Just Another Thing to Consider...

[MrBurns10]

I was at Chapel Hill during the whole ordeal and had many friends at Duke, some of whom were at the party. Panda's account is pretty accurate, as far as I can tell.

I just don't think it's fair to come down hard on Brodhead. There are things I'm sure he regrets, but another poster mentioned all these people who had no right passing judgment doing so and wanting Duke's head for it. Brodhead may not have been the passionate defender the players were hoping for, but I don't think he presumed their guilt at all. I also think that the two posters who said they had friends at the party may also be just a wee bit biased against how Brodhead handled things.

Anyway, another poster who said that the undergrad and med school are separate entities is right. Read my account of my classmate's ordeal if you want to see how supportive the med school admin is.

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[thebeatblitz]

In all honesty, the med school is probably way better. I did that useless FOCUS program freshman year, and some of my most favorite teachers during all four years were faculty at the medical school.

Brodhead's legacy at Duke will speak for itself; I think the media has taken care of that one.

 

[Flopotomist]

Guys.. I don't give a rats tail about the Duke history... but Panda DID bring up a MUCH more interesting topic, and that is the drive to reclassify residents as students instead of employees. Can we get back on that topic? (Yeah, that means YOU, whomever is about to try to have the last word on the matter should just NOT hit the submit key).

 

[neuro1617]

Guys.. I don't give a rats tail about the Duke history... but Panda DID bring up a MUCH more interesting topic, and that is the drive to reclassify residents as students instead of employees. Can we get back on that topic? (Yeah, that means YOU, whomever is about to try to have the last word on the matter should just NOT hit the submit key).

Seriously...back to the topic. That is unbelievable. A resident I was shadowing was joking about how his friend is getting married & he can't even go to the wedding b/c/o work & how his friends are all married w/ nice cars, houses, etc while he is working so many hours for hardly anything. I laughed along with the other residents but he said to think seriously about it because that's the future I would have in medicine. But people, myself included, don't change their minds because it is really what some want to do with their lives. Honestly though who could still say that if this happened? 3+ years of residency without getting paid because you genuinely love medicine and helping people THAT much? You wouldn't be able to afford the cost of living unless you are supported by someone else, especially after already being .5 M $ in debt from medical school. I'll go be a PA or get a PhD in neuroscience. Hell, I'd rather work at Wendy's. At least I'd get paid, albeit for flipping burgers.

Panda-just spent the better part of the night reading your blog (had never seen it previously) after reading this post. It's really great

 

[Ginzo]

You wouldn't be able to afford the cost of living unless you are supported by someone else, especially after already being .5 M $ in debt from medical school.

Uhm, 0.5 million? Pray tell me what medical school costs that much?

 

[elwademd]

Uhm, 0.5 million? Pray tell me what medical school costs that much?

figure out the interest rate on a typical medical student debt load, and see how much you really pay, as opposed to what the schools tell you what you'll owe when it's all said and done.

 

[Flopotomist]

Uhm, 0.5 million? Pray tell me what medical school costs that much?

After you figure costs of an average private undergrad education, med school education, and add interest, you are easily at the half a mil mark.

 

[8744]

...They did not come out publicly to "fight for the players" because how would it look if she turned out to be telling the truth?

Har har. You see? That's the key thing you don't understand. Looking after your subordinates, employees, associates, or students is first and foremost giving them the benefit of the doubt...at least if you are going to claim that your organization has special bonds that transcend a mere business relationships.

The fact that you can't see that is telling. When your subordinates look to you for protection and leadership, they do not want a carefully constructed statement crafted to cover your ass.

 

[8744]

Guys.. I don't give a rats tail about the Duke history... but Panda DID bring up a MUCH more interesting topic, and that is the drive to reclassify residents as students instead of employees. Can we get back on that topic? (Yeah, that means YOU, whomever is about to try to have the last word on the matter should just NOT hit the submit key).

It is relevant. the point is that no orgnization can be trusted. Sorry.

 

[Ginzo]

figure out the interest rate on a typical medical student debt load, and see how much you really pay, as opposed to what the schools tell you what you'll owe when it's all said and done.

Nobody refers to debt in that fashion. When you owe 200 grand on a house, you don't say, "I'm 600 grand in debt." Even though that's closer to what you'd actually pay over 30 years or whatever.

 

[8744]

Nobody refers to debt in that fashion. When you owe 200 grand on a house, you don't say, "I'm 600 grand in debt." Even though that's closer to what you'd actually pay over 30 years or whatever.

Whoa. That's only because people don't think. That 600,000 you will pay over the course of a twenty-five year mortage is real money, don't kid yourself. I used to think it made more sense to buy than rent but I'm beginning to come around to the idea that unless you pay off your house in a reasonable period (fifteen years), above a certain interest rate it makes more sense financially to rent and invest the difference. Real Estate doesn't appreciate in value everywhere, after all.

It is true that if you have a fixed rate mortage at a low interest rate inflation could really be your friend (eventually paying a 2008 mortage with devalued 2025 dollars) but you can't count on this.

 

[Ginzo]

Whoa. That's only because people don't think. That 600,000 you will pay over the course of a twenty-five year mortage is real money, don't kid yourself. I used to think it made more sense to buy than rent but I'm beginning to come around to the idea that unless you pay off your house in a reasonable period (fifteen years), above a certain interest rate it makes more sense financially to rent and invest the difference. Real Estate doesn't appreciate in value everywhere, after all.

It is true that if you have a fixed rate mortage at a low interest rate inflation could really be your friend (eventually paying a 2008 mortage with devalued 2025 dollars) but you can't count on this.

Eh, but the amount of interest you wind up paying is variable. Hence it just being simpler to say the amount of the loan balance, not what you'll actually pay. For example, I've put 10k here or there on credit cards to pay off a car loan. That 10 grand could balloon into some beastly amount if I were a *****, but I tend to move my balances every year to take advantage of 0% intro rates.

As for the real estate issue, I think people's opinions are heavily colored by the present awful situation with the real estate market. Just a few years ago the common wisdom seemed to associate real estate ownership with a guaranteed path to becoming a billionaire. Just look at those fancy yachts Carlton Sheets has in the commercials!

 

[8744]

...In all honesty, the med school is probably way better. I did that useless FOCUS program freshman year, and some of my most favorite teachers during all four years were faculty at the medical school.

You cannot trust any organization larger than your family. Sometimes you can't even trust your family but you get the point. I don't mean that you shouldn't go to Duke Medical School or that you need to live in fear your whole life, only that you cannot expect loyalty or help if you in any way endanger the jobs, money, emotional wellbeing, or standing of bureaucrats.

Here's another annoying story about Duke. As many of you know, to start working there as a resident you have to fill out a whole bunch of paperwork and sign numerous statements attesting that you can be fired for yelling racial epithets, molesting patients, harrassing other employees and all manner of other things that used to be common sense before our society became so litigious. You also need to view some online material and get "certified" in various Joint Comission things like hand washing. No big deal but the paperwork probably takes half a day to organize and submit.

You have to update all of this bureaucratic stuff every year. I filled it out originally at the end of June during orientation and my quit date was one day later the next year. As my quit date approached I started getting the usual polite reminders to fill out all of this stuff. I called the GME office and pointed out that I was leaving the day after all of this stuff expired and that it didn't really make sense to waste my time getting it completed against the possibilty that for one day, I might be out of compliance with the hospital's ass-wiping guidelines.

No dice. The bureaucracy is so inflexible that the tought of me not wasting my time doing this crap was unthinkable. And it is crap. The hospital only has it so they have some ammunition to cover themselves if you screw up, something it will not do because the first thing the lawyer is going to wipe his ass with when he sues the hospital are your certifications of completion for the usual sensitivity training. Such is the talismanic power of paperwork however that it becomes an end in itself and you have to pretend it means something or suffer the wrath.

So I suggested that rather than fill it out, I'd just quit a day early and so irate did my program become at my rebelious nature that I was forced to quit two weeks early instead. (Which was fine actually because the last time I walked down the tunnel and drove out of the parking garage was one of the happiest of my life.)

Bureaucracies have no love for you. The fact that I had spent a year faithfully discharging my real duties made no difference whatsoever.

 

[Ginzo]

Bureaucracies have no love for you. The fact that I had spent a year faithfully discharging my real duties made no difference whatsoever.

It's true. When I started at my current job they delayed my benefits by an entire month because I forgot to sign my middle initial on the paperwork. Since my signature didn't match the name I used when I applied, they sent the forms back to me and made me correct the signature. But they only process benefits once per month. So, I had to wait another month just to get health insurance and what not.

And now, 8 years later, I'm watching them try to hold people to their BS non-compete agreements even though they're undergoing massive downsizing. They want to have it both ways: Not give you a paycheck anymore while still telling you what you can and cannot do.

 

[8744]

It's true. When I started at my current job they delayed my benefits by an entire month because I forgot to sign my middle initial on the paperwork. Since my signature didn't match the name I used when I applied, they sent the forms back to me and made me correct the signature. But they only process benefits once per month. So, I had to wait another month just to get health insurance and what not.

And now, 8 years later, I'm watching them try to hold people to their BS non-compete agreements even though they're undergoing massive downsizing. They want to have it both ways: Not give you a paycheck anymore while still telling you what you can and cannot do.

Thus the importance of a tight legal contract acceptable to and clearly understood by both parties.

 

[8744]

Excellent. How are you supposed to live with no salary? Not that your parents should have to support you, but mine couldn't even if they wanted to.

This is not the hospital's problem. And, if you peruse other threads in the pre-allo forum where numerous SDN members profess such a love for this mother****er (medicine, I mean) that they will be happy if they only make $80,000 per year (or some other arbitrary number that seems like enough), you can see that there are plenty of young medical students who would think that a miserly $20,000 per year or less as a resident would be enough.

After all, they can eat for free at the hospital and will spend most of their time there anyway.

 

[Ginzo]

This is not the hospital's problem. And, if you peruse other threads in the pre-allo forum where numerous SDN members profess such a love for this mother****er (medicine, I mean) that they will be happy if they only make $80,000 per year (or some other arbitrary number that seems like enough), you can see that there are plenty of young medical students who would think that a miserly $20,000 per year or less as a resident would be enough.

After all, they can eat for free at the hospital and will spend most of their time there anyway.

Kind of sad. Even if they started making the residents pay tuition on top of the money the government gives the hospitals they'd still claim that they lose their shirt on training residents.

 

[MilkmanAl]

Nobody refers to debt in that fashion. When you owe 200 grand on a house, you don't say, "I'm 600 grand in debt." Even though that's closer to what you'd actually pay over 30 years or whatever.

Med school is a unique situation, though. For those of use who'll have prohibitive interest payments, paying on the loans during residency, let alone med school, is pretty much impossible. Consequently, my loans will accrue an additional 4 years of interest before I can even reasonably think of paying them off. I'll probably be roughly 350K in debt by the end of med school, interest included, so that'll easily ratchet up into the 400k+ range by the time I'm practicing. Good thing I'm interested in high-paying specialties or I'd be totally screwed.

 

[Ginzo]

I'll probably be roughly 350K in debt by the end of med school, interest included, so that'll easily ratchet up into the 400k+ range by the time I'm practicing. Good thing I'm interested in high-paying specialties or I'd be totally screwed.

You know this conversation is making me thank my lucky stars that I didn't get into the private school I was lusting after. And that I'm fortunate enough to be paying for a lot of my state school tuition out of pocket while my wife pays the living expenses.

 

[HanginInThere]

Whoa. That's only because people don't think. That 600,000 you will pay over the course of a twenty-five year mortage is real money, don't kid yourself.

Sure it's real money, but when people talk about how much money they have or how much they owe, they talk about the current assets/debts, not what it will end up being in the end.

If I put ten dollars in the bank that I'm planning on leaving in for a year, I have $10... not $10.40 or whatever.

If I spend $20 with my credit card and plan on paying the minimum balance every month until it's gone, I owe $20... not $80 or whatever.

If I buy $100K worth of savings bonds, I have $100K today... not the $200K they'll be worth when they mature.

And if I borrow $200K to buy a house or go to med school, I'll owe $200K on my house or in student loans, not the ~$400K it will end up costing me by the time I've paid it off.


neuro1617's point that owing a ton of money makes it that much harder to survive with no income is totally legitimate, but talking about "already being .5 M $ in debt from medical school" is either (a) way more than most people end up owing or (b) inacurately counting future interest as part of the debt.

I see that elwademd and Floptometrest have assumed (b), but neuro never clarified the statement.

 

[prettymonkey]

this might be a super stupid question. why do they say that it costs such a ridiculous amount of money to train someone to become a doctor? where does my $40,000 a year in tuition go? and then there is what was pointed out about the institution getting paid like $130,000 a year per resident and only paying the resident $40,000. so 4 years of med school + 3 years residency is at least a half a million into someone else's pocket at the expense of the medical student/resident. what am i missing? why is it so expensive for the institutions to train someone to be a physician when we are paying so much?

 

[LucidSplash]

Sure it's real money, but when people talk about how much money they have or how much they owe, they talk about the current assets/debts, not what it will end up being in the end.

At issue is the contention that, regardless of how people usually talk about assets/debts,it is far better to consider the actual cost of such things. Too many people of my generation (I'm 26) only consider the monthly payment when making financial/budgeting decisions. The contention is that this isn't very wise because it fails to take into account what you are costing yourself in interest.

It is good for us to discuss the actual cost of such things precisely because people usually do not talk about it in this way and many people are clueless of what the "real" costs are.

 

[thebeatblitz]

If I spend $20 with my credit card and plan on paying the minimum balance every month until it's gone, I owe $20... not $80 or whatever.

And if I borrow $200K to buy a house or go to med school, I'll owe $200K on my house or in student loans, not the ~$400K it will end up costing me by the time I've paid it off.

I don't think you understand how any of this actually works.

 

[MilkmanAl]

My point is that while I'll take out, say, $200k worth of loans for med school, I'll have 4 years of 8.5% interest accrued on that before I can start paying off the loans. I'm not factoring in how much I'll pay over the life of the loan. I'm talking about what my principal balance will be when I start payments.

 

[wisconsindoctor]

My point is that while I'll take out, say, $200k worth of loans for med school, I'll have 4 years of 8.5% interest accrued on that before I can start paying off the loans. I'm not factoring in how much I'll pay over the life of the loan. I'm talking about what my principal balance will be when I start payments.

Pay your balance the first of every month. It helps.

 

[Jolie South]

this might be a super stupid question. why do they say that it costs such a ridiculous amount of money to train someone to become a doctor? where does my $40,000 a year in tuition go? and then there is what was pointed out about the institution getting paid like $130,000 a year per resident and only paying the resident $40,000. so 4 years of med school + 3 years residency is at least a half a million into someone else's pocket at the expense of the medical student/resident. what am i missing? why is it so expensive for the institutions to train someone to be a physician when we are paying so much?

i've been wondering the same thing. i can sort of see where the med school tuition goes. there's obviously a need to hire faculty/support staff, but for residency where does the extra money go?

 

[HanginInThere]

I don't think you understand how any of this actually works.

I've got a mortgage. Believe me, I understand how all of this works. It's a question of language, and what I owe is a different thing than what it will cost me to pay back what I owe by the time I'm done.

If you're working with MilkmanAl's point that when you finish your training and start paying back the med school loan you've got a bigger balance because interest has been added to it, I've got no argument with that - at that point you will owe the inital loan plus the interim interest.

But if you're saying that at the end of residency you owe all that money PLUS the future interest you'll have to pay over the lifetime of the loan, I'm going to disagree with your terminology.

 

[MilkmanAl]

Uh...if my current payments weren't about twice as much as I earn, I'd think about it. Deferrals, go!

 

[neuro1617]

Sure it's real money, but when people talk about how much money they have or how much they owe, they talk about the current assets/debts, not what it will end up being in the end.

If I put ten dollars in the bank that I'm planning on leaving in for a year, I have $10... not $10.40 or whatever.

If I spend $20 with my credit card and plan on paying the minimum balance every month until it's gone, I owe $20... not $80 or whatever.

If I buy $100K worth of savings bonds, I have $100K today... not the $200K they'll be worth when they mature.

And if I borrow $200K to buy a house or go to med school, I'll owe $200K on my house or in student loans, not the ~$400K it will end up costing me by the time I've paid it off.


neuro1617's point that owing a ton of money makes it that much harder to survive with no income is totally legitimate, but talking about "already being .5 M $ in debt from medical school" is either (a) way more than most people end up owing or (b) inacurately counting future interest as part of the debt.

I see that elwademd and Floptometrest have assumed (b), but neuro never clarified the statement.

I wasn't talking about just the flat out cost of medical school but the amount you're going to have paid when it's all said and done. I get this number from people who come to my school to talk about their med school and the costs of a medical education...but does it really matter if I did overshoot the number? The exact cost is irrelevant-the point is we're all going to have a large amount to pay back, which is difficult if you are essentially jobless until your 30's.

 

[Excelsius]

This is not the hospital's problem. And, if you peruse other threads in the pre-allo forum where numerous SDN members profess such a love for this mother****er (medicine, I mean) that they will be happy if they only make $80,000 per year (or some other arbitrary number that seems like enough), you can see that there are plenty of young medical students who would think that a miserly $20,000 per year or less as a resident would be enough.

After all, they can eat for free at the hospital and will spend most of their time there anyway.

There's the problem. How can we expect to have great doctors in this country when they are being screwed for eight or more years before they even become a doc? There must be a huge psychological impact and that would explain why some doctors have terrible attitude problems or have that god-complex. To survive through all this garbage one really might have to be almost god-like.

I am certainly glad that I saved a lot of money at a CC. I will be more careful now before deciding to transfer to a state school or an expensive university. Some residencies last for seven years (neurosurgery). If the salaries are reduced or removed altogether, the only students who can afford to go through med school will be people who are coming from wealthy families.

Panda, do you think universal healthcare is going to have a negative impact on residencies or doctors in general? The system seems to be pretty bad already and maybe some intelligent government oversight might help the situation.

 

[SketchLazy]

I am curious to hear more from Law2doc on this. I don't understand the inability to unionize.

I also want to know why it is that residents can't unionize. What is the reasoning behind the laws that prohibit them from doing this? It can't be patient safety because patient care techs have unions and they are responsible for patient safety also.

It seems like hospitals validate their treatment of residents by saying that it's all part of training, so residents get the shoddy pay, the crappy hours, and now possibly the reduction or withdrawal of benefits. But when you look at the rigor of the training and the responsibilities of residents, they clearly do an intense amount of work that should merit certain employment rights. In what other field is training 3-7 years with such a heavy burden?

 

[sunny1]

i've been wondering the same thing. i can sort of see where the med school tuition goes. there's obviously a need to hire faculty/support staff, but for residency where does the extra money go?

it goes to the "free" lunches.

 

[Gut Shot]

This all stems from a fairly long, complex, and often contradictory series of court battles involving residents, graduate students, and taxes. Well, ostensibly it involves taxes.

You can find a lot more information online, such as here (which has a particularly insightful comment), here, here, here, here and here.

 

[45408]

it goes to the "free" lunches.

I'm gonna eat so much hospital food that it'll effectively double what they're paying me.

 

[ColKurtz]

I also want to know why it is that residents can't unionize. What is the reasoning behind the laws that prohibit them from doing this? It can't be patient safety because patient care techs have unions and they are responsible for patient safety also.

This may be way off but the way its been explained to me is that every individual doctor is considered an autonomous business, so doctors can't unionize because this would create a monopoly.

 

[Doctor J]

Horrendous, unfair, almost criminal. But if they can get away with it they will.

Sigh.

To answer the question about government funded universal healthcare somehow fixing this problem, the government already funds GME. If a hospital can get away with treating a resident as a student and thereby save a couple thousand a year, they will, regardless of government oversight (or, to be more accurate, lack thereof).

My wife was so mad upon hearing this possibility, it was quite surprising. I guess she's looking forward to a positive income almost as much as I am.

 

[DoctaJay]

This all really baffles me. Most residents are paid around $50,000, and most fellows don't make more than $65K/year. While nurses easily pull in $70K a year. I'm not sure of the salary for PAs, CRNAs, respiratory techs, etc., but I'm sure they are making a pretty penny too..probably close to $50,000/year. Why in the world would they go after a resident's salary?

Well heck, even if they stop paying the benefits, thanks to EMTALA, we will still be able to get some healthcare .

 

[Ginzo]

Why in the world would they go after a resident's salary?

Easy prey. Screw the mid-levels over too much and they'll just get new jobs.

 

[Mr Cookie Pants]

So I spoke to my dad about this and his input as a former gas man/current financial planner was:

a) they had to pay for health care back in his residency (when in 1980 they made 11k a year)
b) classification as students makes residency 'pay' a stipend. Since you're a student receiving a stipend, there should be better tax breaks. Who knows, the resident might come out ahead here.

 

[Nilf]

Med students and residents have no power in the system. They are pawns, and the storm clouds are gathering (rising tuition and student debt, increasingly unfavorable loan terms, and declining physician compensation).

And since there is no shortage of applicants for the available med school seats, nobody who has the power really gives a damn about our concerns.

You've nailed it. Whether you like it or not, medicine is business just like any other, ruled by supply and demand. Only when the applicant pool start drying out, society will start to take notice.

Look what happened to the applicant pool for general surgery and family practice. Much has been written and blogged on why that happened and what to do about it.

 

[notdeadyet]

Hey, Panda- Another thought on your reclassification?

I have a hunch that a big motivator for your residency program is that by reclassifying Residents to Students, you are no longer protected by the 80 hour/week limit. That law does not apply to students.

I'd guess one of the main reasons for a residency program to make that move is to allow them to go back to unlimited hours. Just a thought.

Regardless, my condolences...

 

[8744]

...The bureaucracy is so inflexible that the thought of me not wasting my time doing this crap was unthinkable. And it is crap. The hospital only has it so they have some ammunition to cover themselves if you screw up, something it will not do because the first thing the lawyer is going to wipe his ass with when he sues the hospital are your certifications of completion for the usual sensitivity training. Such is the talismanic power of paperwork however that it becomes an end in itself and you have to pretend it means something or suffer the wrath...

As an addendum, I hope you all realize that all of the compliance paperwork, diversity affirmations, and the like serve only one purpose, namely making it easier for your hospital (or any organization) to throw you to the wolves when the time comes.

 

[8744]

Hey, Panda- Another thought on your reclassification?

I have a hunch that a big motivator for your residency program is that by reclassifying Residents to Students, you are no longer protected by the 80 hour/week limit. That law does not apply to students.

I'd guess one of the main reasons for a residency program to make that move is to allow them to go back to unlimited hours. Just a thought.

Regardless, my condolences...

It will not affect me in the slightest. I have a contract for the 2008-2009 residency year.

The 80-hour work-week is not a law (except in New York). It is an ACGME guideline and, student or not, residency programs that violate it can lose their accreditation.

 

[45408]

This all really baffles me. Most residents are paid around $50,000, and most fellows don't make more than $65K/year. While nurses easily pull in $70K a year. I'm not sure of the salary for PAs, CRNAs, respiratory techs, etc., but I'm sure they are making a pretty penny too..probably close to $50,000/year. Why in the world would they go after a resident's salary?

Well heck, even if they stop paying the benefits, thanks to EMTALA, we will still be able to get some healthcare .

Well, they could easily cut nurses' salaries. What with this job surplus and all, they would never find another job. Ha ha. If my wife's salary took a pay cut, they'd lose an employee, and she'd have a new job in under a week.

Residents are fish in a barrel. What are you going to do when they start shooting? Find a different residency? Good luck with that.

 

[45408]

As an addendum, I hope you all realize that all of the compliance paperwork, diversity affirmations, and the like serve only one purpose, namely making it easier for your hospital (or any organization) to throw you to the wolves when the time comes.

Hey, we told him not to say that word, but he did, so kill him first.