Methods: A review of published literature was used to develop an initial conceptual framework. Only students with debt were included in this exploratory study. Data analysis (correlation, t-tests, chi-square tests, and analysis of variance) were performed using IBM®SPSS® software version 19.0. Associations were examined if Spearman’s correlation coefficient was > 0.3. Statistically significant (p < 0.05) associations were then modeled for association with the outcome (intention to work in an underserved area) and main independent variable (dental school debt).
Results: Percapita dental school debt ($193,252 ± $91,770 among those with debt), attending a private or public dental school, volunteer activity while a dental student, and having children were not associated with intending to work in underserved areas. Age, gender, race/ethnicity, parental income, and career choice were associated with intent to work in an underserved area. Significant within group differences in amount of dental school debt were seen. A multi-causal “web of causation” model was developed. Dental school debt was not found to be a key driver of intent to work in underserved areas. Parental education and income; sense of ethical obligation and service to others; loan repayment program; will to serve vulnerable populations; service to own race/ethnic groups and participation in clinical rotation in underserved areas were important determinants for intent to work in underserved areas.
Conclusion: The model offers an understanding of factors that may predict practice behavior and their relationship to dental school debt.