Is it possible that in the future, med students will have to pay for residency?

[Astra]

Being bored, I browsed the dental forums and to my surprise, they have to pay for their residency training. Is it possible this will expand to some medical specialties in the future? If not, what's stopping it?

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[Endoxifen]

Being bored, I browsed the dental forums and to my surprise, they have to pay for their residency training. Is it possible this will expand to some medical specialties in the future? If not, what's stopping it?

I am a premed, so I know next to nothing about residency, but I imagine that, considering that many residency slots go unfilled, the first school to introduce unpaid residency (let alone one at cost) would swiftly see their residency disappear.

 

[bioboy23]

That would suck for the NSG folks lol. 11+ years of paying for education. I certainly hope that never happens.

 

[Astra]

I am a premed, so I know next to nothing about residency, but I imagine that, considering that many residency slots go unfilled, the first school to introduce unpaid residency (let alone one at cost) would swiftly see their residency disappear.

Not necessarily. If a school introduced a derm,ortho residency and you have to pay 80k per year, I'm sure you'll find plenty of people still applying.

that 320-400k would be a sound investment from their frame of mind as the lifetime earnings of a derm/ortho is several millions

 

[Endoxifen]

Not necessarily. If a school introduced a derm,ortho residency and you have to pay 80k per year, I'm sure you'll find plenty of people still applying.

Now that you say it, I could totally imagine something like that happening. Still, I don't know who's dumb enough to do something like that. They would be, ignoring living expenses ,~$160,000/year poorer than their peers.

 

[Certified Corsair]

Being bored, I browsed the dental forums and to my surprise, they have to pay for their residency training. Is it possible this will expand to some medical specialties in the future? If not, what's stopping it?

I thought dental schools didn't have residency. Don't they just start working after 4 years?

 

[bioboy23]

Not necessarily. If a school introduced a derm,ortho residency and you have to pay 80k per year, I'm sure you'll find plenty of people still applying.

that 320-400k would be a sound investment from their frame of mind as the lifetime earnings of a derm/ortho is several millions

Maybe it would cost money but be slightly easier to match? I could maybe see that happening.

 

[LoveBeingHuman:)]

Residents do a crazy amount of work for their program. This sounds absurd and, moreover, inhuman. Would it work? Maybe, since residency is required to get a license. But the side effects would be pretty bad.

 

[Endoxifen]

Residents do a crazy amount of work for their program. This sounds absurd and, moreover, inhuman. Would it work? Maybe, since residency is required to get a license. But the side effects would be pretty bad.

The Caribbean school of residency

 

[ifnotnowwren]

I thought dental schools didn't have residency. Don't they just start working after 4 years?

They have optional residencies - they can start practicing straight out of school or they can do a residency to specialize.

 

[LoveBeingHuman:)]

Where is the thread that mentions dental residents have to pay?

 

[Astra]

Now that you say it, I could totally imagine something like that happening. Still, I don't know who's dumb enough to do something like that. They would be, ignoring living expenses ,~$160,000/year poorer than their peers.

take this scenario.

You aren't the best applicant for derm. Your only match is a residency program that you have to pay for. Derms make more than most specialties and that cost is 1 years salary, so to you, its still a sound investment. Other derm programs gradually shift to this pay for models as they see the potential revenue. This model gradually spreads to all the high paying competitive specialties. Are people going not apply to them? Nope because you still get a great return on your investment. Eventually, this could trickle down to the less competitive specialties.

I thought dental schools didn't have residency. Don't they just start working after 4 years?

Tuition & Fees | Orthodontic Residency | Graduate Dental Education Programs | Academic Programs & Admissions | Penn Dental School

 

[Astra]

Where is the thread that mentions dental residents have to pay?

Latest Annual Net Income of Specialists....Enjoy

 

[Endoxifen]

take this scenario.

You aren't the best applicant for derm. Your only match is a residency program that you have to pay for. Derms make more than most specialties and that cost is 1 years salary, so to you, its still a sound investment. Other derm programs gradually shift to this pay for models as they see the potential revenue. This model gradually spreads to all the high paying competitive specialties. Are people going not apply to them? Nope because you still get a great return on your investment. Eventually, this could trickle down to the less competitive specialties.

Alternatively, such a move is seen as spit in the face of the entire profession. Recent grads and more established doctors band together to protest and boycott the program.

 

[Astra]

Alternatively, such a move is seen as spit in the face of the entire profession. Recent grads and more established doctors band together to protest and boycott the program.

Lol, I highly doubt that is gonna happen. They have their own problems to worry about

 

[Endoxifen]

Lol, I highly doubt that is gonna happen. They have their own problems to worry about

You'd be suprised. A moratorium was called on a large proportion of CRISPR research by the larger scientific community following its discovery because it had a serious potential impact on molecular and biochemical research (and possibly not for the better). When people's livelihoods are at stake, I can imagine something like that happening.

 

[LoveBeingHuman:)]

@Catalystik @gyngyn Is something like this ever gonna happen for medical residencies?

 

[Anti-PD1]

Thomas Nasca, head of ACGME:

“Institutions can expand internal medicine, pediatrics and family medicine residency programs by ceasing to pay residents in more competitive programs like dermatology, orthopaedic surgery and radiology. They could use federal funds that previously supported the competitive programs to pay for new primary care positions and could start charging residents in the more competitive programs tuition,” Nasca says.

http://connect.jefferson.edu/s/1399/index.aspx?sid=1399&gid=2&pgid=1077

After the The Balanced Budget Act (BBA) of 1997, hospitals have had to pay for a greater proportion of the cost of graduate medical education.

It is possible. And similar to how medical schools can charge you $60K a year (which at my school funds grad student stipends, and pizza for student group meetings no one is actually interested in, among other things), I could see students/residents agreeing to this. What's the alternative? Do you not want to be a dermatologist? Pay your dues, etc.

 

[LoveBeingHuman:)]

If something like this were to happen, I'm sure anyone that is already in a residency program would continue to be paid.

 

[gyngyn]

@Catalystik @gyngyn Is something like this ever gonna happen for medical residencies?

I don't predict the future.
I can tell you that there were "pay to play" derm programs when I matched.
ACGME did not tolerate them and they disappeared.

 

[LoveBeingHuman:)]

I don't predict the future.
I can tell you that there were "pay to play" derm programs when I matched.
ACGME did not tolerate them and they disappeared.

Which specialties would you say are more prone to something like this?

 

[gyngyn]

Which specialties would you say are more prone to something like this?

Derm.

 

[Astra]

I don't predict the future.
I can tell you that there were "pay to play" derm programs when I matched.
ACGME did not tolerate them and they disappeared.

so from a legislative point of view, what's stopping residencies charging residents?

 

[gyngyn]

so from a legislative point of view, what's stopping residencies charging residents?

Working without pay is unAmerican.
Working without pay to scam others doesn't fly, either.

 

[libertyyne]

I dont know if unfunded residency spots still exist. But this article speaks about them being a thing 4 or so years ago. Trainees in Radiology and Other Specialties See Dream Jobs Disappearing

 

[Astra]

Working without pay is unAmerican.

that didn't stop dental residencies.

 

[gyngyn]

that didn't stop dental residencies.

I am not an expert in Dentistry.

 

[libertyyne]

I am not an expert in Dentistry.

LoL.

 

[Astra]

I am not an expert in Dentistry.

I get that, but I'm just asking you, in your expertise, are there any rules or legislation preventing residencies from becoming unpaid or even requiring residents to pay for their training?

 

[LutGholein]

You mean residents would have the pleasure of paying 60k a year to work for 3-7 years? After coming out of med school with 300k+ debt? That's rich.

I bet hospital networks would love this fanfic

 

[gyngyn]

I get that, but I'm just asking you, in your expertise, are there any rules or legislation preventing residencies from becoming unpaid or even requiring residents to pay for their training?

The rules on post graduate medical training would prohibit this.

 

[Tenk]

Won't happen. Other stuff will happen long before this.

 

[LoveBeingHuman:)]

The rules on post graduate medical training would prohibit this.

I think what's happening is that the idea that one day we might have to pay for residency rather than getting paid is giving us intolerable nightmares And we're looking towards you to help us feel better.

 

[CharlieBillings]

Money is too important. Physicians are hard working. It would only take a few years for the prostrospective physician pool to destroy itself.

 

[AnatomyGrey12]

that didn't stop dental residencies.

And dental graduates don't need a residency to practice. Thy don't need a residency to do orthodontics, oral surgery (not the maxillofacial stuff) or endodontics. The residency makes them more marketable, but isn't required to encorporate these into their practice.

 

[aldol16]

I don't think it'll get to that point. As it seems to me, residents are cheap sources of labor for hospitals. Sure, they have to invest in mentorship and training but those residents also treat a large proportion of the teaching hospitals' patients. If there aren't federal funding sources in place, I wonder if hospitals will take on a larger share of that cost or if they'll find another way to fund it.

Many academic post-docs are funded through the PI precisely because it's a cheap-ish source of highly skilled labor for them.

 

[libertyyne]

I don't think it'll get to that point. As it seems to me, residents are cheap sources of labor for hospitals. Sure, they have to invest in mentorship and training but those residents also treat a large proportion of the teaching hospitals' patients. If there aren't federal funding sources in place, I wonder if hospitals will take on a larger share of that cost or if they'll find another way to fund it.

Many academic post-docs are funded through the PI precisely because it's a cheap-ish source of highly skilled labor for them.

I am trying to figure out how Dental graduates are any different .

 

[AnatomyGrey12]

I am trying to figure out how Dental graduates are any different .

See my post above. Dental residencies are not required to practice.

 

[Astra]

And dental graduates don't need a residency to practice. Thy don't need a residency to do orthodontics, oral surgery (not the maxillofacial stuff) or endodontics. The residency makes them more marketable, but isn't required to encorporate these into their practice.

true but the context was working without pay and dental residencies are guilty of that.

 

[Astra]

I don't think it'll get to that point. As it seems to me, residents are cheap sources of labor for hospitals. Sure, they have to invest in mentorship and training but those residents also treat a large proportion of the teaching hospitals' patients. If there aren't federal funding sources in place, I wonder if hospitals will take on a larger share of that cost or if they'll find another way to fund it.

Many academic post-docs are funded through the PI precisely because it's a cheap-ish source of highly skilled labor for them.

Greed has no bounds. I'm sure some execs would rationalize making us pay for residency.

 

[aldol16]

Greed has no bounds. I'm sure some execs would rationalize making us pay for residency.

It would take collusion across the board in order to make that work. They can probably all agree that it would be financially beneficial on their end since now they're getting paid by both the consumers (patients) and suppliers (doctors). But the first person to do it would see a drastic reduction in the quality of their residents because the best residents would go elsewhere. So there's no incentive for anybody to start doing it unless there was collusion on an unprecedented scale.

 

[libertyyne]

See my post above. Dental residencies are not required to practice.

I am still drawing a blank as to why that would be different for Physicians. You really only need PGY 1 to practice. Still not seeing the difference. Why would organizations care?

 

[Matthew9Thirtyfive]

true but the context was working without pay and dental residencies are guilty of that.

That completely ignores the huge difference that he pointed out, which is a big part of what makes it incredibly unlikely that med residencies will be pay to play.

 

[Matthew9Thirtyfive]

I am still drawing a blank as to why that would be different for Physicians. You really only need PGY 1 to practice. Still not seeing the difference. Why would organizations care?

Good luck getting privileges anywhere or paid by insurers with only a medical license and an intern year.

 

[Astra]

It would take collusion across the board in order to make that work. They can probably all agree that it would be financially beneficial on their end since now they're getting paid by both the consumers (patients) and suppliers (doctors). But the first person to do it would see a drastic reduction in their residents because the best residents would go elsewhere. So there's no incentive for anybody to start doing it unless there was collusion on an unprecedented scale.

I disagree, people gunning for derm with subpar stats, will still apply. If it was family medicine or another non high paying specialty, I definitely agree.

That completely ignores the huge difference that he pointed out, which is a big part of what makes it incredibly unlikely that med residencies will be pay to play.

wut? The only point I was trying to make is that paying for dental residency is working without pay.

 

[aldol16]

I disagree, people gunning for derm with subpar stats, will still apply. If it was family medicine or another non high paying specialty, I definitely agree.

Sorry, I meant drastic reduction in the quality of their residents. The quality of got missed in my original comment and I've corrected it. People who want the super-competitive specialties but have sub-par stats would be the ones who go to the ones that require them to pay.

 

[libertyyne]

Good luck getting privileges anywhere or paid by insurers with only a medical license and an intern year.

If I am correct, insurers dont care for billing purposes. Privileging does matter so does malpractice. That being said I am not completely sold on the fact that just because you need it to get privileged is the chief deterrent. You also need to go to medical school, why not consider residency as a training requirement as well.


I dont what would happen in the future if they fail to increase funding for spots and US medical school graduates outnumber positions. All you would need is someone willing to lend more money to cover costs during residency for it to become a thing. There are currently unfunded residency spots, I dont see how it is unfathomable to see an increase in the amount of unfunded spots.

 

[AnatomyGrey12]

wut? The only point I was trying to make is that paying for dental residency is working without pay.

Yes, because they are completely optional. Choosing to do a residency as a dental grad is choosing to forego at least 150k for more specific training. It's totally a choice. A medical school grad is essentially forced to go to residency, its either go to residency or have a useless piece of paper. There is a fundamental difference.

 

[KShah1]

Nvm

 

[Endoxifen]

Not sure if you were saying this about dental or medical, but all medical residency slots are filled each year with an overflow of applicants, both thru the main match and the supplemental

Really? I've been told that there are more slots then there are applicants! I'm glad I had that qualifier before hand.