Resideny Without Pay

[rabbitsfeet777]

Hey folks,

Suppose you want to get into a specific competitive residency such as ENT, Derm, etc. Can you apply to a residency program and say you DO NOT want to get a salary, and will that increase your chances for getting onto that particular field? This is assuming you have little or no debt and have some financial backing to sustain for you for a couple of years.

Thanks

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[Blade28]

If you're going through NRMP, not only do I think that this is not an option, but I also doubt it would garner you any favor.

I mean, otherwise, you're basically bribing the program director $40k to take you, right?

Now contracts outside the ERAS Match, who knows?

 

[swpm]

Suppose you want to get into a specific competitive residency such as ENT, Derm, etc. Can you apply to a residency program and say you DO NOT want to get a salary, and will that increase your chances for getting onto that particular field? This is assuming you have little or no debt and have some financial backing to sustain for you for a couple of years.

No. The RRC approves programs for a set number of residents. They can't just take extra bodies.

Besides, do you really want to see programs taking on a bunch of underqualified but wealthy scut-monkeys working for no pay, draining teaching resources, reducing the number of good cases available to other residents?

 

[Pilot Doc]

No. The RRC approves programs for a set number of residents. They can't just take extra bodies.

True, but the limiting factor in most residency sizes these days is not RRC credentialling but CMS GME support. Congress won't pay for any more residents and not many people are willing to foot the bill. An enterprising derm (or whatever) department could very easily double their size, drop out of the match and convert all their slots to require $50K/yr payment to the department.

I doubt it would work, but I don't think there are regulatory hurdles to stop them.

 

[LADoc00]

No. The RRC approves programs for a set number of residents. They can't just take extra bodies.

True, but the limiting factor in most residency sizes these days is not RRC credentialling but CMS GME support. Congress won't pay for any more residents and not many people are willing to foot the bill. An enterprising derm (or whatever) department could very easily double their size, drop out of the match and convert all their slots to require $50K/yr payment to the department.

I doubt it would work, but I don't think there are regulatory hurdles to stop them.

Your wrong. THE limiting factor is credentialed spots. For most programs the money from CMS is a minimal factor. See you could train 25 dermatologists but where the hell would they get their ABMS certificate from?? The Amer Academy of Derm would only let them sit a fraction of that 25 for the exam.

For most residencies it is a tight control of supply and demand by the individual medical boards that is manipulating everything behind the scenes.

I was actually present when a representative from a competitive surgical subspec showed up at my medical school and cited the program. They had an unusual number of trainees leave at the same time due to research and the board couldnt penalize them. They did penalize the program, prohibiting them from advancing any further candidates for a year...crazy.

 

[yaah]

Another example where TV leads you wrong. John Carter MD did this in ER, among the thousands of things he did that were not normal medical/hospital procedure. You could probably volunteer your time but you would not be given resident privileges and responsibilities, more like an observer.

 

[rabbitsfeet777]

We're not saying that a program would all of the sudden double their residency spots from 5 to 10. But suppose they got a genuine candidate that really wanted to do a field but couldn't get in because he wasn't 98.9% on the boards. I think working for free may show some serious commitment, because there are very few men/women in their late 20's or early 30's that would sacrifice pay for a spot like Carter from ER. I know my uncle who was in a Rheumatology program in LSU had an additional resident who was working for free and got financial backing from a hospital in Michigan.

 

[Faebinder]

What LaDoc00 said is correct. Most program directors will come here and tell you their program is allowed X number of residents per year, not necessarily evenly split amongst the years mind you, but then again why should they kick a PGY2 person to give a position to a PGY1. So they usually go with equal numbers amongst all levels but if someone leaves at level 2, they dont have a problem taking a level 1 from what i hear. Again why should they.

Credentials are the problem, not the money.

 

[TRAMD]

Money is an issue. Medicare pays residencies for their residents: about twice what your salary is. It is doubtful that the residency would get paid for you in an odd set-up like this and it is likely they would actually lose money on you.

It certainly isn't going to put you above more qualified applicants that expect to be paid.

 

[howelljolly]

For what its worth, I know a physician who, 20 years ago Scrambled into a residency program that had just opened that year... and he wasnt paid for the first year. Im not sure why... maybe the funding hadn't come thru yet... but its a true story.

 

[smq123]

We're not saying that a program would all of the sudden double their residency spots from 5 to 10. But suppose they got a genuine candidate that really wanted to do a field but couldn't get in because he wasn't 98.9% on the boards. I think working for free may show some serious commitment, because there are very few men/women in their late 20's or early 30's that would sacrifice pay for a spot like Carter from ER.

Programs don't just care about money. The good programs also care about their reputation - which is largely represented by the type of research that their department produces, and also by the caliber of the average resident coming out of that program.

If you're really interested in ENT, but don't have the technical skills to be a good H&N surgeon, the program will lose reputation on you. (They will also lose a lot of time and energy because you will require more supervision than the other residents - which will piss off the attendings.) If you don't have the mind-set to be a good researcher, then you won't produce any research of value - which eats up resources and space. So, if you're missing the important components, despite being willing to work for free, I don't know how much you will help yourself.

 

[Blade28]

Money is an issue. Medicare pays residencies for their residents: about twice what your salary is. It is doubtful that the residency would get paid for you in an odd set-up like this and it is likely they would actually lose money on you.

It certainly isn't going to put you above more qualified applicants that expect to be paid.

Dude, why'd you change your avatar? Now you look like Stiffler.

 

[futuredo32]

Mt.Clemens Regional Medical Center has one radiology resident who is unpaid. Before the year started, he had to pay the hospital his salary and then they give him the checks every week or every other week. They only have D.O. residencies though, so it wouldn't be helpful for M.D.s.

 

[NotAProgDirector]

It's technically an RRC violation to not pay a resident, and could cause a program to lose it's accreditation. Implementing / enforcing this rule would be up to each individual RRC (there's one for each specialty), but the rule is in the Institutional requirements, which means that if a program did this, the whole institution could get cited when the GME office has an institutional review:

The relevant language is:

II. B. Financial Support for Residents: Sponsoring and participating sites must provide all residents with appropriate financial support and benefits to ensure that they are able to fulfill the responsibilities of their educational
programs.

I guess you could argue that "appropriate" financial support might be $0 for someone who requests it, but I doubt that would fly with the GME office or the RRC.

In case you're interested, the link is here. Just choose the Institutional requirements link.

 

[VentdependenT]

Mt.Clemens Regional Medical Center has one radiology resident who is unpaid. Before the year started, he had to pay the hospital his salary and then they give him the checks every week or every other week. They only have D.O. residencies though, so it wouldn't be helpful for M.D.s.

Why the hell would you ever do that....

 

[Faebinder]

Why the hell would you ever do that....

Mmm... I am sure you can get a list of over 1000 FMGs who would do Radiology residency for free. Lifestyle + money.

 

[TRAMD]

Dude, why'd you change your avatar? Now you look like Stiffler.

There may be no avoiding that. People said I looked like Stiffler with my old pic and in person so . . .

 

[Blade28]

Ah, well, then I'm sorry.

 

[TRAMD]

Ah, well, then I'm sorry.

It could be worse. I could look like Eugene Levy (Jim's dad).

I find it funny that your short post takes up so much room due to all the stuff under your avatar.

 

[Blade28]

It could be worse. I could look like Eugene Levy (Jim's dad).

I find it funny that your short post takes up so much room due to all the stuff under your avatar.

I can't help it.

 

[Long Dong]

Hey folks,

Suppose you want to get into a specific competitive residency such as ENT, Derm, etc. Can you apply to a residency program and say you DO NOT want to get a salary, and will that increase your chances for getting onto that particular field? This is assuming you have little or no debt and have some financial backing to sustain for you for a couple of years.

Thanks

There is this D.O. derm residency that doesn't pay, so I've heard from some of my med students.

http://opti-west.westernu.edu/phlb.html

Why the hell would you ever do that....

Maybe because once they finish they would make back what they paid the program for those 4 years in their first year of practice. And maybe even get on Dr. 90210, once that happens it's probably all gravy, like this guy. http://www.kirbydermatology.com/

 

[Winged Scapula]

There is this D.O. derm residency that doesn't pay, so I've heard from some of my med students.

http://opti-west.westernu.edu/phlb.html

If you follow the links through, it does indeed state that this is unfunded although funding MAY become available during the 2nd or 3rd year of residency.

 

[gryffindor]

In dentistry, since we are not under the ACGME guidlines, unpaid residencies are not uncommon. Orthodontics is one of our most competitive specialties. Some residencies charge $50K+ tuition per year for 3 years (that's after all the tuition you paid for 4 years of dental school) yet have zero spots open after match. At my program, since we are based in a hospital, we are lumped into the same GME office as the medical residents. For 16 years, our GME office collected the same amount from CMS for us as they got for the OMFS and medical residents, but paid us salary = $0. In fact, the hospital charged us a 16K tuition each year and thought nothing of it because the lawyers and bean counters knew ACGME rules didn't apply to us. They finally started paying a salary, although it is not equivalent to what OMFS and the other medical residents at this hospital get.

However, the orthodontics residency at UCLA is under scrutiny right now for allegedly accepting multiple 6 and 7 digit donations and then admitting a relative of the donor in a subsequent class. http://forums.studentdoctor.net/showthread.php?t=468026

Clearly money talks and I wouldn't put it past a medical residency either. I don't see why an unscrupulous residency wouldn't accept an underhanded position. UCLA ortho is taking a lot of heat for doing just that. It would be a slippery slope if 1 started getting away without paying a resident's salary or charging a "tuition" and others could cite "we're just being copy cats" as a reason to do it as well. Although I think the chances of it happening would be small since you guys have the tradition of being paid a salary and the ACGME wording that aProgDirector posted on your side.

To clarify: Many dental residents who attend residency programs at dental schools are classified as grad students so the salary rules don't apply at those programs and they can charge $50K tuition per year. However, I can think of at least 4 dental residencies that are hospital affiliated and fall under the same CMS funding as medical residencies but have GME offices that monkey with under-paying the dental residents just because they can get away with it.

 

[turquoiseblue]

Isn't Bill Clinton the one to blame for this cap on funding and residents?
Can't congress change it? because we need more residents to fill up the shortage of physicians--it just doesn't make sense to reduce residency programs or limit the number of residents.

I wish they made programs to help especially past residents, they cap them from getting future programs due to funding issues. That destroys life, liberty, and the pursuit of happiness, which is the essence of this country. What's so wrong to switch a program-seems like Bill made it a sin, and he's not even a doctor.

 

[docB]

Isn't Bill Clinton the one to blame for this cap on funding and residents?

Did Clinton really push changes in med ed? I am absolutley not a Clinton supporter but I can't remember any high level politician giving a damn about medical education ever.

 

[Apollyon]

Did Clinton really push changes in med ed? I am absolutley not a Clinton supporter but I can't remember any high level politician giving a damn about medical education ever.

What happened under Clinton was that residents were reclassified as "employees", instead of what Republicans had done for years and years, continuously reiterating that residents were "students", and, by that, screwing them as much as possible. Hey, they're students, not employees, so, let's get 'em!

 

[BogglestheMind]

Isn't Bill Clinton the one to blame for this cap on funding and residents?
Can't congress change it? because we need more residents to fill up the shortage of physicians--it just doesn't make sense to reduce residency programs or limit the number of residents.

I wish they made programs to help especially past residents, they cap them from getting future programs due to funding issues. That destroys life, liberty, and the pursuit of happiness, which is the essence of this country. What's so wrong to switch a program-seems like Bill made it a sin, and he's not even a doctor.

A program for past residents? Why would a past resident need a residency? It makes a lot of $ense for some doctors as if there were too many doctors practicing then salaries would bottom out. Bill Clinton doesn't have anything to do with this.

 

[Strength&Speed]

A program for past residents? Why would a past resident need a residency? It makes a lot of $ense for some doctors as if there were too many doctors practicing then salaries would bottom out. Bill Clinton doesn't have anything to do with this.

i think he means that if you did one residency and didnt like it and wanted to switch....as of now funding IS a major issue for people who want to do a separate residency.

 

[turquoiseblue]

i think he means that if you did one residency and didnt like it and wanted to switch....as of now funding IS a major issue for people who want to do a separate residency.

Yes, that's what I mean. Also if a resident was in residency before, even if they left the program in the middle, programs don't really take them again, and some residents never become doctors-future programs are less likely to fund them anymore because they used their caps up (e.g. having to repeat a year).

Bill Clinton signed the bill that created the cap on the number of spots and on funding, but I'm sure others in congress also were supporters and made it happen. It was the Balanced Budget Act of 1997.
Here is the link--it's on the third page: http://www.amsa.org/pdf/Medicare_GME.pdf