Finance 101 for MDs

Finance 101 for MDs: From saving and investing, to running a practice like a business, Dr. Stephanie Zhou teaches trainees financial literacy

Social media is often blamed for the sense of FOMO (fear of missing out) people feel when comparing their lives to those of people in their network.

By Alisa Kim

"Financial literacy is what allowed me to get out of poverty and learn how to maximize the power of money as a tool."

Dr. Stephanie Zhou, an Assistant Professor in the Department of Family and Community Medicine (DFCM) at the University of Toronto, understands how people feel pressured to “keep up with the Joneses” when scrolling on social media. “You’re friends with people in your class. You see them go on expensive vacations and buy expensive clothing. This is very common on Instagram, which is a highlight reel of people displaying lavish lifestyles,” she says.

For years, Dr. Zhou, who did her medical training at the Temerty Faculty of Medicine at U of T, has been on a mission to educate and equip others to enhance their financial health. Her foray into this space began with a talk she gave called “Affording Medical School,” aimed at encouraging students—particularly those from economically disadvantaged backgrounds—to choose a career in medicine by tapping into scholarships, resources and assistance programs designed to lower the barrier to entry to medical school.

The positive response to the talk led her to work with the Dean’s office at the Temerty Faculty of Medicine to develop a financial literacy curriculum for medical students and residents. Courses for medical students cover topics like budgeting, credit scores and choosing a line of credit, paying down student loans and the basics of investing. “A lot of students don’t know what compounding is, how it works, and how it can snowball your debt,” says Dr. Zhou, who cites 2020 data showing the median debt for graduating medical students is about $100,000. “A lot of students don’t get financial literacy teaching because in medicine, you’re so focused on learning the medical content. There are times when students have finished watching one of my lectures and asked what a TFSA [tax-free savings account] was. You realize by talking to students and getting the feedback, their financial literacy is very low.”

A unique feature of the curriculum is a section she teaches on social determinants of wealth. “We talk about financial abuse, intergenerational debt and Black debt, the economics of poverty and what perpetuates poverty. We also talk about why is it that certain racial groups may have experienced discrimination in the financial system and how that impacts them in our generation,” she says.

The courses she teaches residents deal with billing, how to manage their practice, negotiating contracts for shortterm locum positions and incorporating their business. Every doctor is a small business owner, says Dr. Zhou, who is also an addiction medicine physician at Sunnybrook Health Sciences Centre and the lead physician at the Don Mills Family Health Team. She makes the link between poor financial literacy among physicians and the decreasing number of new and existing practices. “Expenses are getting much higher in terms of rent and paying staff. If doctors don’t learn how to bill, which is the main way they earn income, they’re not able to make enough to help them run their practice. There’s also administrative work that’s not paid so doctors may not be figuring out how to make that portion more efficient. That’s not stuff doctors are taught or think about, such that once they go into practice, it leads to them not feeling experienced enough, so there’s no incentive to open a new family clinic or any clinic for that matter, because it’s not financially sustainable.”

She notes prior to her talks on billing, she surveys the class—who are nearing graduation—about their comfort level with opening a practice. “Everyone chooses ‘least comfortable’ as their answer. It is surprisingly high. ‘Have you ever been taught billing?’ ‘Are you comfortable asking your preceptor about billing?’ The majority say no and they’re about to graduate in four months.”

Dr. Zhou also connects poor financial skills to another major health system problem: physician burnout. “When you are very much in debt, you have pressure to work harder and harder and longer hours just to service that debt. You can’t out-earn a spending problem. That’s what leads to a lot of doctors burning out because the more they work, the more time it takes away from family and their personal lives. They work really hard and then think, ‘now I have to treat myself’ and it perpetuates a cycle of poor spending habits and high debt,” she says.

Such insights resonate with Dr. Alis Xu, who is completing her final year of the Integrated 3-Year Program in Leadership at DFCM and is also co-president of the Family Medicine Residents Association of Toronto. “Dr. Zhou does a great job of not just telling us the technical things about billing, but also giving us life wisdom. I think sometimes that’s what a resident needs—a bit of financial coaching. I think her teaching helps with lifestyle changes we can make to help us with financial wellness,” she says.

Dr. Xu also links financial stress with physician burnout. She cites research showing part of the reason graduates of family medicine do not pursue comprehensive office-based family medicine is because they hope to circumvent burnout. “Some people want to avoid that, and that’s totally fair, but if we want to encourage people to take on the role of family physician—the ‘quarterback’ who coordinates care—then we need to think about what are some of the things we can do to prevent people from burning out? Having that financial literacy is a key part of that,” she says.

During the pandemic, Dr. Zhou started accounts on social media, both with the handle Breaking Bad Debt to share her content with a wider audience. Many of her YouTube lectures have racked up thousands of views, with students from across Canada from various disciplines commenting on her videos. Due to enormous interest in financial education, Dr. Zhou started the Canadian Physicians Financial Wellness Conference to bring the financial literacy curriculum to a national audience. Each year, ticket proceeds have gone to charitable causes.

When asked why she thinks this area is so important, Dr. Zhou, who worked part-time jobs and applied for scholarships and bursaries to fund her education says, “Financial literacy is what allowed me to get out of poverty and learn how to maximize the power of money as a tool. I always tell my students money is one of the most powerful tools in society, especially as a way to advocate.”

In a full circle moment, she, along with her partner, Colin Lynch, have created an endowment fund called The Equity Award, to provide scholarships in perpetuity for students in need who have also developed opportunities and resources for others with financial need. “It’s not just a bursary. It encourages you that even if you come from a low-income background, you can still pay it forward,” says Dr. Zhou. “Having income to do that through my investments allows me to empower other people.”