Dentists of Tomorrow 2023: An Analysis of the Results of the 2023 ADEA Survey of U.S. Dental School Seniors Summary Report

ADEA Education Research Series | Issue 6 | October 2023

Emilia C. Istrate, Ph.D., M.A.I.S.; Betsy L. Cooper, Ph.D., M.A.; Pradeep Singh, Ph.D.; Gülsün Gül, D.D.S., M.B.A., M.P.H., M.S.; Karen P. West, D.M.D., M.P.H.

In This Issue:  Finding 1  |  Finding 2  |  Finding 3  |  Finding 4  |  Finding 5 |  Appendix

This report summarizes the key findings of the analysis of the results of the American Dental Education Association (ADEA) Survey of Dental School Seniors, Class of 2023 (henceforth called “the ADEA 2023 survey” and the overall survey series is called “the ADEA Senior Survey”). The study examines the journey of U.S. dental schools’ predoctoral senior class of 2023, from its influences and motivations to pursue careers in dentistry and the graduating students’ perceptions of their dental school experience to their plans upon graduation and the investment in their careers. Whenever feasible, the analysis compares the answers of the 2023 survey respondents with their 2018 counterparts. Further, this research attempts to better understand the journey of predoctoral senior students of historically underrepresented race and ethnicity (HURE) groups by comparing the responses of the overall response sample with those of the HURE students. This research considers the following four race and ethnicity categories to be part of HURE: non-Hispanic African American, Hispanic, or Latino of all races, non-Hispanic American Indian or Alaska Native, and non-Hispanic Native Hawaiian or Other Pacific Islander.

For the first time, this annual analysis examines the preferences and plans of senior students in pursuing a career in oral health research. It investigates the students’ experience with research activities during their predoctoral dental program, for the entire response group and specifically for the HURE survey participants. Further, it analyzes the timing for a planned career in oral health research.

ADEA surveyed the 66 U.S. dental schools with a graduating class in 2023 between Feb. 21 and June 16, 2023. A total of 6,720 students received the survey, and 3,214 students from 65 schools responded. As a result, 48% of senior students in the 2022-23 academic year responded. The response sample to the ADEA survey is representative of the overall senior student population at U.S. dental schools that received the ADEA 2023 survey (see Table A1 in the Methodological Appendix).

Key findings of this analysis include:

Finding 1: More senior students responding to the 2023 ADEA survey indicated they decided to pursue a career in dentistry before undergraduate college than while in college.

Almost half of the 2023 respondents decided to become a dentist before going to college, more than the proportion of respondents who decided during college (see Figure 1). HURE students’ responses in 2023 highlight this pattern: more than half of the HURE participants in 2023 decided on a career in dentistry before college, relative to 37% during college. This decision timing has changed slightly compared with 2018 for the overall response group and HURE participants.

52% of the HURE senior students responding to the ADEA 2023 survey decided to become a dentist before college.

The top reasons for attending the dental school from which the respondents were graduating in 2023 were virtually a tie in number of mentions.A lower cost of attendance, proximity to family and friends and academic reputation were the most frequently cited reasons by the overall 2023 respondents for choosing the school they were graduating from in 2023. For HURE students, the differences among the top three reasons were even smaller than for the overall response group.

Shadowing a dentist was the most frequently cited top influence on pursuing a career in dentistry. The personal dental experience was a close second. Having someone close (family or friend) in the profession rounded up the top three influences for pursuing an oral health career. When it comes to motivation to become an oral health professional, service to others was the most cited by the ADEA 2023 survey participants. Enjoying working with hands and the artistic, creative, and aesthetic aspects of dentistry were also top reasons for the ADEA 2023 survey participants to become a dentist.

Finding 2: The respondents to the ADEA 2022 survey indicated a high level of readiness to go into the profession.

The ADEA 2023 survey asked participants to estimate the adequacy of clinical experience gained across 14 different areas of education. For 12 of the 14 categories, a majority of respondents (different percentages for each category) reported receiving appropriate or above appropriate levels of clinical experience during dental school. A majority of 2023 respondents stated they would have wanted more clinical experience in endodontic therapy (52%) and surgical placement of implants (76%).

Most of the senior students responding to the ADEA 2023 survey stated high levels of confidence in their skills across the 15 clinical areas mentioned in the survey. On average, 82% of survey respondents were moderately or highly confident in their abilities gained across the 15 clinical areas included in the survey. In six clinical areas, confidence in skills exceeded 90% for overall respondents: restoration of teeth; the ability to perform health promotion and disease prevention, including caries management; patient assessment, diagnosis, comprehensive treatment planning, prognosis and informed consent; recognizing the complexity of patient treatment and identifying when a referral is indicated; evaluation of the outcomes of treatment, recall strategies and prognosis; and local anesthesia and pain and anxiety control, including consideration of the impact of prescribing practices and substance use disorder. Overall, respondents felt the least confident in their abilities to deal with hard and soft tissue surgery (58% stated being moderately or highly confident in their abilities gained in this area), as well as malocclusion and space management (56%).

92% of respondents agreed and strongly agreed with having acquired the clinical skills required to begin practice in general dentistry.

On average, 90% of respondents agreed or strongly agreed with the preparedness to practice statements in the survey (see Figure 2). The ADEA 2023 survey asked respondents’ level of agreement to 11 different statements that reflected a variety of abilities needed to enter dental practice (see Table A2 in the Methodological Appendix for the full text of the statements). The overwhelming majority (96–97%) of survey respondents felt most ready about six areas: having the communication skills to interact with patients and coworkers, understanding the ethical and professional values that are expected of the profession, the need for continuing education requirements as practitioners, having the basic skills in clinical decision-making, understanding common conditions and their management, and considering themselves prepared to work with diverse staff and patients. Only one area received less than 80% agreement: 53% felt prepared to manage a successful business.

Finding 3: The senior predoctoral students responding to the ADEA 2023 survey were more likely to join a private practice upon graduation than their 2018 counterparts.

Between 2018 and 2023, the share of ADEA survey respondents who expressed plans to work in a practice immediately after graduation reached 53% (see Figure 3). The proportion of survey respondents indicating plans to enroll in advanced education in 2023 was similar to five years earlier. The share of respondents planning to practice dentistry in a nonprofit or government agency recorded a small decrease between the two annual student cohorts.

Entering private practice remained the favorite professional choice for senior predoctoral students responding to the ADEA 2023 survey. This choice increased in popularity among the 2023 respondents relative to the 2018 cohort, including for the HURE students (see Figure 3). Almost half of 2023 HURE survey participants stated they planned to join a private practice upon graduation, 10 percentage points more than the 2018 HURE respondents.

34% of the 2023 respondents who planned to go into private practice immediately upon graduation intended to join a DSO-affiliated practice.

Working for a dental service organization (DSO) is rapidly becoming a top choice for respondents stating they were going into private practice immediately upon graduation. More than a third of the 2023 respondents (34%) who planned to go into private practice immediately upon graduation intended to join a DSO, almost double the proportion of 2018 respondents (16%). This trend was heightened for HURE respondents. In 2018, 21% of the HURE participants planning to join a private practice mentioned going to work for a DSO. Five years later, 40% of the HURE respondents expressed similar plans.

ADEA survey respondents maintained their interest in attending further dental education in 2023 relative to the 2018 response cohorts (see Figure 3). The ADEA 2023 survey allowed respondents to rank their applications by preference along types of advanced education, such as general dentistry programs, approved specialties and specialties not approved by the National Commission on Recognition of Dental Specialties and Certifying Boards (NCRDSB). Almost half of the 2023 respondents (49%) indicating they applied to continue their education ranked general dentistry programs as their top choice. A similar proportion (47%) considered NCRDSB-approved specialties their top choice. Only 1% of the survey participants continuing their education chose as their top choice specialties not approved by the NCRDSB.

Practicing dentistry for a government agency or a nonprofit was selected less by the 2023 students than their 2018 counterparts (see Figure 3). The decline was also seen with HURE respondents. The loss in interest in pursuing a dentist career with the military was the biggest culprit for this decline. In 2018, almost half of the respondents planning to work in nonprofits or government were planning to serve in the armed forces. Five years later, only 14% were expressing a similar interest. At the same time, there was more interest to serve as a dentist with the civilian federal government. Almost three in five 2023 respondents planning to practice in a nonprofit or government setting stated intentions to join a Federally Qualified Health Center upon graduation. This was almost double the proportion of their 2018 colleagues stating similar professional plans upon graduation.

The 2023 senior students experienced the COVID-19 outbreak while they were in their first year of dental school. For most of the senior dental students who responded to the ADEA 2023 survey, professional plans upon graduation did not change from before the COVID-19 outbreak. Only 15% of the 2023 survey participants reported they changed their immediate professional plans upon graduation because of the COVID-19 pandemic and 17% of HURE respondents reported the same.

Finding 4: ADEA 2023 survey respondents expressed interest in a career in research, but later in their career.

One in five of 2023 participants expressed interest in being involved in research at some point during their career. Among the survey respondents who intend to do research, the share of those planning to conduct research mid-level or later in career increased from 52% from the 2018 cohort to 57% in the 2023 cohort (see Figure 4). The shift for HURE participants mirrored this change, from 53% to 59% between the two response cohorts. The differences between the two cohorts for the HURE respondents and for the entire response groups are not statistically significant at 90% confidence level.

20% of the ADEA 2023 survey participants reported “definitely or “probably” to being involved in research at some point during their career.

The 2023 respondents stated they conducted research in different ways during their dental predoctoral degree, but at lower rates than their 2018 colleagues responding to the ADEA survey. The proportion of respondents who indicated pursuing peer-reviewed oral or poster presentations almost halved between 2018 and 2023, from 19% to 11%. Just over a quarter (26%) of the 2023 survey participants mentioned they conducted a research project with a faculty member on an elective or volunteer basis during dental school, a drop from almost a third of the 2018 survey participants. Other examples include working on a community-based research project (14% of the 2023 respondents, down from 21% in 2018), and authorship of a peer-reviewed paper submitted for publication (7% in 2023, down from 11% five years before). 

Finding 5: Average education debt was $296.5 thousand for students graduating with debt and responding to the ADEA 2023 survey.

When accounting for inflation, this amount was 12% lower from what the 2018 respondents reported. Education debt is a combination of the dental school debt the senior students graduate with from dental school (the loans contracted to finance partially or all the cost of the predoctoral degree) and their predental education debt, which is the outstanding education debt the senior students had when they entered dental school. Annual average education debt amounts varied between 2018 and 2023 given different cohorts and various response rates to the debt question to the ADEA survey over the years (see Figure 5).

Most of the average education debt that predoctoral students reported in the ADEA 2023 survey was from dental school debt (95%). Five percent of the 2023 average education debt was from predental education debt.

12% decrease of the average education debt for indebted graduating students responding to ADEA 2023 survey relative to their 2018 counterparts, when accounting for inflation.

The percentage of ADEA survey respondents graduating with debt increased between 2018 and 2023. While in 2018 80% of respondents reported graduating with education debt (dental school debt and/or outstanding predental debt), by 2023 the proportion rose to 84%. For students participating in the ADEA survey, the percent of those graduating with dental school debt also increased, from 78% in 2018 to 82% in 2023.

On average, ADEA 2023 survey respondents financed two-thirds of their dental education through debt (66%), the rest covered to a large degree by a combination of financial support from family and friends (19%) and grants and scholarships (10%). Savings (4%), part-time employment (1%) and other sources (0.4%) were smaller sources of funding for a doctoral degree for the 2023 respondents. Respondents to the ADEA 2018 survey had a similar pattern of funding sources.

Federal loans persisted as the top source of financing a doctoral education degree between 2018 and 2023. Eighty-four percent of 2023 respondents who contracted loans for dental school used federal direct unsubsidized loans, more than their 2018 colleagues. More than three quarters (77%) of ADEA 2023 survey participants graduating with debt took federal direct Grad PLUS loans, at a higher rate than the 2018 response cohort (70%). Almost one in six (16%) respondents graduating with dental school debt used Health Professions Student Loans, similar with the cohort five years before. ADEA 2023 survey respondents mentioned a variety of other loans employed to finance their dental school degree, from private loans from lenders, personal loans from family, loans directly from the school, and state loan programs.

U.S. dental schools continued their mission to train and educate oral health professionals and provide oral health care through their clinics to local communities.

The 2022-23 academic year was a year of hope, with the COVID-19 pandemic lessening its effect and federal government ending the federal COVID-19 Public Health Emergency. A new generation of dentists graduated from 66 accredited U.S. dental schools in the 2022-23 academic year. U.S. dental schools stood steady in their mission to train and educate oral health professionals and provide oral health care through their clinics to local communities.

Methodological Appendix

About ADEA: The American Dental Education Association (ADEA) is The Voice of Dental Education. Our mission is to lead and support the health professions community in preparing future-ready oral health professionals. Our members include all 80 U.S. and Canadian dental schools, more than 800 allied and advanced dental education programs, over 55 corporations and approximately 15,000 individuals. Our activities encompass a wide range of research, advocacy, faculty development, meetings and communications, including the esteemed Journal of Dental Education^®, as well as the dental school application services ADEA AADSAS^®, ADEA PASS^®, ADEA DHCAS^® and ADEA CAAPID^®. For more information, visit adea.org.