Newyorkgiants

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just wanted updates on moonlighting especially in the northeast.

Does your program allow it and how much do you get paid?
 

bigdan

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$200/hr? Hot damn. That's good locums money in the northeast for a board certified anesthesiologist!

At which program is $200/hr being paid? Or do you mean external moonlighting on your own license & malpractice?

UPMC ain't exactly northeast, but it was $60/hr for in-house moonlighting.

$200/hr...
 

urge

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$200/hr? Hot damn. That's good locums money in the northeast for a board certified anesthesiologist!

At which program is $200/hr being paid? Or do you mean external moonlighting on your own license & malpractice?

UPMC ain't exactly northeast, but it was $60/hr for in-house moonlighting.

$200/hr...
200/hr is crazy. They are likely losing money since they need to pay an attending to supervise on top.
 

anes121508

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oh no this is for fellows who can staff cases after their clinical duties as a fellow.

residency was 65 during the week and 75 on the weekend. 10$/hr to hold the pager from home.
 

AdmiralChz

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Most I've talked to around the east coast range from $ 50/hr on the low end to ~ 90/hr on the high end. Most seem to fall between 65-75/hr.

Maybe some above 100/hr I suppose, but 200/hr would be unusually high.
 
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leaverus

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$200/hr? Hot damn. That's good locums money in the northeast for a board certified anesthesiologist!

At which program is $200/hr being paid? Or do you mean external moonlighting on your own license & malpractice?

UPMC ain't exactly northeast, but it was $60/hr for in-house moonlighting.

$200/hr...
hot damn?
 

pgg

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oh no this is for fellows who can staff cases after their clinical duties as a fellow.
That's still really good. I got $170/h and $162.50/h and $180/h at my last three moonlighting jobs, and that was as a board cert attending carrying my own malpractice.

Fellows at my program now are offered $100/h.
 
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Promethean

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$200/hr? Hot damn. That's good locums money in the northeast for a board certified anesthesiologist!

At which program is $200/hr being paid? Or do you mean external moonlighting on your own license & malpractice?

UPMC ain't exactly northeast, but it was $60/hr for in-house moonlighting.

$200/hr...
$200/hr might be high (maybe) but $60/hr is insulting. There are OR travel nurses making that kind of money with just a 2 year RN degree. Figures it was UPMC. They underpay everyone they can.

In most industries, temporary /contract workers can extract a premium wage because they are filling an urgent need at less impact to the employer than hiring another full time employee and taking the long term commitments that entails.

Regular staff nurses (like circulating RNs) are able to make $30-40 in a lot of ORs, and contract / travel nurses can pull $40-60+ depending on supply and demand.

If you are only being offered $60 ish for WAY more responsibility, that is a rip off. CRNAs make more than that. It would certainly cost a lot more than that to hire another regular full time anesthesiologist to fill those hours. If you are good enough to do the work, you are good enough to be paid for it appropriately.
 
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Moonlighting at a community hospital outside of residency as house officer (as opposed to anesthesia). Job entails being the only physician in the hospital. Answering all pages : medical, surgical, codes, rapid response, etc. Since not doing anesthesia and working on your own license you need to have completed intern year. 80/ hour.

In house moonlighting doing anesthesia 80/ hour as a resident.

Moonlighting on an internal medicine service helping with notes on the weekend. 80/ Hr

My preference is anesthesia, then internal medicine, and lastly house officer. As I progress through training the less liability and responsibility the better. :)
 
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KaoticMessiah

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$200/hr might be high (maybe) but $60/hr is insulting. There are OR travel nurses making that kind of money with just a 2 year RN degree. Figures it was UPMC. They underpay everyone they can.

In most industries, temporary /contract workers can extract a premium wage because they are filling an urgent need at less impact to the employer than hiring another full time employee and taking the long term commitments that entails.

Regular staff nurses (like circulating RNs) are able to make $30-40 in a lot of ORs, and contract / travel nurses can pull $40-60+ depending on supply and demand.

If you are only being offered $60 ish for WAY more responsibility, that is a rip off. CRNAs make more than that. It would certainly cost a lot more than that to hire another regular full time anesthesiologist to fill those hours. If you are good enough to do the work, you are good enough to be paid for it appropriately.
bigdan was referring to the resident moonlighting rate at UPMC, which was $60/hr.
Attending rate is much higher than that.

This thread seems to be featuring two different sets of answers, one from attendings and one from residents.
 

Promethean

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I am saying that offering $60/hr for resident moonlighting is insulting.

There are CRNAs at UPMC making $85+/hr for their first 40, and then $125+ as overtime. They aren't going to have a resident replace hours that could be worked by a regular full time CRNA getting his or her 40 hours in. Moonlighting residents are filling shifts that would otherwise have to be filled by CRNAs on overtime. So, they are literally paying residents less than half the market value for those shifts. They are saving at least $65 per hour that you moonlight for them. Residents don't understand the value of their labor, and see an extra $500 as a substantial boon, making them ripe for exploitation.

If they hired enough CRNAs full time to eliminate the need for moonlighting / overtime shifts, they'd bear additional back end HR expenses. The organization would save those costs, plus the overtime rate increase, even if they paid the residents at parity with regular CRNA rates. By taking advantage of the fact that residents don't know their own worth, the organization is just double-dipping.
 

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Can't disagree that$60/hr isn't equal to what a CRNA gets, or that UPMC underpays. But what program pays the same as what a CRNA gets?

The market isn't what does the resident deserve, it's what will the resident work for. Just like the market for attendings. Those attendings that HAVE to live in a big city and get sub-$300k jobs aren't getting what they deserve, they're getting what they're willing to work for. You coulda told me about how much I'm getting boned on the $60/hr when I was a resident, and I still woulda worked it, because I wanted to keep putting something toward my debt each month, and buy my girl something nice for her birthday, etc.
 

Promethean

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Can't disagree that$60/hr isn't equal to what a CRNA gets, or that UPMC underpays. But what program pays the same as what a CRNA gets?

The market isn't what does the resident deserve, it's what will the resident work for. Just like the market for attendings. Those attendings that HAVE to live in a big city and get sub-$300k jobs aren't getting what they deserve, they're getting what they're willing to work for. You coulda told me about how much I'm getting boned on the $60/hr when I was a resident, and I still woulda worked it, because I wanted to keep putting something toward my debt each month, and buy my girl something nice for her birthday, etc.
I hear ya. I worked for UPMC as an OR nurse for $25/hr because I loved my job, I loved my coworkers, and I loved my patients. I tolerated that because I had extrinsic reasons to do so. It doesn't change the fact that I was getting boned, because they were paying traveller nurses to work right along side me for $45/hr plus a premium of probably $30+ on top of that rate to cover taxes, benefits, and profit for the agency. Since leaving, my inbox is stuffed full of offers to go back to work for $45-60/hr... including to go do my own old job. I've literally been recruited several times by different agencies to go back and fill my old position at twice what I was being paid, under better employment terms. The need has become more and more urgent as the pay is so substandard that they can no longer attract and retain sufficient experienced OR staff to meet their needs.

As you say, they were able to pay such low wages because there were people willing to work for those rates. But that is changing and now the predictable thing is happening, and they need to pay premiums to get shifts covered by bringing in temporary and contract labor. Apparently, they still believe that paying extra for temporary labor is cheaper than raising wages across the board to a level that would keep experienced staff on hand.

Thus, I've learned that the secret to being paid what you are worth is not to accept less. As long as there are doctors willing to work for as little as RNs, they will pay you less than they pay CRNAs for covering the same shifts.
 

SaltyDog

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Apparently, they still believe that paying extra for temporary labor is cheaper than raising wages across the board to a level that would keep experienced staff on hand.
This belief seems to be shared by every hospital management team in the country. Either they're all a bunch of re'tards (say it like in the Hangover) or they're onto something??
 

Promethean

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This belief seems to be shared by every hospital management team in the country. Either they're all a bunch of re'tards (say it like in the Hangover) or they're onto something??
What they are onto might not be what is optimal for patients and health care providers, but what is adequate for bottom lines. It is important to identify what the desired outcomes are, when judging whether they are being achieved. Even dysfunctional organizations are accomplishing what they are set up to do... it is just that they are set up to create negative outcomes, whether out of malicious intent or design flaws.

I don't dispute that it might make financial sense, at least from a short term perspective. However, they are missing opportunities for longer term team building and organizational development.

Also, it isn't as universal as you suggest. There are organizations that do compensate appropriately. I know, because I watched UPMC hemorrhage talent to those other opportunities, when they arose. You just don't see a lot of want ads posted by facilities that value their human capital, because they don't lose it as readily through attrition.
 

ranvier

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Can't disagree that$60/hr isn't equal to what a CRNA gets, or that UPMC underpays. But what program pays the same as what a CRNA gets?

The market isn't what does the resident deserve, it's what will the resident work for. Just like the market for attendings. Those attendings that HAVE to live in a big city and get sub-$300k jobs aren't getting what they deserve, they're getting what they're willing to work for. You coulda told me about how much I'm getting boned on the $60/hr when I was a resident, and I still woulda worked it, because I wanted to keep putting something toward my debt each month, and buy my girl something nice for her birthday, etc.
We were offered 50$/hr to moonlight on OB, exactly half the 100$/hr the crna's were being paid.

We all passed.
 
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Promethean

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We were offered 50$/hr to moonlight on OB, exactly half the 100$/hr the crna's were being paid.

We all passed.
Remember that you aren't competing against their straight $100/hr rate, but their$150/hr overtime rate, since they aren't going to fill shifts with residents if they already have full time CRNA staff that haven't reached their 40 hours. So, really, you would have been saving them $100 per hour if you'd taken the bait versus what they would have ended up having to pay the CRNAs who put in the overtime.

Girlfriend is a psych resident and she gets 140/hr to moonlight!
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This is much closer to the $100-120/hr that I've seen offered to FM & IM residents for moonlighting. This is why I can't fathom offering a specialty like anesthesia so little.
 

urge

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Speaking of moonlighting rates, how much do you think is fair for a single Saturday 8hr shift doing endo at a local place you have never been to? Assuming they cover malpractice.

Got an email from a head hunter not long ago. I had plans so I didn't reply but looking around it seems rates are 1.2 to 1.5 but I don't think I'll get out of bed for less than 2.
 
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ranvier

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Remember that you aren't competing against their straight $100/hr rate, but their$150/hr overtime rate, since they aren't going to fill shifts with residents if they already have full time CRNA staff that haven't reached their 40 hours. So, really, you would have been saving them $100 per hour if you'd taken the bait versus what they would have ended up having to pay the CRNAs who put in the overtime.



This is much closer to the $100-120/hr that I've seen offered to FM & IM residents for moonlighting. This is why I can't fathom offering a specialty like anesthesia so little.
I know the staffing situation better than you since I was there. It was a 12 hour shift with no overtime. As I posted, we were offered half the crna rate. They had no benefits either in this particular position.
 

Promethean

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I know the staffing situation better than you since I was there. It was a 12 hour shift with no overtime. As I posted, we were offered half the crna rate. They had no benefits either in this particular position.
It is true, I don't know your particular situation. I'm just quoting what I've seen. Certainly didn't mean to give offense.
 

AdmiralChz

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Our program (and most surrounding) haven't changed their moonlighting pay for 5, maybe even 10 years. As long as the slots are filled (and they always are), there is minimal incentive to do so. Plus we have between 5-8 shifts per weekend, which is pretty solid with a wide variety of options (ICU, OB, OR, blocks) so it's hard to complain too much. The less desirable shifts fill late, but eager CA-1s with kids usually end up snatching them up.

We have the option of moonlighting in the ER as well, every once in a while. These are usually 7P-7A shifts on the weekends and actually reimburse at a lower rate - fun to do once or twice a year.

Do not know of a single resident around here that does external moonlighting through a different institution, there is more than enough present without needing to go outside.
 

Laryngophed

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There is also the worry that moonlighting isn't as optional as it seems. Push back too much and refuse to work for what they are offering and suddenly your program has a new mandatory call shift to cover without the benefit of the pay being offered.
 

urge

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Resident pay, in general, is insulting...not just moonlighting.
You have to consider that residents are extra clumsy and have most of the complications. Ie., dropped the central line wire, opened the wrong kit, dropped the spinal needle, opened 3 drugs that will never be used for the case, put 3 BIS stickers on same patient, let the vaporizer run dry and then push 5 of versed hoping there is no awareness, dislodged arytenoid during intubation....

An old anesthesiologist I know says that once they got rid of the residents in his hospital the complications became very rare.

If government were not involved in fixing resident salaries, we would know the real market value of a resident.
 

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You have to consider that residents are extra clumsy and have most of the complications. Ie., dropped the central line wire, opened the wrong kit, dropped the spinal needle, opened 3 drugs that will never be used for the case, put 3 BIS stickers on same patient, let the vaporizer run dry and then push 5 of versed hoping there is no awareness, dislodged arytenoid during intubation....

An old anesthesiologist I know says that once they got rid of the residents in his hospital the complications became very rare.

If government were not involved in fixing resident salaries, we would know the real market value of a resident.
Those examples do not apply to the vast majority of the residents in a hospital. What kind of medical waste is a psychiatry resident creating? Residents are utilized as a labor force. That is a fact. They are not paid at an equal rate as other "practitioners," while doing a higher volume of more difficult work. They have to learn on top of performing these "clinical duties." Those mistakes you cited sound like CA1 errors. If a late year CA2 or CA3 is making those errors then there is a bigger problem.

As an aside, I have seen vastly more medical waste done by CRNAs than residents. When I'm supervising CRNAs and I go through the drawers while I'm giving a break, I find all sorts of unnecessary syringes and drugs drawn up, not to mention an ETT of every half size styleted with a syringe attached. Those all get thrown out at the end of every day.

Residents are grossly underpaid and that is a fact.
 

bigdan

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We were offered 50$/hr to moonlight on OB, exactly half the 100$/hr the crna's were being paid.

We all passed.
We were initially offered $50/hr, and many passed on that as well. They increased it to $60/hr, and we filled all the shifts available. I never even considered what an overtime CRNA would have made, because $60/hr was worth it to me.

Compared to CRNA or attending pay - or hell, plumber or electrician pay - it's not much money. But "worth it" means different things to different people at different times. When I was in residency, $60/hr was worth it. Straight outta fellowship, one of my co-fellows took a SoCal job making pediatrician money, and one took a job in rural Midwest that started at $600k, and would go up after partnership. Both are happy, and both say it's "worth it"...
 

urge

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Those examples do not apply to the vast majority of the residents in a hospital. What kind of medical waste is a psychiatry resident creating? Residents are utilized as a labor force. That is a fact. They are not paid at an equal rate as other "practitioners," while doing a higher volume of more difficult work. They have to learn on top of performing these "clinical duties." Those mistakes you cited sound like CA1 errors. If a late year CA2 or CA3 is making those errors then there is a bigger problem.

As an aside, I have seen vastly more medical waste done by CRNAs than residents. When I'm supervising CRNAs and I go through the drawers while I'm giving a break, I find all sorts of unnecessary syringes and drugs drawn up, not to mention an ETT of every half size styleted with a syringe attached. Those all get thrown out at the end of every day.

Residents are grossly underpaid and that is a fact.
I'm afraid that without the ACGME money psych residents might have even to pay to train since they don't lead to much revenue. That's my point. The market value is not playing a role due to goverment intervention.
 

GravelRider

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I'm afraid that without the ACGME money psych residents might have even to pay to train since they don't lead to much revenue. That's my point. The market value is not playing a role due to goverment intervention.
Until there are no more psychiatrists...

Healthcare as a whole is a false economy that doesn't follow typical economic rules. CMS pays for residents much as it pays a significant part of your income. CMS and the insurance companies could decide tomorrow that your anesthesia services are worth 25% of what they are today. Now let's take that example and use it for orthopedic surgeons. Actually, if you really like to put in joints, you have to pay for the pleasure. Your income and every other physician's income have nothing to do with the demand created by the customer (patients)...unless you are a cash-only concierge physician.
 

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FM resident here (use to be on the anesthesia forums as a med student but still come by here once in a blue moon).

For us $85/hr for urgent care on the weekdays. $100/hr on the weekend.

$100-125 for doing swing shifts (4-5hrs in the evenings) or admission shifts as a hospitalist.
 
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kazuma

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My program was $50/hr. I did ~375hrs from spring CA1 to spring CA3. Main OR cases, just showed up like a regular day of work, didn't have to be licensed or pay for own malpractice insurance. Pay sucked but it was better than nothing when I had small mouths to feed. There was a secret underground chief moonlighting gig at a vent farm that was passed along the chief chain. That paid 1000/night IIRC and was pretty low key but involved some risk especially when the management tries to keep patients when the moonlighter feel that they needed to be admitted to a hospital. I never did that gig.
 

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At my program, pay in the OR was roughly $50/hr. However, an extra shift in the ICU was $140/hr. That extra ICU shift was scary though, because the support at night was essentially nonexistent and the cticu had patients on ecmo, vads, post-transplant, etc. But that supplemental pay was so worth it.


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sigrhoillusion

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People have to realize that moonlighting rates at these large northeast programs are so low, cause the residents don't really have a choice. If nobody wants to pick up the weekend OB shift for $50/hr, then you will be PLACED on the OB weekend shift for $50/hr...

That being said, I know Jefferson was $50/hr for moonlighting certain shifts on the weekend, but they were planning on raising it (but I think they had been saying that for 5+ years...) Regardless, those shifts were always filled by requesting residents. And if you got a shift and somehow didn't want it, there were numerous residents willing to take it from you.
 

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Large northeast program, $100/hr to moonlight as resident
 

Mman

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We got something like $50 or $60 per hour for in house moonlighting in the OR. First come first serve for the shifts and they always filled voluntarily. When people are living on a resident salary, it's nice pocket change.
 

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On the rare occasion that we get to moonlight we get $65/hr. Still don't understand why we don't get the CRNA rate when we're doing sicker patients for bigger surgeries. It's a bunch of malarkey!


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Mman

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On the rare occasion that we get to moonlight we get $65/hr. Still don't understand why we don't get the CRNA rate when we're doing sicker patients for bigger surgeries. It's a bunch of malarkey!


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probably the same reason they get paid 6 figures and you get paid less than 1/2 for your normal work. Don't worry, you'll make it up down the road.
 

pgg

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Market forces. They pay residents crap because they can. It's no more or less complicated than that.

I wasn't allowed to moonlight as a resident but I sure would've snapped up hours for $50 per.

I'm not allowed to moonlight as a fellow now, but I probably wouldn't. I spend enough hours in the hospital already and the marginal utility of the extra income isn't worth it to me, today.
 

pjl

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Instead of moonlighting we just worked the hours without added pay...
50 bucks an hour is a lot better than that.


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kidthor

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Yeah - my residency just made us work more. Be thankful (?) that you even have the option to moonlight whether it's optional or not.

Why pay a CRNA anything when you can have a resident do the same work for free or better (we got to stock the anesthesia carts and do machine checks on off floor locations as an added bonus - for free).
 

GravelRider

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Market forces. They pay residents crap because they can. It's no more or less complicated than that.
Then technically these are not market forces at work here. There is nothing about resident or fellow wages (moonlighting or otherwise) that resemble anything near a free market that would be acted upon by market forces. The only way to describe how residents and fellows are paid is by price-fixing. There is no law of supply and demand here.
 

Foodie

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Instead of moonlighting we just worked the hours without added pay...
50 bucks an hour is a lot better than that.
Ditto. I remember attendings being apologetic when my day as a CA3 would foreseeably end late, as they were leaving for their golf games around 2pm. Of course these were the same guys who would tell stories about old days when they worked 90-100 hrs/wk as residents.
 

pgg

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Then technically these are not market forces at work here. There is nothing about resident or fellow wages (moonlighting or otherwise) that resemble anything near a free market that would be acted upon by market forces. The only way to describe how residents and fellows are paid is by price-fixing. There is no law of supply and demand here.
Sure there is.

The market has X residents and Y available hours to be worked.

The program has an offer to buy labor at a quoted rate Z.

If the hours are filled by residents volunteering for them, the rate offered is enough. If the hours aren't being filled, the program will either raise the rate offered, or make the work a mandatory part of the residency program.

Just because it's a buyer's market, or you don't like the market, doesn't mean there isn't a market. Of course there is.