Urology residents face many challenges to their personal financial health. The increasing cost of medical education and associated loan burdens leave the average urological resident with debts in excess of several hundred thousand dollars at the onset of their careers.¹ Residents may also be unaware of the threats to their newly attained income, namely death and disability. Finally, residents may not fully appreciate the importance of saving for retirement, and the associated benefits of saving within a qualified retirement savings account such as a Roth Individual Retirement Account (IRA) and employer-sponsored 401(k).² The deficiency of personal finance knowledge within the urological resident demographic has significant consequences. Resident financial status may influence the decision to pursue a fellowship and/or enter either academics or private practice.³ Moreover, poor financial literacy has been shown to have a deleterious effect on job satisfaction and burnout.⁴

Despite the potential benefits of incorporating financial literacy training into urology residency curricula, few studies have evaluated the financial literacy of urology trainees or the efficacy of financial education interventions. During the COVID-19 pandemic, this educational gap was addressed with a financial literacy lecture given by Dr. Sammy Elsamra on 2 separate dates under sponsorship of the American Urological Association New York Section EMPIRE (EducationalMulti-InstitutionalProgram forInstructingResidents) Lecture Series and the New England Section Virtual Lecture Series. Attendees were polled prior to viewing this lecture with a 22-item questionnaire addressing current financial/loan status, knowledge of repayment plans, and knowledge of retirement and disability plans

What Do Urology Residents Know about Personal Finances?

A total of 50 individuals attended the EMPIRE lecture and 76 attended the New England Section Virtual Lecture. Of the viewers 63 responded to the pre-lecture survey, representing a 50% response rate (fig. 1). Of the responders 51 (81%) reported having some degree of student loans. Among those with student loans, 92.4% of participants reported student loans in excess of $100,000, with 21 (42.3%) individuals reporting loans greater than $250,000 (fig. 2). Approximately 50% of respondents expressed an interest in obtaining financial advice and 71.4% of respondents reported a previous interaction with a financial advisor (fig. 3).

Figure 1. Distribution of participant year of training.

Figure 2. Overall degree of student loan debt.

Figure 3. Reported preferences in management of personal finances.

Student loan accruement did appear at least moderately concerning to most participants, with 73.6% rating their level of student debt concern as at least a 3 on a Likert scale of 1 to 5. Of the individuals 9.6% had refinanced their loans at the time of the survey. Amongst those who had not completed refinancing their loans, participants reported a myriad of repayment plans including self-pay (21.8%), Public Service Loan Forgiveness (PSLF) (17.8%), time-based loan forgiveness programs including income-based repayment, pay as you earn, revised pay as you earn (15.7%), or a combination of programs (fig. 4). Importantly, nearly 14% of the respondents were not aware of any loan-repayment options.

Nearly 43% of respondents reported not having disability insurance. Of those who are insured, more individuals have specialty-specific insurance than nonspecialty specific (30.2% vs. 23.8%). With respect to life insurance, 46% of respondents had no life insurance at all; the remainder had primarily term life insurance. The most commonly cited reasons for not obtaining disability or life insurance were either not having enough money or being unaware of the products. The majority of participants are currently contributing to a retirement savings plan (71.4%).

Figure 4. Participant plan for repayment in those who had not refinanced loans.

Comment

Student debt and repayment options represent an important contributor to the financial well-being of residents⁵ with the link between educational debt, physician burnout, and work-life balance well-established.^4,6 In a study of 21,208 medical residents in the United States, investigators demonstrated that quality of life and work-life balance were significantly lower among residents with educational debt, particularly amongst those with debts exceeding $200,000. Additionally, financial debt was linked to both emotional exhaustion, and depersonalization.⁴ Conversely, financial health has also been shown to be positively associated with resiliency, thus underscoring the importance of early financial literacy education.⁶

Both residents and faculty agree that financial training is an important part of surgical training. According to a study by Tevis et al, 80% of surgical residents believed strongly that financial education was needed in surgical training.⁷ A study by Lusco et al corroborated these findings, reporting that 87% of general surgery program directors agreed that residents should be trained in business and practice management.⁸ However, few interventions in resident financial literacy have been described.

The implementation of a medical school financial literary curriculum has been described, but what options exist once trainees have reached residency? At a local level, programs can institute dedicated lectures, built into existing lecture time, given by either a staff urologist with high financial literacy or by an employee of the hospital with specialty in financial guidance. Such a program, however, would still require “buy in” by residents and likely would most benefit those who already have an interest in personal finances. Interval ACGME (Accreditation Council for Graduate Medical Education)-instituted short seminars have also been shown to change financial behaviors and investments and could be more widely implemented.⁹ At a more systemic level, all trainees could be required to privately meet with a financial advisor upon the initiation of their training, and to be given their options for retirement planning, disability plans, and student debt repayment programs. Interval followup meeting to review life changes could also augment the utility of these meetings. Such programs may combat physician burnout and improve the financial wellness amongst residents. Future longitudinal studies should also evaluate the efficacy of such training programs in terms of short-term choice changes as well as subjective wellness outcomes.