As part of AccessOMFS’s mission to help those interested in oral surgery, it was only a matter of time before there was a discussion about debt. I am sure as a dental student, you are acutely aware of the amount of debt one can acquire when obtaining your DMD/DDS. This number climbs even higher if you elect for the six-year route, and unfortunately medical education isn’t much cheaper. Student debt, in a general sense, has been discussed ad nauseum. Therefore, I will do my best to focus my discussion on OMFS debt and the following questions:
1. What is the spectrum of student debt among oral surgeons?
2. Will I be able to repay this debt?
3. How do I repay this debt?
The answers to these questions are not straightforward and there are a lot of variables at play. However, through a little digging, and your help, I hope to be able to paint a somewhat clearer picture of what the numbers look like.
What is the Spectrum of Student Debt Among Oral Surgeons?
Fortunately, I am not the first to pose this question, and I was able to find some literature that had explored this topic. Granted, it is not purely objective data since it was accumulated via survey, but it is better than anything else we have at the moment. According to Jones and Ellis,1 the average range of debt of graduating chief residents surveyed in 2018 was $300-350k. There was a difference in debt ranges among four-year ($250-300k) and six-year residents ($400-450k). There were 120 respondents to the survey, with 24.16% indicating that they had greater than $500,000 in debt. The paper does a great job of exploring all the nuances, including asking residents about how their debt will affect their future practice decisions and if moonlighting made a difference in debt accumulation. I encourage you to read it.
Without a doubt, these are striking figures, especially when there were some respondents that had over $900k in debt. Some other data points worth looking into include debt breakdown by surgery program, region, and private/public medical schools. To push the issue further, it would be important to look at the debt loads of entering residents to determine if we are pushing away good candidates by not offering them a means to reduce their financial burden. Although not scientific, I did some surveying to help answer these questions. Note that I have no way to validate this data, but you may be able to get an indication of what you would be looking at should you pursue a certain program or pathway. The survey results are below. Thank you to those paying it forward with your data.
AccessOMFS General Debt Survey (Responses) : Debt Survey
| Practicing Surgeon, Resident, or Applicant? | Year of DMD/Res Graduation | Dental School | Dental School Debt | Residency Program | Length of training | Residency Debt | Total Debt | |
| Resident | 2019 | Columbia | $400,000.00 | Cincinnati | 4 years | $0.00 | $500,000.00 | |
| Applicant | 2020 | UConn | 220000 | Kentucky | 6 years | 80000 | 300000 | |
| Resident | 2016 | Private School | 100000 | Texas | 6 years | 170000 | 280000 | |
| Resident | 2020 | Some really expensive one… | 380000 | NE 6 Yr program | 6 years | |||
| Resident | 2019 | North East | 100000 | North East | 6 years | 0 | 100000 | |
| Resident | 2020 | Private school | 472000 | 6 years |
Will I Be Able to Repay This Debt?
Unequivocally, the answer to this question is yes. Despite this, there are some caveats. Could you afford a $100k car on a $100k salary? Of course you could, but you probably shouldn’t. It all boils down to the kind of financial and life goals you have and how you expect to achieve them. If you have $1M in debt, your life is going to look substantially different than someone with $100k. The answer to this question requires two components. The first is, what does repayment of this debt look like? The second is, what income will I have to repay this?
To give an example, I’ll start with a screenshot of my loans and projected payments. If you haven’t seen this before, you can go to studentaid.gov to get the same data associated with your loans.
As you can see, it depends on your repayment schedule. For loans around $250k you are looking at around $2-3k/month. This is consistent with a ROAAOMS paper on resident debt where nearly 43% of recent graduates reported monthly loan payments of greater than $3,000 per month.2 As a note, the $55k is the resident salary and these figures will change as your income changes. Now, let’s try two different scenarios. One with $450k of debt and one with $850k of debt, each with six percent interest (could be higher or lower depending on your loan profile). The studentaid.gov site would not allow me to change my loan amount to get other estimates, so I used another student loan calculator at SmartAsset.com shown below. Since it is a basic calculator it does not include the nuances of forgiveness and graded payments. However, it still demonstrates the potential large monthly payments. Don’t forget, this is in addition to paying for your housing, car, family, taxes, and other living expenses.
How will you pay for this? Again, let’s look at what data there is available. The latest ADA income survey data is from 2018. There were 76 private practice oral surgeons who responded with an average net and median income of $420k and $375k, respectively. Based on $420k/year (before taxes per methodology), then this should leave a practicing oral surgeon with ~$35k/month. This is more than adequate to be able to pay back your student loans. Additional data can be found via an accounting firm, known as Cain Watters and Associates. CWA is known to typically take higher producing practices on as clients so there is a little bit of selection bias there to explain the higher income.
The ADA survey information presented doesn’t distinguish between new grads and practicing surgeons. The Jones and Ellis paper referenced earlier does, and when asked what their expected first-year salary out of residency would be, the responses indicated a median income of $250,000 and a mean income of $264,008.1 This is consistent with ads seeking oral surgeons on Dentaltown. Although far from the number presented in the survey, this is still more than adequate to make a dent in those student loans. My guess is that the numbers from the paper are gross income, which means after taxes you are looking at a significantly lower number. Therefore, if you have a very high debt burden, then after graduating you are not going to be living the high life immediately after residency. Granted, this is all relative. A salary as high as mentioned above is great by the measure of the majority of Americans and pretty much everyone in the world, but I think it is important for applicants and graduates to have a sense of what they are getting themselves into. Below is an AccessOMFS income survey.
How Do I Repay This Debt?
The final question is less of a direct answer and more of a presentation of options. Each case is a personal decision as well as one with many variables. The most important thing is that you have explored your options and have a plan. I am not an expert on student loan planning, the tax implications, or refinancing. There are tons of resources out there for free including at the White Coat Investor and Student Loan Planner. Some things you need to know before applying to residency or graduating residency include:
· Total amount of debt incurred prior to applying
· Interest rate of debt
· Amount of additional debt incurred via residency
· Goals for practice (i.e. how will you repay this)
· When to apply for loan forgiveness programs and/or refinancing
Answering these questions early and setting realistic goals can save you a substantial amount of money. These factors are very important to consider especially when you are looking at where you want to live and how you want to practice. Oral and maxillofacial surgeons derive their core income from labor. If you aren’t working, you aren’t producing. When looking at hundreds of thousands of dollars in debt, that’s a lot of hard-working hours. Additionally, if you want the nice practice, fancy car, and big house, your student loans can directly impede you from obtaining these things. You may feel helpless but there are things you can do both as an applicant and a resident to help yourself out. If you have a large debt burden as a dental student, it may be prudent to look closer at four-year programs instead of incurring the extra time and medical school debt. If you are set on the medical degree, then there is a drastic difference in the amount of tuition you may have to pay between programs. There are plenty of top tier programs where the additional costs of the M.D. are minimized. The important thing is to at least do the calculations to see where you will end up so that you can still achieve your goals. It’s easy to get caught up on the interview trail hoping to match at any program, but if you have a handful of interviews, you have more power than you think to determine where you will train.
As a resident, don’t let your debt run away from you either. If you are entering a four-year program or finishing medical school, you can immediately sign up for income-based repayment (IBR). Since your income the previous year in dental/medical school is usually negligible or zero, you may owe nothing on your loans for the first year and be able to have the government pick up some of the tab. I won’t belabor the specifics of how to do that, but there are plenty of free resources and student loan planners that are available to help educate you on this topic. Over the long-term, this can amount to thousands of dollars saved. When student debt is in the hundreds of thousands of dollars, any amount can help. The bottom line is you have worked very hard to get here. Don’t let ignorance be an excuse to pay more than you have to.
Considering the importance of this topic and the ability of student loans to have an immense impact on OMFS as a profession, I hope that readers will pay it forward by divulging some of their information in the surveys included in this article. Programs are biased to downplay the amount of loans their residents take on, and I hope that for posterity’s sake, our applicants are fully informed before they make important decisions about their future career.
Resources:
1. Jason P. Jones, Edward Ellis,Trends associated with debt loads among oral and maxillofacial surgery chief residents,Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology,Volume 128, Issue 6,2019,Pages 590-596,ISSN 2212-4403,https://doi.org/10.1016/j.oooo.2018.12.025.(http://www.sciencedirect.com/science/article/pii/S2212440319300124)
2. Ehlie Bruno, Stephanie Zastrow, Paul Covello, Daniel Hammer,The Resident Organization of the American Association of Oral and Maxillofacial Surgeons Debt Task Force Perspective on Educational Debt and the Impact on the Specialty of Oral and Maxillofacial Surgery, Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 2, 2019, Pages 235-237, ISSN 0278-2391, https://doi.org/10.1016/j.joms.2018.09.018. (http://www.sciencedirect.com/science/article/pii/S0278239118310887)
3. 2018 ADA Survey on Income