Shaishav Datta, Sabrina Fitzgerald, Wafa Khoja, Harrison Watt, Alain J. Azzi

alain.azzi@mail.mcgill.ca

Conflicts of interest: The authors are all Financial Transition to Practice (FTP) Ambassadors at their respective institutions. Funding: There is no source of funding.

Medical training in Canada requires many years of commitment to develop skills necessary for effective patient-centered care. However, there is more to a successful practice than diagnosis, treatment, and pathophysiology. Today, many early-career physicians find themselves unprepared for the complexities of the personal and professional financial decisions they must make on a daily basis, even with hired assistance.1 These include understanding billing systems, insurance plans, tax policies, accounting, investments, debt management, and other financial decisions associated with starting a new practice. Research shows that most early-career physicians learn about financial literacy from their peers or through independent research.1 Formal education on financial literacy remains minimal while the process of learning these skills concurrent to making a transition to practice provides undue stress and is implicated in contributing to early-physician burnout.1,2

Further, medical learners accrue significant personal financial burden as a direct result of the cost and length of their training. This is especially reflected in trainees who pursue longer residencies and fellowships, as they continue to work at a lower income level than they would make if they had entered practice directly. Many studies have suggested that medical learners have low personal financial literacy and are not well prepared to manage their own finances.3

Thus, while the Canadian medical education system prepares its trainees to become world-class clinicians, it falls short in equipping graduates with the skills to navigate the complexities of personal and professional finance. To address this issue, basic financial literacy must be introduced early, during medical school, and extended into residency training as they approach independent practice.

Over the last decade, various organizations have initiated programs that serve to contribute towards financial literacy in medical learners. Table 1 provides a brief overview of some national-level resources (Table 1). Available upon request.

Table 1. Various platforms for trainees to learn about basic personal and professional finance.

1. Canadian Medical Association (CMA): https://www.cma.ca/physician-wellness-hub/topics/personal-finance Practice management topics from Joule and MD Financial Management

2. Canadian Federation of Medical Students (CFMS):https://www.cfms.org/resources/finances/ Financial planning and education provided by MD Financial Management and CFMS, insurance discount information, free tax filing services.

3. Federation of Medical Women of Canada (FMWC): https://fmwc.ca/resources/mdfm/ Written resources, tools, and calculators for medical students, residents, practitioners, and retirees provided by MD Financial Management.

4. Association of American Medical Colleges (AAMC): https://aamcfinancialwellness.com/index.cfm Financial Wellness resource provides courses, individualized recommendations, and tracking tools in an independent manner.

While these resources are useful, they are often created and supported by commercial organizations that stand to gain benefit from their users. This often leads to unanswered questions regarding conflicts of interest causing medical trainees to remain distrustful of the information provided by these sources.1 Additionally, teaching financial skills using non-interactive modalities makes it difficult for learners to engage with and apply their knowledge, leading to poor long-term retention and application of the information.4 While single interventions understandably improve short-term behaviors, we believe financial literacy education should be provided through comprehensive tutorials that are incorporated at key points of contact with students, from on-boarding to financial aid disbursement to exit counseling. In this way, the importance of responsible financial decision-making is reinforced over time.4

Medical institutions recognize this gap, and many are developing financial curricula to address these challenges. As an example, the Temerty Faculty of Medicine, University of Toronto has incorporated ~10 hours of dedicated didactic and interactive module-based learning over the academic year. However, there is currently a lack of national standardization of the content, resulting in discrepancies in access to the same educational quality.

The Financial Transition to Practice (FTP) group was established with the hopes to mitigate the aforementioned gaps in knowledge. It is a grassroots initiative, currently functioning through a social media platform, aimed at increasing awareness and knowledge to medical students across Canada. Since its debut in early October 2020, over 1800 Canadian trainees have joined the group, validating the interest medical students have in enhancing their financial literacy. At the core of the group are student leaders acting as ambassadors for each of the seventeen Canadian medical schools. By providing knowledge, we hope to empower medical students to gain confidence and autonomy over their finances and related decision making. Current membership is free of charge and all content is non-sponsored to ensure minimized conflicts of interest.

Informational content presented through the group has included live question and answer sessions hosted by both rural and urban professionals that directly addressed inquiries made by group members. Recorded webinars regarding basics of accounting and debt management through the continuum of training have been shared. Webinars that allow for interactive versions of basics of investments and insurance, incorporation, shareholder agreements, buying a practice, financial ethics, and practice management are in development. These are examples of high-yield financial literacy topics the group hopes to share with members, as literature shows it is beneficial to be familiar with such topics prior to transitioning into practice.1,3 Through this national effort, we hope to mitigate gaps in current medical education in order to assist Canadian medical students to transition into practice with the necessary financial knowledge and strategies needed to be autonomous, informed, and proficient practitioners.

References
1. Bar-Or YD, Fessler HE, Desai DA, Zakaria S. Implementation of a Comprehensive Curriculum in Personal Finance for Medical Fellows. Cureus. 2018;10(1):e2013. https://doi.org/10.7759/cureus.2013
2. West CP, Shanafelt TD, Kolars JC. Quality of Life, Burnout, Educational Debt, and Medical Knowledge Among Internal Medicine Residents. JAMA. 2011;306(9):952–960. https://doi.org/10.1001/jama.2011.1247
3. Comber S, Crawford KC, Wilson L. Competencies physicians need to lead – a Canadian case. Leadersh Health Serv (Bradf Engl). 2018;31(2):195-209. https://doi.org/10.1108/lhs-06-2017-0037
4. Lujan HL, DiCarlo SE. Too much teaching, not enough learning: what is the solution? Adv Physiol Educ. 2006;30(1):17-22. https://doi.org/10.1152/advan.00061.2005