is a good financial investment, up to a certain level of student debt: an inter-professional economic analysis. Journal of Physiotherapy 64: 182-190].

Does student debt affect dental students' and dentists' stress levels?

Introduction Many studies have shown financial worries and debt to induce stress in individuals, this combined with the existing stress of being a dentist raises the question of how student debt affects students' and dentists' stress levels.Objectives Determine whether student debt has had any noticeable effect on student stress levels; investigate whether student debt has any effect on dentists' career choice; investigate whether the increase in tuition fees has influenced the number of applicants to study dentistry at the University of Birmingham.Method Anonymous questionnaires were completed by 70 4th year and 38 5th year BDS and 22 Dental Core Trainees (DCTs). Participants circled the response which best fitted their situation regarding statements on their level of stress and future career path. Ethical approval granted. Application figures to study dentistry obtained from head of admissions.Results Forty-two percent of males and 63% of females strongly agreed with the statement that having no debt would reduce their stress levels. Of those with debt >£40,000, 11% strongly agreed and 42% agreed that their total amount of student debt causes them stress. Whereas, those whose debt is <£40,000 only 2% strongly agreed and 28% agreed that their total amount of student debt causes them stress. Seventy-seven percent of participants who had parental or family financial support reported this reduced their stress levels. Student debt was found to deter females from undertaking further study more than it deters males (P <0.001). Students with a higher level of debt were more likely to worry about their total student loan(s) (P <0.001). Moreover, students with a higher level of debt were more likely to be stressed about their total student loan(s) (P <0.001). Parental/family contribution to student expenses reduces student stress (P <0.001). Applications to study dentistry since the rise in tuition fees have decreased by 42%.Conclusion Student debt has had an impact on student stress; students reporting a higher level of debt also report more stress and concern about paying off their student debt. Having no student debt would reduce stress levels, although to what extent is undetermined. Applications to study dentistry have fallen since the increase in tuition fees.

Retention and recruitment of general dentists in an adjunct teaching model-A pilot study

PURPOSE/OBJECTIVES

Retention and recruitment of part time clinical adjunct faculty members in dental education is becoming increasingly difficult as dental schools come to rely on this workforce for their increased involvement in clinical education. Contributing factors include full time faculty shortage, aging workforce, practice and student debt, practice and family commitments, and financial compensation. This study attempts to ascertain barriers to teaching so appropriate strategies can be formulated to address this issue.

METHODS

In the spring of 2016 an email survey was sent to current and former adjunct faculty members to ascertain demographics and retention and recruitment strategies. Descriptive analyses were completed for all variables in the sample.

RESULTS

Twenty nine of forty six subjects responded to the survey with a response rate of 63%. Subjects over the age of sixty comprised 55% with only 17% being under the age of forty five. Overall family and practice commitments along with compensation were the primary barriers to teaching part time. For new dentists, student loan debt was the primary barrier to teaching. Travel to teach was also a barrier as 70% of respondents drove 200 miles or less to the dental school.

CONCLUSION

The study demonstrated that the aging part time work force is a great concern and new part time clinical adjunct faculty members must be recruited. Barriers to recruitment and retention of faculty must be considered and addressed to sustain this teaching model.

The cost-effectiveness of three interventions for providing preventive services to low-income children

OBJECTIVE

We evaluated the impact of loan repayment programmes, revising Medicaid fee-for-service rates, and changing dental hygienist supervision requirements on access to preventive dental care for children in Georgia.

METHODS

We estimated cost savings from the three interventions of preventive care for young children after netting out the intervention cost. We used a regression model to evaluate the impact of changing the Medicaid reimbursement rates. The impact of supervision was evaluated by comparing general and direct supervision in school-based dental sealant programmes.

RESULTS

Federal loan repayments to dentists and school-based sealant programmes (SBSPs) had lower intervention costs (with higher potential cost savings) than raising the Medicaid reimbursement rate. General supervision had costs 56% lower than direct supervision of dental hygienists for implementing a SBSP. Raising the Medicaid reimbursement rate by 10 percentage points would improve utilization by <1% and cost over $38 million. Given one parameter set, SBSPs could serve over 27 000 children with an intervention cost between $500 000 and $1.3 million with a potential cost saving of $1.1 million. Loan repayment could serve almost 13 000 children for a cost of $400 000 and a potential cost saving of $176 000.

CONCLUSIONS

The three interventions all improved met need for preventive dental care. Raising the reimbursement rate alone would marginally affect utilization of Medicaid services but would not substantially increase acceptance of Medicaid by providers. Both loan repayment programmes and amending supervision requirements are potentially cost-saving interventions. Loan repayment programmes provide complete care to targeted areas, while amending supervision requirements of dental hygienists could provide preventive care across the state.