Debt, Not Dreams Deciding Dentists' Future

May 14, 2015

Jenna Pascoli stands in a small, glass-paneled room inside the The Lake Erie College of Osteopathic Medicine School of Dental Medicine clinic in Bradenton and  pulls on a blue, paper medical gown over her scrubs.  

She slides on eye goggles and a head lamp, then snaps blue, latex gloves onto both hands. One breaks. She grabs another.  She sits next to her patient and checks her blood pressure.  

Jenna Pascoli, a third-year dental student at the The Lake Erie College of Osteopathic Medicine School of Dental Medicine in Bradenton, treats a student at the school's clinic. She's one of many dental students struggling with high student loan debt.
Credit Daylina Miller/Health News Florida

Now that she's entered her third year of dental school, Pascoli has moved beyond lecture halls and lab simulations into a real on-site clinic that sees patients.

Cavities, crowns, root canals- she's done them all. 

Someday, Pascoli dreams of treating patients who don't make a lot of money or don't have insurance. But she said $328,000 in student loan debt stands in the way. 

Florida is lacking dentists in rural, low-income areas, but graduating dental students are not flocking to this little towns to set up practices. The reason? It's hard to make money and students often graduate with large loans looming over their shoulders. 

Pascoli can relate. 

"Let's say I do go to an underserved area, which is what I want to do," she said. "I need to think, 'How am I going to pay these loans off?' but also 'How am I going to establish myself as a practitioner and get the local community involved in my practice and also afford to start a practice?'"

  In the past two years, Florida's Legislature has passed three different dental bills, but none provided financial help. This past session, Senate Bill 606 would have provided new dentists up to $100,000 a year to pay their loans or set up a clinic if they worked in communities serving low-income patients. The bill won support from the full Senate, but the legislative session ended before the House could vote on it.

Pascoli went to Tallahassee to push for the bill. She said there are plenty of students willing to serve low-income patients. According to the Florida Dental Association, the state has 1,100 fewer dentists than it needs in rural areas. The biggest shortages are in the panhandle and interior parts of South Florida. 

"Florida is a large state and it has access to care issues," Pascoli said. "We are here. There are plenty of dental students to serve those needs. We just need help."

But even before this latest bill failed, some Florida dentists were moving forward on fixing at least part of the problem. 

In South Tampa, Dr. Terry Buckenheimer treats patients who, most often, can afford dental care or have insurance. That allows him the financial flexibility to participate in the statewide Donated Dental Services program, which provides emergency care free to low-income patients. He said this year's bill would have helped young dentists do the same. Instead, they're in serious debt. 

"Dentists now are coming out of dental school $200,000 to $4oo,000 in debt and they can't afford to go into an underserved era or rural area and gain enough assets to pay off their loans," Buckenheimer said.

And in South Florida, Weston-based dentist Dr. Michael Eggnatz is working with the dental association to build better partnerships between communities that need dental care and dental schools.

"We looked at past legislation that has failed or passed and not really worked and that's why the Florida Dental Association came up with Florida's Action for Dental Health," Eggnatz said. "We looked at a comprehensive approach to try to promote attainable dental care for uninsured and underinsured people in Florida."

Part of the plan is to get state and federal funding for county health clinics and dental practices in low-income communities. It would help dentists and aspiring dentists, such as Pascoli, practice where they're most needed and also pay the bills. 

"Students who want to serve the underserved, we're not looking to make some astronomical salary but 

Jenna Pascoli graduates in a year from the The Lake Erie College of Osteopathic Medicine School of Dental Medicine in Bradenton but fears high loan debt will keep her from working in a low-income community.
Credit Daylina Miller/Health News Florida

we do have to pay off our debt," Pascoli said.

Without help, some dental students at Florida’s three dental schools (Nova Southeastern University College of Dental Medicine, University of Florida College of Dentistry and LECOM) say they are tempted to go into corporate dentistry where they don't have to worry about the bottom line. 

Pascoli says she will do what will pay the bills. 

"At the end of the day, I will not be able to advance my career and build a practice in an area that needs me to be there if I can't get some sort of help with my loans," Pascoli said. "It's just not going to be possible."

At least, she said, she has another year before she has to make that decision.   

Daylina Miller is a reporter for WUSF in Tampa. Health News Florida receives support from the Corporation for Public Broadcasting.