Personal Financial Well-being of Family Medicine Residents and Residency Curricula: A CERA Study

The Accreditation Council for Graduate Medical Education has emphasized general well-being as a milestone in graduate medical education.¹ This construct includes personal financial wellness, defined as “a comprehensive, multidimensional concept incorporating financial satisfaction, objective status of financial situation, financial attitudes, and behavior.’’²

Medical careers often begin with debt³ and residency stipends do not balance loan repayments. Higher absolute debt predicts perceived depression, stress, and worse general health.⁴ Furthermore, family Medicine (FM) ranks among the lowest-compensated specialties⁵ with average annual compensation averaging $236,000.⁶ 

Survey studies in orthopedics, internal medicine, medicine-pediatrics⁷ and surgery⁸ found residents had low financial literacy and financial preparedness.⁹ While there have been studies about FM residents and debt,^10,11 there are no studies evaluating financial well-being of FM residents.

Our study aimed to measure the financial well-being of residents and its association with the delivery of financial curricula in residency and other demographics.

Our survey questions were a part of a larger omnibus survey conducted by the Council of Academic Family Medicine Educational Research Alliance (CERA), methodology of which has been described previously.¹²

After American Academy of Family Physicians (AAFP) institutional review board approval, 5,000 resident members of AAFP were electronically surveyed between April and May 2021. The response rate for the survey was 5.32% (266/5,000).

The Consumer Financial Protection Bureau (CFPB) financial well-being scale was included in the survey.^13,14 The CFPB financial well-being scale employs the Item Response Theory (IRT) analysis, which is a more precise statistical measure than a simple summary score and returns a variable intermittent range from 19 to 82 with only 21 unique possible scores. Based on the frequency distribution of our data and financial literacy research, we determine three financial well-being classifications: low (19-39), medium (40-59), and high (60-82).

We conducted descriptive statistics (frequency and percentage, mean and standard deviation). We tested associations using χ² tests and one-way analyses of variance to study the association between the financial well-being and the various demographics. We used Stata software, version 16.1 for all statistical analyses.¹⁶

Respondents were 56% (n=148) women, 60% majority White (n=160) and 28% (n=73) were international medical graduates (IMGs). Table 1 provides descriptive statistics as well as demographics of respondents. The resident AAFP membership location is comparable and is the only equivalent data shared with us from the AAFP.  

Mean financial well-being score of the residents is 55.7±12.1. According to our scale, a range of 40-59 is considered medium financial well-being with 55.7 being near the higher end. The distribution of the residents’ financial well-being across the various ranges is shown in Table 2. Compared to a national sample of adults in the United States aged 18 years and above, the financial well-being of our resident respondents lies between the 50th and 75th percentiles across all age groups and income status (see supplement 1).

Financial well-being was positively associated with residency year (P<.05), the PGY-2 and PGY-3 residents had higher financial well-being scores than PGY1 residents (Table 3). Financial well-being was also positively associated with income (P<.01) and citizenship (P<.05); US citizens exhibit higher financial well-being scores compared to noncitizens. Educational debt is negatively associated with financial well-being (P<.001). Higher financial well-being is positively associated with the presence of any financial literacy curricula even if it was only offered once during the residency. Financial well-being is also higher among those who are interested in retirement planning and lower for those interested in curricula on debts and taxes.

The frequency of personal finance content delivery in our sample is as follows: “never” 20.7% (n=53), “once in the residency” 22.3% (n=57), between “once in the residency” and “once per year” 39.1% (n=100), and “1 to 4 times per year” 18% (n=46). Most respondents (79.1%; n=204) agreed/strongly agreed that financial curriculum is relevant to their education while 34 respondents (13.2%) neither agreed or disagreed, and 20 respondents (7.7%) disagreed. We did not find a correlation between FM residents’ attitudes about relevance of financial curriculum and receiving finance content in the curriculum.

When asked about the preferred format to deliver personal finance curriculum, 39% (n=101) of residents reported “access to personal finance advisor,” 31% (n=80) “workshop,” 16.3% (n=42) “lecture/presentation,” 8.9% (n=23) “web-based modules,” and 4.7% (n=12) “written or online resources.” Many of the residents (66.3%, n=171) reported that this information should be delivered throughout the residency, while 18.2% (n=47) reported optimal delivery during PGY2 and later and 15.5% (n=40) prefer delivery in PGY1.

This is the first study to attempt a measurement of resident personal financial well-being with the CFPB scale. Higher financial well-being was positively correlated with any personal finance curricula in residency. Although our study of FM residents reveals mean CFPB scores in the upper medium range when compared to the US adult population, we find almost one in five FM residents reported not receiving personal finance curriculum during their training, despite many of them indicating this curriculum is relevant. To address this, residency programs should focus curriculum efforts on debt and financial well-being of FM residents. Systematic reviews illustrate that early and sustained interventions for wellness are key.¹⁷ Just-in-time intervention of financial education can be beneficial to financial well-being.¹⁸ Residents in our study indicated time with a personal financial advisor and workshops would be preferred for delivery content.

Limitations to our work include a low response rate, which is often seen in electronic surveys¹⁹ and especially notable given this CERA survey was not a part of the regular annual surveys. A low response rate introduces potential bias related to small sample size. Reassuringly, despite these limitations, the CFPB can be a feasible and useful tool for understanding resident financial well-being.

In conclusion, a national survey of FM residents revealed medium-high personal financial well-being, with higher well-being positively associated with any financial curriculum in residency. Most FM residents found personal financial curriculum relevant to their education and would like curriculum throughout residency. Residency programs can use this information and the CFPB tool to assess and support financial well-being curriculum development.