Army student loan repayment program

Objectives: The objectives of the survey were to quantify the extent of indebtedness of junior dental officers and to determine the impact of a loan repayment program on career decisions. Methods: We designed a customized survey instrument because no preexisting, validated, survey instrument was available. A query was performed in the Medical Operations Data System to identify all captains (O-3) currently on active duty in the Army (N = 348). The survey sample included 64 junior officers with a 2000 date of rank to captain (O-3), of whom only 52 were in the Medical Command Outlook address book or the Army Knowledge Online white pages. The questionnaire was sent out to these targeted junior dental officers through their official e-mail accounts. Dentists assigned to Korea and to dental field units do not use the same e-mail system as the rest of the Dental Command; therefore, their addresses were not available. In an attempt to increase response rates, commanders were asked to emphasize the importance of responding to the questionnaire. Results: From the sample population of 52 officers who were queried directly, 34 responses were received, for a response rate of 65%. However, commanders forwarded the survey to all Dental Command captains and 102 responses were received. The respondents represented 30% of the total Army inventory of captains; 92% of respondents reported that they had dental school loans, with 43% reporting loans in excess of $50,000. The average dental school indebtedness was approximately $60,700. More than 60% of all respondents reported that loan repayment could change their minds about remaining on active duty. Officers not included in the original sample rated the impact of loan repayment statistically higher than did officers in the original sample. Conclusions: The findings were that the majority of junior Army dental officers had significant student loans and many of these officers indicated that they would consider remaining on active duty if loan repayment or other monetary inducements were offered.

Introduction

The U.S. Army has had difficulty recruiting and retaining dentists, because of declining dental school enrollment, a robust economic environment for dentistry, and changing demographic patterns. The enrollment decline, coupled with an accelerated rate of retirement, has created more attractive economic opportunities for new graduates. By 2007, the number of U.S. dentists retiring will exceed the number of dental school graduates by a ratio of 2:1.1 Up to 50% of these new graduates are female and are expected to work 30% fewer hours than their male peers. With more women and minorities enrolled in dental schools, there is insufficient data to know whether these graduates have the same level of interest in joining and then being retained in the military, compared with previous dental school graduates.1 Whereas in the past it was common for only one spouse to be employed, it is now much more common for both spouses to work, and the frequent moves associated with military life may not be compatible with the nonmilitary spouse's career.2 In the past 10 years, recruitment problems were addressed with a multiple-year dental school scholarship, called the Health Professions Scholarship Program (HPSP), and accession bonuses. The Army currently offers 120 HPSP scholarships each year, and applicants have historically outpaced availability. These programs have improved the recruitment of dental officers in the past 3 years and are projected to continue to provide young dental officers in the future. However, retention rates for these new accessions have been low, which will have adverse effects on the future of the Army Dental Care System. Retention rates are estimated at 43 to 52% for the past 5 years (U.S. Army Personnel Command, Dental Corps Branch, unpublished data).

A shortage of military dentists would degrade the dental health of U.S. Army soldiers, directly affecting their deployability. Studies from field exercises and recent Bosnia deployments demonstrated significantly higher rates of dental emergencies for dental class 3 soldiers.3,4 Dental class 3 soldiers have conditions identified as potentially causing a dental emergency within 12 months. The resulting shortages from low retention rates will also negatively affect the staffing of the Professional Filler System (PROFIS) and Table of Organization and Equipment positions in the near future. These positions are occupied by go-to-war dental officers and have top priority to be filled; no civilians can be used in these positions to alleviate shortfalls. Currently, there are 62 senior dental officers (O-5 and O-6) filling PROFIS positions, but only seven of these positions are for senior officers. The effect is that the dental officer might outrank the commander of the unit, which might negatively affect the morale and retention of senior officers.

Dental school expenses place a burden on dentists once they graduate. A recent survey from the American Dental Education Association noted that the cost of dental school tuition has increased as a result of decreased state funding related to the current economic downturn.5 Yearly tuition rates have increased 12% for residents at public schools, 9% for nonresidents at public schools, and 5% for students at private schools. In 2002, the average yearly tuition costs were $12,260 for state residents at public schools, $26,803 for nonresidents at public schools, and $32,809 for private schools.5 Not included in these figures are fees for books and required dental instruments and the costs associated with everyday living expenses. In 2000, the average student loan debt was $68,000 for public dental schools and $114,000 for private dental schools. A more recent survey from the American Dental Association reported that the average educational debt for new graduates is increasing and dental graduates from 1999 to 2001 averaged $111,386 in educational loans, an increase of over $27,550 from those who graduated between 1996 and 1998.6 A comparison of educational debt for three periods is presented in Figure 1. Ninety-six percent of students had some student loans, with >45% having student loans in excess of $100,000.7 Coupled with educational debt is the perception that military officers' salaries are not commensurate with those of their civilian counterparts. The average net income of private practice-owner new dentists was $162,579 in 2001, as reported by the American Dental Association Survey Center.6 The same survey reported that government and hospital new dentists averaged $84,030 in 2001.

A loan repayment program might improve the retention of junior officers. A Health Professions Loan Repayment Program (HPLRP) would offer eligible officers $25,000 for a 2-year commitment. Officers could apply for the loan for consecutive years, and the payback time would be served concurrently. An officer who applies for the HPLRP for 2 consecutive years, for a $50,000 (after-tax) loan, would be obligated for 3 years.

To put together a business case analysis to justify funding such a program, the Dental Command planned to survey captains with 2 to 4 years of active federal commissioned service to ascertain the impact on career decisions of a loan repayment plan among the targeted population of dental officers. The objective of the project was to quantify the extent of indebtedness of junior dental officers and to determine the effects of a loan repayment program on career decisions.

Methods

Data Collection