Residency Training Lacks Financial Education

Residency program curricula encompass the clinical understanding and skill sets required for each respective medical and/or surgical subspecialty. However, attention has recently been directed toward knowledge gaps in these curricula that may contribute to increased physician stress. Personal finance can be a negative source of stress for many physicians.

Formal financial education is not part of traditional medical training, leaving residents inadequately prepared for their financial futures. In addition, resources that can aid in financial preparation are often not discussed or provided, thereby resulting in a poor understanding of financial management. Unfortunately, previous attempts to incorporate financial education into training curricula have faced barriers. Work-hour restrictions, accessibility to instructors who have financial education backgrounds, and the belief that this type of education is out of residency programs’ scope have resulted in the cessation of proposing finances as part of the education structure.

The average total student loan debt for recent medical school graduates is about $215,900. Residents have been shown to have not only greater levels of debt than the general public but also less net wealth, fewer assets, and less retirement savings. This financial burden has been associated with anxiety, stress, and attrition. According to several studies, trainees often have low levels of satisfaction with their financial status and report that financial wellness impacts both their career choices and relationships.

A study published in the Journal of Surgical Education demonstrated key deficiencies in financial education, including having knowledge about investing, saving for retirement, negotiating salaries, applying for a mortgage, purchasing insurance, and tax planning. Furthermore, 95 percent of residents surveyed agreed that personal finance should be taught during residency training.

Shappell et al. reported the following three high-yield topics for inclusion into curricula: how to set financial goals and monitor progress; how to seek financial advice; and information on the five key target areas of education debt, retirement planning, investments, disability insurance, and life insurance. It is important to obtain appropriate educators with diverse backgrounds including someone with a master’s degree in finance or business as well as individuals with financial advising backgrounds. The prior study in the Journal of Surgical Education provided a sample 5-year financial education curriculum model that included the following educational topics:

• year 1: financial planning, setting financial goals, seeking financial advice
• year 2: creating a budget, managing finances
• year 3: debt management, loan repayment, financial information about private practice and academic careers
• year 4: savings and retirement planning; life, health, disability insurance options; how to set up a trust
• year 5: information on entering a practice, contract negotiation, billing compliance, medical malpractice, lifestyle/financial management, real estate planning

Unfortunately, no standardized curricula offer this type of financial education. Residency programs may offer this information as part of the didactic time allotted by the Accreditation Council for Graduate Medical Education for the education of trainees. Alternatively, to combat barriers such as work-hour restrictions or the fact that this type of education may not be the responsibility of the program, residency programs could provide resources or basic information as an extracurricular program that residents could access throughout the course of their training voluntarily and if interested.

Programs should be encouraged to expand upon and tailor these guided topics to their individual residents’ needs. A program can also be optional for spouses and partners of residents to better help trainees navigate their personal finances and family planning during a period that can be overwhelming. Resources are often variable across programs. Medical organizations, including the Association of American Medical Colleges, as well as loan services, such as Federal Student Aid, offer educational videos and handouts that may be useful for residents and can serve as a guide for organizations.

Many residents feel underprepared when navigating their personal finances and lack confidence when making financial decisions. Some strategies are available to alleviate financial burden, such as debt-repayment programs and moonlighting, but, in the authors’ opinion, those are not adequate. Educational programs that incorporate financial planning and methods to reduce residents’ debt burden would be valuable during medical training. The eventual curriculum should be evaluated for effectiveness in increasing residents’ understanding of financial management and modulated over time to fit changing fiscal stressors. Educating residents can help mitigate financial stress, which can improve physician well-being, reduce attrition, and potentially result in better patient care.

Arianna Gianakos, DO, is a foot and ankle orthopaedic surgeon and an assistant professor of orthopaedic surgery at Yale Orthopaedics and Rehabilitation, Yale School of Medicine in New Haven, Connecticut.

Ronald A. Navarro, MD, FAAOS, FAOA, is the regional chief of orthopaedic surgery for the Southern California Permanente Medical Group and professor of orthopaedic surgery for the Kaiser Permanente School of Medicine. He is also a member of the AAOS Now Editorial Board.

References

1. Kovar A, Carmichael H, Harms B, et al: Over worked and under paid: how resident finances impact perceived stress, career choices, and family life. J Surg Res 2021;258:82-7.
2. Gianakos AL, Semelsberger SD, Saeed AA, et al: The case for needed financial literacy curriculum during resident education. J Surg Educ 2023;80(4):597-612.
3. Hanson M: Average medical school debt: student loan statistics. EducationData 2020. Available at https://educationdata.org/average-medical-school-debt.
4. Teichman JM, Cecconi PP, Bernheim BD, et al: How do residents manage personal finances? Am J Surg 2005;189(2):134-9.
5. Sargent MC, Sotile W, Sotile MO, et al: Stress and coping among orthopaedic surgery residents and faculty. J Bone Joint Surg Am 2004;86(7):1579-86.
6. Shappell E, Ahn J, Ahmed N, et al: Personal finance education for residents: a qualitative study of resident perspectives. AEM Education and Training 2018;2(3):195-203.