Offering to Do Residency for Free?

[ultane123]

i heard today that one guy offered to do residency for **free**? yes declined pay for all 4 years of urology training just to get into a urology program. he did match though, so it was a non issue at the end.

but is this possible?

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[Winged Scapula]

i heard today that one guy offered to do residency for **free**? yes declined pay for all 4 years of urology training just to get into a urology program. he did match though, so it was a non issue at the end.

but is this possible?

Is is possible to make the offer but no program would take him up on it (it is a favorite tactic amongst FMGs who seem to believe this myth that you can get a residency that way). It would be unethical (if not illegal) for them to take a resident on without paying them and most programs I dare say would not take the chance. Why should they - especially in Urology? They've more than enough qualified candidates and its not like the money comes out of the PDs pocket.

 

[3dtp]

... It would be unethical (if not illegal) for them to take a resident on without paying them and most programs I dare say would not take the chance. Why should they - especially in Urology? They've more than enough qualified candidates and its not like the money comes out of the PDs pocket.

...and it is a violation of the ACGME institutional requirements, not that [gasp] a hospital would ever violate an ACGME rule.

 

[Winged Scapula]

...and it is a violation of the ACGME institutional requirements, not that [gasp] a hospital would ever violate an ACGME rule.

Of course not!

 

[Pox in a box]

Working for free would have no incentive to excel.

 

[f_w]

'For free' wouldn't work because there are still the overhead cost. What does work occasionally is to buy your residency. Rich daddy sets up a 'foundation' that makes a 'restricted grant' of 80k/year and voila, spoiled son has his radiology residency. Who said money can't buy you happiness.

 

[hapahaole123]

'For free' wouldn't work because there are still the overhead cost. What does work occasionally is to buy your residency. Rich daddy sets up a 'foundation' that makes a 'restricted grant' of 80k/year and voila, spoiled son has his radiology residency. Who said money can't buy you happiness.

Not referring to this per chance?

2006: Reports surface of underperforming kidney and bone marrow transplant programs. In addition, UCI's cardiology chief and associate chief draw criticism from staff and regulators for not holding state licenses or U.S. board certifications, the anesthesiolgy department faces possible sanctions, and possible ethical lapses are reported, including suspected violations of nepotism rules in hiring. The Times also reports that a young Orange County physician was accepted into a newly created residency position the same month his father pledged $250,000 to the radiology department.

http://www.calnurses.org/media-center/in-the-news/2006/february/page.jsp?itemID=27546763

 

[f_w]

Not referring to this per chance?

Among others.

Anyone remembers the poor saudi resident who got tangled up in the post 9/11 madness ? The FBI had decided that 'buying 4 airline tickets for people with arabic sounding names' (his wife and kids) was reason enough to arrest the guy and hold him as a terrorist (the same antiterrorism unit was unable to find the real conspirators 1 month earlier even after their field agents tried to spoon-feed them the information). At the time, it turned out that this resident did his training based on payments from a saudi oil company.....

And there are others. I don't think it is common in the US, most people don't have 80k per year lying around and hospitals are rarely corrupt enough to go along with the deal. I do know of someone who did his neurosurgery residency in canada while paying his own way.

 

[gryffindor]

Is is possible to make the offer but no program would take him up on it (it is a favorite tactic amongst FMGs who seem to believe this myth that you can get a residency that way). It would be unethical (if not illegal) for them to take a resident on without paying them and most programs I dare say would not take the chance. Why should they - especially in Urology? They've more than enough qualified candidates and its not like the money comes out of the PDs pocket.

Is it illegal? I am at a major medical center, however, I am doing a dental specialty residency. The hospital classifies me as a resident, I attended the same orientation as all the medical residents, park in the same garage, have the same options for medical insurance, my id tag says "resident." But guess what - I don't get paid. In fact, I pay them "tuition" each year - although I can't borrow any federal money to pay this tuition because the medical center has me classified as a "resident" so I am ineligible. So we are stuck with private bank loans to pay the tuition & living expenses. There is an oral surgery residency at this hospital as well (another dental specialty), however, they get their PGY salary like all the other medical residents.

The more senior residents tell me that in the past, some of the residents got lawyers to see how it was possible to get away with this. Apparently they were told that the hospital can collect the GME money for us and doesn't have to necessarily pay us. It is a very politically involved mess and I wouldn't even know where to look as to whether it is legal or not. However, since we are a dental specialty, it's possible the ACGME rules are "exempted" from our program so the hospital is able to collect the GME money for us from the government but doesn't have to share it. We are not the only residency program like this - there are 2 other programs in my specialty at other medical centers where the residents are either not given the salary and charged "tuition" or they are given the PGY1 salary of 48K, but also charged a 25K tuition each year. The rest of the specialty programs around the country are either not hospital affiliated (about 40 programs located at dental schools who don't necessarily get GME money) or are hospital affiliated but pay their residents the PGY salary (approximately 5 programs out there like this).

How do they get away with this? Well, it's a competitive specialty - if I chose to turn my spot down after the match, there were 250 unmatched candidates who would have gladly taken the spot. I'm actually surprised this hasn't happened in medicine - couldn't there be a hospital out there who could offer a position to an unmatched candidate in a competitive field and say "hey - you can come to our accredited residency and be a dermatologist upon completion, but you will have to pay us an "educational fee" for each of your years here. And the amount of that "fee" is exactly equivalent to your PGY salary."

I'd be interested in hearing your opinions.

 

[Faebinder]

Is it illegal? I am at a major medical center, however, I am doing a dental specialty residency. The hospital classifies me as a resident, I attended the same orientation as all the medical residents, park in the same garage, have the same options for medical insurance, my id tag says "resident." But guess what - I don't get paid. In fact, I pay them "tuition" each year - although I can't borrow any federal money to pay this tuition because the medical center has me classified as a "resident" so I am ineligible. So we are stuck with private bank loans to pay the tuition & living expenses. There is an oral surgery residency at this hospital as well (another dental specialty), however, they get their PGY salary like all the other medical residents.

The more senior residents tell me that in the past, some of the residents got lawyers to see how it was possible to get away with this. Apparently they were told that the hospital can collect the GME money for us and doesn't have to necessarily pay us. It is a very politically involved mess and I wouldn't even know where to look as to whether it is legal or not. However, since we are a dental specialty, it's possible the ACGME rules are "exempted" from our program so the hospital is able to collect the GME money for us from the government but doesn't have to share it. We are not the only residency program like this - there are 2 other programs in my specialty at other medical centers where the residents are either not given the salary and charged "tuition" or they are given the PGY1 salary of 48K, but also charged a 25K tuition each year. The rest of the specialty programs around the country are either not hospital affiliated (about 40 programs located at dental schools who don't necessarily get GME money) or are hospital affiliated but pay their residents the PGY salary (approximately 5 programs out there like this).

How do they get away with this? Well, it's a competitive specialty - if I chose to turn my spot down after the match, there were 250 unmatched candidates who would have gladly taken the spot. I'm actually surprised this hasn't happened in medicine - couldn't there be a hospital out there who could offer a position to an unmatched candidate in a competitive field and say "hey - you can come to our accredited residency and be a dermatologist upon completion, but you will have to pay us an "educational fee" for each of your years here. And the amount of that "fee" is exactly equivalent to your PGY salary."

I'd be interested in hearing your opinions.

Reason is probably the fact that there are a lot of residency spots (Thank God, though the trend of increase of graduate to spots is disturbing). In medicine, you can't work after you have gotten your MD or DO. You have to at least finish 1 year of internship and get the state license to even be able to moonlight. In dentistry not everyone has to go through residency (that's my understanding).

 

[3dtp]

Is it illegal? I am at a major medical center, however, I am doing a dental specialty residency. The hospital classifies me as a resident, I attended the same orientation as all the medical residents, park in the same garage, have the same options for medical insurance, my id tag says "resident." But guess what - I don't get paid. In fact, I pay them "tuition" each year - although I can't borrow any federal money to pay this tuition because the medical center has me classified as a "resident" so I am ineligible. So we are stuck with private bank loans to pay the tuition & living expenses. There is an oral surgery residency at this hospital as well (another dental specialty), however, they get their PGY salary like all the other medical residents.

The more senior residents tell me that in the past, some of the residents got lawyers to see how it was possible to get away with this. Apparently they were told that the hospital can collect the GME money for us and doesn't have to necessarily pay us. It is a very politically involved mess and I wouldn't even know where to look as to whether it is legal or not. However, since we are a dental specialty, it's possible the ACGME rules are "exempted" from our program so the hospital is able to collect the GME money for us from the government but doesn't have to share it. We are not the only residency program like this - there are 2 other programs in my specialty at other medical centers where the residents are either not given the salary and charged "tuition" or they are given the PGY1 salary of 48K, but also charged a 25K tuition each year. The rest of the specialty programs around the country are either not hospital affiliated (about 40 programs located at dental schools who don't necessarily get GME money) or are hospital affiliated but pay their residents the PGY salary (approximately 5 programs out there like this).

How do they get away with this? Well, it's a competitive specialty - if I chose to turn my spot down after the match, there were 250 unmatched candidates who would have gladly taken the spot. I'm actually surprised this hasn't happened in medicine - couldn't there be a hospital out there who could offer a position to an unmatched candidate in a competitive field and say "hey - you can come to our accredited residency and be a dermatologist upon completion, but you will have to pay us an "educational fee" for each of your years here. And the amount of that "fee" is exactly equivalent to your PGY salary."

I'd be interested in hearing your opinions.

I'm not sure how it works with dental residency or who is the accrediting agency. Are you o/m/f? Our ENT service has omf/dds rotate on the same cases as the mds.

For medical residents, the ACGME governs and there is a nebulous clause III.b. of the institutional requirements. This clause says that residents must be provided with appropriate financial support and benefits. I'm not really sure what "appropriate" means or how they interpret that, but I think it means we're supposed to be paid a reasonable amount so we don't starve or have to live in a box in the drainage culvert outside the hospital.

Does the ADA do the accreditation? If so then there may be a whole new set of rules and you poor buggers would be worse off than we are, except you can go out and open a shop down the street and start making money out of the gate! We can't anymore.

 

[yaah]

If this is all true, then how did John Carter MD get his ER spot a few years back, HMMMM?

 

[Solideliquid]

If this is all true, then how did John Carter MD get his ER spot a few years back, HMMMM?

One of my favorite episodes, from what I remember they didn't have any more funding that year for resident salaries. That's the reason he did his first year in ER without getting paid, but after the first year they started paying him.

 

[radonc]

One of my favorite episodes, from what I remember they didn't have any more funding that year for resident salaries. That's the reason he did his first year in ER without getting paid, but after the first year they started paying him.

in most specialties, any given program may be able to accomodate an extra resident or two..unfortunately, they receive funding from the Govt for a certain number of positions defined by medicare/aid data. so, they would have to pay for any resident 'out of their pocket' ie 'department funds' for any extra residents they would like...so if a resident offered to work for free, and his stats were good, im sure they would go for it.

btw, i know someone who is working for 'free' in a competitive specialty, but they are getting health insurance through the hospital (somehow).

 

[southerndoc]

Although I think it's illegal by ACGME standards to allow a resident to work without payment, I'm beginning to question that.

The ACGME limits on the total number of residents certainly apply. However, there are programs that are accredited for more residents than the hospital funds. It might be possible for someone to grab one of these positions without payment. I haven't read anything directly from the ACGME that states otherwise.

 

[gryffindor]

in most specialties, any given program may be able to accomodate an extra resident or two..unfortunately, they receive funding from the Govt for a certain number of positions defined by medicare/aid data. so, they would have to pay for any resident 'out of their pocket' ie 'department funds' for any extra residents they would like...so if a resident offered to work for free, and his stats were good, im sure they would go for it.

btw, i know someone who is working for 'free' in a competitive specialty, but they are getting health insurance through the hospital (somehow).

Thanks everyone for your responses. The above post is exactly what I was talking about. I wonder if it happens more often that you'd think. If you dangled a spot with no salary in an uber-competitive specialty in front of an unmatched candidate who is planning to reapply to that specialty, I bet it would be gone immediately.

I am an orthodontics resident, and each year 250 positions are filled in the match and about 250 people are left without spots. This is despite the fact that some of those who match into school-affiliated programs will be paying $60K in tuition for 2 - 3 years and get no salary/stipend to offset any costs. Add this debt to the 6 figure debt some of these people have from dental school = Since residency is not mandatory for dentists, those who don't match can practice right away as general dentists and reapply if they wish.

Even though I pay my medical center a tuition while they supposedly withhold our GME money, I still feel fortunate in that the debt I will have after my 3 years here is still way less than if I had matched at one of the pricier programs in the country.

The situation does suck though - there was a brief period from 2001 - 2003 where ALL dental residents around the country were getting paid with GME money. In 2003, the government totally axed this GME funding for all dental residencies EXCEPT for the OMS & Pediatric Dentistry (& a few others) programs that are affiliated with a hospital.

I think our accrediting body is called CODA (commision on dental accreditation). I combed throught the ACGME site though and can't find mention of where the dental GME money comes from. Maybe I have to look at the CMS site - I recall they had something to do with the situation when the GME money got cut in 2003.

BTW, the ACGME clause III b is meaningless - yeah it says medical residents have to be given "appropriate financial support & benefits," but we all know that the PGY salary you get is a joke compared to the amount of hours most of you guys work in your residencies.

 

[Llenroc]

Some doctors that my father knows says that working for free was the order of the day for doing fellowships, at least in New York in the 1980's.

These programs never had enough funding, and would often let you in if you agreed to "provide your own funding". These guys would be worked like dogs in the hospital, and then spend their free time moonlighting, or even doing ****e jobs like working as a waiter in a restraunt.

This kind of thing does not happen today, I hope.

When my Dad was doing his fellowship in the 1990's, he said that everyone's pay in the department had been reduced to 80% of the usual amount for a PGY4 or whatever, because there wasn't enough funding to go around. My Dad lucked out though, because he was being sponsored by a different department.

 

[lateness]

Reason is probably the fact that there are a lot of residency spots (Thank God, though the trend of increase of graduate to spots is disturbing). In medicine, you can't work after you have gotten your MD or DO. You have to at least finish 1 year of internship and get the state license to even be able to moonlight. In dentistry not everyone has to go through residency (that's my understanding).

that is so true. with just an MD but no residency, you are pretty much screwd. you really can't do any medically related jobs at all, without proper certicification or training, so an MD with no residency would have to do something not related to hospital work for money, if they were not to get residency. But unlike that, being a dentist, i have many friends who finished dental school right out, and salaried easily 6 figures and up. MDs don't have that option unfortunately.

 

[ultane123]

btw, i know someone who is working for 'free' in a competitive specialty, but they are getting health insurance through the hospital (somehow).

just out of curiosity, which speciality is this? will they get paid after their first 1-2 years? i wonder how they arranged this??

 

[Winged Scapula]

If this is all true, then how did John Carter MD get his ER spot a few years back, HMMMM?

He got reimbursed for all those surgeries and babies he delivered as a medical student and then intern to pay the program for his position!

 

[3dtp]

BTW, the ACGME clause III b is meaningless - yeah it says medical residents have to be given "appropriate financial support & benefits," but we all know that the PGY salary you get is a joke compared to the amount of hours most of you guys work in your residencies.

C'mon now! Is nebulous a synonym for meaningless? At least we all got a 55-60% per hour raise when the work hour rules were enforced.