Residents close to going on strike: Need data please

[anonymous411]

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My residency union is moving very close to going on strike due to a breakdown in negotiations with the hospital.

My main question is the following: What are the long term professional/career repercussions for a resident who participates in a strike? This thread is not meant to be an ethical debate on the morality of physicians going on strike.

Thanks for any help.

 

[ThoracicGuy]

My residency union is moving very close to going on strike due to a breakdown in negotiations with the hospital.

My main question is the following: What are the long term professional/career repercussions for a resident who participates in a strike? This thread is not meant to be an ethical debate on the morality of physicians going on strike.

Thanks for any help.

ACGME guidelines require a certain number of days worked to be able to complete your training. Your strike would have to come from vacation days or your training would have to be extended.

 

[rokshana]

and if you missed those days, they could easily not renew your contract (you go on probation because of missed days over your allotted 4 weeks per year, then can be dismissed or not have contract renewed)…union does not trump ACGME…

you really should check with them (ACGME).

 

[Gastrapathy]

No one can predict what will happen. The hospital could just close their GME programs or they could cave and then not renew large swaths of the current residents. You have one year contracts right? Once they've honored that, they are probably going to f you.

 

[Law2Doc]

Yeah I think the issues were nicely laid out by the responders here: (1) you need the requisite number of days of work, time in the ICU, etc to graduate on time, and (2) you are on one year contracts which the employer is under no obligation to renew. Furthermore (3) other places won't be keen to take in residents who were let go from contracts after striking, and (4) there is no shortage of people wanting residency spots so scabs will be easy to come by -- you are very replaceable, more so the more junior you are. So your union can ask for things, but the members probably can't afford to strike. Which is why unions have not been particularly popular in the residency setting. It's nice to have collective bargaining, but your organization has no teeth unless you are willing to risk your career over your demands. Your employer knows this. They might give in to token inexpensive things to keep a happy work force, which helps Th culture and recruiting, but beyond that it becomes easier just to let you go at years end.

 

[anonymous411]

Thanks for all the help and information, I really appreciate it. This is a lot of good information and a lot for me to think about.

 

[anonymous411]

And yeah we do have 1 year contracts only.

 

[SouthernSurgeon]

Another question I'd ask, in addition to the excellent issues above - is do you really have buy-in for a strike? Sure, a lot of residents belong to your union...but when push comes to shove are they actually going to stick their necks out and not show up to work? Or are you going to have a ton of dissentors.

 

[Law2Doc]

Another question I'd ask, in addition to the excellent issues above - is do you really have buy-in for a strike? Sure, a lot of residents belong to your union...but when push comes to shove are they actually going to stick their necks out and not show up to work? Or are you going to have a ton of dissentors.

Agreed. It would have to be pretty intolerable work environment for anyone I know to risk their training in order to go on strike. Most people talk a big game but aren't going to jeopardize their careers over a complaint about a living wage during training or a few additional benefits, in what we all acknowledge is just a relatively short couple of year stint. Residency isn't the career. It's just the couple of years we all stomach while training for something better. A person with their eye on the prize won't sweat the journey because he's focused mostly on the destination.

 

[anonymous411]

Agreed. It would have to be pretty intolerable work environment for anyone I know to risk their training in order to go on strike. Most people talk a big game but aren't going to jeopardize their careers over a complaint about a living wage during training or a few additional benefits, in what we all acknowledge is just a relatively short couple of year stint. Residency isn't the career. It's just the couple of years we all stomach while training for something better. A person with their eye on the prize won't sweat the journey because he's focused mostly on the destination.

Yeah some people are questioning the strike decision and the residents are not compelled to strike by the union; it will be a personal decision for each of us. I'm trying to think through this decision very carefully as it really seems that this is a big decision that could really affect my future.

 

[DrBowtie]

Yeah some people are questioning the strike decision and the residents are not compelled to strike by the union; it will be a personal decision for each of us. I'm trying to think through this decision very carefully as it really seems that this is a big decision that could really affect my future.

What are the major gains that the strike is hoping to accomplish?

 

[anonymous411]

What are the major gains that the strike is hoping to accomplish?

Patient care fund, increase in wages (hospital proposal is to freeze wages for the next few years), workspace walkthroughs to check for bad hospital equipment,

 

[surg]

Hate to say it, but absent some serious abuse, it would be difficult to justify a walk off the job strike that could potentially jeopardize patients. Those things don't seem to qualify. An informational leafleting would probably accomplish everything you are hoping for without making it seem that you are abandoning patients.

More importantly, all this needs to be done in the context of a collective bargaining setup that specifically authorizes such a strike. Without that, any wildcat strike is likely to result in sanctions against the "strikers" and the union as well if the union encourages such a work action. Your union needs to discuss this with a lawyer ASAP. You may be considered public safety workers and have specific cooling off periods that are required before striking as we'll.

Likewise, as noted while there are whistleblower protections and protections against retaliation for legal collective bargaining actions, in no circumstance can that guarantee you that your educational evaluations won't be affected in some way for fellowship or job prospects. Most doctors are so skittish about interpersonal problems at work, so it is hard to believe that there aren't some places that won't want to take someone that might cause a problem, no matter how justified your cause it.

My suggestion is for the union to find a way back to the table. A 3rd party mediation may be of help. The hospital wants to resolve this as well. I can't seem them blocking things that might improve care for little or no cost. The salary item is really the toughest part. You may need professional help to demonstrate why your demands are reasonable, etc and to understand their position to find a way to come to a compromise.

 

[michaelrack]

Yeah some people are questioning the strike decision and the residents are not compelled to strike by the union; it will be a personal decision for each of us. I'm trying to think through this decision very carefully as it really seems that this is a big decision that could really affect my future.

this strike is going to fail; don't get involved. A union that isn't well organized and doesn't take steps (whether legal or illegal) to compel members to honor a strike isn't going to succeed.

 

[Law2Doc]

this strike is going to fail; don't get involved...

This. Patient care fund and workspace walkthroughs sounds like things tacked on to make this sound like its about something other than salary, and as mentioned at least one of these (the walkthroughs) might be achieved through minimal discussions rather than striking. So don't try and be a kidder, this is totally about salary. You haven't given us a ballpark current salary, but it would have to be an absurdly low salary in a very long residency for most people to strike. Again, residency is very temporary. It's not the same as the auto worker who has to support his family in this same job on a particular salary forever, with no better paying job on the horizon. You have to keep your eyes on the prize, and that prize isn't the few bucks an hour more you might get via a successful strike, it's finishing residency untainted and unscathed.

 

[anonymous411]

Hate to say it, but absent some serious abuse, it would be difficult to justify a walk off the job strike that could potentially jeopardize patients. Those things don't seem to qualify. An informational leafleting would probably accomplish everything you are hoping for without making it seem that you are abandoning patients.

More importantly, all this needs to be done in the context of a collective bargaining setup that specifically authorizes such a strike. Without that, any wildcat strike is likely to result in sanctions against the "strikers" and the union as well if the union encourages such a work action. Your union needs to discuss this with a lawyer ASAP. You may be considered public safety workers and have specific cooling offer idols that are required before striking as we'll.

Likewise, as noted while there are whistleblower protections and protections against retaliation for legal collective bargaining actions, in no circumstance can that guarantee you that your educational evaluations won't be affected in some way for fellowship or job prospects. Most doctors are so skittish about interpersonal problems at work, so it is hard to believe that there aren't some places that won't want to take someone that might cause a problem, no matter how justified your cause it.

My suggestion is for the union to find a way back to the table. A 3rd party mediation may be of help. The hospital wants to resolve this as well. I can't seem them blocking things that might improve care for little or no cost. The salary item is really the toughest part. You may need professional help to demonstrate why your demands are reasonable, etc and to understand their position to find a way to come to a compromise.

Yeah the biggest reason that the resident union is strongly considering a strike is that negotiations have been going on for the past year and have completely stalled even after involvement of 3rd party mediation. The resident union is saying the reason for going on strike would be that the hospital is not bargaining in good faith.

 

[anonymous411]

Does anyone know of what has happened to residents in the past who have gone on strike in terms of their long term career trajectories and whether their long term career paths were affected? I read about the 1975 strike of residents in New York but could not find any information on what ultimately happened to those residents in terms of career derailment, etc.

 

[Law2Doc]

Does anyone know of what has happened to residents in the past who have gone on strike in terms of their long term career trajectories and whether their long term career paths were affected? I read about the 1975 strike of residents in New York but could not find any information on what ultimately happened to those residents in terms of career derailment, etc.

If you can't find what happened to them it probably means their career trajectories didn't reach the stratosphere... Most of the time people find something elsewhere, finish up their training. Would they have gone further if not for burning a bridge or two? Usually. There's a reason most of us spend residency keeping our heads down.

 

[shopsteward]

It sounds like a bit of a ragbag of aims: as Law2Doc says, the patient care fund and equipment walkthroughs are not strike issues for residents: there should be other ways and means of obtaining the desired ends rather than having a head-on collision with management, and they are not issues specific to residents but to the management of the hospital as a whole.

For your small possible salary gains in the few years you are in residency vs the downside risks, I personally wouldn't strike or recommend my members to strike. To what extent are residents involved in your union leadership? I would be concerned that you have leadership who either don't fully understand resident's position, or who are possibly looking to take advantage of a potentially high-profile strike for wider union purposes (sad to say, not unknown).

 

[QofQuimica]

I don't understand why residents would strike over the two non-salary issues at all. If you have equipment that isn't working, call maintenance or physical plant or whomever is in charge of fixing broken things at your hospital, and put in a work order. And what the heck is a patient care fund for residents?

Salary, well, I have news for you: no resident thinks they're being paid as much as they're worth, and no hospital thinks the residents are worth what they're being paid. The truth is that resident salaries probably average out to being about right over the course of your training, considering that you cost more than you're worth as an intern and less than you're worth as a senior. And as the others have already said, given that residency is a temporary period in your life, and given that your bosses can hurt you a lot more than you can hurt them, I wouldn't even think of striking about anything during residency unless I was so fervent in my belief that something was wrong that I was willing to give up my entire career in medicine rather than stand aside and let it go unchallenged. Do you really feel that strongly about your fellow residents getting a few thousand extra dollars per year during residency?

 

[DoctwoB]

Salary, well, I have news for you: no resident thinks they're being paid as much as they're worth, and no hospital thinks the residents are worth what they're being paid. The truth is that resident salaries probably average out to being about right over the course of your training, considering that you cost more than you're worth as an intern and less than you're worth as a senior.

I agree with the general gestalt of this thread, its hardly worth jeopardizing your career over a strike for a COL raise. If the strike is about anything other then money, the hospital should be willing to negotiate.

I do strongly disagree with the last point that we "cost more then we're worth" as an intern. Sure we may require more supervision and run questions through seniors more often then experienced residents, but think of the cost of the alternative. Good luck finding anyone else to cover 80hrs of night-float/week for 50k per year.

It's quite telling that on some specialties at my program, there is an intern run service and a PA or NP run service. Without fail there are at least 2 PAs to cover the same number of patients as one intern (and usually the less complex patients). By my math 2 PAs at ~80-100k each + benefits is much more expensive then 1 intern for whom the hospital gets ~100k from medicare. Another example: The program had moonlighting junior residents cover my night off for 1k per shift. Makes the ~10 bucks an hour I get seem like quite the bargain, doesn't it?

 

[Law2Doc]

I agree with the general gestalt of this thread, its hardly worth jeopardizing your career over a strike for a COL raise. If the strike is about anything other then money, the hospital should be willing to negotiate.

I do strongly disagree with the last point that we "cost more then we're worth" as an intern. Sure we may require more supervision and run questions through seniors more often then experienced residents, but think of the cost of the alternative. Good luck finding anyone else to cover 80hrs of night-float/week for 50k per year.

It's quite telling that on some specialties at my program, there is an intern run service and a PA or NP run service. Without fail there are at least 2 PAs to cover the same number of patients as one intern (and usually the less complex patients). By my math 2 PAs at ~80-100k each + benefits is much more expensive then 1 intern for whom the hospital gets ~100k from medicare. Another example: The program had moonlighting junior residents cover my night off for 1k per shift. Makes the ~10 bucks an hour I get seem like quite the bargain, doesn't it?

Totally a tangent here, and there are already numerous threads disputing your premise, but you are missing most of the costs of an intern, which really amount to halving the production of the attendings they are working with. The salary paid to the intern is but a small portion of tHe investment being made to train them, and most places that choose to train resident do so knowing they are going to lose money but gain prestige. There's a reason the money paid to hospitals per resident is more than double the residents salary -- no hospital would likely do it for less. Q is spot on here, you are not.

 

[atomi]

Patient care fund, increase in wages (hospital proposal is to freeze wages for the next few years), workspace walkthroughs to check for bad hospital equipment,

I like the way that is sandwiched in there. It sounds like money is the crux of the issue. Residency is a short term training gig. Remember all those student government groups in college and how they got all heated up over campus political issues? Did any of the things those people were arguing about really matter in regards to their lives down the road? No, because they were only there for 4 years.

I'm not sure I see the value of risking your career and establishing yourself as a "complainer" by participating in a walkout that isn't mandated by your union (I did not even know residency unions existed). All for what? An extra $10k/year or something? Agree with comments about keeping your head down and getting through it.

h. The salary paid to the intern is but a small portion of tHe investment being made to train them, and most places that choose to train resident do so knowing they are going to lose money but gain prestige. There's a reason the money paid to hospitals per resident is more than double the residents salary -- no hospital would likely do it for less. Q is spot on here, you are not.

What I don't understand is preliminary programs and TYs. What benefit do these offer the hospital if they are a losing prospect financially? They will not be around for more than one year so the hospital could recoup its investment when they become productive upper levels. What motivates a program to offer preliminary spots?

 

[AStark]

While resident collective bargaining is the norm here, I don't think there's even been a real strike, though there have been some close calls. As recently as 2011, residents in Quebec were poised to strike, but it was going to be something closer to "work-to-rule" where most clinical service would have still occurred, including 100% of ICU and emerg coverage. They just weren't going to teach med students. Of course, Quebec residents are grossly underpaid and have the worst contract in the country (and still do), so it was an entirely reasonable job action. Contract disputes elsewhere have gone to binding arbitration (see here), and generally speaking I think this is a better way of handling them.

 

[Law2Doc]

What I don't understand is preliminary programs and TYs. What benefit do these offer the hospital if they are a losing prospect financially? They will not be around for more than one year so the hospital could recoup its investment when they become productive upper levels. What motivates a program to offer preliminary spots?

you don't do it for the money. You do it for the prestige of being a teaching hospital, which has benefit in recruiting prestigious faculty and is appealing when getting certain governmental subsidies and grants. Once you have your GME office set up and if you are training categoricals (who may eventually be profitable) the hit per prelim isn't that much.

 

[QofQuimica]

Totally a tangent here, and there are already numerous threads disputing your premise, but you are missing most of the costs of an intern, which really amount to halving the production of the attendings they are working with. The salary paid to the intern is but a small portion of tHe investment being made to train them, and most places that choose to train resident do so knowing they are going to lose money but gain prestige. There's a reason the money paid to hospitals per resident is more than double the residents salary -- no hospital would likely do it for less. Q is spot on here, you are not.

This.

I'm a new academic attending at a hospital that has full-time mid levels. Absolutely no comparison in terms of how much more work it is to supervise an intern vs a mid level, especially because most of our mid levels have been here for many years and know the system well. For sure no attending trains med students or residents because it makes their job easier!

 

[Impromptu]

GME's don't honor contracts, anyway. For our last year they forced us to sign a new contract a few months after having already signed one, (I, program director, GME director). They decided they wanted to cut our salary by near $1000 (if I remember correctly). We were told that if we didn't sign we would no longer be employed there. This was for my last year of residency. I probably could have fought it, but you have to pick you battles. I now have a great gig where that $1000 is less than a day's work. $1000 hurt as a resident, but I think I made the right choice.

 

[Law2Doc]

GME's don't honor contracts, anyway. For our last year they forced us to sign a new contract a few months after having already signed one, (I, program director, GME director). They decided they wanted to cut our salary by near $1000 (if I remember correctly). We were told that if we didn't sign we would no longer be employed there. This was for my last year of residency. I probably could have fought it, but you have to pick you battles. I now have a great gig where that $1000 is less than a day's work. $1000 hurt as a resident, but I think I made the right choice.

Agreed, you had no ability to fight here. You could spend a ton of time and a few filing fees in court to win back that $1000 while burning a lot of bridges, but to what end. You pick your battles. Don't spite yourself out of principle or to prove a point. It's only a few years. Which is why unions in residency make no sense.

 

[AStark]

Agreed, you had no ability to fight here. You could spend a ton of time and a few filing fees in court to win back that $1000 while burning a lot of bridges, but to what end. You pick your battles. Don't spite yourself out of principle or to prove a point. It's only a few years. Which is why unions in residency make no sense.

Unions in residency make plenty of sense, but strikes probably don't. Much of the time residents are designated as providing an "essential service" which means no legal strikes are possible, but there is recourse to courts and arbitration if health authorities are seen to be sabotaging negotiations. It also means that they can't arbitrarily breach the contract as in this example. Temporary or not, this is predatory behaviour and should not be tolerated.

 

[maxxor]

Hmm...makes me wonder if the slow-down strikes would be an alternative. Around where I trained, residents went on strike and refused to write discharge summaries and delayed discharge of patients until late in the evenings so there was always a huge backup in the ED. Patient care was theoretically not compromised, but the point was made. Not sure what concessions they won, if any.

 

[Law2Doc]

Unions in residency make plenty of sense, but strikes probably don't. Much of the time residents are designated as providing an "essential service" which means no legal strikes are possible, but there is recourse to courts and arbitration if health authorities are seen to be sabotaging negotiations. It also means that they can't arbitrarily breach the contract as in this example. Temporary or not, this is predatory behaviour and should not be tolerated.

An inability to strike means the union has no teeth. This was learned in the 1920s. Nobody caves to a Union with no teeth. If it get concessions it means you would have without the union and people paid dues for nothing.

 

[Law2Doc]

Hmm...makes me wonder if the slow-down strikes would be an alternative. Around where I trained, residents went on strike and refused to write discharge summaries and delayed discharge of patients until late in the evenings so there was always a huge backup in the ED. Patient care was theoretically not compromised, but the point was made. Not sure what concessions they won, if any.

A slow down isnt going to get you the good evaluations and letters you need for future career steps. As a resident I would still tell you to keep your head down end try to get the work done. Be the guy who shines while everyone else drags their feet -- it will help you with your bosses, something worth more than a few cent an hour.

 

[maxxor]

A slow down isnt going to get you the good evaluations and letters you need for future career steps. As a resident I would still tell you to keep your head down end try to get the work done. Be the guy who shines while everyone else drags their feet -- it will help you with your bosses, something worth more than a few cent an hour.

100% agree. That's what I would personally do, but I remember hearing about these "slow down strikes" and thought they were an interesting way to avoid a true walk-out.

How do Nurses manage to strike?

 

[Law2Doc]

...
How do Nurses manage to strike?

1. There isn't a giant backlog of nurses waiting to take their place.
2. It's not a short training stint -- this is a potentially permanent job. It's much easier for other nurses to get behind you if you are talking about a terminal job rather than the three years before your six digit career.
3. The public doesn't perceive nurses as greedy and overpaid the way they seem to with doctors.
4. It's much easier to find another nursing job if the hospital dumps you than it would be to find a new residency.And you aren't on a one year contract anyhow, so it's harder to let you go without cause.

 

[AStark]

An inability to strike means the union has no teeth. This was learned in the 1920s. Nobody caves to a Union with no teeth. If it get concessions it means you would have without the union and people paid dues for nothing.

Fortunately labour law has somewhat advanced since the 1920s, though perhaps much of the US has regressed thanks to "right to work" laws. But here if a government wants to legislate certain professions as "essential services", the trade off is that they must face the possibility of having disputes decided by binding arbitration. Maybe that structure doesn't work well in the highly fragmented US training system, but to suggest that collective bargaining is somehow impossible or undesirable for residents is disingenuous or at best wilful blindness.

 

[Law2Doc]

Fortunately labour law has somewhat advanced since the 1920s, though perhaps much of the US has regressed thanks to "right to work" laws. But here if a government wants to legislate certain professions as "essential services", the trade off is that they must face the possibility of having disputes decided by binding arbitration. Maybe that structure doesn't work well in the highly fragmented US training system, but to suggest that collective bargaining is somehow impossible or undesirable for residents is disingenuous or at best wilful blindness.

I'm not sure who has willful blindness here actually. We are talking about a couple of year training stint. One where you have ample protection of hours via the acgme already. Matters of actual patient and safety concerns can be raised in countless ways without paying out monthly union fees. And if we are talking about issue of pay, you generally knew and signed on for that when you matched, so what are we talking about needing a union for anyhow? Just get through your couple of years to that career at the other end. The goodwill from your bosses is worth a whole Lot more than a Couple of bucks a week. Might not seem like it during residency, but will afterwards. So yes, you can pay union fees and haul your bosses to the arbitration table in certain very limited instances, but to what end? I promise you the guy who just puts in his time and does his job goes further in this career. And obviously arbitration doesn't always get what you want or the OPs union wouldn't be talking about striking.

 

[Elisabeth Kate]

This.

I'm a new academic attending at a hospital that has full-time mid levels. Absolutely no comparison in terms of how much more work it is to supervise an intern vs a mid level, especially because most of our mid levels have been here for many years and know the system well. For sure no attending trains med students or residents because it makes their job easier!

Just curious from an attending point of view, how does a new mid level compare with a new intern?

 

[QofQuimica]

Just curious from an attending point of view, how does a new mid level compare with a new intern?

Tough to compare because it's apples and oranges. Even though midlevels sometimes get used interchangeably with residents on certain services, I don't actually think of them as being equivalent. The midlevels have a limited job description that they fulfill, and they come in already trained to do those tasks. Most quickly get very good at performing their specific set of functions in the hospital. Sure, there is a learning curve to learn the system if they're new to the hospital. It's not too different in concept than how I came here as a new attending; I've had a pretty steep learning curve this month myself. But unlike in residency, my supervisor does not have to train me how to be a physician as a new attending. Even though I'm new, I started this job already fully trained to perform my job description. Likewise, I don't have to train the midlevels on how to be midlevels any more than I have to train the nurses, the unit secretaries, or the janitors on how to do their jobs. The interns, in contrast, do not come in knowing how to function as physicians. That's why we have to train them for 3+ years.

 

[Impromptu]

Remembering back to my residency years, the anesthesia residents did far more work than the mid-levels there. It probably took about 6 months for the newer residents to start surpassing the veteran mid-levels in the main ORs, and the residents learned to do that even quicker in every department they worked in, OB, pediatrics, ICU. My current private practice mid-levels are great at the specific functions they do, but if it didn't involve restructuring our entire system, I would take residents over them most days of the week.

 

[da8s0859q]

The impression I've gotten from similar talks with attendings here is that while obviously a new intern is a new intern as all of us are at some point, towards the end of intern year and so many offservice rotations and into senior years, including PGY2, they/we start equalling or surpassing the workflow of the midlevels. Obviously variable. Have met some phenomenal midlevels and some slightly slower senior residents.

And of course there's the training difference -- medical school versus PA/NP programs -- which is not to bash at all, just to say that they have different aims.

 

[Law2Doc]

Remembering back to my residency years, the anesthesia residents did far more work than the mid-levels there. It probably took about 6 months for the newer residents to start surpassing the veteran mid-levels in the main ORs, and the residents learned to do that even quicker in every department they worked in, OB, pediatrics, ICU. My current private practice mid-levels are great at the specific functions they do, but if it didn't involve restructuring our entire system, I would take residents over them most days of the week.

It was probably even longer than six months (from many attendings point of view, although you probably thought you were starting to "get it" by then, and may have been). But even assuming arguendo that it was only six months, the point is every year you have a new batch of interns, so it's not a one time six+ month investment -- the intern is always useless and slowing you down the first half of every year. By contrast many midlevels stay at their jobs 15-20 years. So they show up with some training and they stay at the same level after you train them. Yes there's less upside, and an intern will more likely grasp harder concepts faster, but that's irrelevant -- you don't want your midlevels to get expertise and move on the way the intern will. You want them to just get to the equivalent of an intern in the second half of the year, and stay that way for twenty years -- and most do. Which makes them much much more valuable than the interns you have to endure from August - January every year, who cost you a ton of time and money. If not for the money that comes with them, hospitals would be insane to accept interns. They slow the attendings they work with to a crawl for a big chunk of the year, and that costs hospitals a lot more than the $110k they are getting to train each intern. By the time the resident is a third year or beyond, they are probably making the hospital money, but many residents leave after three years.

Don't kid yourself that interns are making a hospital big money money and are "all that". You (the intern) are essentially the guy/gal so undesirable that his/her parents had to pay someone just to date him. 🙂

 

[QofQuimica]

And of course there's the training difference -- medical school versus PA/NP programs -- which is not to bash at all, just to say that they have different aims.

Exactly. This is a key point and why it's not really right to equate midlevels with residents even if they sometimes perform similar tasks in the hospital. Midlevels are *not* trainees. They are already functioning in their ultimate job description from day 1. The goal for a new midlevel is to continue to become more proficient and efficient at their current job. No one expects the midlevel to be able to lead the team and otherwise do my job three years from now. But that is exactly what is expected of every single new intern (i.e., to be prepared to be an attending physician in 3-7 years upon completion of residency).

 

[DarknightX]

My residency union is moving very close to going on strike due to a breakdown in negotiations with the hospital.

My main question is the following: What are the long term professional/career repercussions for a resident who participates in a strike? This thread is not meant to be an ethical debate on the morality of physicians going on strike.

Thanks for any help.

This is throwing the ethics aside; I'm sure the hospital can find a way to take care of the patients without you guys.

You would all be absolute fools to strike. You are in a training program and you need to complete a certain number of days of training (or cases) in order to be board eligible. You're going to throw that all away for a couple of extra hundred bucks? Or for some free parking or better cafeteria food or whatever it is?

Make no mistake, your resident union has absolutely zero leverage, which is why resident unions are a joke. Can't strike or collectively bargain if you don't have any leverage.

 

[dpmd]

you don't do it for the money. You do it for the prestige of being a teaching hospital, which has benefit in recruiting prestigious faculty and is appealing when getting certain governmental subsidies and grants. Once you have your GME office set up and if you are training categoricals (who may eventually be profitable) the hit per prelim isn't that much.

The fact that it is a hit is evident by the fact that where I trained the hospital shut down the transitional year program due to money (and is shutting down the family medicine program). As for the replacements being so much more expensive, when the transitional year residents were gone they just had everyone else cover the work. I am not sure what they are doing for when the FM residents go away.

 

[maxxor]

The fact that it is a hit is evident by the fact that where I trained the hospital shut down the transitional year program due to money (and is shutting down the family medicine program). As for the replacements being so much more expensive, when the transitional year residents were gone they just had everyone else cover the work. I am not sure what they are doing for when the FM residents go away.

All the more reason to let residents bill third party payers. If it's such a cost to train the next generation, we better find a solution that is sustainable. Especially if Medicare decides they don't want to fund GME in 10 years.

 

[Law2Doc]

All the more reason to let residents bill third party payers. If it's such a cost to train the next generation, we better find a solution that is sustainable. Especially if Medicare decides they don't want to fund GME in 10 years.

Sadly the obvious solution would be to start charging residents for the privilege of working...

 

[DarknightX]

The fact that it is a hit is evident by the fact that where I trained the hospital shut down the transitional year program due to money (and is shutting down the family medicine program). As for the replacements being so much more expensive, when the transitional year residents were gone they just had everyone else cover the work. I am not sure what they are doing for when the FM residents go away.

All the more reason to let residents bill third party payers. If it's such a cost to train the next generation, we better find a solution that is sustainable. Especially if Medicare decides they don't want to fund GME in 10 years.

Please enlighten me, what exactly would you be billing for? All your care is done under the supervision of an attending, and you can't double bill, so not sure what exactly you'd be trying to bill for.

Good luck getting third party payers to pay unlicensed, non-board eligible physicians for anything.

And I agree with Law2Doc, if Medicare decides not to fund GME, the only solution will be either having residents pay or at the very best work free. Good luck with striking then. Many of you are EXTREMELY overvaluing the worth of your services.

 

[maxxor]

All work done by a PA is done under the supervision of an attending. They can bill. It's not double billing.

The PAs where I do my residency must have all their notes cosigned as we do.

 

[SouthernSurgeon]

And I agree with Law2Doc, if Medicare decides not to fund GME, the only solution will be either having residents pay or at the very best work free. Good luck with striking then. Many of you are EXTREMELY overvaluing the worth of your services.

The issue of GME funding and how much it "costs" or "earns" a hospital to train residents is never as black and white as it seems on SDN. There are actually a number of economists who've studied the issue and have come to competing conclusions. There was a nice point/counter-point perspective on this in the NEJM recently.

I think the idea of residents paying for their training is largely untenable. As much as SDN'ers like to say that they'd eat a poop hot dog...they aren't going to pay for 3 years of a primary care residency and 3 (potentially) more of fellowship. Maybe derm and urology and a few other select fields could get away with this. But it would drastically heighten any predicted doctor shortages.

 

[Law2Doc]

The issue of GME funding and how much it "costs" or "earns" a hospital to train residents is never as black and white as it seems on SDN. There are actually a number of economists who've studied the issue and have come to competing conclusions. There was a nice point/counter-point perspective on this in the NEJM recently.

I think the idea of residents paying for their training is largely untenable. As much as SDN'ers like to say that they'd eat a poop hot dog...they aren't going to pay for 3 years of a primary care residency and 3 (potentially) more of fellowship. Maybe derm and urology and a few other select fields could get away with this. But it would drastically heighten any predicted doctor shortages.

Some would pay and some wouldn't. Those that wouldn't would quickly get replaced by the thousands who previously couldnt get residencies (and a lot more FMGs who previously didn't even bother applying for a US residency). There will be no shortage because you'd have the same number of bodies, just perhaps different bodies. And people would be able to "afford" it because lending institutions would be more than happy to extend more loans to people so close to the end of their training -- it's a much better risk then lending to college or med students. So i wouldn't be too sure this couldn't happen. Everyone has some financial Breaking point at which it's not worth it, but its so far down the road for most of us that they could take quite a Bit of our money before we just quit the field, and there's always someone behind you wishing they were in your shoes. Maybe the shorter fields would be more popular and fellowships would become less popular unless there became more of a correlation between years of training and income (which I don't think would be a bad thing, actually). But I seriously doubt many people are going to say screw it, $250k in tuition debt is my limit, no way I'm going to pay another X$ a year to get to that finish line. Think about it -- a few decades back if you told people that some day people would have to borrow $250k to go to med school they'd tell you it could never happen -- people would stop going into the field. And yet here we are.

Of course you also have to bear in mind that some of us already willingly paid for a second advanced degree that took as long and cost as much as some residencies presumably would. So I and every dual professional degree type on here is living proof that making someone pay for another three years of "education" isn't exactly an impassible wall. Plenty of people already previously wrapped their minds around that financial decision and still pushed on. I think the migration you suggest from medicine wouldn't happen. And I can't honestly tell you I wouldn't have pressed on even if I got a bill instead of my paltry residency salary. I wouldn't have been happy about it, but doubt it would have been a deal breaker for me.