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Letters: Dental education

August 28, 2019

I would like to thank Dr. Robert N. Bitter for his thoughtful My View “What Can We Do For Dental Education?” in the June 17 ADA News. Indeed, the exorbitant cost of a dental education is daunting to individuals and the profession at large. As someone who was a dental educator for a dozen years and has been a private practice dentist for 32, I agree that this has far-reaching consequences for students and practitioners alike.

However, with due respect, I think that the idea of going hat-in-hand to the government to try to solve this issue is a mid-20th century solution to a 21st century problem. Student debt is the symptom, as he points out, but lack of government funding is neither the only nor even the major cause. In an era when the federal government is more than $20 trillion in arrears and state, county and municipal governments are also in debt to the tune of several times that figure, it is difficult if not impossible to imagine that austerity generally will not be the way forward for the nation for the foreseeable future, and that government spending generally will need to be curtailed for the very survival of our country. Of course we are all passionate about our profession and the good it can do, but at the end of the day, we must have the humility to admit that we are simply a competing interest with other entities. In such an environment it is also difficult to imagine that an injection of cash will even be there to stop the bleeding. The solution he prescribes to have Medicaid subsidies will likely not completely cover any current shortfall and runs the risk of making dental education even more dependent on government at a time when it sorely needs to be less so.

Beyond that, a mere injection of money will not end the structural problems and perverse incentives that led to a dental education costing as much as it does (and increasing in price far beyond the every other good or service in society) in the first place. To be sure, this bloat is not specific to dental education — it is endemic to the education industry at large, and increases of 500-600% in administrative costs plus the effect of student loans and subsidies on removing any feedback loops for universities to control costs are not limited to dental schools.

Nonetheless, the cost of a dental education will continue to rise unless and until such feedback loops are reintroduced into the dental education industry. The small increase in subject matter in the past 30 years in no way justifies this type of price increase.  

Perhaps dentistry can be the leader in this regard and blaze the trail for other fields of education by getting back to basics on the amount of administration while at the same time innovating in terms of how to deliver a great training and education without such a high price tag. I think we’re up to that. At any rate, the big-government money solution will be a kick-the-can approach at best.

Better to roll up our sleeves now and do a real, sustainable fix.

Robert K. Thompson, Jr., D.M.D.
Cohasset, Massachusetts