Physicians Are Financially Illiterate

[artemis]

hightower wrote:

Most starry eyed twenty somethings are completely disconnected from money and personal finance...

Click to expand...

That's the fundamental problem right there.  Student loans are being pitched to people who are adults in only a technical sense (they are 18 or older).  In the majority of cases, they have no actual experience living on their own, doing real budgeting, or managing large sums of money, and so they have no real understanding of just how much debt they are actually taking on and how it's going to affect their finances long-term.

I do think that medical schools which try to educate their students about the financial realities ahead of them (like mine) do manage to do some good.  But most students (both in college and in postgraduate education) are naive enough and optimistic enough to think that if they just work hard and are pure of heart, somehow things will somehow magically work out.

Nice to see some good financial content on Kevin MD, btw!

[RogueDadMD]

The White Coat Investor wrote:

I wouldn’t argue “Med School or Residency?” I would do something in both.

Click to expand...

Absolutely -- I've found at our institution the students and residents/fellows want this and now devour it.

I'm now giving presentations to our entire graduating med school class, all the surgery residents, and started a combined lecture series for our peds and IM residents.  We're expanding this peds/IM series from 4 to 5 lectures next go around.  It's part of their regular noon conference schedule and open to all their fellows as well, so attendance has been good. The department heads and residency directors love it -- I thought they would resists given that I'm in a place that at times is almost the textbook definition/stereotype of ivory tower academic environment, but it's been the opposite.  The leadership absolutely want their trainees to receive this info, the chief residents are enthusiastic about it, and the trainees ask for more.

I am presenting 2 abstract as posters  at the Pediatric Academic Society meeting in May, 2017 on these topics.  One on this lecture series and one on the survey of a few hundred residents/fellows I did evaluating their financial knowledge and readiness (that's the paper that's close to publication).

The abstracts are both going to be available online in a couple weeks for anyone to read (I think), so once they are I can share them here.  Not sure if I'm allowed to distribute them before the conference has officially put them online.   There's more data than can fit in the abstracts, but they are nice snapshots.

[Zaphod]

Yes, its much better to have a combination of basic fundamentals and just in time topics that are immediately actionable.

[WallStreetPhysician]

WallStreetPhysician wrote:

Great article, WCI. Unfortunately, one article won’t make the change happen overnight, but with a million baby steps, we’ll chip away at this problem. I’ve been working on an article in a similar vein as yours for the past few weeks that I’m planning to submit to KevinMD. We’ll see if the KevinMD editors are on board with pushing for improved financial literacy among physicians.

– Wall Street Physician

Click to expand...

My guest post was published by KevinMD this evening.

http://www.kevinmd.com/blog/2017/04/doctors-need-become-informed-physician-investors.html

The article is not earth-shattering to WCI forum participants, but it's a different way of encouraging physicians to become more financially literate ("informed physician investor" was the term I used).

-WSP

 

 

[LizFK]

Newbie here - I've been scouring the forums and learning more, and I came across this thread and I had to comment.  I have been saying this for YEARS, and I'm glad to see others are finally discussing it.  With all of the discussion of public education in this country, it's amazing that very few people touch upon the fact that we have standard requirements in high school math for trigonometry and algebra (classes that most may not need and can be taken at the college level for careers requiring that knowledge base), but there are no basic finance, accounting, investing or even just basic life skills courses.  Most students that graduate with a high school diploma has no idea about compound interest or even how to balance a checkbook or analyze a bank statement.  It's expected that the parents teach these important life skills, but if the parents don't know or don't understand, then we just continue to churn out generations of uneducated, indoctrinated workers.  This may be purposeful, but that doesn't mean that we can't change the system.

In four years of medical school, there are many courses that many physicians, particularly specialists, may never use, but there is not even one basic business administration or finance course, yet for years, physicians would open up private practices or join groups, and now many medical students are graduating with increasing debt at even higher interest rates, with no clue how to invest or pay off debt without shortchanging their retirement income potential.

In all seriousness, beyond venting on forums, how do we go about changing the education model?  I know the public school level is even more difficult, but who sets the standard for medical school curriculum?  I personally try to work on the smaller battles and build from there.

[RogueDadMD]

I've started giving talks to our Med students in addition to all our medicine and peds residents. I think there's enough desire and momentum out there that you just people just need to start asking for it.

[Muaddib]

Presenting information to people at an early stage is great, but many may not ready to hear it, or aren't in a place to priotitize it.

at 2 years out of training I finally got extra disability and life insurance outside of employer benefits (whole life through NWM unfortunately), started Roth IRA for me

3 years out I realized whole life didn't make sense and started reading (Beth Kobliner's Get a Financial Life).  then found WCI

4 years out finally switched whole to term

4 1/2 year out got out of pre load high ER fund that NWM did for my roth IRA and transferred to VG, started spousal IRA @ VG, changed 529 plans from brokered plan( of course with higher ER and pre load), to basically same products without preload and lower ER at direct plan

coming up to 5 year, will hopefully start putting $ into taxable account

 

hearing something, then knowing it, and then doing something about it, is not always a quick process for some of us

 

I do think that built into residency orientation should be a talk, and probably once a year refresher with some directed points to new residents and graduating residents

and send emails every month reminding residents to avoid talking to northwest mutual

 

btw, 1 week after I moved my roth and 529 plans from NWM clutches, i have been receiving weekly voicemails from NWM office to set up a meeting "to go over things"

[StarTrekDoc]

IMHO, education should start the very first day upon acceptance.  It should be required for anyone taking any student loans out.  Medicine is very much a cottage industry and it really makes a difference on employment choices.   It should span the entire spectrum, including reimbursement coding and value based medicine concepts.  By the time residency rolls around, the MS should be versed in these just as importantly versed in the ability to take an adequate history and develop basic assessments and plans.

With the average MS coming out with $200,000+ debt, there's a responsibility of that med school to address that need in as much providing a solid foundation of medical knowledge.

Like many schools now have 4 year arcs of training in patient experience, a financial one should be done--and not just washed out private practice folk in academia with a highly skewed view of the world.

An ideal society that would be able to push this would be AMSA to all med schools.

[RogueDadMD]

If I never did private practice and went straight to academics, what does that make me? I didn't wash out, so maybe I am a "never was?"

Too bad my trainees are learning from someone who "never was" and doesn't understand money.

[StarTrekDoc]

Cool your academia jets Rogue.  Your venom is hitting a fellow guy in the UCalifornia system.

Never stated academic docs don't understand money and was actually referencing Vagabound's post earlier on that some lectures have poor experiences from private practice and can easily poison the well for medical students with that perspective.  With your above response, it would be interesting to see how well you represent practice options to your students.

This is were leveraging the clinical instructors out in the community would be very nice to get into a lecture series.  Better yet, their clinical managers/CFO would be nice to incorporate into such a curriculum.

Finances is such a wide spectrum.  From debt management, savings, expense control to contract setup/negotiations, to choice of practices from single rural to multiple specialty to large health system, profit/nonprofit.   All these fall into 'financial literacy' and like I referenced earlier would be largely beneficial for a framework curriculum be setup by a national organization.  My guess is AMA/AMSA may have something, but haven't looked into that at all.....perhaps a worthy project for academic advancement of some folk with that vein.

[RogueDadMD]

StarTrekDoc -- I was being facetious. I amused myself with my response. My sarcasm is wasted!

However to answer your question -- last year we had an entire session devoted to practice structures, specifically to teach trainees about life outside academia, because yes, they need to know about life outside the ivory tower.

Had a doc from an IM concierge practice, private practice gen peds, employed private adult cards, and academic peds specialist. They gave an overview of their practice and essentially said what they liked and didn't like about it.

There's no way one person can teach them everything they need to know, unless that one person is themself.

[RogueDadMD]

I can't find the right thread anymore, but we were having a discussion of topics taught during personal finance lectures to med students/trainees and people were asking what type of content some of us cover.

I'm giving my two-part talk to our peds/IM residents this week (as part of a 5-part series).  I just finished updating it and I said I would share the topics I am covering.  Attached is a 3-slide PDF with the overview of what I cover/don't cover (taken directly from my talk).

I should note that this provides the specific finance topics I cover, but it doesn't represent all the material in my presentations.  I have a very personal introduction to get them to relate to the topic and to me specifically, as well as a slide I added (this year) discussing some of my own finances (I don't give them my net worth, but give some broad strokes).

To make it enjoyable I also relate personal anecdotes and try to make each slide interesting on its own (to the degree that is possible).

I really enjoy public speaking (I would rate myself a B+, maybe A- on the better days), but have an occasional tendency to ramble when I get excited, so that's also built into the talk.  

In the slide of things I am not covering, I still very briefly touch on some of them, but I don't devote sections of the talk to them.  Also, some of those topics are covered in the 3 other sessions we provide (such as student loans, which was an entire hour talk last week by an loan expert from our med shcool financial education department).

I also provide some external references (websites, etc) to read at the end.

 

[VagabondMD]

Rogue Dad, M.D. wrote:

I can’t find the right thread anymore, but we were having a discussion of topics taught during personal finance lectures to med students/trainees and people were asking what type of content some of us cover.

I’m giving my two-part talk to our peds/IM residents this week (as part of a 5-part series).  I just finished updating it and I said I would share the topics I am covering.  Attached is a 3-slide PDF with the overview of what I cover/don’t cover (taken directly from my talk).

I should note that this provides the specific finance topics I cover, but it doesn’t represent all the material in my presentations.  I have a very personal introduction to get them to relate to the topic and to me specifically, as well as a slide I added (this year) discussing some of my own finances (I don’t give them my net worth, but give some broad strokes).

To make it enjoyable I also relate personal anecdotes and try to make each slide interesting on its own (to the degree that is possible).

I really enjoy public speaking (I would rate myself a B+, maybe A- on the better days), but have an occasional tendency to ramble when I get excited, so that’s also built into the talk.  

In the slide of things I am not covering, I still very briefly touch on some of them, but I don’t devote sections of the talk to them.  Also, some of those topics are covered in the 3 other sessions we provide (such as student loans, which was an entire hour talk last week by an loan expert from our med shcool financial education department).

I also provide some external references (websites, etc) to read at the end.

 

Click to expand...

Looks good, but I am not sure that FIRE deserves a prominent role on Day 1. I think it is a concept that is best understood once all of the building blocks are in place, and it will only appeal or be applicable to a small fraction of the audience (IMO).

[RogueDadMD]

You may be right. Trying to shake it up a little.

My plan isn't to preach the virtues of FIRE or guilt people about it. It's to make sure their eyes are open and they understand a potential benefit of managing their finances well. Hopefully a way to set the tone for the reason they need to do a good job on the rest.

I'm in an traditional academic setting where people routinely work into their 60's and beyond. There aren't really any role models on a day to day basis that will help open eyes to the concept of NOT working forever.

I'm not a role model in that regards either since I won't be retiring at 45. But I'm hoping to find more ways to get them taking an active interest in their financial habits and goals.

[hightower]

I think it's great you're doing that.  We never had any good talks on financial management topics in residency.  Our program director asked a financial advisor to come and talk to us once.  He wasn't very good and the talk left us all more confused than before.

Definitely let us know how it goes and things you learned from doing it, changes you would make, etc.

It's something I've considered volunteering for in the future. I feel like I've really learned a lot and could probably give an interesting talk and even share my own experiences with learning about money, mistakes along the way, etc.