PA versus resident salary

[doctalaughs]

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Out of curiosity, what do you guys think about the fairness of PAs and other midlevels getting paid significantly more than residents right out of school?

You could argue that residents are still "in training" but the experience level of a resident is unquestionably higher than a PA just out of school. And in every other field you gain experience on the job as you get paid so it's not like residents aren't providing valuable work.

Thought this topic might be interesting what with residents suing the match system for salary fixing.

 

[irlandesa]

Out of curiosity, what do you guys think about the fairness of PAs and other midlevels getting paid significantly more than residents right out of school?

You could argue that residents are still "in training" but the experience level of a resident is unquestionably higher than a PA just out of school. And in every other field you gain experience on the job as you get paid so it's not like residents aren't providing valuable work.

Thought this topic might be interesting what with residents suing the match system for salary fixing.

I don't think that PA's should be paid less, but residents need to be paid more. Many people say that throwing money at problems won't solve them, but I assure you that the more money you throw in my direction, the sooner I'll be able to solve the problem of my enormous debt! Residents are cheap and underappreciated labor and need to be given more room to negotiate since they are valuable employees. I don't know if I like the idea of overthrowing the Match; will have to read up on it more. I think the rationale for poor resident salaries is that the additional experience gives us earning potential way beyond that of a PA (esp. if you specialize beyond residency). From what I gather, PA salaries tend to stagnate pretty soon after graduation, but I could be wrong.

 

[Pilot Doc]

The rationale for midlevel practicioner salary is

1) They can bill for services!
2) Supply and demand (very large supply of resident labor compared to PA/NP)

Fairness plays no part.

 

[doctalaughs]

I understand that fairness plays no part, but it seems that the salaries would indicate that the residents suing the match are right: that the match artificially depresses resident salaries.

I mean, a resident can do the same job or more than a PA/NP just out of school. Maybe a PA can bill for procedures, and a resident cannot? But that is artificial as well and more part of their lobbying abilities.

The people advocating for the match claim that without the regulations residents would work for much less since they would be so competitive for positions they would essentially work for free.

I just don't know if that is right or not, and if it is there is something seriously wrong with resident/physician mindset. I mean, would you ever see a graduate of a top law school working for $40k/year? Nope, as an associate they get $150,000 + and they get expereience/training on the job. I would think that residency programs would compete for top graduates and pay them more...

 

[PublicHealth]

I mean, would you ever see a graduate of a top law school working for $40k/year? Nope, as an associate they get $150,000 + and they get expereience/training on the job.QUOTE]



Table 1. Median salaries of lawyers 6 months after graduation, 2001

All graduates
$60,000

Private practice
90,000

Business/industry
60,000

Judicial clerkship and government
40,300

Academe
40,000


Source: National Association of Law Placement

http://www.bls.gov/oco/ocos053.htm

 

[fourthyear]

The rationale for midlevel practicioner salary is

1) They can bill for services!...
QUOTE]

Why is it that PA/NP can bill for services but a resident can't? When residents see patients in our clinics, but an attending does not, the hospital can't bill for it. This makes no sense to me. A resident, certainly one with a permanent medical liscense (which most are qualified for in 2nd year of residency), should be able to bill for seeing a patient. Of course there should be some supervision - how about the chart review that many PA/NP use to satisfy this requirement. An attending does not have to follow them into each patients room and see the patient themselves in order to say they are supervising the PA for a billed visit.

Heck, after just one year internship and gaining a medical liscense, many GP's of the past would be off on their own starting their own practice billing for everything? What happened? Medicare/medicaid billing restrictions and lawsuits may have played a part. I don't know. All i know is now we are all doing a minimum of 3 years residency and getting paid much less for more hours worked during that time that PA/NP.

Hospitals are losing money like crazy and if they could bill more for resident-provided services they'd be able to have more revenue. Don't know whether this would ever translate to more money for us though.

 

[doctalaughs]

I mean, would you ever see a graduate of a top law school working for $40k/year? Nope, as an associate they get $150,000 + and they get expereience/training on the job.QUOTE]



Table 1. Median salaries of lawyers 6 months after graduation, 2001

All graduates
$60,000

Private practice
90,000

Business/industry
60,000

Judicial clerkship and government
40,300

Academe
40,000


Source: National Association of Law Placement

http://www.bls.gov/oco/ocos053.htm

That's why I said "top" law schools. I guarantee the salaries of the top 10 law schools immediately after graduation is 125k+

I'm sure residents would love being paid that 60k average after graduation.

 

[Teufelhunden]

That's why I said "top" law schools. I guarantee the salaries of the top 10 law schools immediately after graduation is 125k+
.

When comparing new-grad salaries between medicine and law, why compare salaries of "top" law school grad to the salaries of ALL med school grads? I always see people on these forums making comparisons to law school grads, and quoting ridiculous numbers (like 150K), when in reality it is a very select few who will earn that much straight out of school.

Let's compare apples to apples.

That aside, I agree with most on this thread, though. We should ditch the match and let market forces enter the picture, which I believe will elevate our salaries. I think U.S. grads would fair better financially without a match. However, a lot of foreign grads might actually see a decrease in pay, IMHO.

Another thing that might happen: Some of the programs that struggle to fill spots might actually pay MORE. With market forces in play, some FP program may have to offer 60K/yr, and the derm program at the same institution might only have to pay 20K/yr to fill their spots.

It would definitely be interesting.

 

[DrQuinn]

That's why I said "top" law schools. I guarantee the salaries of the top 10 law schools immediately after graduation is 125k+

I'm sure residents would love being paid that 60k average after graduation.

My brother graduated from the University of Notre Dame Law School, and for two years after that he made 40k as a law clerk. After two years he joined a large med mal defense firm and made ~80k for 3-4 years. He now does litigation at a large firm and makes ~160k a year... he's been out ~6-7 years.

Q, DO

 

[edmadison]

That's why I said "top" law schools. I guarantee the salaries of the top 10 law schools immediately after graduation is 125k+

I'm sure residents would love being paid that 60k average after graduation.

You are 100% wrong. Salary doesn't depend on where you went to law school (not directly) it depends on what job you take. I had many friends out of Harvard Law School who took jobs making very little money as district attorneys. I had many others who took jobs working at the big firms for bank. The difference between residents and associates is that residents are guarenteed big bucks when training is complete and associates aren't. Of course, it is easier to get the big firm job if you go to a top school, but once there, all associates of the same level of experience make the same money.

As far as PAs go, they should make more than residents. They represent an income stream for the hospital. They don't have a limit on the number of patients they can carry, they don't spend a bunch of time in lecture, they don't automatically leave the hospital after 3-5 years and they can bill.

Ed

 

[ortho2003]

Why is it that PA/NP can bill for services but a resident can't? When residents see patients in our clinics, but an attending does not, the hospital can't bill for it. This makes no sense to me. A resident, certainly one with a permanent medical liscense (which most are qualified for in 2nd year of residency), should be able to bill for seeing a patient. Of course there should be some supervision - how about the chart review that many PA/NP use to satisfy this requirement. An attending does not have to follow them into each patients room and see the patient themselves in order to say they are supervising the PA for a billed visit.

Heck, after just one year internship and gaining a medical liscense, many GP's of the past would be off on their own starting their own practice billing for everything? What happened? Medicare/medicaid billing restrictions and lawsuits may have played a part. I don't know. All i know is now we are all doing a minimum of 3 years residency and getting paid much less for more hours worked during that time that PA/NP.

Hospitals are losing money like crazy and if they could bill more for resident-provided services they'd be able to have more revenue. Don't know whether this would ever translate to more money for us though.

Residents cannot bill for services, because they are paid out of the medicare/medicaid fund. Our services have already been billed for in advance at the tune of about 100K a year. If we were to bill again, we would be double dipping. That is why most resident clinics now require attendings to see patients and sign off on them so they can bill for the attendings work and squeeze a little more cash from an already drained system.

As for residents being paid too little. THe starting resident salary is still slightly above the median household income (most of which are double income families). We are still in training and should be happy that we are no longer required to take out loans to pay for our training.

 

[doctalaughs]

You are 100% wrong. Salary doesn't depend on where you went to law school (not directly) it depends on what job you take. I had many friends out of Harvard Law School who took jobs making very little money as district attorneys. I had many others who took jobs working at the big firms for bank. The difference between residents and associates is that residents are guarenteed big bucks when training is complete and associates aren't. Of course, it is easier to get the big firm job if you go to a top school, but once there, all associates of the same level of experience make the same money.

As far as PAs go, they should make more than residents. They represent an income stream for the hospital. They don't have a limit on the number of patients they can carry, they don't spend a bunch of time in lecture, they don't automatically leave the hospital after 3-5 years and they can bill.

Ed

About 5% of my class went to Harvard Law and another 15% went to a top 10 law school. If -- and I repeat if -- you want a 125k+ job after a top 10 law school you can get it, guaranteed. Harvard Law's own financial aid page says projected graduate salary is 125k:

http://www.law.harvard.edu/students/finaid/

Some of them go DA because they like it. Sure they make next to nothing. But they know their worth. Sure graduates of lower tier law schools can make bank but their chances are remote and they usually make very little.

Anyway I'm sure I won't convince you so back to the original topic.

Residents aren't a revenue stream for the hospital? (I actually don't know since I'm not a resident yet). They don't spend as much time as PAs seeing patients, lecture time aside?

 

[fourthyear]

As far as PAs go, they should make more than residents. They represent an income stream for the hospital. They don't have a limit on the number of patients they can carry, they don't spend a bunch of time in lecture, they don't automatically leave the hospital after 3-5 years and they can bill.

Ed

WHATTT??? Surgery resident at all the programs myself and my friends go to DO NOT have a limit on number of patients they carry. They DO NOT spend more than maybe 3 hours a week in lecture -and even if they did spend more hours than that in lecture, they still work 80 hours a week...does the average a PA put in 80 hours a week - no freakin' way b/c if they wanted to work that hard for that little money they would have gone to med school.

We all make our carrer choices based on how much we can delay that pacheck gratification in order to do the job we want to do. But I still don't see why the labor of a PA is worth more than an MD with who has more depth of medical training (this is not meant to put down PA's, but they do spend less time in both basic science and clinical rotations than med students do, so they have less depth of training than even an intern). I guess I buy the argument that medicare/medicaid has paid upfront $100/resident, but...we se only 1/3 of that money ourselves when a PA who works less hours than us gets paid much more than us.

 

[fourthyear]

Another truth we are not mentioning here is the type of hospitals many of us residents are employed at vs. the type of hospitals/practices PA's are working for. Many of our residency programs are based at hospitals who collect very little for the amount of services we provide to patients with no medical coverage. The PA's/NP's are more likely IN GENERAL to work for hospitals and practices that can afford to pay for them b/c their actually collecting some money from insurance companies or paying patients. Maybe some of the private/community residency programs could afford to pay more if they had to, but for many of us at the poorer hospitals, these places might shut down if they had to pay us twice the salary the do now. They can barely afford to pay enough to keep nurses and attendings there, to pay all the residents double their current salary would not be realistically possible.

As much as I would like to make more money, the fact remains - we have an imperfect healthcare system and right now part of the solution to provide poor people with medical care is us making less money than our work is probably really worth. Honestly, the good-hearted person in me feels this is somehow an okay sacrifice for us to make to do this "helping people" stuff we all said we wanted to do when we signed up for med school. We're all going to end up with decent salaries in the end, and job security, both of which many of our current patients won't ever have.

 

[doctalaughs]

Residents cannot bill for services, because they are paid out of the medicare/medicaid fund. Our services have already been billed for in advance at the tune of about 100K a year. If we were to bill again, we would be double dipping. That is why most resident clinics now require attendings to see patients and sign off on them so they can bill for the attendings work and squeeze a little more cash from an already drained system.

As for residents being paid too little. THe starting resident salary is still slightly above the median household income (most of which are double income families). We are still in training and should be happy that we are no longer required to take out loans to pay for our training.

It's this kind of attitude that will ensure residents will never be paid their worth. I'm not sure of the practical barriers to residents getting paid more (ie medicare, gov't regulations, hospitals losing money) but I have to agree with 4th year - why should residents get paid less than PAs? Who cares about the median household income? Do associate lawyers look at that and say "you're right- lower my salary." Physicans are the only professionals to jump through these hoops unquestioningly and not look at their own value.

 

[ortho2003]

It's this kind of attitude that will ensure residents will never be paid their worth. I'm not sure of the practical barriers to residents getting paid more (ie medicare, gov't regulations, hospitals losing money) but I have to agree with 4th year - why should residents get paid less than PAs? Who cares about the median household income? Do associate lawyers look at that and say "you're right- lower my salary." Physicans are the only professionals to jump through these hoops unquestioningly and not look at their own value.

We are paid our worth. We are still students essentially, learing a trade. I am very happy to be making better than the average salary while I train, rather than taking out 40K in loans like I had been doing for the previous four years. I don't understand why people thing residents are so valuable, or that we are being undercompensated for our work. We do not generate huge revenue, so it isn't like somone is getting rich off us like the sweat shops in the third world countries. We are paid a decent wage while putting in long hours training to become competent physicians. Once we are finished with training and we can hang our own shingle, we will be compensated quite well. Until the, we should be happy that we have an opportunity to get paid to train in a profession that will guarantee us being in the top 10% of earners in the country when we finish.

By the way, it doesn't matter what PAs make, but the answer as to why we should make less than PAs is quite simple. They generate income...we don't. It isn't fair that WNBA athletes only make 35-100K a year, while NBA athletes make 2-30mil. Hell, the WNBA stars all have college degrees, while very few if any NBA stars do. They should probably make more since they have more eductaion. Oh wait...I know why they make less, because sponsors will shell out billions to sponsor NBA games as will networks, stadiums can also charge hundreds per seat, while they can't get a 10th of that for WNBA games. THose that generate income will be compensated...those that don't, wont.

 

[doctalaughs]

We are paid our worth. We are still students essentially, learing a trade. I am very happy to be making better than the average salary while I train, rather than taking out 40K in loans like I had been doing for the previous four years. I don't understand why people thing residents are so valuable, or that we are being undercompensated for our work. We do not generate huge revenue, so it isn't like somone is getting rich off us like the sweat shops in the third world countries. We are paid a decent wage while putting in long hours training to become competent physicians. Once we are finished with training and we can hang our own shingle, we will be compensated quite well. Until the, we should be happy that we have an opportunity to get paid to train in a profession that will guarantee us being in the top 10% of earners in the country when we finish.

By the way, it doesn't matter what PAs make, but the answer as to why we should make less than PAs is quite simple. They generate income...we don't. It isn't fair that WNBA athletes only make 35-100K a year, while NBA athletes make 2-30mil. Hell, the WNBA stars all have college degrees, while very few if any NBA stars do. They should probably make more since they have more eductaion. Oh wait...I know why they make less, because sponsors will shell out billions to sponsor NBA games as will networks, stadiums can also charge hundreds per seat, while they can't get a 10th of that for WNBA games. THose that generate income will be compensated...those that don't, wont.

I agree with your NBA analogy but it doesn't compare. Maybe residents aren't generating revenue, but that's just a superficial look at how the rules are setup to screw residents. The rules COULD be setup for residents to generate revenue since they are doing the EXACT same procedures as PAs and working longer hours PLUS they have more training. The fact that the hospitals can bill for a PA yet get a lump sum for each resident doesn't matter -- they get X, Y, Z procedures done by a resident for cheaper labor compensation than a PA. It all goes in the global budget. Residents are getting screwed.

 

[NonTradMed]

When comparing new-grad salaries between medicine and law, why compare salaries of "top" law school grad to the salaries of ALL med school grads? I always see people on these forums making comparisons to law school grads, and quoting ridiculous numbers (like 150K), when in reality it is a very select few who will earn that much straight out of school.

Let's compare apples to apples.

I'm thinking they did that b/c getting into a top law school is COMPARABLY to getting into any medical school (US allopathic). So it's a valid comparison in that, someone who is smart enough and works hard enough to get into a medical school will probably qualify for a top law school, and that it seemed unfair that coming out, a law student with an ivy league degree would just be as incapable of practicing law as a med student is of practicing medicine (without help), yet the law grads get paid six figure salaries, while their intellectual counterparts in medicine gets paid less than $40k.

I do believe comparing law to medicine is like comparing apples to oranges, b/c their income distributions are different, but from an individual standpoint, it does seem unfair that someone who worked hard just like you who picked law school (and went to a good one), can come out with six figure offers. The average salary oft quoted for law students includes 3rd and 4th tier law schools (which proliferated in the 70's and 80's) which will take anyone with a pulse as long as you are willing to make a six figure loan! 🙄

Granted, that's not good enough reason to raise resident salaries, but the logic is if residents have about as much to offer in terms of productivity as law grads, then their pay is unfair and the Match depresses the wages.

 

[Sessamoid]

I agree with your NBA analogy but it doesn't compare. Maybe residents aren't generating revenue, but that's just a superficial look at how the rules are setup to screw residents. The rules COULD be setup for residents to generate revenue since they are doing the EXACT same procedures as PAs and working longer hours PLUS they have more training. The fact that the hospitals can bill for a PA yet get a lump sum for each resident doesn't matter -- they get X, Y, Z procedures done by a resident for cheaper labor compensation than a PA. It all goes in the global budget. Residents are getting screwed.

You just don't get it. PAs are generally hired by groups that make a profit, thus they can afford to pay their assistants well. Academic departments are typically cash strapped, as are most teaching hospitals. The patients they treat are generally uninsured or underinsured. They don't have the cash to pay residents more even if they wanted to.

And to the person who thought that a PA could only do as much as a newly graduated med student... umm yeah. Newly minted residents are worse than useless as far as productivity. They take immense hand-holding, they make lots of mistakes that have to be cleaned up after, and they require lots of didactics. An experienced PA can be an invaluable aid, they require much less hand-holding, don't need regular lectures, and have a better idea about the limits of their scope of practice than first-year residents do.

 

[ortho2003]

I agree with your NBA analogy but it doesn't compare. Maybe residents aren't generating revenue, but that's just a superficial look at how the rules are setup to screw residents. The rules COULD be setup for residents to generate revenue since they are doing the EXACT same procedures as PAs and working longer hours PLUS they have more training. The fact that the hospitals can bill for a PA yet get a lump sum for each resident doesn't matter -- they get X, Y, Z procedures done by a resident for cheaper labor compensation than a PA. It all goes in the global budget. Residents are getting screwed.

If it were only that simple. The rules can't be changed. The medicare/medicaid system is cash strapped as it is. They aren't going to start letting hospitals bill for our procedures so residents in training can make more money. HMO's and other private payers aren't going to pay pay for residents performed procedures either. If you haven't heard, we are in a health care crisis in this country already. Bottom line...we are still learning and training, we are not meoney generators and we are not underpaid. We are compensated much better than our attendings ere when they were training. Whether you like it or not, we are still students....very few students can say they are making 40K a year for studying.

 

[doctalaughs]

If it were only that simple. The rules can't be changed. The medicare/medicaid system is cash strapped as it is. They aren't going to start letting hospitals bill for our procedures so residents in training can make more money. HMO's and other private payers aren't going to pay pay for residents performed procedures either. If you haven't heard, we are in a health care crisis in this country already. Bottom line...we are still learning and training, we are not meoney generators and we are not underpaid. We are compensated much better than our attendings ere when they were training. Whether you like it or not, we are still students....very few students can say they are making 40K a year for studying.

You both make good points and I understand the situation. But you must concede that it is RULES of the system that cause a PA to make more than a resident, not a difference in the jobs they are doing. I understand that it may be hard to change these rules given the financial situation of healthcare america. But I still think these rules are arbitrary and not unquestionable. The rule that residents cannot bill is as arbitrary as the rule that PAs can bill - it's a product of the political process and the lobbying effort of insurance, PA groups, hospitals etc. And the "student" or "in training" designation is based directly on those rules as well. If residents could bill and generate revenue would we still call them students? Are associate lawyers who bill and make money for the firm called law students? They are gaining experience. They are receiving training from more senior lawyers. But they are valuable employees based on billable hours and are compensated accordingly. And residents are not worth **** because of the rule that they cannot bill. So you can accept that rule if you'd like based on your altruism for the healthcare crisis. I personally think that abolishing that rule and raising resident salaries to the skill level that the capitalistic market dictates would be a drop in the bucket. Pragmatically I know that will never happen until we address the major financial issues in the healthcare crisis first though...

 

[ALTorGT]

residents in hospitals seem to be getting seriously ripped off in the US. I'm going to graduate this year and start my internship in Sydney next year and will be paid an hourly wage that increases by about 12% a year until I finish residency in whatever field I choose. Probably take 3 years longer than in the US, but med school here is only 6 years after high school, so we graduate 2 years earlier and are technically in the workforce faster (and thus earning sooner and incurring lower educational expenses). But, once you finish residency, you earn more than us here. So I suppose that compensates somewhat (But hey, I'd rather take my high five figure - low six figure salary throughout my mid to late twenties - when I can actually enjoy it as a single person in the city rather than some suburban dwelling 35 year old with a mortgage, a wife and some pimply kid).

 

[deltamed]

bump

 

[kchan99]

I wonder where lab research figures into this. Many teaching hospitals are affiliated with universities with large research programs. There are faculty who solely do research and don't see patients or give lectures frequently. Most of the research is funded by outside grants, but the university must chip in for the lab space and professors' salaries. True, some of this is covered by donations if the school is lucky.

 

[xanthines]

A lot of labs generally make money for the school. The schools grabs a large % of of your grants as part of "indirect costs." If you're a luck researcher, you get to utilize this money somehow (computers, equipment, slush fund) because the school really only does use it for indirect costs. At other schools (like mine) you get nothing! If you're not pulling in grant money, the school takes away your lab and your office; it's clinical work for you. I've seen it happen.

As a side story: I've also seen a tenured research give the finger to the administration (metaphorically) and stick it out until he somehow miraculously got another grant. He had no lab or office, but STILL got some money. And now, it's like nothing ever happened!

$$$ makes the world go 'round.

-X

I wonder where lab research figures into this. Many teaching hospitals are affiliated with universities with large research programs. There are faculty who solely do research and don't see patients or give lectures frequently. Most of the research is funded by outside grants, but the university must chip in for the lab space and professors' salaries. True, some of this is covered by donations if the school is lucky.

 

[deleted6669]

pa's provide a level of continuity of skill that new residents can't expect to meet. yes, pa's make good money and yes, residents get screwed on salary. part of the reson for this is that pa's are by definition seeing the bread and butter cases first and the difficult caseas second while generally residents do the reverse to improve their learning experience. at one facility I work at( with residents ) they triage er pts as red/yellow/green by level of acuity with red at the top.
pa's see yellow, then green, then red. residents see red then yellow then green.attendings see red and yellow only. most procedural pts are green so the pa's see the vast majority of these. this is where the er makes money, not the uninsured multisystem trauma pts or septic alcoholics brought in by ems. they are a great learning experience for all concerned, without a doubt, but reimbursement is minimal.

 

[kchan99]

When "indirect costs" are used to fund equipment, does this include the instruments that researchers move with them if they move to another school?