Clinically Competent and Fiscally at Risk: Impact of Debt and Financial Parameters on the Surgical Resident : Journal of the American College of Surgeons

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Original scientific article

Clinically Competent and Fiscally at Risk: Impact of Debt and Financial Parameters on the Surgical Resident

Tevis, Sarah E. MDa; Rogers, Andrew P. MDb; Carchman, Evie H. MD, FACSb; Foley, Eugene F. MD, FACSb; Harms, Bruce A. MD, MBA, FACSb,*

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Journal of the American College of Surgeons 227(2):p 163-171e7, August 2018. | DOI: 10.1016/j.jamcollsurg.2018.05.002


While the costs of medical training continue to increase, surgeon income and personal financial decisions may be challenged to manage this expanding debt burden. We sought to characterize the financial liability, assets, income, and debt of surgical residents, and evaluate the necessity for additional financial training.


All surgical trainees at a single academic center completed a detailed survey. Questions focused on issues related to debt, equity, cash flow, financial education, and fiscal parameters. Responses were used to calculate debt-to-asset and debt-to-income ratios. Predictors of moderate risk debt-to-asset ratio (0.5 to 0.9), high risk debt-to-asset ratio (≥0.9), and high risk debt-to-income ratio (>0.4) were evaluated. All analyses were performed in SPSS v.21.


One hundred five trainees completed the survey (80% response rate), with 38% of respondents reporting greater than $200,000 in educational debt. Overall, 82% of respondents had a moderate or high risk debt-to-asset ratio. Residency program, year, sex, and perception of financial knowledge did not correlate with high risk debt-to-asset ratio. Residents with high debt-to-asset ratios were more likely to have a high level of concern about debt (52% vs 0%, p < 0.001) when compared with residents who had low debt-to-asset ratios. The majority (79%) of respondents felt strongly that inclusion of additional financial training in residency education is a critical need.


In a climate of increasingly delayed financial gratification, surgical trainees are on critically unstable financial footing. There is a major gap in current surgical education that requires reassessment for the long-term financial health of residents.

© 2018 by Lippincott Williams & Wilkins, Inc.

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