My intern hourly income this month...

[excalibur]

$7.50

Awesome...I was bored and figured it out. What's sad is I know that's more than some of the tallies out there...so let's hear them.

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[LostTommyGuns]

I just wrote a thought provoking e-mail about nurses making notably more than me and the government taking an inappropriate amount of my $$$, but SDN logged me out prior to posting...

Anyway this month has been good: $8.50/hr

 

[coprolalia]

We, as residents, are only allowed to work an 80-hour week, according to ACGME regulations (unless you are a Neurosurgery resident, where there is an 88-hour per week exemption).

These are the actual regulations:

Duty hours are defined as all clinical and academic activities related to the program; i.e., patient care (both inpatient and outpatient), administrative duties relative to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled activities, such as conferences. Duty hours do not include reading and preparation time spent away from the duty site.

1. Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.
2. Residents must be provided with one day in seven free from all educational and clinical responsibilities, averaged over a four-week period, inclusive of call.
3. Adequate time for rest and personal activities must be provided. This should consist of a 10-hour time period provided between all daily duty periods and after in-house call.

http://www.acgme.org/acWebsite/resInfo/ri_OSHAresp.asp

There are 13 four-week (13 weeks x 4 = 52, and 52 weeks x 7 days = 364 days) periods during the calendar year. Each week has 168 hours (7 days x 24 hours). You are only allowed to have, during a four-week block, 80 hours of duty on average during that month. If they screw you one week, they gotta make it up to you the next. Them's the rules.

Furthermore, you must be given 10 hours of "me" time after each day and between calls. In other words, the minimum amount of time you are given, by the regulations, after you take call or when you go home for the day is 10 hours (e.g., if you go home from the hospital at 8:00 PM, you can't be expected to show-up again next morning for work until 6:00 AM). Many, many programs violate this, I know.

So, the maximum number of hours you can work during that 4-week block is 320 (80 hours x 4 weeks = 320 hours). Remember, you have to get at least 10 hours after duty, and you still need to get 4 days off during that month. Still, if you worked 80 hours per all thirteen blocks in that year, you'd work 4,160 hours - and that would only be if you got no vacation. Most programs give 3 or 4 weeks of vacation per year. A vacation is usually seven days, although many programs will give you the weekend before and after that vacation as well. Nonetheless, if you get 4 weeks of vacation, you have to subtract out 320 hours (those 80-hour weeks x 4 weeks you didn't have to work) for a total number of hours per year equaling 3,840. It's 3,920 hours worked in a year if you only get three weeks vacation.

In other words, on average, if you are working out your hourly wage to $7.50 per hour during a "worst-case-but-by-the-book" scenario (80 hours every week and only three weeks of vacation per year), you are only making $29,400 per year. So, you are either in a residency program that grossly underpays its residents, or your program is violating the 80-hour work week regulations as written.

Which is it?

Personally, I "averaged" between $12.50 and $14.50 per hour, when I last worked it out (which was some time ago). It's a pittance. But, it's residency. And, residency sucks. I guess it's called paying your dues or some **** like that. The only dues I'm paying right now are to Sallie Mae, and she's a cruel mistress. If you want to factor that out of my salary, I'm making about as much as an illegal migrant worker picking onions in the New Mexico sunshine. But, at least he gets to enjoy the blue sky and fresh breeze...

-copro

 

[LostTommyGuns]

We, as residents, are only allowed to work an 80-hour week, according to ACGME regulations (unless you are a Neurosurgery resident, where there is an 88-hour per week exemption).

...

In other words, on average, if you are working out your hourly wage to $7.50 per hour during a "worst-case-but-by-the-book" scenario (80 hours every week and only three weeks of vacation per year), you are only making $29,400 per year. So, you are either in a residency program that grossly underpays its residents, or your program is violating the 80-hour work week regulations as written.

...

Personally, I "averaged" between $12.50 and $14.50 per hour

Good points - I won't comment on the 80 hour rule... people know when it's followed and when it's not.

Unfortunately you neglected to account for the fact that we calculated it (or at least I did, and I'm betting Excalibur did too) by taking our monthly take home pay (post income, social security, etc.) and dividing it by the hours we worked in a month... therefore it'll be roughly 25-30% lower than your calculation. ($29,400 post tax = $39,200 pre-tax). We can argue semantically about whether we "earn" the money that the government takes away from us before we ever see it but at least you know how we calculated...

On second thought - I sure hope that's the way excalibur calculated it...

Additionally the ACGME accepts 4 days off per month (versus 4 days per 4 weeks) which means we get four less days off than your calculation... Not a signif. diff but worth noting.

 

[excalibur]

There are 13 four week blocks in a year, but some residencies don't go by 4 week blocks, they go by monthly blocks. Each month (except non-leap year Feb) has 4 weeks and change. May has 4 and 3/7 weeks to it. The rule does state that you have to work 80 hours averaged over 4 weeks. I really don't know how that factors into a month block....which 4 weeks do you average it out over? Do you leave out the first 3 days of the month or the last 3 days? What I do know is that for 4 and 3/7 (4.4285714) weeks you are on one service. If during the time on that service you work an AVERAGE of 80 hours/WEEK, then the max hours you can work in that month is 354 (80 hours/week x 4.4285714 weeks/month).

 

[GSresident]

Interesting discussion.
I was an intern before the 80 hour workweek. Using my pre-tax and pre-deductions income, my hourly rate was $6.60. Not bad!

 

[badgas]

This month on wards, I'm getting about $10/hr. Next month on a rads elective, I will be banking about $325/hr... gotta love 2 hr work weeks Just ONE more 30 hr medicine call left!!! I'm like a 5 year old the night before christmas.

 

[coprolalia]

This month on wards, I'm getting about $10/hr. Next month on a rads elective, I will be banking about $325/hr... gotta love 2 hr work weeks Just ONE more 30 hr medicine call left!!! I'm like a 5 year old the night before christmas.

That's the whole point. You have some months where you work extra hard and long (that's what she said), and others that are relatively a cakewalk.

===================================================

To take a worst case scenario, let's use the followng example:

One 31-day month, say March, where you're busting your hump and completely pegged right at the 80-hour workweek regulations. Let's say that your program pays you a paltry $36,000 per year (which I don't know many, if any, programs that still pay that low... but let's assume).

You have 31 potential work days. Subtract your four guaranteed days off. Now you're talking 27 work days, as stated above (including your mandatory 10-hour "break" time between shifts). That's 3.86 work-weeks in that month. If you work the full 80 hours each week, you've put in 308.8 hours that month.

Your annual salary is $36,000. One month's salary is, therefore, $3,000 before taxes. Simply dividing $3,000 by 308.8 gives you an hourly wage of $9.72/hour. That's still pathetic, don't get me wrong. But, most programs I've seen these days pay even their interns $40K+ per year starting out. (I'm happy to look at specific examples otherwise.)

Even factoring in taxes, you still make more than $7.50/hour because of the tax bracket you're in. Uncle Sam does not take 33% of your wage when you're making $36k per year. Even if you're single with no dependents, your federal income tax on $36k is $5,430, or 15%. And, that's before your self-exemption. If you subtract out that 15% from your hourly wage, you still come up with $8.26/hour.

Again, if you're telling me you're only making $7.50/hour, I say that you are either severely underpaid on a yearly basis by your program, or you are grossly violating the work-hour rules. Maybe more simply you are just exagerrating on an anonymous Internet forum for effect. Or, maybe you're just really bad at math.

-copro

 

[coprolalia]

The PGY- 1 level stipend for 2008-2009 is $44,250.

http://www.uams.edu/gme/benefits.htm

-copro

 

[dhb]

About 10€/hr which in today's dollars = almost 16$ whoo hoo i'm rich.
factoring in moonlighting i'm up to 13€/h but with restricted free time

 

[excalibur]

...One 31-day month, say March, where you're busting your hump and completely pegged right at the 80-hour workweek regulations. ...

You have 31 potential work days. Subtract your four guaranteed days off. Now you're talking 27 work days, as stated above (including your mandatory 10-hour "break" time between shifts). That's 3.86 work-weeks in that month. If you work the full 80 hours each week, you've put in 308.8 hours that month.

Your annual salary is $36,000. One month's salary is, therefore, $3,000 before taxes. Simply dividing $3,000 by 308.8 gives you an hourly wage of $9.72/hour. That's still pathetic, don't get me wrong. But, most programs I've seen these days pay even their interns $40K+ per year starting out. (I'm happy to look at specific examples otherwise.)

...

Again, if you're telling me you're only making $7.50/hour, I say that you are either severely underpaid on a yearly basis by your program, or you are grossly violating the work-hour rules. Maybe more simply you are just exagerrating on an anonymous Internet forum for effect. Or, maybe you're just really bad at math.

-copro

Ouch! Feel like copro's attacking me, going so far as to check my salary...YIKES! It's OK copro, no hard feelings. Let me double check my math...

I don't think 308.8 max TOTAL HOURS for a 31 day month is correct.

I think where we're disagreeing is how to calculate how many work hours you can work in a month.

I'm not sure why you're subtracting your days off. The ACGME counts your day off as part of the work week. This is the key point. The max ACGME work week is essentially 80 hours AND a 24 hour off day, so your off days are included, not subtracted. I see you say you have 31 potential work days and then you subtract your days off (4) to get 27 and then you calculate your work weeks (divide by 7) to get 3.86 work weeks. Then you multiply by 80 to get TOTAL HOURS FOR THE MONTH. I'm just not sure if that's right. You just turned a 31 day month into a 27 day month doing it that way. I may be wrong, but let's see....

Let's pretend that a special month (Excalibury) of the year has 35 days in it, and 7 days is still a week. All the ACGME rules apply (80 hour work week, mandatory day/week off, etc). That month has 5 weeks in it. If you work 80 hours per week in that month, the TOTAL HOURS FOR THE MONTH is 400

What you're saying is that in Excalibury (35 days), you're guaranteed 5 days off. True. Now you say, there are only 30 days that you can work. True. Now, what you're doing is dividing 30 by 7 to figure out the work weeks and then multiplying by 80 hrs/wk to find out the TOTAL HOURS FOR THE MONTH. I just don't think that's correct. Let's see. So for my 35 day month example you're saying there are 30 work days (b/c 5 you get off) divided by 7 comes to 4.29 work weeks that month. 4.29 x 80 hrs/week is 343 TOTAL HOURS FOR THE MONTH by your method. Again, I just don't think that's correct.

OK, now let's dive into Excalibury some more. Let me log my hours in Excalibury to show that you can work 400 hours and meet the ACGME criteria. Excalibury 1 falls on a Sunday and there are 5 full weeks in Excalibury. Let's fill out the calendar where you do a 30 hour call on Sunday and Wednesday each week, and you have Saturday off.

Sun 1 = 7a-midnight = 17 hrs
Mon 2 = Midnight-1p = 13 hrs
Tue 3 = 7a-5p = 10 hrs
Wed 4 = 7a-midnight = 17 hrs
Thu 5 = Midnight-1p = 13 hrs
Fri 6 = 7a-5p = 10 hrs
Sat 7 = OFF = 0 hrs

That first week of Excalibury you worked 80 hrs without any ACGME violations. You do the above schedule for each week in Excalibury (5 weeks) and you worked 400 TOTAL HOURS FOR THE MONTH without any ACGME violations...not 343 hours.

To illustrate my point further, in a 31 day month, like May, you can work the above schedule for the first 4 weeks (28 days) of the month without violating any ACGME rules, had your off day/week, and you'll already have 320 hours with 3 work days to go. This already exceeds your calculation of 308.8 max hours in a 31 day month, and there are still 3 legal days to work in that month.

Bottom line, each day is 1/7th of a week. So to calculate max TOTAL HOURS FOR THE MONTH, just take the amt of weeks in a month and multiply by 80.

35 day month = 5 weeks x 80 hrs/week = 400 hours
34 day month = 4 and 6/7 weeks x 80 hrs/week = 388.6 hours
33 day month = 4 and 5/7 weeks x 80 hrs/week = 377.1 hours
32 day month = 4 and 4/7 weeks x 80 hrs/week = 365.7 hours
31 day month = 4 and 3/7 weeks x 80 hrs/week = 354.3 hours
30 day month = 4 and 2/7 weeks x 80 hrs/week = 342.9 hours
29 day month = 4 and 1/7 weeks x 80 hrs/week = 331.4 hours
28 day month = 4 weeks x 80 hrs/week = 320 hours
27 day month = 3 and 6/7 weeks x 80 hrs/week = 308.6 hours-->This is what you were getting for 31 day months

So again the max hours you can work in a 31 day month like May is 354. To calculate your hourly wage on a balls to the wall 31 day month, just divide whatever you got paid that month by 354. That is how I came out with $7.50/hr, and yes I had factored in my salary after taxes.

 

[coprolalia]

So again the max hours you can work in a 31 day month like May is 354. To calculate your hourly wage on a balls to the wall 31 day month, just divide whatever you got paid that month by 354. That is how I came out with $7.50/hr, and yes I had factored in my salary after taxes.

Not attacking you, just trying to keep it real.

You're right, though. You can work 80-hours in one week even with getting a day off, per your schedule (which is q3 call... to the max).

However, you can actually work 367 hours (technically) in one 31-day period, using your own calculations if you were actually stuck on a rotation that treated you like a complete farm animal... here's how... let's say that the month started on Sunday, the first... and you got every Saturday off... and they even punished you on the last day of the rotation and made you stay until midnight... because you weren't going to have to show-up until 10:00 AM the first day of the following month for your cushy radiology rotation....

Sun 1 = 7a-midnight = 17 hrs
Mon 2 = Midnight-1p = 13 hrs
Tue 3 = 7a-5p = 10 hrs
Wed 4 = 7a-midnight = 17 hrs
Thu 5 = Midnight-1p = 13 hrs
Fri 6 = 7a-5p = 10 hrs
Sat 7 = OFF = 0 hrs

80 hours

Continuing that schedule...

Sun 8 = 7a-midnight = 17 hrs
Mon 9 = Midnight-1p = 13 hrs
Tue 10 = 7a-5p = 10 hrs
Wed 11 = 7a-midnight = 17 hrs
Thu 12 = Midnight-1p = 13 hrs
Fri 13 = 7a-5p = 10 hrs
Sat 14 = OFF = 0 hrs

160 hours

Sun 15 = 7a-midnight = 17 hrs
Mon 16 = Midnight-1p = 13 hrs
Tue 17 = 7a-5p = 10 hrs
Wed 18 = 7a-midnight = 17 hrs
Thu 19 = Midnight-1p = 13 hrs
Fri 20 = 7a-5p = 10 hrs
Sat 21 = OFF = 0 hrs

240 hours

Sun 22 = 7a-midnight = 17 hrs
Mon 23 = Midnight-1p = 13 hrs
Tue 24 = 7a-5p = 10 hrs
Wed 25 = 7a-midnight = 17 hrs
Thu 26 = Midnight-1p = 13 hrs
Fri 27 = 7a-5p = 10 hrs
Sat 28 = OFF = 0 hrs

320 hours

Sun 29 = 7a-midnight = 17 hrs
Mon 30 = Midnight-1p = 13 hrs
Tue 31 = 7a-midnight = 17 hrs

367 hours

Technically, the GME office could argue that the last three days of the month falls into the next four-week average, and since you are going to be on that cushy radiology month working only two-hours a week, you have to roll that over into that average. (Which is why this four-week thing is kinda arbitrary and pointless anyway...)

So, you work your 367 hours that "month". We've established that you make somewhere around, oh, let's say $42,000 per year as a PGY-1 this year at your institution (I dunno what they're paying '07-'08... too lazy to look it up right now... but that seems reasonable). That's still $9.54 per hour.

And, that schedule is highly unlikely. In fact, if you worked every week like that for the entire academic year, and got no vacation, you would work 4,160 hours in that academic year without violating ACGME rules (don't know if they have to give you vacation). At $42,000 per year, which is reasonable, you're making $10.10/hr. That still sucks in an impressive way for the amount of education we have. But, averaging $7.50/hour is a mathematical impossibility unless as previously stipulated.

Therefore, I stand by what I said before.

-copro

 

[coprolalia]

(And, sorry, but you really lost me with that "Excalibury" stuff. I didn't even try to follow that logic.)

-copro

 

[coprolalia]

Furthermore...

There are 4,160 total available working hours (52 weeks x 80 hours) in one year (assuming that you have to "make up" for vacation time), per ACGME. If you work the 367 hours in that one calendar month, that has to come out of the total allotment for the academic year. So, now you're only left with 3,793 hours left to work during the rest of the year.

Divided over the subsequent 11 months, the maximum you can now work is 345 or 344 hours per calendar month (depending on how many days are in that month).

Because you made only $7.50 per hour during that high-volume month, your adjusted hourly rate for the subsequent months must be slightly higher, actually working out to about 6% more per hour if you work exactly 4,160 hours in that year, which is the premium fraction of hours "overworked" for that unusual month. If you worked less than that, your annual salary is even lower if you still calculate by the $7.50/hour rate, unless (of course) you are violating ACGME regs.

If you follow the ACGME rules absolutely to the letter, and you work those 367 hours in that one calendar month at $7.50/hour, your annual salary is only roughly $33,200. Again, if you worked less hours that particular month, your annual salary calculates even lower. That is, f you made $7.50/hour throughout the entire year, your annual salary would only be $31,200.

Sorry. I just ain't buying it. Most of us are averaging more than $10/hour these days, even during the worst months. It's still pathetic. No one can argue against that. I probably worked more like 3,100 hours in the prior academic year. For me, that averaged out, on the whole, to about $14.90/hr.

-copro

 

[excalibur]

"your annual salary would only be $31,200."

That's right. I've already stated that this is after taxes. $43000/year, but $31800/year after taxes and benefits. So for me, $10.12/hr this month pre taxes and benefits, $7.50/hr this month post taxes and benefits. Cool?

 

[excalibur]

"Technically, the GME office could argue that the last three days of the month falls into the next four-week average"

Yes, I don't know how they treat these extra 3 days. Their rules state "in a 4 week average" but there are mostly 2 to 3 days extra per month, so I don't know how those are treated.

 

[coprolalia]

"your annual salary would only be $31,200."

That's right. I've already stated that this is after taxes. $43000/year, but $31800/year after taxes and benefits. So for me, $10.12/hr this month pre taxes and benefits, $7.50/hr this month post taxes and benefits. Cool?

Well, I don't know how many people calculate their hourly rate after taxes and bennies, but that's the only way the math can work.

Fact is, most of us these days are not getting paid less than $10/hour to be in the hospital. The "woe is me"/"I'm barely making minimum wage" arguments aren't really true, and haven't been since the ACGME changed the rules. I know guys who did a prelim surgery year in 2004 before the change, and they were working about 110 hours/week on some rotations. Those guys had it bad....

-copro

 

[jetproppilot]

$7.50

Awesome...I was bored and figured it out. What's sad is I know that's more than some of the tallies out there...so let's hear them.

Went to Harrah's Friday....sat down at the 2-5 no limit table....3.5 hours later, walked out $643 ahead.

$183.71 an hour, plus free Corona. Not too shabby.

 

[badgas]

Went to Harrah's Friday....sat down at the 2-5 no limit table....3.5 hours later, walked out $643 ahead.

$183.71 an hour, plus free Corona. Not too shabby.

I'd take that over my rads rotation salary. You can't beat poker and free beer. Maybe I can switch my rads rotation to a Harrah's rotation. I have no doubt that it would be more useful.

 

[oudoc08]

It could be worse.

1. You could still be a med student, paying more than you're calculating per hour.

2. You could be roofing houses in Texas in July.


Those are the two thoughts I'll try to keep in mind for the next few years.

 

[Frank Rizzo]

You guys seem to have way too much time on your hands, so I'll throw something out there for you...

What if your an hourly worker, like the majority of lower to middle class Americans, and not paid a set salary? Then the issue of overtime comes in... The basic example being you ring the register @ the local grocery store for $6.75 an hour for the first 40 hours of the week, but if you go over 40 hours you get paid time and a half, which would be roughly $10.12 an hour for each additional hour you work over 40/wk. What would our base hourly salary be if we were hourly employees? I have a feeling that is where the 'minimum wage' comparisons come in.

 

[Dr Acula]

and that's what I made for the YEAR. No, my program was not compliant. I'm REALLY glad that's over. PGY-2? m-f 6a-3p, weekends off, no call, for the first two months