Equal work for equal pay

[member1000765]

This whole thing about a portion of the fast food workers demanding to be paid $15 per hour and the right to unionize (http://www.usatoday.com/story/money...onalds-wendys-burger-king-taco-bell/15058943/) has been dominating the news for the past day or two. As tons of posts have already pointed out, for an 80 hour work week, resident pay equals out to around $14 or $15 at most hospitals.

I don't think that the fast food workers will get $15 per hour anytime soon, but let's say that it actually happened - that would put hourly salary for working at a fast food restaurant on par with that of a resident physician working in a hospital. Now equal pay for equal work is a major workforce issue that I agree with; men and women who do the same type and amount of work should be paid equally without regard to gender. Residency is one example where equal pay for equal work actually exists; residents of the same year at the same hospital make equal salaries regardless of gender. However, does the idea of equal pay for equal work transcend gender and into careers at large?

I would say that working at a fast food restaurant and working as a resident are egregiously not equal work, yet if fast food workers' salaries increase to $15/hour, they would be at equal pay. Assuming that lower level residents function at the same level as a PA or NP (PGY-3 and above function at a higher level in my experience), and a PA or NP makes lets say $75-90k per year, this would violate equal work for equal pay. NP/PA's would do the same work as residents yet get paid drastically higher salaries. After seeing the comments posted from the article on The Atlantic about whether we should pay junior doctors higher salaries, I know there will be cries from the general public of "well residents cost the hospitals money because they have to have their malpractice insurance covered and they can't bill for procedures" and "they aren't even real doctors, they get paid to train!" etc. etc. But let's be honest, residents are vital to the medical system. If one day all the residents in the US decided to walk out and not show up for work, academic hospitals would come to a grinding halt.

So should residents and NP/PA's be paid the same amount for equal work?

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[DermViser]

Residents and NPs/PAs are not on the same par. MDs can not practice without a residency. NPs/PAs don't even have residencies and are "ready on Day 1".

By the way, your "same amount for equal work" is the defense NPs are using to lobby insurers and govts that they should be reimbursed the same as attending physicians, not the current 85% of what an attending is reimbursed.

 

[deleted128562]

Equal pay for equal work, comrade! Or as they used to say in the good ol' USSR: "We pretend to work, and they pretend to pay us!"

 

[DarknightX]

This whole thing about a portion of the fast food workers demanding to be paid $15 per hour and the right to unionize (http://www.usatoday.com/story/money...onalds-wendys-burger-king-taco-bell/15058943/) has been dominating the news for the past day or two. As tons of posts have already pointed out, for an 80 hour work week, resident pay equals out to around $14 or $15 at most hospitals.

I don't think that the fast food workers will get $15 per hour anytime soon, but let's say that it actually happened - that would put hourly salary for working at a fast food restaurant on par with that of a resident physician working in a hospital. Now equal pay for equal work is a major workforce issue that I agree with; men and women who do the same type and amount of work should be paid equally without regard to gender. Residency is one example where equal pay for equal work actually exists; residents of the same year at the same hospital make equal salaries regardless of gender. However, does the idea of equal pay for equal work transcend gender and into careers at large?

I would say that working at a fast food restaurant and working as a resident are egregiously not equal work, yet if fast food workers' salaries increase to $15/hour, they would be at equal pay. Assuming that lower level residents function at the same level as a PA or NP (PGY-3 and above function at a higher level in my experience), and a PA or NP makes lets say $75-90k per year, this would violate equal work for equal pay. NP/PA's would do the same work as residents yet get paid drastically higher salaries. After seeing the comments posted from the article on The Atlantic about whether we should pay junior doctors higher salaries, I know there will be cries from the general public of "well residents cost the hospitals money because they have to have their malpractice insurance covered and they can't bill for procedures" and "they aren't even real doctors, they get paid to train!" etc. etc. But let's be honest, residents are vital to the medical system. If one day all the residents in the US decided to walk out and not show up for work, academic hospitals would come to a grinding halt.

So should residents and NP/PA's be paid the same amount for equal work?

It's not equal work.

Your a trainee who is learning a specific skill set in order to become an attending physician in a certain speciality. Some NP/PA's might assist in the OR (rare where I am, but does happen), but they aren't learning how to do the case (for the most part). They will usually just hold the camera and close skin, if that. Most of the time they will be a perpetual intern/R2 for the remainder of their careers.

And if all the residents decided to walk out, hospitals would slow down for a week and then readjust. You're not as important as you think you are, and at the beginning of the year the interns are actually slowing everything down, not making things more efficient. A dedicated NP/PA to a service is much more valuable than a resident who is on service for 4 weeks at a time.

 

[Mad Jack]

It'll be equal work when PAs and NPs perform the same procedures, work the same hours, take on the same managerial responsibilities, and take on the same liability as physicians. So basically never.

Equal pay for a provider that's working the 9-5, that (most of the time) isn't taking call, that doesn't have to manage the practice and make business decisions, and doesn't take on full liability like a full provider is ridiculous.

 

[Psai]

it's not equal work
a medical assistant or a scribe can take a history
that doesn't make them a doctor

 

[circulus vitios]

Why the hell are you making comparisons between unjustifiably low pay and unjustifiably high pay? It's as apples to oranges as you can get, without actually comparing apples to oranges.

 

[MrChance2]

In an ideal world I agree residents should make more. The clothing workers in Cambodia should probably make more than 50c/hr as well. Unfortunately, the world can be a cruel place sometimes.

 

[VisionaryTics]

Let's apply equal work to equal pay in another way:

Derm residents average, what, 12 hours a week? Emergency medicine less than 40? Residents in those specialties should not be paid as much as residents in specialties who work 79.75 hours per week (as I seem to log routinely...odd...).

 

[username456789]

.

 

[username456789]

Let's apply equal work to equal pay in another way:

Derm residents average, what, 12 hours a week? .

Wut

 

[DermViser]

Let's apply equal work to equal pay in another way:

Derm residents average, what, 12 hours a week? Emergency medicine less than 40? Residents in those specialties should not be paid as much as residents in specialties who work 79.75 hours per week (as I seem to log routinely...odd...).

 

[VisionaryTics]

Hey, we consulted derm this week, and they did nothing. We had to do our own skin biopsy because you guys were drunk on a golf course somewhere.

Damn derm mafia.

 

[Priapism4tooLong]

Let's apply equal work to equal pay in another way:

Derm residents average, what, 12 hours a week? Emergency medicine less than 40? Residents in those specialties should not be paid as much as residents in specialties who work 79.75 hours per week (as I seem to log routinely...odd...).

lol are you joking?? how do derm residents and ESPECIALLY emergency residents average less than 40??

 

[VisionaryTics]

lol are you joking?? how do derm residents and ESPECIALLY emergency residents average less than 40??

1. My post was a joke
2. EM residents do average around 40-50 per week. They just work really irregular hours so it's still really draining.

 

[Priapism4tooLong]

1. My post was a joke
2. EM residents do average around 40-50 per week. They just work really irregular hours so it's still really draining.

ah ok.

In my hospital emergency residents are worked liked dogs.

 

[DermViser]

Hey, we consulted derm this week, and they did nothing. We had to do our own skin biopsy because you guys were drunk on a golf course somewhere.

Damn derm mafia.

ENT consulting Derm? Yeah, uh huh. If anyone is on the golf course, it's ENT.

 

[DermViser]

ah ok.

In my hospital emergency residents are worked liked dogs.

EM is controlled hours. You just don't get to choose when those hours occur in the day. The messing up of one's circadian rhythm is what wears people down, not to mention everyone in the hospital hating them.

 

[VisionaryTics]

ENT consulting Derm? Yeah, uh huh. If anyone is on the golf course, it's ENT.

Not during residency

 

[Priapism4tooLong]

EM is controlled hours. You just don't get to choose when those hours occur in the day. The messing up of one's circadian rhythm is what wears people down, not to mention everyone in the hospital hating them.

Yeah for some reason i thought they did 60 a week. Yes they are normally pretty busy.

 

[VisionaryTics]

Yeah for some reason i thought they did 60 a week. Yes they are normally pretty busy.

They are super busy, but they are super busy for 3-4 12-hour shifts per week. (10 hours seeing new patients + 2 hour wrapup at my med school and residency).

 

[DermViser]

Yeah for some reason i thought they did 60 a week. Yes they are normally pretty busy.

I have no idea how many shifts an EM resident does in a week but the reason why it's so tiring/exhausting bc you're constantly working the entire shift. The speed of things goes in waves, and when the front gets back loaded you have to speed up to get patients out of the ER. This isn't IM.

 

[member1000765]

It's not equal work.

Your a trainee who is learning a specific skill set in order to become an attending physician in a certain speciality. Some NP/PA's might assist in the OR (rare where I am, but does happen), but they aren't learning how to do the case (for the most part). They will usually just hold the camera and close skin, if that. Most of the time they will be a perpetual intern/R2 for the remainder of their careers.

And if all the residents decided to walk out, hospitals would slow down for a week and then readjust. You're not as important as you think you are, and at the beginning of the year the interns are actually slowing everything down, not making things more efficient. A dedicated NP/PA to a service is much more valuable than a resident who is on service for 4 weeks at a time.

I'm not an intern, I've been in this rodeo for awhile. I guess my observations are skewed from a surgical perspective, but in a small surgical specialty we aren't on rotations for 4 weeks at a time, we are on for 4-6 months at a time. We have no NP's or PA's; those are our services, we run them. If we did have a PA or NP, they would have intern responsibilities: putting in orders, doing discharge summaries, etc. With 20-30 patients on some services, yes the attendings will make the big decisions, but 99% of the daily care is performed by the residents. If you took the residents away, the services would fall apart; our attendings will tell you that directly.

I'm just trying to stir up conversation and point out inconsistencies; residents will forever be dumped on, that's how the game works. But when I'm 7 years into training (4 med school + 7 residency/fellowship, not 4 school + 3 residency) and still making only $56k per year, while the people I graduated with from college who did accelerated NP programs have been working for 8 years making twice as much, I will be bitter.

 

[deleted128562]

1. My post was a joke
2. EM residents do average around 40-50 per week. They just work really irregular hours so it's still really draining.

EM resident here. I would be THRILLED if I only did 40-50 hours a week. In just a bit I'll be heading in for my 7th shift in 8 days, shifts which average 12 hours of nonstop pandemonium, and which occur at various times throughout the day. ICU months with their regular predictable hours and the occasional call, feel like a break. Seriously.

 

[Raryn]

EM resident here. I would be THRILLED if I only did 40-50 hours a week. In just a bit I'll be heading in for my 7th shift in 8 days, shifts which average 12 hours of nonstop pandemonium, and which occur at various times throughout the day. ICU months with their regular predictable hours and the occasional call, feel like a break. Seriously.

That's funny, given the Emergency Medicine RRC (the council of the ACGME that accredits EM programs) expressly limits EM residents to 60 hrs/week when they're on EM. They have the regular 80 hrs/week limit when they're on off service rotations

VI.E.1. When emergency medicine residents are on emergency medicine
rotations, the following standards apply: (Core)
VI.E.1.a) While on duty in the emergency department, residents may not
work longer than 12 continuous scheduled hours,
(Core)
VI.E.1.a).(1) There must be at least an equivalent period of continuous
time off between scheduled work period. (Core)
VI.E.1.b) A resident should not work more than 60 scheduled hours per
week seeing patients in the emergency department, and no more
than 72 duty hours per week. (Core)
VI.E.1.b).(1) Duty hours comprise all clinical duty time and conferences,
whether spent within or outside the residency program,
including all on-call hours
VI.E.1.c) Emergency medicine residents must have one day (24-hour
period) free per each seven-day period. This cannot be averaged
over a four-week period. (Core)

So yes, I suppose it may be your 7th shift in 8 days... but that has to mean something like 2 shifts in the following six days, or your programs schedule is explicitly breaking duty hours. Or you're not at an ACGME accredited program.

Oh, and if you're working 12 hour shifts every day, they *can't* be at various times unless theyre just pushing them back an hour or two every day. Because after a 12 hour shift EM programs are required to give you 12 hours off. Either way, your story doesn't add up.

And the last reason it doesn't add up is the fact that you *must* have one day off every seven. They aren't allowed to average them out like every other specialty can.

 

[SouthernSurgeon]

That's funny, given the Emergency Medicine RRC (the council of the ACGME that accredits EM programs) expressly limits EM residents to 60 hrs/week when they're on EM. They have the regular 80 hrs/week limit when they're on off service rotations

It's a yearly treat...when the EM residents get their trauma schedules and email back the trauma chief saying this must be a mistake and that they can't work more than 60/week. Then the trauma chief has to explain to them that this only counts when they are on ED rotations. Then they email THEIR EM chief to complain, only to get told them's the breaks.

Suffice it to say, our EM residents are not known for loving their off service months. They actually hate their medicine and ICU months much much more than trauma.

 

[DermViser]

EM resident here. I would be THRILLED if I only did 40-50 hours a week. In just a bit I'll be heading in for my 7th shift in 8 days, shifts which average 12 hours of nonstop pandemonium, and which occur at various times throughout the day. ICU months with their regular predictable hours and the occasional call, feel like a break. Seriously.

Yes, picking up a phone to admit and for a consult is backbreaking work.

 

[DermViser]

Suffice it to say, our EM residents are not known for loving their off service months. They actually hate their medicine and ICU months much much more than trauma.

Yes, they are quite insufferable on IM months, which means a lot coming from a prelim.

 

[DermViser]

That's funny, given the Emergency Medicine RRC (the council of the ACGME that accredits EM programs) expressly limits EM residents to 60 hrs/week when they're on EM. They have the regular 80 hrs/week limit when they're on off service rotations

How is an RRC able to circumvent the ACGME rules?

 

[SouthernSurgeon]

How is an RRC able to circumvent the ACGME rules?

I don't think it's circumventing. It's an additional restriction on top of the ACGME.

As long as it's not violating the ACGME rules, the ACGME ain't care.

Similarly - the Surgery RRC says you can't take more than 4 weeks of vacation in a year. That's not in the ACGME rules anywhere.

Now if a specialty specific RRC tried to make a rule that violated the ACGME rules, it would be an issue.

 

[link2swim06]

That's funny, given the Emergency Medicine RRC (the council of the ACGME that accredits EM programs) expressly limits EM residents to 60 hrs/week when they're on EM. They have the regular 80 hrs/week limit when they're on off service rotations

So yes, I suppose it may be your 7th shift in 8 days... but that has to mean something like 2 shifts in the following six days, or your programs schedule is explicitly breaking duty hours. Or you're not at an ACGME accredited program.

But. It's averaged over the month. You can't exceed 60 or (80 hours off service) averaged across the month. Some programs may simply make this never exceed 60/80 a week for connivence sake but technically as long as you don't average more than 60/80 per week for the month you are ok.

Plus ER scheduling will flip you from day to night which makes you have a technical day of 'vacation' between the flip but in reality you might have to work at 12am that night. This reduces the hours but this isn't a day of vacation in the traditional sense.

Finally conference time (5-6 hours a week) doesn't count as duty hours. Having a 12 that overlaps with conference could turn it into a 6 hour shift (for duty hour purposes) but you are still at the hospital for 12 hours.

 

[Raryn]

How is an RRC able to circumvent the ACGME rules?

Because the RRC is part of the ACGME. The ACGME has a few over-arching rules but the 20 or so RRCs for the core specialties actually make the specialty specific ones that go on top of that.

For example, the ACGME has an over-arching rule that states "programs may request exceptions to the 80 hour workweek to go to 88 hrs/week" but every single RRC except neurosurg and (I think) Ortho basically says "no requests for exceptions to this rule are allowed".

There's other stuff. Like for example, RRC has slightly differently rules regarding duty hour restrictions for "intermediate level residents" and "residents in their final year(s) of training". The intermediate level ones are a little stricter. IM didn't want to deal with it, so the IM RRC simply states something like "PGY 2 and 3 residents are considered to be in their final years of training. Internal medicine has no intermediate level residents" and left it at that.

 

[Raryn]

But. It's averaged over the month. You can't exceed 60 or (80 hours off service) averaged across the month. Some programs may simply make this never exceed 60/80 a week for connivence sake but technically as long as you don't average more than 60/80 per week for the month you are ok.

Plus ER scheduling will flip you from day to night which makes you have a technical day of 'vacation' between the flip but in reality you might have to work at 12am that night. This reduces the hours but this isn't a day of vacation in the traditional sense.

Finally conference time (5-6 hours a week) doesn't count as duty hours. Having a 12 that overlaps with conference could turn it into a 6 hour shift (for duty hour purposes) but you are still at the hospital for 12 hours.

ED scheduling can flip back and forth and those averaged across the 4 week block rules do apply, but the schedule Mr. hat posted is still either outright breaking the rules or has some pretty nice upsides (like 4 days off in a row the following week or something).

As to your last point, see above:
"VI.E.1.b).(1) Duty hours comprise all clinical duty time and conferences,
whether spent within or outside the residency program,
including all on-call hours"

 

[link2swim06]

Yes, picking up a phone to admit and for a consult is backbreaking work.

If only it was that easy.

It is the one specialty where the faster you work the more work you have. Aka the waiting room is always filled. As soon as I discharge or admit a pt about 10 minutes later there is a new one to repeat the whole process on. You can never 'catch up' in a busy ER. It's akin to running in quicksand.

 

[link2swim06]

ED scheduling can flip back and forth and those averaged across the 4 week block rules do apply, but the schedule Mr. hat posted is still either outright breaking the rules or has some pretty nice upsides (like 4 days off in a row the following week or something).

As to your last point, see above:
"VI.E.1.b).(1) Duty hours comprise all clinical duty time and conferences,
whether spent within or outside the residency program,
including all on-call hours"

I'm not sure where you are getting that last point from but at my program we are told to only log clinical hours. Everything else doesn't count.

 

[SouthernSurgeon]

If only it was that easy.

It is the one specialty where the faster you work the more work you have. Aka the waiting room is always filled. As soon as I discharge or admit a pt about 10 minutes later there is a new one to repeat the whole process on. You can never 'catch up' in a busy ER. It's akin to running in quicksand.

 

[Raryn]

I'm not sure where you are getting that last point from but at my program we are told to only log clinical hours. Everything else doesn't count.

From the accreditation requirements for emergency medicine programs.

https://www.acgme.org/acgmeweb/Port...R-FAQ-PIF/110_emergency_medicine_07012013.pdf

 

[link2swim06]

From the accreditation requirements for emergency medicine programs.

https://www.acgme.org/acgmeweb/Port...R-FAQ-PIF/110_emergency_medicine_07012013.pdf

Oh, it makes sense now. So the next point says:

A resident should not work more than 60 scheduled hours per
week seeing patients in the emergency department, and no more
than 72 duty hours per week.

I don't think any EM program has more than 12 hours of conference a week, ever.

So assuming you max your clinical hours at 60/wk then the conference time would fall within that additional 12 hours allowed a week.

 

[SouthernSurgeon]

Oh, it makes sense now. So the next point says:

A resident should not work more than 60 scheduled hours per
week seeing patients in the emergency department, and no more
than 72 duty hours per week.

I don't think any EM program has more than 12 hours of conference a week, ever.

So assuming you max your clinical hours at 60/wk then the conference time would fall within that additional 12 hours allowed a week.

No.

It means you can't have more than 60 scheduled hours - meaning all your clinical duty shifts can't add up to more than 60 hrs per week on paper.

The extra 12 hours is built in leeway because everyone knows that a scheduled shift doesn't always end exactly on time. It's 12 hours to allow sign out and continuity of care. It's not solely for conference time.

 

[DermViser]

Pretty much. Clock in, clock out.

 

[DermViser]

It's 12 hours to allow sign out and continuity of care. It's not solely for conference time.

Well having your faculty read Tintinalli to you does take time.

 

[mimelim]

EM resident here. I would be THRILLED if I only did 40-50 hours a week. In just a bit I'll be heading in for my 7th shift in 8 days, shifts which average 12 hours of nonstop pandemonium, and which occur at various times throughout the day. ICU months with their regular predictable hours and the occasional call, feel like a break. Seriously.

lol... I mean I know I went into the wrong specialty hours wise, but really? 7th shift in 8 days is working 3 days in a row, heaven forbid!

Try... 5 days on, 4 days at conference, 33 days on, 2 days off, 10 days on, 2 days off. Yes, that is ACGME legal and yes, it includes 2 golden weekends and a conference, but also 33 straight days of 13 hour (lol) days.

 

[KnuxNole]

It's not equal work.

Your a trainee who is learning a specific skill set in order to become an attending physician in a certain speciality. Some NP/PA's might assist in the OR (rare where I am, but does happen), but they aren't learning how to do the case (for the most part). They will usually just hold the camera and close skin, if that. Most of the time they will be a perpetual intern/R2 for the remainder of their careers.

And if all the residents decided to walk out, hospitals would slow down for a week and then readjust. You're not as important as you think you are, and at the beginning of the year the interns are actually slowing everything down, not making things more efficient. A dedicated NP/PA to a service is much more valuable than a resident who is on service for 4 weeks at a time.

This. If residents were to all take off, unless the attendings are pathetic and can't practice well, things should be fine.

 

[KnuxNole]

I have no idea how many shifts an EM resident does in a week but the reason why it's so tiring/exhausting bc you're constantly working the entire shift. The speed of things goes in waves, and when the front gets back loaded you have to speed up to get patients out of the ER. This isn't IM.

This. In my EM month, it is constant seeing patients without time to sit down and rest...doing 6 days of ED shifts 12-14 hours was draining... Compared to in the wards/ICU where there is quite a bit of downtime to sit and rest for hours haha.

 

[DermViser]

This. In my EM month, it is constant seeing patients without time to sit down and rest...doing 6 days of ED shifts 12-14 hours was draining... Compared to in the wards/ICU where there is quite a bit of downtime to sit and rest for hours haha.

You realize in EM they don't do shifts everyday right? You want EM to have their 12 hour shifts AND be like wards/ICU with downtime?

http://skepticalscalpel.blogspot.com/2011/07/choosing-medical-specialty-is-difficult.html
1. Work hours. Hold on a minute, I thought the fuss was about docs working inordinately long hours, like 30 at a time. You mean to tell me that even a 12 hour shift [the longest stretch that any ED MD has to work] causes exhaustion to the point of jeopardizing patient safety? How can this be? Don’t let the ACGME find out or everyone will be working 4-hour shifts. Can we close emergency rooms at, say, 5 pm? I’m not sure the public will buy into that since they are already up in arms about all things related to medical care. And who would order the CT scans?

 

[DermViser]

..is this guy for real? A dermatologist trying to get high and mighty? Relax, and take off the moles when we send them to you.

You realize that before Emergency Medicine was recognized as it's own "specialty" by the ABMS that Internal Medicine and Surgery residents essentially ran the nation's ERs right? http://www.abms.org/about_abms/who_we_are.aspx. To give you context, Dermatology was an ABMS recognized specialty in 1933, Emergency Medicine became an ABMS recognized specialty in 1979.

Have you actually flipped thru a Tintinalli's textbook? It's essentially Internal Medicine (maybe a little bit of Surgery, but not really), but more just an emphasis on the acute diagnostic problems. Yes, there are chapters in Emergency Ophthalmalogy, to humor yourselves, but you guys aren't doing that yourselves -- it's a straight consult call to the Optho guys. Don't kid yourselves - Emergency Medicine is pretty much glorified triage - with a straight call for admitting to IM/Surgery/Psych/OB, or for the ones that don't need admitting, a straight consult to an actual specialist or subspecialist.

 

[KnuxNole]

You realize in EM they don't do shifts everyday right? You want EM to have their 12 hour shifts AND be like wards/ICU with downtime?

http://skepticalscalpel.blogspot.com/2011/07/choosing-medical-specialty-is-difficult.html
1. Work hours. Hold on a minute, I thought the fuss was about docs working inordinately long hours, like 30 at a time. You mean to tell me that even a 12 hour shift [the longest stretch that any ED MD has to work] causes exhaustion to the point of jeopardizing patient safety? How can this be? Don’t let the ACGME find out or everyone will be working 4-hour shifts. Can we close emergency rooms at, say, 5 pm? I’m not sure the public will buy into that since they are already up in arms about all things related to medical care. And who would order the CT scans?

That would be wonderful

True, in EM they don't do everyday shifts. I was an offservice resident though, so my small experience was different. It was fun, but very tiring

 

[DermViser]

That would be wonderful

True, in EM they don't do everyday shifts. I was an offservice resident though, so my small experience was different. It was fun, but very tiring

Of course it was fun. It was one month. Try doing it for the rest of your life.

 

[KnuxNole]

Of course it was fun. It was one month. Try doing it for the rest of your life.

I agree, it's not the specialty for me.

 

[username456789]

..is this guy for real? A dermatologist trying to get high and mighty? Relax, and take off the moles when we send them to you.

They're usually seborrheic keratoses. You should learn to spot them to stop wasting our [and the patients'] time.