By Rick Valachovic, DMD, MPH, Clinical Professor and Director of the NYU Dentistry Center for Oral Health Policy and Management

It’s a cliché to say that traveling opens our eyes to new ways of seeing things. That doesn’t mean it’s not true. My frequent interactions with internationally educated dentists — both overseas and here at NYU — have me thinking about how we first decided it should take eight years after high school to produce a dentist and whether we can do it more efficiently moving forward. Are there ways to shorten the total time to a dental degree and make it more affordable without compromising the quality of education and patient care? The evidence points to a resounding, “Yes!”

It is in just a few countries — the United States, Australia, New Zealand, and some Canadian provinces among them — that most dental schools require a four-year university degree for admission. Almost every other country does not. If you live in China, Japan, Brazil, or most of Europe, you can apply to dental school directly from high school. The time these students spend in dental school is a year or two longer than the time spent here, but they enter the dental workforce years in advance of their U.S. peers. 

Could the United States adopt a similar model? The four-year undergraduate degree has become such an established first step on the U.S. career ladder for all professions that it is hard to imagine an alternate path, but there are precedents. Before the 1970s, most people entered dental school after just two years in college. That was still the case for many of my dental school classmates, some of whom were veterans during the Vietnam War era. The increase in applicants resulting from the Baby Boom changed that. When the numbers of applicants competing for 6,000 first-year slots swelled to 16,000, some dental schools began requiring bachelor’s degrees for admission. 

Those dental students who lacked four years of undergraduate preparation were able to graduate and obtain licensure, and I suspect there are many students today who could also succeed in U.S. dental schools without first completing a traditional bachelor’s degree. The undergraduate classes students take in subjects not directly related to dentistry may have value in and of themselves, but they cost money—more and more each year. For some students, the return on investment of accumulating credits outside their chosen area of study may be marginal at best. 

Whatever benefit students derive, it’s difficult to see how those additional courses necessarily contribute to preparing students for dental school. Meanwhile, the cost of obtaining those credits has skyrocketed, while burgeoning student debt has prompted Americans to question the value of higher education. Might there be benefit in allowing students who can demonstrate their knowledge and skills in the prerequisite sciences, math, and English to enter dental school without a four-year undergraduate degree?

The ROI on a dental education remains strong, but some potential applicants are hesitant to take on more educational debt. Replacing a year or two of college with a year or two of earnings would certainly be a win from their vantage point. That said, I realize this line of thinking may be anathema to some. If nothing else, it flies in the face of recent trends in some of the other health professions. 

• Physical therapy moved from a two-year degree in the 1930s to a four-year degree in the 1960s. Today a six-year Doctor of Physical Therapy degree is the standard for entry into practice.
• Pharmacy has followed a similar path. In the 1990s, the six-year Doctor of Pharmacy (PharmD) degree replaced the four-year Bachelor of Science degree, which reigned throughout the preceding half century.
• Nursing has also encouraged higher levels of education. Although the profession still accepts a variety of degrees for entry into practice, many hospitals have been preferentially hiring nurses with bachelor’s degrees over those prepared at the associate-degree level, and more and more advanced practice registered nurses enter their fields with practice doctorates rather than master’s degrees. 

At the same time, a countervailing trend aims to shorten the time it takes to earn a professional degree. For instance, nursing schools now offer a host of accelerated degree programs at both the undergraduate and graduate levels to speed entry into the workforce. The Association of American Medical Colleges is working to implement a competency-based educational model, which would lay a foundation for self-paced medical education. In 2013, the Blue Ribbon Commission for the Advancement of Osteopathic Medical Education recommended the creation of a competency-based model for educating primary care physicians. These moves suggest broad agreement that the value of education is not accrued through seat-time alone.

In dentistry, many schools have replaced numerical requirements with other ways of demonstrating clinical competence and readiness for practice. And some dental schools have opted for year-round education so their students can enter the workforce in three years rather than four. At NYU, we offer early admission to undergraduates who can meet our requirements in three years of college study. These students arrive well prepared and possess the maturity needed to pursue professional studies. 

These are steps in the right direction, but could we be doing more? Is it time for all U.S. dental schools to consider alternatives to the eight-year path? The answer seems obvious to some of my internationally trained colleagues. I personally find my encounters with our seven-year students persuasive. They are thriving in dental school and will soon be treating patients outside our clinic walls. The sooner they get there, the better.