aProgramDirector - orientation

[Doowai]

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Sir, you had mentioned that if orientation is mandatory then its supposed to be paid.

Who makes and enforces this rule? ECFMG? State or federal laws? aProgramDirector?

 

[DrMom]

It is my understanding that orientation is basically like basic job training, which is an unpaid requirement for many jobs.

 

[Samoa]

Orientation for other jobs is always paid. This is the only field I've heard of where it's not.

 

[DrMom]

Orientation for other jobs is always paid. This is the only field I've heard of where it's not.

It definitely happens in other jobs.

 

[beanbean]

My program did not pay us for orientation last year. We started about 2 weeks before July 1 and had general orientation, ACLS, ATLS, orientation to the various hospitals IS systems etc. I am curious how many of us get paid for orientation vs not paid.

 

[sirus_virus]

In real life, serious employers pay for orientation, relocation, etc.. The ones that don't pay are typically those cheesy sales jobs and financially distressed mom and pop businesses.

 

[NotAProgDirector]

This is something that I thought was true at the Federal level, but a quick google search finds nothing. So now, I'm not so sure. Perhaps Law2Doc or someone with more legal background than I will chime in.

 

[jacksonhole]

I think the real question is whether residency is a "job" or "schooling". It is true the most real jobs do pay for all time spent at the jobsite, regardless of orientation or not. Many professional jobs pay for relocation expenses as well. I know this first hand by working as a financial planner prior to going to medical school. My company wined and dined me to death! Residents don't seem to get that kind of treatment.

Residency is kind of in a grey area...technically we are not getting credit or paying a tuition of sorts...so not really school per say, but it is leading toward being eligible for full licensure and board certification.

I wonder if all the employee laws apply to residents or not. If you get fired can a resident apply for unemployment and so on? Some programs seem to ride that fine line of abusing human rights. Something ironic isn't it???

 

[elwademd]

there are some programs that pay for orientation. i know mine did when i was an intern.

so, i'm not sure what the difference is.

 

[HCE]

This is something that I thought was true at the Federal level, but a quick google search finds nothing. So now, I'm not so sure. Perhaps Law2Doc or someone with more legal background than I will chime in.

it may come down to checking with your particular state's Wage and Hour office, or some similar agency...

 

[3dtp]

The National Labor Relations Board (Case 1-RC-20574; In RE: Housestaff of Boston Medical Center) ruled that medical residents are employees under the NLRA. They state specifically that residents "therefore are entitled to all the statutory rights and obligations that flow from our conclusion." This case, was about the collective bargaining rights of residents, but the statutory outflow would appear to indicate that residents are to be considered employees under the Act. And, if you are an employee, then you should be paid for your time that your employer has demanded of you, in my non-legal opinion.

Mass, Maryland, California, Michigan and others have recogized this and residents are covered under their state statutes. In these states, the state considers you an employee. I suspect if you have federal income taxes, FICA taxes and state income taxes withheld you would be considered a statutory employee for the purposes of wages and salaries.

The Labor Board recognizes two distinct categories of employees: exempt and non-exempt. The exempt employees are exempt from overtime reporting/payments and are generally ungraded/professionals who do not get paid overtime. These are called salaried workers.

This would be the category that residents fall into. The other category are those who exert no control nor supervision and independence over their jobs. These are non-exempt and are owed overtime in accordance with federal law. These are also colloquially called "hourly" workers, such as nurses.

To the best of my knowledge, NY is one of the states that the labor board considered, and I think NYU was one of the hospitals that was involved in the original labor board decisions, along with BMC.

I was paid for my orientations, both transitional and residency (4 days in one case, 2 in the other, mainly to do the drug screen and get computer passwords and such). When I first heard that there were programs that did not pay for a mandatory "orientation, " my first thought was hokie sox, this can't possibly be true. But, alas, it clearly is. Are there no depths to which hospitals won't sink?

A program that does not pay for orientation, because the law says they have to or otherwise, in my mind merits a DNR on the ROL.

 

[xaelia]

We were paid for orientation.

Man it's nice to get that paycheck the first week in July.

 

[HCE]

The National Labor Relations Board (Case 1-RC-20574; In RE: Housestaff of Boston Medical Center) ruled that medical residents are employees under the NLRA. They state specifically that residents "therefore are entitled to all the statutory rights and obligations that flow from our conclusion." This case, was about the collective bargaining rights of residents, but the statutory outflow would appear to indicate that residents are to be considered employees under the Act. And, if you are an employee, then you should be paid for your time that your employer has demanded of you, in my non-legal opinion.

Mass, Maryland, California, Michigan and others have recogized this and residents are covered under their state statutes. In these states, the state considers you an employee. I suspect if you have federal income taxes, FICA taxes and state income taxes withheld you would be considered a statutory employee for the purposes of wages and salaries.

The Labor Board recognizes two distinct categories of employees: exempt and non-exempt. The exempt employees are exempt from overtime reporting/payments and are generally ungraded/professionals who do not get paid overtime. These are called salaried workers.

This would be the category that residents fall into. The other category are those who exert no control nor supervision and independence over their jobs. These are non-exempt and are owed overtime in accordance with federal law. These are also colloquially called "hourly" workers, such as nurses.

To the best of my knowledge, NY is one of the states that the labor board considered, and I think NYU was one of the hospitals that was involved in the original labor board decisions, along with BMC.

I was paid for my orientations, both transitional and residency (4 days in one case, 2 in the other, mainly to do the drug screen and get computer passwords and such). When I first heard that there were programs that did not pay for a mandatory "orientation, " my first thought was hokie sox, this can't possibly be true. But, alas, it clearly is. Are there no depths to which hospitals won't sink?

A program that does not pay for orientation, because the law says they have to or otherwise, in my mind merits a DNR on the ROL.

Aren't the residence at Boston Medical Center in a Union? Does this have any impact on the Board's decision at that location? Otherwise, I'm not sure why the NLRB would be involved at all (?)

 

[3dtp]

Aren't the residence at Boston Medical Center in a Union? Does this have any impact on the Board's decision at that location? Otherwise, I'm not sure why the NLRB would be involved at all (?)

Yes, the issue that brought the matter to the attention of the NLRB was that of organizing. This is where the labor lawyers come in handy.

My legally naive construction (outside of my own state where I own a business and pay a labor lawyer good money to advise me), on this is that if I cause a worker to be in a certain place at a certain time for my convenience and as a precondition of hiring, then I have an obligation to pay. If on the other hand, I say to my prospective employee, you need to get an (BLS/ACLS/ATLS/CDL) in hand before you start, then all I can do is say show me the paperwork on the first day. How/when they get it is not my concern.

In my state, this is the law, and it applies to "employees." Since the crux of the ruling was that residents are employees, with the right to organize, I think, but could be wrong, that the ruling also means that if you control 'em, you gotta pay 'em.

I'm sure that the various and sundry hospital lawyers, like Bill Frist's associates at HCA have studied this carefully and have or think they have found a loop hole.

This is why (finally!) the ACGME mandated programs publish their contracts, prior to match day. The only problem is these programs incorporate myriads of extraneous stuff by reference to other documents which are not readily available. This is a major concern. No one should consider ranking a program until/unless they have seen a copy of the proposed contract, and the documents incorporated by reference,

As an aside comments made by Aprogdir on an earlier thread ring very true. In the comments, apd was absolutely correct. I went looking for a second program at one point. In discussing the situation with several program directors, a repeated theme arose: You have to do something about [a bad program]. Programs that misbehave make us all look bad. The only problem with a resident/resident wanna-be "doing something" is that the resident will be ultimately VSF. This is what needs to be changed.

There are good programs out there. They really do exist and for those in them, as gruelling as it may sometimes seem, be thankful. Most residents do not have an opportunity to spend time in more than one program. Those that do have a basis for comparison. They can see that there are excellent programs as well as those that should be relegated to Yucca Mountain.

 

[165808]

At my University of California residency program, we were told at orientation that we were considered to be in an educational program, not "real" employees. We are being paid a "stipend," not a salary, according to them. It's a legit program, and since all UC schools do things pretty much the same, it's probably that way across the board.

We are definitely not paid for our mandatory orientation, so I'm wondering if this is how they get around that? Being paid for orientation would have been sweet....that was 6 days of my life gone 😀

 

[lord_jeebus]

At my University of California residency program, we were told at orientation that we were considered to be in an educational program, not "real" employees. We are being paid a "stipend," not a salary, according to them. It's a legit program, and since all UC schools do things pretty much the same, it's probably that way across the board.

We are definitely not paid for our mandatory orientation, so I'm wondering if this is how they get around that? Being paid for orientation would have been sweet....that was 6 days of my life gone 😀

I'm also at a UC residency program (Irvine, it seems you are there too), and I did get paid for orientation 😕. Maybe you should contact your coordinator. I wasn't paid for ACLS but was paid for the rest of it.

 

[dragonfly99]

I was not paid for my orientation days before my medicine residency. I was at a "top 20" or so medicine residency program. Our orientation was only a couple of days though. I woudn't go so far as to say not to rank programs that don't pay for orientation. There are a lot of other benefits (financial and otherwise) to consider before getting super bent out of shape about a couple of orientation days. I'm very shocked that some programs have a week or two of orientation. How long does it take to get your computer passwork and a Tb skin test?!!!

 

[lord_jeebus]

I'm very shocked that some programs have a week or two of orientation. How long does it take to get your computer passwork and a Tb skin test?!!!

I remember such wonderful things as a talk on "noise abatement" where a nurse suggested we wear softer shoes, and an hour-long talk on how to critique a journal article.

I also remember that orientation at our VA hospital had us talk to people from every bogus department, but didn't include information on parking or computer passwords!

 

[165808]

I'm also at a UC residency program (Irvine, it seems you are there too), and I did get paid for orientation 😕. Maybe you should contact your coordinator. I wasn't paid for ACLS but was paid for the rest of it.

Hmmmm....well, the first week consisted of mainly PALS and NRP for four days, and one full day of peds-related orientation. Then the last day was that big all-UCI shindig. I'm not sure if I was paid for the big UCI thing (it was only one day, after we already started), but I know for sure via our program coordinator that we weren't paid for the other week.

So, we weren't paid for that first week because it was mainly PALS/NRP? Makes sense. They paid for us to take those courses, so I never thought of being paid, but everyone on this forum made me think otherwise!!

 

[Winged Scapula]

I was not paid for residency orientation which lasted several days:

one day each for ACLS and ATLS
one day for mandatory hospital orientation (ie, lectures on needle sticks, sexual harassment, blood bank, etc.)
3 days for surgery orientation
another day for getting badges, computer ID codes, TB testing, etc.

There were also empty days between the above so effectively you had to leave home about 2 weeks early.

I WAS paid for fellowship orientation which lasted one day, was mostly useless lectures (see above), lots of touchy feely stuff about how to approach patients (sit down when you talk to them, don't frown), etc. It was painful but I got something like $400 for it. Unfortunately, it did not include useful things like how the paging system works, a hospital map, etc.

I figured the difference was a strong Committmee of Interns and Residents at my fellowship program.

 

[165808]

I remember such wonderful things as a talk on "noise abatement" where a nurse suggested we wear softer shoes, and an hour-long talk on how to critique a journal article.

The noise abatement lecture was hilarious!!

 

[lord_jeebus]

The noise abatement lecture was hilarious!!

The best part was how 90% of the people there were having their own loud private conversations by that point in the day

 

[NotAProgDirector]

We are being paid a "stipend," not a salary, according to them.

Are you having FICA tax withheld from your paycheck? If so, then it's not a stipend. If not, then you probably end up mush further ahead financially anyway.

Whether residents are students and hence exempt from FICA has been a longrunning issue. A reasonable summary is here.

I had a 3 week orientation.

I missed the first two weeks of it.

I never had any problems. No one seemed to notice.

Ahhh. But did you get PAID for those two weeks. That would be a nice trick.

 

[jacksonhole]

Aprogramdirector is right.

What a fiasco this fight regarding whether a resident is a student or employee. The School, College, University (SCO) doesn't want to pay FICA and the IRS wants the FICA. I wonder who is going to win this one??? Just so everyone is on the same page, your hospital contributes the same amount to FICA on your behalf.

I for one think the resident is an employee and is subject to FICA. We don't pay tuition, rather we get paid, we work at least 40 hours a week-accourding to the IRS this is suggests an employee, we get vacation/benefits/retirement/required to be there or get fired and so on-again the IRS says it suggests employee. In fact the IRS considers residents, Professional Employees, people who do work in science, research, publications and so on. They will get their money one way or another. Paying FICA is not all bad either. If you don't pay FICA you are not eligible for social security retirement benefits (I know, probably wont get it anyway), but if you are ever involved in an accident or become schizophrenic and you have nothing to your name, you may not receive any benefits from Uncle Sam either....

 

[165808]

Are you having FICA tax withheld from your paycheck? If so, then it's not a stipend. If not, then you probably end up mush further ahead financially anyway.

I don't think so....I have medicare and Federal tax withheld. We don't pay into Social Security -- it goes into a different fund for us that we can invest into various other funds. I think that's the "DCP casual" deduction I see. Just those three!!

So maybe we really are just on a stipend....

 

[Winged Scapula]

No state taxes withheld?

Seems weird to withhold Medicare but not Social Security. I hope that fund you invest in is good; it would be a bit of a suprise when you retire to find that you don't have enough savings and aren't getting anything from the government (which may happen anyway).

 

[xaelia]

Amusingly enough, I was paid for orientation I did not attend. I worked at my prior hospital overlapping my orientation at the new hospital, so I actually had a week of double-pay.

No, they can't have their money back. It was $4k in moving expenses.

 

[Samoa]

Are you having FICA tax withheld from your paycheck? If so, then it's not a stipend. If not, then you probably end up mush further ahead financially anyway.

Whether residents are students and hence exempt from FICA has been a longrunning issue. A reasonable summary is here.

We have FICA and Medicare withheld, but were not paid for residency orientation. Our hospitals all pay their regular employees for orientation, though.

 

[3dtp]

I don't think so....I have medicare and Federal tax withheld. We don't pay into Social Security -- it goes into a different fund for us that we can invest into various other funds. I think that's the "DCP casual" deduction I see. Just those three!!

So maybe we really are just on a stipend....

Social Security was not always mandatory for some. There was at least one alternate "contribution" known as the Railways Retirement Income Act, and the one that Congress set up for itself so it wouldn't have to pay into that turkey. Social Security is also known as the FICA or Federal Insurance Contributions Act.

In the mid-late 1970s (or possibly even as late as the early 1980s) any government institution, which includes political sub-divisions such as a state university system were given an option: opt in to social security or opt out and provide an alternate plan. Most figured (wrongly I suspect) that the then rampant inflation made the 15% social security tax (7.5/7.5 employer/employee) look pretty attractive, assuming that the federal benefits could increase without bounds while the contribution was fixed. I think the rate was lower, perhaps much lower in those days. I do know that the cap has steadily risen over the years. This could explain the DCO contribution. California tax lawyers, your comments please?

The fact that you are still contributing to medicare which is I think 1.5% or so tells me that you may be considered an employee for statutory purposes.

Jacksonhole is right on the money. The IRS has a fairly comprehensive set of regulations concerning what constitutes an employee. This arose because at one point businesses were laying off employees on Monday, and retaining them as "consultants" on Tuesday to avoid the FICA/FUTA payments. WRONG! said the IRS, pay up. Hit a major auto supplier for tens of millions.

 

[3dtp]

In real life, serious employers pay for orientation, relocation, etc.. The ones that don't pay are typically those cheesy sales jobs and financially distressed mom and pop businesses.

Agreed. I once took a job with a company at what was billed as a senior exec level. The company was a small mom and pop technoweenie company who ummm shall we say weren't completely accurate with their representations of sales. They had hired a number of high level technical people as a front in hopes of convincing the proposed contractee to grant them the contract. After I started, they told me that the exec benefits (car, health insurance, vacations, etc) didn't start for 6 months. Although the cash was great, this iwas unusual. So, I started looking for other work the next week, found a great job, and was about to give 2 weeks notice, when I was told that I was being laid off (along with all the new scientists/engineers they had just hired), and would I please sign a release so I could get my severence. After a 30 second negotiation, they decided to triple the severence package and I signed.

Residents in a "noble" profession should not be treated this way by hospitals and universities. It is just plain wrong and worse, it teaches them to behave this way when they are in command.

 

[nykka3]

I'm also at a UC residency program (Irvine, it seems you are there too), and I did get paid for orientation 😕. Maybe you should contact your coordinator. I wasn't paid for ACLS but was paid for the rest of it.

I thought I was going to get paid for orientation but alas no moulah.

 

[ekydrd]

At my program we also are in a gray area between being a student and being an employee. We also are paid with a stipend rather than a salary, enjoy many of the benefits of student status (tickets to school games and such), but also have a few employee type benefits such as health insurance and free parking. But we did not get paid for the 10 days of orientation in June prior to starting.