How Personal Finance Perceptions Affect Student Pharmacists’ Career Choices
Dr. Nick Hagemeier joins Tim Ulbrich to talk about an article he and his colleagues published in the American Journal of Pharmaceutical Education titled Student Pharmacists’ Personal Finance Perceptions, Projected Indebtedness Upon Graduation, and Career Decision Making. They discuss the history of student loan debt in pharmacy education, Nick’s experience teaching personal finance to pharmacy students and why today’s graduates, more than ever, should be equipped with the knowledge and tools necessary to manage the pressures associated with large student loan debts.
About Today’s Guests
Nicholas “Nick” Hagemeier, PharmD, PhD, is Vice Chair and Associate Professor of Pharmacy Practice and Director of Student Professional Development at the East Tennessee State University Gatton College of Pharmacy. Dr. Hagemeier also serves as Director of ETSU’s Pharmacy Practice Research Fellowship. He earned his PharmD, MS, and PhD degrees from Purdue University. He was awarded NIH funding to conduct research on the role of pharmacists in preventing opioid-related morbidity and mortality and was appointed to the US Health and Human Services Pain Management Best Practices Interagency Task Force in 2018. He has published 44 peer-reviewed manuscripts and has presented his opioid and wellbeing research nationally. He is a graduate of the American Association of Colleges of Pharmacy Academic Leadership Fellows Program. He is currently serving as a Presidential Fellow at ETSU. Dr. Hagemeier has a passion for using communication to improve patient care, applying social/behavioral research in practice, and helping students thrive personally and professionally. In the College of Pharmacy, he champions wellbeing-promoting initiatives such as Phitness Phriday and the mentoring program. Dr. Hagemeier resides in Johnson City, Tennessee with his wife Molly and four children, Will (14), Clara, (12), Fritz (10), and Katie Ann (6). His hobbies include exercising with his F3 buddies, running, and playing the banjo.
Summary
Dr. Nick Hagemeier is an Associate Professor at the Gatton College of Pharmacy, East Tennessee State University. Nick shares that he made a lot of financial mistakes after graduation, but after taking a Dave Ramsey course at his church, his eyes opened and he paid off a lot of debt quickly, sold his new car and proceeded to go back to graduate school to get his PhD.
He and another colleague started a personal finance course in their college of pharmacy driven by a passion to equip pharmacy students with the knowledge they need to make smart decisions about their finances and student loans, even while still in school. Nick wanted to get data about if and how personal finance perceptions or the amount of student loans carried affected the careers or training that pharmacists took. Some colleagues at other colleges of pharmacy were also passionate about this topic and joined forces to conduct a study across three schools. They surveyed students at the beginning of their personal finance class and had 700 usable responses. Their hypothesis was that the amount of student loan indebtedness would impact postgraduate training. Through the survey they discovered that the actual student loan debt amount wasn’t predictive of pursuing postgraduate training, however the perception of debt pressure and stress associated with the debt was predictive. Nick was surprised by their findings and shares that this is modifiable and they are able to equip students with skills to manage their stress and debt.
You can read the full study here.
Mentioned on the Show
- Refinance Your Mortgage with Credible
- AJPE: Student Pharmacists’ Personal Finance Perceptions, Projected Indebtedness Upon Graduation, and Career Decision-making by Nicholas E. Hagemeier, PharmD, PhD, Chad K. Gentry, PharmD, Debbie C. Byrd, PharmD, MBA, L. Brian Cross, PharmD, Daniel Rose, PharmD, Nasar Ansari, PharmD, Pooja Subedi, MPH, and Tandy Branham, PharmD
- YFP 082: Debt Free Theme Hour with the Teacher and Pupil w/ Joe Baker and Blake Johnson
- Bureau of Labor Statistics Occupational Outlook on Pharmacists
- YFP 124: The Behavioral Investor w/ Daniel Crosby
Episode Transcript
Tim Ulbrich: Hey, what’s up, everybody? Welcome to this week’s episode of the Your Financial Pharmacist podcast. I’m excited to welcome Dr. Nick Hagemeier, associate professor at the Gatton College of Pharmacy, East Tennessee State University, to talk about his findings from research he and colleagues published in the American Journal of Pharmaceutical Education assessing student pharmacists’ personal finance perceptions, projected indebtedness upon graduation, and career decision-making. Dr Hagemeier, welcome to the Your Financial Pharmacist podcast.
Nick Hagemeier: Hey, Tim, thanks for having me. It’s a pleasure to be here.
Tim Ulbrich: Appreciate you taking the time to do this. I know it’s crazy times with schedules and wrapping up the academic year and COVID-19 and all that that brings, so thank you so much for taking time.
Nick Hagemeier: Absolutely.
Tim Ulbrich: So Dr. Hagemeier, when I read your research article that you and your colleagues published in AJHP, which we’ll link to in the show notes and I would encourage our listeners to check out for themselves, I knew that our community, the YFP community, would really take interest in what you found through this study So before we jump into the study and your findings, tell us about your work that you’re doing at ETSU right now and your career path leading up to your current position.
Nick Hagemeier: Oh, wow. Well you know, the work we do is ETSU, we have a personal finance elective that we have probably around 20 students will take that every fall semester.
Tim Ulbrich: OK.
Nick Hagemeier: And that’s been, you know, it’s been a huge blessing to me and Brian Cross, we’ve co-coordinated that class I think since 2013 now. And it’s probably — you know, we’ll tell the students in that class it’s our most fun class to teach because we know the impact that the knowledge that we’re sharing with them had on our lives and we know that it can be a game-changer for them. And you know, we’ll have students that buy in and actually will change their lives. And that’s something that keeps you coming back for more.
Tim Ulbrich: You know, and it reminds me, Nick, I’m guessing you get several of these emails from graduates. Perhaps in the moment it sticks, maybe it doesn’t, it’s a later point in time. It reminds me of Joe Baker we’ve had on the show teaches personal finance at UAMS in Harding. He’ll regularly hear from students about wow, the impact that this had on me later on or when they get to a later decision point about student loan debt or home buying or life planning or whatever, you know, it’s often planting seeds. That’s what I find, and I don’t know if that’s the same for you, but it’s often planting seeds. And some of those come to be in the moment in terms of the fruit, and sometimes it’s a little bit later on.
Nick Hagemeier: I absolutely agree. Yeah. We tell our students in that class that you know, probably the best time to do the course evaluation is about five years from now. But you’re right though that some of that seed will be planted right then, and it will be a game-changer for them while they’re in pharmacy school. That’s obviously our preference. But getting those thank you emails or just learning about the impact that it had years down the road, that’s awesome.
Tim Ulbrich: So tell us a little bit more, Nick, about your career path into your current position: where you did your training and I know you have some advanced degrees and training as well.
Nick Hagemeier: Yeah, I did my pharmacy degree at Purdue University. And then started trying to figure out what I wanted to do next. And I really didn’t have a good feel for that until my P4 year, and a mentor suggested that rather than residency training, which is what I thought I was going to pursue that I might want to consider a PhD. So I didn’t really know a whole lot about it at the time, to be honest. But I trusted his judgment and when you know who that person is, it was Nick Popevich. And he’s well known, a dear man, and I really think he had my best interests in mind. And he was right. And so that’s what I did. And I worked in the community pharmacy setting part-time during my Master’s degree and then stopped after my Master’s degree and worked full-time in the independent community pharmacy setting. I worked at a couple different pharmacies because my primary one didn’t have enough hours to support me. So I worked 30 at one and 11 hours at another. And did that for a few years and then transitioned into chain. And that was really — I don’t even know how to put it into words, you know. It really brought back my career aspirations and made me reflect on what do I really want to do? And I felt like I was stuck. I didn’t know anything about money. I had been — the example I give my students that just shows you how dumb I was about money is I had a note on my wife’s engagement ring. We were engaged in — we got married in 2002, engaged in 2001 I believe, 2002. And I had not paid anything on this note until 2009.
Tim Ulbrich: Oh, wow.
Nick Hagemeier: I just kept paying the interest. I mean, how silly is that? So I got — the church we were attending offered the Dave Ramsey course, and I’m like, well, I don’t know anything now. This really can’t hurt. And we took that course, and it was absolutely eye-opening for me. It really did change my life. And that’s what we tell the students, and Brian Cross has the same story. And we’re very transparent with the students about our ignorance, things that we did wrong as we were going through pharmacy school and then early in life. Eventually, I figured out how to get out of debt. I paid off a ton of debt over a very quick period of time, sold a car I had just bought — my only new car I’d ever owned, I sold that and got out of a ton of debt and figured out a way to make it work to go back to school so that I could do what I love doing. And that’s what I did. I went back to Purdue, got a PhD in 2009, graduated in 2011. And here I am at ETSU.
Tim Ulbrich: And I love, Nick, that you took your personal experience and you know, I always joke with my students the school of hard knocks is the best way to teach this topic.
Nick Hagemeier: That is for sure.
Tim Ulbrich: And I think it makes you real. And I can tell the students appreciate that, I’m sure the same is for you and just that vulnerability and sharing that this is a topic, it’s so behavioral, and we are all constantly learning. We’re all constantly making mistakes, hopefully less over time. We hopefully do better over time. But it’s human behavior, you know, when it comes to personal finance and making mistakes. And I’m so glad to hear that you share those stories with your students. You know, I’ve tried to do the same, even though it’s hard to sometimes admit like oh my gosh, did I really do that? Did I really pay a note on an engagement ring for that period of time?
Nick Hagemeier: Yep.
Tim Ulbrich: Did I really make that mistake? But I think it makes it real for the students, and I think it also allows them to see that hey, mistakes are going to happen and you continually learn, you pick yourself up and you move forward. And I also love that you have really been able to not only teach and give back to the students but also transition to moving some of this into the research space and being able to ask some really important questions that are having an impact on our student pharmacists, on our graduates and our profession as a whole. So let’s talk about this study, again, published in AJPE, “Student Pharmacists’ Personal Finance Perceptions, Projected Indebtedness Upon Graduation and Career Decision-Making.” Tell us a little bit about the purpose of this study. What led you to wanting to conduct a study about student pharmacists and the link between their indebtedness and their career decision-making process?
Nick Hagemeier: Well, I was fortunate to have some colleagues at other institutions that at that time that were just as passionate about this as I was. And I’m a data guy. I love anecdotes, I love good stories, but at the end of the day, I want to know are there data that support my assumptions or assertions that we’re going to make? So I had a little bit of a captive audience, and I had students that were willing to participate in this research, so I just wanted to try to figure out, you know, OK, I know I think personal finance influences decision-making, career decision-making, whether people are going to grad school or fellowships or residencies, you name it. And I just wanted to have some data to do that. And Chad Gentry had been at ETSU and he had been at Lipscomb, and Debbie Byrd was then at the University of Tennessee and now serves as our dean. But they were both doing work like this, and I reached out to them to see if they would be willing to participate in — actually some of this happened at an AACP meeting, just we were talking about this. And they both expressed interest that hey, they’d like to survey their students too. So I developed a survey instrument and kind of put it through the ringer here at ETSU, tweaked it a little bit early on, and then invited Chad and Debbie to participate as well. And so it was really cool that we got data from three different institutions. I think that’s a strength of the study as opposed to just having students at ETSU.
Tim Ulbrich: I do as well, and we’ll talk more about the potential for extrapolating some of that data to other colleges and students across the country. So tell us a little bit — you started to talk about three institutions, but tell us a little bit more about how you conducted the student, who specifically was evaluated, how they were evaluated, and the types of questions that you asked in the survey.
Nick Hagemeier: Sure. So we — I think an important point is that we surveyed the students right out of the gate, so right when we had them in a personal finance class. And it differed across institutions as to whether that was required or not. We surveyed them before we gave them any knowledge.
Tim Ulbrich: OK.
Nick Hagemeier: So we were trying to look at baseline, like how are you feeling? Like what are your perceptions about this? What are your self-efficacy beliefs or your confidence in your skill set related to personal finance? Wanted to know about their perceptions of debt and the pressure that goes along with that or can go along with that. So we developed this paper-based or web-based survey, depending on the institution, and the students took this at the beginning of the class and then we got the data back and we analyzed it here at ETSU. So we had P2s and P3s.
Tim Ulbrich: OK.
Nick Hagemeier: That were participating in this research; that varied across the institutions as well.
Tim Ulbrich: And tell us a little bit more, you mentioned one of the strengths, which I agree with, would be across multiple institutions. So thinking about the generalized ability of this data, tell us a little bit more about those three institutions and why that is a strength as we consider how this might apply to other colleges and other students across the country.
Nick Hagemeier: Yeah, so we could really separate out the data, you know, but I think that there is strength in the end there that you get from three different institutions. But you’ve UT, which is a public university. You’ve got Lipscomb, which is a private university. Then you’ve got ETSU, which is kind of the mutt, right? We’re a private college within a public university, which I don’t know if most people are aware of that or not.
Tim Ulbrich: I did not know that, no.
Nick Hagemeier: Yeah, so there were no state dollars to support ETSU opening a College of Pharmacy.
Tim Ulbrich: OK.
Nick Hagemeier: Back in the day, and the only college of pharmacy was in Memphis at UT. But it was a private model within a public university, so it’s a completely tuition-driven college. So I mean, you’ve got three different types of colleges, all three of those exist around the U.S. And we looked at common themes across all three of those.
Tim Ulbrich: OK. And from what I can remember, over 700 usable responses, really strong response rate, around 90%. So talk us through with that data in mind of the main findings of the study. And then we’ll talk about what those perhaps could mean and the implications of those.
Nick Hagemeier: Sure. So one of the things, and one of our hypotheses was that the amount of indebtedness, so the actual dollar amount, would impact post-grad training, pursuance direct entry into practice versus pursuing another path. And so that was one thing we were going to look at. And then something else that was interesting were just perceptions, right? Because you can have this dollar amount, but if you don’t pay any attention to it, maybe it doesn’t matter.
Tim Ulbrich: Yep.
Nick Hagemeier: Maybe it doesn’t matter. And so we were interested in really both of those. And I was really interested in self-efficacy beliefs too because confidence, you know, confidence is really important. There’s all kinds of literature that shows that’s the case. Now, whether students are accurately reporting their confidence, if their confidence actually matches their ability, that’s another question. But those were some of the things that we were looking at. So I think the main finding here was that the actual student loan debt amount wasn’t predictive of pursuing post-grad training. But the perception of debt pressure and stress associated with that debt was predictive. So I think you know, that to me was — we didn’t anticipate finding that, but that was just a really interesting finding. And it’s really cool because that’s modifiable.
Tim Ulbrich: Right.
Nick Hagemeier: Right? We can equip students with some of the skills and knowledge that, just help them manage that stress, manage that debt, minimize that debt and therefore, position them to pursue the careers that they want to pursue.
Tim Ulbrich: Yeah, and I think that’s a really important point as we just summarized that as I understand it, Nick, to reiterate what you said, the actual indebtedness amount that they reported or projected indebtedness upon graduation didn’t have an impact on their career decision options they were considering for the future, but rather, the debt influence and pressure and their perception of that, which was a combination of how they responded to a series of questions around things like I’m concerned about my anticipated debt load, I feel pressure to get out of debt, my debt load factors in my career plans after I graduate, my debt load influences my decisions. So I think that perception, I’m so glad you assessed that because I think that’s been my experience in working with students as well as my personal experience, you know, sometimes the dollar amount, especially when we think about it from the student perspective, the actual dollar amount may not necessarily have hit them yet. But it may be weighing on their mind, and for students at different levels. You know, I’ll talk with some students sometimes that have $75,000-80,000 of projected debt and they’re very much thinking about the stress. And I’ll speak with others that maybe $250,000 or $300,000 of projected debt, and you know, it still feels like at that point Monopoly money and something that’s not top of mind.
Nick Hagemeier: Yeah.
Tim Ulbrich: One of the things I found really interesting — and I wanted to pick your brain on this — is when I was looking at the findings presented in the results section, Table 2, which was the pharmacy student personal finance constructs and perceptions, I was caught off guard — and these, as I understand it, were a series of questions they responded on a Likert Scale with a higher number essentially indicating a more favorable response and agreement. And as I looked at those, I was caught off guard by how high these responses were. So for example, questions like “I’m confident in my ability to manage my personal finances,” the mean was a 3.81. Again, 1-5 scale. “I’m confident in my ability to get out of debt,” 4.05. So to me, when I saw that, I feel like there’s perhaps some overconfidence here. I mean, can you speak to that and what you’ve seen either in other literature — I know from my experience looking at some of the vet med literature, which I know has published more in this area of personal finance, there’s a lot of data supporting the idea that perhaps overconfident in school and underestimating what impact that’s going to have in the future. So was there anything there that you took away to say maybe there is some overconfidence here in the response?
Nick Hagemeier: Well, I completely agree with you. You know, again, this is just anecdotal, but based on some of my experiences and conversations that I’ve had with students that I know responded a 4 or 5 on this, and you know, I’ll talk to them about, “OK, so you’re confident in your ability to develop a personal budget.” “Yes, I am.” “OK, what about like sticking to it?” “Oh, I don’t ever stick to it. But I can develop one.” So part of it’s in the items that I asked. But again, I think that this is something where a lot of students probably covered it in high school, they’re familiar with it. So there’s comfort in saying that I’m confident in things with which I’m familiar.
Tim Ulbrich: Sure. Yep.
Nick Hagemeier: But again, you mentioned in the beginning, it’s behavior-based. And man, some of these behaviors are so hard. And I do feel like this is a situation where they’re probably overconfident. I don’t think their behaviors, their knowledge or their skill set matches those high numbers that you see in the manuscript.
Tim Ulbrich: Yeah, and one of the things I noticed too as I was looking at the data, again anecdotally talking from my experience working with students, is the item they rated the lowest on relative to the others was the statement, “I’m confident in my ability to choose appropriate investment option.” And I will say consistently when I talk with students about what’s the topic you feel least confident about and you want more information? It often is investing. And similarly, you know, I feel like that sometimes they feel perhaps overinundated with like student loan debt information but when I sit down and talk about repayment options and really dig into the weeds, I sense that there’s a feeling that they may not need that information. But once you dig in, they really have some of those Aha! moments of like oh my gosh, I had no idea of the implications of if I choose this one repayment option versus this and why this decision is so important. So I say this because I think it’s important — and we’ll talk more about this as we talk about next steps in personal finance education — I think it’s important we look at the responses and how students feel but also take a step back and layer on top of that what do we think they really need? And does their reported confidence in perhaps being ready to address and tackle the student loan debt, is that reality? Or do we still need to spend more time? Because I think it’s a topic that at the surface may not seem so overwhelming but can certainly be complicated when we think about the nuances of repayment and the implications it has with the rest of their financial plan.
Nick Hagemeier: Yeah, I agree. And we try to link them together. We try to talk about with our students, this ability to develop a budget, it may not seem that related to your ability to choose appropriate investment options.
Tim Ulbrich: Yeah.
Nick Hagemeier: But wow, if you can figure out the budgeting part and maximize the amount that you can put towards your student loan debt and towards your investments and etc., etc., and then that really gets their attention. So it’s the linking them has been impactful.
Tim Ulbrich: Absolutely.
Nick Hagemeier: From a teaching perspective. But yeah, I completely agree with you. It is important to pay attention to those numbers. And you know, in our class, we lovingly call them out if we feel like you’re overconfident. Well, that’s awesome, but your behaviors aren’t matching what your confidence levels. Yeah. They’re not matching.
Tim Ulbrich: Sure. Talk to us a little bit more about what you found in terms of their — the connection between this debt influence and pressure perceptions and their actual areas of training after graduation, whether that be the decision to pursue post-graduate training or not or even going into, say, a hospital practice versus chain community or supermarket mass-merchandiser type of practice.
Nick Hagemeier: Yeah, so we did a couple different models here. And this Table 3 in the manuscript, you see the unadjusted odds ratio, so that’s just looking at each one of these variables independently. And debt pressure perceptions are mentioned in there was a significant predictor there. It’s the only one that is. And we dumped them all into this soup together and looked at an adjusted odds ratio. And it still held there that debt pressure perceptions were the only significant predictor. Again, student loan debt, anticipated student loan debt at graduation wasn’t. When we looked at it from a — I mean, there’s significant overlap here, I will tell you that because you know, when we’re looking at community chain versus independent versus supermarket mass-merchandiser versus hospital. So most of your people that are going to pursue residency are going to be in that hospital bucket, right? So there’s some overlap here. But the debt pressure perceptions, they significantly predicted going into chain community as compared to going into hospital. OK? Which is just another way to say what we saw with pursuing post-graduate training or directly entering practice. We thought there might be differences across some of the higher paying, historically higher paying jobs that they’re in practice as compared to some that may not be. And we saw a little bit of that, but I mean the biggest difference was by far the hospital versus community chain.
Tim Ulbrich: So I know we’re conjecturing here a little bit, but taking this data and then thinking about what’s been evolving or changing in the last few years, and this is I think difficult because we look at the Bureau of Labor Statistics data as one way to track some of the workforce trends and obviously the salary trends of a pharmacist. I think it often leaves us wondering, well, for new practitioners, I know here at least in the Columbus, Ohio, area, we’re definitely seeing a trend where what might have been when I graduated in 2008 the community position as being more of the lucrative financial move, that is changing because of several companies making decisions to go back down to 32 hours, some more recently even cutting pay and some as recent with the COVID-19 situation and then obviously also just thinking about the relative flat nature of those salaries over time. So do you see this changing, this perception of students and what they viewed as perhaps the debt influence and perception impacting a decision that if I’ve got more debt, I might be thinking about more of the community space because of the financial benefit to that position? Do you think that’s a ship we’ll see going forward?
Nick Hagemeier: Yeah, that’s a great question. And you know, succinctly, I don’t really know.
Tim Ulbrich: Yeah.
Nick Hagemeier: I think that there’s a lot more transparency and some of the other issues that have surfaced — and they were there when I was in chain as well — but some issues with patient safety and workload and things like that that I think are more in the media now, they’re more on the minds of our students. And I don’t think it’s as simple as dollars. I don’t have any data to support that, I just think that just based on some conversations with students, I think that this is really something that’s top of mind. And they’re realizing it’s a complex decision. And you’re right, Tim, all those things that you mentioned about salaries are flat at best and you know, there’s a lot of unknowns right now. So short answer is I don’t know.
Tim Ulbrich: Yeah.
Nick Hagemeier: But I think that still, it to me, it just takes me back to this is all the more reason to help students figure out how to manage money in pharmacy school.
Tim Ulbrich: Amen.
Nick Hagemeier: So that they have the skill set to make decisions that are in the best interest of themselves and their loved ones and the people that they’re caring for. And you know, that’s something I’m really passionate about, and I just, I think that this is just driving home the point that this is really important now. Not when you get out, this is really important now. And we have a ton of success stories, and we’ll tell — we share with our students the success stories of previous students about — we’ve had students that were spending $1,200 a month eating out.
Tim Ulbrich: Right.
Nick Hagemeier: Like wow.
Tim Ulbrich: Yep.
Nick Hagemeier: I’ve got a family of six, and our budget is $300. So you know, just kind of helping them see that and put some numbers with some of their behaviors. And then adjust it and then figure out hey, I’m not miserable. You know, I was actually able to save close to $10,000 over the course of an academic year. I mean, we’ve had just outrageously successful students that make game-changing decisions. And they don’t even recognize how big of changes those are yet. They won’t recognize that until they get out and can make those loan payments so much easier.
Tim Ulbrich: Absolutely.
Nick Hagemeier: And see some of the fruits of their labor.
Tim Ulbrich: I agree, and it reminds me as you were talking, Nick, of I had Dr. Daniel Crosby on the show talking about his book, “The Behavioral Investor.” And he studies behavioral economics. Essentially, that’s his job is to look at all that and look at the research. And he talks a lot about the correlations between happiness and money and talks about that threshold where somewhere around the $70,000 mark where you’ve got enough to cover your basic living expenses and have a little bit of margin and breathing room. But after that, you start to see an inverse relationship happen. And I think that’s been my personal experience as well as so many students I’ve worked with is when they start to identify that point of OK, living on a budget and being able to do so so that I can achieve my goals and have some healthy level of restriction, again, not in a negative sense but in more intentional allocation of funds, like I think there’s actually an ironic happiness that comes from that, especially as you then start to be able to free up funds and do things that the literature does support provides happiness like giving and experiences and other things like that as well. So I love the passion for I think igniting this desire in students to learn. And let’s talk about that more because in the article, you mention that this study could serve as an intervention point for colleges so they can support student pharmacists and the debt pressure they face. Talk to us a little bit more about what you think that looks like in an ideal state in terms of how we best support our students. Is it a personal finance elective that’s kind of a one-and-done? Is it something more longitudinal where we hit them at multiple points in time? Is it required? Is it optional? What are your thoughts around this?
Nick Hagemeier: Well, I think that it could be a mixed bag. I mean, one thing that I think for sure is this is not a one dose and done. I think that this warrants discussion throughout the curriculum. And you know, it could certainly be an elective, and we have the elective here. But I have framed it in terms of wellbeing. I really like how Gallup defines wellbeing across the five domains with career or purpose, community, social, financial, physical. And I’m really defining that financial wellbeing for students the way that Gallup defines it, not in terms of the amount of money you make, but it’s more about security and living within your means. And that gets their attention. And we assess wellbeing frequently. So this is top of mind, this is something that our mentors will discuss with the mentees. So this is something that I kind of get the pleasure of championing this wellbeing initiative at ETSU and the mentoring program. So I’ve kind of got a built-in mechanism to facilitate conversations with students and do so on a regular basis. Now, that doesn’t mean that necessarily all of our faculty are equipped to have those conversations. But again, they know they’ve got resources in the elective and in Brian Cross and myself to get them help if they need it. So I don’t know that there’s a necessarily like a magic way or a best way. I don’t think we have the evidence to support that. But I do think that, you know, I would prefer it be if possible to get it in front of all the students and for people that have access to students to think of creative ways to frame it. You know, wellbeing, I think students were less familiar with that than they are money. And so framing it in that way I think has worked to our benefit — and I don’t know if they know it or not yet, but theirs as well.
Tim Ulbrich: Yeah.
Nick Hagemeier: That’s been our approach, and I think that that’s worked pretty well.
Tim Ulbrich: I agree with you wholeheartedly. And I think we don’t yet have the evidence to say this is the best approach. I mean anecdotally and my gut says I feel like it’s something that’s more longitudinal in nature and that really meets the students where they are. So as I think about the financial needs of an incoming P1, you know, to me, really understanding like the anatomy of a student loan is really important because I think — again, I don’t have the literature to back this up — but I think if you really understand the anatomy of a loan and interest and the types of loans, that likely might help shift your behavior while you’re in school and obviously have long-term impacts afterwards. Whereas we think about like P4, OK, they’re getting ready to enter obviously into that new practitioner phase, get ready to go into active repayment, a lot of the decisions resulting in the debt load they have at the moment have been made. But they’re now entering a different phase of how do I actually manage this debt? And then obviously other decisions, investing and life planning and all those other things. So I think something more longitudinal in nature. The other thing we talk a lot about, Nick, at Ohio State is how do we customize this? You know, I think and I sense that this resonates with the learner, which I think is true in learning in general — but how do we customize this, especially when we’re talking about a topic that is so inherently personal, right? So if we know the literatures shows about 15% of students graduate without student loan debt, so if we do have education materials, well, for those students, you know, how do we engage them in other topics that are most meaningful? Or we know that students come in with a very different baseline understanding of this topic, perhaps that they had in their home life or previous coursework that they’ve taken, so how do we provide some base education for all students but then almost allow like a choose-your-own adventure based on the goals that they have as well as the existing knowledge and experiences they’ve had?
Nick Hagemeier: Yeah, that’s — I mean, those are great thoughts. And I think that you know, something that I’ve — again, I don’t necessarily know that I have the evidence. I think I do, but the knowledge versus skill. Completely knowledge-based experience or whatever that might be, I just don’t think it’s going to be that impactful.
Tim Ulbrich: Yeah.
Nick Hagemeier: You know, just like me sitting in a CE program that’s completely knowledge-based, to what extent am I actually going to take that and use it? It’s tough because it involves behavior change. So for the most — you know, our first stop is the budget and that basic behavior. And from there, because we’ve seen students that don’t have any student loan debt. But they don’t know how to do a budget.
Tim Ulbrich: Yep.
Nick Hagemeier: There’s just some very basic things. But if we can meet students where they are, that would be fantastic. That’s probably easier said than done.
Tim Ulbrich: Yeah.
Nick Hagemeier: But it’s worth trying to do.
Tim Ulbrich: And we’ve had a little bit of success, I think the online space has allowed us to do a little bit more of that, of the customization of learning that we may not be able to do as much in the classroom. But I think it’s just a good reminder for hopefully we have some colleges and faculty listening about collaborating and here, we’re sharing ideas but others doing the same. Nick, the last question I have for you is in the background of the article, you talk about how an educational investment is composed of both a monetary investment, so tuition, and an opportunity cost, time spent in school. So if we look at the sharp increase in student loan debt in pharmacy education, so 2010 the median indebtedness of a graduate for those that had debt was $100,000. 2019, that was $170,000. So just a nine-year period, $70,000 increase. What advice would you have for high school students, undergrad students that are evaluating this educational investment? They’ve determined that pharmacy is the career path for them, they want to be a pharmacist. But they also see what’s ahead of them in terms of this educational investment. What suggestions would you have for them?
Nick Hagemeier: Wow. That’s a really good question. Actually, I just before recording this, Tim, had a talk with some students from academic APPE. And one of the questions that they asked me was what advice would you give to high school students that are interested in pursuing pharmacy, given the current landscape? Which isn’t a whole lot different than the question you just asked. And my response was that they need to look at what it is about the profession that just really lights a fire in them. And then try to figure out — like do some research and try to figure out, you know, can I expect that that’s going to be present in this profession when I graduate? It’s changing so fast. And you know, I think that the more exposure that we can get students to different careers in pharmacy and informing them — you know, and AACP has done a good job of this here in recent years, of just trying to show what can a pharmacist actually do? Because there’s so many misperceptions there. But I think that thinking beyond what they see currently in the profession to what it could be. And then seeing if they’ve got the passion to drive it to what it could be, that’s hard work. That’s my — I think that’s my best way of answering that question. It’s so hard. There’s so many different biases that I have there and different life experiences that influence that. You know, would I do this again? Yup. But I would do it in a lot more informed manner. I kind of took the scenic route and made a lot of dumb decisions along the way. You know, looking back, I could have done this a lot better.
Tim Ulbrich: Yeah, I agree with you. And I think as you define that, you know, in the article in terms of the educational investment, I think that — I didn’t think about it that way. And I agree with you. I could have made the same decision, I think I would have just made a little bit more of a straight path, which is easy to say, right, in hindsight?
Nick Hagemeier: Right.
Tim Ulbrich: But I think when you think about your investment and I would say tuition as well as cost of living — because we see so much of the actual indebtedness is cost of living that’s taken out on unsubsidized loans that are accruing interest — and then the opportunity cost, I mean obviously that time spent, that variable you may or may not be able to impact in a significant way. But the cost of getting there and how you get there and how you minimize the indebtedness, which obviously impacts what it looks like on the back end, I think is certainly a variable that the student, prospective student, can change but also that we on the side of the education part can also help our students be able to navigate that in a little bit better way.
Nick Hagemeier: Yeah, I absolutely agree. And you know, just reflecting on my response to that question, if I would have taken the more direct route, I wouldn’t have struggled in all these areas of wellbeing, you know? And then I’m thinking, well, shoot, then maybe I wouldn’t even be able to have that much of an impact on students now and helping them succeed financially.
Tim Ulbrich: Yeah.
Nick Hagemeier: So then now I’m like, well, maybe I don’t regret what I did.
Tim Ulbrich: Yes.
Nick Hagemeier: You know, I made some dumb decisions so that you don’t have to and helping students appreciate that and helping them figure out as a high school student that your career starts — when you’re in college, consider that a career. And helping them think about money and you mentioned too that the opportunity cost, the amount of dollars that have to be borrowed or that can be borrowed aren’t necessarily the amount of dollars that you need to borrow and helping them understand that on the back side. I’ll tell you, one thing that we’ve done that’s been really impactful and it’s kind of funny, but I don’t know, Tim, do you all have Cookout up there?
Tim Ulbrich: No.
Nick Hagemeier: The restaurant? OK. It’s a little fast food restaurant that’s really close to the chain, and it’s really close to the college pharmacy. A lot of students go there. And so we’ve kind of — you mentioned like the anatomy of a student loan and the interest. We’ve taken that and applied it to eating at Cookout. So Cookout is known for their $4.99, you can get all you want for $4.99 there. And then trying to take that out over OK, so you’re using that $4.99, that’s borrowed money. Right? So if it’s not, let’s pretend that it is. And then I’m going to choose an interest rate that’s pertinent now for student loans and we’re going to look at that over a 10-year. How much is your Cookout actually costing you when you’re paying it back in 10 years? OK, what about if you do it on a 25-year loan? And holy smokes, they just like are like, “I don’t think I even want to go to Cookout anymore.”
Tim Ulbrich: Right? Right.
Nick Hagemeier: Just helping them realize some of those everyday decisions that they’re making and what that looks like in terms of loan anatomy and futuring. That can be really impactful and at least evokes an emotional response in them, which I think is something that’s necessary to really have impact here.
Tim Ulbrich: I agree, I love how you teach that because it makes it real, right? That’s something they deal with every day. Maybe not every day, but you know, every week or however often they go. And I think making this topic that can seem so big, so overwhelming, especially when you’re talking about big numbers of what you’re going to pay back over 10 or 25 years, but saying OK, the decisions you’re making today, what does that look like? What impact does that have? And really trying to make it as tangible as possible. And I love, Nick, what you said, you know, one of the things that people ask me all the time is, would you have done things differently? Absolutely, I would have done a lot of things differently. Do I regret the path that I’ve taken? And my answer is no, for the exact reason that you mentioned, that learning through those decisions and then being able to teach and influence others, like I think it’s worth it. Would I have done it differently? Yes. Do I regret it? No. So I appreciate so much, Nick, your passion for this topic. I appreciate you taking time to come on the show to discuss your journey and the article that you published in AJPE, “Student Pharmacists Personal Finance Perceptions, Projected Indebtedness upon Graduation, and Career Decision-Making.” So thank you so much, Nick.
Nick Hagemeier: Absolutely. Thanks, Tim. I really appreciate being here.
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