PA vs Residents

[Miami_sofia]

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Why do PA's and APRNs get paid 2x much as residents, even though residents work crazier hours and are also licensed. I was talking to an emergency medicine PA and she told me she made 114k, meanwhile the intern is lucky to get 60k. There isn't much difference between the two (correct me if I am wrong), if anything senior residents can actually carry out an entire procedure w/ minimal assistance whilst the PA cannot do so. Why can't we form a union?

 

[libertyyne]

Why do PA's and APRNs get paid 2x much as residents, even though residents work crazier hours and are also licensed. I was talking to an emergency medicine PA and she told me she made 114k, meanwhile the intern is lucky to get 60k. There isn't much difference between the two (correct me if I am wrong), if anything senior residents can actually carry out an entire procedure w/ minimal assistance whilst the PA cannot do so. Why can't we form a union?

PA's get paid the market rate, residents dont. There are states where PAs would be lucky to get 30, and other metro areas where they get paid 60-80.

 

[atomi]

Because residents get paid through Medicare. PAs get paid on the free market.

 

[operaman]

Actually the pay is fairly similar when you count the included free tuition for the resident who is also receiving a great deal of teaching if they are at any halfway decent program. If you add an average year of Med school tuition to residency salary and you get about what a PA or NP makes.

 

[Miami_sofia]

Actually the pay is fairly similar when you count the included free tuition for the resident who is also receiving a great deal of teaching if they are at any halfway decent program. If you add an average year of Med school tuition to residency salary and you get about what a PA or NP makes.

I disagree bc PA's have "residencies" as well while getting much more than residents.

 

[Perrotfish]

Why can't we form a union?

1) Its illegal for physicians to strike
2) Residencies are exempt from anti trust laws.

So you can't sue and you can't strike. You CAN unionize (some residencies do) but without the ability to sue or strike I have never understood how that's any different from just having the residents write down their concerns and email them to the PD.

 

[VA Hopeful Dr]

Why do PA's and APRNs get paid 2x much as residents, even though residents work crazier hours and are also licensed. I was talking to an emergency medicine PA and she told me she made 114k, meanwhile the intern is lucky to get 60k. There isn't much difference between the two (correct me if I am wrong), if anything senior residents can actually carry out an entire procedure w/ minimal assistance whilst the PA cannot do so. Why can't we form a union?

Because when we finish residency we get a minimum of a 4X income increase?

 

[mimelim]

Why do PA's and APRNs get paid 2x much as residents, even though residents work crazier hours and are also licensed. I was talking to an emergency medicine PA and she told me she made 114k, meanwhile the intern is lucky to get 60k. There isn't much difference between the two (correct me if I am wrong), if anything senior residents can actually carry out an entire procedure w/ minimal assistance whilst the PA cannot do so. Why can't we form a union?

I disagree bc PA's have "residencies" as well while getting much more than residents.

#1 Working more/crazier hours does not entitle you to higher pay. That simply is not how just about any economic system works. For that matter, I worked in residency between 80-110 hours/week, often double that of our FM or even IM counterparts, never mind the increased length of residency. Should I have been paid more per year than those residents?
#2 Being licensed does not entitle you to higher or equal pay. It offers some job protections, but not all licenses are equivalent and some are obviously more valuable than others.
#3 Most residents are on training licenses and do not have full unrestricted state licenses.
#4 There is a substantial difference between a PA and an intern. One is (almost) by definition a new graduate. The other may have the same experience (fresh graduate) or 20+ years of work experience in that particular field.
#5 I could do everything I do now from a technical standpoint a year before I graduated. No (or extremely few) PAs can do what I do. That is neither here nor there for compensation.
#6 You can form a union. There just isn't much of a point (see @Perrotfish 's post above)
#7 PA residencies pay about 45-65k. That is approximately what medical residencies pay. Or close enough at least.

Why are PAs paid differently? Because how their positions are funded are differently. Our ACGME system is in dire need of an overhaul on many fronts. But, trying to draw false comparisons with another profession does not help anything.

 

[Perrotfish]

#1 Working more/crazier hours does not entitle you to higher pay. That simply is not how just about any economic system works. For that matter, I worked in residency between 80-110 hours/week, often double that of our FM or even IM counterparts, never mind the increased length of residency. Should I have been paid more per year than those residents?

I mean, yes, you should have. Your work was higher value per hour and you also did more of it, you should have been paid more. It doesn't work that way but that's how I would design the system. Engineers have managed to combine a free market employment system with a path to licensure, I think its crazy that physicians can't seem to do the same.

 

[mimelim]

I mean, yes, you should have. Your work was higher value per hour and you also did more of it, you should have been paid more. It doesn't work that way but that's how I would design the system. Engineers have managed to combine a free market employment system with a path to licensure, I think its crazy that physicians can't seem to do the same.

I'm pretty sure the majority of non-surgical residents would disagree with that 😉, but that is just a guess. I mean don't get me wrong, I would have liked to have been paid more in my residency. I often felt over-used and frankly exploited. There was a point where took on what was essentially a second job to keep financially afloat (family sick, funds low, etc). I just really don't like the comparison with mid-level providers. It just always comes off as whining and entitlement rather than a rational push for changes, that are absolutely necessary.

 

[VA Hopeful Dr]

I mean, yes, you should have. Your work was higher value per hour and you also did more of it, you should have been paid more. It doesn't work that way but that's how I would design the system. Engineers have managed to combine a free market employment system with a path to licensure, I think its crazy that physicians can't seem to do the same.

Let residents bill and not rely on a stipend from CMS.

For my specialty, this means interns will make way less, 2nd years the same or a little more, and 3rd years a fair bit more than current salaries.

Or, you know, if it ain't broke...

 

[mimelim]

Let residents bill and not rely on a stipend from CMS.

For my specialty, this means interns will make way less, 2nd years the same or a little more, and 3rd years a fair bit more than current salaries.

Or, you know, if it ain't broke...

Surgical residents would get paid even less XD. A lot less E&M coding 😉, unless we could bill for a portion of the surgeries we do... Then maybe...

 

[VA Hopeful Dr]

Surgical residents would get paid even less XD. A lot less E&M coding 😉, unless we could bill for a portion of the surgeries we do... Then maybe...

I said billing, I meant all billing.

Think it would play out similarly - interns get hosed and each year is better with the later years likely doing decently.

 

[Goro]

#4 There is a substantial difference between a PA and an intern. One is (almost) by definition a new graduate. The other may have the same experience (fresh graduate) or 20+ years of work experience in that particular field.
#

This reminds me of a variation of a joke:
Q: What's the difference between an MSIV and a PGYI?
A: Summer vacation

 

[Stagg737]

I'm pretty sure the majority of non-surgical residents would disagree with that 😉, but that is just a guess. I mean don't get me wrong, I would have liked to have been paid more in my residency. I often felt over-used and frankly exploited. There was a point where took on what was essentially a second job to keep financially afloat (family sick, funds low, etc). I just really don't like the comparison with mid-level providers. It just always comes off as whining and entitlement rather than a rational push for changes, that are absolutely necessary.

As a psych resident I totally agree. I typically work 45-60 hours in a week and usually get full weekends with no call. No way I should be getting paid as much as the surgery and IM people working 70+ hours a week with only 1 day off. There's a lot wrong with the comparison to mid-levels, but I get the sentiment as residents (even interns after their first few months) are frequently more competent and useful than many of the midlevels are.

 

[Giovanotto]

Because when we finish residency we get a minimum of a 4X income increase?

this logic hurts my head, and I didn't want a headache today.

 

[MedicineZ0Z]

Why do PA's and APRNs get paid 2x much as residents, even though residents work crazier hours and are also licensed. I was talking to an emergency medicine PA and she told me she made 114k, meanwhile the intern is lucky to get 60k. There isn't much difference between the two (correct me if I am wrong), if anything senior residents can actually carry out an entire procedure w/ minimal assistance whilst the PA cannot do so. Why can't we form a union?

Not much difference? The level of competence is incredibly different. That's a start...

 

[MedicineZ0Z]

Let residents bill and not rely on a stipend from CMS.

For my specialty, this means interns will make way less, 2nd years the same or a little more, and 3rd years a fair bit more than current salaries.

Or, you know, if it ain't broke...

A huge portion of residents nationwide are on visas. Billing would be a major visa violation and basically anything that isn't a predetermined stipend would also be a major violation.

 

[nimbus]

I used to work with a general surgeon who wasn’t paid at all during his surgical internship at Bellevue in NYC.

Here’s a link from Michigan.

http://www.medicineatmichigan.org/sites/default/files/archives/v9_houseofficers.pdf

Some dental residencies still charge tuition.

Tuition & Fees - Penn Dental Medicine


Things have been and still can be worse.

 

[VA Hopeful Dr]

A huge portion of residents nationwide are on visas. Billing would be a major visa violation and basically anything that isn't a predetermined stipend would also be a major violation.

Huh, so what you're saying is that the current system is the way it is for a reason.

Interesting

 

[shemer77]

I'd assume one part of the equation is that there are a lot of residents and foreign doctors who want to work in America driving prices down.

 

[jw3600]

PA's get paid the market rate, residents dont. There are states where PAs would be lucky to get 30, and other metro areas where they get paid 60-80.

Uhhhh. No PA is working for 30. Are you out of your mind?

 

[libertyyne]

Uhhhh. No PA is working for 30. Are you out of your mind?

um yes , before kentucky became more friendly for PAs they were job offers in the 30's.

 

[GoBuckeyes913]

You should be more concerned with the practicing laws than pay.

NPs and PAs are taking over everything, and they lobby hard with underpowered studies to show their equivalence to MD/DOs.

 

[MedicineZ0Z]

Huh, so what you're saying is that the current system is the way it is for a reason.

Interesting

Lol. Heard plenty of serious proposals for allowing resident billing. But too many hospitals rely heavily on visa sponsored IMGs. Undesirable locations/hospitals (although some are good programs still in okay locations) will take a IMG with a step score of 245 over a US MG with board failures. In many cases they are Canadian IMGs who went offshore and hence have strong cultural competence as well.

 

[MedicineZ0Z]

You should be more concerned with the practicing laws than pay.

NPs and PAs are taking over everything, and they lobby hard with underpowered studies to show their equivalence to MD/DOs.

I think ANYone who doesn't see midlevels as being an alarming crisis is literally beyond delusional. What happens in a few years when the number of midlevels is multiplied by 5?? Physician jobs and pay will drastically erode. More than 1 MBA in the industry told me doctors will become lower paid medical managers of half a dozen NPs/PAs. BTW, this is already happening as of a year ago. 170k salary for supervising 4 NPs.

I just can't comprehend how this doesn't set off every alarm. Doctors need to unify to strongly oppose midlevels rather than these bs "collaborative" initiatives the AMA and like pump out.

 

[Lawpy]

I just can't comprehend how this doesn't set off every alarm. Doctors need to unify to strongly oppose midlevels rather than these bs "collaborative" initiatives the AMA and like pump out.

I highly doubt they will. Why? Their own professional organizations are throwing them under the bus in favor of midlevels.

Take a look at what the ACEP in Emergency Medicine did: Why would anyone do an emergency medicine residency?

"The American College of Emergency Physicians, provided a grant for this program. The programs goal is for ENP's to practice pretty much as EM docs with or without supervision."

 

[Goro]

I highly doubt they will. Why? Their own professional organizations are throwing them under the bus in favor of midlevels.

Take a look at what the ACEP in Emergency Medicine did: Why would anyone do an emergency medicine residency?

"The American College of Emergency Physicians, provided a grant for this program. The programs goal is for ENP's to practice pretty much as EM docs with or without supervision."

 

[MedicineZ0Z]

I highly doubt they will. Why? Their own professional organizations are throwing them under the bus in favor of midlevels.

Take a look at what the ACEP in Emergency Medicine did: Why would anyone do an emergency medicine residency?

"The American College of Emergency Physicians, provided a grant for this program. The programs goal is for ENP's to practice pretty much as EM docs with or without supervision."

lmao and they crap on FM working in the ED.

It's funny how the standard for doctors is incredibly high but we have extremely unqualified people practicing alongside them. All these pseudoprofessions and fake degrees are comical.

 

[Matthew9Thirtyfive]

lmao and they crap on FM working in the ED.

It's funny how the standard for doctors is incredibly high but we have extremely unqualified people practicing alongside them. All these pseudoprofessions and fake degrees are comical.

It’s all about money. The people in charge who are doing that **** don’t care about docs or patients (or even midlevels). They care about money.

 

[NITRAS]

Residents form a union. . . . . funny.

I said billing, I meant all billing.

Think it would play out similarly - interns get hosed and each year is better with the later years likely doing decently.

I have a hard time believing attending's would be ok with their wRVU's being syphoned off to residents in most places.

 

[235009]

I'm pretty sure the majority of non-surgical residents would disagree with that 😉, but that is just a guess. I mean don't get me wrong, I would have liked to have been paid more in my residency. I often felt over-used and frankly exploited. There was a point where took on what was essentially a second job to keep financially afloat (family sick, funds low, etc). I just really don't like the comparison with mid-level providers. It just always comes off as whining and entitlement rather than a rational push for changes, that are absolutely necessary.

Having doe an IM residency at a well-respected university program I completely agree that, when you look beyond individual weeks to the big picture, I definitely did WAY less work than surgical residents. A week of clinic every fourth week that consisted of 4 half days of clinic, elective weeks, ~2 hours of conference every day, 4 weeks of vacation plus a holiday, free health and cheap dental insurance.

Also those who think an intern (or even a resident) is equivalent to a PA is out of their mind. An intern in IM is being supervised by two people (resident and attending) for precisely that reason. On subspecialty services it's 3 people! And when you're rotating through a subspecialty service in particular you have no clue what's happening usually and work your way up to competence by the time you're done with the rotation in 3-6 weeks. Same can't be said for a PA who's been doing the same thing day in and day out for 5, 10, or 20 years!

I think ANYone who doesn't see midlevels as being an alarming crisis is literally beyond delusional. What happens in a few years when the number of midlevels is multiplied by 5?? Physician jobs and pay will drastically erode. More than 1 MBA in the industry told me doctors will become lower paid medical managers of half a dozen NPs/PAs. BTW, this is already happening as of a year ago. 170k salary for supervising 4 NPs.

I just can't comprehend how this doesn't set off every alarm. Doctors need to unify to strongly oppose midlevels rather than these bs "collaborative" initiatives the AMA and like pump out.

Why did you go to med school then? Why haven't you quit yet?

 

[VA Hopeful Dr]

Residents form a union. . . . . funny.


I have a hard time believing attending's would be ok with their wRVU's being syphoned off to residents in most places.

There are easy ways around that. Make the resident wRVUs low enough (say 50% of usual rate) and the attendings get the other half.

Pay the attendings a higher base salary in exchange.

 

[mvenus929]

Because when we finish residency we get a minimum of a 4X income increase?

That is very optimistic. I get 63k as a fellow. I may make 2.5x that as an attending.

 

[mimelim]

That is very optimistic. I get 63k as a fellow. I may make 2.5x that as an attending.

Someone offered me 11x guaranteed for 4 years excluding bonuses and whatnot. Oh and a signing bonus worth just under double my annual PGY7 salary. Granted, I didn't take the job for mainly geographic reasons. There aren't that many people with the opportunities to make 200k+ right? I mean I get that people may pick to not go to particular locations and will take paycuts for a variety of reasons, but that isn't to say that there aren't opportunities upon graduating for just about everyone graduating.

 

[Goro]

Someone offered me 11x guaranteed for 4 years excluding bonuses and whatnot. Oh and a signing bonus worth just under double my annual PGY7 salary. Granted, I didn't take the job for mainly geographic reasons. There aren't that many people with the opportunities to make 200k+ right? I mean I get that people may pick to not go to particular locations and will take paycuts for a variety of reasons, but that isn't to say that there aren't opportunities upon graduating for just about everyone graduating.

You're an attending now! Congrats! And good luck!

 

[MedicineZ0Z]

Having doe an IM residency at a well-respected university program I completely agree that, when you look beyond individual weeks to the big picture, I definitely did WAY less work than surgical residents. A week of clinic every fourth week that consisted of 4 half days of clinic, elective weeks, ~2 hours of conference every day, 4 weeks of vacation plus a holiday, free health and cheap dental insurance.

Also those who think an intern (or even a resident) is equivalent to a PA is out of their mind. An intern in IM is being supervised by two people (resident and attending) for precisely that reason. On subspecialty services it's 3 people! And when you're rotating through a subspecialty service in particular you have no clue what's happening usually and work your way up to competence by the time you're done with the rotation in 3-6 weeks. Same can't be said for a PA who's been doing the same thing day in and day out for 5, 10, or 20 years!



Why did you go to med school then? Why haven't you quit yet?

And yet me as a student have literally taught those same experienced midlevels how to do basic things you'd expect from an intern on day 1.
Experience only counts when you're doing things that aren't mindless. It's literally only on SDN where I hear about these brilliant midlevels. In real life? Through 7 states, numerous hospitals/clinics, they all display a mediocre level of competence - including ones with experience in subspecialties.

 

[Matthew9Thirtyfive]

And yet me as a student have literally taught those same experienced midlevels how to do basic things you'd expect from an intern on day 1.
Experience only counts when you're doing things that aren't mindless. It's literally only on SDN where I hear about these brilliant midlevels. In real life? Through 7 states, numerous hospitals/clinics, they all display a mediocre level of competence - including ones with experience in subspecialties.

I've met PAs that were good and maybe one or two NPs. But these were midlevels who stayed in their lanes and weren't trying to play doctor.

 

[MedicineZ0Z]

I've met PAs that were good and maybe one or two NPs. But these were midlevels who stayed in their lanes and weren't trying to play doctor.

I've met and/or worked with around 40-50 midlevels and gotten insight into maybe 20 of their knowledge/skills. I very honestly can't say I met a single one who I felt was competent for any sort of independent practice.
The majority were clueless for anything outside of their daily scope. The generalists had no clue how to read an ekg etc. Most weren't great at dosing meds. They were either too careless or overly careful and sent every little thing to the ER. And me as a med student trusted the diagnostic accuracy of my classmates well above theirs.

I worked alongside one who would consult with me for some bread and butter stuff (during my subI) which was good, cause I think a lot of attendings especially underestimate the knowledge of med students vs midlevels.

 

[Matthew9Thirtyfive]

I've met and/or worked with around 40-50 midlevels and gotten insight into maybe 20 of their knowledge/skills. I very honestly can't say I met a single one who I felt was competent for any sort of independent practice.

Yeah, that's my point. They weren't practicing independently and weren't trying to. Midlevels are called midlevels for a reason. They shouldn't be practicing independently. The ABP is saying 3 years of residency doesn't properly train pediatricians well enough to practice hospital medicine without a fellowship, but an NP with 500 clinical hours and an online degree can do it right out of "school"?

But my point was that I've met some who were good at what they did, and what they did was practice as midlevels.

 

[MedicineZ0Z]

Yeah, that's my point. They weren't practicing independently and weren't trying to. Midlevels are called midlevels for a reason. They shouldn't be practicing independently. The ABP is saying 3 years of residency doesn't properly train pediatricians well enough to practice hospital medicine without a fellowship, but an NP with 500 clinical hours and an online degree can do it right out of "school"?

But my point was that I've met some who were good at what they did, and what they did was practice as midlevels.

and we now have PA-EM residencies (lol) and NP ICU residencies (lolol) so that they can be independent in those settings.

We need to be either all in (in favor of) or all out (opposing) midlevels. There's no winning otherwise.


Saying interns are inferior to midlevels only happens in two scenarios:

1. very low quality intern

or

2. uninterested off service intern

 

[NITRAS]

People rise to their level of training and experience.

It is an absolute rarity to find a 6 month pgy 1 who can come up with a reasonable complete assessment and plan on a moderately complicated hospitalized patient...I also don’t consider medical students qualified to render educated opinions on appropriate medical care or education.

 

[jw3600]

It is an absolute rarity to find a 6 month pgy 1 who can come up with a reasonable complete assessment and plan on a moderately complicated hospitalized patient...

Seriously....?

 

[W19]

lmao and they crap on FM working in the ED.

It's funny how the standard for doctors is incredibly high but we have extremely unqualified people practicing alongside them. All these pseudoprofessions and fake degrees are comical.

Lol... Even FM docs with 1-yr fellowship... Like there is something so special about EM

 

[W19]

A fair starting salary for residents would be 80k, +10k every year as you go up the PGY ladder.

 

[VA Hopeful Dr]

Lol... Even FM docs with 1-yr fellowship... Like there is something so special about EM

Its almost like its a completely different field. Its crazy, isn't it?

A fair starting salary for residents would be 80k, +10k every year as you go up the PGY ladder.

Why don't you show your work with exactly how you arrived at that number including income produced by the resident (including CMS funding) compared with resident expenses.

 

[W19]

People rise to their level of training and experience.

It is an absolute rarity to find a 6 month pgy 1 who can come up with a reasonable complete assessment and plan on a moderately complicated hospitalized patient...I also don’t consider medical students qualified to render educated opinions on appropriate medical care or education.

First, you have to define what is moderately complicated? I don't know any of my PGY1 colleagues at this stage who can't come up with a reasonably complete assessment and plan of a patient with pneumonia, CHF/COPD exacerbation, DKA, HHNS, Hypertensive urgency/emergency, a-fib etc... that have other comorbidities...

 

[W19]

@NITRAS @VA Hopeful Dr

The above conditions are arguably 60-70% of IM admission...

 

[VA Hopeful Dr]

@NITRAS @VA Hopeful Dr

The above conditions are arguably 60-70% of IM admission...

How'd I get thrown in, I agreed with you on that part?

 

[Psai]

People rise to their level of training and experience.

It is an absolute rarity to find a 6 month pgy 1 who can come up with a reasonable complete assessment and plan on a moderately complicated hospitalized patient...I also don’t consider medical students qualified to render educated opinions on appropriate medical care or education.

Eh I think that by January/February I was at that level