Unprepared at Enrollment: Assessing the Financial Literacy and Employee Benefit Selection Preparedness of Graduating...

Introduction As graduating medical students transition to residency, they are required to make critical financial decisions regarding employer-sponsored benefits such as health insurance, retirement plans, and disability coverage. Despite the significant impact of these decisions, many students receive little to no formal financial education during medical school and thus are unprepared to manage and navigate these personal finance decisions. This study aims to evaluate graduating medical students' baseline knowledge in key financial domains regarding employer-sponsored benefits. Methods We conducted a prospective, single-institution study of fourth-year medical students at The Warren Alpert Medical School of Brown University during the Internship Preparatory Course over two years. Students were invited to complete an anonymous, voluntary survey consisting of 15 multiple-choice questions assessing basic knowledge across three domains: health insurance, retirement plans, and disability insurance. Responses were categorized as correct, incorrect, or "don't know" to prevent respondents from attempting to guess answers. Survey results were stratified by prior participation in open enrollment or ownership of employer-sponsored retirement accounts. Two-sample t-tests compared performance between groups. Results Out of 129 students attending the workshop, 75 completed the survey (response rate: 58%). The median age was 27 years (±2); 14.7% had previously participated in an open enrollment process, and 29.3% had prior experience with an employer-sponsored retirement account. Overall, the average percent of correct responses was 11.4% and incorrect responses 26.4%, and the "don't know" option was selected in 62.2% of questions. Domain-specific performance showed 15.7% correct in health insurance, 17.9% in retirement, and 0% in disability insurance, with nearly 70% of disability-related responses being selected as "don't know." No students answered any disability insurance questions correctly. Students with prior open enrollment experience or retirement accounts performed slightly better (average correct: 12.7% vs. 10.9% and 12.7% vs. 10.6%, respectively), but these differences were not statistically significant. Conclusion This study reveals critical deficiencies in financial literacy among graduating medical students, particularly in selecting and understanding employer-sponsored benefit options that they will encounter in residency. Despite modest differences based on prior exposure, knowledge gaps remained profound across all domains. These findings support a growing body of literature advocating for the integration of structured, targeted financial education into the medical school curriculum. Equipping future physicians with essential financial knowledge prior to entering residency may reduce costly mistakes that compound over time, improve financial literacy and well-being, and promote more informed benefit selection early in their careers.