PracticalDermatology

Financial education for medical trainees is an unmet educational need. Although most physicians eventually earn high salaries, the road to entering the workforce is longer for them compared to other professionals. Medical school loan repayments and low financial literacy, coupled with delayed financial stability, can cause distress and impact career choices for graduating resident physicians. Therefore, efforts towards establishing a personalized and robust financial curriculum should be a priority for clinical educators along with clinical competency.

Clinical competence, rightfully, is the cornerstone of medical education at any stage of training. Focusing on clinical competence alone, however, would be a shortcoming of medical curriculums. Physician wellbeing, including financial wellbeing, is a prerequisite for the provision of quality care for patients. Financial wellbeing is closely related to productivity and resilience of physicians. Shappell, et al. explored resident knowledge, attitudes, and experiences regarding personal finances in a qualitative study. Residents expressed anxiety relating to their educational debts, expressed a desire for financial education due to lack of information, and indicated uncertainty as to where to find relevant and useful information on their personal finances.¹

Residents and fellows in another study reported equal or higher monthly expenditure than income and expressed dissatisfaction with their personal finances.² This is while physician earnings are similar to the national average income. In another qualitative study by Phillips, et al., educational debts were identified as a stressor for medical trainees which may affect their professionalism.³ For all these reasons, medical educators should be aware of the trainees’ experience and distress related to financial wellbeing. Incorporating financial education into clinical curricula will improve future physicians’ performance and job satisfaction, leading to higher quality health care for patients.

Financial wellbeing could potentially affect patient wellbeing through its influence on physician career choices. In two separate studies on dermatology trainees in 2006 and 2014, financial debts were found to have no effect on their career choices.^4,5 This could be due to the increase in income for dermatologists during the same time periods, and the possibility of large debts affecting trainee choices could not be reliably ruled out. Many other specialties have reported at least some degree of financial instability and educational debts affecting career and training decision-making among residents. Higher educational debt has been found to drive pediatricians toward primary care or hospital-based careers and away from pursuing fellowship training.⁶ Neurology residents in another study still pursued fellowship training despite large student loan debts but were deterred from undertaking a career in academia.⁷ This points to the fact that providing financial education for residents is critical not only in the short-term but also in the long run to improve physician wellbeing and job satisfaction, factors that directly affect the quality of care provided by physicians.

We read with great interest the recent article by Sharma and Rojek about financial illiteracy of dermatology residents.⁸ Residents were interested in learning about negotiating salary (88.7 percent), investing (73.7 percent), tax planning (66.9 percent), and purchasing insurance (63.9 percent). Additionally, 95 percent were interested in a financial education curriculum during residency. We would venture that most dermatologists in practice would feel the same way.

Data on the need for financial education for residents, although sparse in the literature, strongly suggests a knowledge gap and a critical need. Clinical educators need to be aware of this knowledge gap and ensure that future US physicians are not only competent to provide excellent medical care to patients but also are financially well and informed. This allows them to maintain their own wellbeing and therefore be able to provide medical care and make career choices free of undue stress. There are multiple possible methods of providing this knowledge to trainees, including incorporation into formal and informal curricula, workshops, and meetings.

Amongst almost 100 dermatology conferences over the last 15 years attended by one of the authors (JW), only one (a pre-AAD meeting meant for residents) had a lecture about investing and other financial related topics. Programs designed to enhance financial literacy in residents and trainees should be more widely available.

To learn more, consider attending the inaugural 2020 San Diego Dermatology Symposium from September 11-13, 2020 at the InterContinental San Diego where Dr. Wu will discuss this more in depth. sddermsymposium.org

Funding sources: None

1. Shappell E, Ahn J, Ahmed N, Harris I, Park YS, Tekian A. Personal finance education for residents: a qualitative study of resident perspectives. AEM education and training. 2018;2(3):195-203.

2. Ahmad FA, White AJ, Hiller KM, Amini R, Jeffe DB. An assessment of residents’ and fellows’ personal finance literacy: an unmet medical education need. Int J Med Educ. 2017;8:192-204.

3. Phillips JP, Wilbanks DM, Salinas DF, Doberneck DM. Educational Debt in the Context of Career Planning: A Qualitative Exploration of Medical Student Perceptions. Teaching and Learning in Medicine. 2016;28(3):243-251.

4. Salter SA, Kimball AB. Rising educational debt levels in recent dermatology trainees and effects on career choices. Journal of the American Academy of Dermatology. 2006;54(2):329-331.

5. Sung S, Kimball AB. An evaluation of educational debt levels in dermatology residents and effects on career choices. Journal of the American Academy of Dermatology. 2014;70(6):1141-1142.

6. Frintner MP, Mulvey HJ, Pletcher BA, Olson LM. Pediatric resident debt and career intentions. Pediatrics. 2013;131(2):312-318.

7. Doherty M, Schneider A, Tirschwell D. Will neurology residents with large student loan debts become academicians? Neurology. 2002;58(3):495-497.

8. Sharma AN, Rojek NW. Assessing the financial literacy of dermatology residents: A nationwide survey. Journal of the American Academy of Dermatology. 2019.