Resident Pay seems unfair...
Started by MB333999
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Do you know why residents are called "residents"? Several decades ago they were paid enough to eat and clothe themselves... that was it. They literally resided in whatever accommodations were available on the hospital campus. Change began when some residents infamously applied for food stamps, and qualified.
Fast forward to today, when residents have a living wage, health insurance, disability insurance, work hour restrictions, etc., and they can't even bill for their work. Is the glass really half empty?
It's all about how you look at it. Does it suck that, when you break it down, we're making less than $15/hour? Sure. Does it suck that we're finally making money again? Hell no. Does it suck that we'll be making about twice as much as what we were giving for living expenses loans during medical school? Hell no again.
While we're be working a lot, we'll be making more than a lot of other people do in this country, and in a few years, most of us will see an increase in pay by at least a factor of 3.
While we're be working a lot, we'll be making more than a lot of other people do in this country, and in a few years, most of us will see an increase in pay by at least a factor of 3.
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qft
Yes.
Several decades ago 'resident' was mostly another word for interns, because that's all the training that the vast majority of physicians went through. Maybe a few top surgeons might do a second year, but by in large your year as a resident was a short process of hazing that forced physicians to make the transition from medical student to practicioner in a very short amount of time. Also keep in mind this was back when any path other than HS ->college --> medical school without a break was basically unheard of, and student debt was typically much less. For an almost invariably single, male, 26 year old physician with very little debt a year or two of poverty was no disaster.
Also, decades ago, there was nothing 'unfair' about not paying residents a living wage, since the vast majority of them weren't actually profitable employees. They were no different than Interns today: in need of constant supervision. They were in no way capable of increasing the size of the census list since the attending would still need to carry every patient in the hospital as though he was working alone. I'm pretty sure they also didn't bring federal funding to the hospital (could be wrong on that one, though). Hospitals paid the young docs the nothing that they were worth.
Fast forward to today: Residency began it's slow expansion several decades ago and now is anywhere between 3 and an insane number of years. Take, for example, a Peds CT surgeon. He starts medical school at the average age of 24, then has 4 years of medical school --> 5 years of a surgical residency (and maybe a research year or two) --> 3 years Peds Surgery fellowship --> 2 years Peds CT surgery fellowship before he can even start on the bottom rung of a practice. By the third year of his 10+ years of residency training he is running rooms and managing floors almost without supervision and is therefore paying for several times his own salary by increasing the number of patients the attending can 'carry'. Furthermore for this entire time he fundeded by the federal government to the tune of 100k/year, so even if he didn't see a single patient the hospital would still make a profit on him. He's also probably drowing in, what since 2003, is non dischargable debt.
The push-back from residents that has led to improved work hours and something approaching a living wage came about when residents began to realize that residency had morphed from a short period of training, in which they were getting a good financial deal by being paid at all, into a very long period of employment, where residents are working for less than the wages they deserve because they're employed by an organization that anti-trust laws don't apply to. I'm glad it's gotten better, but if we're going to keep residencies as they are then we have a long way to go.
Edit: I don't want to come off as too conspiracy theory-ie. I'm aware that most Residency directors and hospitals probably don't think of themselves as unfair or profit mongering. However I think it is very easy to trick yourself into believing that a convenient position is also the fair and correct one.
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1) What training? As a medical resident fresh out of medical school, you don't really have all that much in the way of a useful skillset. You can perform a physical exam, and maybe a few procedures and BLS, but having any sort of toolset to be able to see patients in a given subfield of the profession is still years off. Your 8 years of education doesn't mean squat to an attending with decades of practical experience who has to oversee dozens of patients in addition to training a green batch of residents.
2) You're still a student. Consider it a graduate school stipend (one that's far more generous than most stipends for graduate programs). The hours suck, sure--but decades ago they were far, far worse--and people got through it just fine.
3) While the 45 grand a year is daunting when you're loaded down with as much debt as most of us will be, keep in mind that in a few years you'll be making several times that. Additionally, according to most docs I know, it's really not all that bad if you make a conscious effort to keep your expenses down. As they say, live like an attending when you're a resident and you'll live like a resident when you're an attending.
the field is vastly more complex now than it was 50 years ago. to let anyone run loose these days with an unrestricted medical license after just one year of GME is nothing short of ludicrous.
no one is forcing the peds CT fellow to pursue peds CT. as a chief, s/he could have been board certified and making attending dollars four years sooner. to suggest that s/he is functioning independently as a third year resident and is worth of being compensated as such, as you have done, is silly.
believe it or not, considering the compensation package residents receive and the amount of resources they consume that could be used more efficiently (had we not the need for a future stream of doctors), $100k is chump change. with an attitude like this, you likely also believe that your medical school is making a profit on your tuition dollars
"push-back from residents" has never been a significant factor in changing the nature of residency requirements. reform began in New York when the press realized that an out-of-control system had begun actively killing both patients and residents. the changes that have accrued since then have been the result of either a similar response on the part of the profession to bad publicity, or a latter-day understanding on the part of PDs that you get more love in the Match with sugar than with spice.
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That was really my only point. Thanks for agreeing.
the field is vastly more complex now than it was 50 years ago. to let anyone run loose these days with an unrestricted medical license after just one year of GME is nothing short of ludicrous.
no one is forcing the peds CT fellow to pursue peds CT. as a chief, s/he could have been board certified and making attending dollars four years sooner. to suggest that s/he is functioning independently as a third year resident and is worth of being compensated as such, as you have done, is silly.
believe it or not, considering the compensation package residents receive and the amount of resources they consume that could be used more efficiently (had we not the need for a future stream of doctors), $100k is chump change. with an attitude like this, you likely also believe that your medical school is making a profit on your tuition dollars
"push-back from residents" has never been a significant factor in changing the nature of residency requirements. reform began in New York when the press realized that an out-of-control system had begun actively killing both patients and residents. the changes that have accrued since then have been the result of either a similar response on the part of the profession to bad publicity, or a latter-day understanding on the part of PDs that you get more love in the Match with sugar than with spice.
i realize it's fun to shoot your mouth off on the intarwebs about how rotten you have it as a person about to hold a US medical license, but please refer to my signature v v v v v
Yeah, Perotfish is an anti-establishment, this medical education thing is crazy, type of guy. He's been running his mouth non-stop on this topic.
I agree with Gravity.
Most surgical residents don't walk out of training thinking it should have been half as long and they should have been on their own years ago.
9 years to operate on a human being doesn't sound so bad to me. It's a big responsibility.
And yes, medical debt sucks, but we signed up for this.
As stated previously the Medicare program subsidizes residents salary but not only for the supervising attending but others as well. Because of the ACGME guidelines a residency program needs to meet certain criteria. The program director, program coordinator and other administrative staff are responsible for the everyday running of a residency program. These positions would not be there if the hospital did not have residency. After all that money that is given out by the government is spent on the resources that are necessary to train a resident there really isnt that much left to pay us. The good thing is that salaries are higher in metro areas where the cost of living is higher. In NYC for example resident salaries are high 50s to low 60s, and may push 70K for some of the senior surgical residents.
It's really great to know that after 4 years of doctorate level training, I'll be making less than I would straight out of undergrad. How's that for perspective?
I'm not complaining, I already dealt with that realization a while ago.
I still don't understand how residents in their 3rd+ year of post-doctoral training--the MD training of which is more training than NP's and PA's get anyway--aren't worth as much as an NP or PA ...
I'm not complaining, I already dealt with that realization a while ago.
I still don't understand how residents in their 3rd+ year of post-doctoral training--the MD training of which is more training than NP's and PA's get anyway--aren't worth as much as an NP or PA ...
Just playing the devil's advocate, I don't understand why everyone is being so complacent? Things are better now then they were in the past, great, but where do things go from here? Even Karl Marx would be puzzled right now, what happened to "self-love"? "It's not by the benevolence of the baker ..."
Maybe I put too much work into my econ theory class
Again, I don't think compensation is the biggest issue right now.
Maybe I put too much work into my econ theory class
Again, I don't think compensation is the biggest issue right now.
In case it hasn't been said before - it's not a free market.
The government subsidizes your training. That's just a fact. If the government didn't do it, most likely you'd have to pay to get residency training, and there'd be many fewer spots.
The government subsidizes your training. That's just a fact. If the government didn't do it, most likely you'd have to pay to get residency training, and there'd be many fewer spots.
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Simple. A 3rd year resident isn't going to stay very long. Honestly, the way the learning curve is set up, the resident only becomes valuable in their most senior years, right before they leave to go off to a fellowship, or test the private practice market. Very few stay on as faculty at the same hospitals as an attending, and many will suggest you don't want to do this because it is hard to break out of being viewed in the "trainee" role if you trained at the place where you ultimately practice. By contrast, with a competitive salary, you can keep a PA or NP for years. So those are the folks who merit more money, not the residents. So yes, they are "worth" more to the hospital, because the hospital might actually be able to keep them.
That's a funny thing. I wasn't worth a dime to anyone until I was board eligible. When you cross that magic threshold of being able to obtain malpractice insurance and bill for your work, all of a sudden the sky cracks open and it's a whole new world.
It's sort of like how your pill-popping aunt suddenly starts calling the moment you get a DEA number.
IDK about that one. There's not too many jobs that are "more respected" than a physican. (Just saying) I agree with everything else tho.
I mean... dont get me wrong, I hear those same things. I see the way some of these nurses and patients treat the docs but as an overall picture the doctor still has more respect. Hell, people bash everyone in any top or low profession (ie.from trashmen to the president) But like I said, sure some people dont respect them but majority do...and by a wide margin.
And that post crystallized the reasons.
Licensing is pretty ridiculous in many ways. Not really gonna derail the thread with my thoughts on that, though.
PS, how can anyone seriously believe that residents wouldn't get trained if it weren't for the government? Maybe they wouldn't get paid, maybe they would get paid more--I'm not privy to the actual incentives of residency training on either end of the table, at this point. But not trained? Silliness.
For the licensee, yes, it often seems ridiculous. For a patient searching for a competent physician to deal with his/her medical care, not so much.
FlowRate said:
An odd piece of logic. Would we all still get to work if all the roads and highways suddenly evaporated forever? Yes, I reckon we would, by some means. And over time our society would adjust to being roadless. But it would be one Hell of an ordeal, with no guarantee of the relative freedom and simplicity we currently enjoy.
If the CMS did stop funding resident education, who knows what would happen? I imagine things would become more like indentured servitude, with combined training and employment contracts similar to what the military currently does.
I brought up these issues recently in a FinAid forum, but this thread has a lot more traffic so I'll mention them here. Also they pertain to the burden of high debt/low pay for residents, so my intentions are not to hijack.
1. Income based repayment. If you have high debt and low pay, you can can have your monthly loan payments reduced to 15% of "discretionary income." I think almost all residents with debt would qualify for this. There are some caveats, like interest will capitalize after 3 years, and remaining balance can be forgiven after 25 years...Can anyone speak about this from personal experience?
2. Public service loan forgiveness program: this program allows for loan forgiveness after 10 hrs of working at a nonprofit and in specific public service jobs. I heard that residents qualify for this program, so technically you would only need a few (like 4-6 years, depending on residency) of additional service to get the any remaining loans dismissed. Can anyone confirm/deny this info?
Perhaps my asking these questions will help clear up how burdensome debt is for residents.
1. Income based repayment. If you have high debt and low pay, you can can have your monthly loan payments reduced to 15% of "discretionary income." I think almost all residents with debt would qualify for this. There are some caveats, like interest will capitalize after 3 years, and remaining balance can be forgiven after 25 years...Can anyone speak about this from personal experience?
2. Public service loan forgiveness program: this program allows for loan forgiveness after 10 hrs of working at a nonprofit and in specific public service jobs. I heard that residents qualify for this program, so technically you would only need a few (like 4-6 years, depending on residency) of additional service to get the any remaining loans dismissed. Can anyone confirm/deny this info?
Perhaps my asking these questions will help clear up how burdensome debt is for residents.
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No one can speak from personal experience about the loan forgiveness (either plan) because these programs are new. All residents could qualify for income based repayment, but evidently there are some out there who would rather have that money for spending than spend it on loans even if there are benefits (such as having less interest accrue and capitalize at the end of residency, even if the forgiveness doesn't pan out-not really getting how the government thinks they are going to be able to pay off all these loans when they can't even agree on a budget right now without that expense).
I'll still be making more in my intern year than I am now as a 3rd year Chem teacher. I'm ok with that.
I have no problem with the salary I'll be making as an intern. All the states I'm applying to for residency have licensure after 1-year, so after about December of my pgy2 year I'll be able to moonlight and make more. Really residency is a time for training, not to be a baller.
As a second year resident, you're planning on doing extra work on the side?
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Lots of people do it. I would have (on my easier months) if it were allowed by my program.
Going into EM so most programs cap around 60 hours per week while working in the department, allowing a fair amount of time per week that could be spent moonlighting. Many programs I'm applying to encourage moonlighting as a way to introduce residents to the responsibility of being an attending, assuming you're a licensed resident in good standing with the program. Granted, I'm definitely not planning on working an extra shift every week; I know I'll be very tired, but it's definitely possible and a shift or two a month @ $80/hr goes a long way towards paying bills.
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