Editor’s note: The 14 ACS Advisory Councils, which serve as liaisons in the communication of information to and from surgical societies and the Regents, periodically submit articles on the notable initiatives taking place in their respective specialties. This feature is a submission from the Advisory Council for Oral and Maxillofacial Surgery.
The rising cost of medical education is an increasingly urgent issue for physicians and their patient populations. According to the Association of American Medical Colleges, the average medical school graduate leaves with nearly $200,000 in student debt, a figure that is expected to continue growing.
This student loan crisis is changing who is applying into medical school, what specialties doctors are choosing, and where and how these physicians are practicing. Pursuing a medical career has always been financially demanding, but as tuition debt soars, highly qualified undergraduate students are pivoting to other career opportunities with a faster return on their investment, and medical students are looking toward high-paying specialties at the expense of more altruistic, patient-centered fields.
Changes in oral and maxillofacial surgery (OMS) provide a prime example of these forces at work. The average debt for dental school graduates in 2023 was $296,500. The average debt burden of oral and maxillofacial surgeons was $584,000, almost $300,000 more than general dentists.
At the same time, the number of applicants for OMS dropped from an all-time high of 493 in 2020 to 384 in 2024 as dental students increasingly go straight into general practice, rather than applying for OMS. Those who remain will tend to be those with more affluent backgrounds who can afford to take on the increased debt burden.
Those students who do pursue OMS also are changing how they learn and how they practice. Once, the 6-year dual degree programs for OMS received more applicants and were more competitive. Now, more students are applying to the 4-year single degree programs, avoiding additional debt for medical school and entering practice 2 years sooner. New OMS graduates are choosing to work for large medical/dental service organizations. These are backed by private equity, offer an incredibly high starting salary, and, generally, exclusively focus on high-paying procedures. They provide a tempting alternative to taking on additional debt to open a practice and perform the full scope of the specialty.
High student debt is changing who is applying into surgery, what surgical specialties they pursue, and what kind of practices they have. While some argue that the market should dictate career choices, medicine does not follow simple supply and demand economics. The demand for healthcare is inelastic—people will seek medical care regardless of its cost because health is a fundamental necessity—unlike consumer products where demand fluctuates based on price. Relieving this economic pressure requires higher education reform, whether through lowering the cost of education, subsidizing the cost through other means, or finding low-cost financing options for students. This problem today is going to affect the practice of medicine for years to come.
