I completely agree. I would also feel a lot better if they told me, well we make more by seeing more patients/doing more procedures with you guys around, than if we were on our own. When you are an attending, you will have residnets do some of your work, and you'll bill more too.
Like my chief resident told me during intern year when I wanted to do a rotation that did not require resident coverage because of low patient volume, "Without residents, this hospital would collapse."
Sigh. You guys don't get the difference between the function of a resident and the function of a PA/NP. Let's put it this way:
The work residents do is offset at least somewhat by the significant amount of resources expended on training them and keeping the program running.
When you hire a PA, you don't have to use your most valuable staff members (the attendings) to give them lectures 10-15 hours a week. You don't have to put together an entire administrative infrastructure, with at least one attending working half-time in administration (the PD) subsidized to a full salary and at least one secretary/coordinator in order to coordinate your PAs work. You don't have to slow down your own procedures so that the PA can better understand how they're going to do it themselves later,
because they won't be doing it themselves later. If a PA made an attendings procedure take twice as long, that PA would be fired. If a resident does it, well, that's how he's learning.
I've worked with mid-level providers in a number of rotations and I'd say that a good one with some experience is easily at the level of an intern 6-8 months into their residency. Maybe even a 2nd year resident in some cases. That's fine. But the thing is,
they stay there. They don't get comprehensive education in how to do everything on their own, and their lack of such attention means the other members of the team are freed up to be more efficient. On the other thing, residents frequently slow things down when they're learning. But we accept that slow down because otherwise we won't end up with any new competent, independent providers.
So yes, if our programs didn't give a rats ass about educating us and just used us for scutwork while the attendings were off earning maximal money, a resident could easily earn his entire salary and more. But that would be a piss-poor educational experience, and one that isn't (or shouldn't be at least) the case in any program that's actually ACGME accredited. Our attendings accept the inefficiency of the residents and everything that entails (extra supervision in some cases, extra autonomy in others) and try to maximize our educational potential. That's why programs pay four people (an attending, a senior, two interns) to run a team of patients when the attending could honestly work more hours and do the same work themselves. That's why our attendings get paid less in academia than private practice. It's because they're spending resources on
training you, not just using you for the maximum amount of work.