On student debt, culpability, and the generation gap

Sept. 22, 2016
Is dental student debt among millenials their own fault? A recent grad explores this popular belief.

A prominent leader in dentistry recently told me that today's dental students are buried in debt because they spend too much money on flashy cars, housing, and vacations. I've heard this before. I'm a millennial who will graduate from dental school in a month, and this strikes me as a misunderstanding between generations. It's also—somewhat—rooted in truth.

I'd like to help generations come together on this. Changes in the cost of dental school can make student debt difficult to understand for practicing dentists. The spending behavior of today's students can be even more baffling without some knowledge of millennial values. Let's talk about the values first. A study conducted by Harris and sponsored by Eventbrite found the following: "[The millennial] generation not only highly values experiences, but they are increasingly spending time and money on them: from concerts and social events to athletic pursuits, to cultural experiences, and events of all kinds. For this group, happiness isn't as focused on possessions or career status. Living a meaningful, happy life is about creating, sharing, and capturing memories earned through experiences that span the spectrum of life's opportunities."1

Millennials value experience over goods. So they likely agree with baby boomers who say dental students shouldn't spend money on expensive cars, clothes, or housing. On the other hand, they likely don't agree on whether or not it makes sense for dental students to pay to run in marathons, attend music festivals, or travel to other countries. So where is the disconnect? Millennials are not the first to be deprived of the things they value during dental school. Baby boomers valued owning, and dental school delayed car and home ownership for that generation just as it now holds millennials back from experience. The difference may be in the temporal nature of experience.

Some things in life can best be lived when one is young and healthy. As the Harris study puts it, millennials strive for experiences that "span the spectrum" of life's opportunities, and dental school blocks out four years of young adulthood.1 It's one thing to look forward to owning a boat at the end of dental school. One can amass goods after graduation. It's different to be looking forward to an experience even as it slips away. Living a life confined to lecture halls, libraries, and simulation labs can make millennials unhappy in ways that can be difficult for generations with different values to understand.

So I ask boomers to work on that understanding. When it comes to possessions, millennials can live happy, spartan lifestyles in dental school. They're built for it. But it's not healthy for a generation that values the formation of memories to remember only dental school. The emotional and psychological costs of dental school are becoming well known-so much so that the American Student Dental Association (ASDA) has launched a nationwide wellness initiative to offer support and resources to its members. Staving off four years of unhappiness may well be worth a reasonable, calculated increase in debt.

But today's students need to stop buying unneeded goods. Any millennial can name a classmate who drives a luxury car to anatomy lab or has a different, trendy pair of shoes for every day in clinic. Millennials should wait to own like the boomers did before them. According to Bryan Cook, PhD, senior vice president for educational research and analysis at the American Dental Education Association (ADEA), the average debt of a 2015 dental school graduate is $255,567. For a 1996 graduate, it was $84,247, or $127,266 when adjusted for inflation (Bryan Cook, PhD, e-mail communication, February 11, 2016). This means the value of dental student debt has doubled in 20 years. Is millennial spending to blame? We don't have concrete numbers on dental student spending, but the ADA Health Policy Institute's 2014–2015 report on tuition, admission, and attrition found the average costs for all four years of dental school have increased more than $100,000 for in-state students in the past 10 years.2 This means the rising costs of dental school make up a large part of the increase in student debt.

But not all of it. If my experience is an indication, millennials can assume their spending contributes to the problem, and that problem may affect more than just monthly loan payments. The cover story of the November 2015 issue of the Journal of the American Dental Association explored the effect of student debt on the practice decisions of new dentists. It found those with higher debt were less likely to specialize and more likely to enter private practice, accept high-paying jobs upon graduation, and work longer hours.3 Demographic factors such sex and race, however, had larger effects.3 Millennials will need to weigh those findings as they consider further spending.

Some of my mentors are baffled when I tell them I spend money on skiing, surfing, and backpacking. Maybe our generations don't need to viscerally understand each other. While boomers and millennials were raised with different values, our searches for happiness are similar in that they are intensely individual.

Perhaps the best thing we can do is fight generational misunderstanding. Millennials share some culpability for their debt. They need to control spending on experience and stop buying needless goods. In the meantime, they're making sacrifices to enter our profession, and I hope we can work together to learn and respect their needs for well-being.

1. Millennials: Fueling the experience economy. Eventbrite website. https://eventbrite-s3.s3.amazonaws.com/marketing/Millennials_Research/Gen_PR_Final.pdf. Published August 19, 2015. Accessed August 3, 2016.
2. ADA Health Policy Institute. Survey of Dental Education Series Report 2: Tuition, Admission, and Attrition. http://www.ada.org/en/science-research/health-policy-institute/data-center/dental-education. Published June 2015. Updated December 2015. Accessed August 3, 2016.
3. 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(11):800-807.

Christian Piers, DDS, MFA, is a recent graduate of the University of Colorado School of Dental Medicine. He is now an orthodontic resident at the University of North Carolina at Chapel Hill. He is the immediate past president of the American Student Dental Association (ASDA), and also serves on the Editorial Board of the Journal of the American Dental Association (JADA) and ADA Council on Dental Education and Licensure (CDEL).

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