A ship cruises atop ocean waves. As it steams toward its destination, the lookout spots an iceberg in the distance. The captain needs to change course to avoid it, but how far?
The safest assumption for that captain is that there’s even more to that iceberg than is visible. The ship had better give it a wide berth, allowing for a massive and dangerous bulk beneath the ocean’s surface.
I like to think of icebergs as a metaphor for some of the difficulties we face in life. And a big one that confronts us every day in health professional education is the enormous burden of learner debt. We see students taking out loans to pay the ever-increasing cost of tuition. But do we understand all the ways that affects their lives, and then ripples out into the lives of everyone else?
Dentistry in particular is greatly impacted by this issue. The average educational debt incurred by dental school graduates has grown from about $66,000 in 1996 to $294,000 in 2022. Dental educational debt is so high that it can deter graduates from pursuing important positions within dentistry such as academia, research, and public health.
Graduates may have intended to serve disadvantaged communities, but in the course of their education, the debt they accumulated pressured them to take a high-paying job rather than pursue their original goals. The iceberg threatened to sink their ship.
Learner debt impacts the diversity and career options of our graduates and alters the ability of health professions to meet the full needs of the population. Clearly, it is incumbent on all of us—administrators, faculty, staff and learners—to think about how to solve this problem.
Finding the Right Approach
Have we been thinking about debt and solutions to debt correctly?
Are we seeing what lurks beneath the surface of the “iceberg” of student debt?
We have implemented scholarships and loan repayment programs to mitigate debt. While these tactics help some people a great deal, they don’t address the root cause of the problem. It’s akin to rearranging the proverbial deck chairs and not changing our ship’s course.
The recent Supreme Court decision blocking the Biden Administration’s plan to forgive a portion of student loan debt is further proof that it won’t be easily or quickly solved.
Can we reframe our approach and try to reduce cost (rather than find ways to pay off the high cost)? Can we find a way to re‐imagine dental education into a lower‐cost experience?
New Ways of Thinking
Great thinkers through the years have given us pointers to help us unlock solutions to difficult problems.
Albert Einstein said “If I had an hour to solve a problem, I'd spend 55 minutes thinking about the problem and five minutes thinking about solutions.”
I’m not going to argue with Einstein! Understanding the problem is critical to creating new ways of thinking. Yet I would caution that too many times, we identify the root cause and then get bogged down in the wrong mentality, asking, “Why did this happen?” rather than “What shall we do about this?” Regressively asking why something happened leads to blame, excuses, and justifications.
We all need positive feedback when learning something new. So, when people or teams are learning to think differently, what should we be doing?
A recent speaker at the American Dental Association's Dental Quality Alliance, Steve J. Anderson, says leaders should start meetings with an inquiry along the lines of, “What is the best thing that happened since our last meeting?” The goal is to get the mind focused on positivity, creativity, and solutions—not problems.
Leaders Listen, Don’t Dictate
I think a lot about how to approach the issue from my position as a dental school dean.
As a leader, isn't it easier to just tell people what to do, rather than facilitate a process that may be rife with conflict? John Whitmore put it this way: “To tell denies or negates another's intelligence. To ask honors it.”
We should be practicing the leadership skill of listening. Every team member needs to listen in order to solve the dilemma. This is because effective and sustainable solutions often arise from additive iterations rather than one person with a miracle cure. Leaders can be most helpful if they stay out of the details and interact by looking for patterns and qualities that cannot be seen by those closest to the issue. The best leaders think differently and are succinct and specific about what they want to say while being gracious about the effort of those attempting to solve the issue before them.
The captain is not alone on the ship. Each member of the crew with their wealth of skills has an interest in continuing the journey to safe harbor. For our mission in health professional education, the only way we can assure this for the long-term is by reducing the burden of student debt.
Michael S. Reddy, DMD, DMSc
Dean, UCSF School of Dentistry
Associate Vice Chancellor, Oral Health Affairs
