[Editor's Note: This is a post written by a practicing physician, Matthew Pirotte, MD, FACEP, an assistant residency director in the Northwestern Memorial Hospital Emergency Medicine Residency Program. You can follow him on Twitter @ MJP_MD. I have been fortunate to have WCI grow as quickly as it has, and that is primarily due to word of mouth growth as attendings tell residents, residents tell interns, interns tell students, and students tell attendings all about it. There are literally thousands of “WCI Apostles” out there spreading the word and I am very grateful for it. This guest post is from one “apostle” to the others with a few tips about how to get this information into the hands of those who most need it. As one who gives similar presentations a couple of dozen times a year in various formats, I wholeheartedly agree with his recommendations. Dr. Pirotte and I have no significant financial relationship.]
As a committed academic emergency physician and budding financial planning guru, I have begun to peddle my wares around my city (Chicago), my specialty, and my hospital. I have a one hour grand rounds that I give that I call “Basic Financial Life Support” in which I cover salary, taxes, retirement planning, savings rate, and some basics of student loan repayment. I end on a controversial topic by advising residents to be very cautious about engaging with professional financial planners who “specialize in physicians.”
Matthew Pirotte, MD
I have given this talk to residents in pediatrics, emergency medicine, and anesthesia and have given it at 3 different medical centers. It has been accepted both regionally (local ACEP) and nationally (Council of Residency Directors in Emergency Medicine). Talking to residents is an interesting ball game. In some ways they are your hardest audience. Unlike medical students who are generally more awed by faculty, residents will start playing Candy Crush on their iPhone the second you lose their attention. Unlike faculty at a paid CME event, residents are usually being forced to be at conference and have had this topic selected for them instead of by them. These facts have led me to some interesting conclusions. Here is what I have learned over the years.
Residents Are Starving For This Information
They don’t hear this anywhere else other than when, as senior residents, they get bombarded by requests for “no obligation” steak dinners with the local financial professional. I would give myself a B+ as a public speaker; I am certainly no great orator. I lecture on other topics and do not see near the level of engagement as when I start talking about how to retire on time. I use the “iPhone test” to gauge my speaking – how many residents are playing on their phone or laptop? When I talk about central lines, it’s about 20%. When I talk about tax-protected retirement accounts there is often not a single phone visible in the room. I recently gave a voluntary lecture to a group of anesthesia residents and had at least 20 people show up. They want this stuff.
You Can’t Be Too Basic.
When speaking to residents about personal finance, assume no baseline level of knowledge. This is based on my experience and in no way meant to be pejorative; they will not know what we as faculty don’t teach them. I start my BFLS talk by defining lots of simple terms (401k, 403b, stock, mutual fund, expense ratio) and explaining some critical but often misunderstood concepts (federal income tax brackets, concept of tax-deferral). I used to worry that this would be perceived as insulting or pandering, it isn’t. You need to start at the very bottom and work your way up.
They Value Transparency
As teaching faculty I think we should be radically transparent with our trainees when possible. I usually start by telling them how much money I made last year and my net worth. Given that neither of these numbers are earth-shattering it helps to break the ice. I often pull up my investment and retirement website on the screen and take them through it. They need to see where I am to decide if they are going to trust me. I also point out that due to some interesting things in 2016 (maybe worth another guest post), that big number on the screen is slightly below where it should be. I get consistent feedback that the transparency is useful. The next step for me is to host a physician panel for my residents with other faculty who are also willing to be transparent, for example I have another partner who really needed his disability policy and is willing to talk to the residents about it. I’m really looking forward to that.
Financial Literacy Among Residents Is On The Rise
There will usually be one or two residents in the room with quite a bit of knowledge on this topic. Many read WCI or other blogs and some have had extensive discussions with friends or family in the financial industry. I am impressed by how many of my residents have started putting at least a matchable amount into our 401k and by how few are in deep credit card debt. The message is getting out (thanks Jim).
Their Biggest Questions Are About Student Loans
While I try to encourage them to have a clear plan for when those fat attending paychecks start to hit their account, the most common questions are about student loan management. This is challenging because in contrast to the decision to max out a tax-protected retirement account, student loan management is much more of an individual discussion. The first point is to advise them to get all their loan information together in a spreadsheet and understand exactly what they are dealing with. I generally try to give them ideas about debt/income ratios and advise them to put their specific information into calculators to see if PSLF is even going to be an option for them. The interesting thing is that it does not seem that residents have a clear sense of what are good and bad positions in this space. I recently had a mid-level resident in a high paying specialty with a debt-free physician spouse ask me what I thought he should do with his loans. When I asked how much he had he said “$70,000” and I almost laughed out loud. [For those who don't get this little joke, it's funny because this couple should have these loans paid off within 2 or 3 months without doing any sort of refinancing or enrollment in a government program-ed]
A surprising number of residents have saved a surprising amount of cash
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The resident couple with $18,000 in a savings account as PGY2s, the couple living on one paycheck and saving the other, the single resident living on half his income, the graduating senior with no credit card debt who is trying to decide if she should put her extra money towards a Roth IRA or make a loan payment – all impressive young docs I have met in the last year. I sometimes feel embarrassed that it took me so many years and so much reading to get to where some of these residents seem to be instinctively.
Much like bedside teaching, lecturing to residents is a unique and special joy and privilege.
What do you think? If you are a resident, what financial topics are you most interested in right now? If you have since graduated, looking back what do you wish your faculty would have told you? Comment below!
When I started residency, our program director invited his own financial advisor to talk to us. I started out skeptical, but he pretty quickly calmed my fears. He made virtually all the same recommendations as WCI has been making for years.
He is a fiduciary fee only financial advisor (pay only for advice, cost doesn’t change if you have more money to manage). Recommended getting as much term life as you can get for as cheap as you can get it. Said to *almost* never get whole life insurance. Get own occupation disability with the ability to increase at the end of residency. Lots more advice that was right in line with WCI advice.
He was less informed on student loan management, especially for residents, but overall I thought he seemed solid and I’m grateful my PD is watching out for us. I’ll not be using his services at this time, but I’d consider it later down the road when I make real, substantial $$$$.
So…..his advice was great except for the number one financial issue residents have. I’m amazed how little most financial advisors who state they specialize in docs know about student loan management.
In his defense, he never stated that he “specialized in doctors.” Our PD invited him. He never requested to come see us. He had quite a bit of sound advice, but his lack of knowledge about student loans was quite apparent. I wanted to send him a couple of your blog posts.
Kudos to Dr. Pirotte! If they are truly thousands of WCI Apostles like him out there, I have hope for the collective financial future of physicians.
If a lecturer had shown his or her personal retirement account websites and discussed specifics of salary and net worth, it would have had a profound impact on me as a resident. I’d have thrown my phone to the floor. As you say, people are starving for this information, as evidenced by the popularity of personal finance websites like WCI.
It’s critical to give these talks as early in medical training as possible. Once doctors move on to attendinghood and collect a gaggle of “financial people” around them, they become exponentially more difficult to extract back to managing their own personal finances.
Keep up the good work!
Very kind comments. I think faculty need to be very accountable to learners in all areas. If I’m talking to you about how to approach a patient in a particular way, I should tell you about my satisfaction scores, outcomes etc.
Plus, much like Jim and many on this forum, I just don’t find money to be difficult to talk about.
I remember during my intern year, a Northwestern Mutual financial advisor gave a one hour talk to our small group of residents. The talk was reasonable, and went over the basics.
One of the challenges of giving talks to an audience of residents is that the level of baseline financial knowledge is highly variable. There were advanced residents in the room who clearly had read WCI and were mentioning backdoor Roth IRAs (not me) within the first 10 minutes of the presentation! There also are residents out there who struggle to keep spending in check and probably would need to start at Dave Ramsey Baby Step #1 (Save $1,000 for an emergency fund).
That’s true. I think you have to start assuming that people know nothing b/c I’d rather the high performers be bored than to leave the people in the dust who are behind to start.
Even fairly financially sophisticated residents still have lots of questions and I find are still usually unable to really process what $300k/year really is like to work with.
Thanks for your post, Dr. Pirotte. After 4 years in hospital employed small town subspecialty surgery private practice (my “financial fellowship”) I’ll be rebooting my career into academics by completing a sub-sub specialty fellowship next year. Given my soon to be completed MBA and apostle status of WCI and PoF I am looking forward to assisting Med students and residents through talks such as yours. Your tips are extremely helpful and I especially like your iPhone analysis to objectively determine your audience’a level of interest and engagement. Keep up the good work!
I often tell people at the start of my talks to feel free to work on other stuff if I’m boring them. If you are keyed into your audience it’s a heck of a lot better way to adjust future talks than relying on the few people who fill out surveys.
I have had the same experience. The FP residents that I teach are VERY attentive when I talk about money.
Here is a typical talk I give to them if others want to see it:
http://wealthydoc.com/blog/wealthy-doc-gave-a-talk-to-fps-about-finance-investing
It’s awesome to see so many other WCI apostles out there. After WCI wrote his commentary on my resident/fellow personal finance study paper a few weeks ago I had several people contact me to let me know they are trying or are pursuing similar things at their institution.
I’m also a committed academic emergency doc (peds though) and we’ve got a 5-part lecture series built into the noon conference schedule for our peds/IM residents now. I’ve also been giving talks to the surgery residents and medical students. I give 2 of the lectures covering personal finance, and it’s quite enjoyable. I haven’t been showing my net worth (would need the wife’s permission for that and I haven’t broached that), but I give tons of personal examples of things I’ve done right and wrong.
You’re absolutely right that they all want this. The sophistication of the residents is growing, in part due to WCI, and part due to necessity from increasing student loan debt, however a lot still need some familiarity with the basics.
I very much think the ACGME should be trying to get individual programs to at least do 1-2 hours of this during every academic year. I’d love to collaborate with you if there are opportunities!
Great work! I didn’t know you could get lectures “accepted” by these councils — perhaps I’ll look into that for the AAP.
Great post. Financial literacy is a sad situation with our trainees. When I was doing academics I often tried to have these conversations. The fellows, Cardiology ones at that, were less interested. They felt very much like they knew more then they did. As it went to the residents and medical students, the interest was higher.
It would be nice if schools and training programs made financial literacy part of their teaching. Maybe in the next 5 years this will change due to people like you. Keep up the good work.
I’m a PGY-2 who has given several personal finance talks to my residency and friends and am doing more this fall. I frame things a bit differently than Dr Pirotte because I haven’t made it to attending level yet, but the hunger for this information is out there and I agree with everything he wrote. Saving for retirement is asked about, but the two topics I found people most concerned about are taxes (since most residents have never done them before) and student loan management. The demand for this education is there, as my hopefully soon to be finished manuscript on a national resident survey will attest to.
On the financial advisor note, I have met with two financial advisors who cater specifically to our attendings and target residents. Both are AUM up to 3% annually, with additional fees for financial planning and both of whom advocated for whole life once your “basic term and retirement savings” are taken care of for “tax advantages”. I dropped contact with both after one meeting and have been encouraging my co-residents to avoid that kind of advice.
Wow, 3% is pretty much highway robbery unless we’re only talking about some tiny amount of assets here.
I’d be interested in your manuscript/publication whenever you’re ready to share.
I’d be very interested in the survey as well. If you’re looking for faculty level director and/or collaboration just send me a Twitter DM MJP_MD
Very commendable. I tried to do the same in the dental school in Nj and they did not even respond. The residents will thank you forever. Keep up the good work
Just sent this blog to my NJ dental school Maybe it will hit the right person
Thanks for the post. I became a frequent follower of this site at the end of fellowship, and try to inform other colleagues of how much great information is on here. I am also thankful, though, for a clinician who I shadowed in med school who introduced my wife and I to the Roth IRA and the importance of living on less than our combined incomes. We both moonlighted throughout residency and, coupled with our resident salaries, earned on average ~135k/year between the two of us. Our combined loans were around 340k at the beginning of residency and were down to 220k at the end of fellowship. We also have 50k now in Roth IRAs that is solely from contributions during our residency years.
Good financial information at a young age can go a long way
I think I would be interested in working with med students and residents on these types of talks. Are there any types of classes physicians can take to learn more about this themselves? Sort of like a CFE academy?
not that i know of but i’m starting to think we should be creating one!
Thanks, Dr. Pirotte for taking time to teach these residents some incredibly useful information. This is invaluable for them, and I hope this attitude continues to spread.
I am very glad you are doing this. Unfortunately, other programs are not as proactive or innovative. I sent a copy of the WCI book as a gift to my old program director, but did not even hear anything back.
The only financial “education” that I got as a resident was from a fellow resident who was thought to be a “guru investor”. He was making a lot of money buying and selling stocks of this great company – named Enron. Good thing I did not have any money to invest back then then…
How does one like myself convince the dental school to allow me to speak to the seniors and or PG students
No Expert but would enjoy the experience and gratification of helping others
Wish all had the knowledge I garnered from the get go with ZERO knowledge upon graduation!!
you don’t need permission really for anything other than to give a voluntary lecture.
as long as they’ll give you a room for an hour and let you email students you’re good.
Matthew, are you by any chance willing to share a template of your talk to the residents? None of the residency programs at my institution offer anything like that and there is some conference time available for me to introduce the topic.
DM me on twitter @MJP_MD
When I used to talk about personal finance amongst my resident peers, I felt I was always being looked down about for discussing money and “medicine”. I agree residents want this stuff desperately, but in the background, there is always the taboo “physicians don’t discuss money”. It finally seems like that is starting to fade
yeah i think it seemed more gauche when med school was basically free and salaries were even higher. i get the sense that there was more of an attitude hat since everyone was doing really well it was vaguely vulgar to discuss.
nowadays when i’ve seen residents take sub $100k attending jobs while carrying over $300k in loans, we gotta talk about it.
One of the best pieces of advice we could give graduating residents is to go into community practice. The pay difference is substantial. The bigger the debt burden the more important this decision is.
Great pointers. I am giving my third year of talks to the residents and students in my upper mid west locale. I have similar observations.
They are hungry for knowledge
They want to know about loans
A few are educated on finance
Med students look like deer in headlights compared with residents
No such things as too basic
I’ve also found that telling them to treat the talk like a regular lecture on a medical subject is helpful. Review it over and over as if there is a test. Give them a reference list for further reading. I find that they come to me through the year and email me with questions that they have after a second or third time through the material.
I’ve learned a lot teaching them and hope to continue. There’s a huge unmet need and we seem to be the only ones educating our younger members.
Keep up the education!
let’s connect on this. those of us in academics working on this should be generating scholarly writing on this topic. shoot me a twitter DM @MJP_MD
twitter?
Well done Dr. Pirotte. I appreciate your pearls of wisdom.
Thanks to ALL of you who have taken on the task of educating our med students and residents about financial planning.
These discussions can’t start early enough or be often enough. I was asked by my med school in 2005 to do a lecture for 3rd year students and I am still doing it annually. I also lecture residents nearly every other year since 2002 and I really enjoy the opportunity. I recently repeated one of my favorite talks-I surveyed our faculty for “best and worst financial moves they have ever made”-then compiled the list and had a sit down roundtable conversation inviting faculty, residents and students to discuss the results. Similar to sharing net worth – this makes it very real to everyone involved.
Really enjoyed today’s topic and post. Thank you again for your efforts.
Great post. I too have been teaching financial wisdom to residents for many years. I found the hunger for this information was incredible. I realized I could reach so many more residents if I put some of the information into writing and started my Doctors Guide book series. The first two books in the series, The Doctors Guide to Starting Your Practice Right (A guide to navigate the transition from resident to attending) and The Doctors Guide to Eliminating Debt are particularly good for residents. Some residency programs have purchased the books in bulk and given them out for Christmas Gifts. So some of the programs are beginning to provide this information to their residents. Other programs have no interest in providing any information that is not medical. I understand they have a limited amount of time to teach a lot of information, but sending residents out into the world with a huge debt and no tools to deal with it may not be in the program’s best interest.
Keep up the good work.
Thumbs up, bro. I do something similar, but one of my big weaknesses is staying basic, or someone wants to ask an advanced question and I have trouble not going down the rabbit hole. Also, they’re poorly attended, usually just by the pathology residents whose patients aren’t exactly waiting on them…at any rate, solid post, with points I will incorporate into my own material. Thank you very much.
i think the way to handle that is to have a short time frame to get through your content and an open q+a afterwards where you invite people to leave as soon as they want. take questions and promise to answer them later. the learners who want to parse interest rates will usually hang around later than the ones who want to know how they can pay off their $32k in student loans once they finish their joints fellowship
It only takes ONE HOUR and some hand out references to teach basic passive investing with a diversified portfolio covering the basic asset classes
I would always give them a list of DON’T DO”S-like whole life, variable life, annuities, loaded funds, stock trading, divorce, etc, etc etc
AND #1-Never invest in anything you are not well educated about
I definitely preach the WCI gospel and refer many residents to this site. I wonder if you notice a dichotomy between the single unattached resident or the ones that have spouses or children? I think with a spouse and/or kids you start to think more about needing to provide for those you love. I can remember back in the day as a resident making some rather stupid movies financially (making payments to be a big screen TV for example!) but coming out OK.
Two things I often tell residents are: 1. most small financial faux pas are fixable once you get on the right track (like buying a big screen TV.) 2. Think of the income you expect to make as an attending and think of the lifestyle you think it will afford. For most people you’ll need to take it down a few notches.
Nice job, Matt. You’re making Loyola med proud.
I give similar talks to different resident groups and my experience is quite the same. These talks generate way more interest and questions then anything clinical related.