Thursday, July 14, 2022

by Miriam Sweeney 

Money is one of the most influential things in our lives that is simultaneously most difficult to talk about. And the medical field is no exception. In my unique situation, I’ve had the opportunity to talk with an abnormally high number of doctors-to-be about their finances.

It started when I began to edit friends' personal statements with them before their applications to medical school. Editing one friend’s statement led to editing their friend’s statement, and soon enough, I had a small seasonal editing side gig on my hands.

As I worked with premeds to articulate why they wanted to go to medical school, it surprised me how infrequently people would tell me that one of their motivations for going to medical school was financial.  When talking with bright young people who are midway through their undergraduate degrees and sincerely contemplating the next decade of their lives and stating (not only with a straight face, but with excessive volunteer and shadowing hours and effort to get great grades) that they think that going back to school and staying in it for years to come is actually a fantastic idea, very few talked me about how much money they hope to make.

In fact, as part of my personal statement editing process, I’ll ask everyone why they want to go to med school.  I never let them give me just one simple answer. I encouraged everyone I worked with to brainstorm a list of responses in the style of “there are no wrong answers here.” Of course, I didn’t tell them they needed or even should include all the reasons in their personal statement, but I wanted to see their minds were open and they were willing to be honest with themselves. And not one of the dozens of students who I worked with ever mentioned compensation until after I prodded them and indicated that money and lifestyle are also valid reasons for enormous career decisions. Once prompted, everyone would chuckle, loosen up a bit, and agree that they wanted to be compensated well for hard work in their career.

But we don’t talk about this. We don’t talk about how much money we make or how much money we wish we made. Or, if we do, perhaps we fear being lumped together with money-hungry ladder climbing go-getters who want nothing more than to increase their salary and die someday on a king-sized bed built of hundred dollar bills. No one wants to be lumped into a category with that guy.

But that stigma is keeping us from conversations that could potentially truly benefit us and help us in continuing our education of how to navigate the world as professionals, providers, family members, members of various communities, and adults in general.

When exploring the need for a physician personal finance education platform, I had as many conversations with medical students, residents, and early-in-their-attending-years physicians as I could. I want to know the same thing from all of them: I wanted to better understand their experience and relationship with money and how those have shaped their decisions and experiences in relation to their careers. In a field as demanding and highly intellectual as medicine, I was surprised by the enormous variety I found when people talked through their relationship with money.

Some people I talked to were extremely debt-tolerant, going into more debt than strictly necessary to ensure that their undergraduate medical school and residency experiences were not just livable, but top-notch. Others had been raised in families where they were taught that maintaining a monthly balance on their credit cards would improve their credit scores (in case you fall into this category, know that it doesn’t). Still others would readily confess (and sometimes proudly brandish) their utter and complete ignorance to all things financial — whether we were discussing simple monthly budgets or complex investing and retirement plans — and wave to me in the direction of a significant other, a cousin, or, in many cases, a tired and caring member of their physician faculty who had somehow earned himself or herself the reputation for being the go-to money person on staff for generations of medical students, residents, and attending physicians.

In stages as demanding and vertical as medical school and residency, it is a blessing, I’m sure, to have someone in your life who is willing to take on the mental load of finances. In fact, in my informal research, I discovered it was more common than not for a medical student's partner to be not just in charge of household finances, but the primary go to person for matters of their own educational debt and repayment. In other words, we find ourselves with a system that is not only so demanding and rigorous that it’s leading to increasingly poor health outcomes for its own people, but that it leaves individuals so flabbergasted as to how to navigate its financial implications that those individuals are left to resort to the patient research of their loved ones to understand their own options for how to pay for their medical education.

Such a system, combined with the trend of not talking about finance, also creates an uncomfortable inequality between professionals. According to recent statistics, 25% of medical students graduate without debt from medical school.^[1] That means that if you as a medical student are looking to your peers for an example of what a suitable, sustainable lifestyle is like for yourself, then a quarter of the time, you may be looking at someone who is not dealing with the mental load and pressure of debt in the way you are dealing with it. Even something as simple as seeing your friends take vacations or make arguably unnecessary purchases may create subliminal pressure for you to also indulge in things that appear to be affordable for a fellow medical student, whether or not you have determined that they are personally affordable for you.

This tendency to avoid discussing personal finances has also led to extreme oversimplification from a systemic perspective. I was again surprised in my conversations with medical students and residents to hear how generally unhelpful many of their interactions with their financial aid offices at their respective institutions have been. One person recounted being told (for the entirety of a lecture, mind you, that was advertised as designed to help them to make a plan for budgeting on a limited residence budget) that their financial situation was their fault because their generation was likely to be buying fancy coffee daily instead of brewing their own. Such oversimplification and condescension was, I’m sorry to say, much more common than one would hope in these conversations with medical students, residents, and attending physicians. Such an experience, even this one in its extreme, produces droplets of shame that are bound to fester and prevent otherwise productive conversations, whether formal or spontaneous, from happening in the first place. It could prevent an individual physician from learning something about money management or investing that could change their lives – and, by extension, the lives of their patients and families – for the better.

For most people, it is unthinkable to get through a full medical education without any debt. And that’s not necessarily a bad thing; modern society allows for investments of time and money into the promise of future value, and the existence of student loans is one of the things helping to ensure that we have the best providers being trained and not just the providers who happen to come from families who can afford to make them doctors. But if we don’t reevaluate our own relationship with money and openly revisit the stigma of talking about money and one another, I’m afraid that we will create a stagnant environment where needed change – whether that change is needed on administrative levels to ensure the sustainability and financial viability of healthcare organizations, or needed on individual levels to sustain and promote good mental health for hard-working physicians– is entirely inaccessible.

You can start today. If you have a solid knowledge of personal finance, complete with a robust retirement and investing plan and debt payoff strategies, then bring up something you’ve learned or heard recently about personal finance with your colleagues. If they see you’re willing to discuss finances, they may also be willing to open up.

Conversely, if you don’t feel confident in your own understanding of your options and personal finances — or even if you just recognize that there’s no way to know what you don’t know — then make a plan to learn something. There are plenty of podcasts and Youtubers who discuss personal finance at length, and some of us even focus specifically on physician personal finance. If you want a bite sized, free way to start that educational experience, I would love to hear if the app that my team and I built in response to those dozens of conversations I had scratches that itch for you.

What is perhaps most important is remembering that money is just a tool. If we treat it like a tool and not like a prize to be won on one end of the spectrum or an unknown, unfeeling god to fear on the other, then we’ll be more likely to be personally in control of our money. We’ll be more able to be a source of positive change where changes are needed to make the world safer, healthier, and more prone to thrive.

^[1] MedSchoolInsiders: https://medschoolinsiders.com/pre-med/the-real-cost-of-medical-school/#:~:text=Approximately%2012%25%20graduate%20with%20%24300%2C000,just%20a%20few%20years%20ago.