Financial Literacy and Wellbeing Among Medical Students, Residents, and Attending Physicians in Lebanon: Results From a Nationwide Multi-Centered Survey

Abstract

Financial wellbeing and financial literacy are crucial aspects of personal and professional lives, particularly in graduate medical education. Low financial literacy among healthcare professionals, including physicians, has been identified as a concern, impacting job satisfaction, productivity, and burnout. Few studies have used validated methods, assessed financial wellbeing, or compared financial outcomes across the continuum of medical education and practice. This study aims to measure the financial wellbeing of healthcare professionals and trainees and its predictors using validated instruments on a nationwide scale in Lebanon. This is a multi-institutional cross-sectional study using an online survey using validated instruments, including the CFPB Financial Well-Being Scale and Lusardi and Mitchell’s “Big Five” financial literacy questions. The data was collected in April and May 2020. The population includes medical students, residents, and practicing physicians in all six private medical schools and their affiliated medical centers in Lebanon. A total of 330 responded, with a response rate of 20.7%. The financial wellbeing score (out of 10 was 57.2 ± 9.7 before the financial crisis and dropped to 45.2 ± 10.1 during the country’s financial crisis. With a passing grade of 60%, 75.3% (195/259) failed the financial knowledge questions. Attending physicians outperformed students and residents/fellows regarding knowledge scores. Financial wellbeing was positively associated with age, family socioeconomic status, and household income. It was negatively associated with the crowding index and agreement with the attitude of living for today and letting tomorrow take care of itself. Medical students, residents, and physicians in Lebanon had low financial literacy. Attending physicians have high financial wellbeing despite low financial literacy and lack of formal education. The COVID-19 pandemic and economic crisis adversely affected the financial wellbeing of all three groups.

Introduction

Financial wellbeing is gaining interest worldwide since financial management skills are essential in both one’s personal and professional lives. Nonetheless, financial wellbeing is an emerging concept lacking a clear definition. Brüggen et al ¹ defined financial well-being as “the perception of being able to sustain current and anticipated desired living standard and financial freedom.” Others define financial well-being as fulfilling current and future obligations, having a sense of financial security, having freedom of choice, and having a higher quality of life. ² Financial well-being is associated with subjective overall well-being and is influenced by adverse financial situations.^3,4

Increased financial literacy may result in improved financial wellbeing and less financial concerns. ⁵ Financial literacy was first introduced in 1992 and defined by the Organization for Economic Co-operation and Development (OECD) as “the combination of awareness, knowledge, skill, attitude and behavior necessary to make sound financial decisions and ultimately achieve individual financial wellbeing.”^6,7 The general public’s financial literacy is quite low. ⁷ Healthcare professionals were shown to be just as financially illiterate as the general population, “the oxymoron of financial illiteracy in a highly educated population.” ⁸

The term “oxymoron” in the context of financial illiteracy among healthcare professionals was first used by Mahendru et al ² to highlight the unexpected contrast between their advanced education in medicine and their lack of financial literacy. This is not meant to imply that healthcare professionals are uniquely prone to financial illiteracy, but rather to emphasize that their lack of financial education is surprising given their otherwise high levels of academic and professional achievement. The study underscores the need to address this gap, as financial literacy is crucial for their personal well-being and professional longevity.

Our study sought to assess the foundational financial knowledge across various stages of medical training and careers. It’s evident that personal finance education has been largely overlooked within medical training programs. One of our key inquiries was to determine whether financial knowledge is primarily acquired through experience and whether financial well-being naturally improves with career progression.

The insights gained from this study could be instrumental in developing targeted educational interventions aimed at enhancing the financial literacy of medical trainees.

We focused on medical students, residents, and attending physicians because they encounter financial challenges that are distinct from those in other professions. These challenges include prolonged training periods, substantial educational debt, and delayed workforce entry, often resulting in postponed financial independence. Additionally, the financial decisions they must navigate such as managing student loans, making investment choices, and planning for retirement are particularly complex. Despite these significant responsibilities, financial education is rarely incorporated into their medical training, making this group especially susceptible to financial illiteracy. This study seeks to illuminate these unique challenges and highlight areas where targeted financial education could provide the most benefit.

Financial literacy may not be essential for physicians’ competency but it has an influence on job satisfaction, productivity ⁹ and burnout. ¹⁰

Many researchers have mentioned the relevance of financial literacy and explored the needs for financial curricula,^{11 -13} but relatively few have examined the degree of financial literacy. A lack of familiarity with financial topics was recognized among psychiatry residents and a US national representation of dermatology residents.^14,15 Similarly, only one-third of the medical students enrolled in a finance in medicine interest group in a Canadian setting agreed that they were financially literate. ¹⁶ None of the preceding investigations used a validated method to assess financial literacy. Other single-institution studies have reported low financial literacy scores among chiropractic college students enrolled in business classes, orthopedic surgeons and medical residents and fellows using validated tools.^9,17,18

All those studies touched our field of interest, but there is still plenty to be done. Few employed standardized instruments, the majority were single institution based and conducted in the US or Canada, and none assessed financial wellbeing. This study aims to add to the existing knowledge by measuring financial wellbeing and its predictors including financial literacy using validated instruments on a nationwide scale. There is no study comparing financial wellbeing among the continuum of medical education and practice in the same context. It is a multi-institutional nationwide study that includes all medical schools in Lebanon and all levels of medical field workers, involving students, residents, fellows, as well as attending physicians in an Arab country.

We began conceptualizing this study in 2018, before the economic crisis hit Lebanon in October 2019 and the COVID-19 pandemic, and by the time we were ready to collect data, Lebanon faced both unprecedented crises. The economic crisis in Lebanon, which began in 2019, was driven by a combination of factors including government debt, corruption, political instability, and the collapse of the banking sector. The Lebanese pound lost more than 90% of its value over several years, leading to hyperinflation and wiping out savings in the bank and in social security and retirement plans. Access to cash in bank accounts became severely restricted, loans were difficult to obtain, and people faced hardships due to rising prices, unemployment, and food insecurity. The crisis led to a sharp decline in financial wellbeing, as people struggled with cash shortages and uncertainty about the future. Recognizing the impact these events would have on financial wellbeing, we adjusted our survey to study their effects. While this situation makes it challenging to generalize findings to pre-crisis times, our aim was to capture how such crises influenced financial wellbeing

Materials and Methods

Study Design

This is a multi-institutional nationwide cross-sectional online survey-based study among medical students, residents and practicing physicians in all six private medical schools in Lebanon. The aim is to measure the financial wellbeing and its predictors using validated instruments.

Inclusion criteria

Participants in this study were final-year medical students enrolled in one of the six private Lebanese medical schools. Additionally, medical residents and fellows currently in training at the affiliated hospitals of these private medical schools were included. Practicing physicians employed at the affiliated hospitals and involved in academic activities, referred to as attending physicians, were also part of the study population.

Exclusion criteria

The study excluded medical students who were not in their final year of study. Residents, fellows, and attending physicians not affiliated with the private medical schools or their hospitals were not included. Medical professionals working exclusively in private practice without any affiliation to the academic centers were also excluded. Furthermore, individuals who did not provide informed consent were not part of the study.

Setting and Participants

A convenience sample was targeted, including all final year medical students of the six private Lebanese medical schools, all residents and attending physicians working at the respective affiliated hospitals (Appendix A). The data was collected in April and May 2020. The participants were invited through email by the respective administrators at each study site to complete an online anonymous Limesurvey, ¹⁹ with three weekly follow up reminders. The landing page of the survey included the informed consent. By clicking on accept, the participants gave their written informed consent.

Survey

The survey is divided into six main sections: demographics, financial wellbeing, financial literacy or knowledge, attitude, and behaviors.

Financial wellbeing was measured using the abbreviated 5-item version of the financial well-being scale questionnaire developed and validated by Consumer Financial Protection Bureau Financial (CFBP) (CFPB 2017). According to this tool, financial wellbeing includes control over day-to day finances, capacity to absorb a financial shock, staying on track with financial goals and having the financial freedom. Financial well-being scores range from 0 to 100, and they are divided into five categories: Very Low (0-29), Low (30-37), Medium Low (38-49), Medium High (50-57), and High/Very High (58-100). Higher scores indicate stronger financial security and the ability to handle both regular expenses and financial emergencies, while lower scores suggest financial stress and difficulty meeting day-to-day needs (Appendix D). The scale has been widely used and validated in various contexts, demonstrating robust psychometric properties.

Financial knowledge was measured using the “big five” financial literacy questions created by Hastings et al, ²⁰ testing knowledge about inflation, compound interest, diversification, and stock and bond ownership. These questions are validated instruments testing knowledge about inflation, compound interest, diversification, and stock and bond ownership. They have been extensively used in financial literacy research globally and are recognized for their reliability and validity. There isn’t a universally defined “passing score” for the “big 5.” However, in our study we went with what many studies consider as financially literate which is three out of the five questions. ²⁰ For example, in the S&P Global FinLit Survey, answering three or more questions correctly is often used as a benchmark for financial literacy.

The survey included three questions related to financial attitude and five questions related to financial behaviors from the OECD/INFE toolkit for measuring financial literacy and financial inclusion. ²¹ The OECD toolkit is a validated instrument used internationally to assess financial literacy components, including attitudes and behaviors.

The tools used in our study, such as the “Big 5 financial literacy,”“financial wellbeing” questionnaires and the financial attitudes and behaviors, are validated instruments that have undergone rigorous testing in prior research. They are widely recognized in academic literature and have been proven to reliably measure the intended concepts across various populations. They are robust and commonly accepted tools, including those developed by the OECD and CFPB, ensuring that our findings are both credible and comparable to other studies in the field.

The tools used in our study, though developed by a US agency, have been applied across various international contexts, including developing countries. For example, the study by Karakurum-Ozdemir et al ²⁵ demonstrated the successful use of these financial literacy tools in different economic environments including Lebanon and other developing countries.

While we acknowledge economic differences between countries, such as saving behavior driven by macroeconomic factors, these validated instruments help assess financial literacy universal.

We used the STROBE cross sectional checklist when writing our report. ²² The STROBE checklist is provided as a Supplemental File accompanying this manuscript.

Pilot testing

A pilot study was conducted recruiting nine participants at AUBMC: three 4th year medical students, three residents and three attending physicians. The questionnaire was amended as needed. The pilot study results were not included in the final analysis. Then, Lebanon suffered from a major financial crisis with the depreciation of the currency, so it was imperative to modify the survey questions to address the financial wellbeing before and during the crisis.

Statistical Analysis

SPSS version 24.0 software (SPSS, Chicago, IL) was used to analyze the data, with the P-value set at .05 for statistical significance. Descriptive statistics were calculated for demographics, financial well-being, knowledge, and attitudes using mean and standard deviation for continuous variable and percentages for categorical variables. The financial knowledge score was computed as a continuous variable calculated by multiplying the number of correct answers to the Big Five questions by 100/5; it was also represented as a categorical variable based on a passing grade of 60% or above. Bivariate analyses were performed to evaluate the financial knowledge among students, residents/fellow and attending physicians using one-way ANOVA for the continuous knowledge variable and Chi-square for the categorical knowledge variable. Bivariate analysis was performed between financial wellbeing score and the various demographics using Pearson coefficient for continuous variables and one-way ANOVA for categorical variables. Multiple linear regression was performed to predict financial wellbeing scores using the factors that were statistically significant in the bivariate analysis.

IRB Approval

The Institutional Review Board of the American University of Beirut granted the main ethical approval on 23 March 2020 (SBS-2020-0058). Ethical approval from all medical schools and hospitals followed.

Results

Participants

A total of 1592 individuals were contacted through, with 330 responding for a response rate of 20.7%. The demographics of the study participants are shown in Table 1. Sixty-eight (20.9%) were students, 144 (44.3%) were residents/fellows, and 113 (34.8%) were attending physicians. The mean age was 35.0 ± 13.1 with nearly equal gender distribution. Most respondents reported that their families’ socioeconomic status is middle to upper middle class. Two thirds mentioned having at least one loan.

Table 1.

Descriptive Data of Study Participants.

Characteristic	Mean ± SD
Age (years) (N = 326)	35.0 ± 13.1
Crowding Index (N = 271)	0.7 ± 0.3
Characteristic	n (%)
Gender (N = 311)
Male	145 (46.6)
Female	166 (53.4)
Level of training or practice (N = 325)
Medical student	68 (20.9)
Resident/fellow	144 (44.3)
Attending physician in a teaching hospital	113 (34.8)
Hold another graduate degree other than MD (N = 326)
No	272 (83.4)
MBA	10 (3.1)
MPH	19 (5.8)
MSc	13 (3.9)
PhD	12 (3.7)
Total household income 10 (N = 252)
Less than 450$	3 (1.2)
450$−2,000$	60 (23.8)
2001-5000$	68 (27.0)
5001-10,000$	69 (23.4)
More than 10,000$	62 (24.6)
Family’s SES status (N = 267)
Lower	3 (1.1)
Lower middle class	24 (9.0)
Middle class	128 (47.9)
Upper middle class	91 (34.1)
Upper	21 (7.9)
Presence of any loans (N = 330)
Yes	205 (62.1)
No	125 (37.9)

Financial Knowledge and Attitude

The financial knowledge score was based on the correct responses to Big Five questions. The financial knowledge score was 38.6 ± 18.1, out of total score of 100 (Table 2) or mean score of 2.3 ± 1.5, out of total score of 5. Twenty-two participants (6.7%) scored all the 5 questions correct. With a passing grade of 60%, 75.3% (195/259) failed the financial knowledge questions. Attending physicians outperformed students and residents/fellows regarding knowledge scores. One fifth (69/320, 21.6%) reported taking a business, finance, or economic class in university. When asked about sources of learning about money management, they reported family (174/326, 53.4%), own experience (187/326, 57.4%), friends (46/326, 14.1%), traditional media such as magazines, TV and radio (39/326, 12.0%), social media (27/326, 8.3%) and classes/books (31/326, 10.5%. The remainder (68/326, 20.9%) reported that they did not learn about money management.

Table 2.

Financial Knowledge of Students, Residents, and Attending Physicians.

	Students (N = 49)	Residents/Fellows (N = 111)	Attending Physicians (N = 97)
	Mean ± SD	Mean ± SD	Mean ± SD
Financial literacy knowledge score (Scale 100)	33.3 ± 15.9a,c	34.0 ± 17.9a,b	46.4 ± 17.0b,c
	n (%)	n (%)	n (%)
Percentage of pass grade (>60%)	6 (9.4)	17 (26.6)	41 (64.1)

^aP = .0147.

^bP < .0001.

^cP < .0001.

Almost half of the participants agreed that they tend to live for today and let tomorrow take care of itself. During the crisis, their attitude toward money management shifted where more physicians considered spending money was unsatisfying and disputed that money exists to be spent (Appendix B).

Financial Wellbeing

The financial wellbeing score (out of 100) was 57.2 ± 9.7 before the financial crisis and dropped to 45.2 ± 10.1 during the country financial crisis (paired T-test, P < .001). Table 3 shows the distribution of the wellbeing scores. Wellbeing of attending physicians was higher than fellow/residents and students, both before and during the crisis. However, more attending physicians fell into the low financial wellbeing category and very few remained in the high financial wellbeing category following the crisis.

Table 3.

Financial Wellbeing Scores of Medical Students, Residents/Fellows, and Attending Physicians.

Before crisis n (%)
Well-being score	Total sample	Medical student	Resident/fellow	Attending physician	P (Chi-square)
Low	4 (1.3)	3 (4.6)	1 (0.7)	0 (0)	<.001
Medium	177 (57.7)	38 (58.5)	98 (72.6)	39 (27.9)
High	126 (41.0)	24 (36.9)	36 (26.7)	64 (62.1)
During crisis n (%)
Well-being score	Total sample	Medical student	Resident/Fellow	Attending physician	P (Chi-square)
Low	57 (18.6)	13 (20.3)	27 (19.9)	17 (16.7)	<.001
Medium	227 (74.2)	49 (76.6)	106 (77.9)	68 (66.7)
High	22 (7.2)	2 (3.1)	3 (2.2)	17 (16.7)

Appendix C shows the bivariate analysis between the wellbeing score among medical students, residents/fellow and attending physicians as a group and the various demographics. Financial wellbeing was positively associated with age, family socioeconomic status, and household income. It was negatively associated with crowding index and agreement with the attitude of living for today and letting tomorrow take care of itself. There was no association between financial well-being and financial knowledge. A multiple linear regression was performed to predict financial wellbeing score from age, crowding index, household income, family socioeconomic status and attitude toward living for today. The model was statistically significant, F(14, 216) = 8.293, P < .001, R ²  = .350. Only crowding index, family socioeconomic status and the attitude toward living for today and letting tomorrow take care of itself added statistical significance to the prediction, P < .05. Crowding index significantly predicted financial well-being score (ß = −4.223, [95% CI, −8.620, −0.187], P = .040). A middle-class family significantly predicted financial well-being score (ß = −6.830, [95% CI, −13.1, −0.558], P = .033). Disagreement with the statement to live today and let tomorrow take care of itself significantly predicted financial well-being score (ß = 4.273, [95% CI, 1.665, 6.882], P = .001).

Discussion

The rising costs of medical schools coupled with working at lower incomes during residency have put many of newly practicing physicians into debt and financial burden. Moreover, the literature has reported lack of medical curricula that covers financial management skills.^{11 -13} This study identified low financial well-being and financial literacy among medical students and residents/fellows, while two-thirds of attending physicians had high financial wellbeing and had passing grade on financial knowledge. Predictors of financial wellbeing were more related to the upbringing of the physician in terms of family socioeconomic status and current crowding index. Positive attitude toward living today without a concern for the future was a negative predictor of financial wellbeing.

While it’s true that physicians are expected to earn higher salaries later in their careers, the concern lies in the significant financial stress they face during their training, particularly as residents. These early financial challenges—often marked by accumulating debt and low incomes—can negatively impact their wellbeing and decision-making. Therefore, introducing financial literacy early on is essential to equip physicians with the tools needed for long-term financial security, even if they are expected to earn more later in life.

Upon graduating, physicians do not immediately achieve financial stability. In the U.S., for example, the average medical student debt is around $202 453, with the total debt, including undergraduate loans, reaching approximately $233 924. While some may have debts nearing $300 000, repayment can extend over 20 to 40 years. In Lebanon, a similar trend is emerging, where 7 out of 8 medical schools are private, leading to increasing tuition costs and growing debt burdens for students. Our additional paper explores the rising trend of student loans among Lebanese medical students, further illustrating the financial hurdles they face early in their careers.

With the rising costs of tuition and growing medical school debt, pursuing a career in medicine is no longer a guaranteed path to financial prosperity. Physicians must make smart financial decisions from day one to ensure their long-term financial wellbeing.

We argue that financial literacy should be treated with the same importance as clinical skills in the medical curriculum. Historically, clinical skills were seen as something learned passively on the job, but they are now formally recognized as essential and taught as part of medical education. Likewise, financial literacy should be proactively integrated into the curriculum to better prepare physicians for the financial challenges ahead, rather than leaving them to learn it through experience alone. This approach ensures that physicians, despite their future earning potential, are better equipped to manage their finances during the most vulnerable stages of their careers.

The financial wellbeing score of our sample compares to the 75th percentile financial well-being scores of US individuals aged 30 to 61 with annual household income between 50 000$ and 74 999$ or average well-being score of individuals aged 30 to 61 with annual household income between 75 000$ and 99 999$. ²¹ It is quite interesting that the attending physicians had a high financial well-being score despite low financial literacy and common unreliable sources of information regarding money management. The attending physicians, in this study, are academics who work at the country’s most prestigious hospitals. Therefore, they are thought to have a prominent position with high income and salaries. Furthermore, financial wellbeing was associated with higher family income. With the growing costs of medical education, household income may be a factor in an individual’s decision to pursue a medical career, allowing for inequality and disparity. Agreement with living in the now without considering the future was associated with lower financial wellbeing. This might explain why the country’s financial crisis had a negative effect on the attending physicians’ financial wellbeing. The financial crisis has reduced the purchasing power, making it difficult to spend money. This was noted in our survey as the financial attitudes and behaviors of all groups shifted during the crisis away from positive financial planning attitudes and behaviors. Our findings show a statistically significant decline in financial wellbeing during the crisis across all three groups studied (students, residents, and attending physicians). Financial wellbeing is a complex construct and further research is needed to understand its determinants across various industries and countries.

Most individuals lack the knowledge and skills necessary to succeed in the ever more complex financial world.^7,23 A comparative report on complete correct responses to three financial literacy questions around the world have shown a range of 3.7% in Russia and Romani, 30% in the US to 53% in Germany and Switzerland. ²⁴ Our study has shown a proportion of 6.7% of participants who scored correctly on all the five knowledge questions. The physicians, in this study, scored lower than the general population in Lebanon as reported by a research comparing the financial literacy scores among middle income countries, Mexico, Lebanon, Uruguay, and Turkey. ²⁵ Adetayo et al stated that “as a very literate group, there is an unacceptably high level of “illiteracy” concerning financial education.” ⁸ In one study done by OECD by Karakurum-Ozdemir et al, the percent of the population in Lebanon that answered at least 3 out of 5 questions correctly was 74.7%.

Our study has shown variation in passing rates per group: 9.4% of students versus 26.6% of residents versus 64.1% of attending. All which are below the mean in the overall Lebanese population. Which goes to show the “oxymoron financial illiteracy” in the physician population. Therefore, education for financial literacy has been heavily promoted by the international organizations mainly the Organization for Economic Cooperation and Development (OECD) with the support of the World Bank and the International Monetary Fund (IMF). ²⁶ Moreover, financial literacy is gaining interest in the K-12 curriculum and among young people. ²⁷ Few studies have reported positive effects of financial curricula among medical residents^13,28; nevertheless, there is a need for a wide implementation of structured financial curricula and adoption of financial literacy as one of ACGME competencies. This goes in agreement with a recent study conducted in Lebanon concluding that a higher financial well-being is positively linked with having a better financial literacy through a financial curriculum during residency. ²⁹

It is particularly concerning that physicians, who are typically considered to have “permanent income,” were unable to withstand Lebanon’s financial crisis effectively. This resulted in their financial wellbeing scores dropping to levels comparable to U.S. households earning below 100% of the Federal Poverty Level (FPL). This highlights the severe impact of the crisis on even traditionally secure professions and emphasizes the urgent need for financial preparedness and literacy among physicians to navigate economic instability. Our study may offer a valuable lesson for physicians in other countries facing economic instability. Since our research was conducted, more countries like the UK and Egypt have entered economic crises, which could similarly impact the financial wellbeing of professionals, including physicians. It would be valuable to conduct a follow-up study in 2024, now that the currency has somewhat stabilized and the COVID-19 pandemic has eased.

In our multivariate regression analysis, we explored the relationships between various predictors (eg, crowding, attitudes, socioeconomic status) and financial wellbeing. While it may appear that behavior causes financial wellbeing, we acknowledge that the reverse could also be true—better financial wellbeing might enable individuals to exhibit more favorable financial behaviors, such as saving more. This reflects a broader economic principle, where those with higher financial security tend to have lower marginal propensities to consume.

The goal of our study was not to establish definitive causal relationships but to highlight associations and identify predictors of financial wellbeing in this specific population. Our findings suggest that while financial behaviors and attitudes are significant predictors, they likely interact with financial wellbeing in complex, bidirectional ways. Further longitudinal research would be needed to explore the causality between these factors. The purpose of this analysis was to offer insight into key factors influencing financial wellbeing among medical professionals, demonstrating the importance of addressing these predictors through education and support.

The surprising lack of a direct relationship between financial wellbeing and financial knowledge in our study highlights the complexity of financial wellbeing, which is influenced by a combination of factors beyond financial literacy alone. One major determinant we found was parental socioeconomic status (SES), which had a strong impact on participants’ financial wellbeing. However, unlike financial knowledge, which can be improved through education, SES is a fixed factor that individuals cannot change. Furthermore, the external economic environment—specifically, the financial crisis in Lebanon and the COVID-19 pandemic—likely played a dominant role in shaping financial wellbeing during the study period. These overwhelming external forces may have diminished the immediate impact of financial knowledge on wellbeing.

Despite this, measuring financial literacy remains valuable, as it identifies knowledge gaps and equips individuals with the tools to make informed financial decisions. Financial education is still critical, as it empowers individuals to better navigate complex financial systems and build long-term resilience, even in unstable economic conditions. Our findings also highlight the need for financial education programs to go beyond knowledge dissemination and focus on practical application, behavioral change, and the ability to cope with external factors. Therefore, while financial literacy may not have shown a direct impact on wellbeing in this specific context, it remains an essential skill that can contribute to improved financial outcomes over time.

Moreover, physicians should not remain passive when it comes to economic debates and financial matters. It is no longer sufficient for them to focus solely on their medical practice under the assumption that everything will be financially secure. Given the complexities and flaws in the current economic system, doctors need to actively engage in broader economic discussions and advocate for systemic improvements that affect their profession and financial well-being. Therefore, while financial literacy may not have shown a direct impact on wellbeing in this specific context, it remains an essential skill that can contribute to improved financial outcomes over time.

Strengths and Limitations

This study has several notable strengths. Primarily, it is comprehensive in scope, being a multi-institutional and nationwide survey that includes all six private medical schools in Lebanon and their affiliated medical centers. This extensive inclusion enhances the representativeness of the findings and allows for a more generalized understanding of financial wellbeing and literacy among medical professionals in the country. Additionally, by involving participants across different stages of their medical careers—medical students, residents/fellows, and attending physicians—the study provides valuable insights into how financial wellbeing and literacy evolve throughout a medical professional’s journey. The use of validated instruments, such as the abbreviated 5-item Financial Well-Being Scale developed by the CFPB and the “Big Five” financial literacy questions by Lusardi and Mitchell, adds robustness and credibility to the research. These standardized tools ensure reliability and facilitate meaningful comparisons with other studies globally. Furthermore, conducting the study during the Lebanese financial crisis and the COVID-19 pandemic offers unique and timely insights into how such unprecedented events impact the financial stability and attitudes of healthcare professionals. Being one of the first studies of its kind in an Arab country also fills a gap in the literature and sets a precedent for future research in similar contexts. A response rate of 20% among healthcare professionals is considered a good response, although it may still affect generalizability to the overall population of physicians in Lebanon.

There are some limitations to generalizability to other contexts or countries, mainly due to the presence of one public medical school and targeting attending physicians in academic hospitals. The use of a convenience sampling method may also contribute to may also contribute to selection bias. Participants who are more financially literate or concerned about their financial wellbeing might have been more inclined to respond to the survey. This self-selection could skew the results and limit the ability to generalize the findings to all medical professionals. Another limitation of this study is the absence of a formal sample size calculation or power analysis. The exploratory nature of the research, coupled with the unprecedented circumstances of the Lebanese financial crisis and the COVID-19 pandemic, made it challenging to perform an a priori sample size estimation. As a result, the statistical power may be insufficient to detect smaller effect sizes or subtle associations between variables. This limitation may affect the generalizability of the findings and the ability to draw definitive conclusions. Future studies should consider conducting a sample size calculation to ensure adequate power and potentially include a larger or more diverse sample to validate and extend our findings.

The country financial crisis and the COVID pandemic could have affected the financial well-being scores. Both crises significantly impacted the economy and healthcare sector, which may have skewed financial wellbeing scores, particularly by exacerbating financial stressors unrelated to financial literacy. This limits the ability to generalize the findings to more stable contexts or countries that are not undergoing similar crises.

Conclusion

This study is the first to comprehensively examine financial literacy and wellbeing across all the stages of medical training in career progression within a single study, and it was done on all the private schools in the country of Lebanon. This multi-institutional nationwide study among medical students, residents and attending physicians in Lebanon has shown overall low financial literacy. Our findings further show that, even after entering the workforce, physicians exhibit lower financial literacy compared to the general population in Lebanon. Attending physicians have high financial wellbeing despite low financial literacy and lack of formal education. Crowding index, family income and attitude toward living today were the main predictors of financial well-being.

The impact of Lebanon’s financial crisis and the COVID-19 pandemic was evident, significantly reducing financial wellbeing across all groups studied. This underscores the vulnerability of even high-income professionals to external economic shocks and highlights the importance of financial preparedness and resilience. The study underscores that financial wellbeing is influenced by multiple factors beyond financial knowledge, including socioeconomic background and external economic conditions. While financial literacy alone may not guarantee financial wellbeing, it remains crucial and should be coupled with practical application, behavioral change, and active engagement in broader economic issues to improve long-term financial outcomes for physicians. This not only benefits physicians personally but also has broader implications for job satisfaction, productivity, and the overall sustainability of the healthcare system.

Appendix A.

List of the Six Private Medical Schools and the Primary Affiliated Teaching University Medical Center.

Medical School	University Hospital
American University of Beirut 30	American University of Beirut Medical Center (AUBMC)
University of Balamand	Saint George Hospital University Medical Center
Beirut Arab University 30	Makassed General Hospital (MGH)
Lebanese American University 31	Lebanese American University Medical Center – Rizk Hospital (LAUMC-RH)
University of Saint Joseph (USJ)	Hôtel Dieu de France (HDF)
Holy Spirit University of Kaslik (USEK)	Notre Dame de Secours 21

Appendix B.

Financial Attitude of Medical Students, Residents/Fellow and Attending Physicians Before and After the Crisis.

		Strongly agree	Undecided	Disagree
		n (%)	n (%)	n (%)
I tend to live for today and let tomorrow take care of itself (N = 278)	Before crisis	79 (28.4)	45 (16.2)	154 (55.4)
	During crisis	75 (27.2)	48 (17.4)	153 (55.4)
I find it more satisfying to spend money than to save it for the long term (N = 273)	Before crisis	91 (33.3)	73 (26.7)	109 (39.9)
	During crisis	59 (21.7)	63 (23.2)	150 (55.1)
Money is there to be spent (N = 276)	Before crisis	148 (53.6)	75 (27.2)	53 (19.2)
	During crisis	77 (28.1)	77 (28.1)	120 (43.8)

Appendix C.

Bivariate Analysis Between Financial Wellbeing Score and the Various Demographics Among the Total Sample of Medical Students, Residents/Fellows and Attending Physicians.

	Pearson coefficient	P-value
Financial knowledge total score (n = 244)	0.097	.129
Age (N = 244)	0.237	<.001
Crowding index	−0.252	<.001
	Mean financial well-being
	mean ± SD	P-value one-way ANOVA
Gender (N = 289)		.252
Female	57.8 ± 9.9
Male	56.5 ± 9.9
Level of practice (N = 303)		<.001
Medical student	55.3 ± 10.4
Resident/fellow	54.8 ± 8.7
Attending physician	61.4 ± 9.4
Total household income (N = 236)		<.001
Less than 450$	50.3 ± 6.4
450−2000$	50.5 ± 9.01
2001-5000$	54.4 ± 6.32
5001-10 000$	60.5 ± 8.51,2
More than 10 000$	64.3 ± 10.01,2
Family’s SES status (N = 248)		<.001
Lower	51.7 ± 7.6
Lower middle class	50.7 ± 11.81,2
Middle class	54.5 ± 7.41,2
Upper middle class	61.2 ± 9.72
Upper	66 ± 10.21
Presence of any loans (N = 307)		<.001 (Independent t-test)
Yes	55.6 ± 9.3
No	59.6 ± 9.7
Attitudes
I tend to live for today and let tomorrow take care of itself (N = 262_)		.003
Agree	54.6 ± 10.51
Neutral	56.2 ± 8.7
Disagree	59.2 ± 9.51
I find it more satisfying to spend money than to save it for the long term (N = 258)		.385
Agree	56.1 ± 8.8
Neutral	58.2 ± 8.9
Disagree	57.8 ± 11.2
Money is there to be spent (N = 261)		.063
Agree	56.2 ± 9.0
Neutral	59.6 ± 9.1
Disagree	57.3 ± 13.0

Appendix D: Financial Wellbeing Score Ranges

Financial well-being scores range from 0 to 100, and they are divided into five categories: Very Low (0-29), Low (30-37), Medium Low (38-49), Medium High (50-57), and High/Very High (58-100). Higher scores indicate stronger financial security and the ability to handle both regular expenses and financial emergencies, while lower scores suggest financial stress and difficulty meeting day-to-day needs

Source. Adapted from CFPB Financial well-being scale: scale development technical report, 2017.