residency salary???

[Entadus]

Sigh… seems like you’re trying to be purposely naive.

As a trainee, you were not credentialed as active medical staff at your hospital.

That breaks both ways. As a trainee you don’t have any of the liability and can pretty much participate in the care from any field (neurosurgery to fam Med to critical care) but you are not a staff physician and do not get paid like one. As active medical staff, you pretty much have to practice only your field, you get paid much better but also carry the liability.

If you get credentialed as active medical staff, you should get paid like one. That’s it.

Naive, yes, but purposefully so, definitely not. Trying to learn and I appreciate the discussion. I'll freely admit I'm no expert on these matters.

I think it's perfectly fair to mention the liability issue. If that's the main point, then sure, just say that. The post I responded to didn't explicitly mention it.

However, I still don't agree with your premise that employee salary/resident salary is mainly determined by liability risk (and thus that residents deserve lower pay than NP/PA due to this primary reason). Why would that be the case?

Some simple objections:
1) It's not true that residents carry zero liability. Residents are covered by liability insurance, typically $1MM per occurrence and $3MM total coverage. It's true that residents tend to have LESS liability than attendings, but zero?
2) It still ignores the productivity side. Take a high liability specialty like OB/GYN for example. Even if you assume the senior resident has no liability since their attending takes it all. The 3rd or 4th year residents are still covering the whole OB floor all night, 7 nights a week. If you didn't have those residents, you would have to pay someone else for all those deliveries, C-sections, and cross cover. By losing those residents, the total amount of liability would not change, but the amount of WORK done (babies delivered, incisions, sutures, prescriptions, etc) would need to be replaced. What market rate would be paid to replace them?
3) Not to focus too much on mid-levels, but as a group they also tend to have less liability (in practice, if not in theory) than attending physicians. In many states they still require supervision by an attending also. So why would they be paid more and residents be paid less if both tend to have less liability?

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[VA Hopeful Dr]

Naive, yes, but purposefully so, definitely not. Trying to learn and I appreciate the discussion. I'll freely admit I'm no expert on these matters.

I think it's perfectly fair to mention the liability issue. If that's the main point, then sure, just say that. The post I responded to didn't explicitly mention it.

However, I still don't agree with your premise that employee salary/resident salary is mainly determined by liability risk (and thus that residents deserve lower pay than NP/PA due to this primary reason). Why would that be the case?

Some simple objections:
1) It's not true that residents carry zero liability. Residents are covered by liability insurance, typically $1MM per occurrence and $3MM total coverage. It's true that residents tend to have LESS liability than attendings, but zero?
2) It still ignores the productivity side. Take a high liability specialty like OB/GYN for example. Even if you assume the senior resident has no liability since their attending takes it all. The 3rd or 4th year residents are still covering the whole OB floor all night, 7 nights a week. If you didn't have those residents, you would have to pay someone else for all those deliveries, C-sections, and cross cover. By losing those residents, the total amount of liability would not change, but the amount of WORK done (babies delivered, incisions, sutures, prescriptions, etc) would need to be replaced. What market rate would be paid to replace them?
3) Not to focus too much on mid-levels, but as a group they also tend to have less liability (in practice, if not in theory) than attending physicians. In many states they still require supervision by an attending also. So why would they be paid more and residents be paid less if both tend to have less liability?

I'll repost my earlier post in this thread that explains this:

Because they can either bill for their services (PA/NP), or can do their job completely unsupervised (RNs). Residents, generally speaking, can't do either of those.

They also don't have to have the infrastructure of a residency program: lots of attendings who aren't full-time clinical and so have to be paid for administrative time, support staff like program coordinators, residents are pretty inefficient at first, you aren't generally all that productive on off-service rotations but still get paid for it

If residents got paid on production like attending physicians your income would take a big hit intern year, each year past that you'd increase the earnings until in later years you could out earn average resident salary. But you also wouldn't necessarily earn anything on off-service months depending on the set up.

 

[Iamnew2]

This 100%. There’s no impetus beyond it being the decent thing to do. Which 99% of time means it’s not going to happen.

this idea that the "legal and business friends" make so much is so so flawed. SOME people in law and business do well, not the vast majority. per percentage, physicians who are wise with negotiating sans some specialties, do far better than the vast majority of law/business people.

 

[NITRAS]

Try restating this without the BS "provider" word (which was introduced to serve NP's and not physicians, let alone residents).

And I would beg to differ that resident physicians have no credentials. Even besides the MD DEGREE, as a 2nd year IM resident, not only was I licensed in my state, but was doing procedures (intubation, central lines) and running code blues/code rapid responses.

You wouldn’t be allowed to intubate, put in central lines without the supervision of a credentialed physican. You are credentialed, but only under the supervision of another.

If you were not in residency nor BC/BE, the vast majority of the hospitals wouldn’t allow you to do any of that.

PS, it s 2022. NP’s and PA’s are here to stay. It is best to figure how we are going to go forward with them, how MD’s/Do’s need to figure how to differentiate and market our level of expertise and training in the marketplace.

 

[Ganon]

I’ve spent the last month and a half trying deal with poorly supervised interns trying to kill people and waste money/meds/time/radiation. Definitely not a net positive.

And you're a hospitalist, so presumably these are IM/prelim interns.

So... You're the one supervising them?

>_>

Lot's of very bad takes from this thread. Very disheartening.

 

[smq123]

And you're a hospitalist, so presumably these are IM/prelim interns.

So... You're the one supervising them?

Not necessarily. In some hospitals, there are the hospitalists, who may see patients by themselves or with an NP/PA, and then there is the teaching service, which are taught by a separate pool of faculty members. Those attendings may or may not always be around, so a lot will be left up to the senior residents, who vary in quality themselves. There are lots of different set ups.

I haven't read through the entire thread, so I can't attest to every "bad take" that you're referring to, but....there are definitely a contingent of med students and residents who are very vocal, and overstate their own abilities and value to the healthcare system in general. It's ok to say that residents are sometimes not very good, sometimes painfully inefficient and incapable, and sometimes cost more to the hospital than they bring in. That's why we do residency - to learn how to be better, to be more efficient and more capable, and to eventually become team leaders. I freely admit that, especially as an intern, there were definitely times when I slowed things down, and I'm grateful for my teachers who patiently corrected me and (mostly silently) rolled their eyes when I wasn't looking.

 

[NITRAS]

And you're a hospitalist, so presumably these are IM/prelim interns.

So... You're the one supervising them?

>_>

Lot's of very bad takes from this thread. Very disheartening.

I get admissions from EM residents who are “supervised” to one degree or another by an EM attending.

I do work with some IM residents, but not much. I can’t tell if I’m just crotchety or if it is COVID, but I feel that the IM residents aren’t as good this batch as previous ones either.

 

[VA Hopeful Dr]

I get admissions from EM residents who are “supervised” to one degree or another by an EM attending.

I do work with some IM residents, but not much. I can’t tell if I’m just crotchety or if it is COVID, but I feel that the IM residents aren’t as good this batch as previous ones either.

Probably some of both. There's no way medical education during COVID isn't going to have some decent changes - some good, some bad.