1 Scared Intern

[Idiopathic]

I didn't want to get involved....and yet, here I am....props, Idiopathic.

No prob

Morphines a dirtier drug, but nurses/doctors understand the doses better and it is cheaper. If someone has a reaction to it, then switch them, but I always start with it (barring renal failure).

And if you are worried about addictive potential, much worse to get the patient started on a D-drug (dilaudid, demerol...)

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[foo]

I make about $3250 per month. On my call months (like this month) I probably work 22 out of 28 days or about 70 hours a week for a whopping $11 bucks an hour. I have seen positions at Taco Bell advertised for $10 bucks (in the Northeast). I also want to point out that at Taco bell, everything over 45 is time-and-half. Over 60 is double time.

Here goes:

My monthly salary for 280 hours: $3250

Taco Bell Gordita Jockey working 280 hours per month at $10/hr:

((45x10)+(15x15)+(10x20))x4=$3500

at $7.50/hr: $2625

Net difference between my salary and reasonable Taco Bell hourly wage of $7.50 for the same hours: $625

Value of four years undergraduate, two years of graduate school, four years of medical school, and two years of residency training:

$52/year of higher education per month.

Look on my face when my snotty neighbors accuse me of being a rich doctor:

Priceless

I understand the point you are making, the work you are doing as a resident is valuable and it is not reflected by your salary. But residency training is subsidized heavily by society.

So while you are earning only $7.50/hour as a resident, you are learning a lot and obtaining valuable experience (could you please estimate what that may be worth to you in the future Panda?). I am sure the Taco Bell employee is also learning and obtaining experience (could you please estimate what that might be worth to him or her in the future?).

What I think is unfair is the huge debt load that most medical students accumulate before their residency years. If education was better subsidized by society, would you feel less abused as a resident? Would you feel less pressure and anxiety?

Would you consider in the future, when you are a fairly well off physician in our society, funding a scholarship for a future medical student? (To help ease their pain).

Another way to think about this... Do you think a system that taxes at a higher rate those that earn more money in society (than those working at Taco Bell or in residency) is fair? (Society needs to get money to invest in education, defense, health care, etc., from somewhere).

What do you think Panda? (I am only half-teasing you because of your public conservative viewpoint; no disrespect intended by the way Panda). Just explaining a different point of view for society. (I did not say "better", just "different").

How should we structure a fair society for our kids?

 

[deleted87716]

I make about $3250 per month. On my call months (like this month) I probably work 22 out of 28 days or about 70 hours a week for a whopping $11 bucks an hour. I have seen positions at Taco Bell advertised for $10 bucks (in the Northeast). I also want to point out that at Taco bell, everything over 45 is time-and-half. Over 60 is double time.

You're neglecting the fact that most "Gordita jockeys" aren't working overtime...they're working around 40 hours/week, or even less. It's not cost-effective for restaurants to pay employees overtime, so they hire lots of people.

$10/hour * 40 hours/week = $400/week, or $1600/month. That less than half of what you're bringing home, with no upside. It's a dead-end job.

In three years, you'll be making more money than any Taco Bell employee could ever dream of. You can grumble about the fact that you're underpaid during your residency training, but you're forgetting that you're not an independent practitioner as a resident. You're closer to a mid-level provider, and are compensated accordingly. You're also getting something out of the deal that's priceless...namely, an education.

 

[8744]

You're neglecting the fact that most "Gordita jockeys" aren't working overtime...they're working around 40 hours/week, or even less. It's not cost-effective for restaurants to pay employees overtime, so they hire lots of people.

$10/hour * 40 hours/week = $400/week, or $1600/month. That less than half of what you're bringing home, with no upside. It's a dead-end job.

In three years, you'll be making more money than any Taco Bell employee could ever dream of. You can grumble about the fact that you're underpaid during your residency training, but you're forgetting that you're not an independent practitioner as a resident. You're closer to a mid-level provider, and are compensated accordingly. You're also getting something out of the deal that's priceless...namely, an education.

Whoa. I would love to get compensated like a mid-level provider as a resident. If I made $80,000 per year as a resident I'd probably call it a fair salary.

To the medicine service on which I am rotating as nothing more than a scut and admitting slave, I am the ultimate bargain. I do for $8.50 an hour what they would have to pay a hospitalist $120 per hour or a PA $70 per hour to do. No question about it. There isn't even any pretense of teaching on this particular service. I did 14 admits last night as well as handling floor calls for about 150 patients most of whom I knew absolutely nothing about.

It's a racket and you know it. Somebody is making money and it ain't me.

 

[8744]

I understand the point you are making, the work you are doing as a resident is valuable and it is not reflected by your salary. But residency training is subsidized heavily by society.

So while you are earning only $7.50/hour as a resident, you are learning a lot and obtaining valuable experience (could you please estimate what that may be worth to you in the future Panda?). I am sure the Taco Bell employee is also learning and obtaining experience (could you please estimate what that might be worth to him or her in the future?).

I don't buy your reasoning. The fact is that to the hospital, most residents are cash cows. Society may be subsidizing my training and may be reaping the benefits of my service but the hospital makes a pretty good chunk of change in the process. Not only does Medicare pay substantially more to the hospital than I recieve for a salary but I do real, necessary, and billable work for the various services to which I am a chattel slave.

At my hospital, the other services panic at the thought of losing an intern for a rotation because they have to pay a moonlighting resident fifty bucks an hour to cover the "gap." Clearly my time is worth at least fifty bucks an hour on the free market.

And, if the experience is worth so much, why not work for free? I mean, if pay doesn't matter. Hell, why not, as was suggested on another thread, pay tuition for residency and eliminate government funding altogether?

What I think is unfair is the huge debt load that most medical students accumulate before their residency years. If education was better subsidized by society, would you feel less abused as a resident? Would you feel less pressure and anxiety?

There is nothing wrong with taking on debt for an education. It is the access to credit that drives a capitalistic society and if I make, in two years, what an Emergency Medicine attending can reasonably expect to make it will have been a good investment.

I feel abused because I have twelve years of higher education, am providing a service which (at least according to KentW) is worth 60 or 70 bucks an hour, and am being paid a tenth of that. You guys act like I don't understand delayed gratification.

The point is that life doesn't stand still. Why should I work like a slave for people making money off of me just becasue in some number of year ranging from three (for Family Medicine) to seven (for Neurosurgery) I'll eventually make a better salary?

Would you consider in the future, when you are a fairly well off physician in our society, funding a scholarship for a future medical student? (To help ease their pain).

No. **** them. It's not my problem. I don't think it's bad to borrow money for education.

Another way to think about this... Do you think a system that taxes at a higher rate those that earn more money in society (than those working at Taco Bell or in residency) is fair? (Society needs to get money to invest in education, defense, health care, etc., from somewhere).

What do you think Panda? (I am only half-teasing you because of your public conservative viewpoint; no disrespect intended by the way Panda). Just explaining a different point of view for society. (I did not say "better", just "different").

How should we structure a fair society for our kids?

I don't give a rat's ass, on most days, about fairness and other nebulous concepts. I'm merely pointing out that residency pay sucks, your program pretty much has you by the gonads, and there is nothing really that can be done about it so long as so many of you are willing to take one for the team without complaint, making a virtue out of being screwed.

 

[deleted87716]

I feel abused because I have twelve years of higher education, am providing a service which (at least according to KentW) is worth 60 or 70 bucks an hour, and am being paid a tenth of that.

You're missing the point that outside of residency, you are virtually unemployable as a physician. You aren't entitled to be paid like a fully-trained doctor until you are a fully-trained doctor.

You guys act like I don't understand delayed gratification.

No, you're the one who's acting like they don't understand it. Residency is a means to an end, nothing more. You're being paid a stipend, not a salary, for OJT, and it's a seller's market.

I'm merely pointing out that residency pay sucks, your program pretty much has you by the gonads, and there is nothing really that can be done about it so long as so many of you are willing to take one for the team without complaint, making a virtue out of being screwed.

And whining about it helps how...?

 

[Adam_K]

Residency is a means to an end, nothing more. You're being paid a stipend, not a salary, for OJT, and it's a seller's market.

Whoa.

Despite the fact that Jung v. AAMC was dismissed thanks to political interference run by Sens. Clinton and Kennedy, there was a very good reason for the lawsuit, namely that the defendants were colluding. In other words, no market to speak of.

 

[8744]

You're missing the point that outside of residency, you are virtually unemployable as a physician. You aren't entitled to be paid like a fully-trained doctor until you are a fully-trained doctor.



No, you're the one who's acting like they don't understand it. Residency is a means to an end, nothing more. You're being paid a stipend, not a salary, for OJT, and it's a seller's market.



And whining about it helps how...?

Except in Michigan and a few other states which require two years of training to be licensed, I can be a fully licensed physician after intern year (and passing Step 3), perfectly qualified to do insurance physicals, urgent care, and anything for which someone is willing to hire a licensed physician. I can even open up my own practice, the success of which of course depends on people's willingness to be treated by a non-board certified physician. On the other hand they are willing to treated by PAs and NPs so what's the problem?

And I'm not asking to be paid like a fully trained doctor, just not like a fully trained Taco Jockey.

They call it a stipend but it is a salary and treated as such for tax purposes and probably by the hospitals accountants. They even list my fictitious hourly wage ($20.13) on my pay statement.

As for whining about it, it doesn't help at all. But that doesn't mean that large parts of medical training aren't a money-making racket for the various services involved. This is so obvious on my current service.

 

[deleted87716]

Except in Michigan and a few other states which require two years of training to be licensed, I can be a fully licensed physician after intern year (and passing Step 3), perfectly qualified to do insurance physicals, urgent care, and anything for which someone is willing to hire a licensed physician.

But that's not what you're doing, is it? What you're doing requires supervision until you're qualified to do it on your own. Somebody's paying for that supervision. In a roundabout way, it's you.

 

[deleted87716]

Despite the fact that Jung v. AAMC was dismissed thanks to political interference run by Sens. Clinton and Kennedy, there was a very good reason for the lawsuit, namely that the defendants were colluding. In other words, no market to speak of.

People who complain that the Match is anti-competition don't remember what it was like before there was a Match. Believe me, it wouldn't be better.

 

[Faebinder]

I make about $3250 per month. On my call months (like this month) I probably work 22 out of 28 days or about 70 hours a week for a whopping $11 bucks an hour. I have seen positions at Taco Bell advertised for $10 bucks (in the Northeast). I also want to point out that at Taco bell, everything over 45 is time-and-half. Over 60 is double time.

Here goes:

My monthly salary for 280 hours: $3250

Taco Bell Gordita Jockey working 280 hours per month at $10/hr:

((45x10)+(15x15)+(10x20))x4=$3500

at $7.50/hr: $2625

Net difference between my salary and reasonable Taco Bell hourly wage of $7.50 for the same hours: $625

Value of four years undergraduate, two years of graduate school, four years of medical school, and two years of residency training:

$52/year of higher education per month.

Look on my face when my snotty neighbors accuse me of being a rich doctor:

Priceless

Oh ya... damn i forgot the overtime... how we are taken for granted in medicine... so sad.

 

[deleted109597]

People who complain that the Match is anti-competition don't remember what it was like before there was a Match. Believe me, it wouldn't be better.

Probably not. How would it be any different than getting into college, getting into medical school, or getting a job? All of those have back doors that help, and nobody has claimed that a match system would be better for that.
And seriously, isn't Texas getting rid of their medical school match for that reason?

 

[8744]

But that's not what you're doing, is it? What you're doing requires supervision until you're qualified to do it on your own. Somebody's paying for that supervision. In a roundabout way, it's you.

So the slave must pay the overhead for his slave-driver?

Like I said, since the medicine program at my hospital is willing to pay 50 dollars an hour for residents to cover "gaps" in the call schedule (intern "gap," senior residents get 80 bucks an hour) this is a de facto admission by the program that the residents are being underpaid. I guarantee they would have no takers for ten bucks an hour and probably not for twenty either as working a twelve hour "gap" on top of your regular duties to only make 120 bucks is so not worth it.

We are also not allowed, even if licensed, to do anything other than in-house moonlighting. In other words, if I have a license to practice medicine, my program unfairly prevents me from doing insurance physicals and other low-level but relatively well-paying medical work.

What the hospital really wants is to make the residents work unlimited hours for less than they pay now and I can sense that the adminstration looks back nostalgically at the days before work-hour limitations when there was no gap and unlimited man-hours to throw at the principle business of the hospital which is to make money. (Not that I object to making money, I'd just like more of it myself).

Personally, I'm surprised we actually get paid as much as we do. There is no reason to pay us at all. Some programs would probably fill easily if the residents made nothing or even had to pay for their own training.

 

[8744]

Oh ya... damn i forgot the overtime... how we are taken for granted in medicine... so sad.

Well? Why not pay a resident for overtime? It would certainly encourage a little efficiency and maybe create a penalty for frittering away our time on useless things.

 

[8744]

But that's not what you're doing, is it? What you're doing requires supervision until you're qualified to do it on your own. Somebody's paying for that supervision. In a roundabout way, it's you.

I am being paid, this month, to be a hospitalist and to admit hundreds of paying customers for the various private internal medicine serivces in town. The supervision at night when most of the admitting action goes down is minimal except for one particular attending who was pimping me about calculating creatinine clearance over the phone at 4AM.

I was so not in the mood. (The lab calculates it for us)

 

[Apollyon]

People who complain that the Match is anti-competition don't remember what it was like before there was a Match. Believe me, it wouldn't be better.

And you do? I think 1952 was the first year for the NRMP Match. I know you're older than me, but I was thinking something like 5 or 7 years, max.

 

[deleted87716]

And you do?

Did I say that I did?

More info here: http://www.savethematch.org/history/history.aspx

 

[foo]

I don't buy your reasoning. The fact is that to the hospital, most residents are cash cows. Society may be subsidizing my training and may be reaping the benefits of my service but the hospital makes a pretty good chunk of change in the process. Not only does Medicare pay substantially more to the hospital than I recieve for a salary but I do real, necessary, and billable work for the various services to which I am a chattel slave.

At my hospital, the other services panic at the thought of losing an intern for a rotation because they have to pay a moonlighting resident fifty bucks an hour to cover the "gap." Clearly my time is worth at least fifty bucks an hour on the free market.

And, if the experience is worth so much, why not work for free? I mean, if pay doesn't matter. Hell, why not, as was suggested on another thread, pay tuition for residency and eliminate government funding altogether?

There is nothing wrong with taking on debt for an education. It is the access to credit that drives a capitalistic society and if I make, in two years, what an Emergency Medicine attending can reasonably expect to make it will have been a good investment.

I feel abused because I have twelve years of higher education, am providing a service which (at least according to KentW) is worth 60 or 70 bucks an hour, and am being paid a tenth of that. You guys act like I don't understand delayed gratification.

The point is that life doesn't stand still. Why should I work like a slave for people making money off of me just becasue in some number of year ranging from three (for Family Medicine) to seven (for Neurosurgery) I'll eventually make a better salary?

No. **** them. It's not my problem. I don't think it's bad to borrow money for education.

I don't give a rat's ass, on most days, about fairness and other nebulous concepts. I'm merely pointing out that residency pay sucks, your program pretty much has you by the gonads, and there is nothing really that can be done about it so long as so many of you are willing to take one for the team without complaint, making a virtue out of being screwed.

It is important to give a rat's ass about fairness. On most days one might summarize what you said as: residents don't make enough money given the many sacrifices of a long medical education and that's not fair... That might be an unfair characterization of your nebulous concepts however...

The Taco Bell worker most likely can not afford health insurance and will end up in your ER when he or she gets sick; good care will be provided by the underpaid residents, and the residents will only be able to afford to buy the cheap burritos at Taco Bell. The hospital will lose money in the ER and therefore will charge those of us with insurance more money. Cost shifting is rampant in a capitalistic society (that's how one can maximize profits). It is not a fair system...

Survival of the fittest sounds fair ("****" the medical students, "****" the residents, "****" the sick people, "****" the hospital, "****" the insurance companies, and "****" Taco Bell). Cheap residents and cheap burritos that's the ticket - who give a rat's ass?

 

[8744]

....The Taco Bell worker most likely can not afford health insurance and will end up in your ER when he or she gets sick; good care will be provided by the underpaid residents, and the residents will only be able to afford to buy the cheap burritos at Taco Bell. The hospital will lose money in the ER and therefore will charge those of us with insurance more money. Cost shifting is rampant in a capitalistic society (that's how one can maximize profits). It is not a fair system...

I'm just a PGY-2 Intern and I don't care if the Taco Bell Gordita Jockey has health insurance or not.

**** him. It's his problem. He can go to the devil for all I care. I just want to make more money. I can't, of course, as my gonads are in somebody else's hands but it seems odd to lay the entire burden for providing health care to poor on my shoulders.

I have my own problems to worry about. Taco guy can see to his life and I'll see to mine.

 

[Apollyon]

Did I say that I did?

People who complain that the Match is anti-competition don't remember what it was like before there was a Match. Believe me, it wouldn't be better.

I guess it's my fault - I read into what you'd written.

edit: I was right! 1952.

 

[swpm]

Unless a patient can't tolerate morphine because of pruritis or what not, what advantage does hydromorphone have? Not much and it costs more.

Well, like I said, less nausea, less histamine release and pruritis. It's a cleaner drug ... and given the overall cost of being an inpatient or getting outpatient surgery in the first place, the cost difference is trivial.

The second or third time I saw a scrub tech drop a bit of ortho hardware on the floor, creating a multi-thousand-dollar paperweight, I quit caring about the cost of the drugs I used to put the patient to sleep or manage his pain/nausea postop.

Oh, sure. Ill page anesthesia at 2AM for a blood patch. At my major teaching institution, we probably wont be able to easily get one if it isnt 7AM-7PM M-F. I agree with the supine stuff, but if someone has been suffering with PDPH for two days at home, they have probably tried all that. If you cant get a blood patch (or saline patch) then you still need to treat the pain. Caffeine, tordol, etc all have their place, but a little fentanyl goes along way to treating this acute pain, and it doesnt stick around too long.

OK, point taken ... but as an anesthesia resident, at my institution, we'd make it to the ER within a couple hours, unless we're just slammed in the ORs. We'd grumble about it, but not too loudly, 'cause chances are the PDPH is courtesy of one of our own residents/SRNAs wet tapping someone a couple days earlier.

 

[Mman]

Well, like I said, less nausea, less histamine release and pruritis. It's a cleaner drug ... and given the overall cost of being an inpatient or getting outpatient surgery in the first place, the cost difference is trivial.

Well, in a 1000 bed hospital over the course of a year, starting every patient who needs a PCA on hydromorphone instead of morphine is a pretty big cost to pay for minimal benefits. I mean, nausea, pruritis? I'm guessing a minimum of 60-70% of patients tolerate morphine PCA with minimal to no unpleasant side effects. If they get pruritis? Treat it and switch to something else.


As a fellow anesthesia resident, I agree that it doesn't have nearly as much place in the OR especially relating to outpatient surgery. But for interns covering floor patients? Works fine and dandy.

 

[DrNick2006]

Interesting that you have a problem with Phenergan's SE profile, but not Reglan's.

Whatever you're comfortable with, I guess.

LOL!!

I like marinol when I/m nauseated

 

[Krazykritter]

I'm just a PGY-2 Intern and I don't care if the Taco Bell Gordita Jockey has health insurance or not.

**** him. It's his problem. He can go to the devil for all I care. I just want to make more money. I can't, of course, as my gonads are in somebody else's hands but it seems odd to lay the entire burden for providing health care to poor on my shoulders.

I have my own problems to worry about. Taco guy can see to his life and I'll see to mine.

I seriously LOL'd at this post. Panda Bear is the House of SDN for me after that.

We all want to be compensated, but that post did seem a little childish. It can't be that cut-throat of a world out there, is it?

 

[Idiopathic]

I seriously LOL'd at this post. Panda Bear is the House of SDN for me after that.

Dont give him that much credit. Its comments like those that truly enlighten the rest of us as to what Panda truly is.

If he wants to be paid like a doctor, he should learn to act like one. we are all real sorry that you have to make 40K a year and have a bright future. What a ****ing baby.

 

[Idiopathic]

OK, point taken ... but as an anesthesia resident, at my institution, we'd make it to the ER within a couple hours, unless we're just slammed in the ORs. We'd grumble about it, but not too loudly, 'cause chances are the PDPH is courtesy of one of our own residents/SRNAs wet tapping someone a couple days earlier.

True, but not after hours or on the weekend...ESPECIALLY if it was a neurologist/ED doc/pain guy who did the wet tap

 

[Adam_K]

Dont give him that much credit. Its comments like those that truly enlighten the rest of us as to what Panda truly is.

If he wants to be paid like a doctor, he should learn to act like one. we are all real sorry that you have to make 40K a year and have a bright future. What a ****ing baby.

What exactly is wrong with Panda's position?

Just because you are comfortable being an indentured servant doesn't mean the rest of us are.

 

[8744]

Dont give him that much credit. Its comments like those that truly enlighten the rest of us as to what Panda truly is.

If he wants to be paid like a doctor, he should learn to act like one. we are all real sorry that you have to make 40K a year and have a bright future. What a ****ing baby.

Well, let's turn that statement around. Since I am indeed acting like a doctor, why am I not being paid like one? If you think that at this point in my training I am just some scared intern serving as a conduit for the attending's orders or some kind of scut-ox you are mistaken.

For that matter, how does a doctor act? I know lots of doctors and to a man they are concerned about their pay and their hours. And ain't none of 'em enjoy being on call or working long hours for nothing. I bet if attendings only made $40,000 a year most of them would look for different careers.

It's bad enough that residents are powerless, chattel slaves without you guys defending the massa'.

Two words: Stockholm Syndrome

As to having a bright future, that may be true but what does that have to do with being paid decently now? That's like saying that since I have pretty good prospects of breathing in a couple of hours I should just hold my breath until then. Life moves on. Four years is a long time. The kids have got to eat. The wife needs clothes. Dozens of unavoidable expenses (car insurance, property taxes, heat, water, lights) siphon money away from the family treasury.

 

[8744]

I seriously LOL'd at this post. Panda Bear is the House of SDN for me after that.

We all want to be compensated, but that post did seem a little childish. It can't be that cut-throat of a world out there, is it?

I'm not cutting anybody's throat. I merely obeserved, succintly, what everybody knows. a) We must look after our own interests ahead, far ahead, of those of total strangers. b) Taco Jockey is an important job (because I do enjoy my Gorditos and they never taste as good if you try to make them at home) but it requires nothing but a tenth grade education and the capacity to work hard and honestly. c) I really do not give a rat's ass about the choices other people make and I have no objection whatsoever if Taco workers are paid 20, 40, or even 100 dollars an hour. If their emplyer thinks they're worth it then God love them. What it has to do with me is inexplicable.

I also want to point out that if you think most people go around worrying about other people to the extent that they accept their low salary because some people in the world make less then we must live on different planets. If that were the case, people would have no objection to working for a bowl of rice and some mushy, greasy vegetables because there are places in the world where this is considered a fair day's pay for a fair day's work.

 

[cchoukal]

Interesting discussion. Awhile back, as a med student, I read a "journal article" about the costs of GME (residency). Granted, it was published in the journal of my state's medical association and, thus, not subjected to the same editorial rigor as if it appeared in the NEJM. The authors examined the costs to a hospital in terms of extra tests/studies ordered as a result of inexperience, decreased productivity of attending physicians resulting from teaching duties, and a variety of other factors, against the financial benefits (mainly Medicare subsidies). On balance, the authors concluded the cost of training a resident ranged from $100K to $300K/year, depending on specialty.

Here's the link:

http://www.mmaonline.net/publications/MNMed2003/February/Rydrych.html

I don't know that I agree with the methods (they sort of assume if the attending wasn't teaching, they'd be billing 100% of the time, and they included portions of faculty salary in the cost of educating residents) or the conclusions, but I believe it's the only published data on the subject and I think it should add to this discussion.

 

[Faebinder]

From the article...

Most previous analyses of GME costs have either compared total costs at teaching and nonteaching hospitals as a way of isolating costs that are unique to the teaching environment while controlling for case mix, geographic location, or other factors, or they have used hospital cost data to examine the specific costs attributable to teaching in one or more facilities.

You have got to be f$$king kidding me right? What kind of insane math is this? Some teaching hospitals also teach CRNA, PAs, NPs... do they also count their costs and call it GMA??!?!?!?!

What about the difference between medical students, residents and fellows?!?!?!? It's pretty obvious the productivity of the three are completely different!

My biggest biggest beef with this dumb found method in this article is that is accounts for hospital COSTS but not hospital REVENUE. Just because a teaching hospital costs more, it doesn't mean that it's due to GME. Teaching hospitals take more severe cases and if they dont take them then no one will... The costs have nothing to do with higher education and are mainly because the other private hospitals are too smart to take these patients so they end up going to the sucker hospitals (teaching hospitals) that have no choice but to accept their care.

If it is not profitable, non teaching hospitals wont admit/provide/allow it. That's why there are 'teaching hospitals' that are private... they select what they cover and what they dont cover but still cover more than what a regular non teaching private hospital covers.

 

[8744]

Interesting discussion. Awhile back, as a med student, I read a "journal article" about the costs of GME (residency). Granted, it was published in the journal of my state's medical association and, thus, not subjected to the same editorial rigor as if it appeared in the NEJM. The authors examined the costs to a hospital in terms of extra tests/studies ordered as a result of inexperience, decreased productivity of attending physicians resulting from teaching duties, and a variety of other factors, against the financial benefits (mainly Medicare subsidies). On balance, the authors concluded the cost of training a resident ranged from $100K to $300K/year, depending on specialty.

Here's the link:

http://www.mmaonline.net/publications/MNMed2003/February/Rydrych.html

I don't know that I agree with the methods (they sort of assume if the attending wasn't teaching, they'd be billing 100% of the time, and they included portions of faculty salary in the cost of educating residents) or the conclusions, but I believe it's the only published data on the subject and I think it should add to this discussion.

This is ridiculous. I order fewer tests than the attendings. In fact, your level of timidity (which is why you order unnecessary tests) goes up with your medicolegal liability. What usually happens is that I will call the attending on the phone with an admission and she will suggest a whole slew of ultimately useless tests that I had never even thought of doing.

As for productivity, in the traditional model of academic medicine where the attending spends all day roaming the hospital with his entourage he may be less productive than if he was seeing patients in clinic. On the other hand, to spend an hour discussing sodium is his personal choice and to hold the resident accountable for his poor time management skills is absurd.

On the medicine service that I am now on, however, our only job is to admit patients. Rounding and the rest of it is secondary. There is no supervision from attendings during this except for a brief phone call. I repeat, I admit anywhere from ten to fifteen patients a night when on call. To hire a hospitalist to do this would cost 120 bucks per hour.

 

[Hurricane]

How did this get derailed from an interesting discussion of the pros and cons of various prn meds to yet another thread about how residents aren't paid enough - don't we have enough of those?

 

[Adam_K]

This is not a study in any sense of the word. This becomes abundantly clear when you consider that the methods include counting some of faculty salary as a teaching expense, while relying on 'underfunded' teaching hospitals to report indirect expenses.

 

[8744]

This is not a study in any sense of the word. This becomes abundantly clear when you consider that the methods include counting some of faculty salary as a teaching expense, while relying on 'underfunded' teaching hospitals to report indirect expenses.

And it's insulting, when you think about it. Their reasoning boils down to calculating how much they pay the attendings, dividing this by the number of residents they supervise, and calling this a "cost."

Essentially, they are saying that (in the extreme case) training a resident costs them up to $400,000 per year for which they are only reimbursed $100,000 or so from Medcare. The truth is that since residents do work which would otherwise have to be done by an expensive mid-level or doctor, they are revenue generators for hospitals. This can be hidden easily because residents do not actually bill for their time. The hospital accountant can hold up the books and say, with total honesty, that residents don't make the hospital any money and many of you will believe it.

Let's take a typical patient I saw on call the other night. I did the history and physical exam, wrote all the orders, placed a central line, an arterial line, fine-tuned her in the Emergency Department, and admitted her to the ICU and the extent of my attending supervision was a phone call essentially saying, "OK, sounds like you've got it under control." The patient had insurance so who knows how mant thousands of dollars were billed for procedures and critical care.

It's not as if the attendings, who even at big academic centers are not hospital employees but work for private groups, don't bill for their time. At Duke, the billing sheet was in the front of the chart and while the usual attending note is illegible scrawl, they were fastidious about filling this thing out in a legible manner. Again, I have no objection to this.

 

[cchoukal]

I agree the methods of data aggregation (I hesitate to say "study") don't seem to capture all of the entries on each side of the ledger. How best to quantify residents' contributions? Should residents complete billing paperwork (we do in anesthesiology)? Our field (anesthesia) is sort of interesting in that our role as "attending-extenders" is a little more concrete. Without us (or CRNAs), the anesthesiologist literally can't be in two or more cases at once (and therefore can't bill for them). In that regard, residents dramatically increase productivity. And yet, the "study" I referenced found anesthesiology residents the most expensive to train.

On a medicine service, I've heard the argument that the attending could do it all (admitting, rounding, etc.) faster on his/her own. I can't say I agree with this, but I do think, as I said, that the increase in attending productivity is a little harder to quantify (unless you're attending is billing in the clinic/cathlab/endoscopy suite) while you're admitting/workingup/roundingon patients on his/her behalf.

All the anecdotes aside, though, it's not unusual for professions to require a period of apprenticeship (physicians, butchers, hairdressers) during which the apprentice is a poorly paid assistant, ostensibly gaining experience to be used later in the hopes of higher earnings. Granted, hairdressers don't have the same high likelihood of top earnings later on that physicians enjoy. Is our apprenticeship different/worse because it involves so many more hours per week than others? Because we are so much more underpaid relative to residency graduates compared to butchers and their apprentices? Just thinking out loud...

 

[dutchman]

I think the problem might just be that Taco workers are overpayed. Maybe we should cut their pay so we could have easier access to gorditas.

 

[8744]

I think the problem might just be that Taco workers are overpayed. Maybe we should cut their pay so we could have easier access to gorditas.

I advocate universal access to Taco Bell under a single payer system.

 

[Adam_K]

I advocate universal access to Taco Bell under a single payer system.

 

[danielmd06]

I advocate universal access to Taco Bell under a single payer system.

The access to Taco Bell is a right...not a privilege.

This promises to be a hotly contended topic in the upcoming Presidential elections. Can Democrats and Republicans derive a satisfactory plan for socialized fast food?

Most importantly I think we all should ask ourselves "What would Joseph Stalin do?"

 

[path15]

I think one of the main issues regarding the fairness of residency training lies in the hours/week, not the pay. Obviously, we are still in training and would not be compensated at the same rate as attendings, so 40-50,000$/year is okay. However, when you work on average 80 hours/week, its not fair and I'm not sure why more residents don't try to change this or actively speak up against it -
How did the ACGME decide 80 hours was fair? And seriously, 30 hour shifts? What other profession requires trainees to work 30 hour shifts?

In australia residents are paid about the same as we are but, they get paid overtime, so they make well above 60,000$/year.

 

[Adam_K]

Most importantly I think we all should ask ourselves "What would Joseph Stalin do?"

Uncle Joe would probably start with nationalizing all Taco Bell outlets and sending the fat cat corporate and franchise owners to the gulag for denying our collective natural rights to gorditas. Then, he'd put the workers in charge of the stores. Free tacos for everyone, so long as the supplies last.

 

[foo]

Since the EM residents are only averaging 60-65 hours per week. It would be really great if they would take the time to make some gorditas for those residents that are working 80 hours and don't have time to go to Taco Bell. Perhaps it could be part of a paid "moonlighting" burrito elective?

 

[Idiopathic]

Well, let's turn that statement around. Since I am indeed acting like a doctor, why am I not being paid like one? If you think that at this point in my training I am just some scared intern serving as a conduit for the attending's orders or some kind of scut-ox you are mistaken.

For that matter, how does a doctor act? I know lots of doctors and to a man they are concerned about their pay and their hours. And ain't none of 'em enjoy being on call or working long hours for nothing. I bet if attendings only made $40,000 a year most of them would look for different careers.

It's bad enough that residents are powerless, chattel slaves without you guys defending the massa'.

Two words: Stockholm Syndrome

As to having a bright future, that may be true but what does that have to do with being paid decently now? That's like saying that since I have pretty good prospects of breathing in a couple of hours I should just hold my breath until then. Life moves on. Four years is a long time. The kids have got to eat. The wife needs clothes. Dozens of unavoidable expenses (car insurance, property taxes, heat, water, lights) siphon money away from the family treasury.

If you dont think making 40K a year is being paid decently, then you havent really been poor. I have a house, a car, a computer, cable and am able to feed, clothe and house my family. I couldnt possibly care less about your wants and needs and what you feel is right. This is the system under which we work, and its about as good as it will get. Our payment subsidizes indigent care and our salaries, and those are the people that allow us to train. I dont think of myself as a slave, and Im sorry that you do (oh, or do you think that everyone else is a slave...but not wise old pandabear )

Get over yourself.

 

[8744]

If you dont think making 40K a year is being paid decently, then you havent really been poor. I have a house, a car, a computer, cable and am able to feed, clothe and house my family. I couldnt possibly care less about your wants and needs and what you feel is right. This is the system under which we work, and its about as good as it will get. Our payment subsidizes indigent care and our salaries, and those are the people that allow us to train. I dont think of myself as a slave, and Im sorry that you do (oh, or do you think that everyone else is a slave...but not wise old pandabear )

Get over yourself.

Come again? You mean that I have to work for slave wages because Mr. Smith, one of my habitual drunks, falls asleep in the truly impressive Michigan winter and gets severe frostbite on both his hands and, inexplicably, the tip of his penis?

On your other point, I assure you I am just as mortified to have been suckered into working as a slave as anybody. Everybody makes mistakes and, if you read my blog, you will see that I have certainly accumulated my share.

As for it being about as good as it will get, I agree with you. In fact, I'm surprised we get paid at all as we have absolutely no choice but to work for what we do. If you are happy about it then I guess you are one of those happy, cheerful house slaves just a pickin' and a grinnin.'

I also want to point out that while your hospital may not, our hospitals (the one where we do most of our off-service rotations anyways) make money. hand over fist. We have a very high proportion of insured patients unlike, say, my Alma Mater where insurance (private,that is) was rare indeed. Everybody I see, it seems, is dying on GM's dime. By your logic, if the hospital runs in the red, you should cheerfully accept a pay cut.

In regards to $40,000 per year being enough to support you family, well, I ask you to name me one other career where you would accept the minimum salary possible that would just allow you to make ends meet. What you're saying is that if you were, let's say, and engineer and you were offered $56,000 (which is what I was offered to stay at the job I quit to work for myself) you would say, "Thanks, all I need is $40,000 so there is no need to pay me any more."

This would be ridiculous. I could probably support my family on $20,000 per year but we'd have to sell our house, get rid of the dogs, live in a crappy two-bedroom apartment in an equally crappy part of town, get rid of my car, and eat a lot of peanut butter and Tuna Helper.

So why not agitate for a pay cut to $20,000 per year, I mean, seeing that it will subsidize the crack habits of the indigent by providing them with medicines and care that would otherwise come out of their crack, beer, and cigarette money?

 

[Entei]

I guess it's my fault - I read into what you'd written.

edit: I was right! 1952.

I don't think it was your fault. I think it was all too easy to "read into" what he wrote. And I'm not sure how linking to a website full of propaganda helps his argument.

Dont give him that much credit. Its comments like those that truly enlighten the rest of us as to what Panda truly is.

If he wants to be paid like a doctor, he should learn to act like one. we are all real sorry that you have to make 40K a year and have a bright future. What a ****ing baby.

It's sad that people have tried to turn this thread into a forum for showcasing their grudges against Panda Bear. I'm not a Panda groupie, but I don't think his position in this thread is all that unreasonable. It's certainly not extreme enough to start mud slinging and call him unprofessional. Everyone wants to be paid more for the work they do. That's human nature. Regardless, the issue here isn't the 40k a year, but the hourly wage that works out to. Maybe the real question is why do think your work only deserves to be compensated at the same hourly wage as the burrito-assembler at Taco Bell? I agree with you that's the best we're going to get, but why should we just smile and accept it? If you can't vent a little on an internet message board, where can you?

Speaking as one of those up and coming scared interns, can we get back to talking about how we shouldn't be scared? I think we could all use a little more comforting re: this matter.

 

[Idiopathic]

Heres the deal: everyone knows what this is supposed to be like going in, and Im pretty sure PB knew when he started this journey that there would be a significant amount of type where the work sucked and the pay sucked, and everything is done for the end result. He is also one of the more inflammatory posters around, so I feel no sympathy, and Im sure he doesnt take it too seriously anyway.

 

[Idiopathic]

Come again? You mean that I have to work for slave wages because Mr. Smith, one of my habitual drunks, falls asleep in the truly impressive Michigan winter and gets severe frostbite on both his hands and, inexplicably, the tip of his penis?

On your other point, I assure you I am just as mortified to have been suckered into working as a slave as anybody. Everybody makes mistakes and, if you read my blog, you will see that I have certainly accumulated my share.

As for it being about as good as it will get, I agree with you. In fact, I'm surprised we get paid at all as we have absolutely no choice but to work for what we do. If you are happy about it then I guess you are one of those happy, cheerful house slaves just a pickin' and a grinnin.'

I also want to point out that while your hospital may not, our hospitals (the one where we do most of our off-service rotations anyways) make money. hand over fist. We have a very high proportion of insured patients unlike, say, my Alma Mater where insurance (private,that is) was rare indeed. Everybody I see, it seems, is dying on GM's dime. By your logic, if the hospital runs in the red, you should cheerfully accept a pay cut.

In regards to $40,000 per year being enough to support you family, well, I ask you to name me one other career where you would accept the minimum salary possible that would just allow you to make ends meet. What you're saying is that if you were, let's say, and engineer and you were offered $56,000 (which is what I was offered to stay at the job I quit to work for myself) you would say, "Thanks, all I need is $40,000 so there is no need to pay me any more."

This would be ridiculous. I could probably support my family on $20,000 per year but we'd have to sell our house, get rid of the dogs, live in a crappy two-bedroom apartment in an equally crappy part of town, get rid of my car, and eat a lot of peanut butter and Tuna Helper.

So why not agitate for a pay cut to $20,000 per year, I mean, seeing that it will subsidize the crack habits of the indigent by providing them with medicines and care that would otherwise come out of their crack, beer, and cigarette money?

Im all for earning more money and Im all for hospitals making less and distributing more to the community. We agree on that.

I do take umbrage with your argument that "we make less than a taco bell worker", because its misleading and fallacious. We are salaried employees and we work until our works done, because thats the way it is. I know that my hospital has plenty of money, I also know that I get things that most midlevel salaried trainee-level workers dont get (great insurance, dental plan, free parking, moving stipend, computer, book fund) that adds up to a nice chunk. I also get to train to do something I love.

I know we are the first line of care, and interns/residents are essentially irreplaceable as a group, but I dont see the necessity of attempting to leverage that need to get a slight increase in pay. If you choose to describe my actions with your slave rhetoric, then whatever..."you are what I thought you were", to paraphrase Dennis Green.

I think that you look at the bottom line of medicine and see the disparity in money and work hours and that becomes the basis for your dissatisfaction. To me, that is testament to your failure to understand what medical training is all about, and I feel sorry for you, because you may never find fulfillment in medicine. Resident salaries have gone up markedly in the last ten years and work hours have gone down substantially as well. I guess I feel sorry that you have such a narrow mindset and cannot see the forest for the trees.

Good luck to you in your endeavors. I hope you find a way to enact real change, since I sense that is what you really want.

 

[8744]

Im all for earning more money and Im all for hospitals making less and distributing more to the community. We agree on that.

I do take umbrage with your argument that "we make less than a taco bell worker", because its misleading and fallacious. We are salaried employees and we work until our works done, because thats the way it is. I know that my hospital has plenty of money, I also know that I get things that most midlevel salaried trainee-level workers dont get (great insurance, dental plan, free parking, moving stipend, computer, book fund) that adds up to a nice chunk. I also get to train to do something I love.

I know we are the first line of care, and interns/residents are essentially irreplaceable as a group, but I dont see the necessity of attempting to leverage that need to get a slight increase in pay. If you choose to describe my actions with your slave rhetoric, then whatever..."you are what I thought you were", to paraphrase Dennis Green.

I think that you look at the bottom line of medicine and see the disparity in money and work hours and that becomes the basis for your dissatisfaction. To me, that is testament to your failure to understand what medical training is all about, and I feel sorry for you, because you may never find fulfillment in medicine. Resident salaries have gone up markedly in the last ten years and work hours have gone down substantially as well. I guess I feel sorry that you have such a narrow mindset and cannot see the forest for the trees.

Good luck to you in your endeavors. I hope you find a way to enact real change, since I sense that is what you really want.

At some programs, residents have to pay for parking. Believe it or not. Also, my dental plan sucks. Sorry. As for a moving stipend, this is rare indeed, even in the non-competitive specialties where they need incentives like that.

As for the "book fund" or CME money, it's nice but I'd rather have the money. I don't need that many books and, for example, most of next year's is going to be used to pay for Step 3 and other mandatory activities so the benefit to me is zero except in the sense that it adds nothing to my standard of living.

In regards to working until the work gets done, this is silly. The work is never done. I could pick up charts all day, every day, 365 days a year and there would still he more charts. Eventually, you have to go home. When is a question of tolerance and preference. In the so-called real world where I worked for many years a professional engineer, every company I worked for either paid overtime for hours over 45 or gave compensatory time off when things slowed down a little. So while on a big project approaching completetion it was not unusual to work, let's say, on Saturdays we either got paid or got extra vacation days.

But the idea that every fourth day we would work through the night until one or two the next day was unheard of. Nothing in life is that important, even medicine, where this should be required of anybody.

 

[OR 1]

Hey- I'm the original OP. I think I'm more scared after reading all of these posts!

What do you advise for an intern if you get a resident that doesn't want to be bothered with their new 'tern?"

I guess I'm most worried about night calls and what is expected at the intern level. My med school dismissed the medstudents before overnight call as there weren't rooms for the students, so I haven't had alot of experience with problems that arise on night call.
I get that if it's pain, agitation, nausea that I handle these myself. But how much is the intern expected to know about calls that aren't "pedistrian?" Like night calls for GI bleeds, Flash Pull Edema, PE whatever?