Nurses making more than residents?

[Goro]

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Indeed. Residency is in many ways analogous to a post-doctoral fellowship. You make more than a grad student, you get to be more independent, but you don't have a tenure-track position and you sure can't write for R01s or R21s.

Here's a secret: residency isn't "what we do." Residency is a temporary training period that allows us to do what we do- practice independently as fully-trained physicians. And trust me, the pay for that is many many times more than $12/hour. Those of us who "accept the status quo" aren't sheep, we have basic comprehension of the fact that a resident is not the same as a new lawyer or engineer- both of whom have completed their training pathways and started their careers.

 

[VA Hopeful Dr]

As someone whose undergraduate degree was in engineering, I can assure you that young engineers have not completed their training; it is just beginning and will take careful supervision/review over time. Ditto for lawyers. Your attitude about residency being a temporary training period reflects an attitude that I find patronizing and exemplifies what I find wrong with much of the "old guard." The surgical area I intend to go into will take me nine years of residency/fellowship. You call that temporary, and suggest I should suck it up because good days are up ahead. I have a hard time accepting your approach because it deflects from the issue I bring to the forefront, i.e., the value of a resident over the course of training compared to an NP or PA. I believe people should be paid what they are worth and not be compromised by collusive teaching hospitals and a congress that passed a bill that destroys a level playing field.

Man this argument never gets old.

I will preface this with saying that my training is not surgical, so my experience there is limited to what I saw in med school and 2 rotations in residency.

Residents, except at the very end, are not as efficient as attendings. Period. For example, in both my residency and med school, inpatient medicine teams had 2 interns with around 10 patients each with 1 supervising upper level per attending. That's around 20-25 patients per attending. Everywhere I have worked since finishing residency, hospitalists routinely had upwards of 30 patients per physician. So we're talking patients without the overhead of 3 residents, including support staff and admin time that most academic docs have.

Clinic was similar. 3rd years were seeing about 10/half day, 2nd years 6, interns 3 - so 19 patients per half day in clinic. Most outpatient doctors are seeing around 15-18 per half day, once again without paying resident overheads.

Neither of these factor in payer mix since teaching hospitals are notorious for taking care of un/underinsured.

My experience with surgery was similar, if not worse since the learning curve is steeper. A lap chole by a 4th year at my med school program took about 30-40 minutes, not including room turnover so total time of around 90 minutes. A good private surgeon can do one in 10-15 minutes, so total of about 1 hour including room turnover. Once again, without overhead and with a better payer mix.

But none of this matters, one of us always makes the exact same argument when this nonsense comes up and it never works. So, instead of just bitching about how unfair it all it, why not starting January 1st keep track of everything you bill for (by which I mean what is actually collected), substract your salary and benefits, and whatever fraction of the attending's salary and benefits you are responsible for (50% if you are one of 2 residents they are supervising, 33% if one of three, you get the idea).

At the end of the year, if you are showing a substantial surplus, then we'll talk.

 

[WingedOx]

It is for my prelims

Of course one prelim from another has no bearing on your future career*, unlike the residency that will actually train you to do the job you're going to be paid for once you're done

*hence why programs like Reading PA or Resurrection IL are competitive. The goal of a prelim is to do as little work as possible. No one is going to care about your hospitalist skills when you're applying for Optho jobs at the end of residency.

 

[Docbeme]

Man this argument never gets old.

I will preface this with saying that my training is not surgical, so my experience there is limited to what I saw in med school and 2 rotations in residency.

Residents, except at the very end, are not as efficient as attendings. Period. For example, in both my residency and med school, inpatient medicine teams had 2 interns with around 10 patients each with 1 supervising upper level per attending. That's around 20-25 patients per attending. Everywhere I have worked since finishing residency, hospitalists routinely had upwards of 30 patients per physician. So we're talking patients without the overhead of 3 residents, including support staff and admin time that most academic docs have.

Clinic was similar. 3rd years were seeing about 10/half day, 2nd years 6, interns 3 - so 19 patients per half day in clinic. Most outpatient doctors are seeing around 15-18 per half day, once again without paying resident overheads.

Neither of these factor in payer mix since teaching hospitals are notorious for taking care of un/underinsured.

My experience with surgery was similar, if not worse since the learning curve is steeper. A lap chole by a 4th year at my med school program took about 30-40 minutes, not including room turnover so total time of around 90 minutes. A good private surgeon can do one in 10-15 minutes, so total of about 1 hour including room turnover. Once again, without overhead and with a better payer mix.

But none of this matters, one of us always makes the exact same argument when this nonsense comes up and it never works. So, instead of just bitching about how unfair it all it, why not starting January 1st keep track of everything you bill for (by which I mean what is actually collected), substract your salary and benefits, and whatever fraction of the attending's salary and benefits you are responsible for (50% if you are one of 2 residents they are supervising, 33% if one of three, you get the idea).

At the end of the year, if you are showing a substantial surplus, then we'll talk.

The argument I am putting forth is comparing the compensation and work week of a resident/fellow to a PA/NP. I would expect that it would take the full term of residency and fellowship, and years of practice thereafter, to achieve the skill set and knowledge base of a well trained physician, regardless of the area of specialization. Does the hospital make a net profit from the services of each resident? I believe the answer is a resounding "yes" and probably available through a FOIA request for hospitals associated with public universities.

 

[Obnoxious Dad]

As someone whose undergraduate degree was in engineering, I can assure you that young engineers have not completed their training; it is just beginning and will take careful supervision/review over time. Ditto for lawyers. Your attitude about residency being a temporary training period reflects an attitude that I find patronizing and exemplifies what I find wrong with much of the "old guard." The surgical area I intend to go into will take me nine years of residency/fellowship. You call that temporary, and suggest I should suck it up because good days are up ahead. I have a hard time accepting your approach because it deflects from the issue I bring to the forefront, i.e., the value of a resident over the course of training compared to an NP or PA. I believe people should be paid what they are worth and not be compromised by collusive teaching hospitals and a congress that passed a bill that destroys a level playing field.

Your willingness to spend nine years in training at resident /fellow wages reflects the fact that your salary is sufficient to attract and retain you. If you didn't want to take on medical school debt and go through the rigors of residency and fellowship while working for a salary that doesn't compensate you adequately (in your eyes), you should have stayed in engineering with all of the other economic nitwits. You are a whiner, but your eager participation in this madness shows that you really have nothing to complain about.

I will be the first to admit that the medical profession has done a poor job of designing and pricing medical education. That applies to both med school and residency. Furthermore, the jokers who run that show might be aware that they are running a guild system right out of the middle ages. It appears to me that they have done their best to make medical education as expensive, exclusive, time consuming and aggravating as possible. They've done this to drive up medical wages and in the end you will benefit at the expense of the rest of society.

I suspect that the non-anatomy half of the first year of medical school and the second year of med school could be done entirely online because so many students just watch lectures on line and download power points in their pajamas. Would the cost of testing students in those online courses exceed $3,000? Would the per student cost of anatomy exceed $15,000? The only year of med school that should be expensive is the third year. The average cost per student for the third year at AN EFFICIENT MEDICAL SCHOOL might be $25,000? What is the per student burden in the fourth year? It might be $20,000. Why are medical students paying $60,000 per year in tuition?

The economics of residency education have not been thoroughly investigated. According to a recent study by the Rand Corporation it appears that office based residencies like ophthalmology and dermatology are big money losers for their hosts but at the margin large hospital intensive residency programs in internal medicine, surgery, pediatrics etc save their institutions money. The reason we don't fully understand the economics of the process across residency types is that academic physicians are incompetent managers.

If you don't want to spend nine years in training, go into family practice and stop complaining.

 

[VA Hopeful Dr]

The argument I am putting forth is comparing the compensation and work week of a resident/fellow to a PA/NP. I would expect that it would take the full term of residency and fellowship, and years of practice thereafter, to achieve the skill set and knowledge base of a well trained physician, regardless of the area of specialization. Does the hospital make a net profit from the services of each resident? I believe the answer is a resounding "yes" and probably available through a FOIA request for hospitals associated with public universities.

Prove it then, because I seriously doubt it - and even if the answer is yes, I bet its not a large amount of profit.

 

[IlDestriero]

The problem is that residents and medical students slow the whole system down. I've worked as an attending in an academic setting and a non academic setting. Let me assure you that trainees dramatically slow the system at every level. You may think you're providing some great free service, but time is money in healthcare. And getting out early ain't so bad either.

 

[Commer_Knocker]

Prove it then, because I seriously doubt it - and even if the answer is yes, I bet its not a large amount of profit.

Some of the arguments out there to validate this:
-Indirect GME funding is too high by around 25%
-After second year, residents in some specialties give back more than they take in salary
-A hospital with residents can increase the resident workload to avoid hiring other staff- this can be a wide range of positions, effectively allowing hospitals to save money on hiring by upping resident work hours; I'd imagine this savings is huge.

I've never heard any credible argument that the GME money per resident from the government was inadequate to cover expenses, so given some of the above factors, I wouldn't be surprised if programs made money off of residents, as many have said is the case. How much that is, I cannot say.

 

[Docbeme]

Your willingness to spend nine years in training at resident /fellow wages reflects the fact that your salary is sufficient to attract and retain you. If you didn't want to take on medical school debt and go through the rigors of residency and fellowship while working for a salary that doesn't compensate you adequately (in your eyes), you should have stayed in engineering with all of the other economic nitwits. You are a whiner, but your eager participation in this madness shows that you really have nothing to complain about.

I will be the first to admit that the medical profession has done a poor job of designing and pricing medical education. That applies to both med school and residency. Furthermore, the jokers who run that show might be aware that they are running a guild system right out of the middle ages. It appears to me that they have done their best to make medical education as expensive, exclusive, time consuming and aggravating as possible. They've done this to drive up medical wages and in the end you will benefit at the expense of the rest of society.

I suspect that the non-anatomy half of the first year of medical school and the second year of med school could be done entirely online because so many students just watch lectures on line and download power points in their pajamas. Would the cost of testing students in those online courses exceed $3,000? Would the per student cost of anatomy exceed $15,000? The only year of med school that should be expensive is the third year. The average cost per student for the third year at AN EFFICIENT MEDICAL SCHOOL might be $25,000? What is the per student burden in the fourth year? It might be $20,000. Why are medical students paying $60,000 per year in tuition?

The economics of residency education have not been thoroughly investigated. According to a recent study by the Rand Corporation it appears that office based residencies like ophthalmology and dermatology are big money losers for their hosts but at the margin large hospital intensive residency programs in internal medicine, surgery, pediatrics etc save their institutions money. The reason we don't fully understand the economics of the process across residency types is that academic physicians are incompetent managers.

If you don't want to spend nine years in training, go into family practice and stop complaining.

 

[VA Hopeful Dr]

Some of the arguments out there to validate this:
-Indirect GME funding is too high by around 25%
-After second year, residents in some specialties give back more than they take in salary
-A hospital with residents can increase the resident workload to avoid hiring other staff- this can be a wide range of positions, effectively allowing hospitals to save money on hiring by upping resident work hours; I'd imagine this savings is huge.

I've never heard any credible argument that the GME money per resident from the government was inadequate to cover expenses, so given some of the above factors, I wouldn't be surprised if programs made money off of residents, as many have said is the case. How much that is, I cannot say.

- Source?
- Perhaps, but is it enough to make up for the loss the first 2 years?
- You act like hospitals without residents close shop at 6pm - hint: they don't, nor are they in financial trouble.

 

[Commer_Knocker]

- Source?
- Perhaps, but is it enough to make up for the loss the first 2 years?
- You act like hospitals without residents close shop at 6pm - hint: they don't, nor are they in financial trouble.

-"Medicare Payment Advisory Commission, or MedPAC, which advises Congress, has estimated indirect payments may be $3.5 billion higher than actual indirect costs. Overall, federal spending for GME has been increasing for decades and now is at about $10 billion for direct and indirect payments."
-Maybe, maybe not. I guess that would depend on specialty.
-They may not be in financial trouble, but are they in as good of shape as teaching hospitals in those departments? I'd venture to say no, but there probably isn't concrete data out thereon this, so we can only speculate. But I have heard residences characterized as profitable in this regard.

 

[Docbeme]

Your willingness to spend nine years in training at resident /fellow wages reflects the fact that your salary is sufficient to attract and retain you. If you didn't want to take on medical school debt and go through the rigors of residency and fellowship while working for a salary that doesn't compensate you adequately (in your eyes), you should have stayed in engineering with all of the other economic nitwits. You are a whiner, but your eager participation in this madness shows that you really have nothing to complain about.

I will be the first to admit that the medical profession has done a poor job of designing and pricing medical education. That applies to both med school and residency. Furthermore, the jokers who run that show might be aware that they are running a guild system right out of the middle ages. It appears to me that they have done their best to make medical education as expensive, exclusive, time consuming and aggravating as possible. They've done this to drive up medical wages and in the end you will benefit at the expense of the rest of society.

I suspect that the non-anatomy half of the first year of medical school and the second year of med school could be done entirely online because so many students just watch lectures on line and download power points in their pajamas. Would the cost of testing students in those online courses exceed $3,000? Would the per student cost of anatomy exceed $15,000? The only year of med school that should be expensive is the third year. The average cost per student for the third year at AN EFFICIENT MEDICAL SCHOOL might be $25,000? What is the per student burden in the fourth year? It might be $20,000. Why are medical students paying $60,000 per year in tuition?

The economics of residency education have not been thoroughly investigated. According to a recent study by the Rand Corporation it appears that office based residencies like ophthalmology and dermatology are big money losers for their hosts but at the margin large hospital intensive residency programs in internal medicine, surgery, pediatrics etc save their institutions money. The reason we don't fully understand the economics of the process across residency types is that academic physicians are incompetent managers.

If you don't want to spend nine years in training, go into family practice and stop complaining.

Your reply was not unexpected, and it reflects a host of erroneous assumptions and statements that deflect from my contention. I'm starting to think that you don't possess the intellectual capital to discuss this topic rationally. If I chose to be chided by a parent, I can phone home.

The reason I choose to accept the compensation I receive is because I have no choice. Had you followed the discussion, you would have remembered my original premise included a link detailing the anti-trust waiver for hospitals involved with residency training. It is called collusion and its meaning should be clear.

As for your discussion of the cost of medical school, nice deflection, but it is not germane to what I said.

You allege that the economics of residency education is not knows. You can't possibly believe this statement Searching the topic suggests otherwise via a large number of scholarly articles on the topic.

Below is the link to a piece that got me thinking about this topic and which I cited before and mention in my comments above. Try reading the piece. It may open your eyes. Perhaps you may wish to discuss your inane positions with its author.

http://www.slate.com/articles/healt...n_training_are_organizing_for_collective.html

 

[WingedOx]

Oh man, where to start with this whiny rant.

I take responsibility for resurrecting this thread from the dead. There are way too many responses since my last post to respond to them individually, but I noticed certain trends.

First, the number of posters accepting the status quo of working very long hours for minimal pay I find disturbing and a harbinger of the trends that are already taking place in medicine. If you are willing to work for considerably less than what some jurisdictions are legislating as a minimum wage for working at MacDonalds, you don't value what you do highly enough. Four years of college and four years of med school and you will work for $12/hour, give or take? I can only shake my head with wonder as hospital corporations continue to make money on the backs of the very people that have the power to say "no". It starts in residency and will continue throughout many of our careers. With this attitude, it is easy to understand why doctors are lead like sheep to the slaughter. Think about the four years of college, the years of grad school some of us attended, the four years of medical school and years of residency; include the amount your education cost and then figure out your return on investment. It isn't pretty, particularly if you go into primary care and some of the lower paying specialties.

And yet how many over-educated people do you know with PhDs in god knows whatever liberal arts subject who are still making **** salaries? Why is that? because education and effort toward that education doesn't equal usefulness to an employer. Go on... walk out of your residency and tell me you have better economic options available to you right now. Go on... I'll wait. How much do you think people are going to value the time and effort you've put into your training when it is of no benefit to me as an employer in another field? You are paid what you're worth simply because you don't have better options. Programs could depress your salary and you'd still take it.

You can hold your breath for higher compensation until you're blue in the face and pass out, but if you can't come up with a reason for it besides "because I want it," well, you're SOL.

Second, the benchmark I used was NP's and PA's. An NP typically goes to four years of college and a year of grad school. For a PA, add one more year of grad school. In a typical hospital setting, they work half the hours and get twice the compensation. Remember, a resident with a bit of training under his/her belt will be supervising PA's and NP's. So someone please explain why their compensation is so much higher and their duty hours are so much less. From my perspective, it is completely illogical. Thank congress for the antitrust exemption that allows teaching hospitals to dispense involuntary servitude on their residents.

Sorry, but in what world is a resident "supervising" NPs and PA?

Third, there was some discussion about other professions that pay well upon completion of school, either college or graduate/professional school. Certain engineers in areas of demand make considerably more than residents, and that is after four years of college. If you went to law school, particularly the better programs and are fortunate enough to end up at a large firm, you will start out as a new associate with six figure income. Your hours will be long, but your compensation will at least in part make up for the time spent. Ditto for many MBA's. And the people you work with typically don't puke on your shoes.

Those options were available to you (though you seem to believe that exceptions prove the rule); however you chose to get an MD which is useless without a residency. Until you have that certificate, you employment value is little more than asking "Tall, Grande, or Venti"

Fourth, if you live in major metropolitan areas, the typical cost of housing/rent is not cheap nor is childcare which costs close to$1,000 per month per child. And heaven help you if you live in San Francisco, Boston, and other high rent districts.

Welcome to life. I've mentioned what the top programs in the city I live in are offering attendings in my field over on our specialty board. It's PATHETIC. and you can double or more your salary by going 45 min outside the city. And yet, they still find people to take the jobs because people want to be in the city. Supply and demand.

Fifth, we aren't worth much as residents because we don't generate much unsupervised income. If a fourth year surgical resident running an ICU matches that criteria, there is little I can say other than you are wrong. Ditto for fellows and how they are compensated.

Bottom line is this - although I'm not sure what we can do about it, we need to wake up and start putting an appropriate value on what we do. I chose the NP/PA example because it is a very easy benchmark.

As I said above, you ARE paid what you're worth. if you disagree, go find another career with your MD and half-completed residency that pays more over your working life than what you'd make staying on your current path. Until then your post comes across as a whine to end all whines.

 

[VA Hopeful Dr]

-"Medicare Payment Advisory Commission, or MedPAC, which advises Congress, has estimated indirect payments may be $3.5 billion higher than actual indirect costs. Overall, federal spending for GME has been increasing for decades and now is at about $10 billion for direct and indirect payments."
-Maybe, maybe not. I guess that would depend on specialty.
-They may not be in financial trouble, but are they in as good of shape as teaching hospitals in those departments? I'd venture to say no, but there probably isn't concrete data out thereon this, so we can only speculate. But I have heard residences characterized as profitable in this regard.

- First, a quote is not a source. Second, I would need to see more than that - congressional advisory boards don't tend to be all that accurate. Third, how about a concrete example from an existing hospital showing that they are getting too much money from residents?
- So you don't actually know if the net change across training is actually towards profit. Nice job sport.
- Yes, resoundingly yes. Non-teaching hospitals, assuming not rural, do very very well. There is exactly concrete data on this since all non-profits must submit tax records which are part of the public record. I've looked them up for my town. The teaching hospital runs at about 4-5% profit, the non-teaching one is 18%. But no, your gut feeling about hospital finances is obviously correct.

 

[Commer_Knocker]

-that is a source of information. I thought a quote was easier than linking a random article with that same info buried in it. A hospital will never release that kind of info, because its not jn their best interest; when asked, they have continuously refused.
-That's an opinion I've seen uttered by a lot of people in healthcare. If you can offer personal experience/insight, then by all means.
-A sample size of two is hardly any better than my conjecture. Even if they are less profitable, it doesnt mean they aren't making money off of their residency programs; other factors may be at play- treating more patients under Medicaid or who are uninsured, due to locations in urban areas, handling more complex cases, supporting greater research footprints, etc.

 

[WingedOx]

I'm starting to think that you don't possess the intellectual capital to discuss this topic rationally.

 

[VA Hopeful Dr]

-that is a source of information. I thought a quote was easier than linking a random article with that same info buried in it. A hospital will never release that kind of info, because its not jn their best interest; when asked, they have continuously refused.
-That's an opinion I've seen uttered by a lot of people in healthcare. If you can offer personal experience/insight, then by all means.
-A sample size of two is hardly any better than my conjecture. Even if they are less profitable, it doesnt mean they aren't making money off of their residency programs; other factors may be at play- treating more patients under Medicaid or who are uninsured, due to locations in urban areas, handling more complex cases, supporting greater research footprints, etc.

- Welcome to science, I want the whole article.
- I have never heard anyone who has actually completed residency and worked a few years utter such a thing, its always residents who are pissed off they aren't making more money for how hard they work. Even here, that seems to mostly hold true.
- All true, those reasons are exactly why the government has agreed to fund GME - teaching hospitals act as safety nets, research centers, and specialty centers.

 

[Mad Jack]

http://www.rand.org/content/dam/rand/pubs/research_reports/RR300/RR324/RAND_RR324.pdf

If you want actual facts, here they are. Residents can be anything from a massive money sink to a huge revenue generator, depending on their specialty, the location of the hospital, number of overall residents, etc etc. It's a really complicated topic- some hospitals may be losing a fortune, while others are making one.

 

[YF786]

They deserve it! They have worked hard too and always caring towards patients. I have seen doctors that come in once a day and just write their report and leave it to nurses. Nurses are the ones that are always looking after the patients and put in a lot of hard work. Residents should not be complaining, they should be thankful that they are being paid while learning.

 

[IlDestriero]

They have worked hard too and always caring towards patients. I have seen doctors that come in once a day and just write their report and leave it to nurses. Nurses are the ones that are always looking after the patients and put in a lot of hard work.

Whenever I read this Nursing Society PAC bullet point this I just have to laugh. That's your job, and the Physicians job is to write the orders and go back to the OR or clinic after rounding and see more patients. If you're lucky they'll admit more so you get to keep your job. They don't care less than you, they do their job, and you do yours. In the end, hopefully, the patient gets good care from the team (that includes the custodians and insurance specialists and admin and techs) and goes home. They care too, even though they're not there on the floor doing what nurses are paid to do.
None of which has anything to do with resident salary.

 

[Obnoxious Dad]

Your reply was not unexpected, and it reflects a host of erroneous assumptions and statements that deflect from my contention. I'm starting to think that you don't possess the intellectual capital to discuss this topic rationally. If I chose to be chided by a parent, I can phone home.

The reason I choose to accept the compensation I receive is because I have no choice. Had you followed the discussion, you would have remembered my original premise included a link detailing the anti-trust waiver for hospitals involved with residency training. It is called collusion and its meaning should be clear.

As for your discussion of the cost of medical school, nice deflection, but it is not germane to what I said.

You allege that the economics of residency education is not knows. You can't possibly believe this statement Searching the topic suggests otherwise via a large number of scholarly articles on the topic.

Below is the link to a piece that got me thinking about this topic and which I cited before and mention in my comments above. Try reading the piece. It may open your eyes. Perhaps you may wish to discuss your inane positions with its author.

http://www.slate.com/articles/healt...n_training_are_organizing_for_collective.html

Listen, chum, I have an MBA from a top 25 business school, as well as a law degree. I passed two bar exams as well as all four parts of the CPA exam on the first try. If there's an economic ***** around here, it's you. I cite a study by the Rand Corporation which was linked above by Mad Jack and the best you can offer is a piece by an MD/union steward in Slate Magazine. You are hilarious. If you read the Rand study, rather than the adolescent gibberish in Slate, you just might be able to comprehend that the economics of residency are anything but simple. Furthermore, counselor, the Sherman Act is a law that was passed in 1887 and was aimed at oil and industrial companies rather than hospitals offering medical training to entitled ingrates like you.

You had a choice. You could have been an engineer or a pizza thrower. You walked into this knowing what kind of deal you were going to get and now you are whining about it. Your behavior, rather than your whining, is all that matters. You don't have to stay for nine years. When your residency is concluded, please go into private practice, make $400,000 per year and ask people if they feel sorry for you.

 

[KEB]

They deserve it! They have worked hard too and always caring towards patients. I have seen doctors that come in once a day and just write their report and leave it to nurses. Nurses are the ones that are always looking after the patients and put in a lot of hard work. Residents should not be complaining, they should be thankful that they are being paid while learning.

Which is precisely why I'm 34 years old and planning to apply to medical school. I should have done it years ago when I had the chance. Live and learn. Spending twelve hours a day with patients is nothing short of abject hell.

 

[username456789]

They deserve it! They have worked hard too and always caring towards patients. I have seen doctors that come in once a day and just write their report and leave it to nurses. Nurses are the ones that are always looking after the patients and put in a lot of hard work. Residents should not be complaining, they should be thankful that they are being paid while learning.

0/10

 

[WingedOx]

Listen, chum, I have an MBA from a top 25 business school, as well as a law degree. I passed two bar exams as well as all four parts of the CPA exam on the first try. If there's an economic ***** around here, it's you. I cite a study by the Rand Corporation which was linked above by Mad Jack and the best you can offer is a piece by an MD/union steward in Slate Magazine. You are hilarious. If you read the Rand study, rather than the adolescent gibberish in Slate, you just might be able to comprehend that the economics of residency are anything but simple. Furthermore, counselor, the Sherman Act is a law that was passed in 1887 and was aimed at oil and industrial companies rather than hospitals offering medical training to entitled ingrates like you.

You had a choice. You could have been an engineer or a pizza thrower. You walked into this knowing what kind of deal you were going to get and now you are whining about it. Your behavior, rather than your whining, is all that matters. You don't have to stay for nine years. When your residency is concluded, please go into private practice, make $400,000 per year and ask people if they feel sorry for you.

My money is still on Harbaugh leaving after a non-football-related incident. Like a Gary Moeller but bigger and more obnoxious.

 

[chipwhitley]

This thread demonstrates a fundamental difference between nurses and doctors. Doctors fight to justify and maintain the status quo. Nurses fight to get every inch and penny they can, whether they deserve it or not, and they get it.

 

[WingedOx]

My money is still on Harbaugh leaving after a non-football-related incident. Like a Gary Moeller but bigger and more obnoxious.

oh man, somehow I posted that to the wrong thread. I need to not leave two comment boxes open at the same time.

 

[W19]

This thread demonstrates a fundamental difference between nurses and doctors. Doctors fight to justify and maintain the status quo. Nurses fight to get every inch and penny they can, whether they deserve it or not, and they get it.

Lets say doctors are stupid!

 

[NotAProgDirector]

There are good points (and bad points) on both sides of this argument.

Residency training is clearly necessary, with the way that medical school is currently structured. Although I didn't train in Engineering or Law, I expect the situation is somewhat similar -- people who graduate from those schools are not really 100% ready to work on their own -- instead, they need to work with some experienced practitioner to "learn the ropes". The question is, how much should they be paid as they work, but continue to learn at the same time. In Eng and Law, it's however much someone is willing to pay you. Some people (esp those from great schools) might get a great paying job right out of school. Others might get a crap paying job. And some might get no job at all. In medicine, basically everyone gets a job after school. The pay scale is rather flat (i.e. differences between programs is small), partially because medicine has highly standardized it's post graduate training compared with Law or Engineering. Ultimately physicians (in general) make better salaries than most in law/engineering.

The slate article linked is simply wrong. The law created exempts the Match. There is nothing in the law that allows programs to collude with each other, or set salaries. The idea that students could negotiate for their salaries without the match is simply untrue. If you're hired at my institution, in essentially any entry position, your salary is set by a committee. Secretaries can't negotiate for their salaries, and neither can new hospitalists. The starting salary is what it is, match or no match.

Programs don't collude with each other -- or at least I've never seen any evidence of such. I don't call other programs and see what they are offering. We do get annual data about the average salary in the field -- and this puts upward pressure on the salaries. We don't want to be below average, if we are we raise them until they are above average, which raises the average, which makes other programs raise their salaries, etc. Gas stations get data on the average price of gas, this is no different.

Which brings us to the meat of the issue, are residents paid a "fair" salary? Should they get more because they deserve more? This is complicated, because it depends on what you mean by "fair":

One argument is that hospitals "make money" on residents because of Medicare payments and the ability to not hire others to do the work residents are doing. This argument has several problems:

A. As has already been mentioned in this thread, it's not clear that hospitals "make money" on all residents. It's going to depend upon how the residents are utilized. In my program, for example, if on our hospital medicine service we removed all of the residents, we wouldn't change any staffing levels at all. We have both teaching and non-teaching teams, and this would just shift us to all non-teaching. We have hospitalists in all night already. On the other hand, my Heme/Onc and Cardiology services would need some additional resources to replace resident work -- so it clearly depends upon the details.

B. My residents have quite a few outpatient, research, and elective months. During this time, they are of no "value" to me or the hospital at all.

C. Even if the hospital does make money on residents, it's not clear that's "bad". The hospital needs to make money in some areas, to help pay for other services that lose money. All businesses work this way. I totally understand that, if you can clearly see your employer making a bunch of money off of your work, you'd like to claim a piece of that pie. It's human nature.

As I've said before (on this thread, I think), a major driver of low resident salaries is the standardized postgraduate training system which forces you to take a residency job and doesn't let you leave easily without torpedoing your career. That said, it's also what generates a highly competent and skilled physician labor force. Whether residents really "add value" financially to a hospital is highly controversial, and the Rand study linked above is probably the best assessment, but the TL;DR version is "it's complicated" which isn't satisfying.

The last line of the post above is interesting to think about:

Bottom line is this - although I'm not sure what we can do about it, we need to wake up and start putting an appropriate value on what we do.

The problem with the marketplace is that you don't put a value on the work you do, the market does. I think that teachers have a very valuable role to play, yet they get paid crap. I think investment bankers don't really add much to society, but they get paid quite a bit. That's the price we pay for living in a capitalistic society. Paying people "for what they're worth" is a different mentality.

I do agree with ObnoxiousDad above -- we've created a difficult bottleneck for creating physicians that raises salaries and costs the system. He does live up to his screen name, but also does tend to speak the truth. Forsooth, I am one of the " jokers who run that show might be aware that they are running a guild system right out of the middle ages"

 

[charmiedermie]

That's like complaining that an engineering intern that is a month from finishing their degree is being underpaid because in one month they'll have a job in which they're earning five times as much.

Just stop comparing, please. You keep doing apples to oranges. Engineers start working after a bachelor's at age 22, or a masters at age 24. Your comparison is very false.

Ok, but you do realize we're being paid to learn right? Fresh out of med school we could easily kill someone and they're taking extra time to train us. Those nurses are done training.

And yet every June, a fresh new autonomous NP joins the healthcare workforce with no postgraduate training whatsoever and everyone accepts them with open arms.

There's three year curriculums out there. I think they could be more broadly utilized. But I really do feel that there's a place for the four year curriculum, particularly for those students that don't really know what exactly it is they want to do like myself.

Those 3 year curriculums are only for people who want to do primary care, which is actually counterintuitive. Even the best schools do 1 year preclinical, 1 year clinical, 1 year research, and 4th year as always.

We're talking about the pay, not the conditions, of residency. I've experienced the salary in question and it was hardly awful.

The pay and hours intertwine. 55K is a great salary, but not for 80+ hours and after 8 years of postsecondary education at age 26. You haven't made one good comparison to another profession with medicine.

You get benefits as a resident. And you can't afford to max out your 401k/Roth until you're an attending, that's just a given. It's a temporary situation though- we're not saying 55k is ideal forever. And we're also talking about largely dual income households- 55k isn't enough on its own if you have a family and massive debt. As a temporary, short-term situation, however, it's not that bad is all I'm saying.

It is when you are working 80+ hours during internship and/or residency. There is an article written by a very well respected Harvard economist: http://www.gailwilensky.com/include...nsky-NEJMp1402468_The_Econ_of_Grad_Med_Ed.pdf, that states that residents bear the cost of their own training and are an asset to hospitals. I trust his judgement as an economist.

That is something I have a major issue with. How is it that dentists are competent after dental school but we believe that all medical students require X amount of years in residency. I honestly believe that although some residencies make sense, others are just a hindrance.

Dental schools have always been like this, and for the longest time med schools were actually like this too. You practiced as a GP, if you wanted. Then Medicare was created which funded GME and so a new specialty to take advantage of that was created - Family Practice, which mandated 3 years of residency, so GPs disappeared. That is why your MD diploma is now a piece of paper.

 

[jdh71]

How do you all feel about nurses making more annually than most residents? I realize that residents are still "in training" and will get a massive pay increase right after residency, but it seems pretty messed up given that residents work > double their hours.

Are you high?

Did you load a large bowl of marjiuana into a bong and take a gigantic binger straight to your dome before logging into SDN and posting that?

It's not a rhetorical question.

 

[Docbeme]

Listen, chum, I have an MBA from a top 25 business school, as well as a law degree. I passed two bar exams as well as all four parts of the CPA exam on the first try. If there's an economic ***** around here, it's you. I cite a study by the Rand Corporation which was linked above by Mad Jack and the best you can offer is a piece by an MD/union steward in Slate Magazine. You are hilarious. If you read the Rand study, rather than the adolescent gibberish in Slate, you just might be able to comprehend that the economics of residency are anything but simple. Furthermore, counselor, the Sherman Act is a law that was passed in 1887 and was aimed at oil and industrial companies rather than hospitals offering medical training to entitled ingrates like you.

You had a choice. You could have been an engineer or a pizza thrower. You walked into this knowing what kind of deal you were going to get and now you are whining about it. Your behavior, rather than your whining, is all that matters. You don't have to stay for nine years. When your residency is concluded, please go into private practice, make $400,000 per year and ask people if they feel sorry for you.

No, I didn't have a choice and that is the basis for my contention that residents are getting the shaft. How many other careers can you enumerate that are similarly bound? And frankly, I didn't go into medicine for the money; there are many other options that compensate talented individuals better than a career as a surgeon.

Congratulations on all of your hard work getting an MBA and a law degree but unfortunately, you are either full of it or you didn't learn much in school. What would the Sherman Act being passed in 1887 have anything to do with the discussion? You did learn in law school that laws can be amended, did you not? That is exactly what took place in April of 2004. If a lowly resident with little more than an engineering degree and an MD could figure it out, I'm shocked that you could not. Here's the link to the appropriate code section:

http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title15-section37b&num=0&edition=prelim

I read your Rand study along with a bunch of other articles all available via various search engines. Your Rand study is all over the place and it does not contradict my contention that residents have no choice and, in many institutions generate significant profits. Residents are stuck with the Match and have zero bargaining power with the institution that selects them. It is part of a long standing practice that provides a source of cheap labor for institutions by eliminating competition and the upside that negotiation brings to the table.

What I choose to do with my life after I finish my program has zero bearing as to how I am compensated during residency. The years I spend in training can not be returned and even if there is enhanced monetary light at the end of the tunnel, it is a straw man to use that logic as justification for low wages during residency. I'm sure that a man with your vast educational background can calculate that eight or nine years of sub-par compensation impacts one's lifetime ROI in a very negative manner, to say nothing of the short term financial stress that many residents have to live with, particularly when children arrive and daycare manifests itself. And if you think that more senior residents are not as valuable as RN's, NP's and PA's working half the hours residents routinely do, at least by surgical residents, then you aren't living in my world.

 

[ohioguy]

But residency has always been like this; except before the capping of the work hours in residency to 80/wk, plus different COL numbers back then, it was even less.

For the privilege of learning how to become a competent and hopefully effective physician, you will be given a stipend of about $12/hour. You do realize that there are those in residency that would work even more hours for the same pay in order to get more experience and build more expertise, right?

Man lets stop with this privilege nonsense.

In the words of a current chairman and someone who helped start UPMC...of course residents get taken advantage of. Cheaper to pay $50,000 than twice that for a nurse practitioner.

 

[Obnoxious Dad]

No, I didn't have a choice and that is the basis for my contention that residents are getting the shaft. How many other careers can you enumerate that are similarly bound? And frankly, I didn't go into medicine for the money; there are many other options that compensate talented individuals better than a career as a surgeon.

Congratulations on all of your hard work getting an MBA and a law degree but unfortunately, you are either full of it or you didn't learn much in school. What would the Sherman Act being passed in 1887 have anything to do with the discussion? You did learn in law school that laws can be amended, did you not? That is exactly what took place in April of 2004. If a lowly resident with little more than an engineering degree and an MD could figure it out, I'm shocked that you could not. Here's the link to the appropriate code section:

http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title15-section37b&num=0&edition=prelim

I read your Rand study along with a bunch of other articles all available via various search engines. Your Rand study is all over the place and it does not contradict my contention that residents have no choice and, in many institutions generate significant profits. Residents are stuck with the Match and have zero bargaining power with the institution that selects them. It is part of a long standing practice that provides a source of cheap labor for institutions by eliminating competition and the upside that negotiation brings to the table.

What I choose to do with my life after I finish my program has zero bearing as to how I am compensated during residency. The years I spend in training can not be returned and even if there is enhanced monetary light at the end of the tunnel, it is a straw man to use that logic as justification for low wages during residency. I'm sure that a man with your vast educational background can calculate that eight or nine years of sub-par compensation impacts one's lifetime ROI in a very negative manner, to say nothing of the short term financial stress that many residents have to live with, particularly when children arrive and daycare manifests itself. And if you think that more senior residents are not as valuable as RN's, NP's and PA's working half the hours residents routinely do, at least by surgical residents, then you aren't living in my world.

Since you are such a legal scholar, you may be familiar with the 13th amendment of the US Constitution. If not, here’s the text: "Neither slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States, or any place subject to their jurisdiction."

You didn’t have to go to medical school. You didn’t have to pursue residency training. You didn’t have to choose a residency that lasts five years. You didn’t have pursue fellowship training that lasts an additional four years. You didn’t have to be a parent. You don’t have to train as a fellow in a high cost of living city. You made all of these choices.

Because you studied engineering, instead of economics or business, I guess you didn’t understand the economics of medical training. Based on the narcissistic tone of your posts, I guess you never bothered to ask anyone about the consequences of your decisions. You thought you understood them, but apparently you did not. You are now getting a better handle on the consequences of your decisions and the fact that you must live with them. Welcome to adulthood.

You want to be paid more as a resident and fellow? Well, the American healthcare system can’t afford that. The total cost of healthcare has gone from 5% of the GDP in 1960 to 18% today. Americans can’t figure out how they might pay for it. The US taxpayers in various ways are shelling out $15 billion per year for residency training. Some people, like the IOM, want to cut that significantly. Here’s the AAMC’s response to the IOM: https://www.aamc.org/newsroom/newsreleases/381882/07292014.html

I have two suggestions for you.

Suggestion 1: Interrupt your training for two years and make $500,000 after taxes. Spend $100,000 per year while you’re practicing general surgery and put a mere $300,000 in the bank. After those two years go back into fellowship training for four years and spend down the $300,000 along with the $40,000 in after tax money you’ll get paid as a fellow.

Suggestion 2: Compare your situation with the other six billion people in the world and ask yourself how many of them would feel sorry for you.

 

[Docbeme]

Since you are such a legal scholar, you may be familiar with the 13th amendment of the US Constitution. If not, here’s the text: "Neither slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States, or any place subject to their jurisdiction."

You didn’t have to go to medical school. You didn’t have to pursue residency training. You didn’t have to choose a residency that lasts five years. You didn’t have pursue fellowship training that lasts an additional four years. You didn’t have to be a parent. You don’t have to train as a fellow in a high cost of living city. You made all of these choices.

Because you studied engineering, instead of economics or business, I guess you didn’t understand the economics of medical training. Based on the narcissistic tone of your posts, I guess you never bothered to ask anyone about the consequences of your decisions. You thought you understood them, but apparently you did not. You are now getting a better handle on the consequences of your decisions and the fact that you must live with them. Welcome to adulthood.

You want to be paid more as a resident and fellow? Well, the American healthcare system can’t afford that. The total cost of healthcare has gone from 5% of the GDP in 1960 to 18% today. Americans can’t figure out how they might pay for it. The US taxpayers in various ways are shelling out $15 billion per year for residency training. Some people, like the IOM, want to cut that significantly. Here’s the AAMC’s response to the IOM: https://www.aamc.org/newsroom/newsreleases/381882/07292014.html

I have two suggestions for you.

Suggestion 1: Interrupt your training for two years and make $500,000 after taxes. Spend $100,000 per year while you’re practicing general surgery and put a mere $300,000 in the bank. After those two years go back into fellowship training for four years and spend down the $300,000 along with the $40,000 in after tax money you’ll get paid as a fellow.

Suggestion 2: Compare your situation with the other six billion people in the world and ask yourself how many of them would feel sorry for you.

 

[Psai]

Suggestion 2: Compare your situation with the other six billion people in the world and ask yourself how many of them would feel sorry for you.

??

 

[justabanana]

??

Relative wealth is associated with happiness. If you only compare yourself to people with influential/meaningful amounts of money, you will be unhappy. Instead, compare yourself to the 99.8% of the people in the world that are poorer than you.

 

[Psai]

Relative wealth is associated with happiness. If you only compare yourself to people with influential/meaningful amounts of money, you will be unhappy. Instead, compare yourself to the 99.8% of the people in the world that are poorer than you.

Why? Are you aspiring to go lower than your current position?

 

[username456789]

Why? Are you aspiring to go lower than your current position?

You are not allowed to be unhappy because there is probably at least someone else in the world who has it worse.

 

[justabanana]

Why? Are you aspiring to go lower than your current position?

No. Most of the time, if you want to do cool ****, compare yourself to people who are doing cooler **** than you are. The dissatisfaction this creates will create momentum that moves you upward.

The problem is when unhappiness stops propelling you forward and starts impairing you. At that point it might be useful to compare downwards so you can appreciate what you already have, rather than sit around wallowing in what you don't have. If wallowing in what you don't have is no longer moving you forward, stop doing it.

And @GuyWhoDoesStuff, no one said that. But, maybe you think it's somehow relevant because at least someone in the world actually believes it?

 

[username456789]

And @GuyWhoDoesStuff, no one said that. But, maybe you think it's somehow relevant because at least someone in the world actually believes it?

My face actually scrunched up in a physical cringe when I read this attempt at a burn. Oof. Back to the drawing board for you.

 

[justabanana]

My face actually scrunched up in a physical cringe when I read this attempt at a burn. Oof. Back to the drawing board for you.

Hey, c'mon now. At least make fun of something I didn't actually say like last time. It's less hurtful.