Debt, Diversity, and Dentistry: How Federal Loan Caps Could Reshape Our Workforce

Implementing federal student loan limit changes via U.S. Department of Education negotiated rulemaking.

As federal policymakers move to cap graduate borrowing, dentistry faces a looming crisis that could reshape who enters the profession and influence career choices within it. With average dental school debt topping $300,000 (ADEA, 2024), federal loans remain the only realistic option for students from low-income and first-generation backgrounds. Capping borrowing below the cost of attendance will force future dentists into private loans with higher interest rates and strict credit requirements. This shift will disproportionately affect students already facing systemic barriers, potentially driving them away from dentistry altogether. These changes are likely to undermine diversity and equity in the workforce. Economic diversity is foundational to inclusion, yet the proposed changes will deter those without wealth or generational safety nets. Research shows racially and socioeconomically marginalized students already graduate with substantially higher debt (Shields et al., 2023).

Federal policy changes may add to uncertainty in an already complex environment for prospective and early-career dental professionals. Shifts in how federal programs define qualifying employment for loan forgiveness can raise questions for universities, health centers, and nonprofits that train or employ dental providers. As interpretations change and as legal or administrative challenges potentially reshape these policies, institutions must navigate how partnerships, service models, and advocacy activities could influence loan forgiveness eligibility for their staff. This ambiguity risks discouraging early-career clinicians from choosing public-sector or safety-net roles, even as access to care in these settings remains especially fragile.

Private loans also eliminate eligibility for service-based loan forgiveness programs like National Health Service Corps (NHSC) and Public Service Loan Forgiveness (PSLF), which enable dentists to work in public health settings. Federal loan caps and new PSLF restrictions risk fracturing the pathway for mission-driven providers by pushing students into private loans that eliminate access to PSLF and NHSC, undermining the financial viability of careers in community clinics, rural practices, academia, and public health settings. These shifting rules also create uncertainty for universities, health centers, and nonprofits, as they could deter early-career clinicians from public-sector roles precisely when safety-net access is most fragile.

What We Can Do Now: A Call for Collective Action

This moment demands collective leadership to safeguard equitable access to education. Ensuring a diverse dental workforce will not happen by accident—it requires deliberate policy, creative funding, and sustained advocacy from all sectors.

For Institutions: Prioritize Affordability

Dental schools must put affordability at the center of their strategies in order to ensure a diverse student body. This means actively working to expand need-based and “last-dollar” gap funding that fills tuition shortfalls after federal aid, ensuring no student withdraws solely for financial reasons. Institutions should also integrate financial literacy and debt navigation into pre-dental and D1 curricula, emphasizing real-world decision-making and empowering students to manage the economics of their profession.

For Policy and Program Leaders: Safeguard Service

Leaders must advocate that federal policy changes preserve PSLF and NHSC eligibility and allow flexible borrowing for service-oriented fields, recognizing their essential role in equitable care delivery. States and schools should be encouraged to tie debt relief programs directly to service in rural or underserved areas, supporting equitable distribution of providers and fulfilling dentistry's responsibility to public health.

For Financial & Loan Partners: Innovate with Inclusion

Financial institutions have a unique opportunity to act as partners in health equity. They should develop inclusive lending products that fill the gap left by federal caps, offering fair rates, flexible underwriting, and protections aligned with service-based forgiveness programs. This innovation is low-risk, as dentists are historically low-risk borrowers (with default rates well below 1%). This is a moment for mission-aligned lenders to step up and design responsible private loan frameworks that prioritize inclusion, affordability, and service.

For Mentors and Practitioners: Cultivate the Pathway

Practitioners and mentors play a crucial role shaping the next generation. This means starting early, honest conversations with mentees about financing pathways and debt trade-offs. Furthermore, the profession must actively support or sponsor micro-scholarships and mentorship initiatives that help students from underrepresented backgrounds persist, and advocate within professional associations for policy change centered on educational equity.

Looking Ahead: Turning Awareness into Action

Diversity in dentistry is not optional—it’s essential for ensuring oral health care is equitable, accessible, and trusted. This challenge can become an inflection point—one where the dental profession leads, modeling how financing and equity can work hand in hand to secure the future of oral health for all, ensuring affordability is never a barrier to access and diversity.

 

Authored by Drs. Zachary Brian, Scott Wolpin, Lisa Kearney, Arlet Arratoonian, and McAllister Castelaz from the NNOHA Policy and Advocacy Committee and the AAPHD EDI Committee.

 

References

American Dental Education Association. (2024). ADEA survey of dental school seniors: Class of 2024. ADEA.

Nasseh, K., & Vujicic, M. (2017). The relationship between education debt and career choices in professional programs: The case of dentistry. Journal of the American Dental Association, 148(11), 825–833. https://doi.org/10.1016/j.adaj.2017.06.042

Shields, R. K., Suneja, M., Shields, B. E., Tofte, J. N., & Dudley-Javoroski, S. (2023). Healthcare educational debt in the United States: Unequal economic impact within interprofessional team members. BMC Medical Education, 23, 666. https://doi.org/10.1186/s12909-023-04634-1