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I too feel the pain of 100K + debt while looking forward to 3 years of low paying residency and 2-3 years of low paying fellowship before being able to do 'normal' things that people with our amount of education do (like but a house save some money) but I have to play devils advocate for a moment. I worked in a molecuar bio lab before med school and there were some post docs in the lab (4 years college, 4-5 years phd, 3rd year post doc) who were making ohh around 18,000 a year. Basically enough to rent a studio apartment and walk to the lab, bullion cubes and rice for dinner (you know the drill). So what's that all about, are they just more dedicated and committed to saving the world from disease- or are they just plain stupid? I think most of us get into medicine intent on helping people, curing them, make the world a better place... when did we all get so bitter and pissed off about how much money we are NOT making? (and why aren't the phd's and post docs as bitter and pissed off?) 😕
 
•••quote:•••Originally posted by intern in waiting:
• (and why aren't the phd's and post docs as bitter and pissed off?) 😕 •••••Believe they are. Ever worked in a lab. Those are some disgruntled people.
 
It is sad commentary on how highly educated people can be brainwashed. I guess the common adage book smarts do not replace common sense holds true.

"Hospitals can't afford it" "We are only students"
I just find it incredible that those people can't think past these sophomoric arguments.

How many of you who defend the current system have had real jobs in the non-slave, capitalistic economy? People don't work 48 hours straight! It's ok to be paid what you are worth....really! Trust me! 🙂
 
Damn,

I done leave for a little while, and all damn hell breaks loose. Ok, let's get this party started:

Having run a successful business for the last two years (sold it to a publically traded firm), and coming back to medicine to hopefully change that system as it exists, I have come to some major conclusions.

Conclusion number one:

THE CURRET RESIDENCY SYSTEM IS COMPLETE BULLSHIZZZ....

PERIOD.

It exists purely to fund a defunct medical system with cheap labor. WE ARE ASIAN SWEAT SHOP EMPLOYEES; that is all we are. We exist to squeeze out a profitable product, by reducing the margin of cost. Because we exist the healthcare system can continue to be exceedingly inefficient. I love the battered wife syndrome of: "we deserve to get paid dick...because we are apprentices, and apprentices are paid nothing so they can learn their craft". Hey numnuts, you aren't learning glass blowing, or blacksmithing, and this isn't the 1600's. The only people who apprentice these days are fetching donuts for executive producers. YOU ARE IN THE BUSINESS OF SAVING LIVES, AND YOU GET PAID THE EQUIVALENT OF A MCDONALDS WAITER. THE SYSTEM WHICH YOU LOVE TREATS YOU LIKE DIRT. YOU CAN BE FIRED WITH NO RECOURSE AT ANYTIME, AND YOUR FUTURE EMPLOYMENT CAN BE COMPRIMISED. EVENTHOUGH YOUR PRESENCE IS THE MOST VALUABLE NECESSITY TO ENSURING THE SURVIVAL OF PATIENTS EVERYWHERE, YOU MAKE LESS THEN THE TECH WHO YOU WORK WITH, AND YOU HAVE NO RIGHTS WHATSOEVER, WHILE THE TECH IS IN A UNION ALONG WITH THE NURSES AND OTHER AUXILLIARY STAFF, AND CAN WALK OUT ANY TIME. Do you realize who's bitch you are? The hospital doesn't employee you....THEY OWN YOU...and because you have this, "don't rock the boat, that could be scary" mentality, you continue to take it in the ace while the system cleans up. DON'T LET IT CONTINUE TO HAPPEN...FIGHT FOR YOUR INALIENABLE RIGHTS AS A HUMAN BEING. The rest of medicine is headed towards market forces, why can't residents.

2) LISTEN...ALL OF YOU. Do you know what happens to a company that doesn't meet revenues, that doesn't curb costs, that spends freely, and continually misses forecast. BANKRUPTCY. That's right...you become a failure. So what you do is you shed your bad assets (indigent care, pro bono work), charge more for your premium services (high quality primary care physicians and specialists), and have competent billing and accounting procedures. YOU OUTPERFORM THE OTHER GUY IN YOUR INDUSTRY. You discover where your liabilities are and you trim them. IF YOU WANT TO PAY YOUR PHSYICIANS ****...THEN YOU SHOULD EXPECT THEM TO NOT TAKE YOUR JOBS.

3) If residents get paid commiserate value then I would get more of them, pay them what I pay nurses, and cut down on nursing staff. I would use mid level providers and nurses to provide the assistance role. This way I get premium care (from intelligent residents), I can reduce cost (I can get one resident to do the job of a PA and a nurse), and the residents are happy (less hours, more pay). THESE HOSPITALS HAVE GROWN TOO DEPENDANT ON THE FEDERAL GOVERNMENT. The Federal Government is an inefficient business that does nothing to advance anything. Working in the government is like trying to watch a first run film in a third world country; it'll be the year 2002 and you'll be watching Rocky 3.

4) HELLO FREE MARKET: Does this mean smaller med school sizes? No. Does this mean less medical students gradated? NO. It means that the market will determine demand. IF A HOSPITAL JUST CAN'T AFFORD TO PAY IT'S RESIDENTS 20,000 MORE; THEN TAKE FEWER RESIDENTS. ONLY ACCEPT PATIENTS WITH VERIFIED BILLING. CHARGE ABOVE GOING RATES FOR A SUPERIOR PRODUCT. I don't stand in line, I get high quality care from top residents and attendings. AND GUESS WHAT..THE INDIGENT POPULATION THAT CAN'T SEEM TO PAY...EVER...HAS BEEN FAILED BY THE GOVERNMENT. If the government wants to fund those who don't work, don't pay and don't contribute to the economic cycle they can either a: GO TO CANADA, or B: run the government hospital system more efficiently. EITHER WAY I DON'T CARE..BECAUSE AT LEAST THE RESIDENTS GET HUMANE HOURS, BETTER PAY (ATTENDINGS TOO) AND THE QUALITY OF SERVICE IS HIGHER.

Do you know why Cisco Systems is better than anyone else in networking? Because: THEY HAVE A SUPERIOR PRODUCT THAT THEY CHARGE MORE FOR, AND AN AGRESSIVE SALES STAFF THAT BRINGS THAT REVENUE IN. Do you know why certain law firms can bill at $300 dollars an hour? BECAUSE THEY HAVE STAFF THAT IS FAR SUPERIOR, AND THEREFORE HAVE A SUPERIOR PRODUCT TO OFFER. If you provide a superior product, and superior service...YOU WILL BE REWARDED WITH INCREASED REVENUE, AND INCREASED SATISFACTION.

AND DO NOT TELL ME THERE IS NO WAY THIS CAN HAPPEN, BECAUSE TEACHING HOSPITALS ARE PUBLIC HOSPITALS, AND BLAH, BLAH. Well then, choose were you learn. 60 Hours a week in a well run private hospital, taught by attendings who have the time to teach. OR A HUNDRED HOURS AT A PUBLIC HOSPITAL WHERE THE TEACHING MIGHT BE BETTER, BUT THE CONDITIONS ARE HELL AND YOU GET PAID SHIZZZ....

You choose....

this is from the other listing....double coverage...
 
Many have mentioned that we should let the free market prevail. I find this appealing, because I'm a free market guy (Damn that George Bush imposing steel tarriffs!). But think about this: How many applicants would take lower salaries to get the specialty they want! I want to do ortho, without question I would take less money to be sure of getting a slot. It could have the potential to turn the system on its ear. "Undesireable" programs would have to pay more to attract applicants while hot specialties would pay less (or nothing).

As I noted earlier, the system just doesn't have the money to pay residents substantially more. Teaching hospitals are using the government stipends just to break even. There is an epidemic of "red ink" among teaching hospitals. I think this all sucks and is mainly the governments fault for low medicaid and medicare payments. The best solution is shorter hours. It's good for the residents and its much better for patient care!

Ed
 
•••quote:•••Originally posted by edmadison:
•As I noted earlier, the system just doesn't have the money to pay residents substantially more. Teaching hospitals are using the government stipends just to break even. There is an epidemic of "red ink" among teaching hospitals. I think this all sucks and is mainly the governments fault for low medicaid and medicare payments. The best solution is shorter hours. It's good for the residents and its much better for patient care!

Ed•••••Well, I agree that hours are more important than salary, but disagree with you about whether or not there is enough money in the system for a raise.

Every year, hospitals get 200k per resident position. out of that money, 40k goes to salary, another 30k goes for malpratice insurance. that leaves 130k in pure profit per resident.

Given those facts, I find it hard to believe that they cant afford a modest pay increase.
 
MacGyver:

Look at the math. If a teaching hospital has 100 residents and they increase salary by $20,000 that's a cost to them of 2 million dollars a year. With most teaching hospitals already losing substantial money, where are they going to find this cash? They can't raise fees, because those are set by the government and insurance companies. The only answer would be to cut staff. Should the hospital fire 50 nurses? You do that and you'll have to decrease the number of beds in your hospital which will cost you even more money.

The $130K/resident of "pure profit" has already been spent. It's a government subsidy to support teaching hospitals.

Please don't get me wrong -- I want more money. I'm just a realist. The system is broken financially. It's just a matter of time before it collapses. Then the government will walk in and save the day. God help us all then.

Ed
 
You can't get blood from a turnip...

The argument that's 'a-buzz' on this board that hospitals are reimbursed $200,000 per resident/year is plain WRONG! True that Medicare pays approx 2x's a resident salary to the training facility, and there is additional revenue generated by resident procedures billed to 3rd party payers, but the reimbursement does not nearly reach this level. And the money left over isn't just pure-profit... There are costs involved in training residents: Salaries, malpracitice, benefits such as insurance, meals, health-care; perks such as book allowances, meeting allowances, etc. However, a few of the biggest expenses related to training residents is in the form of fixed costs, attending salaries, and largest of all... indigent care. Yes, because the gov't pays these hospitals to train residents, the expectation is for these facilities to provide care for the uninsured masses. Is this extra resident pay commensorate with this HUGE expense: NO!

That is why, if you took a pole of hospitals across the country, the facilities in the worst financial stead are academic/university training facilities... The tertiary facilities that are best off are the ones who get support from big research dollars and charitable contributions.

So the argument for higher pay comes down to where does the money come from? Today there are more uninsured Americans than in any time in recent history; the US taxpayer pays ~20% of their tax dollars to entitlements programs, of which the majority of those funds are ear-marked for indigent health-care; US citizens pay more for their healthcare than in any other country in the world; and the US ranks 35th amongst all nations in health outcomes i.e.: M&M.

So the it's gonna be impossible to get more money from this current bankrupt system. It's gonna take sweeping reforms, but changing the system may increase the revenue stream. The largest chunk of health-care dollars and biggest profits in US health-care go to 3rd party payers, that is, private insurance companies. Perhaps decreasing top administrators 7-figure incomes could create more money to treat the uninsured or even train new-physicians. Of course, this will never happen.

Also, it's really and argument of symantics as to whether a resident is a student or a physician. Clearly, we residents are not students, however, until we get full liscensure, we're not full-physicians either. As I see it, my salary as a PGY-1 was a STIPEND unitl I was eligible for full practice rights as dictated by state law. Then I went out to the small town ER's nearby and did some moonlighting and more than doubled my income. Once you have marketable skills, you have a chance to make money... Your residency training gives you that opportunity.

So, perhaps the most important point of this suit will be improving resident work-hours... Hopefully... I just don't see how salaries can increase.
 
A few comments on what has turned into a degenerating conversation on an important issue.

David Green- I think a sense of history on medical education is very relavent to this topic. Work hours,working conditions, and compensation have been steadily improving for the last 100 years. While we all agree that improvments could be made, I suggest you put our current status in some perspective

Drusso- the stagnated return on investment re. your education is an interesting way of looking @ the field of medicine, but it can all be traced back to the slow death of the 3rd party payer system and should be interpreted in that context. Fields with clients outside the system (cosmetic surgery, LASIX, bariatric surgery, etc..)seem to get pretty good "return" @ this point in time, & maybe you should have steered towards one of those fields so as not to be disappointed

Synite- I will not waste my time with you. Obviously you feel that medcine is an inconvenient lifestyle choice. Its amazing to me that you fell thru the cracks and managed to convince an admissions committee that you actually wanted to be a doctor.

RTK- I think you have good insight into both the financial & work-related issues involved & I enjoyed your post
 
Financial solvency is not a good reason for exploitation.
 
Dr. Oliver correctly states that work hours and salary have improved somewhat from the past. However, these token changes occured while the hospital system itself underwent sweeping transformation.

Although call schedules have improved, the hospitals have become increasingly burdened with paperwork and have sicker, more acute patients. Therefore, residents now working 100+ hour weeks are working harder and sleeping less than their predesessors. On-call nights are filled with frequent pages and diligent documentation, leaving little time for relaxation or sleep. I still remember the dean of my medical school describing his q2 call schedule during residency as "not that bad." There's no way that any resident working a q2 schedule in today's environment would have such kind words. And the salary improvements have merely compensated for inflation--nothing more, nothing less.

Medicine is still a great field and well worth any suffering that you may have to undergo during residency training, but why should we suffer more than we need to because of a medical system unwilling or unable to adapt.
 
Just wanted to point out that the amount of reimbursement hospitals receive from the government for each resident is NOT 200K. Its more in the range of 60-100K. Hospitals receive a different amount based on how many Medicaid and Medicare patients they see. Some actually get less than 60K, some more than 100K. This information can be found at: <a href="http://www.cbo.gov/showdoc.cfm?index=17&sequence=1" target="_blank">GME Reimbursement Info</a> . I don't disagree with those who believe residents should be paid more and have more decent hours, but I think having accurate information when discussing and issue is important.
 
WBC,

I'm afraid you are terribly mistaken, and this is part of the problem. Hospitals are compensated no less than 200k for AMG residents period. That number is half for an IMG. Please investigate this further if you continue to remain confused.
 
It is funny how sure everyone seems to be that they are so right when it comes to this, and other topics.

Here's my perspective. I researched what med school, residency and medical practice was like before I decided I wanted to go down this road. I knew what I was getting into. If I didn't feel that this was a fair or worthwhile I wouldn't have done it. Now that I am knee-deep in it, I still don't think its that bad.

Sure I could use some extra money, and less hours, but I still don't feel its that bad. Life goes on.
 
Klebsiella,

Where are you getting the 200,000 AMG / 100,000 FMG compensation numbers from?
 
P Diddy,

My numbers come from intimate knowledge of the process as well as research I have done over the past year. Unfortunately there is a dearth of internet related information on this topic save some outdated and now defunct links to past news stories. When time permits, I will scan and post some information I know our members will find interesting. I hope you can appreciate the reasons for this lack of publicized information on a topic that is near and dear to our hearts.

Sadly, WBC is 100% wrong on this matter. Hospitals have multiple financial streams that fund residency slots. The bottom line is that we are enormous money makers for these same hospitals.
 
OK, I don't understand much about the health care system, especially not the economic side, so correct me if I'm wrong in my reasoning.

The way I see it, if there isn't enough money to increase residents' salaries, then there also isn't enough money to decrease residents' hours. Put simply, time is money.

For example, suppose there is a hospital with 5 residents doing 120 hours' work per week for a total of 600 man-hours. If this hospital reduces each resident's workload to 60 hrs/wk, that totals only 300 man-hours. To account for the lost 300 man-hours, the hospital must hire another 5 residents, which will cost ~ $175,000/yr.

This extra money may as well be paid directly to the 5 residents who are already working there, thereby doubling their salaries and eliminating the need for hiring more residents. Even if you disagree with this - you'd rather have fewer hours than higher pay, say - it makes no difference to the hospital whether you have fewer hours or a better salary: it has to pay the difference, and the difference is the same either way. (In fact, it's probably costlier to hire more residents, b/c you have to account for more book and travel stipends, etc.)

Put another way, you can't go from a q5 to a q10 call schedule if there's no one to take call for five days out of every ten.

But I'm probably missing something. I would appreciate someone's explaining me what part I'm not getting. As I said, I know little about the inner workings of the health care system.

Thanks for your input.

dg
😕 😕
 
•••quote:•••OK, I don't understand much about the health care system, especially not the economic side, so correct me if I'm wrong in my reasoning. ••••I will correct you. You are wrong.

•••quote:••• The way I see it, if there isn't enough money to increase residents' salaries, then there also isn't enough money to decrease residents' hours. Put simply, time is money. ••••You aren't seeing things clearly at all. There are resources to increase Resident salaries in the form of revenue streams dependant on the number of slots offered. Truisms that apply to other businesses don't necessarily apply to medicine in the context that it exists today.

•••quote:•••For example, suppose there is a hospital with 5 residents doing 120 hours' work per week for a total of 600 man-hours. If this hospital reduces each resident's workload to 60 hrs/wk, that totals only 300 man-hours. To account for the lost 300 man-hours, the hospital must hire another 5 residents, which will cost ~ $175,000/yr. ••••Again, you are very confused about how hospitals and residency programs are funded. There is largely significant incentive to hire more residents regardless of the number of hours they work. The more they hire, especially AMGs, the higher the reimbursement. This translates into a significant revenue stream for the hospital. The resident salary is a fraction of this number. The hours residents put in is just gravy on the monopolistic train.

•••quote:••• But I'm probably missing something. I would appreciate someone's explaining me what part I'm not getting. As I said, I know little about the inner workings of the health care system. ••••Your missing almost everything. Don't feel bad, as most interns/residents don't understand just how badly they are getting screwed. It's nice to see the three representing the class action suit take action. Hopefully this doomed litigation will serve to educate others who are as grossly misiniformed as yourself.

•••quote:•••Thanks for your input. ••••Your welcome
 
Well, I guess it is time to through my hat into the fray...

WBC--I the imortal words of my EBM lecturer "Put up or shut up!" I would be more than happy (actually giddy) if you could provide some proof as to your claims of $200,000 reimbursment to hospitals. However, my own reseach and research that was done and posted by others on this site show what you say to be an untruth. Your "intimate knowledge" is not sufficient in this day and age.
RTK made some good points as did droliver and many others. Look, at it this way. The match is like democracy--it isn't a perfect system, but it is the best we got. What people don't seem to realize is that every lawsuit and every law that is passed take power out of the hands of physicians and places it elsewhere. The right and need to govern oneself should be considered sacred. Does there need to be a change--yes. Is a lawsuit the way to acomplish that change--absolutely not.
And to all of those who will counter with--"the system won't allow us to change/won't change." I have to say--have you tried? The first negative I have heard about the match (outside of a couple of people who didn't match) was the inception of this lawsuit. There wasn't to my knowledge a growing grass roots movement to change resident pay like there is to change resident work hours. We should try to work within the system before we circumvent it or bring an outside party into the mix.

And for the love of God--quit comparing us to lawyers. If we become associated with that bunch our reputation will be ruined. :wink: <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" />
 
•••quote:•••Originally posted by droliver:
•A few comments on what has turned into a degenerating conversation on an important issue.

Synite- I will not waste my time with you. Obviously you feel that medcine is an inconvenient lifestyle choice. Its amazing to me that you fell thru the cracks and managed to convince an admissions committee that you actually wanted to be a doctor.•••••droliver, thank you for ignoring every one of my points. how do you question my suitability for medicine, simply because i am vocal about what i think is a flawed system? i'll be a doctor even if it means going through the system as it's currently structured. but i dont have to be silent about it. if you enjoy abuse, thats your perogative. but obviously, you missed everything i wrote. please reread my post.
 
Interesting thread.

I don't know how it was figured out that most residents make around $12 an hour. I don't make that much and I work great hours normally (Pathology resident).

Here is how I did the math check it out and see if I missed something.

Pay $35,000 a year
Work 49 weeks a year (3 weeks vacation)
I about 50 hours a week on my easy rotations. Probably a little more if I have to actually come into the hospital when I am on call. Alot more if I am on a Surgical Path rotation. So I will just use 50 hours to maximize my pay.

$35,000/49=$714/wk

$714/wk = x(40hours/wk) + 1.5x(10hours/wk)
$714 = 65x
x = $10.98

The 1.5x is for overtime don't forget hourly employees get that. :wink:

Ouch i didn't make the $12.00.

So my surgery buds are getting around $7.00/hr based on 80 hours per week.

I believe residents should make at least as much as the average nurse. Here that would be around $20-30/hour.

I also believe hospitals should have to pay residents as hourly employees. That in itself would lower the insane hours some residents work. As long as there are no market forces to force better conditions things will not change.
 
Here's how I came up with $12.50.

As a PGY-1 I will get $39,000. We have 4 weeks vacation, so we work 48 weeks. So we make $812 per week. When you average out tough/easy rotations, we work an average of 65 hours per week. That works out to $12.50 per hour.
 
Quite a number of posters have bemoned the lack of "free market" forces in the placement, compensation and working hours of residents. I've also seen posts about some organization that are trying to do the right thing with their residents with higher pay and fewer hours, thereby attracting good candidates. We need to encourage more of this!

Many posters also seem to have the idea that demanding more from the System or scrapping the system so the "market forces" can work there magic are missing the bigger picture. So too are the board certified doctors who state that the only way to fix the whole of the medical system is to make it completely free market affair.

Part of the reason that we have medicare and the system currently in place, is because social patterns changed at the begining of the 20th century and there was a NEED for a new kind health care support system. You want to exclude people from a system because they can't pay? You best be prepared to give up any idea of going to medical school as well, because it's the very same government guarranteeing those substantial student loans which allow you to go to med school in the first place! Just a few days ago I saw lot's of students freaking out because they thought they were going to have to get Medical loans at free market rates - some of the very same "free marketeers" present on this thread.

So, take a momment to stretch your mental muscles a bit and try to access a bit of the "vision" for which some see a lack of here and consider that some of the suggestions previously made here in this thread are indeed going in the right direction, although, perhaps not quite far enough.

1) First let's consider GME and the whether or not it needs to be "apprentice" work. Is there really any better way than to learn by doing? Currently there seems to be a lot of talk about the physician "never stops learning" but not many people give much thought to it. Especially in acedemic medicine. I'm not sure that the current model for apprenticeship is the best and it certainly seems to break down faster in larger organizations where there is more beauracracy and less contact between Resident and Attending, but find me something better before trying to flush it out with the bath water.

2) BS and MD eight year model. Perhaps the better solution is to adapt a more European model and make the BS and MD degrees combined for a total of six years instead of eight. It would also reduce the the overall debt load.You say you want to compress it even more? Ok, start special High Schools geared to pre-med education. Not everyone would be inclined to it, but it's a start.

3) Scutwork versus learning - Here I do agree somewhat with the Free Market folks that money is being wasted in training hospitals for no other good reason than poor management. Very little of the money seems to be accountable and this is wrong. However, it's also wrong to measure stricly on a financial bottom line - Quality needs to be accounted for as well, far beyond just saying that one can put out a good product, but does the system and management in place create consistent levels of quality and care? - for patient and staff!

4) Low pay is simply one of the symptoms of chronicly poor system management. A system based more on the acedemic model than anything else. After all Residency is "Graduate Education," which does seem to imply a bit of learning. Since not very many people are whining about the fact that they are getting paid to learn, but simply how they are being made to learn, this narrows the problem a bit. (Although some do seem forget that being an MD and being Board Certified are very different.) One short term solution may be to try and unionize in ways similar to other Grad students around the country. Another would be for hospitals to be encouraged to use more PA's and Nurse Practitioners. These highly educated professionals often bring more experience to an organization and get paid only a bit more to do the same work as a resident. The MD's today are essentially economic and intellectual "hot-house flowers" which can increasingly only exist in very specific environments. This in no way minimizes what they have to contribute. However, do keep in mind that health care system is increasingly osified which in turn leaves fewer options for doctors.

5) Keep in mind that going "Free Market" is a concept not a solution. How are you going to do it and what do you expect to get from it? How far do you expect it to go? I reallize that health care is not written into the Constitution, but neither is a guaranteed profit.
 
Klebsy, one thing I don't understand about the system is that if programs are rewarded financially for hiring more residents - as you posited in your message - then why doesn't each program hire 100+ residents, each resident working 1 hr/wk? They'd make more money that way, wouldn't they?

Obviously, there must be a limit to how many residents each program can hire, or everyone would hire 100+ residents and laugh all the way to the bank. Who sets the limits on the # of residents allowed? And, once again, if there are limits as to the numbers of residents allowed, then how can residency programs cut the number of hours worked per resident if they cannot hire more residents (due to externally-imposed limits)?

If anyone can explain this one, Klebsiella or otherwise, I'd like to hear it, b/c this is all a friggin' mess to me; also, Klebsiella, I'd like to hear your proof of "intimate knowledge" as one of the recent posters asked you to produce. I'm not disputing your facts, just wanting to know your sources. 🙂

dg

P.S. "You're" means "you are". "Your" is the possessive form of "you". I'm sorry, man, but when it happens several times in the same message, it's not a typo or a coincidence, eh, Klebsy boy? It's a sign of something more disturbing, I fear to think what....
 
We see the capitalist economy model work in virtually every other post-graduate field.
Do lawyers work 24-48 hour shifts? Do MBAs secure jobs that pay $12/hour?
Are these professions any different the healthcare field? Do these people magically come out of their schools knowing every facet of their new position? No, they are trained on the job. And yet....they are paid a fair wage with reasonable work expectations.

It is obvious that the current matching system has failed miserably for the employees. The solution is the incorporate free market principles into this process.

Employees are:
1) Persons whom employers have control in telling what to do and when to do it.
2) Paid a wage for their services
3) Persons whose services and work have a effect on the employer's revenue

Residents are employees...despite what the AAMC and hospital administrators want to brainwash you into believing. Just because they are in the health care industry does not make them exempt from the freedoms enjoyed by other employees in other fields.
 
&#65279;K, It's my time now- I had intimate knowledge of a third-world country- have had opportunity of
working there. Nearly 90% of the population were non-insured and have to pay the bill themselves.
The Govt. tried to provide medical care for everybody and ultimately provided anything but
"medical care"- it's horrible mess to see the people lined up in the OPD or sharing a single bed with another one(or two)! It's notconceivable by anyone in the US med environment. The situation is just the opposite in privately funded for-profit hospitals which matched any premier inst anywhere in the world, for people who can afford to pay for it. The contradiction is existing for decades as for as I knew it.
Is the US is headed for the same direction- that I can't guess. I would love to receive better pay, tofill less forms, to concentrate more on my patient care to horn my skills more, work in a morehumane way. I don't buy the argument that this is the way medicine is practised for decades- then you would have shut off all the Lab/Scan techs for age old hand/eye/ear maneuvers.
You can't bury your head in the sand waiting for the storm to pass- you have to get a shelter- it's not there right now, we have to build it up for ourselves sake as it's not only for our living but also forthe safety's sake of our progeny(we can't leave them in the hands of incompletely trained/unskilled docs trained in B-grade centers).
I don't know to read the fine-prints of the balance-sheet of the hospital I work, but I know for sureit makes a lot of profit and probably can raise the pay of residents a little more. It had turned around in couple of years using basic concepts of cost-containment and better management skills- the same should apply in dealing with it's residents pay- weed off the inefficient and pay better to the remaining, which they have surprisingly neglected or have afforded to neglect due to our own slave
mentality.
Will the law-suit change it all- no-definitely not, but at least something should start out
of it-that I definitely hope.
 
Doc Hubby,

Is it "The Prince's Bride" or "The Princess Bride"? Just checking! <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" />
 
I'm all for free market enterprise, and private medicine (within the context of universal access), but what I haven't read in this discussion is the health dollars taken out of the system by for-profit insurance companies. Aren't they working overtime to squeeze hospitals/doctors over billings? Why are we letting these dollars escape our control? You would think in a larger sense that savings and efficiencies achieved are the province of the health care system, not for-profit companies that will forever take that money out of health care. I guess what I'm getting at is, even if the battle of the moment is hospital vs. resident, is there that 'phantom menace' lurking in the shadows that's the true enemy?
 
•••quote:•••Originally posted by rsk77:
•s there that 'phantom menace' lurking in the shadows that's the true enemy?•••••Yes, indeed there is a phantom menace. And soon, when super-residents are reproduced in laboratories at a dizzying rate, putting the rest of us doctors out of work, we will see Attack of the Clone Residents.

(From the audience I hear Attack of the Groans.)

😎
 
•••quote:•••Originally posted by davidgreen:
• •••quote:•••Originally posted by rsk77:
•is there that 'phantom menace' lurking in the shadows that's the true enemy?•••••Yes, indeed there is a phantom menace. And soon, when super-residents are reproduced in laboratories at a dizzying rate, putting the rest of us doctors out of work, we will see Attack of the Clone Residents.

(From the audience I hear Attack of the Groans.)

😎 •••••Wait till we get back to the original trilogy. Staff Wars: A New Hope, Staff Wars: The NRMP Strikes Back and Staff Wars: The Return of the Fellow.

Did I hear those groans intensify?
 
For those of you who refer to residency as an apprenticeship, my brother-in-law is a plumbing apprentice (2nd year) and he gets paid $15/ hr. Electrician apprentices get paid even more. Plus, they all get full benefits, lots of vacations and don't work more than 40 hrs per week without getting paid time and half. The fact that we are learning skills while working does not mean we should not get paid fair wages.
mary
 
•••quote:•••Originally posted by Ryo-Ohki:
•We see the capitalist economy model work in virtually every other post-graduate field.
Do lawyers work 24-48 hour shifts? Do MBAs secure jobs that pay $12/hour?
•••••Associates working at New York law firms (those who everyone quotes making $120K+) typically working 80+ hours per week. Many lawyers make far less an work similar hours. Not quite as bad as residents, but certainly not high pay/low hours.

Also, the comparisons to MBAs is not reasonable. The vast majority of the students at the top business schools are older students with significant business experience.

Ed
Ed
 
•••quote:•••Originally posted by edmadison:
•
Originally posted by Ryo-Ohki:
[qb]We see the capitalist economy model work in virtually every other post-graduate field.
Do lawyers work 24-48 hour shifts? Do MBAs secure jobs that pay $12/hour?
•••••Associates working at New York law firms (those who everyone quotes making $120K+) typically working 80+ hours per week. Many lawyers make far less an work similar hours. Not quite as bad as residents, but certainly not high pay/low hours.

Also, the comparisons to MBAs is not reasonable. The vast majority of the students at the top business schools are older students with significant business experience.

Ed
Click to expand...
 
Do lawyers work 24-48 hour shifts?

Yes, the associates you mention may indeed work 80 hours/week. You missed the entire point, however. They had a CHOICE. There are many choices out there for law students that do not involve 80 hours a week. And they even get to entertain offers and decide pay/time wise what is best for their career and life! Novel concept, huh.

Could you imagine if their law school sold them as slaves to law firms after they graduated? This troubling connection between the hospitals and medical schools is at the heart of the problem.
 
•••quote:•••Originally posted by Ryo-Ohki:
•Do lawyers work 24-48 hour shifts?

Yes, the associates you mention may indeed work 80 hours/week. You missed the entire point, however. They had a CHOICE. There are many choices out there for law students that do not involve 80 hours a week. And they even get to entertain offers and decide pay/time wise what is best for their career and life! Novel concept, huh.

Could you imagine if their law school sold them as slaves to law firms after they graduated? This troubling connection between the hospitals and medical schools is at the heart of the problem.•••••I didn't miss the point at all. I'm just trying to point out that the life of a law school graduate is not as wonderful as is posted here. Yes, if they are top candidates, they can choose to sell their souls to the devil they can make 100K+/year, however, that comes with a huge price in terms of long hours and no job security. Not to mention boring and largely meaningless work. The majority of law school graduates do not have this option. They work long hours for little pay in whatever job they can find.

As I have repeatedly said, I think the plight of residents stinks. Weekly hours and shift length should be capped. Unfortunately, significant pay raises are probably financially feasible. I believe that the current system is a monopoly and should be toppled. Just be carefull for what you wish for, there is no guarantee that a free market will improve the situation.

One more comment about the physician/lawyer comparison. Many lawyers make a good living, but many more do not. Law school is not a ticket to a great job unless you are fortunate enough to graduate from a top ten school. There are too many lawyers and too few good jobs. Many lawyers 4-7 years after graduation must scramble to find any job, because their firms find it more cost effective to hire new graduates. Medicine is different. If you graduate from any US medical school and endure you residency, you are virtually guaranteed a lifetime of relative prosperity. Almost all physicians can make at least $150K if they are flexible about where they will live. This is pretty good even factoring in loans.

This does not make it OK to treat residents like slaves. That is wrong! I only add my commentary to place their plight in perspective with that of young lawyers.

Ed
 
Notice that Klebsiella has gone eerily silent since an earlier poster asked him to display proof of his "intimate knowledge" of the mysterious world of hospitals and funding. He has also failed to address the "less hours without hiring more residents" dilemma I posed to him.

Hmmmmm... could it be that Klebsiella, in fact, has no intimate knowledge, no sources to back him up, nothing at all, in fact, but an inflated sense of self and puffed-up arrogance against those who disagree with, or simply ask for explications from, him?

We shall wait with baited breath.
😎
 
'We shall wait with baited breath.'

Bated breath.
 
One word gents: toothbrush!
 
Many of you are familiar with the obnoxious and childish antics of one DavidGreen. This particular poster has decided his/her sole role is to edit and correct my posts. At least he/she has found one small way to contribute. Unfortunately, the rest is pure rubbish.

In another thread, this poster with degenerate tendencies, claims to have spent years in ivy league setting, including harvard. Please observe the following profile of this slippery individual.

Member Status: Newbie
Member Number: 13770
Registered: March 24, 2002
Posts: 30
Location: Huntsville, AL
Occupation: Anesthesiologist
Homepage: (none)
Interests: Medicine
Undergrad School & Year: U Alabama, 1994
Graduate School & Year: U Alabama, 1998
Internship or Residency: Mass General, 2002 (expected grad)
Male / Female: male

You will notice that said 'davidgreen' apparently forgot to 'fix' his/her profile before rattling off about all the ivy league schools he/she attended. Last time I checked, U. of Alabama was not a member of the league.

I took the liberty of copying/pasting this info so we have a record of his/her grotesque subterfuge.

Is your life so pathetic that you find solace in lying to a community of physicians? Are you even a medical student? Unlikely.

What you are is a fraud.

I think you have been sniffing too much of the gas you claim to be passing.
 
I find it interesting that Mr. Klebsiella has failed to demonstrate his "intimate knowledge" of the medical system. Perhaps by "intimate knowledge" he meant that he knows what kind of bras and panties the nurses wear. Even if this was his intent, he has failed to prove himself.

Just answer the [bleepin'] question, Klebsy!

As for the user davidgreen: IT'S CALLED LEAVING A FALSE TRAIL! How hard is that?

Here's the setup:
My two roommates and I are tired of having to register for each and every bloody website out there, from medical to news to sports to car sites, so we have a bulletin board right next to the computer in the living room that has a convenient login name and easy-to-type password for the sites we frequent. Usually, we just have the computer "remember" our login name and password for each site, but sometimes that feature is reset on our computer, so we always have the bulletin board to refer to.

David = middle name of one roommate
Green = maiden name of one guy's mother
Alabama = long form of the pejorative 'Bama, which is oft-said in our apartment.

Hence, David Green from Alabama. Reasonable sounding Alabama university names and graduation dates enclosed. It's that easy. <img border="0" title="" alt="[Eek!]" src="eek.gif" />

So, when you see "davidgreen" on the screen, it could by any one of us (three) guys, or any other random dude or dudette who chanced by our computer and logged on to this website. If any of you are so inclined, look back carefully at the various davidgreen posts and you'll find different tones and agendas.

If password sharing is illegal, then I guess the administrator of this site will destroy davidgreen's (Apt 312's) account. No matter, we'll just sign on as someone else.

There's no stopping us.

Baited breath: I hope some of you got the pun. The message I wrote was "bait" for Klebsiella. So, there's the "bated breath" (anticipation) meaning and the "baited breath" (laying the bait) meaning. Sorry, I don't mean to insult anyone's intelligence, but P Diddy's message made me think that the pun - insignificant as it was - may have got lost in the shuffle.

Enjoy yourselves.
 
I agree that free-market competition is the way to go for practically all aspects of life in America including residency positions.

But is this not what we have already? Is there any law or specific agreement that prevents any one residency from offering more money or fewer hours or better benefits than other residencies?

I don't think the residencies are hiding too much. We know the salary and benefits and can find out the working conditions from other residents. A lawsuit won't stop the collusion between the various hospitals. If one hospital changes their salary, the others will quickly find out and do the same -- just like the airlines do with their ticket prices.

We all know what the salary will be when we become residents. And while I also think it should be increased, I don't think this lawsuit is going to accomplish that. Like others have stated, the matching program and salary/hours are two separate issues. Even if the resident's salary for Dermatology at Mass General were only $10,000 per year they'd still probably have many more applicants than positions.

I think there are only two things that will raise the salary of residents: an increase in funding from the federal government with the individual programs giving residents a bigger piece of their funding (slim to no chance of that) or a decline in people willing to become residents leading to supply/demand requiring higher wages to attract more people. A lawsuit attempting to dismantle the NRMP is not likely to increase wages, just make finding a residency more confusing.
 
Collusive oligopoly, mpp. The same principle applies here. This issue is at the heart of the lawsuit.

The matching program is one of the major tools used to lower salaries and create the abusive working hours.

I have to start a hospital. So many naive young doctors to exploit for money.....
 
Can you explain how the matching program lowers salaries? How does the NRMP lead to abusive working hours?

Collusive oligopolies exist everywhere in America but it does not mean there isn't competition. Until there are far more residency positions than there are applicants, there is no reason for any of the programs to raise the wage regardless of whether or not the NRMP exists. People will just rank the residencies that will give them the best combination of education, salary, benefits, hours, etc. The limiting factor to me is the demand for residencies and the requirement to complete one to become licensed.

I think one other way to raise the salary of residents is to get rid of residency altogether and just license physicans upon completion of medical school and passing the USMLE, as was the case in the not too distance past -- the GP. This is the difference between lawyers and MBA's, etc...the residency requirement to become licensed. Engineers have something similar called EIT (Engineer in Training) for which at low pay (similar to a resident) you must work for a specified number of years as an apprentice (depends on the state, usually about 5) before you can achieve Professional Engineer status.

I keep seeing people write that they have no choice when it comes to residency. But of course there are choices...you can become one of these high-paid lawyers, MBA's, electricians, plumbers, etc., that everyone keeps comparing themselves with.

By the way, although I may be naive, I am far from young, and if your hospital offers the type of education, benefits, hours, salary that I'm looking for, I will surely rank it high on my list.
 
A) Collusive oligopolies are illegal.

B) EITs are college graduates. They do not have four years of post graduate work like MDs. They do not work 80 hour work weeks. They make more money then residents. For example, on a government scale (I know they have a different one for engineers), a college graduate with good grades will start out at GS-7 ($30K). In two years, he will be making more then most 4th year residents, GS-11 ($45K). All of this without going through 4 years of graduate work.

C) How does the matching system artificially lower wages and cause the insane 24-48 hour shifts?
Like I said, it is at the heart of the law suit. Please read it.
<a href="http://www.usatoday.com/news/nation/2002/05/07/residents-brief.htm" target="_blank">http://www.usatoday.com/news/nation/2002/05/07/residents-brief.htm</a>

D) My hospital will conspire with other hospitals and schools to make sure we offer the same, LOW, salary. We will make you work an insane amount of hours and make you thank us for it. Instead of the traditional white coat, our administrators will dress in black leather and carry matching whips. We will make you bend over and say, "Thank you, sir! May I have another?" Now, say it. Say it! *whip crack*
 
•••quote:•••Originally posted by davidgreen:
•I find it interesting that Mr. Klebsiella has failed to demonstrate his "intimate knowledge" of the medical system. Perhaps by "intimate knowledge" he meant that he knows what kind of bras and panties the nurses wear. Even if this was his intent, he has failed to prove himself.

Just answer the [bleepin'] question, Klebsy!

As for the user davidgreen: IT'S CALLED LEAVING A FALSE TRAIL! How hard is that?

Here's the setup:
My two roommates and I are tired of having to register for each and every bloody website out there, from medical to news to sports to car sites, so we have a bulletin board right next to the computer in the living room that has a convenient login name and easy-to-type password for the sites we frequent. Usually, we just have the computer "remember" our login name and password for each site, but sometimes that feature is reset on our computer, so we always have the bulletin board to refer to.

David = middle name of one roommate
Green = maiden name of one guy's mother
Alabama = long form of the pejorative 'Bama, which is oft-said in our apartment.

Hence, David Green from Alabama. Reasonable sounding Alabama university names and graduation dates enclosed. It's that easy. <img border="0" title="" alt="[Eek!]" src="eek.gif" />

So, when you see "davidgreen" on the screen, it could by any one of us (three) guys, or any other random dude or dudette who chanced by our computer and logged on to this website. If any of you are so inclined, look back carefully at the various davidgreen posts and you'll find different tones and agendas.

If password sharing is illegal, then I guess the administrator of this site will destroy davidgreen's (Apt 312's) account. No matter, we'll just sign on as someone else.

There's no stopping us.

Baited breath: I hope some of you got the pun. The message I wrote was "bait" for Klebsiella. So, there's the "bated breath" (anticipation) meaning and the "baited breath" (laying the bait) meaning. Sorry, I don't mean to insult anyone's intelligence, but P Diddy's message made me think that the pun - insignificant as it was - may have got lost in the shuffle.

Enjoy yourselves.•••••Precious indeed <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" /> Your posts never fail to amuse. Further, each succeeding post reveals a more sinister level of depravity and emptiness in your life. Here's a hint: Don't let the abject desperation that has become your life become so apparent on this board. 🙁

You lied, and were caught perjuring yourself on a student doctor message forum. If you had any sense of decency, you would apologize and wipe the mud off, instead of turning your moniker into an frenzied online circus of twisted fanaticism. Do you even believe the cr.p you write?!? 😕 😕 😕

Let's revisit your ode to elitism one more time shall we? You spoke so diligently (hiccup) of how you worship the intellect you claim is only found in ivy league school students. You than proceeded to blatantly lie, claiming attendance to Harvard undergrad. Your perjured bio posted above however, reveals attendance to the Univ. of Alabama. I find this level of deceit and insatiable need to lie sickening, especially when such filth is thrust upon an otherwise sacred forum.

You also state you are attending an anesthesiology program at mass gen. Apparently this is the meter of excellence and ?elitism? your warped views have emanated from. Here is the problem with your twisted view of ivy league schools. You see 3 years ago when you started your pgy2 year, anesthesia was the easiest and most dreaded field around. Mass Gen. regularly had open slots, a matter of public record in fact. It is likely that you are not surrounded by 'elite' minds, but many bottom of the barrel candidates who were unable to find slots in even the lowest FP residencies. Sorry if this assessment hits too close to home. You made your bed sir/madaam, now sleep in it.

Elitism? The smartest? Anesthesia three years ago?!?! Please spare us.

And please keep your fraudulent claims off our boards. Or at the very least, have the decency not to get caught.

That was really very funny.
 
To Ryo-Ohki and mpp,

The term "oligopoly" refers to an industry run by only a few companies (think Coca-Cola vs. Pepsi). This clearly isn't the case with hospitals, because there are hundreds of them.

The hospitals act more like a Cartel--similar to the way that OPEC operates. The many countries that make up OPEC could compete with each other to provide the lowest-priced oil. However, if they all meet once a year (at OPEC meetings), they can agree to all sell oil at above-market prices. If all of the countries "fall in line" then the US and other oil-consuming nations have no choice but to pay the higher price for oil. The fact that OPEC does this is public knowledge, as is the price that OPEC sets for its oil. In fact, even non-OPEC countries read the minutes of the OPEC meetings and set their prices accordingly.

Replace OPEC with the ACGME in the above example. The ACGME openly polls residency programs about their salaries, and the residency programs set their salaries accordingly. The NRMP is one of the tools that ensures hospitals "fall in line" -- they cannot broker special deals with residents. In this way, the residents' salaries end up being below market value.
 
•••quote:•••Originally posted by mpp:
•Engineers have something similar called EIT (Engineer in Training) for which at low pay (similar to a resident) you must work for a specified number of years as an apprentice (depends on the state, usually about 5) before you can achieve Professional Engineer status.
•••••Well in engineering the situation is quite murky. In fact, for most engineering fields, getting the EIT (which I have) and the PE is really a luxury and you dont need it. The only engineering fields where having such licenses are a must is civil/structural engineering. For my field of electrical/computer engineering, only a very small percentage of people choose to get the EIT and PE.

I dont know what the situation is for civil/structural engineering, but for EE/CE, having the EIT/PE generally makes very little difference in your pay. Starting out of college, you can expect to make approx 45-55k per year, with or without the EIT certificate.

For EIT designation, you have to take a national standardized test in engineering, covering all of the basic physical sciences. Its an all-day test like the MCAT with a morning and afternoon session. Everybody takes the same morning test, covering physics, chem, math thru differential equations, statics, dynamics, fluid dynamics, thermodynamics, etc. For the afternoon session, you can choose to take a discipline-specific test (i.e. electrical engineering, civil, industrial, mechanical, etc) or a general engineering exam that is basically just the same topics as the morning session except covering more in-depth and advanced concepts.

If you pass this test, called the FE (fundamentals of engineering exam) then you can apply for an EIT certificate. Once you get this, you work for a period of time under the supervision of a professional engineer (PE) depending on the state, anywhere from 3 to 8 years. Then you take another standardized test called the principles and practice of engineering exam. I dont know the details of this test, but if you pass it, then you have to fill out another application to get your PE license. From what I understand, its pretty intensive, and just because you pass the principles exam does not mean you will get your PE license. Plus, you have to pay a hefty fee every year (approx $300) to renew the license.

I think most states wont allow you to work as an engineer involving public projects (i.e. power distribution grids, highway design) without having a PE. Having the PE license allows you to 'sign off' on projects under your expertise and you are ultimately liable for any design problems.
 
Spiderman 719, you're right on the money about sign-on bonuses. Hospitals are already doing just that to encourage "quality" candidates or just ones that they need to "guarantee" a complete Match result. Who knows exactly what their reasons might be, but quite a few possibilities immediately come to mind. One hospital in particular even posts this "dividend" on its FREIDA listing: $7,000.00 sign-on once the deal is completed. They also have other neat perks as well. It doesn't exactly circumvent Match rules, but it does create interesting outcomes nonetheless.
 
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