Residents Rise Up

Discussion in 'General Residency Issues' started by Haybrant, 05.20.14.

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  1. Haybrant

    Haybrant 1K Member 10+ Year Member

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  3. Sheldor

    Sheldor 5+ Year Member

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    Honestly, everything he says rings true. With over 300k in student debt, no retirement savings, and an hourly wage less than I earned as a lab tech with my bachelors, it is easy to get discouraged.

    Glad someone is speaking up!
     
  4. Chickenandwaffles

    Chickenandwaffles Banned Banned

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    I think residents have been speaking up for a long time, but we have no power to do anything about it. We can't force the hospitals to pay us more, which is truly in the end demeaning and would be against the law in any other industry. For call intensive residencies, those residents are making slightly more than minimum wage.
     
  5. DoctwoB

    DoctwoB 5+ Year Member

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    /
     
    Last edited: 05.21.14
  6. OTN

    OTN Member 10+ Year Member

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    Careful what you wish for. There's absolutely no guarantee that in a free market residents would make more money/have more free time, etc. In fact, in a highly-competitive specialty like radonc, I'd be willing to bet the more competitive residencies would see a drop in salary.
     
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  7. Chickenandwaffles

    Chickenandwaffles Banned Banned

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    Unlikely. And what are you basing your argument on here that they would drop? And most residencies are not that competitive. Rad onc accounts for less than 200 people a year.
     
  8. rymd

    rymd Chief Resident 7+ Year Member

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    Beware the Unintended Consequences. Exhibit A: Dental residencies. Many have tuition requirements. I say that's even worse then being paid the median household income in the US. http://quickfacts.census.gov/qfd/states/00000.html

    Chickenandwaffle: This is a radiation oncology forum. Its members care about it.
     
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  9. Mr RADical

    Mr RADical 2+ Year Member

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    I agree. Competitive specialties might not fair better in a free market. At the medical school I went to they had to specifically state that they were not willing to hire dermatology residents who offered to 'work without salary' because they often received offers. In many specialties the light at the end of the tunnel (board certification) may be worth more to some people than what their salary or hours are during residency.
     
  10. Chickenandwaffles

    Chickenandwaffles Banned Banned

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    I never implied rad onc was not important. I also did not realize it was the rad onc forum. I was talking about residency in general though.
     
  11. Gfunk6

    Gfunk6 And to think . . . I hesitated Lifetime Donor SDN Moderator 10+ Year Member

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    I moved this back to the General Residency Forums since this topic would have broader appeal than just in Rad Onc.
     
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  12. ThoracicGuy

    ThoracicGuy 2+ Year Member

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    Great, a union. So will residents want to give up a portion of their paycheck to support these unions? Will residents be happy knowing that a portion of their dues will go to potentially support political causes they don't agree with? What will residents do if they don't like their pay or hours? Will they strike? I can just imagine how well that will go over. "Doctors on strike at local hospital for higher wages and less hours. News at 11!"

    You're getting a salary equivalent to the average household for a period of 3-5 years (or a bit more for fellowships) and then you'll be earning significantly more than the average household salary afterwards. But hey, if you don't like the pay or hours, I'm sure there are others out there that would be happy with that pay and hours to train to do a great residency...
     
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  13. Chickenandwaffles

    Chickenandwaffles Banned Banned

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    This is the problem, people with this mentality. If you are ok with working for less than 50k after an 8 + year education, fine. But thinking that most people are ok with that or that it's right is a whole different thing.
     
  14. ThoracicGuy

    ThoracicGuy 2+ Year Member

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    I've been through it. I had my 8 years of college and med school and 10 years of residency/fellowship. I was paid from the upper 30s to the lower 60s over that time. Now I am in the 6 figure salary as an attending. Would I have like to have been paid more? Sure, everyone would, but you're not going to find salaries increasing significantly other than inflation/COL increases. You aren't going to have alot of the public supporting your stand either. Many feel that doctors are paid too much as it is, your PR campaign to raise resident wages is likely to fail.

    In the end, I managed just fine on the salary. If an average family of 4 can survive on that salary, you can too for a few years.
     
  15. IMPD

    IMPD 2+ Year Member

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    There are places and times where the working conditions for residents have been awful and the current union (CIR) has improved situations in some places that I know of.

    For all the problems in medicine, it is interesting to read various proposals to remedy it. The situation - transient employees, basically - is a set up for abuse. Whether you believe it or not, the ACGME does see part of it's mission to look out for the residents. As time grinds on and Medicare support for training changes, other changes may become possible. Hard to see a temporary work force (residents) or a politically fractured one (attendings) unionizing en masse.
     
  16. Chickenandwaffles

    Chickenandwaffles Banned Banned

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    This is a fallacy that the avg "household" salary is in the 50k range. A lot of households don't work, many only have 1 person working, and a lot of households are in professions that don't require much education and skills. For professionals, salaries are much higher, even starting salaries. Nurses make the same if not more than we do. PA/NP people who are clueless make double what we make.

    So it's completely mythical to think that the average professional household salary is 50k. I mean if you are counting those who work at McD's or people who clean houses, sure. But for those people who've gone to college, and have invested time in grad school, they make far far more. Most professional people, whether it be in tech, finance, health, etc., are making 100k + within a few years of finishing. Such professional couples are in the 200k "household" range.

    So you have to compare apples to apples. Don't compare us to laborers or people with unskilled jobs that started working at 18 or something. Those people may have a combined 50k household income, but it's completely comparing apples to oranges, as they will obviously have low paying jobs.
     
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  17. DoctwoB

    DoctwoB 5+ Year Member

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    Call me a naive libertarian, but this talk about how residents should make X amount is misguided. Residents should want to make as much money as possible for their work. Hospitals should want to pay them as little as possible for their work. Their salary will be somewhere in the middle.

    The problem with the current situation is that the market is so distorted that nothing approaching efficiency results. Residents are required to complete a residency to practice and hospitals are allowed to collude in setting prices, making a resident's only recourse to unionize and collectively bargain.

    In addition to higher salary and better working conditions, residents could also argue for multi-year contracts, rather then being at the mercy of each program for a renewal.
     
  18. KnuxNole

    KnuxNole Sweets Addict 10+ Year Member

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    You'll be surprised how many people would be perfectly 100% ok with a doctor strike to get respect. Nurses talk about this without hesitation, so it isn't far fetched to hear physicians doing it.
     
  19. KnuxNole

    KnuxNole Sweets Addict 10+ Year Member

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    Also, for a lot of residents, they have been living in middle to upper class environments, where living well above 50K is the norm. So that "small" amount is a shock in that regard.
     
  20. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus 10+ Year Member

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    The federal government didn't let air traffic controllers strike, it sure won't let doctors. Basically a union without the power to strike is just a hole you are going to throw monthly dues into. And unlike nurses, who the public sympathizes with, doctors, from a public perspective are overpaid, so nobody will be on your side.
     
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  21. sb247

    sb247 wait...you mean I got in? 2+ Year Member

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    the difference between those situations is they had air traffic controllers to cover the immediate emergency.......there simply isn't some other bank of doctors lying around
     
  22. Neuronix

    Neuronix working like a dog SDN Advisor SDN Administrator 10+ Year Member

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    Rad onc resident here. I'm pretty involved in our institution's GME as well. Frankly, our rad onc residents are pretty happy with our level of responsibility, research/elective/free time, and funding. As such, I don't think we'd ever even want to unionize. To even attempt to unionize is practically declaring war on your GME/program, which they are not going to take lightly.

    So I agree that the idea of unionization makes more sense for call heavy specialties. If your residency is already pretty lousy as far as hours, teaching, and research opportunity/funding, then unionization may make sense for you (with the caveat that "they can always hurt you more."). In this way, I think unionization makes more sense for the average medicine or surgery program where the residents work 80 hours a week with limited research opportunities, especially if those residents aren't particularly happy with their education. There are some rad onc residencies like this, but it seems less common.
     
  23. KnuxNole

    KnuxNole Sweets Addict 10+ Year Member

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    So when the nurses strike successfully, we'll have to do all the nursing work too! D:
     
  24. Neuronix

    Neuronix working like a dog SDN Advisor SDN Administrator 10+ Year Member

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    You're describing what has already happened in NYC or at the VA.
     
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  25. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus 10+ Year Member

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    Sure there are. There are thousands of foreign trained doctors who don't match each year who would be more than happy to play scab if it got them in.
     
  26. Chickenandwaffles

    Chickenandwaffles Banned Banned

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    The same goes for nurses, thousands of foreign nurses who can work here for less, yet they still strike. How does that work?
     
  27. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus 10+ Year Member

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    Simple. THe same doesn't go for nurses. The federal government deems certain groups essential such that they aren't allowed to strike. They took that position with air traffic controllers, threatened it with teachers, and most believe surely would with doctors. Nurses haven't drawn that ire and hence we have to believe the government deems them less essential. So that's how it works.
     
  28. sb247

    sb247 wait...you mean I got in? 2+ Year Member

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    and nurses aren't 300k in debt....so they can risk not getting that job back. we simply can't afford our license being pulled
     
  29. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus 10+ Year Member

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    That too.
     
  30. Chickenandwaffles

    Chickenandwaffles Banned Banned

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    I don't have debt, but don't think they can pull your license for striking.
     
  31. sb247

    sb247 wait...you mean I got in? 2+ Year Member

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    and I didn't think they could make everyone buy health insurance, or tap every phone in the bahamas, or drone assasinate US citizens without trial.....and yet here we are
     
  32. Chickenandwaffles

    Chickenandwaffles Banned Banned

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    There is so much fear in medicine, that's part of what keeps us back.
     
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  33. Raryn

    Raryn Infernal Internist Gold Donor 7+ Year Member

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    I'm in no way supportive of physicians unionizing and striking, but this is a pretty disingenuous comparison. Air traffic controllers are all federal employees. As in, they all work directly for the federal government, much like VA physicians.

    Physicians may contract a portion of their revenues directly with the feds (to varying extents from doc to doc), but outside of the VA/military they can't exactly fire us.
     
  34. kingofmedicine

    kingofmedicine That is how daddy eat. WOOF. 2+ Year Member

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  35. Haybrant

    Haybrant 1K Member 10+ Year Member

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    It's pretty obvious we need a true physicians union. Yes, not a residents union, nobody could care less. But that is where it will start. You see, we're at a point where the baby boomer physicians really could care less about what happens to new physicans. They are old, set in their ways, wiling to bow to their hospital administrator overlords. Our generation will stop the bleeding they have inflicted and seeing a residents union emerge is a step in that direction. We are not government employees like air traffic control. It is time we start organizing, figure out what principals we require to return integrity to our field and stop outside influence from damaging our patient relationships. Doesn't matter if you are medicine or surgery or pathology, we have a common purpose which is our patients. We have to come together.
     
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  36. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus 10+ Year Member

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    Oh please, It's pretty well established that the government can take pretty significant steps to protect the public well being. They won't shrug their shoulders and let doctors strike. We aren't auto workers. So yeah, they can and will exactly fire you. Or more accurately bring in people to replace you. Either by promoting midlevels or bringing in foreign trained physicians or both. And the public won't flinch an eyelid-- once they show video of grandma dying in the sicu or some baby with a congenital heart issue not able to get an operation, this would be an extremely popular move. Which is why unions are a suckers bet in this field. Doctors doing their jobs is so essential to the nations well being that your government is not going to sit back and let you strike.
     
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  37. sb247

    sb247 wait...you mean I got in? 2+ Year Member

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    While the libertarian in me still says it isn't the government's business if a private doctor shows up to work tomorrow, @Law2Doc is right. They'll pull licenses and issue fines and promote midlevels in a way that will neither be beneficial to us nor legal/constitutional in our eyes and it won't matter because they'll do it anyway
     
  38. DoctwoB

    DoctwoB 5+ Year Member

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    There are other options beyond a complete strike that would have a less compromising effect on patient care, for example refusing to provide elective procedures/care while maintaining care of inpatients/EDs, etc.
     
  39. newres64

    newres64

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    I don't think striking is necessarily the answer, but residents should be more vocal about being underpaid. I find it very interesting that many fields that require a similar level of higher education and have a significant disparity between new entry wages and senior wages start out at a higher level than most medical residents. I know physical therapists that are getting jobs right out of school for 60K a year, brand new MBA graduates making 70K. Even if their starting income is close to ours, it usually increases significant;y over the next 5 years.

    Also, to those who make the argument that we shouldn't complain because we are making the "median household income"- keep in mind that the median household debt level is only around $80,000 (which 90% is in the form of a mortgage) compared to the median medical school graduate who owes around $200,000- and that is just educational debt. Also it should be noted that the median salary for a PGY-1 is $45,000 while the median national household income is $50,000 so we are technically paid less than median household income. When talking about salary we must understand cost of living as well. How far do you think $50,000 a year will go if you live in NYC? I can tell you from personal experience- not far. If you want to live a decent neighborhood you will have to settle for either a studio or a bigger apartment with a roommate (frankly, how many of us really want to be living like college students when we are close to 30?). You will also probably need someone to cosign a lease for you since your income won't be 40x the monthly (which is required).

    I don't think any resident is asking to be paid 6 figures as a PGY-1, but is asking for something in the vicinity of $60,000 so unreasonable? Or a more graduated payscale that reflects our true economic value ($10,000 raise each level)?
     
  40. gutonc

    gutonc No Meat, No Treat SDN Administrator 10+ Year Member

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    Sure...then all those "elective cases" wind up in the ER, get admitted and we're back at square 1.

    Not...gonna...happen.
     
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  41. Chickenandwaffles

    Chickenandwaffles Banned Banned

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    Seriously? You think the public won't blink an eye when they are being treated by midlevels who know nothing because the doctors are getting paid less than nurses? I highly doubt it. Patients complain NOW that they have to be seen by non-doctors, take doctors out of the equation and the public will make a huge outcry. Also we are taking about residents, or are we saying that hospitals can't run without residents? Surely attendings can take care of patients without residents for a while, can they not?

    Further the public is ignorant. Most people think that doctors even in training are making hundreds of thousands of dollars. People would be shocked to know that some residents get paid less than 50k for 80 hours of work. I have had this simple conversation with lay people and when I explained how residency works, how much we work and what we get paid they could not believe it.

    Residents should be making in the 65-70k range, particularly given that a number of hospitals pay that without blinking an eye. LIJ in Long Island pays 70k+, UTSW pays 56k for PGY-1s. Those salaries are more reasonable, getting paid less than 50k is not.
     
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  42. newres64

    newres64

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    That's why residents need to become more vocal about their compensation. I think any action taken to rectify this situation should start with an education campaign. I think the majority of the public would be sympathetic to our "cause" if they were probably informed

    That is a fair salary to start out at (PGY-1, PGY-2) IMHO. As you move farther up you should be even higher, like PGY-4/5 making $80-90K. There is no logical reason why a senior anesthesiology resident should only make 60k in his/her final year when the next year they will make 250k as an attending. Has their economic productivity increased 4x over that year? probably not.
     
  43. newres64

    newres64

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    Low residency pay is not a result of market forces. We're not like lawyers (whose starting salary is similar) who have saturated our field. In fact, the field of medicine is the complete opposite, with demand exceeding supply. The low wages are the result of our healthcare industry needing to cut/control costs and like most fields/industries, this is done on the backs of the most vulnerable group.

    Also, another thing I forgot to add. Residency pay has increased over the last few decades at the inflation rate while medical school debt has increased at 6.3%.year (https://www.aamc.org/download/328322/data/statedebtreport.pdf). So in reality, or actual buying power of our salaries has decreased.

    On edit: on a rough calculation, it would cost the country about $3 Billion/year to increase residency salaries by an average of $10,000/year. This is pennies when we pay upwards of 3 Trillion a year on healthcare, $400 billion of which is on direct hospital costs
     
  44. Raryn

    Raryn Infernal Internist Gold Donor 7+ Year Member

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    Their economic productivity increased far, far more than 4x over that year, because at the end of that year they're able to bill on their own without paying a separate anesthesiology attending to supervise.
     
  45. ThoracicGuy

    ThoracicGuy 2+ Year Member

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    You'll get an attending salary in a few years. The physical therapist does not have your earning potential and could reach a ceiling around $75,000. Those MBA graduates, maybe they'll eventually make up to $120,000. As a primary care physician, you may start around $175,000 and it can go up from there.
     
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  46. newres64

    newres64

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    I'm well aware of that, the problem is that many of us are struggling NOW. My MBA friends are already making close to that number because many have been working for over 5 years. Saying "well don't, worry, in a few years you will be making alot more" just doesn't cut it. I personally, haven't seen any explanation backed up with data/facts that supports why residents should get paid so little. If my pay at 50k is fine because i'll be making 175k in 3 years, is it alright if I get paid 30K now if i will make 195k when i get out? or what about 20K now and make 215K when i start out.? Where do we draw the line and why? Those are my questions. Most professions in this country have salaries that are determined by market forces that are usually closely linked to the economic productivity of the job. I read somewhere (i've been trying to find the source) that hospitals generally only lose money during a residents first year, but after that their productivity increases to the point that what they produce is multiples of what they are paid.

    I'd gladly (and i believe i speak for many residents as well) trade 3 years of a reduced attending salary of $15,000 (so getting paid 150K instead of 175K) for $15,000 a year now in residency.
     
  47. SouthernSurgeon

    SouthernSurgeon Lifetime Donor 7+ Year Member

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    The issue residents always seem to overlook in these conversations is billing.

    A first year attending's clinical productivity has not increased exponentially over what they were capable above as a resident...but as you say their economic productivity has - because now they can bill for their services.
     
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  48. Chickenandwaffles

    Chickenandwaffles Banned Banned

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    Well attendings bill for residents' services, they are not free. And attendings are able to see more patients in general as a result of residents, so their billings INCREASE not decrease. It's like suggesting that an attending who uses a PA sees less patients or bills less.

    So if a program has residents doing whatever type of work, most attending productivity increases in general and billings increase. Further, the salary/benefits/etc are covered by Medicare. So extra $$$ is going into the system. It's getting free labor + more ability to bill. So while the resident may not be able to bill directly, the attending is billing for the resident.
     
  49. newres64

    newres64

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    Billing is not the only way to assess economic value. If this was the case nurses, PAs, maintenance workers have no economic value since they cannot get benefits directly from what they do.

    Also, if there were no residents, you would still need an attending anesthesiologist to be present. I see this argument a lot that residents cost the system money because hospitals are forced to higher attending to supervise them. That can only be the case if residents are actually performing tasks of no economic value, that are not needed, or are redundant. Is this the case in reality? No, we all know residents are a vital part of our health system. A hospital without residents would have to higher someone else to do their job- and the person who would be hired (NP, PA, Attendings) are in all likelihood going to be paid more than the resident doing the job. A good example is the ED, where you have residents doing the same jobs as PAs but getting paid up to 30% less.

    Again, we are not asking for 6 figure salaries as a PGY-1, but a salary that is more reflective of our education, skill, and productivity throughout our residency training
     
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  50. Chickenandwaffles

    Chickenandwaffles Banned Banned

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    I completely agree. Especially because a number of hospitals across the country are doing this. If NY hospitals can pay 65-70k +, I don't see why more hospitals can't provide a dignified salary for residents.
     
  51. newres64

    newres64

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    Status:
    Resident [Any Field]
    so are you suggesting the hospital doesn't bill for any services done by resident? We know thats not the case, when the resident does the work the patient still gets billed but under the attendings name. The same with PA/NPs. The only thing that changes when you become an attending is that you can put your name on this bill now. Is that really worth a $100K+ raise in true economic value?
     

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