New Ruling on the NRMP Lawsuit

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Originally posted by tofurious
whether you were personally offered packages is not a true indicator of whether these are common practices across the board.
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For the record, no one offered me special packages. The packages I listed were standard for all residents who matched at the program. The financial packages are as varied as the opinions on this forum. ;)

I have a question for you. What experience do you have with the residency selection process and various programs?
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As has been said before I don't see any increase in pay to residents based on having a voluntary match. The vast majority of programs that fill every year are probably still going to be offerring the same packages they were offering before. The weak programs that can't fill will often offer better deals such as the FP residency in Iowa which can't probably fill, but they were doing that match era anyways.

Another point to consider. Would you really want to be in a position where every resident could negotiate their own salaries and financial deals? How would you like doing the same amount of work and call as another resident, but because he was a superstar in medschool he is getting $20,000 more than you because you were just average joe med student. In the end every resident should be paid the same for doing the same amount of work or the will be major problems amongst the residents. If you want to do more work such as moonlighting that is fine, but I am not sure we really go down the other path.
 
Alright. At the risk of being an insurmountable pest, I'm reposting my theoretical scenario and question:

Final scenario:

Lawsuit successful, match becomes voluntary. Consequences:

1. Match becomes voluntary, applicants seek positions both in and out of the match without penalty.
2. As discussed above, the match outcome is essentially the same for both programs and applicants.
3. As discussed above, there is an added element of uncertainty.
4. As discussed above, there is NO increase in wages or benefits above normal inflation related adjustments (same as now).

Would NRMP-match supporters still oppose the suit if all the above turned out to be true? mpp? Andrew_Doan? Goober? 1996? Anyone else?

Just curious. All opinions welcome.
 
Hello everyone,

I am writing to you all in regards to your thoughts about the current NRMP match system and the way it is set up. As you know, there is a lawsuit going on against the NRMP and the NRMP is trying to save its ass with the "Save the match.org" website. This currently system favors the programs too much. Many program will talk to each other after the interviews are done and negotiate which students they want with another program and rank them in a way you are destined to go to that program no matter how you rank them. We as applicants dont know what really goes on behind the scenes, but I do have proof of this.

Another reason it should be abolished is that the NRMP is the "middle man" of this entire system. Medical students pay too much as it is for tuition and fees for boards exams, etc with practically no income. The applicant should have direct contact when it comes to acceptances/rejections with the institution instead of playing these "mind games" with each other. Also, the system should be set up the way fellowships/med school applications are currently. The programs should give an applicant an acceptance letter directly and it is up to the applicant to decide whether he or she wants to attend that place, cutting out the "middle man" or NRMP. If he doesnt accept, then the schools should look into their waitlist. It would save us money and swing the favor back towards the applicant in letting him make his own choice and destiny. These are just my opinions. Everyone has the right to theirs, but I wish someone would set up an organization and try to abolish the current match system. The system should be set up by medical students that favors medical students. After all, we are "cheap" labor when we become residents.

Residents: http://www.residentcase.com/
NRMP: http://www.savethematch.org/

Take the time to review the websites and familiarize yourself with the issues being addressed. The outcome of this decision will affect more than just the NRMP match (also being sued are close to 30 medical schools/hospital systems and all of the following bodies: AMA, AHA, AAMC, ACGME, ABMS). Moreover, it will set legal precedent, whichever way the verdit turns out.
 
Originally posted by tofurious
To Andrew: I didn't mean to be offensive, but I was responding to someone else's comments when you quoted me with "did you read my post?" That came across as accusatory, and I said NO.

Now that I've read your most recent post, I can almost say the same thing to you: did you read my post? I said that 1) the most prestigious places will not pay their residents more; and 2) there is competition at the best places for faculty even when their attending salary is very low compared to other places; what that does is to encourage people who are excellent academicians but who also need to make some $ to either pay back loan or support families to go somewhere else and make the non-Hopkins and non-MGHs better, which I think is good for medicine in general. And I was being half-sarcastic when I start using words like super stars. You made it sound like you asked for packages and therefore you were offered them. A systemic change should benefit both an MD-PhD from Hopkins and a MD from Wayne State, and whether you were personally offered packages is not a true indicator of whether these are common practices across the board.

mpp: you have obviously not seen some of the county programs where they are very often forced to take all FMGs to fill the spots, because of location. I think some of them would like to get more AMGs, and one way to do so is to offer the AMGs better overall packages to compensate for location/other shortcomings.

margaritaboy: opponents to the lawsuit are likely to still oppose the lawsuit, since that's what stern opponents do. They oppose.
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tofurious: you still don't get it. The type of competition among programs for applicants ALREADY exists. There is a very wide variety of salary level and benefit packages offered by different programs. A voluntary match will not drive the programs to change what they are currently doing. What Dr. Doan described in his post was not an exception. Many programs, especially lower tier programs or programs in less desirable locations, are already offering higher salary, extra benefits, and other perks to attract more applicants to rank them higher. Anyone who has gone through the match would know that all the benefits of the "voluntary match" that you described already exists under the current match.
 
Originally posted by yoman
Hello everyone,

I am writing to you all in regards to your thoughts about the current NRMP match system and the way it is set up. As you know, there is a lawsuit going on against the NRMP and the NRMP is trying to save its ass with the "Save the match.org" website. This currently system favors the programs too much. Many program will talk to each other after the interviews are done and negotiate which students they want with another program and rank them in a way you are destined to go to that program no matter how you rank them. We as applicants dont know what really goes on behind the scenes, but I do have proof of this.


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Well since you claim to have proof of programs colluding so that you are destined to go there no matter how you rank them, i would like to see your proof.

I worked pretty closely with my PD in selecting residents when I was a resident and at no time did I ever have the impression he was talking to the other programs to fix the system. Every year it was a surprise on match day how far we went down on the candidate list. Sometimes we were very surprised and other times we guessed pretty much on the money. I seriously doubt there is this huge conspiracy among all the PD in all the specialties for every residency program to get the applicants they want.
 
Originally posted by yoman

This currently system favors the programs too much. Many program will talk to each other after the interviews are done and negotiate which students they want with another program and rank them in a way you are destined to go to that program no matter how you rank them. We as applicants dont know what really goes on behind the scenes, but I do have proof of this.
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What's your proof, and what's your experience with this? At least for ophthalmology, it's always a surprise to the PD on match day.
 
With all the back and forth, I almost missed a question for me.

I had a really positive residency selection process. I was at or near the top of many of the residency programs' rank lists I interviewed at, so it came down to where I really wanted to go. However, as I cared less about the peripheral packages (every place had pretty decent health insurance - which I had rarely used in med school - and the book fund/travel fund added up to less than $5,000 at most places; PLUS the salary differences often reflect cost of living differences rather than large differences in pay - with the exception of Columbia who grossly underpays its residents compared to other NYC programs), I was more concerned about the generally low salary of residents across the board than where I was going to end up per se. (I have a laptop I love, and I don't really believe in a PDA personally) I was offered a job starting at $80,000 out of college in 1994, and many of my friends with liberal arts degrees -- thus not too much marketable skills -- have jobs paying at least $50,000 a year. Thus, I tend to believe that trainees or not ("not" according to the labor board and the IRS), we have put aside lucrative offers to pursue this career and we provide a service that is worth so much more than what we are compensated for. The NIH took 40 years to finally realize that the post-doc salary should be more than just a stipend - it should be such that it is the sum of a stipend to support the "trainee" (without a post-doc, it's hard for a PhD to get a job - similar to residency?) and his/her family (given many people in the business of delayed gratification begin to have families long before they get their first real job) AND an opportunity cost making up some of the difference in what the post-docs would have made elsewhere such that the qualified candidates are willing to stay in science and the smart college grads are willing to enter into science. Obviously, similar to what the lawsuit is about, this did not voluntarily come from the individual PIs nor the institutions. It was an NIH mandate. Some places had to increase their post-doc salaries from < $25,000 to $40,000 within 5 years. If this can be done on a national basis without bankrupting the scientific institutions, I think it can be done with the medical community as well.

Now a question for you, Andrew: what is a Navy FAP?
 
Originally posted by tofurious

Now a question for you, Andrew: what is a Navy FAP?
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I agree with many of your concerns and understand your point of view. Although many of our friends took jobs paying $50,000 or $80,000 out of college, few will ever break the $150K/year or will they ever break the $200k-250K/year salary level. In contrast, medicine pays low during residency, but you will have the opportunity to make as much as you're willing work. It's funny that during residency, no matter how much more we work, we're all paid the same. However, as private practice physicians, the more we work, the higher our compensation. The more late night consults on call, the higher the reimbursements. ;)

Navy FAP is a military program for residents interested in military careers. I am hoping to work up to an academic and research career with Navy ophthalmology at one of their academic institutions.

http://forums.studentdoctor.net/showthread.php?s=&threadid=62983
 
Interesting thread you pointed me to. It sounds like the Navy knows how little residents get paid and therefore use that as a recruiting strategy... (my Navy connection was back in college, when the Naval Research Office paid for my research and we'd have a Captain come for quarterly progress meetings in dress uniform which was pretty hilarious on a super-liberal West Coast campus).

Do you know anyone who might pay for my trip to do space medicine at Kennedy Space Center for a month (without contractural obligation of course)?
 
Originally posted by tofurious
Interesting thread you pointed me to. It sounds like the Navy knows how little residents get paid and therefore use that as a recruiting strategy... (my Navy connection was back in college, when the Naval Research Office paid for my research and we'd have a Captain come for quarterly progress meetings in dress uniform which was pretty hilarious on a super-liberal West Coast campus).

Do you know anyone who might pay for my trip to do space medicine at Kennedy Space Center for a month (without contractural obligation of course)?
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I'm not sure on that one. I know the Navy has programs for their officers, but I'm not sure about civilian programs.
 
Originally posted by tofurious
mpp: you have obviously not seen some of the county programs where they are very often forced to take all FMGs to fill the spots, because of location. I think some of them would like to get more AMGs, and one way to do so is to offer the AMGs better overall packages to compensate for location/other shortcomings.
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But what does this have to do with the match? Why can't they offer AMG's better overall packages through the match? Or, in other words, why would they all of a sudden have better packages to offer because the match is gone?
 
Originally posted by margaritaboy
Alright. At the risk of being an insurmountable pest, I'm reposting my theoretical scenario and question:

Final scenario:

Lawsuit successful, match becomes voluntary. Consequences:

1. Match becomes voluntary, applicants seek positions both in and out of the match without penalty.
2. As discussed above, the match outcome is essentially the same for both programs and applicants.
3. As discussed above, there is an added element of uncertainty.
4. As discussed above, there is NO increase in wages or benefits above normal inflation related adjustments (same as now).

Would NRMP-match supporters still oppose the suit if all the above turned out to be true? mpp? Andrew_Doan? Goober? 1996? Anyone else?
Just curious. All opinions welcome.
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I think your scenario is flawed, but even if it were true, I would oppose the change. The match is fine the way it is.
 
Originally posted by margaritaboy
Alright. At the risk of being an insurmountable pest, I'm reposting my theoretical scenario and question:

Final scenario:

Lawsuit successful, match becomes voluntary. Consequences:

1. Match becomes voluntary, applicants seek positions both in and out of the match without penalty.
2. As discussed above, the match outcome is essentially the same for both programs and applicants.
3. As discussed above, there is an added element of uncertainty.
4. As discussed above, there is NO increase in wages or benefits above normal inflation related adjustments (same as now).

Would NRMP-match supporters still oppose the suit if all the above turned out to be true? mpp? Andrew_Doan? Goober? 1996? Anyone else?

Just curious. All opinions welcome.
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How would a voluntary match work in your scenario? Could an applicant enter into the match and also accept offers outside the match? If the the results of the match are not binding than what is the purpose of having a match?
 
Originally posted by mpp
I think your scenario is flawed, but even if it were true, I would oppose the change. The match is fine the way it is.
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Many of the disagreements on this thread have to do with the ultimate outcome of the suit. Many who oppose the suit have made good arguments that things would remain the same. But there is a difference between disagreeing on the ultimate results of the suit, and categorically opposing the suit across the boards. Right?

If ALL contested points were conceded to you; Namely, NO increase in compensation, more uncertainty for applicants, and ultimate placement in residency were no different for applicants than current system; Would you still oppose the suit? And why? Would we be worse off? You yourself have just said,
The match is fine the way it is.
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Ironically, many NRMP supporters have argued that it would remain the same even after a successful suit. If things didn't change, then what do you have to lose? Especially when you are guaranteed the added flexibility of choice (going in or out of the match), and there is a POSSIBILITY that compensation or working conditions could improve?
Originally posted by Goober
How would a voluntary match work in your scenario? Could an applicant enter into the match and also accept offers outside the match? If the results of the match are not binding than what is the purpose of having a match?
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Good questions. The suit in question does not propose having a non-binding match. And yes, an applicant could seek positions outside the match. If the applicant were not offered one, or didn't find one that fit his/her expectations, then they could go through the match much as we do today. Or, one could simply go through the match without seeking positions outside the match. Whatever they wanted.
 
Although it is not perfect, I am in support of the match. Does anyone know when the "new match" would be implemented if the NRMP loses this suit? Hopefully not until after 2006. :scared:
 
Originally posted by Andrew_Doan
I think PainDr said it very well. The old system was worse and unfair to applicants:
http://forums.studentdoctor.net/showthread.php?s=&postid=1244158#post1244158
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I must say of all the NRMP supporters, I've found your arguments to be the most informed and well thought out. I salute you. You have given me some angles and points on which to ponder the wisdom of the suit.

On the other hand, the sentiments in the post you cite:http://forums.studentdoctor.net/sho...158#post1244158
Those who want to abolish the match need to do a little research before shooting their mouths off and causing trouble. You want to talk about unfair treatment? In the old days people were manipulated, coerced and threatened! It was utter chaos.:scared:
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....have been echoed many times. And I've been quick to point out: THE LAWSUIT DOES NOT PROPOSE TO 'ABOLISH' THE MATCH . And I'm not sure how its proposed changes are equated with going back to the 'old system.'

I don't mean to be harsh or condescending. But this is an issue in which I have a sincere desire to hear well thought-out dissenting opinions. I've learned a lot just through reading this thread and its links.

Its only fair though, to attack the suit on points that are based in fact, or on those points the suit makes a claim to. Are you saying that the suit claims to abolish the match? Or are you saying that the match would be abolished de facto if the suit were successful? If so, how?
 
Originally posted by margaritaboy

Its only fair though, to attack the suit on points that are based in fact, or on those points the suit makes a claim to. Are you saying that the suit claims to abolish the match? Or are you saying that the match would be abolished de facto if the suit were successful? If so, how?
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You're right. To claim that the suit will abolish the match is wrong. However, I am against suits that don't accomplish a clear purpose. You're proposing, as well as many in this forum, that salary compensation will not change even if the suit is successful. If this is the case, then why even proceed with the suit? If things are not broken now, then why fix them?

I am against the suit because its primary goals are to:

"First, to set aside anticompetitive restraints and allow resident wages and working conditions to improve as hospitals vie with each other to attract and keep the residents they want. Second, to recover damages for residents employed since May 1998 to compensate them for underpayment of wages resulting from antitrust violations, excluding those who ?opt out? of the plaintiff class. "

First, the suit wants to abolish anticompetitive restraints. There are plenty of examples that salary competition and benefit packages vary from program to program. The programs are not scheming to determine low wages for applicants.

Second, the suit wants to recover "damages for residents". I think this is wrong. Resident education was paid for by Tax Dollars. There's no extra money after paying resident salaries, benefits, malpractice, overhead, and the salaries of the professors who trained them. I think it's wrong to sue for something that does not belong to the plaintiffs. Also, because of the plaintiffs' residency, they're all out there making six figure salaries, and now they want to sue for damages? This is rather pathetic don't you think?

I think the current Match system protects both applicant and hospitals. Hospitals can be assured that their slots will be filled. Applicants can be assured that the selection process is fair. I'm not sure how an alternative match will help the applicant in regards to increasing compensation. Thus, this is why I'm not supporting the suit. The only people I see benefiting from this suit are the plaintiffs who are seeking recovery of "damages". :rolleyes:
 
have been echoed many times. And I've been quick to point out: THE LAWSUIT DOES NOT PROPOSE TO 'ABOLISH' THE MATCH .
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Oh . . . but it does.

The match works because it is not voluntary you see. Programs are REQUIRED to offer the majority of their positions in the match, and US students are REQUIRED to participate in the match to find their residency program. Right now the only people that can sign outside the match are FMG's, and I understand this is the last year for that.

So let's look at what the FMG's life is like right now, since that's where we all will be soon if this lawsuit succeeds.

FMG's are likely to get out-of-match offers from programs that don't think that they can fill with the applicants they want in the match. These offers require the FMG to make a chioce - take their chances in the match (where they are not favored due to other more desirable applicants) or take what they consider to be a less desirable spot because it's a sure-thing.

End result- not-as-great sure thing -or- risk matching.

So why would the suit effectively "End the match?"

At least right now we can be confident about the number of places offered for each program in the match. That is to say, we can know that programs won't be full before the match happens.

If the lawsuit succeeds then this is no longer a certainty. Programs could conceivably offer all their positions before the match. It is possible that the applicant would not find out that his desirable programs were full until late Jan, when programs have to finalize their # of match positions.

So we are all effectively put in the place of the FMG. We will be interviewing and we will receive offers. Those offers MUST NECESSARILY expire in some short time period, otherwise there is no point to making offers. Programs are going to want to use the option of making pre-match positions to get the best appplicants BEFORE THE MATCH, so they need to be able to make multiple offers.

Back to my analogy, we will receive offers as we interview. We can have no confidence that this program will have spots left for the match because they could conceivably offer them all pre-match and we wouldn't know. So obviously students will feel pressured to take these offers. And essentially the system switches back to what we had before the match, by default, because noone can be confident in the match.

Programs cannot know if their desirable applicants will still be around for the match, and applicants have no idea if programs will be available for the match.

And so, voluntary or not, the match is over if this suit succeeds. And that's not "A Good Thing (TM)"

C
 
1. Officially, the lawsuit does not propose the total abolishment of the Match. Can the practice of extensive out-of-match offering effectively eliminate the use of the Match? Sure, that's a possibility. But that's up to the programs to decide how many spots they are going to grant outside the Match.

2. I am not sure why people are so concerned about the need to accept choices right away. Are you unhappy with your medical school choices? Did you not have to 1) interview at many places 2) get vibes about places 3) hope you get accepted at places you like and use places you can care less about as safety programs 4) hold some spots without outright acceptance 5) accept your final position by a certain date??? There are many more college applicants than medical school spots, versus the opposite situation where there are many more residency spots than applicants. Theoretically, we will all have more than one offer. You know which programs to choose from, versus you hope your rank list works out well with the programs' rank lists. Do you think programs will jump on their first 5 candidates and offer them spots? That's probably as likely as you taking your first ever offer.

3. Has anyone ever wondered what if the Match algorithm has a glitch in it? Would anyone know about it?
 
Originally posted by cg1155
Right now the only people that can sign outside the match are FMG's, and I understand this is the last year for that.
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I thought the only people that HAD to use the match were US MD seniors - otherwise, FMG's, Canadians, US graduates (at least 1 year out), and DO's all can sign outside.
 
Ahh, I stand corrected. But my point stands.

C
 
Originally posted by tofurious


2. I am not sure why people are so concerned about the need to accept choices right away. Are you unhappy with your medical school choices? Did you not have to 1) interview at many places 2) get vibes about places 3) hope you get accepted at places you like and use places you can care less about as safety programs 4) hold some spots without outright acceptance 5) accept your final position by a certain date??? There are many more college applicants than medical school spots, versus the opposite situation where there are many more residency spots than applicants. Theoretically, we will all have more than one offer. You know which programs to choose from, versus you hope your rank list works out well with the programs' rank lists. Do you think programs will jump on their first 5 candidates and offer them spots? That's probably as likely as you taking your first ever offer.
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However, during the medical school application process they did not rescind their offers after 10 days. Having 10 days or so to make a decision when you have yet to complete the rest of your application process is the main problem with the new system.

Also, the new system does not fix what it proposes to: it does not offer more competition with better salary and benefits. The match does not stifle competition any more than a non-match system would. Programs under the match can still offer whatever they can afford to attract the best candidates.
 
Andrew_Doan: Well said. I agree that the suit overstates its case on certain fronts, and that the recovery of 'damages' is a weakness that does not add credibility to their cause. Our differences are not many, but I guess I am willing to take a chance (or gamble, depending on your point of view) on reform. But I respect your position.

cg1155: The way I understand it, the programs could predetermine the number of spots they would reserve for both in-match and out-of-match offers prior to interview season.

So, program X could say they would reserve 10 of 20 spots for the match, and the other 10 for out-of-match offers. Any applicant wishing to participate in the match would know that AT LEAST 10 spots would be available entering the match. Maybe more if the program did not fill their 10 out-of-match spots.

You are right that if a significant number of programs decided to offer all their positions outside the match, that the NRMP may be effectively impotent.

But, I'm willing to bet that NRMP lawsuit supporters would argue that the NRMP as it is now, favors hospitals and residency programs. Therefore if it became voluntary, then most positions would still be offered through match since it would still presumably work in their favor. In other words, if it is in their favor now, why change? I'm not saying I agree completely with the above. But it sounds like a reasonable extension of the suit's position.
 
The way I understand it, the programs could predetermine the number of spots they would reserve for both in-match and out-of-match offers prior to interview season.
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But free market forces would not make that option attractive. If the goal is to get the best residents, and these residents are getting pre-match contracts from places, you would theoretically want all 20 of your residents to be "Contract-worthy" to cop a Seinfeld-ism. There is no incentive to participate in the match in this system.

C
 
Originally posted by cg1155
But free market forces would not make that option attractive. If the goal is to get the best residents, and these residents are getting pre-match contracts from places, you would theoretically want all 20 of your residents to be "Contract-worthy" to cop a Seinfeld-ism. There is no incentive to participate in the match in this system.

C
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That's an interesting thought, cg1155. It took me a minute to get it, but now that I have it, I must say....interesting...

Free market forces may indeed win out, but perhaps in a different way. Many have said that they would prefer to interview at many institutions without time-limited offers or pressure from programs. My bet is that those same people (which may be most in this forum) would elect to participate in the match for that reason.

If programs wanted to get their hands on these contract-worthy applicants, then they would be obligated to reserve some spots for them through the match. Programs would be obligated to accommodate applicants going either route, or else cut themselves off from a pool of applicants.

But...if a program predetermined ALL of its spots for out-of-match offers (so that it could maximize the # of offers), but also knew that it wouldn't fill all of its out-of-match offers, then applicants really wouldn't know how many spots would be available, if any, through the voluntary match. Than applicants would be forced into playing a different kind of game....potentially twice!Interesting....
 
:mad: All plaintiffs are crybabies!!What the Hell they are thinking?
Medicine is well respected job and hard work.They new that!!

I am tired of people suing people in our society.It will lead toward more political corectness then anything else.
During Residency-work hard,learn and shut up or find s/o else to do.
After that,take the best money possible,work hard and help people the best you can even if they can afford to pay.
Hungry doctors=oxymoron!!!

It is about helping others that makes us special,not how to get there and under what circumstances.:clap: :clap: :clap:
 
I went through the match last year for rad onc and was glad that match system was in place. I feel that it it offers strong applicants their best chance of ending up at their top choice. I am skeptical of other possible solutions being able to maximize this. A few rad onc programs do not participate in the match, and students who get offers from these programs are faced with a very difficult decision of accepting a sure thing from a lesser program or turning down the spot and sticking with their chances in the match. It really stinks, and it is not something I would wish on any fourth-year. It seems likely that some element of this would exist in all fields if the NRMP lawsuit succeeds.

As for the low-pay and sub-par working conditions of residency, does anyone deny this? I went into internship accepting that I was going to be underappreciated and underpaid. Many of us went into medicine for reasons other than money. We all know what we are getting into. Yet, this does not make the current treatment of residents ok.

Up until a few weeks ago, I really didn't care about any of this until one of my surgery months. I found out that PA's in our department are making $60-100k per year. (I realize that this might be higher than what PA's in other areas are making, but my point still stands.) This department has dramitically increased the number of PA's in response to the curtailing of resident hours with the 80 hour work week. For the most part, they see patients in clinic, but they do assist with surgery when a fellow or resident is not available. They were hired to do the work that residents used to do and are still doing. The difference being that the PAs' hourly pay is 4x what a resident is making (double our salary for half our hours). If the department got rid of residents, it would cost them dearly. The would have to hire at least 2 PA's to cover the 80-100 hours per week that a resident works which would cost them $120-$200k.

I realize that we are trainees, but I was doing the exact same thing in clinic that the PA was. I was seeing patients, presenting them to the attending, and dictating patient notes, just like the PA, except I was more efficient (more patients seen/hour). We saw roughly 50 pts in morning surgery clinic, and there is no way that the attending could see this volume of patients without the help of residents or PA's. When the department had to go through a competitive market (which is what they do when they hire PA's),they are paying $30-$45 per hour. This approximates the floor of how this department truly values my labor. Instead I make less than $9/hour of which the department pays nothing (medicare pays my salary). As for costs associated with educating residents, we only had a few hours per week of didactic lectures, which is not breaking the bank by any stretch of the imagination.

Do you all realize, we are the lowest paid employees in the hospital on a per hour basis. The local VA tried to have surgery residents clean the OR rooms and prep it for the next case after they had fininshed their current case because it would save the hospital money. We are paid well below our market value and treated poorly because as residents we have no power in the bargaining process. I think they are several reasons for this, one of which is the anticompetitiveness inherent in the match.

The NRMP lawsuit is simply a tool to improve the bargaining power of residents which lead to the ends of pay closer to our true market value and better working conditions. Yet, it seems that we could accomplish many of these same goals from collective bargaining and unionization without giving up the benefits of the match.
 
I think XRT has hit the nail on the head, but the other day I found myself asking this question: do I want the system to improve through a lawsuit, or do I want to pay an annual due to a union that may be as responsive to my personal needs as my department? The collective bargaining power of a union rests in its ability to pull its members out of work. Granted, hospitals definitely want to avoid that, but what if the hospitals call our bluff? Are we actually going to walk out of the hospital and become the villains in society's eyes as police and firemen do whenever they try to improve their own working conditions through union actions? I personally would not feel comfortable using the usual union tactics in medicine because of the stakes at hand, and I would surely prefer the threat of a lawsuit to improve our working conditions without tying myself to another monolithic power.
 
But tofurious, If you rely on the lawsuit to improve things you're still assuming that departments will suddenly become benevolent and increase wages for no apparent reason. Unions can at least force the issue.

C
 
What muscle does the union have? (And why has the AMA not served as the union-equivalent?) Are we going to line up and picket outside each hospital?
 
I personally would not feel comfortable using the usual union tactics in medicine because of the stakes at hand, and I would surely prefer the threat of a lawsuit to improve our working conditions without tying myself to another monolithic power.

Collective bargaining or unions does not have to be a dirty word. It is one method to shift the balance of power a little towards residents. Right now all of the power lies with hospitals and departments. Since residency is just a stepping stone for all of us, a residency union would always have a high turnover rate of members, which would limit its potential power. As in med school, what our attendings think of us still is a powerful mechanism that will always limit our power and place us in a subservient position during residency. There is always the threat of kicking one out of the program, but the bigger issue for many of us will be obtaining a fellowship or finding a job after residency. There will always exist a large incentive for residents to please their program. As one fellow once told me, you don?t need to be a superstar during residency, but you should at least try to fly under the radar whenever possible.

This does not mean that one needs to be a spineless jellyfish, but one does not want to rock the boat either. Just like graduate students and post-docs, residents find themselves in a working/educational environment that is inherently asymmetric in regards to power, more so than in most other fields. This is one of the problems that I have with the NRMP lawsuit is that it does nothing to address this fundamental issue. The balance of power will always be tilted towards programs. I just want it tilted a little less their way. I also think that as residents we need a voice. No one is there to speak about our concerns. When there are improvements to our working conditions, it is a by-product of other agendas. The 80 hour work week stems from a premise of protecting patients from tired and exhausted residents, not from improving the lives of over-worked and underpaid residents.

Additionally, we should all remember that there are unintended consequences to any actions to ?improve? our situation. For example, there are frequently many less residents and fellows in house overnight in order to comply with the 80 hour work week. Thus, interns and junior residents are placed in positions of greater responsibility than in the past. Some services have switched to home call and thus it can be much more difficult to deal with certain issues overnight. I had one pt that needed an emergent trach when I was cross covering one night, but ENT now takes home call. We couldn?t wait that long.

Economics still applies with regards to residency; it is just a more complicated situation than a simple competitive market. If the cost of resident labor rises (i.e. we get paid more), then hospitals will demand less of it. Hospitals should reduce the total number of resident labor hours that they consume. How that plays out in a possible reduction in residency spots is not clear. It is even possible that if residents made significant gains (perhaps too great a gain) in working conditions, such as a 40-50 hour work week, then the number of residency spots could actually increase. My guess though, would be that the number of residency spots would probably decrease. I also think cushy prelim years would be sharply reduced, as residents would no longer be the bargain they used to be.
 
Originally posted by XRTboy
The 80 hour work week stems from a premise of protecting patients from tired and exhausted residents, not from improving the lives of over-worked and underpaid residents.
Click to expand...

I'm not really sure if that was the primary intention of the 80-hour work week rule. In NY, where it was first instituted due to that law-suit that everyone knows about, very few if any hospitals followed the rule. It wasn't until the ACGME implemented the rule (several years later) and started taking away accreditations that residency programs woke up and started enforcing the rule.

And why did the ACGME do this? It wasn't until shortly after this recent lawsuit against them, NRMP, and others was filed did they implement this 80-hour work week rule. And they admitted that this lawsuit did influence them to enact this rule.

I think the ACGME was caught with their pants down and was trying to remedy their situation. There was no way that they could possibly win any lawsuit against them when residents were working 100+ hrs/wk, earning oftentimes below minimum wage, along with the fact that there was a successful lawsuit in NY which limited hrs to 80/wk, brought about by a death of a patient.

Is this recent lawsuit the remedy? I personally find many problems with it, but it did have a large influence of implementing the 80-hr work week rule nationwide. (Which itself has problems, but generally is a good thing.)
 
Here are the issues as I see them (just my opinion, not gospel):

1) First of all, the OP dealt with the issue of the Match and the lawsuit against it. My understanding is that the main complaint is that the Match allows programs to keep salaries artificially low through a monopoly. Nowhere does it state that the Match is unfair in terms of WHERE you match (again, that's just my understanding).

2) Yeah, we get paid jack during residency. However, realize that, as with all things medical, the payoff is delayed. Read the posts on SDN - they are people talking about $100K/yr salaries as being unacceptable and miserly. Why? Because we all KNOW the range of money we will ALL make - it's not unrealistic to be talking about 6-figure incomes. Yes, it sucks looking at PAs raking it in NOW, but guess what? All of them (and a lot of our patients) sit around bitching about us (as attendings) and our salaries and our over-inflated egos. The grass is always greener. The difference is that PAs making $60K have HIT THEIR PAY CEILING. It will NEVER get any higher for them! Still envious?

3) Have you all considered this? If salaries go up, what do you think residencies will do? Have any of you thought about this in the same vein as people who gripe that the minimum wage should constantly be increased? Market forces say that residencies will probably start shutting down and only the most elite (or at least financially well-off) institutions will be able to maintain programs. That's great for the few people who will be trained, since only about 5 docs a year will be certified for the nation - but the rest of us will be clawing each other to get positions. What do you think, that the government will just increase their funding? Hope you guys like those taxes!

4) Unions are not the way to go. The biggest weapon they have is the strike. Are you going to let your patients die by striking because you aren't getting an extra day of vacation? If the answer is yes, then at least you're being honest. Post your real name and where you work for us.

5) This lawsuit smells bad. I read another poster who wrote that the plaintiffs are requesting millions in recompensation. Realize that this is another lottery suit for lawyers, who always get a HUGE chunk off the top - the tobacco lawyers made over $1 billion ...aren't they sweet for helping us out for the goodness of their lil' hearts?

I'm not saying I like getting paid peanuts, but realize that this is VERY temporary.
 
Well, if you ever get injured in a car accident or seroconvert after a needle accident and can't continue on your path towards that $200k/year job, you'd better have a good insurance policy because your disability will only pay you resident salary for the rest of your life.

Everyone keeps on saying that this is a delayed gratification, which no one DISAGREEs with. The problem is the further you delay this, the more likely you are to get struck by lightning.

As for the fear that many hospitals will close down, there are already twice as many residency spots available as there are US medical graduates. The number of hospitals is also not correlated with better access to care, since many hospitals opened up and began hiring residents as cheap labor long before the certificate of need issue ever surfaced. Therefore, closure of these hospitals will not likely influence patient care and can only encourage the do-more-with-less mentality, which all fiscally-secure hospitals do already.
 
tofurious: Read my edited post (on page 7)...sorry, I was editing it while you were posting.

My response is: how does making $50K during three to five years of residency stop lightning from hitting you? Or making $100K for that matter? If you are injured and can't work, you're up the creek no matter WHAT your salary is or was.
 
It doesn't stop lightning from striking you, but it does make a difference in how much money you get. Disability insurance is designed to replace 50-65% of your earned income should you become sick or hurt. The difference between 50% of $40,000 and 50% of $150,000-$250,000 is quite significant.
 
Originally posted by tofurious
It doesn't stop lightning from striking you, but it does make a difference in how much money you get. Disability insurance is designed to replace 50-65% of your earned income should you become sick or hurt. The difference between 50% of $40,000 and 50% of $150,000-$250,000 is quite significant.
Click to expand...

If you're worried about disability, then buy more insurance. It's dirt cheap as a resident. For me, if I get disabled, then I'll do something else. It's easy to make money in this world if you're motivated.

BTW, if you seroconvert, then you can still continue your path. HIV is manageable these days with ART.
 
Originally posted by tofurious
As for the fear that many hospitals will close down, there are already twice as many residency spots available as there are US medical graduates. The number of hospitals is also not correlated with better access to care, since many hospitals opened up and began hiring residents as cheap labor long before the certificate of need issue ever surfaced. Therefore, closure of these hospitals will not likely influence patient care and can only encourage the do-more-with-less mentality, which all fiscally-secure hospitals do already.
Click to expand...

I don't disagree that hospitals take residents for granted. I have always hated the way that nurses are treated like gold because hospitals have such a tough time hiring them, even the sucky ones. Meanwhile, even the superstar residents with off-the-wall scores and performance-reviews sky-high (and I'm far from that, so I'm not tooting my own horn) are treated like doormats.

However, understand this: Say residents start making DOUBLE their current salary. Not only will most programs immediately close their residencies, but the remainder will demand that their residents work twice as hard because they can't afford to hire more residents. Now factor in the 80-hour mandated work week wall. What happens then? More PAs need to be hired, and probably at higher prices because there are so few of them. Now you are making $80K, but the PAs are making $100K or more. And the attendings are starting to grumble because they are only making the same amount. How do you think this scenario will end up in the end? Think LONG TERM, not SHORT TERM - as doctors, we're all capable of being more analytical and less reactionary.
 
Originally posted by kinetic
I don't disagree that hospitals take residents for granted. I have always hated the way that nurses are treated like gold because hospitals have such a tough time hiring them, even the sucky ones. Meanwhile, even the superstar residents with off-the-wall scores and performance-reviews sky-high (and I'm far from that, so I'm not tooting my own horn) are treated like doormats.

However, understand this: Say residents start making DOUBLE their current salary. Not only will most programs immediately close their residencies, but the remainder will demand that their residents work twice as hard because they can't afford to hire more residents. Now factor in the 80-hour mandated work week wall. What happens then? More PAs need to be hired, and probably at higher prices because there are so few of them. Now you are making $80K, but the PAs are making $100K or more. And the attendings are starting to grumble because they are only making the same amount. How do you think this scenario will end up in the end? Think LONG TERM, not SHORT TERM - as doctors, we're all capable of being more analytical and less reactionary.
Click to expand...

I agree with the above. We're being paid to learn. If they pay us more, then we actually have to generate more billing.
 
So why does everyone think that when you raise the resident salary to $80k, hospitals are more likely to fire the $80k/yr residents and hire $80k/yr PAs? Or $100k/yr PAs even? Perhaps attendings doing more "doctoring" could be another solution (as shocking as that may be)? I think the creation/popularization of hospitalists will help solve this problem.

As for Andrew's point, yes, but not everyone has a PhD to do something else. Yes, people who are not driven should rot, but I think they can/should rot in relative comfort given how much the system has asked them to sacrifice.
 
Originally posted by Andrew_Doan
BTW, if you seroconvert, then you can still continue your path. HIV is manageable these days with ART.
Click to expand...

I know that I said we should be analytical and not reactionary, but that's TOO analytical, lol. If I seroconverted, I'd be running in the streets naked and punching out random puppies. I'm just joking ...don't send me hate mail.
 
Originally posted by tofurious
So why does everyone think that when you raise the resident salary to $80k, hospitals are more likely to fire the $80k/yr residents and hire $80k/yr PAs? Or $100k/yr PAs even? Perhaps attendings doing more "doctoring" could be another solution (as shocking as that may be)? I think the creation/popularization of hospitalists will help solve this problem.
Click to expand...

Again, you'll get NO argument from me that attendings kinda use residents. On the OTHER hand, it's too easy to point at attendings and call them lazy - they're not. Some of the attendings I have known are in the hospital almost as much as residents.

Why would people prefer PAs? They wouldn't. You're missing the point, though. Residents will ALWAYS be available. People WANT to be doctors and will go to desperate lengths to be one ...they will go abroad, they will do extra years of research, they will do things that NOBODY would do in other fields.

So, if you have a KNOWN and CONSTANT pool of always available candidates, it will be easy to hire them for your resident-oriented needs. But hire too many and they will be able to do the scut, but not see enough patients to be trained. Unless you train for EIGHT years. Which I assume nobody wants to do. So programs will HAVE to hire PAs (which is why they are doing that now, rather than just expanding their program sizes).

Dude: I am on the side of residents. I am one of those guys who everyone hates because I'm always sitting around talking smack about nurses and PAs (and I know you all are going to write and tell me how ******ed I am - that's your right). Point is, I'm not anti-resident, but I am trying to think objectively.
 
Fact of the matter is, no one can predict what will happen 10-20 years from now regardless the Match still exists or not. I am not aware of any near-complete model of what will happen to the current system taking into account factors such as lifestyle preferences, nursing shortage, NPs and PAs replacing need of certain specialties/personnel, outsourcing of radiology/pathology jobs, increasing number of IMGs and USIMGs, rising cost of prescriptions and general medical care, etc. Perhaps my medical school was at fault for not better preparing me to expand my simple college-level supply vs. demand model into such a multivariable, time dependent, possibly chaotic system as other medical schools have. As a result, I can't give a grand solution to solve all medicine's problems as many others seem capable of, but I share the plaintiffs' desire to fix one immediate wrong that is staring at me. At the end of the day, we can argue all we want about one two or even three factors as we run out of fingers, but one should know that introducing one more variable to refute the result of a simplified model does not necessarily equate to more validity. The great thing about the ideal outcome of the lawsuit is that you do NOT have to participate in something you don't want to, thus relieving Match believers of all the shortcomings of a no-Match world.
 
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