Resident Pay seems unfair...

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MB333999

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Im just wondering, for someone who has 8 years of post secondary education under their belt...why is the pay so low???
seems a bit ridiculous considering their training and amount of hours they work, not to mention the stress they endure and the sacrifices they make/have made.

Does anyone see this changing anytime soon??

cuz man that sucks...

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No. If anything, I think it will be worse. The $ is only one factor to consider, there are other things to consider as well.

do residents and physicians think its fair??? why dont ppl do something about it????

please elaborate bolded =)

Thanks
 
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Like what?

i mean im no expert but perhaps forming a group with other residents/physicians and such to have a louder voice in the community for starters.

nothing in this world is fixed.

Other things to consider:

1. Job satisfaction.
2. Opportunity cost - you could be better off doing something else, make more money, be happier, more respected, etc. CAN YOU be more successful in another field? There's a lot of room in medicine for some mediocre people to have decent paying jobs. Would you be one of them or could you make it as a high-powered ceo or ibanker?

etc etc etc

There's a thread somewhere around here asking physicians whether they would do it all again. That would be informative for you. Cuz if you're thinking of quitting, it's better to do it early. If you're gonna fail, fail fast. (I'm not saying that you're a failure for quitting/changing fields, etc...)

I have thought played out that very scenario you describe (med vs business), and decided that i'd rather do something that im interested in and can feel good about rather than make $$ quickly.

I by no means am thinking about quitting, this thread was mostly motivated by confusion....with regards to how come ppl that are trained really well and work very hard get payed so little??
just doesnt make sense to me.
 
Most residents are already part of a union. This is about as good as it's gonna get. Actually, if you compare to the old school docs and how they trained, we've got it pretty damn good. They used to be called "residents" for a reason. I think it's a misnomer now.

huh?
 
Most residents are already part of a union. This is about as good as it's gonna get. Actually, if you compare to the old school docs and how they trained, we've got it pretty damn good. They used to be called "residents" for a reason. I think it's a misnomer now.

Proof that situation for residents can improve in my opinion
 
I could be wrong but I don't think that CIR/SEIU is actually representing any of the UC program residents. I think that is SEIU's dream but I don't think it's reality yet.

That said residents as a group have very little influence. They are poorly organized and they hove little time or money to organize. Most importantly they have little incentive to organize as they know that their problems have a definite end. The reason things have improved has had more to do with patient safety initiatives and the desire of hospitals and ACGME to appear proactive about it than anyone actually worrying about the resident's quality of life.
 
Im just wondering, for someone who has 8 years of post secondary education under their belt...why is the pay so low???
seems a bit ridiculous considering their training and amount of hours they work, not to mention the stress they endure and the sacrifices they make/have made.

Does anyone see this changing anytime soon??

cuz man that sucks...

Well, residency went from 30k/year to high 40s/year in a relatively short period and at the same time average hours got slashed pretty significantly to a maximum of 80 hours/week average, so this has been "changing". However I think you need to keep the eyes on the prize here. This isn't as much a job as it is a training period. There are about 30,000 people out there seeking about 25,000 spots for the "privilege" of on the job learning over the next 3-7 years. At the end of this training in most cases is a fairly nice income. But at the beginning you are basically a training expense. The government has to subsidize you to even make it worth it for hospitals. So yeah, you are going to get a low "income" for residency, and it isn't going to change much any time soon, and there will be plenty of people lining up to take your place if you balk.
 
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for those with residencies that go on for 5-7 years, i mean sure its transient but its still a significant time period.

Residents may be powerless on their own but if they had support of many physicians they might be able to achieve something.

those physicians were once residents too so maybe some of them will see that its time to give people what they deserve.

obviously its not a cake walk but i think even generating some level of awareness about the situation is worth while.
 
This isn't as much a job as it is a training period. There are about 30,000 people out there seeking about 25,000 spots for the "privilege" of on the job learning over the next 3-7 years.

and there will be plenty of people lining up to take your place if you balk.

good point.
i guess thats why it has to be a collective effort.
 
...
Residents may be powerless on their own but if they had support of many physicians they might be able to achieve something.

those physicians were once residents too so maybe some of them will see that its time to give people what they deserve....

Where do you think the money is going to come from? If it's from the pockets of these many physicians, I doubt they will be eager to help. And besides, physicians who already did their duty as a resident aren't going to care that you are suffering what they already suffered. In fact with changes to hours and the annual cost of living increases that have occurred, most post-resident physicians are going to look at your plight and thing, "boy these guys have it a lot better than I had it".

Not to mention that most residents won't line up with you to argue about salary. Most don't even look at it as a real salary, it's just something you get paid while you serve your time until you get your salary. It's thus looked at more of a stipend, since you are in training. Is it very low income for someone with a lot of schooling? sure. Is it unreasonable based on your actual profitability? Probably not. You are a big cost. They have to pay lots of medmal insurance, and incur lots of administrative and training costs, and you end up slowing things down to some extent, at least during the early years, because you are still learning. The government subsidizes you nicely and makes it very worth it to hospitals, but without that, few places are ponying up their own money to fund unfunded spots, which suggests to me that residents are not as big money makers as some suggest (although I suspect that with the government funding and what a resident generates, the profits outweigh the costs pretty nicely).
 
Where do you think the money is going to come from? If it's from the pockets of these many physicians, I doubt they will be eager to help. And besides, physicians who already did their duty as a resident aren't going to care that you are suffering what they already suffered. In fact with changes to hours and the annual cost of living increases that have occurred, most post-resident physicians are going to look at your plight and thing, "boy these guys have it a lot better than I had it".

Not to mention that most residents won't line up with you to argue about salary. Most don't even look at it as a real salary, it's just something you get paid while you serve your time until you get your salary. It's thus looked at more of a stipend, since you are in training. Is it very low income for someone with a lot of schooling? sure. Is it unreasonable based on your actual profitability? Probably not. You are a big cost. They have to pay lots of medmal insurance, and incur lots of administrative and training costs, and you end up slowing things down to some extent, at least during the early years, because you are still learning. The government subsidizes you nicely and makes it very worth it to hospitals, but without that, few places are ponying up their own money to fund unfunded spots, which suggests to me that residents are not as big money makers as some suggest (although I suspect that with the government funding and what a resident generates, the profits outweigh the costs pretty nicely).

thanks for the added perspective. I wasn't aware that residents were that costly for hospitals. But from another perspective, training a doctor can be looked at as an investment for the hospital (given that the resident practices there once hes done). So maybe they can introduce options for residents where if they sign a contract to work at said hospital once they were done they actually get paid more since the hospital is investing in them to ultimately work at this hospital. I dunno how legit this sounds, just throwing out ideas, i find thats how progress is made 🙂
 
The match puts up a significant barrier for hospitals to compete for residents based on salary, but then again, would you pick your residency on income considerations alone? Most people choose on location, quality, prestige which are more important in my opinion. If residencies competed based on salary, it would likely result in the poorer quality residencies in the worst locations having the best compensation...it would suck for us to have to choose a program that paid significantly more and get a much worse value, but it would be more free market.

It goes without saying that a chief resident in surgery is underpaid for his or her skill set, but also that an intern is overpaid for his or her skill set. Ultimately, amount of education is not the important consideration, it is amount of skill and value-added. Considering that residency is training and that the salary starts out high for someone with limited skills, I don't think it is that unfair.

Also, many residencies, particularly longer length ones, often have built in moonlighting opportunities, making the stated salary a base salary rather than an absolute.
 
The match puts up a significant barrier for hospitals to compete for residents based on salary, but then again, would you pick your residency on income considerations alone? Most people choose on location, quality, prestige which are more important in my opinion. If residencies competed based on salary, it would likely result in the poorer quality residencies in the worst locations having the best compensation...it would suck for us to have to choose a program that paid significantly more and get a much worse value, but it would be more free market.

It goes without saying that a chief resident in surgery is underpaid for his or her skill set, but also that an intern is overpaid for his or her skill set. Ultimately, amount of education is not the important consideration, it is amount of skill and value-added. Considering that residency is training and that the salary starts out high for someone with limited skills, I don't think it is that unfair.

Also, many residencies, particularly longer length ones, often have built in moonlighting opportunities, making the stated salary a base salary rather than an absolute.

how is payment regulated now?? is it up to the hospital or is there some higher authority that says all hospitals will pay this to their residents??
if its the later then increasing payment across all hospitals wouldnt have any effect on choosing where to go based on differences in pay.
 
I'm pretty sure that I kind of used to feel this way when I was a resident, but the more I think about it, I'm pretty sure that if there were absolute free-market competition, resident salaries would probably drop. So if anything, they're too high.

I'm sure that most residents will scoff at this idea, and it is of course impossible to prove (equally unprovable is the proposition that salaries are too low), but here are some things to consider.

1. As Law2Doc has pointed out, at the beginning, there is a lot of cost associated with training new physicians. They make mistakes, slow things down, and they cause a lot of expenses that the hospital must cover.

2. The main pay-off of residency is not the salary, but the skills that you will learn that will essentially GUARANTEE that you will make 4-10x or more of your residency salary. In a free market, this would probably be priced into salaries better and that's why I think they would probably go down.

As an aside, given what my residency has allowed me to accomplish, I absolutely would have done it for free. Of course, with most things like this hindsight is 20/20, and I probably didn't feel that way at the time (but I should have).

3. In dentistry, I believe many residencies actually require the residents to pay tuition. Of course, dentistry is a slightly different beast since one can choose to forgo residency all together and still practice. However, the underlying forces are the same.

Like medical residents, dental residents do scutwork and take care of patients. However, despite the fact that they do these things, everyone realizes that dental residency is something that will presumably allow the dentist to add to their skillset and make more money, and so they pay for the privilege.
 
for those with residencies that go on for 5-7 years, i mean sure its transient but its still a significant time period.

Some programs (like mine) have a pay jump at each year of training so that those in training longer (and therefore more useful to the hospital) get paid more (aside from any increases brought by negotiations which we actually succeeded at without a union in the past)
 
... But from another perspective, training a doctor can be looked at as an investment for the hospital (given that the resident practices there once hes done). So maybe they can introduce options for residents where if they sign a contract to work at said hospital once they were done they actually get paid more since the hospital is investing in them to ultimately work at this hospital. I dunno how legit this sounds, just throwing out ideas, i find thats how progress is made 🙂

In most cases residents don't stay on to work where they trained, and actually it's usually smarter not to do this, at least without a fellowship or other employment in between, because you will always be looked at as the trainee by the folks who were your bosses previously. As for cutting deals that obligate you to continue to work for a particular hospital post-residency, there are legal problems with this and in most cases they can't really obligate you to stay on.
 
In most cases residents don't stay on to work where they trained, and actually it's usually smarter not to do this, at least without a fellowship or other employment in between, because you will always be looked at as the trainee by the folks who were your bosses previously. As for cutting deals that obligate you to continue to work for a particular hospital post-residency, there are legal problems with this and in most cases they can't really obligate you to stay on.

ah ic ic

..so how bout that military budget!
 
Some programs (like mine) have a pay jump at each year of training so that those in training longer (and therefore more useful to the hospital) get paid more (aside from any increases brought by negotiations which we actually succeeded at without a union in the past)

sounds more reasonable
 
As a soon to be resident, let me say compared to paying 40-50K per year in tuition, getting paid 45K makes me feel like I'm rich.

I'm pretty psyched!
 
As I am not in the system, I can't say if its broken or not. But, IMO the resident system is a pretty good trade off.

Medical students need extra training, and hospitals need cheap labor, so they get residents at a low salary.

To me it seems pretty fair, and I don't think I will be complaining.
 
Moving to the premed forum.

why??

As I am not in the system, I can't say if its broken or not. But, IMO the resident system is a pretty good trade off.

Medical students need extra training, and hospitals need cheap labor, so they get residents at a low salary.

To me it seems pretty fair, and I don't think I will be complaining.

I think i have been looking at it as more of a "Residents are working" rather than "Residents are training" perspective, which i've slowly come to realize is wrong. perhaps this compensation is fair after all.

Thanks for all the replies =)
 
High 40s? That's almost double what people in graduate school get... It isn't TERRIBLE 😎
 
I have heard it costs med schools as much as 1 million dollars a year to educate each student and that residency is a way for these schools to recoup some of that money.
 
I have heard it costs med schools as much as 1 million dollars a year to educate each student and that residency is a way for these schools to recoup some of that money.

I heard it costs OVER 9000! a minute to train each student, is this true?
 
Residents pay is paid for by Medicare. Go ahead and try to raise spending by a government program with this congress and see how that goes.

The fact is that you aren't a full fledged doctor yet. Yes you have the initials but you have to be looked after. It isn't like the hospital is saving all that much money by having the resident do the work INSTEAD of the attending, because the hospital has to pay the attending IN ADDITION to you to look after you. They would get off cheaper by just paying the attending and cutting out the middle man.

Well, not exactly. But that is why residents get paid less. You don't get paid as much because they also have to pay the person who looks after you.
 
how is payment regulated now?? is it up to the hospital or is there some higher authority that says all hospitals will pay this to their residents??
if its the later then increasing payment across all hospitals wouldnt have any effect on choosing where to go based on differences in pay.

And where do you expect to get this money? Residencies are paid for largely by Medicare. The government budget is already going to hell, so increasing it so that 'doctors' can have a higher salary isn't going to sit well with most people.

As a soon to be resident, let me say compared to paying 40-50K per year in tuition, getting paid 45K makes me feel like I'm rich.

I'm pretty psyched!

Yeah, that's pretty much how I feel. 'Cept, you know, I still have three years before that point.
 
doesn't the gov foot the bill for resident pay? if so, i dont see the situation improving...however i think there will be reform in the number of hours worked by resident sooner than a pay increase
 
Because the residency forums are for those applying to residency or in residency to discuss training issues. Pre-allo is for those applying to or accepted to but not yet started medical school to discuss training issues.

seriously? This is more germane to residents or med students than premeds.
 
do residents and physicians think its fair??? why dont ppl do something about it????

please elaborate bolded =)

Thanks

Well, until very recently residency was (from an IRS standpoint) considered post-graduate medical education. Residency has JUST recently become considered a job from that same IRS standpoint. This means that now residents can be taxed even more. HOWEVER, now residents have the ability to unionize (although organizations such as the Committee of Interns and Residents, CIR, have existed and fought for rights of residents). Also, from my understanding the actual pay of a resident is actually very high (on par with a physician in that respective field), but the hospitals that you intern / reside at actually withhold a LARGE sum of that money which goes directly toward your malpractice insurance, upkeep, etc... which as you can imagine is exorbitant for a first year doc. So in short, maybe don't expect to earn that much more money, BUT now that residents can unionize I wouldn't be too surprised to see better benefits and working conditions in the future. Although many docs don't really want to cut their hours so they can learn as much as possible and finish residency as fast as possible to make some real cash to pay off those loans.

I apologize if anybody else has touched on this. I didn't read all of the posts.
 
Well, until very recently residency was (from an IRS standpoint) considered post-graduate medical education. Residency has JUST recently become considered a job from that same IRS standpoint. This means that now residents can be taxed even more. HOWEVER, now residents have the ability to unionize (although organizations such as the Committee of Interns and Residents, CIR, have existed and fought for rights of residents). Also, from my understanding the actual pay of a resident is actually very high (on par with a physician in that respective field), but the hospitals that you intern / reside at actually withhold a LARGE sum of that money which goes directly toward your malpractice insurance, upkeep, etc... which as you can imagine is exorbitant for a first year doc. So in short, maybe don't expect to earn that much more money, BUT now that residents can unionize I wouldn't be too surprised to see better benefits and working conditions in the future. Although many docs don't really want to cut their hours so they can learn as much as possible and finish residency as fast as possible to make some real cash to pay off those loans.

I apologize if anybody else has touched on this. I didn't read all of the posts.

I can see why residents may have really high malpractice insurance, but i thought that your attending is responsible for what you do? if so shouldnt HIS/HER malpractice insurance go up not yours? maybe residents get into more trouble than i expect lol.
 
seriously? This is more germane to residents or med students than premeds.

The forums have rules. And rules is rules. Pre-allos can start threads in pre-allo. Allo students can start threads in allo or pre-allo. Residents can start threads in the resident forums, allo, and pre-allo. I don't specific rules about the other forums.

Besides, I actually don't know many residents that complain of low pay or unfair working conditions, even when they're accurately reporting their work hours 😉
 
I can see why residents may have really high malpractice insurance, but i thought that your attending is responsible for what you do? if so shouldnt HIS/HER malpractice insurance go up not yours? maybe residents get into more trouble than i expect lol.

The docs that oversee physicians are either employees of the hospital themselves (and thus the hospital has to pay the overhead anyway), or are private docs who offer their services, and the hospital covers malpractice for the resident so that docs continue to do this.
 
Here's the kicker guys.

By law, an attending can only bill for a service in which they performed the majority or crucial portions. Residents can't bill medicare for their time/procedures. The lab tests, imaging, supplies, etc. all gets reimbursed, but the Resident's time does not. That means that for every case performed by a resident instead of attending (or NP or PA), the money received by hospital goes down.
 
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When you are a resident you are still in the learning phase. They are still teaching you stuff. In return, you give them man hours and they pay you enough to live another day. The pay seems fair to me considering they are giving the skills you need to learn your craft so that you can make more money in the future.
 
Like others have said, I view residency as a continuation of school. I'll take being paid 45k/year while I'm being taught how to do my job. 👍
 
Here's the kicker guys.

By law, an attending can only bill for a service in which they performed the majority or crucial portions. Residents can't bill medicare for their time/procedures. The lab tests, imaging, supplies, etc. all gets reimbursed, but the Resident's time does not. That means that for every case performed by a resident instead of attending (or NP or PA), the money received by hospital goes down.

No, it gets billed under the attendings name.
 
an intern is overpaid for his or her skill set

what does that say for a first year PA?

Clearly the salary curve is different for a physician vs a PA, but it has always struck me as insulting that there is such a disparity in pay.
 
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Well, until very recently residency was (from an IRS standpoint) considered post-graduate medical education. Residency has JUST recently become considered a job from that same IRS standpoint. This means that now residents can be taxed even more. HOWEVER, now residents have the ability to unionize (although organizations such as the Committee of Interns and Residents, CIR, have existed and fought for rights of residents). Also, from my understanding the actual pay of a resident is actually very high (on par with a physician in that respective field), but the hospitals that you intern / reside at actually withhold a LARGE sum of that money which goes directly toward your malpractice insurance, upkeep, etc... which as you can imagine is exorbitant for a first year doc. So in short, maybe don't expect to earn that much more money, BUT now that residents can unionize I wouldn't be too surprised to see better benefits and working conditions in the future. Although many docs don't really want to cut their hours so they can learn as much as possible and finish residency as fast as possible to make some real cash to pay off those loans.

I apologize if anybody else has touched on this. I didn't read all of the posts.

Curious where you heard that? The issue with not letting doctors form a union is more to do with anti-trust/ monopoly (price fixing) issues than having a proper IRS occupation code. The fact that the SEIU had success unionizing part-time workers goes to show what can be done with the right labor conditions. This isn't to say I support the SEIU etc but it's not to say I dont either. I will say that I wish physicians had a stronger voice and more bargaining power than they currently hold and sometimes wonder what the AMA could do about it. I don't think it is right that nurses and hospital support staff -- critical players in patient management -- are legally allowed to strike while physicians can't so much as form an organization that is meant to be more than just a lobbying group. I don't advise striking in almost any situation, and certainly moral issues arise when considering labor issues within medicine. At the same time, a conversation needs to happen that isn't and quite frankly I believe won't happen without a catalyst. I'm less concerned with compensation and more interested in working conditions, rights, and malpractice protection (if tort reform is off the table which has almost never made it onto a serious table). Fortunately, as potential future doctors, we are getting some help by the administration to try to reshape the malices of malpractice and the costs they put on the system. Yet, it remains unseen as to how large an affect such policies will have IF they are implemented. (Article here: http://www.nytimes.com/2011/03/29/opinion/29Avraham.html?_r=3&src=recg )

Also, haven't looked over a 1040 in a little but what makes residents more susceptible to higher tax rates now? I'm no CPA but income from taxable sources is taxed, simple as that. Am I missing something specific to residents?
 
Veterinary residencies pay significantly less than human medical residencies. However, only a small % of graduates actually complete a residency. There's your free market example!

ETA: quoted the wrong person... pretend the quote about dental residencies is above my comment!
 
Im just wondering, for someone who has 8 years of post secondary education under their belt...why is the pay so low???
seems a bit ridiculous considering their training and amount of hours they work, not to mention the stress they endure and the sacrifices they make/have made.

Does anyone see this changing anytime soon??

cuz man that sucks...

Perspective.

Another advantage to those who have worked in crappy fields for years.
 
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