Resident Hazard Pay?

[Raryn]

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Laughable nonsense. Residents are paid from federal GME funding. Not only that, but the GME funding per resident is greater than the resident's salary. We're not only free labor for the institution that "employs" us, the institution actually gets paid to allow us to perform free work for them. It just absolutely sickens me that instead of fighting for their own interests like every single other goddam profession, people in this field will go to any length including outright lies and fabrications in order to sabotage themselves and their colleagues. It's like some kind of disgusting masochistic fetish, I truly cannot find any other logical explanation for it.

This is complicated, and you're never going to get a clear answer here. I've posted about this before, but you cannot make this statement flat out. that residents are profitable.

Let's use the simplest example here - an inpatient internal medicine teaching service (ignoring the students) might typically consist of an attending, a senior resident, and two interns. Depending on how their call schedule is arranged, they might see 10-20 patients - most common average is probably 15. The team sees those 15 patients, rounds on them, and bills insurance for those 15 patients. All four individuals are drawing an income here.

What would happen if the residents didn't exist? Well, there would just be an attending. And an attending hospitalist routinely sees... 10-20 patients. Probably an average of 15. By themselves. And bills the insurance for them. And only gets paid one income (though probably higher than an academic attending).

It's pretty obvious in this situation that if it wasn't for the government subsidy for resident salaries, that the former scenario here is a money-loser for the hospital. Yes, the academic attending has a much "easier" life - particularly when it comes to not having to write notes - but the hospital doesn't care about that. The net productivity of adding the residents is pretty negligible here.

The hospital additionally may have to eat the cost of any inefficiencies caused by teaching teams - this is most visible with Medicare patients, where the reimbursement to the hospital (as opposed to the physicians) is a flat fee based on diagnosis and complexity rather than being able to charge for every individual thing done. If the teaching teams keep patients one day extra in the hospital on average, or they order just a few more blood tests, the hospital loses significant amounts of money from any payor that reimburses based on DRGs (as opposed to paying a la cart).

In other scenarios - clinic work, surgical services, etc - the residents do allow the attending to see more patients and perform more work - but whether in the aggregate that is worth more than what you're paying the residents is hard to say, particularly for one major reason:

The residents have to be taught. You can't just give them scutwork and use them to extend your ability to bill - assuming you aren't a terrible person, you have to actually spend time and effort developing them into independent physicians. If they feel comfortable with a low level task, that's wonderful - but that also means it is time for them to move on to other tasks and you to give that low level task to someone else that is less comfortable with it (i.e. a lower level resident).

Every time someone analyzes whether residents are a net economic benefit or cost, the assumptions made get a different answer. I think that if the Medicare (and equivalent) subsidies didn't exist, most residency programs would actually be a net loss for the system, but you can easily argue against that.

Oh, and don't forget there's tons of other costs the residency program needs to pay for on top of the resident salaries:

A) Payroll taxes

B) Benefits - both direct benefits for the resident (medical, dental, whatever) and malpractice insurance

C) Program directors salary (typically half of it but it may be more or less depending on the specialty) - the PD isn't allowed to be full time clinical work so they have time to dedicate time to the program

D) Program administration (like the coordinator, educational activities, all the paperwork involved with keeping a program accredited, recruitment/turnover every year)

The cost of having a $55-60k/year resident probably does go up to at least $100k/person - which is what the government subsidizes each resident at. Opening new programs without a source of subsidy is often not feasible.

 

[<L>]

Good point - I may be judging the internal emails too harshly on the surface, and clearly I’m not privy to all the other discussions there that surrounded them. I am probably extrapolating based on their very strict media restrictions for trainees combined with the leadership blasting that now-retracted article. Oh and that the same urology chair who blasted his trainees in a public email was also sued by a former partner for some pretty severe allegations of financial impropriety. That doesn’t make the leaked emails malicious, but lots of little pieces of evidence keep coming together to paint a picture.

Here’s the initial letter from Langone himself followed by a rather aggressive comment barrage from senior leaders and anon rebuttals from residents:

Letter to the Editor: “NYU Must Compensate Its Medical Workers Fairly” - Washington Square News

It is deeply disappointing that an “opinion piece” by one of your own editors was allowed to publish despite numerous factual inaccuracies. Of greatest concern is that the piece makes erroneous and unsubstantiated claims that were not fact checked with reliable sources. Most disturbing are...

nyunews.com

And then this one aggregating those comments and other letters:

Letters to the Editor: “NYU Must Compensate Its Medical Workers Fairly” - Washington Square News

Editor’s Note: The following article contains all the Letters to the Editor that the aforementioned article has received. For the sake of transparency, we will update this article if we receive additional Letters to the Editor for this piece. For the sake of concision and consistency, we have...

nyunews.com

Oh Christ... there's some serious Big Trustee Energy in Langone's letter. Now a bunch of PDs and GME employees get to deal with the fallout. I do think the OpEd required a response but NYU leadership would have been wise to have someone clinical do it rather than a guy who's basically an ancillary character from "Succession".

edit: I didn't notice the other staff who signed onto the letter when I first posted this.

 

[ThoracicGuy]

This is complicated, and you're never going to get a clear answer here. I've posted about this before, but you cannot make this statement flat out. that residents are profitable.

Let's use the simplest example here - an inpatient internal medicine teaching service (ignoring the students) might typically consist of an attending, a senior resident, and two interns. Depending on how their call schedule is arranged, they might see 10-20 patients - most common average is probably 15. The team sees those 15 patients, rounds on them, and bills insurance for those 15 patients. All four individuals are drawing an income here.

What would happen if the residents didn't exist? Well, there would just be an attending. And an attending hospitalist routinely sees... 10-20 patients. Probably an average of 15. By themselves. And bills the insurance for them. And only gets paid one income (though probably higher than an academic attending).

It's pretty obvious in this situation that if it wasn't for the government subsidy for resident salaries, that the former scenario here is a money-loser for the hospital. Yes, the academic attending has a much "easier" life - particularly when it comes to not having to write notes - but the hospital doesn't care about that. The net productivity of adding the residents is pretty negligible here.

The hospital additionally may have to eat the cost of any inefficiencies caused by teaching teams - this is most visible with Medicare patients, where the reimbursement to the hospital (as opposed to the physicians) is a flat fee based on diagnosis and complexity rather than being able to charge for every individual thing done. If the teaching teams keep patients one day extra in the hospital on average, or they order just a few more blood tests, the hospital loses significant amounts of money from any payor that reimburses based on DRGs (as opposed to paying a la cart).

In other scenarios - clinic work, surgical services, etc - the residents do allow the attending to see more patients and perform more work - but whether in the aggregate that is worth more than what you're paying the residents is hard to say, particularly for one major reason:

The residents have to be taught. You can't just give them scutwork and use them to extend your ability to bill - assuming you aren't a terrible person, you have to actually spend time and effort developing them into independent physicians. If they feel comfortable with a low level task, that's wonderful - but that also means it is time for them to move on to other tasks and you to give that low level task to someone else that is less comfortable with it (i.e. a lower level resident).

Every time someone analyzes whether residents are a net economic benefit or cost, the assumptions made get a different answer. I think that if the Medicare (and equivalent) subsidies didn't exist, most residency programs would actually be a net loss for the system, but you can easily argue against that.

Oh, and don't forget there's tons of other costs the residency program needs to pay for on top of the resident salaries:

A) Payroll taxes

B) Benefits - both direct benefits for the resident (medical, dental, whatever) and malpractice insurance

C) Program directors salary (typically half of it but it may be more or less depending on the specialty) - the PD isn't allowed to be full time clinical work so they have time to dedicate time to the program

D) Program administration (like the coordinator, educational activities, all the paperwork involved with keeping a program accredited, recruitment/turnover every year)

The cost of having a $55-60k/year resident probably does go up to at least $100k/person - which is what the government subsidizes each resident at. Opening new programs without a source of subsidy is often not feasible.

Stop bringing this logic in here! You gotta feel it.

 

[VA Hopeful Dr]

Stop bringing this logic in here! You gotta feel it.

Are we even allowed to post in this thread without talking about how selfish the attending physicians are?

 

[ThoracicGuy]

Are we even allowed to post in this thread without talking about how selfish the attending physicians are?

No.

That is not being sensitive.

 

[Raryn]

Are we even allowed to post in this thread without talking about how selfish the attending physicians are?

I took the time out of my day and cancelled a morning of patients to give lectures to a local residency program yesterday. For free.

But attendings are terrible. I probably should have written the residents a check for the trouble of having to listen to me 😉

 

[Señor S]

Administrators are scum who view residents as nothing more than overgrown kids playing doctor and treat them accordingly...

So, what else is new?

Asking for "hazard pay" strikes me as pointless, for the reason many others have stated: hospitals are hemorrhaging money right now. All moves are in the direction of cutting pay, benefits and hours. You can't bleed a rock.

 

[deleted814217]

Administrators are scum who view residents as nothing more than overgrown kids playing doctor and treat them accordingly...

So, what else is new?

Asking for "hazard pay" strikes me as pointless, for the reason many others have stated: hospitals are hemorrhaging money right now. All moves are in the direction of cutting pay, benefits and hours. You can't bleed a rock.

Denver Health Executives Get Bonuses 1 Week After Workers Asked To Take Cuts clearly hurting badly for money

 

[deleted814217]

some hospitals are actually doing hazard pay as well. Also regarding the idea of resident cost/value-I do agree it can be difficult to characterize. It is somewhat rotation dependent and field dependent. There is an ICU rotation I do at a community hospital-overnight, there are no in house intensivists-it is residents managing the unit, doing admissions/procedures/running codes, etc, and the hospital itself is hemorrhaging money. I actually once asked the group that staffs it about nocturnal coverage out of curiosity-they said it would cost from the hospitals standpoint too much to have in house attending moonlighters or nocturnists. I argue in that scenario the residents provide a great deal of value, but in settings like the ED for in stance, it can dependent. There has to be an attending there-but some places get by on far less coverage than they would without residents. At one of the community sites they most definitely do not need residents, but at the main academic site, they would have to ramp up coverage if they wanted to work without residents.

It's tough to exactly characterize therefore, but iirc there are studies that bear out that residents do have net monetary value (senior residents in their respective specialities as far as I remember) but at the very least imo there should be a few things. For starters paying fellows asked to work in attending roles as attending seem pretty fair (not being done across the board). Resident cost of living adjustments/yearly raises are not being honored at several hospitals-this is not a whole lot of money tbh and the principle of it speaks volume, I do think these should be honored. Some places are doing hazard pay as well, in varying forms (flat rate vs monthly), worth to note, some form of this should be done imo (probably give priority to people who are being redeployed from their respective field tbh).

The attending here really don't seem to realize the value of $1 to a resident is worth way more than that of attending. As usual they've forgotten what it's like to be a resident and every generation below them is terrible, and how their groups never complained, and they were the last group of people to work hard and made it on their own two feet, and so on and so forth..

 

[Señor S]

Denver Health Executives Get Bonuses 1 Week After Workers Asked To Take Cuts clearly hurting badly for money

A few CEOs following through with their pre-planned looting is meaningless; for every one of those there are 50,000 healthcare workers having their hours reduced, salaries cut or being furloughed (or laid off entirely). That being the case there is literally 0 chance management will approve extra pay for a bunch of residents whom (as I explained above) they regard with mild or not-so-mild contempt. And if they are giving "hazard pay" to residents why shouldn't it also be given to essentially all hospital employees? Anybody around patients runs the risk of being exposed. The money doesn't exist for that.

 

[VA Hopeful Dr]

I took the time out of my day and cancelled a morning of patients to give lectures to a local residency program yesterday. For free.

But attendings are terrible. I probably should have written the residents a check for the trouble of having to listen to me 😉

You're a monster

 

[<L>]

Resident cost of living adjustments/yearly raises are not being honored at several hospitals-this is not a whole lot of money tbh and the principle of it speaks volume, I do think these should be honored.

I'm assuming you're referencing the University of Colorado situation, and yeah, that was the first one of these outrages that made me go "huh?". Admins there owe residents an explanation about where that GME funding is being diverted to and/or what additional costs they're taking on to justify that. I don't remember an example of a COL for residents getting axed, but perhaps some of the older posters than myself can remember one.

Though that said, if I was a resident and found out which of my colleagues posted my PC's name and office number on to outrage click forums on the internet so she could be subject to harassment calls, I'd ****ing murder them. That's not ok.

The attending here really don't seem to realize the value of $1 to a resident is worth way more than that of attending. As usual they've forgotten what it's like to be a resident and every generation below them is terrible, and how their groups never complained, and they were the last group of people to work hard and made it on their own two feet, and so on and so forth..

Bruh, You'd be taken more seriously if you didn't post cringe like this.

I'm barely out of residency. Lots of my friends finished training even more recently. I lived in a 400 sqft apartment with a view of a row of dumpsters. It was still an upgrade from the slum I lived in in med school. And really, my life was fine. I ate out plenty, went to sporting events, live shows, etc. Maybe you guys didn't burn Napster CD-Rs off of dial-up connections in high school but otherwise we're in the same generation. Perhaps the world has changed since the halcyon days of 2016, but I'm more than a little dubious.

 

[46Long]

I'm an attending in the face of a pandemic. I'm likely to see a salary CUT due to decreased volumes/surgeries related to this. I am NOT getting hazard pay even though I still have chances of coming in contact with positive patients on a regular basis.

So, no, I don't have much sympathy for residents complaining about their salary or hazard pay. Everyone is being affected here.

If you accept this salary cut, that's YOUR problem. Doesn't mean the residents dont have an extremely legit point. And in fact, I would not blame them for ALL walking out en-masse. Hospitals and corporations want to socialize the losses but capitalize the gains. SO wrong!!

 

[46Long]

Like, if your institution can swing hazard pay, cool. If it can't then throwing cash at you isn't going to magically fix the trauma of what you're doing.

The point is that they CAN throw money at them but they choose NOT to because the whole residency thing is meant to exploit them and keep residents (and some attendings) powerless and not know what they are worth. If you knew NYU made 4 million dollars on your 250K salary what would you do with that information?

 

[46Long]

Our institution's entire medical staff, EXCEPT for residents and fellows, are having their pay CUT right now. Yes, this includes the ICU docs & hospitalists managing COVID patients. And a non-trivial number of support staff have been furloughed. I think people need to have a bit more perspective and selfawareness at this point.

Any trainees lining up to participate in these pay cuts? Trainees in specialties that have had a significant decrease in patient volumes/experiences willing to be furloughed?

*only hears crickets*

IF your pay is CUT you are absolutely within reason ok to quit (for cause) and the contract is NOT VALID because of breach by the institution. DO what you will with that information.

 

[46Long]

. The assumption that "OMG the PD is collecting a list of names for retaliation!!" is jumping the gun here. The initial email was about wanting to sit down and talk to the residents about their concerns. The NYU GI PD asking to see if he needs to do that with any of his people is...fine. It's the type of discussion my PD would have to have with residents every so often, and I'd have to have similar "look, I know you're upset about this, but trust me, you don't want the unintended consequences of what you're asking for" talks to younger trainees when I was a chief resident too.

You're so precious!!!

If you dont think that GI PD wanted those names for retaliation purposes you are as naive as they come. NYU has a culture of retaliation going back ages (since I was an intern perhaps 23 years ago in NYC). It was common knowlede in NYC. THe GI PD wanted those names to either terminate those fellows or sabotage their career.
"sit down and talk to those residents about their concerns" CMON DUDE.

 

[VA Hopeful Dr]

IF your pay is CUT you are absolutely within reason ok to quit (for cause) and the contract is NOT VALID because of breach by the institution. DO what you will with that information.

Yes, you can quit if that happens as you say. But that's a great example of cutting off your nose to spite your face. If outside of once in a century pandemics, your job is good why would you leave it?

 

[46Long]

Yes, you can quit if that happens as you say. But that's a great example of cutting off your nose to spite your face. If outside of once in a century pandemics, your job is good why would you leave it?

Because they are socializing losses.
WHy do i have to share the burden of taking the employers loss? I didn't take the business risk.. Now if I were a independent contractor working for myself I would absolutely be ok with taking a cut because IM the one who took the business risk. My salary is guarantteed and has nothing to do with whether the employer makes money or not

 

[ThoracicGuy]

If you accept this salary cut, that's YOUR problem. Doesn't mean the residents dont have an extremely legit point. And in fact, I would not blame them for ALL walking out en-masse. Hospitals and corporations want to socialize the losses but capitalize the gains. SO wrong!!

My contact states that I do x number of rvu port year. If I'm below a certain amount, my pay is cut for the following year. I'm not making much rvu right now. If I can make up the missing rvu, which won't be likely, then my pay is cut per contract. If I don't like it, I can try to renegotiate the contract or leave.

This is not unique. Residents want more. Where are they going to get that money when people are getting cuts all over? It's just not realistic.

But walk out, sure. Cut off your nose to spite your face and risk losing your training...

 

[VA Hopeful Dr]

Because they are socializing losses.
WHy do i have to share the burden of taking the employers loss? I didn't take the business risk.. Now if I were a independent contractor working for myself I would absolutely be ok with taking a cut because IM the one who took the business risk. My salary is guarantteed and has nothing to do with whether the employer makes money or not

You don't have to. But if you choose not to, don't be surprised if you have to find a new job 90 days from now.

 

[46Long]

You don't have to. But if you choose not to, don't be surprised if you have to find a new job 90 days from now.

You should be willing to walk out at ANY given time

 

[VA Hopeful Dr]

You should be willing to walk out at ANY given time

Duh? Not sure anyone is saying otherwise.

 

[CopaceticOne]

IF your pay is CUT you are absolutely within reason ok to quit (for cause) and the contract is NOT VALID because of breach by the institution. DO what you will with that information.

I'll say it again: I think people need to have a bit more perspective and selfawareness at this point.

Sure, go ahead and quit. Good luck finding a new residency spot. And if you're further along in your training, you will likely have to extend training because most require you complete the last X months at the institution. Remember, they'll likely need a PD letter. But of course people will ask colleagues they known at the original institution because every field is actually a small world. Oh, and good luck trying to explain that you left because of the money and money alone.

Again - perspective and self-awareness.

 

[46Long]

I'll say it again: I think people need to have a bit more perspective and selfawareness at this point.

Sure, go ahead and quit. Good luck finding a new residency spot. And if you're further along in your training, you will likely have to extend training because most require you complete the last X months at the institution. Remember, they'll likely need a PD letter. But of course people will ask colleagues they known at the original institution because every field is actually a small world. Oh, and good luck trying to explain that you left because of the money and money alone.

Again - perspective and self-awareness.

NOt suggesting those in training quit and not suggesting folks quit because of this invisible enemy, I'm suggesting that if your pay is cut (and you are doing the same work for less now because of the invisible enemy) you have every right to walk out immediately. The quit part applies to attending staff only. Interns and Residents: they have you by the you know what by design so you are screwed. you have to stay lest damage your career

 

[CopaceticOne]

NOt suggesting those in training quit and not suggesting folks quit because of this invisible enemy, I'm suggesting that if your pay is cut (and you are doing the same work for less now because of the invisible enemy) you have every right to walk out immediately. The quit part applies to attending staff only. Interns and Residents: they have you by the you know what by design so you are screwed. you have to stay lest damage your career

You've lost any credibility. "Invisible enemy"? WTF, we are doctors; you, possibly, are not. It is a viral pathogen.

 

[CalmAndCollected]

1. Residency programs don't need to be worried about someone with gap years before their medical school. Irrelevant to the salary offered.
2. Residency programs aren't responsible for your debt you amassed in undergrad or med school.
3. NYC is an expensive place to live. You know the salary going in. If you think it is too low, go somewhere else for training.
4. When you finish your training and get an attending job you'll probably get at least 3 times your resident salary and possibly much more than that. Where you choose to work can affect this as well. You can certainly work towards paying your debt at that time.
5. The salaries offered are often at or above the average salary for a US family of 4. You aren't going to be collecting welfare.

1. While they aren’t responsible for previous debt, residency pay has reduced if you account for inflation and buying power has fallen as well if you account for increase in cost of living.

2. Resident spots are limited and this puts residents in an extremely vulnerable position for being taken advantage of.

3. Residents are necessary parts of our medical system and ensure future doctors are properly trained. They also become future attendings.

4. As a society we have a vested interest in maintaining residency as an attractive offer in order to protect our medical system.

5. A lot of these “capitalist” and “free market economy” takes ignore the fact that in a completely free market economy, there would be no need for regulation of physicians through residency. Anyone could put up a sign saying “medical care 4 $$&” and the free market would dictate who makes money or not. We have elected to protect the quality of our healthcare by require standards of physicians and medical practitioners, and this system should strive in providing them enough protection to get through these regulations to ensure this system is maintained.

 

[<L>]

You're so precious!!!

If you dont think that GI PD wanted those names for retaliation purposes you are as naive as they come. NYU has a culture of retaliation going back ages (since I was an intern perhaps 23 years ago in NYC). It was common knowlede in NYC. THe GI PD wanted those names to either terminate those fellows or sabotage their career.
"sit down and talk to those residents about their concerns" CMON DUDE.

LOL man. I think one of the common themes here from some of the trainees here is the idea that residents being outwardly bitchy is somehow unique or special. It takes a degree of narcissism to think that any resident or fellow is even worth the effort it would take to "sabotage their career" from one of the higher ups.



I'm guessing you immediately felt outrage when you heard about the Eugene Gu or Stephanie Waggle stories too.

 

[Raryn]

1. While they aren’t responsible for previous debt, residency pay has reduced if you account for inflation and buying power has fallen as well if you account for increase in cost of living.

Sauce: https://www.nejm.org/doi/full/10.1056/NEJMp1402468?query=featured_home

More recent numbers via medscape:

To put that into the context of the prior chart, current resident salaries are ~$54k if you inflation adjust 61k to 2012 dollars.

Which means if you compare the recent numbers back as far as the data goes - to 1968 - current PGY1s make more in inflation adjusted terms than any prior PGY1 - ever.

Edit: Just realized the second chart is all residents - the equivalent PGY1 number is just over $50k inflation adjusted to 2012 dollars. So sorry, it isn't the highest ever - it's slightly lower than a few years in the 1970s but still above any other resident since 1980. And still has certainly kept up with inflation.

 

[deleted814217]

Seems like people here will go to any lengths to defend those in charge and are way okay with status quo. Attendings also across the board get paid way less than what they bill for. But nah rather focus on how trainees suck, are terrible, add nothing, and so on. No wonder why this profession is going to pieces..

 

[46Long]

5. A lot of these “capitalist” and “free market economy” takes ignore the fact that in a completely free market economy, there would be no need for regulation of physicians through residency. Anyone could put up a sign saying “medical care 4 $$&” and the free market would dictate who makes money or not. We have elected to protect the quality of our healthcare by require standards of physicians and medical practitioners, and this system should strive in providing them enough protection to get through these regulations to ensure this system is maintained.

Many people believe we have standards and regulations as physicians because we want to "corner the market", enrich ourselves,....... keep the numbers low etc etc etc . Most of these accusations are from the nurses who are sick of bedside nurses and want to be independent practitioners.
Also I would like to alert you to the fact that (Im sure you already know) it used to be like that. A total free market and medical education was standardized by a guy named Flexner.. See flexner report

The Flexner Report ― 100 Years Later - PMC

The Flexner Report of 1910 transformed the nature and process of medical education in America with a resulting elimination of proprietary schools and the establishment of the biomedical model as the gold standard of medical training. This ...

www.ncbi.nlm.nih.gov

 

[qwerty89]

RAND Corp has already looked at this before.

 

[Señor S]

Seems like people here will go to any lengths to defend those in charge and are way okay with status quo. Attendings also across the board get paid way less than what they bill for. But nah rather focus on how trainees suck, are terrible, add nothing, and so on. No wonder why this profession is going to pieces..

A lot of different issues are being conflated here. The bootlicking of administrators is of course nauseating. The idea that program directors, as a class, are too lofty to stoop as low as retaliating against trainees is laughable on its face. The question of whether residents are profitable is an open one with no clear answer (although the fact that many for-profit health systems maintain residency programs is suggestive).

The whole GME system is, in the year 2020, nothing more than a gigantic racket and Ponzi scheme. Excepting a handful of procedural specialties its major purpose is to maintain the sinecures of a bunch of useless "academic" physicians while the rest of the profession is being taken over by midlevels with half the debt and training. But once you're in the shortest way out is through the other end, and you'd be wise to not make waves complaining about anything; certainly not about "hazard pay" in a cash-starved healthcare environment, in a country where "at-will" employment is the rule and not the exception.

 

[46Long]

A lot of different issues are being conflated here. The bootlicking of administrators is of course nauseating. The idea that program directors, as a class, are too lofty to stoop as low as retaliating against trainees is laughable on its face. The question of whether residents are profitable is an open one with no clear answer (although the fact that many for-profit health systems maintain residency programs is suggestive).

The whole GME system is, in the year 2020, nothing more than a gigantic racket and Ponzi scheme. Excepting a handful of procedural specialties its major purpose is to maintain the sinecures of a bunch of useless "academic" physicians while the rest of the profession is being taken over by midlevels with half the debt and training. But once you're in the shortest way out is through the other end, and you'd be wise to not make waves complaining about anything; certainly not about "hazard pay" in a cash-starved healthcare environment, in a country where "at-will" employment is the rule and not the exception.

I agree, hazard pay is NOT worth the fight because how much does that amount to really? THere are bigger issues underlying this one that are the real issues that is namely the independent status of mid-levels. I believe this hazard pay outcry is an offshoot of another issue that has come up and that is the fact that midlevels are being recruited to NYC to "help out" to the tune of 13-15K per week for the duration of the crisis. Ive read ( on this thread possibly) bedside nurses are being recruited for 9k per week.. YOu read that right. So if I am a resident, you GD right thats going to ruffle my feathers and demand some recalibration. THe NYU administration, in their myopic view of the situation failed to understand what really the resident(s) were/are complaining about. SOrt of like interviewing a patient, they're describing a complaint and you have to figure out what they are REALLY complaining about..

 

[Señor S]

I agree, hazard pay is NOT worth the fight because how much does that amount to really? THere are bigger issues underlying this one that are the real issues that is namely the independent status of mid-levels. I believe this hazard pay outcry is an offshoot of another issue that has come up and that is the fact that midlevels are being recruited to NYC to "help out" to the tune of 13-15K per week for the duration of the crisis. Ive read ( on this thread possibly) bedside nurses are being recruited for 9k per week.. YOu read that right. So if I am a resident, you GD right thats going to ruffle my feathers and demand some recalibration. THe NYU administration, in their myopic view of the situation failed to understand what really the resident(s) were/are complaining about. SOrt of like interviewing a patient, they're describing a complaint and you have to figure out what they are REALLY complaining about..

I think the healthcare establishment's reaction to Covid has gone through 2 stages (3 stages if you count "ignoring/downplaying it" as a stage):

1. All-out panic: cancel all elective surgeries and outpatient visits, throw money at anyone and everyone to get them to help. This was, I believe, implicitly done under the "surge" assumption, where hospitals would be packed (and overflowing!) with inpatient Covid admits and revenues would decline only slightly (if at all). I don't think anyone was thinking about potential losses at this point. Unfortunately the surge assumption hasn't come close to panning out nationwide, so the massive and catastrophic decline in revenue has brought us to the second stage...

2. Belt tightening: upon realizing that they're hemorrhaging money the suits are now pushing equally hard to get everything back to normal. Get elective surgeries on the schedules again, get outpatient visits rolling again. Cut pay as necessary, furlough as necessary. Not only is "hazard pay" a non-starter in this environment, but if we believe the line that residents are a money-loser they may be even more inclined than normal to "trim" some of that fat (counterpoint: residents are partially government-funded, they're effectively a "sunk cost" and if another wave of Covid materializes you may need them etc pp.)

But I agree that the contempt of bureaucrats for physicians is a meta-issue as well. No question that the suits (many of whom are physicians themselves!) do enjoy cutting those arrogant doctors down to size when they can. And residents--being young, being (in effect) indentured servants with no leverage to negotiate working conditions, being the most junior of employees--are especially vulnerable to these administrative depredations. We need some class consciousness, and for people to have some professional pride (not just individual pride of the "I am the smartest doctor that ever lived" type, of which we already have plenty). Maybe Covid will be the turning point. I hope so, anyways...

 

[<L>]

But nah rather focus on how trainees suck, are terrible, add nothing, and so on. No wonder why this profession is going to pieces..

Perhaps if you'd ditch the strawmanning and hyperbole, people would take you more seriously?

You guys are reminding me of one of my co-residents who was chief resident a couple years after I was. Good physician, but just generally angry (hardly unique, but most people grow out of it. In fact, we had a line for about 4 years where our angstiest interns all ended up as chief.). Her chief year from all accounts was an epic disaster because she never learned how to pick her battles. She spent the year going all "Viva la Revalución!" and antagonizing the faculty rather than working with them to get stuff dealt with. By the end of it she was burned out and perpetually complaining about what an awful experience she had, which is hilarious because I still communicate with a six year line of people who were in that position and it really only seemed to be a problem for her. I'd say pretty much all of us had a good experience. That's not to say there weren't indignities in the program. Our primary clinical site was a poorly funded mostly-medicaid hospital with a disorganized GME office, and our department chair was an overpaid dimwit who really only still has his job due to institutional inertia. Still, you learn to roll with things, focusing on what you can change and dealing with what you can't.

She later relocated to the opposite coast for a fellowship and was complaining last year about the "toxic environment" there too. At some point it's time to recognize that your issues might be a "you problem".

 

[46Long]

Perhaps if you'd ditch the strawmanning and hyperbole, people would take you more seriously?

You guys are reminding me of one of my co-residents who was chief resident a couple years after I was. Good physician, but just generally angry (hardly unique, but most people grow out of it. In fact, we had a line for about 4 years where our angstiest interns all ended up as chief.). Her chief year from all accounts was an epic disaster because she never learned how to pick her battles. She spent the year going all "Viva la Revalución!" and antagonizing the faculty rather than working with them to get stuff dealt with. By the end of it she was burned out and perpetually complaining about what an awful experience she had, which is hilarious because I still communicate with a six year line of people who were in that position and it really only seemed to be a problem for her. I'd say pretty much all of us had a good experience. That's not to say there weren't indignities in the program. Our primary clinical site was a poorly funded mostly-medicaid hospital with a disorganized GME office, and our department chair was an overpaid dimwit who really only still has his job due to institutional inertia. Still, you learn to roll with things, focusing on what you can change and dealing with what you can't.

She later relocated to the opposite coast for a fellowship and was complaining last year about the "toxic environment" there too. At some point it's time to recognize that your issues might be a "you problem".

I get what you are saying but it is partly her but you gotta admit there is a lot of things to improve upon in medical education and culture

 

[operaman]

Too many posts to quote, but for all the people saying attendings should be willing to walk away: do your contracts have non-competes? They seem fairly standard for most places so walking away means not practicing in your community for a couple of years. I’ve known some people who were able to set up shop mere yards outside the geographic boundaries in their contract but that’s probably not possible everywhere. It just seems like leaving is harder than it sounds sometimes and often the best move is to stay put and endure unless you already have a better gig lined up.

Obviously residents quitting mid stream is the the stupidest possible move ever. The only reason to quit as a resident is if you decide you never want to practice in your field. Ever. And even then probably worth a good long think first.

Frankly im amazed that all hospitals haven’t cut salaries already. Revenues are down substantially and money doesn’t grow on trees. My guess is that the places carrying minimal debt with lots of cash on hand in lesser impacted areas are hoping to weather the storm. Most places seem to be making cuts in a progressive manner with execs taking the largest one, physicians in the middle, and ancillary staff taking the smallest cuts. It sucks but that’s just how things are right now.

 

[ThoracicGuy]

Too many posts to quote, but for all the people saying attendings should be willing to walk away: do your contracts have non-competes? They seem fairly standard for most places so walking away means not practicing in your community for a couple of years. I’ve known some people who were able to set up shop mere yards outside the geographic boundaries in their contract but that’s probably not possible everywhere. It just seems like leaving is harder than it sounds sometimes and often the best move is to stay put and endure unless you already have a better gig lined up.

Obviously residents quitting mid stream is the the stupidest possible move ever. The only reason to quit as a resident is if you decide you never want to practice in your field. Ever. And even then probably worth a good long think first.

Frankly im amazed that all hospitals haven’t cut salaries already. Revenues are down substantially and money doesn’t grow on trees. My guess is that the places carrying minimal debt with lots of cash on hand in lesser impacted areas are hoping to weather the storm. Most places seem to be making cuts in a progressive manner with execs taking the largest one, physicians in the middle, and ancillary staff taking the smallest cuts. It sucks but that’s just how things are right now.

But, but...

 

[Señor S]

But, but...

Everyone's a comedian

 

[Gregor Samsa]

Everyone's a comedian

These guys have been massacring people with FACTS and LOGIC since long before you were born, they don't care about your feelings.

 

[evilbooyaa]

Too many posts to quote, but for all the people saying attendings should be willing to walk away: do your contracts have non-competes? They seem fairly standard for most places so walking away means not practicing in your community for a couple of years. I’ve known some people who were able to set up shop mere yards outside the geographic boundaries in their contract but that’s probably not possible everywhere. It just seems like leaving is harder than it sounds sometimes and often the best move is to stay put and endure unless you already have a better gig lined up.

Obviously residents quitting mid stream is the the stupidest possible move ever. The only reason to quit as a resident is if you decide you never want to practice in your field. Ever. And even then probably worth a good long think first.

Frankly im amazed that all hospitals haven’t cut salaries already. Revenues are down substantially and money doesn’t grow on trees. My guess is that the places carrying minimal debt with lots of cash on hand in lesser impacted areas are hoping to weather the storm. Most places seem to be making cuts in a progressive manner with execs taking the largest one, physicians in the middle, and ancillary staff taking the smallest cuts. It sucks but that’s just how things are right now.

It depends.

Most places will have non-competes. If your pay does get cut or furloughed, it will depend on if that is OK to do that in your contract or not (assuming that you have at least a 'base salary' and do not have a RVU threshold required to 'meet' in order to get your base). If that is not written in your contract or other supporting documents, you have the right to declare the contract breached, and thus the non-compete does not apply to you (since the hospital broke the contract). This can all be challenged in court but contracts are so variable it is hard to have a one-size fits all answer to this.

My take on the OP is relatively simple: I think residents (especially those who are being pulled from educational rotations) staffing COVID-19 units/floors should get paid hazard pay. It will likely be nominal and basically a show of appreciation. There are multiple hospitals in the NY/NJ area that ARE doing this, and most if not all do not have anything close to NYU's massive endowment to use as a fallback as necessary. So I don't really have pity for NYU as an institution on this. Sure, anytime you post something to twitter it is bound to get buried in a long-list of completely unreasonable (even to me) demands. But, across specialties, there are people who are willing to comment publicly about their issues with an institution.

Those comparing this resident to Eugene Gu or Stephanie Waggels or whatever are extremely off-base IMO.

I do understand that certain hospital systems may not be able to do so, but the extremely heavy handed response from NYU's leadership to the 'letter to the editor' is not a good look for them. Malignant NYC programs are going to continue to be malignant (shocker) in the face of adversity.

Also, IM Fellows who are now 'leading' floor teams should absolutely be paid much higher than a fellow salary, like a hospitalist. Physicians (attendings, residents, or fellows) should not 'volunteer' their time (when asked to work without payment) to treat COVID-19 patients.

 

[Little Green Mensch]

Much like the stimulus momey should have gone predominantly to people who are unemployed, any hazard pay ought to be reserved for the people who are actually exposed to SARS Covid-2: ARDS Boogaloo on a regular basis. Including support staff.

As a junior surgical resident, I haven't come in contact with many coronavirus patients. I don't need hazard pay. What I want is for elective cases to be restarted, so my time in training doesn't have to be extended. We also desperately need to come up with a solution for a potential second wave of cases in the fall that doesn't bankrupt our hospitals (who make a huge chunk of their money on elective procedures). An elective case slowdown, rather than cessation (e.g. defer procedures where there is no risk of functional decline if not done, defer cases which have high risk of prolonged hospitalization or ICU utilization but can be adequately temporized) would, in retrospect, have been more reasonable. At our institution, there were tumor patients who went without biopsy, predominantly older patients with classic radiographic features where the oncologists felt comfortable treating empirically, but that seems unnecessary in hindsight.

As for whether residents are a net financial benefit, there are a lot of institutions where residency programs are above their Medicare cap. Residents can be a big force multiplier for attendings, and are substantially cheaper than midlevels. Presumably if midlevels were better value, they'd hire midlevels instead. That may not be as true in other regions, but I think in the Northeast it's more that they already have more Medicare funding and so don't have as much incentive to expand over cap.

 

[CalmAndCollected]

Too many posts to quote, but for all the people saying attendings should be willing to walk away: do your contracts have non-competes? They seem fairly standard for most places so walking away means not practicing in your community for a couple of years. I’ve known some people who were able to set up shop mere yards outside the geographic boundaries in their contract but that’s probably not possible everywhere. It just seems like leaving is harder than it sounds sometimes and often the best move is to stay put and endure unless you already have a better gig lined up.

Obviously residents quitting mid stream is the the stupidest possible move ever. The only reason to quit as a resident is if you decide you never want to practice in your field. Ever. And even then probably worth a good long think first.

Frankly im amazed that all hospitals haven’t cut salaries already. Revenues are down substantially and money doesn’t grow on trees. My guess is that the places carrying minimal debt with lots of cash on hand in lesser impacted areas are hoping to weather the storm. Most places seem to be making cuts in a progressive manner with execs taking the largest one, physicians in the middle, and ancillary staff taking the smallest cuts. It sucks but that’s just how things are right now.

Can’t say for certain for every state, but most non-competes are unenforceable.

Non-competes require that the employee be given something in exchange for it, not just the promise of employment.

For example, if you are a CEO who is the face of a company, it may be bad if you go to the rival company for higher pay, or if you are a celebrity doctor and your employer advertises you as “Dr. Spine” on billboards or something, you may use that history of advertisement to make more money in a private practice. Your employer must then give you a specific benefit, usually in the form of large bonuses.

An employer cannot take away your right to practice a trade, but many employers include illegal non-competes in contracts anyways because it may make the employee less likely to take another job. They are trying to scare you to stick around, and hoping your lack of legal knowledge will scare you enough from fake a better job elsewhere.

I would strongly recommend any physician with a non-compete in their contract contact a lawyer about it’s legality and make it sure it is removed from your contracts when you renew. Most of those are completely illegal and unenforceable, and I wouldn’t let it stop me from walking away from a terrible job.

 

[CalmAndCollected]

Many people believe we have standards and regulations as physicians because we want to "corner the market", enrich ourselves,....... keep the numbers low etc etc etc . Most of these accusations are from the nurses who are sick of bedside nurses and want to be independent practitioners.
Also I would like to alert you to the fact that (Im sure you already know) it used to be like that. A total free market and medical education was standardized by a guy named Flexner.. See flexner report

The Flexner Report ― 100 Years Later - PMC

The Flexner Report of 1910 transformed the nature and process of medical education in America with a resulting elimination of proprietary schools and the establishment of the biomedical model as the gold standard of medical training. This ...

www.ncbi.nlm.nih.gov

In some years, the AMA asked for residency spots to remain low for those reasons. Whether increasing residency spots would have significantly impacted current physician pay is up in the air. Anecdotal experience of high-earning friends with good insurances in a large metro area trying to get a psychiatrist who is still taking patients makes me think otherwise, but I can see why some doctors who work in large metro areas may feel threatened.

In a way, what you said about the free market economy is true in many places, even here in the USA. Many untrained “naturopaths” or “chiropracter” and such putting themselves as alternatives to doctors. In a way, the idea of independent midlevels vs doctor will likely be decided by the free market without any significant regulation.

 

[<L>]

I get what you are saying but it is partly her but you gotta admit there is a lot of things to improve upon in medical education and culture

Is anyone saying there isn't? What about this website has made you think that the attendings/faculty don't have an extensive list of gripes about how their hospitals are run or how their education went?

But if you're the type of person going around whining that residency education is a Ponzi scheme (or raging against the NRMP, as seems to be a theme with posters in this thread), do you think that's why higher ups don't tend to listen to you?

 

[Mass Effect]

Too many posts to quote, but for all the people saying attendings should be willing to walk away: do your contracts have non-competes? They seem fairly standard for most places

As already noted, most non-competes are illegal and unenforceable. The ones who try to sneak it in, generally give a radius and it's usually not by much (I've seen a 10-mile radius, for example). If you didn't want to fight it, just abide by the mileage listed. But again most are illegal in the first place and should never hold you back from walking away from a job for breach of contract.

 

[Mass Effect]

Is anyone saying there isn't? What about this website has made you think that the attendings/faculty don't have an extensive list of gripes about how their hospitals are run or how their education went?

But if you're the type of person going around whining that residency education is a Ponzi scheme (or raging against the NRMP, as seems to be a theme with posters in this thread), do you think that's why higher ups don't tend to listen to you?

I don't know, in the 8 years I've been posting (and the many years I was lurking before that), seems to me everytime a thread appears about the crappy parts of training, a bunch of attendings get on here and list all the million ways the trainee is a whiner and really in many cases their argument boils down to "I dealt with it and you will too." Not to say that's what's happening in this thread since this is a unique issue never faced by this generation, but the sentiment remains the same. I think from hearing attendings talk to residents on SDN sometimes, one would think there really isn't any problem with training besides greedy, overly spoiled brats of residents and that simply isn't true.

It should also be noted that in the past, whenever someone pointed out what I pointed out above, the classic response has been a chorus of attendings coming in to say "no one said there aren't problems with training" so I'll just cue that chorus now. If no one said there aren't problems with training why is every single thread on the topic over-run with attendings telling residents they're wrong, regardless of what the problem is? After a while you come to believe there are quite a few attendings on SDN who really don't think there are any problems with residency and fall short of flat-out saying that because they know it's an unpopular thing to say.

 

[VA Hopeful Dr]

As already noted, most non-competes are illegal and unenforceable. The ones who try to sneak it in, generally give a radius and it's usually not by much (I've seen a 10-mile radius, for example). If you didn't want to fight it, just abide by the mileage listed. But again most are illegal in the first place and should never hold you back from walking away from a job for breach of contract.

That's a dangerous assumption. It's state dependant and in many states they get upheld regularly.

 

[<L>]

As already noted, most non-competes are illegal and unenforceable. The ones who try to sneak it in, generally give a radius and it's usually not by much (I've seen a 10-mile radius, for example). If you didn't want to fight it, just abide by the mileage listed. But again most are illegal in the first place and should never hold you back from walking away from a job for breach of contract.

Ten miles is a massive increase in commute time in a lot of places. If you work in an urban area that's a way to screw you out of taking advantage of a competitive job market. Friend of mine has one on her contract for a 100% inpatient job, which is insane. Probably boilerplate for their health system, but the type of thing that experienced job seekers need to push back against before signing on the dotted line.

 

[<L>]

I don't know, in the 8 years I've been posting (and the many years I was lurking before that), seems to me everytime a thread appears about the crappy parts of training, a bunch of attendings get on here and list all the million ways the trainee is a whiner and really in many cases their argument boils down to "I dealt with it and you will too." Not to say that's what's happening in this thread since this is a unique issue never faced by this generation, but the sentiment remains the same. I think from hearing attendings talk to residents on SDN sometimes, one would think there really isn't any problem with training besides greedy, overly spoiled brats of residents and that simply isn't true.

It should also be noted that in the past, whenever someone pointed out what I pointed out above, the classic response has been a chorus of attendings coming in to say "no one said there aren't problems with training" so I'll just cue that chorus now. If no one said there aren't problems with training why is every single thread on the topic over-run with attendings telling residents they're wrong, regardless of what the problem is? After a while you come to believe there are quite a few attendings on SDN who really don't think there are any problems with residency and fall short of flat-out saying that because they know it's an unpopular thing to say.

well in that case, people are welcome to engage with the points actually being made rather than just calling people bootlickers.