What medical students need to know about money

For 10 weeks each spring, fourth-year medical students at the University of Arkansas for Medical Sciences (UAMS) gather for two hours on Monday evenings to talk about all things finance, from mutual funds and trusts to paying off student loans and contract risks.

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Jason Meisel, MD

The Business of Medicine (BOM) course began in 2012 and was initially offered only to surgical residents, says Jason Meisel, professor of surgery at UAMS and director of the BOM program. But due to its popularity, the two-hour elective expanded to fourth-year medical students in 2015 and has grown steadily.

“About two-thirds of the medical school class attends; last year, we had about 120 residents signed up for the class as well,” Mizell says. “In any given week, I have about 200 to 250 participants.”

Despite the efforts of the financial aid bureaus, says Tyler Olson, a financial planner who works closely with attendees, “students don’t understand loan management and are really afraid of making big mistakes with their loans and putting themselves in a tight spot when transitioning from graduation to residency.”

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Students are often unwilling to pay fourth-year expenses, including relocation costs, application and interview fees, and are given incorrect advice by school staff who “just have enough knowledge to be dangerous,” says Olson, who advises medical students on Twitter. He cited cases where schools asked students to refinance their loans, not realizing that doing so permanently eliminated the possibility of public service loan forgiveness.

“If students have access to the right information and the opportunity to focus for a few hours and make decisions, it will make a huge difference” and reduce the potential for their financial worries to become debilitating to their mental health and personal relationships, and to distract from their training,” Olson says.

Although medical school isn’t a time when students typically flush with money and assets, it’s a good time to provide them with the tools to make wise financial decisions in their personal and professional lives, says Meisel.

The 2022 Medscape Medical Student Lifestyle Report found that medical students want to become more financially savvy in the field of medicine, including managing debt, managing practice, negotiating contracts, and investing—a sign that medical schools may not Cover these topics sufficiently or at the same time. All.

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As part of the UAMS course, Mizell invites guest speakers to share real-world scenarios and provide advice on financial independence, finding side gigs, and managing burnout. Previous guests have included James Daley, MD, founder of The White Coat Investor; Nisha Mehta, MD, founder of Physician Side Gigs; and Jamie Turner, MD, owner of The Physician Philosopher.

Mizell has also established an honors track in Finance with a 4-year curriculum in medical school. Each year, students must read certain websites and books, complete small projects, and meet a teacher. They also take the BOM course twice, once as first-year students and then again during their fourth year.

He says getting students early is imperative, before they make “big mistakes” by taking the full allocation of student loans, paying out-of-pocket for health insurance — in Arkansas, medical students often qualify for Medicaid — or buying an expensive car in anticipation of ” Big fat salary” that awaits them after graduation.

“It’s a lot more intense than a one-hour exit interview at the end of medical school,” Mizell says. He noted similar courses for medical students recently launched at Wake Forest and the University of Wisconsin, where he provided input.

Financial guidance varies widely

Although medical schools are not required to provide extensive education in financial literacy, the accrediting bodies of the Association of American Colleges of Medicine (AAMC) and the American Association of Colleges of Osteopathic Medicine (AACOM) require member schools to provide financial assistance and debt management counseling.

Julie Friesen

But because financial aid offices have different levels of resources, advice is given differently at each location, says Julie Friesen, senior director of student financial and career counseling services at AAMC. For example, some officials may require students to complete entry and exit counseling through the Department of Education’s online portal, while others add one-on-one meetings with students, she says.

To complement the schools’ efforts, AAMC conducts on-site sessions on debt management, particularly in the spring for graduate classes and in the fall for incoming medical students.

The association has also developed a robust collection of videos, articles, and calculators on key financial topics, she adds. Through a recent partnership with AAMC, AACOM states that these same reference materials are also available to member schools.

Specifically, AAMC’s FIRST program is an online repository that provides medical advice on managing money and paying off student loans. The companion web-based program, AAMC Financial Wellness, provides various tools and modules to help students create a budget, manage credit, purchase insurance, and purchase a home or car.

Use of AAMC resources varies widely between schools. Fresne says some administrators use the platform to create their own financial literacy programs, and others assign or only suggest specific components for students to complete. As for anything more intense, Friesen says she’d “be surprised to see a long semester [financial literacy] A course or elective in medical school because the challenge is that they can’t get it into the curriculum.”

Diana Sanders, Ed

First-year medical students at Oklahoma State University College of Osteopathic Medicine (OSU-COM) are introduced to AAMC units in orientation and encouraged to fill out a budget sheet, says Diana Sanders, EdD, the university’s director of financial aid and vice chair of the Board of Directors for Financial Aid Student at AACOM.

Neither the modules nor the budget sheet are mandatory, and the number of students creating AAMC accounts, which is a must to access the modules, is very low, she says. However, “the earlier we can talk about what the financial burden is like, the better.”

In September, first- and second-year OSU-com students must attend a presentation by a certified financial planner, which discusses the basics of budgeting, borrowing, loan repayment, and any other money-related questions.

Next, the Financial Aid Office hosts mandatory information sessions during the transitional and educational weeks for third and fourth year students.

These frequent reminders, Sanders says, have reduced the average debt at graduation from $194,000 to $161,000.

Six years ago, Geisinger Commonwealth School of Medicine in Scranton, Pennsylvania, implemented a new financial literacy curriculum that required students to attend two financial aid sessions each year. And like OSU-COM, Geisinger encourages students to take advantage of other “highly suggested” resources, such as AAMC webinars, monthly podcasts, and on-campus pop-up events, says Susan McNamara, the school’s director of financial aid.

“We initially thought our elective sessions wouldn’t yield the same participation rate, but our most popular sessions, a personalized loan portfolio review and loan repayment strategy, have an 85-90% attendance rate,” she says.

As is common in many schools and in keeping with accreditation standards, Geisinger’s curriculum for financial literacy focuses on debt management and repayment, as do the financial education initiatives at the College of Osteopathic Medicine (ICOM) in Idaho.

“[Our] Sessions tend to focus on financing your medical school education, budgeting, identity theft, credit information and results, repayment strategies, and what to consider about “loan refinancing,” says Nicole MacMillan, the university’s director of financial aid.

“Financial aid professionals do not usually provide guidance or advice outside of financial aid topics.” However, she says some schools employ a financial planner, and ICOM’s Office of Financial Aid encourages students to seek professional advice elsewhere.

Financial literacy is integral to wellness

Mizell acknowledges that it can be difficult to find faculty members to lead a comprehensive financial literacy course and attract unbiased guest speakers without an agenda. However, he says the school’s reluctance to offer a customized course shows a “disconnection with wellness and what students really dread about” — money.

“Other majors, such as nursing and pharmacy, have a more rigorous curricular component that teaches billing, coding, and reimbursement. Now that reimbursement is cut off, doctors won’t make as much money, and they have to be smart about it,” but medical schools have not Update curricula to reflect this shift, says Meisel.

Brian Hurton

Brian Hurton is a fourth-year student at Lake Erie College of Osteopathic Medicine (LECOM) Bradenton, FL, campus, which she says has been limited to billing and sees it as a “key learning point” and something “that absolutely couldn’t have a lot of. Until now. However, the LECOM curriculum has yet to delve into the financial implications and potential benefits of pursuing different practice models, and critical aspects that students should consider, Howerton says.

Ideally, medical schools would make more “easily available resources” and explore money management beyond “anything more than” giving you that money, using it wisely, and not using it for unnecessary things,” she says.

Howerton welcomes detailed discussions and hands-on activities about first-year budgeting, planning for ERAS fees and hidden expenses, investing, loan forgiveness options, and how to evaluate employee benefits during interview season. Besides students’ willingness to ask questions and participate in the process, an extended education in financial literacy will help prepare graduates for successful practice, she says.

Mikaila Calcagni, MD, is the product of financial literacy training. She took Mizell’s BOM course in 2018 and credits her with her ability to become debt-free just 3 years after graduating.

“I was able to start my career and really make money,” she says. “Often, students are ‘sold’ the idea that you can easily get a loan and all you have to do is simply pay it off,” but she says they never learned the ins and outs of finances to make it happen.

Kalkany says investing in the short time in the course resulted in an “exponential” return, and generated “real excitement” from attendees. “They all wanted to know more about it and what I learned. It was interesting to see that this course changes my future and at the same time breaks the long cycle of doctors who are not taught the basics of financial education.”

Steve Webber is a freelance journalist based in the Midwest who specializes in health care and law.

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