Residents Rise Up

[SouthernSurgeon]

so are you suggesting the hospital doesn't bill for any services done by resident? We know thats not the case, when the resident does the work the patient still gets billed but under the attendings name. The same with PA/NPs. The only thing that changes when you become an attending is that you can put your name on this bill now. Is that really worth a $100K+ raise in true economic value?

Hospitals can't bill independently for services provided by residents. Which is not the same as PAs and NPs. PAs and NPs have vastly different supervision requirements for what they can bill for.

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[newres64]

I completely agree. Especially because a number of hospitals across the country are doing this. If NY hospitals can pay 65-70k +, I don't see why more hospitals can't provide a dignified salary for residents.

Exactly. It's almost sickening that in some hospitals residents are getting paid as low $40K in some places.

 

[Chickenandwaffles]

Hospitals can't bill independently for services provided by residents. Which is not the same as PAs and NPs. PAs and NPs have vastly different supervision requirements for what they can bill for.

Not the point. The 15 or whoever many patients the resident sees every morning gets a bill, billed by the attending. "Supervision" by an attending is hit or miss. We all know the attending will regardless bill for those patients. If the resident did not exist, the attending would independently have to see each and every one of those patients. Attendings in general are able to see far more patients, do more procedures or whatever with than without residents. I think we can all agree on that.

So the hospital is not hiring attendings to "supervise" residents, the attending has to be there regardless, and has the possibility to see more people and do more stuff than if he/she were alone and resident-less. So the billing is far more than if they were alone.

Residents can also do far more than NP/PAs can do.

 

[newres64]

Hospitals can't bill independently for services provided by residents. Which is not the same as PAs and NPs. PAs and NPs have vastly different supervision requirements for what they can bill for.

I do not know the requirements NPs but I was under the impression services provided by PAs could not be billed for independently.

Either way, just because the hospital can't bill under the residents name doesn't they don't bill at all. They just bill under an attending's name, which no matter what will always have to be the case for the majority of hospital procedures. Attendings will always have to be there, whether or not the hospital is staffed with residents or not. The economic question is how many attendings/PAs/NPs would have to be hired to perform resident duties if residents were not present and what would you compensate them. Again, I go back to my ED example, the hospital I worked at ran on teams- which had 1 attending, and 3 PA/Residents (somedays we had 2 residents on the team and 1 pa, other times 2 PAs and 1 resident). So it would appear that in this case the hospital has viewed the residents work in the ED equivalent to the PAs...yet the PA makes 80K and the resident makes 55K. Why? No matter what the combination of PA/resident is the amount of attendings doesn't change.

 

[Chickenandwaffles]

I do not know the requirements NPs but I was under the impression services provided by PAs could not be billed for independently.

Either way, just because the hospital can't bill under the residents name doesn't they don't bill at all. They just bill under an attending's name, which no matter what will always have to be the case for the majority of hospital procedures. Attendings will always have to be there, whether or not the hospital is staffed with residents or not. The economic question is how many attendings/PAs/NPs would have to be hired to perform resident duties if residents were not present and what would you compensate them. Again, I go back to my ED example, the hospital I worked at ran on teams- which had 1 attending, and 3 PA/Residents (somedays we had 2 residents on the team and 1 pa, other times 2 PAs and 1 resident). So it would appear that in this case the hospital has viewed the residents work in the ED equivalent to the PAs...yet the PA makes 80K and the resident makes 55K. Why? No matter what the combination of PA/resident is the amount of attendings doesn't change.

Agreed. I remember one program i interviewed at, residents were pulled from one rotation because it was mostly scutwork. The director of the rotation was outraged, and the PD of theprogram I interviewed at asked him, well why would I want to continue having my residents there if all they do is scutwork and do things that provide the dept. with services but no educational activities? Obviously, because all the residents were pulled, they had to hire several midlevels, at a much higher cost.

I don't think anyone is asking for millions here, but 10-15k more would go a long way in increasing resident happiness. For those people who also have kids, a lot of debt, etc. financial stress makes residency even harder. There are many studies to support this.

 

[VA Hopeful Dr]

Well attendings bill for residents' services, they are not free. And attendings are able to see more patients in general as a result of residents, so their billings INCREASE not decrease. It's like suggesting that an attending who uses a PA sees less patients or bills less.

Umm, not even close to true for the majority of specialties. Most attending surgeons can do a gallbladder in under 20 minutes, same with appys. Residents take more like 1-2 hours. The attending must be present the whole time, they can't be running their own room AND supervise a resident. Please explain how that makes the attending MORE productive.

In both my residency (FM) and my wife's (IM), the inpatient team with 1 attending usually manages a service of between 14-18. Most attending hospitalists that I've known see a minimum of 20 patients per day.

 

[newres64]

Residents can also do far more than NP/PAs can do.

And get paid less. PA/NPs wages are controlled generally by market forces. So if economic productivity of PA/NPs are sufficient to warrant a 80-90K year salary then there needs to be an explanation to why a resident gets paid only 50K for doing the same job and more.

To be honest, it'd kind of insulting when I'm given explanations/excuses like the ones i've seen here. I'm an adult, so be honest, you are taking advantage of our labor because you can. I'll feel a lot better if an attending walked up and told me to my face "the reason we pay you so little is because I was paid so little when i was at your level. IF I had to go through it you will" . Atleast it would be honest

 

[Chickenandwaffles]

Umm, not even close to true for the majority of specialties. Most attending surgeons can do a gallbladder in under 20 minutes, same with appys. Residents take more like 1-2 hours. The attending must be present the whole time, they can't be running their own room AND supervise a resident. Please explain how that makes the attending MORE productive.

In both my residency (FM) and my wife's (IM), the inpatient team with 1 attending usually manages a service of between 14-18. Most attending hospitalists that I've known see a minimum of 20 patients per day.

I'm not going to talk about surgery, becauseI don't know how surgery residency works. But in both IM/FM, the number of patients seen by a team with residents is far far greater than one attending. You really think hospitals are just such do-gooers that they have residents because they loveee teaching? no, it's because they are cheap labor, and they can bill more. When I did internship, one attending with residents was responsible for about 30-40 patients daily, most of them seen by the residents individually. Hospitalists saw no more than 15-18 patients a day.

In ortho clinic when I was in med school, one attending "supervised" 1-3 residents and students, with each resident/student seeing about 5 patients an hour and then the attending passing by for about 30 seconds, looking at the post op incision, recovery, whatever, and moving on. REsidents/students did everything else. In the ED, one attending "supervised" 2-3 residents, with the attending adding/axing the residents' plan. Explain to me how the attending is not seeing more and billing more?

 

[newres64]

In both my residency (FM) and my wife's (IM), the inpatient team with 1 attending usually manages a service of between 14-18. Most attending hospitalists that I've known see a minimum of 20 patients per day.

but how many extra attendings are needed then? If none are, then residents are truly not needed in the healthcare setting for anything except educational purposes. That would also mean that neither are PAs/NPs.

I don't necessarily agree that residents always slow down treatment- maybe at first, but as you get to your final years you should be very close (if not at) an attendings level.

 

[Chickenandwaffles]

And get paid less. PA/NPs wages are controlled generally by market forces. So if economic productivity of PA/NPs are sufficient to warrant a 80-90K year salary then there needs to be an explanation to why a resident gets paid only 50K for doing the same job and more.

To be honest, it'd kind of insulting when I'm given explanations/excuses like the ones i've seen here. I'm an adult, so be honest, you are taking advantage of our labor because you can. I'll feel a lot better if an attending walked up and told me to my face "the reason we pay you so little is because I was paid so little when i was at your level. IF I had to go through it you will" . Atleast it would be honest

I completely agree. I would also feel a lot better if they told me, well we make more by seeing more patients/doing more procedures with you guys around, than if we were on our own. When you are an attending, you will have residnets do some of your work, and you'll bill more too.

Like my chief resident told me during intern year when I wanted to do a rotation that did not require resident coverage because of low patient volume, "Without residents, this hospital would collapse."

 

[ketosisevangelist]

The people who set the resident salary schedule do not pass through a membrane from another reality!

By the time you fight for a higher salary, you will be either done with your residency or collecting union dues from the *****s who signed up.

If you want more money that what you are making, join AMWAY.

 

[Raryn]

I completely agree. I would also feel a lot better if they told me, well we make more by seeing more patients/doing more procedures with you guys around, than if we were on our own. When you are an attending, you will have residnets do some of your work, and you'll bill more too.

Like my chief resident told me during intern year when I wanted to do a rotation that did not require resident coverage because of low patient volume, "Without residents, this hospital would collapse."

Sigh. You guys don't get the difference between the function of a resident and the function of a PA/NP. Let's put it this way:

The work residents do is offset at least somewhat by the significant amount of resources expended on training them and keeping the program running.

When you hire a PA, you don't have to use your most valuable staff members (the attendings) to give them lectures 10-15 hours a week. You don't have to put together an entire administrative infrastructure, with at least one attending working half-time in administration (the PD) subsidized to a full salary and at least one secretary/coordinator in order to coordinate your PAs work. You don't have to slow down your own procedures so that the PA can better understand how they're going to do it themselves later, because they won't be doing it themselves later. If a PA made an attendings procedure take twice as long, that PA would be fired. If a resident does it, well, that's how he's learning.

I've worked with mid-level providers in a number of rotations and I'd say that a good one with some experience is easily at the level of an intern 6-8 months into their residency. Maybe even a 2nd year resident in some cases. That's fine. But the thing is, they stay there. They don't get comprehensive education in how to do everything on their own, and their lack of such attention means the other members of the team are freed up to be more efficient. On the other thing, residents frequently slow things down when they're learning. But we accept that slow down because otherwise we won't end up with any new competent, independent providers.

So yes, if our programs didn't give a rats ass about educating us and just used us for scutwork while the attendings were off earning maximal money, a resident could easily earn his entire salary and more. But that would be a piss-poor educational experience, and one that isn't (or shouldn't be at least) the case in any program that's actually ACGME accredited. Our attendings accept the inefficiency of the residents and everything that entails (extra supervision in some cases, extra autonomy in others) and try to maximize our educational potential. That's why programs pay four people (an attending, a senior, two interns) to run a team of patients when the attending could honestly work more hours and do the same work themselves. That's why our attendings get paid less in academia than private practice. It's because they're spending resources on training you, not just using you for the maximum amount of work.

 

[Chickenandwaffles]

Sigh. You guys don't get the difference between the function of a resident and the function of a PA/NP. Let's put it this way:

The work residents do is offset at least somewhat by the significant amount of resources expended on training them and keeping the program running.

When you hire a PA, you don't have to use your most valuable staff members (the attendings) to give them lectures 10-15 hours a week. You don't have to put together an entire administrative infrastructure, with at least one attending working half-time in administration (the PD) subsidized to a full salary and at least one secretary/coordinator in order to coordinate your PAs work. You don't have to slow down your own procedures so that the PA can better understand how they're going to do it themselves later, because they won't be doing it themselves later. If a PA made an attendings procedure take twice as long, that PA would be fired. If a resident does it, well, that's how he's learning.

I've worked with mid-level providers in a number of rotations and I'd say that a good one with some experience is easily at the level of an intern 6-8 months into their residency. Maybe even a 2nd year resident in some cases. That's fine. But the thing is, they stay there. They don't get comprehensive education in how to do everything on their own, and their lack of such attention means the other members of the team are freed up to be more efficient. On the other thing, residents frequently slow things down when they're learning. But we accept that slow down because otherwise we won't end up with any new competent, independent providers.

So yes, if our programs didn't give a rats ass about educating us and just used us for scutwork while the attendings were off earning maximal money, a resident could easily earn his entire salary and more. But that would be a piss-poor educational experience, and one that isn't (or shouldn't be at least) the case in any program that's actually ACGME accredited. Our attendings accept the inefficiency of the residents and everything that entails (extra supervision in some cases, extra autonomy in others) and try to maximize our educational potential. That's why programs pay four people (an attending, a senior, two interns) to run a team of patients when the attending could honestly work more hours and do the same work themselves. That's why our attendings get paid less in academia than private practice. It's because they're spending resources on training you, not just using you for the maximum amount of work.

this is all in a perfect world, which is rarely the case in residencies. Many procedures are done by residents, not attendings. At my previous program, for example, we did a number of procedures entirely on our own, and over 1/2 of the attendings could not do procedures that were taught by residents to other residents, from FNAs, to steroid injections, fluoro procedures, arthrograms, etc. If you ever ran into a problem as a resident with something going wrong, there were only a few attendings that could provide help, as the other attendings were unable to do the procedures. So I am not sure where you are training that this magical world of perfect supervision and never ending teaching happens. I fthat's what you are getting, awsome. That's not most programs though. Attendings in academia get paid less because they work less. Private practice attendings work like dogs, and make more. Simple economics.

 

[newres64]

this is all in a perfect world, which is rarely the case in residencies. Many procedures are done by residents, not attendings. At my previous program, for example, we did a number of procedures entirely on our own, and over 1/2 of the attendings could not do procedures that were taught by residents to other residents, from FNAs, to steroid injections, fluoro procedures, arthrograms, etc. If you ever ran into a problem as a resident with something going wrong, there were only a few attendings that could provide help, as the other attendings were unable to do the procedures. So I am not sure where you are training that this magical world of perfect supervision and never ending teaching happens. I fthat's what you are getting, awsome. That's not most programs though. Attendings in academia get paid less because they work less. Private practice attendings work like dogs, and make more. Simple economics.

Also, remember all this inefficiency and extra costs with education doesn't come out of the hospitals pocket, it comes from uncle sam.

It comes to down to this, what would happen if we got rid of all the residents at all of our hospitals? Would they need to hire more staff? Who would they need to hire? Would the hospital make more money without the residents?

 

[Haybrant]

I didn't entirely start this thread to start an argument about whether residents should or should not make a higher salary. I guess that is an interesting discussion too, though a small issue. Here is the top grossing "non-profit" hospital systems (http://www.beckershospitalreview.com/lists/50-top-grossing-nonprofit-hospitals-2013.html). If a very large hospital has 500 residents, and we are talking about increasing resident salary $10,000 (which would probably never happen) we are talking about 5 million dollars. That is a small small fraction of the billions that these hospital systems are grossing on our backs; you are deluded if you think anyone can come in and do the same jobs we can at our levels. Shame on the people here who say residents should be happy to get paid $40,000.

truthfully though, this post is to raise the wider point that we need a physicians union. Outside influence is killing our field. It is eroding physician/patient relationships. Without physicians standing up this erosion is sure to happen without resistance. Our generation must correct the wrongs of the baby boomers; they will not do it, they don't care about us. We can't fight with each other (i.e. surgery residents looking down on medicine residents and vice versa), we must organize. You are not special bc you are in a certain specialty, you are not. Our common denominator is patients and we must organize around this principal, not look down on each other. Nurses will never talk down about each other and yet you always hear medicine taking down about surgery and vice versa. Politicians count on physicians hating each other. So cut that out. Organize.

 

[NotAProgDirector]

You'll get no argument from me that residents prob deserve a better salary. However, two points worth noting:

1. Programs that pay more are not more competitive so students are clearly choosing programs on other criteria.

2. Resident in some programs (including mine) have significant elective and research time. This generates zero income. An np/pa would not

 

[Chickenandwaffles]

You'll get no argument from me that residents prob deserve a better salary. However, two points worth noting:

1. Programs that pay more are not more competitive so students are clearly choosing programs on other criteria.

2. Resident in some programs (including mine) have significant elective and research time. This generates zero income. An np/pa would not

But many programs don't have a lot of research and/or elective time, especially specialties that have very specific reqs that don't allow for electives. also you seem reasonable for a PD. Not all PDs are reasonable.

 

[Substance]

All we need to do is make medical school hardcore, eliminate the requirement that one needs a residency to practice, and the problems are solved. Interns will work like dogs for a year and that'll cover the hospitals, and then, should people not want to specialize, they can go out and, you know, work.

Can't tell the family docs that though.

 

[VA Hopeful Dr]

All we need to do is make medical school hardcore, eliminate the requirement that one needs a residency to practice, and the problems are solved. Interns will work like dogs for a year and that'll cover the hospitals, and then, should people not want to specialize, they can go out and, you know, work.

Can't tell the family docs that though.

Why hide it from us, I'd be more than happy to compete against someone who just did an intern year.

 

[Shikima]

Has anyone seen this article?

http://www.slate.com/articles/healt...n_training_are_organizing_for_collective.html

 

[NotAProgDirector]

Has anyone seen this article?

http://www.slate.com/articles/healt...n_training_are_organizing_for_collective.html

... it's the first post, and the point of the thread

 

[Shikima]

... it's the first post, and the point of the thread

Derp on me. Thanks.

 

[SouthernSurgeon]

this is all in a perfect world, which is rarely the case in residencies. Many procedures are done by residents, not attendings. At my previous program, for example, we did a number of procedures entirely on our own, and over 1/2 of the attendings could not do procedures that were taught by residents to other residents, from FNAs, to steroid injections, fluoro procedures, arthrograms, etc. If you ever ran into a problem as a resident with something going wrong, there were only a few attendings that could provide help, as the other attendings were unable to do the procedures.

If that is the case and they bill for those procedures, it is Medicare and insurance fraud

 

[Winged Scapula]

If that is the case and they bill for those procedures, it is Medicare and insurance fraud

And a medicine attending who can't do an FNA? My 17-year-old nephew could probably manage one so I'm having trouble believing that part of the story as well.

 

[VA Hopeful Dr]

And a medicine attending who can't do an FNA? My 17-year-old nephew could probably manage one so I'm having trouble believing that part of the story as well.

I'm not so sure. Granted I'm FM, but I have never done one. My wife, who is a 3rd year IM resident, hasn't either.

I'm sure its not hard, but its just not something that I have ever thought about needing to do.

 

[gutonc]

I'm not so sure. Granted I'm FM, but I have never done one. My wife, who is a 3rd year IM resident, hasn't either.

I'm sure its not hard, but its just not something that I have ever thought about needing to do.

What he said. It's not part of our training. You're correct...we probably could do it...but don't.

 

[rokshana]

When I did internship, one attending with residents was responsible for about 30-40 patients daily, most of them seen by the residents individually. Hospitalists saw no more than 15-18 patients a day.

thats just BS…or your program was violating ACGME rules….a team would have to have 2 residents and 3-4 interns to manage a service that big…for a floor team that would be unusual...

 

[Winged Scapula]

What he said. It's not part of our training. You're correct...we probably could do it...but don't.

Really? Hmmm…I would have thought *especially* FM would have done them. You guys don't FNA a breast cyst, or a neck mass when its in the office? Granted my experience with FM is limited but the guys I worked with did the above and more.

 

[SouthernSurgeon]

Really? Hmmm…I would have thought *especially* FM would have done them. You guys don't FNA a breast cyst, or a neck mass when its in the office? Granted my experience with FM is limited but the guys I worked with did the above and more.

Lol I'm pretty sure the medicine teams at my hospital consult derm or path for an FNA when they need one. (After, of course, they've called us to ask for an open excisional biopsy...which we have to painstakingly explain why its not indicated).

 

[Raryn]

Really? Hmmm…I would have thought *especially* FM would have done them. You guys don't FNA a breast cyst, or a neck mass when its in the office? Granted my experience with FM is limited but the guys I worked with did the above and more.

IM generally sends it to IR, at least at my hospital. The only internists I know who would feel comfortable FNAing anything are endocrinologists, and they get training in that.

 

[SouthernSurgeon]

IM generally sends it to IR, at least at my hospital. The only internists I know who would feel comfortable FNAing anything are endocrinologists, and they get training in that.

They send them to IR at my institution for image guided cores. Even when it's a palpable lesion. Sigh.

 

[VA Hopeful Dr]

Really? Hmmm…I would have thought *especially* FM would have done them. You guys don't FNA a breast cyst, or a neck mass when its in the office? Granted my experience with FM is limited but the guys I worked with did the above and more.

No and no. I'm not sticking a needle in anyone's neck in my office. I was taught to do FNA of breast cysts in med school but can't think why I would want to do it now. If I was a rural doc, maybe; but there are so many surgeons around here that love doing these types of things...

 

[Winged Scapula]

Hmmm… well thank you for the education. My FM rotation was a rural one, so I guess I assumed what he did was standard in "the city" as well.

 

[VA Hopeful Dr]

Hmmm… well thank you for the education. My FM rotation was a rural one, so I guess I assumed what he did was standard in "the city" as well.

That makes sense. My current partner used to do rural and so he will do lots of things that I won't - face lesions being a big one. If I were the only doctor, I could do it but if there are local doctors (derm) who can do it with less scarring then I think they should.

 

[Haybrant]

Nobody seemed to pick up on this when i posted it above so posting it again to see what people think. It is a list of the top grossing 'non-profit' hospitals in the country. Im curious what you're thoughts are. Are you surprised by it?

http://www.beckershospitalreview.com/lists/50-top-grossing-nonprofit-hospitals-2013.html

 

[ram006]

Nobody seemed to pick up on this when i posted it above so posting it again to see what people think. It is a list of the top grossing 'non-profit' hospitals in the country. Im curious what you're thoughts are. Are you surprised by it?

http://www.beckershospitalreview.com/lists/50-top-grossing-nonprofit-hospitals-2013.html

I've never really understood how hospitals are non-profit. Is it some sort of tax term that doesn't actually equate to non-profit?

 

[ram006]

Well Google answered that one for me... Doh

 

[rokshana]

They send them to IR at my institution for image guided cores. Even when it's a palpable lesion. Sigh.

for thyroid at least, there aren't a lot of indications to do a core thyroid biopsy …and the endo clinic has U/S as well…
even for a palpable nodule you will use U/S so you can see where you are getting the tissue from…and for ECNU certification you need to be able to submit imaging.

 

[SouthernSurgeon]

for thyroid at least, there aren't a lot of indications to do a core thyroid biopsy …and the endo clinic has U/S as well…
even for a palpable nodule you will use U/S so you can see where you are getting the tissue from…and for ECNU certification you need to be able to submit imaging.

I more meant breast

 

[ThoracicGuy]

Nobody seemed to pick up on this when i posted it above so posting it again to see what people think. It is a list of the top grossing 'non-profit' hospitals in the country. Im curious what you're thoughts are. Are you surprised by it?

http://www.beckershospitalreview.com/lists/50-top-grossing-nonprofit-hospitals-2013.html

It would depend on the expenses of each hospital. A hospital can have a large volume, thus a high gross revenue, but have a large amount of costs making the net profits minimal. So what does this list really tell you except that they probably are high volume centers?

 

[gutonc]

Nobody seemed to pick up on this when i posted it above so posting it again to see what people think. It is a list of the top grossing 'non-profit' hospitals in the country. Im curious what you're thoughts are. Are you surprised by it?

http://www.beckershospitalreview.com/lists/50-top-grossing-nonprofit-hospitals-2013.html

Not sure what your point is. You do understand the difference between gross and net, right?

 

[circulus vitios]

The federal government didn't let air traffic controllers strike, it sure won't let doctors. Basically a union without the power to strike is just a hole you are going to throw monthly dues into. And unlike nurses, who the public sympathizes with, doctors, from a public perspective are overpaid, so nobody will be on your side.

Los Angeles doctors striked for the entire month of January in 1976...

 

[Maybeknot]

Several years ago, there was an attempt to organize a union at my hospital. This attempt failed. A few interesting facts came up during the debate about whether we should unionize or not.

• GME reimbursements provided to the hospital vary depending on the percentage of Medicare patients managed by each hospital. This explains a significant portion of region-to-region salary discrepancies.
  • Incidentally, this "pot of gold" is unlikely to get any bigger in the near future... or ever.
• The main power for the union is collective bargaining. The main sword that is carried is the threat to strike.
  • If there is a strike, residents would be bound by union laws and would have to strike. What does that mean? You can't get paid, you can't go to work, and you very well might not be able to graduate on time. Congratulations! You might get a few extra thousand dollars a year, but have to spend another 6 months in residency, under residency rules, making residency pay.
  • If another union (nurses, techs, electricians) decide to strike, the union might prevent you from crossing a picket line to report to work. (!!)
• The union would represent residents in work matters only... matters under the "education" umbrella are left to the local GME office.
  • In other words, if you get disciplined or fired, even if the cause is unjust, the union will take their 1.5% cut of your last paycheck and wish you good luck.
• The union organizers hosted many a swanky party to attempt to convince residents to join the union. I never received an invitation; in fact, no one in my program did. I'm in a small surgical subspecialty, and my program takes up <2% of the residency spots in the university.
  • The union receives its power by a 50% + 1 vote. This is a total of the voting population, not the actual number of residents. My program was too small for the union to care about while they were attempting to organize the union. Ironically, the union fliers talked about how residents needed to have their "voices heard." I'm pretty sure my program, and similar programs, would get completely ignored under the union umbrella.
  • Apparently, the sizeable chunk-- maybe even most of it, possibly-- of that 1.5% union due gets sent out of town to host parties for other residents to convince them to join the union.

A union for residency doesn't make sense, UNLESS they also actively involve in protecting residents from malignant programs. The union representatives apparently made it clear that this is not something that they do. What really is the point, then? It's nice to ask for more money, but it's not as if anyone is going to convince Medicare to open up their purses to pay us more.

The bigger issue in my mind is that physicians AS A WHOLE have lost clout in the medical system. Aren't we the most experienced, educated, and responsible (both in an ethical and medicolegal aspect) participants in the health care system? Why does our voice get drowned by multiple levels of nurse managers, service coordinators, MBA and MPH-trained hospital vice presidents?

This is the issue we need to be tackling, IMO... not whether a trainee in a limited-term apprenticeship should be getting paid more.

 

[ram006]

The bigger issue in my mind is that physicians AS A WHOLE have lost clout in the medical system. Aren't we the most experienced, educated, and responsible (both in an ethical and medicolegal aspect) participants in the health care system? Why does our voice get drowned by multiple levels of nurse managers, service coordinators, MBA and MPH-trained hospital vice presidents?

This is the issue we need to be tackling, IMO... not whether a trainee in a limited-term apprenticeship should be getting paid more.

Amen. Many good points made. Frustration with pay is understandable but, as you noted, there are multiple moving parts which don't seem to add up to unions being a great idea for residents. I think your point about not being able to work if a union decides to strike should be a deal breaker for any resident with two neurons to rub together. Do I want to get paid more? Obviously. Do I want to extend my training another year because the union was striking over x issue and I couldn't work for 2 weeks? Definitely not. It's a matter of short and long term goals.

Residency is temporary. The bigger picture, and why physicians seem to be increasingly marginalized in healthcare despite being the people actually delivering it, is the real issue.

 

[womp]

The bigger issue in my mind is that physicians AS A WHOLE have lost clout in the medical system. Aren't we the most experienced, educated, and responsible (both in an ethical and medicolegal aspect) participants in the health care system? Why does our voice get drowned by multiple levels of nurse managers, service coordinators, MBA and MPH-trained hospital vice presidents?

The bigger picture, and why physicians seem to be increasingly marginalized in healthcare despite being the people actually delivering it, is the real issue.

Is this a surprise? Reflect back in medical school, who were the people most involved in administration and student councils? Mostly people who excelled at making nice with the other allied health student associations and kissing arse to the 30 redundant deans (each with a mid 6 figure salary) in each school.

We have a whole generation of "physician leaders" who are convinced that we the physicians are the problem, whose entire ability to be promoted up the ranks of health care institutions and government halls rests on spreading this gospel. I sat through a medical school commencement speech where the keynote speaker derided "Lexus and golf" doctors, as if it's such a sin to buy a $35k Lexus in middle age after 20 years of school and training, never mind that the cost of medical school alone could have bought a lifetime of Lexuses. "A phenomenal speech" the sycophant class president would say. And why exactly has tuition been so high given most attendings aren't reimbursed for lectures or teaching? It's so that the administrative bloat who never checks an email past 4:59pm can buy their own Lexuses, while goading and shaming doctors to indentured servitude.

The political correctness that starts first in medical schools and throughout the upper levels of administration is leaving our entire profession for slaughter to far more unapologetic and hungry fields. Meanwhile many doctors can only think to snipe about petty differences among other physician specialties. Wake the f up everybody. All that years of school and specialized training have completely killed our ability to see the horizon and approach our interests collectively.

This issue isn't just limited to physicians though. Our whole country and economy is trending towards an ever larger administrative overhead in nearly every industry. It's the legacy of the Baby Boomers who outsourced our technical and physical economy in return for a few decades of quick and outsized management profits. A Faustian bargain that is just starting to be called, unfortunately it will be on us.