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AUA2023 BEST POSTERS Assessing Financial Literacy and Well-being of Urology Residents
By: Katherine M. Sinchek, MD, Rush University Medical Center, Chicago, Illinois; Morgan Salkowski, MD, Rush University Medical Center, Chicago, Illinois; Kyle Dymanus, MD, Rush University Medical Center, Chicago, Illinois; Christopher Coogan, MD, Rush University Medical Center, Chicago, Illinois; Alexander K. Chow, MD, Rush University Medical Center, Chicago, Illinois | Posted on: 30 Aug 2023
Study Need and Importance
Physicians accrue significant debt throughout their medical education yet report less knowledge of personal finance management compared to their age-matched peers.1-3 With recent studies elucidating the connection between financial and personal well-being, understanding the state of finances among resident physicians is key for training programs to support them in financial wellness early in their careers.4-6 Our study sets out to better understand and further define the financial status, literacy, and attitudes of urology residents across the United States.
What We Found
A web-based survey was sent to 146 ACGME (Accreditation Council for Graduate Medical Education)–accredited urology residency programs in the United States. Respondents were asked to answer 50 questions covering personal debt, financial status, and willingness to participate in formal education on personal finance during residency. The survey included a validated questionnaire authored by the Financial Industry Regulatory Authority7 to provide objective data regarding financial literacy.4
Ninety-nine total responses were received from urology residents located in 23 states. Financial and debt status are reported in the Table. Eighty-eight respondents answered the financial literacy portion of the survey, with an average correct score of 53% (± 22.5%). Residents who reported their knowledge of personal finance and investing as high (7%) or above average (26%) were more likely to have higher scores than those reporting their knowledge as limited (38%) or having no knowledge (11%; P = .01). A lower debt level (<$100,000) was associated with a higher literacy score (P = .01). Residents cited lack of time (75%), lack of resources (51%), and challenging subject matter (47%) as reasons for their limited financial knowledge.
Table. Financial Status, Debt, and Savings of Urology Residents (N=86)
| Question | All debt levels (n=86), No. (%) | No. debt (n=23), No. (%) | <$50,000 (n=4), No. (%) |
$50,000- <$100,000 (n=7), No. (%) | $100,000- <$150,000 (n=8), No. (%) | $150,000- <$200,000 (n=10), No. (%) | $200,000- <$250,000 (n=12), No. (%) | ≥$250,000 (n=22), No. (%) |
|---|---|---|---|---|---|---|---|---|
| Debt | ||||||||
| Have no credit card debt | 68 (79) | 22 (96) | 4 (100) | 0 (0) | 5 (63) | 8 (80) | 9 (75) | 7 (32) |
| Have <$4,000 credit card debt | 10 (12) | 1 (4) | 0 (0) | 0 (0) | 2 (25) | 1 (10) | 2 (17) | 4 (18) |
| Have $4,000-$8,000 credit card debt | 2 (2) | 0 (0) | 0 (0) | 0 (0) | 1 (13) | 0 (0) | 0 (0) | 1 (5) |
| Have >$8,000 credit card debt | 6 (7) | 0 (0) | 0 (0) | 1 (14) | 0 (0) | 1 (10) | 1 (8) | 3 (14) |
| Have home loans and/or mortgage | 33 (38) | 6 (26) | 2 (50) | 2 (29) | 4 (50) | 1 (10) | 6 (50) | 12 (55) |
| Savings | ||||||||
| Have retirement savings | 67 (78) | 20 (87) | 4 (100) | 5 (71) | 7 (88) | 6 (60) | 9 (75) | 16 (73) |
| Have an employer-sponsored retirement plan | 55 (64) | 15 (65) | 3 (75) | 4 (57) | 5 (63) | 6 (60) | 7 (58) | 15 (68) |
| Invest in a Roth or traditional IRA | 56 (65) | 18 (78) | 4 (100) | 5 (71) | 6 (75) | 2 (20) | 7 (58) | 11 (50) |
| Financial planning | ||||||||
| Time off between undergraduate and medical school | 53 (62) | 12 (52) | 2 (50) | 6 (86) | 6 (75) | 2 (20) | 8 (67) | 17 (77) |
| Have estimated amount needed for retirement | 24 (28) | 9 (39) | 1 (25) | 2 (29) | 3 (38) | 1 (10) | 3 (25) | 5 (23) |
| Have attended a financial planning seminar in residency | 40(40) | 11 (48) | 3 (75) | 3 (43) | 3 (38) | 4 (40) | 4 (33) | 7 (32) |
| Have a rainy-day funda | 57 (66) | 18 (78) | 4 (100) | 5 (71) | 5 (63) | 5 (50) | 6 (50) | 14 (64) |
| Able to cover unexpected cost of up to $2,000 | 71 (83) | 21 (88) | 4 (100) | 6 (86) | 7 (88) | 7 (70) | 4 (33) | 18 (82) |
| Have difficulty with covering monthly expenses | 30 (35) | 4 (17) | 1 (25) | 2 (29) | 4 (50) | 3 (30) | 5 (42) | 10 (45) |
| Spend more than or equal to annual household income | 25 (29) | 5 (22) | 1 (25) | 3 (43) | 3 (38) | 3 (30) | 3 (25) | 7 (32) |
| Rely on familial support to cover monthly expenses | 12 (14) | 4 (17) | 0 (0) | 0 (0) | 2 (25) | 1 (10) | 2 (17) | 3 (14) |
| Abbreviations: IRA, individual retirement account/employer-sponsored retirement account (401k, 403b, other). a Rainy-day fund defined as possessing enough capital to cover 3 months of living expenses. |
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Limitations
Major limitations included self-reporting and the inability to verify responses. Limitations also existed in the rate and distribution of study responses. Although the data set included 99 total responses, only 23 of the 50 United States were represented in this group. Additionally, 84 of the 99 respondents indicated living in an urban or near-urban setting while no respondents indicated living in a rural region. Thus, it is probable that our study findings are more closely generalizable to residents living in medium- to large-sized cities. This may contribute to a level of bias regarding the cost of living and the impact it has on one’s ability to afford monthly expenses, reduce personal debt, and even the level of financial literacy one possesses. Diversity in parental education serves as a secondary limitation, with 87 of the 99 respondents reporting a greatest parental level of education of undergraduate degree or higher, with 50 of 99 indicating at least 1 parent with a doctoral degree. While this may be representative of physicians as a group as opposed to those studied in this survey, this reported parental level of education may predict a greater financial literacy and/or well-being from a familial standpoint. Although 86% indicated nonreliance on familial support to cover monthly expenses, a vast majority (78%) reported learning about personal finance, investment, and saving from family members or friends.
Interpretation for Resident Care
Responses indicate a high debt burden yet limited literacy3 in personal finance based on quantitative measures provided by the Financial Industry Regulatory Authority assessment.7 Although most residents reported confidence in ability to meet monthly costs of living, a survey of savings vs debt depicts residents in a precarious position. Formal education in personal finance was also assessed, highlighting a disparity in resident interest and what programs currently offer. While most residents reported having access to personal finance educational programming at their programs, almost all respondents indicated they did not feel it was adequate for their needs.
These results suggest that the addition of a formal course on personal finances would be well received and lead to improved financial well-being in this group. Beyond this, our greatest recommendation would be for residency administrators to treat financial well-being as another aspect of personal wellness overall. Early education and check-ins with residents within a program may contribute to a greater sense of well-being and support overall.
- National Center for Education Statistics. Percentage of Graduate Degree Completers With Student Loan Debt and Average Cumulative Amount Owed, by Level of Education Funded and Graduate Degree Type, Institution Control, and Degree Program: Selected Years, 1999-2000 Through 2015-16. 2018. https://nces.ed.gov/programs/digest/d18/tables/dt18_332.45.asp
- Association of American Medical Colleges. Medical Student Education: Debt, Costs, And Loan Repayment Fact Card. 2021. https://store.aamc.org/downloadable/download/sample/sample_id/468/
- Huston SJ. Measuring financial literacy. J Consum Aff. 2010;44(2):296-316.
- Kibbe MR, Troppmann C, Barnett CC, et al. Effect of educational debt on career and quality of life among academic surgeons. Ann Surg. 2009;249(2):342-348.
- Raj KS. Well-being in residency: a systematic review. J Grad Med Educ. 2016;8(5):674-684.
- Rohlfing J, Navarro R, Maniya OZ, et al. Medical student debt and major life choices other than specialty. Med Educ Online. 2014;19(1):25603.
- Financial Industry Regulatory Authority. National Financial Capability Study. 2018. https://www.usfinancialcapability.org/downloads/NFCS_2018_Report_Natl_Findings.pdf
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