salary

[JayneCobb]

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hypothetically, could a residency program cut your pay when going from one pgy year to the next?

 

[Winged Scapula]

hypothetically, could a residency program cut your pay when going from one pgy year to the next?

Depends on:

1) if you are staying at the same hospital; I know some people who made less for fellowship because they switched hospitals

2) whether they cut it across the board; I do not believe they can cut salaries on a case by case basis

But basically yes, you are not guaranteed a certain salary every year. The contracts are for 1 year. The next year they may offer a position but at a lower salary. Can't say I've seen that happen but theorectically, yes I don't believe there are any requirements to pay residents X amount of dollars or that you have to have a pay increase every year.

 

[JayneCobb]

Depends on:

1) if you are staying at the same hospital; I know some people who made less for fellowship because they switched hospitals

2) whether they cut it across the board; I do not believe they can cut salaries on a case by case basis

But basically yes, you are not guaranteed a certain salary every year. The contracts are for 1 year. The next year they may offer a position but at a lower salary. Can't say I've seen that happen but theorectically, yes I don't believe there are any requirements to pay residents X amount of dollars or that you have to have a pay increase every year.

the AMA states that the pay scale should be based on level of experience, hense the typical graduated scale you see at many places, as a small increase each pgy year in a hospital system is encouraged, but the reason i ask is that the local rumor is that for next year certain (not all) programs would be looking at cuts in salary in the tune of 15% and that would be for those staying at the same hospital and progressing to the next pgy year in their program.

 

[Winged Scapula]

the AMA states that the pay scale should be based on level of experience, hense the typical graduated scale you see at many places, as a small increase each pgy year in a hospital system is encouraged, but the reason i ask is that the local rumor is that for next year certain (not all) programs would be looking at cuts in salary in the tune of 15% and that would be for those staying at the same hospital and progressing to the next pgy year in their program.

That would still meet the AMA's suggestions (of course the AMA has nothing to do with medical education per se) if every level received the cut, as it is not required by ACGME to give pay raises.

Sucks though.

 

[Holderlin]

Why are resident's salaries so low to begin with?

It seems blatantly torturous considering the misery that they go through already.

Would it really collapse the system to throw down 75-80k so people can actually pay a little on their loans, and raise a family if they have one.

Isn't it enough that most students have already borrowed 100-250k, barely scraping by for the last 4 years? The least they could look forward to would be a livable salary to serve as some reward for 4 years of hard training and mitigate the fear of the impending horror that is the medical residency.

It pisses me off just thinking about it.

Maybe, before I'm actually a med student, I should go stand outside of my local hospital and verbally abuse the PD and attending doc as they walk to their car, just to get it off my chest before I have to kiss their ass while hating them.🙂 (no offense to any docs here) joking obviously

 

[JackADeli]

Why are resident's salaries so low to begin with?

It seems blatantly torturous considering the misery that they go through already.

Would it really collapse the system to throw down 75-80k so people can actually pay a little on their loans, and raise a family if they have one...

It really comes down to perspective and intent. Over the years, we hear more and more individuals making socialistic arguments of fairness and not enough income to support families, etc... Now, resident compensation packages include retirement packages and some of the best health insurance plans.

The "salary" of a resident is supposed to technically be a stipend. A resident never was intended to be viewed as a longterm "career employee". The original intent was to provide adequate income to allow payment of basic living supplies to support the individual trainee during training. Frankly, I find it ludicrous for resident compensation to continue to rise upwards of 85K while fully trained and board certified primary care physicians are fight for incomes in the 200k range..... It is a slipperry slope and soon we will hear more and more about how much family support undergrads should receive!

 

[Hernandez]

The "salary" of a resident is supposed to technically be a stipend. A resident never was intended to be viewed as a longterm "career employee". The original intent was to provide adequate income to allow payment of basic living supplies to support the individual trainee during training.

and what of programs restricting or completely doing away with moonlighting due to the new rules? I've personally heard the phrase "the acgme/IOM doesn't give a **** if you can't pay your bills with your salary without moonlighting, moonlighting is going away"

something's going to have to give, I know I'm barely making ends meet as it is, but if my program does away with moonlighiting as well, I won't be able to pay for daycare for 2 kids and the rent and the bills.

 

[Holderlin]

It really comes down to perspective and intent. Over the years, we hear more and more individuals making socialistic arguments of fairness and not enough income to support families, etc... Now, resident compensation packages include retirement packages and some of the best health insurance plans.

The "salary" of a resident is supposed to technically be a stipend. A resident never was intended to be viewed as a longterm "career employee". The original intent was to provide adequate income to allow payment of basic living supplies to support the individual trainee during training. Frankly, I find it ludicrous for resident compensation to continue to rise upwards of 85K while fully trained and board certified primary care physicians are fight for incomes in the 200k range..... It is a slipperry slope and soon we will hear more and more about how much family support undergrads should receive!

Point noted, but these are MD employees treating patients, and a ton of patients at that. They are not students, and so comparisons to grad school and much less undergrad makes no sense.

I think 70-80k is fair. It's still lower than any board certified doctor's salary who works waaaaaaaaaaaaay less, and it's just enough to allow them to pay their loans (interest at least) and live like a normal person who has a decent job, which for someone who has undergone 4 years of training should be expected.

"Socialist".....now this is just plain word prating. What's socialist is not compensating residents at the value of the care they give. Ironically, I bet that would pencil out to much more than 70k.

 

[Holderlin]

and what of programs restricting or completely doing away with moonlighting due to the new rules? I've personally heard the phrase "the acgme/IOM doesn't give a **** if you can't pay your bills with your salary without moonlighting, moonlighting is going away"

something's going to have to give, I know I'm barely making ends meet as it is, but if my program does away with moonlighiting as well, I won't be able to pay for daycare for 2 kids and the rent and the bills.

It's always the old timers who are bitter at the youngens who have it easier than they did. But what they forget is how much easier they had it than their predecessors and so on. Bunch of hypocritical, myopic, greedy, old A-holes.

I have a newborn and a wife as well. Although she could possibly have a decent (not great 50-70k) banking job while this would be going down.

How the hell does this residency business work with a family? The more i read, the more I think it's going to completely own me...

 

[rachmoninov3]

first off, remember that stipends used to be like $7000 anually 30 years ago. We have made considerable strides since then, but with inflation, the current ecconomic suckiness etc yes we could always use a pay increase.

Yet I know my husband and I can survive on a resident's salary. Why? Because we did it prior to medical school. I will be paid the same amount as a resident physician that I earned as a certified nursing assistant. After 4 years of sporadic per diem work, a steady although smaller than I'd like pay check will be a big help!

 

[Holderlin]

first off, remember that stipends used to be like $7000 anually 30 years ago. We have made considerable strides since then, but with inflation, the current ecconomic suckiness etc yes we could always use a pay increase.

Yet I know my husband and I can survive on a resident's salary. Why? Because we did it prior to medical school. I will be paid the same amount as a resident physician that I earned as a certified nursing assistant. After 4 years of sporadic per diem work, a steady although smaller than I'd like pay check will be a big help!

So residents typically get like 40-50k right?

I hear some people on here talk about 30k, which is absurd.

Does anyone have an answer to the question of the real market value of the care that a resident provides in a year? I bet it's damn near 200k

 

[VA Hopeful Dr]

So residents typically get like 40-50k right?

I hear some people on here talk about 30k, which is absurd.

Does anyone have an answer to the question of the real market value of the care that a resident provides in a year? I bet it's damn near 200k

Maybe so, but you've got to look at everything involved. At my medical school, a standard IM floor team consisted of 2 seniors, 2 interns, and an attending. Our daily census hovered around 20 patients. Our one attending could easily do that on his own (heck, many hospitalists do more). So, a patient load that can pay for one hospitalist now has to pay for 4 residents and an attending. The same sort of picture is present in outpatient clinics as well.

Surgeons have it worse since, as I recall, an attending must be physically present in each OR during the majority of the case. Residents almost always take much longer on cases. You're cutting down the number of cases and having to pay extra salaries.

Lastly, the government pays for most of our salary/benefits. Do you think they're going to up the money they give hospitals the way things are right now?

We'd all (myself included) love to make more money. That being said, unless you live somewhere very pricey, a resident's salary isn't all that bad.

 

[JackADeli]

...Does anyone have an answer to the question of the real market value of the care that a resident provides in a year? I bet it's damn near 200k

Unfortunately, it is generally unbillable "work" and thus costs for insurance and benefits without actual reimbursement... see below.

everyone can get into a little peepy match on "salary" and use the "fair" word if you like. The issue is/are:

1. The residents' "work" that everyone believes is underpaid and should be by some peoples' opinions in the $80k range is suppose to be primarily educational, aka student learning.

2. Where a physician can bill for work done, a resident does NOT bring in any billable production. In fact, it is illegal outside of moonlighting... at a completely different institution then the sponsoring residency institution.

3. The federal government pays the hospital a set amount of money to the GME to cover resident costs. yes, residents are an expense. Many here apparently will argue they are more positive revenue then negative revenue.... However, see number 2 above. Also, the hospital must pay for your malpractice premiums, healthcare benefits, often dental, optical, disability, life, etc.... It also goes to help subsidize the lower volumes the physicians in theory perform at academic institutions in order to teach, etc....

4. So, I suspect many would want to know how much the federal gov pays per resident, and in general this can be 80-150K/yr. The issue is the number of ACGME approved residency spots at a given institution does NOT in most cases equal the number of federally funded spots. Most institutions have far more residents then funded spots.

5. Most undergrads and grads students are apparently able to fund themselves on financial aid and summer jobs... but are paying for their education. It seems as if plenty of people go from the negative income of medical school to the positive income of residency and suddenly need daycare money, vacation, etc....

Long and short, there are costs associated with TRAINING and thus with you being a TRAINEE. You can not work independently as a physician until you complete all USMLE and get an unrestricted license. But, you work under the protection and "supervision" of the training hospital. You can not really compare to a PA or NP. Once you have an MD you can't be hired in a lesser role... because you are now a physician which carries licensure requirements and malpractice coverage, etc.... For example, if a patient dies at a local nursing home where you are working part time as a janitor... you can't say, "it doesn't count cause I was not working as a doctor I was acting as a janitor...".

So, to all you undergrads, med-students, interns, ec.... Understand what residency pays, budget and do NOT get the misinterpretation that you should be paid "x" cause your a doctor and want to start a family, etc... during residency. You need to plan and budget. If you planned and budgeted well during undergrad and med-school, then you should find yourself a little better off now that you are moving into a little more positive income.

PS: go ahead and use the word fair regularly during medical school and residency.... explain to everyone what is fair to you and how much you provide. Keep in mind, numerous community hospitals are in the "black" and have no residents.....

 

[Holderlin]

Unfortunately, it is generally unbillable "work" and thus costs for insurance and benefits without actual reimbursement... see below.

everyone can get into a little peepy match on "salary" and use the "fair" word if you like. The issue is/are:

1. The residents' "work" that everyone believes is underpaid and should be by some peoples' opinions in the $80k range is suppose to be primarily educational, aka student learning.

2. Where a physician can bill for work done, a resident does NOT bring in any billable production. In fact, it is illegal outside of moonlighting... at a completely different institution then the sponsoring residency institution.

3. The federal government pays the hospital a set amount of money to the GME to cover resident costs. yes, residents are an expense. Many here apparently will argue they are more positive revenue then negative revenue.... However, see number 2 above. Also, the hospital must pay for your malpractice premiums, healthcare benefits, often dental, optical, disability, life, etc.... It also goes to help subsidize the lower volumes the physicians in theory perform at academic institutions in order to teach, etc....

4. So, I suspect many would want to know how much the federal gov pays per resident, and in general this can be 80-150K/yr. The issue is the number of ACGME approved residency spots at a given institution does NOT in most cases equal the number of federally funded spots. Most institutions have far more residents then funded spots.

5. Most undergrads and grads students are apparently able to fund themselves on financial aid and summer jobs... but are paying for their education. It seems as if plenty of people go from the negative income of medical school to the positive income of residency and suddenly need daycare money, vacation, etc....

Long and short, there are costs associated with TRAINING and thus with you being a TRAINEE. You can not work independently as a physician until you complete all USMLE and get an unrestricted license. But, you work under the protection and "supervision" of the training hospital. You can not really compare to a PA or NP. Once you have an MD you can't be hired in a lesser role... because you are now a physician which carries licensure requirements and malpractice coverage, etc.... For example, if a patient dies at a local nursing home where you are working part time as a janitor... you can't say, "it doesn't count cause I was not working as a doctor I was acting as a janitor...".

So, to all you undergrads, med-students, interns, ec.... Understand what residency pays, budget and do NOT get the misinterpretation that you should be paid "x" cause your a doctor and want to start a family, etc... during residency. You need to plan and budget. If you planned and budgeted well during undergrad and med-school, then you should find yourself a little better off now that you are moving into a little more positive income.

PS: go ahead and use the word fair regularly during medical school and residency.... explain to everyone what is fair to you and how much you provide. Keep in mind, numerous community hospitals are in the "black" and have no residents.....

I appreciate your thoughts.

I understand they're supervised and that costs money, but I think your costs/value ratio is greatly exaggerated, and your examples are anecdotal at best, at least to me.

And it's utterly ridiculous to say that because new MDs must get board certified to practice unrestricted medicine, the care that they give under supervision is somehow non-existent and worthless; it can't be considered, as if it took place in an alternate universe. This is a tyrannical, arbitrary, illogical, and I must say socialist notion. They're worth at least as much as a PA and you know it. You aren't really telling me with a straight face that all the hours of work they do is "primarily educational"? That's BS and I think you know this too.

And these newly minted MDs aren't "suddenly" claiming these new expenses out of the blue as if they're making them up to get more money. Things change drastically in 4 years: you incur massive debt while having already struggled doggedly throughout the whole ordeal, you may have kids or your kids have gotten older and more expensive, re-locating to a residency could mean lost income for a spouse, and then you're faced with 4-7 more years of struggle. The light at this portion of the tunnel I believe is too dim. It's a gradual growth and value argument more so than a sudden appearance of dubious expenses.

I just need to see more data, but I'm convinced residents are worth at least 75k.

 

[JackADeli]

I appreciate everyone has an opinion. I refer you back to the general perspective provided previously:

....you've got to look at everything involved. At my medical school, a standard IM floor team consisted of 2 seniors, 2 interns, and an attending. Our daily census hovered around 20 patients. Our one attending could easily do that on his own (heck, many hospitalists do more). So, a patient load that can pay for one hospitalist now has to pay for 4 residents and an attending. The same sort of picture is present in outpatient clinics as well...

...I understand they're supervised and that costs money, but I think your costs/value ratio is greatly exaggerated, and your examples are anecdotal at best, at least to me...

Again, at least two very important points against your position:
1. Plenty of hospitals/services/etc.... function just fine without the added costs of a cadre of residents. i.e. residents are not a "necessary" commodity in general.
2. It is not anecdotal that the work residents provide is UNREIMBURSED. So, going to the example from VA Hopeful, what would need to occur is cut everyone elses income to pay the trainee 75-80k + benefits/yr. Then let us not forget that most academic attendings are already paid less then community private practice....

...And it's utterly ridiculous to say that because new MDs must get board certified to practice unrestricted medicine, the care that they give under supervision is somehow non-existent and worthless; it can't be considered, as if it took place in an alternate universe. This is a tyrannical, arbitrary, illogical, and I must say socialist notion. They're worth at least as much as a PA and you know it. You aren't really telling me with a straight face that all the hours of work they do is "primarily educational"? That's BS and I think you know this too...

You are very much missing the point and plenty of details. First, nobody said you need board certification to practice unrestricted. You need to complete USMLE to practice unrestricted. Second, more and more insurance companies now do pay less for care provided by "fully trained" (i.e. completed residency) physicians that are not board certified. Third, PAs & NPs can bill and their work is reimbursable... that is just a reality. Fourth, I never said all the work a resident does is purely educational... but it is supposed to be primarily educational. Fifth, you can't have it both ways. residents enjoy the umbrella of claiming the attending is in charge and primary decision maker in patient care... because "you" are just a resident. You are either supervised or your not. If you are and primary liability falls on the hospital and attending and your malpractice coverage is provided under those terms/agreement... that is what it is.

...And these newly minted MDs aren't "suddenly" claiming these new expenses out of the blue as if they're making them up to get more money. Things change drastically in 4 years: you incur massive debt while having already struggled doggedly throughout the whole ordeal, you may have kids or your kids have gotten older and more expensive, re-locating to a residency could mean lost income for a spouse, and then you're faced with 4-7 more years of struggle...

That's life and it is based on a great deal of voluntary personal decisions. One chooses to get married or not. One chooses to have kids or not. Yes, things change, but in general most new residents go from a 30-60K tuition expenditure to a 30-60k/yr income plus benefits circumstance. I am all for people making money. Good luck. But, some of your anger and arguments sound pretty hollow. Again, I encourage students to think long and hard and understand the reality of their future earnings as best you can. You are not trying for a career as a resident. Your are training for a career as a physician. Residency is not the place to plan on growing families and 401ks. Make your decisions wisely and then be prepared to live with it.

...I just need to see more data, but I'm convinced residents are worth at least 75k.

Sure, I definately agree you need to see more data. I suggest you obtain more data before you make strenuous arguments as to what a resident is worth.... You probably need to learn a little about how healthcare providers are paid too.... we provide numerous hours of work that isn't paid! I think it is ludicrous to have primary care physicians and other specialties in many circumstances underpaid and almost double the "compensation" paid to residents!

 

[Holderlin]

I appreciate everyone has an opinion. I refer you back to the general perspective provided previously:

Again, at least two very important points against your position:
1. Plenty of hospitals/services/etc.... function just fine without the added costs of a cadre of residents. i.e. residents are not a "necessary" commodity in general.
2. It is not anecdotal that the work residents provide is UNREIMBURSED. So, going to the example from VA Hopeful, what would need to occur is cut everyone elses income to pay the trainee 75-80k + benefits/yr. Then let us not forget that most academic attendings are already paid less then community private practice....You are very much missing the point and plenty of details. First, nobody said you need board certification to practice unrestricted. You need to complete USMLE to practice unrestricted. Second, more and more insurance companies now do pay less for care provided by "fully trained" (i.e. completed residency) physicians that are not board certified. Third, PAs & NPs can bill and their work is reimbursable... that is just a reality. Fourth, I never said all the work a resident does is purely educational... but it is supposed to be primarily educational. Fifth, you can't have it both ways. residents enjoy the umbrella of claiming the attending is in charge and primary decision maker in patient care... because "you" are just a resident. You are either supervised or your not. If you are and primary liability falls on the hospital and attending and your malpractice coverage is provided under those terms/agreement... that is what it is.


That's life and it is based on a great deal of voluntary personal decisions. One chooses to get married or not. One chooses to have kids or not. Yes, things change, but in general most new residents go from a 30-60K tuition expenditure to a 30-60k/yr income plus benefits circumstance. I am all for people making money. Good luck. But, some of your anger and arguments sound pretty hollow. Again, I encourage students to think long and hard and understand the reality of their future earnings as best you can. You are not trying for a career as a resident. Your are training for a career as a physician. Residency is not the place to plan on growing families and 401ks. Make your decisions wisely and then be prepared to live with it.Sure, I definately agree you need to see more data. I suggest you obtain more data before you make strenuous arguments as to what a resident is worth.... You probably need to learn a little about how healthcare providers are paid too.... we provide numerous hours of work that isn't paid! I think it is ludicrous to have primary care physicians and other specialties in many circumstances underpaid and almost double the "compensation" paid to residents!

I appreciate the information you provide.

I meant your "hospitals running in the black" statement as being anecdotal, and I confused being licensed with begin board certified.

I realize the impossibility of raising resident's salary, especially in these tumultuous times, and you clearly make sense, but the comparisons to an RN/PA still loom. I guess I think resident care should be reimbursable. You'd think they'd want this to bring in more money. In fact it makes perfect sense to allow a resident MD to be reimbursable as a PA. Does it not? Where would the issue be in this proposition?

And I have a wife and a newborn, so this is a huge logistical issue for me.

 

[Arcan57]

I appreciate the information you provide.

I meant your "hospitals running in the black" statement as being anecdotal, and I confused being licensed with begin board certified.

I realize the impossibility of raising resident's salary, especially in these tumultuous times, and you clearly make sense, but the comparisons to an RN/PA still loom. I guess I think resident care should be reimbursable. You'd think they'd want this to bring in more money. In fact it makes perfect sense to allow a resident MD to be reimbursable as a PA. Does it not? Where would the issue be in this proposition?

And I have a wife and a newborn, so this is a huge logistical issue for me.

The issue is that Medicare is paying the hospital to train you. Medicare is not particularly interested in paying twice (once for the hospital and once for what you bill them) for the same thing. It is so not interested that it leveled millions of fines against hospitals that were billing Medicare based on resident work. Hence the sea change in certain specialties regarding attending supervision.

Plenty of my fellow residents had a wife (usually stay at home) and (less commonly until our last year) a child. Live middle class, understand your debt burden will likely increase, and moonlight if given the opportunity.

 

[Hernandez]

I appreciate everyone has an opinion. I refer you back to the general perspective provided previously:

Again, at least two very important points against your position:
1. Plenty of hospitals/services/etc.... function just fine without the added costs of a cadre of residents. i.e. residents are not a "necessary" commodity in general.
2. It is not anecdotal that the work residents provide is UNREIMBURSED. So, going to the example from VA Hopeful, what would need to occur is cut everyone elses income to pay the trainee 75-80k + benefits/yr. Then let us not forget that most academic attendings are already paid less then community private practice....You are very much missing the point and plenty of details. First, nobody said you need board certification to practice unrestricted. You need to complete USMLE to practice unrestricted. Second, more and more insurance companies now do pay less for care provided by "fully trained" (i.e. completed residency) physicians that are not board certified. Third, PAs & NPs can bill and their work is reimbursable... that is just a reality. Fourth, I never said all the work a resident does is purely educational... but it is supposed to be primarily educational. Fifth, you can't have it both ways. residents enjoy the umbrella of claiming the attending is in charge and primary decision maker in patient care... because "you" are just a resident. You are either supervised or your not. If you are and primary liability falls on the hospital and attending and your malpractice coverage is provided under those terms/agreement... that is what it is.

you're missing the boat big time, first off, not many residents are "an added cost" since most programs are funded by the government, and i think it was the now banned expcm who argued that residencies made the hospital money, at the very least thety break even unless they're footing the whole bill themselves.

I'll be honest, my biggest financial stress now is an unsold house that just isn't moving on the market, i matched for fellowship before the market went to crap, but now im stuck with it. personally that's fine, and you won't hear me arguing that they should be boosting my pay by 20-30k/year, but the hospital where i work's impending policy of absolutely NO moonlighting is asinine and will likely be the final straw that breaks me financially as its the nexus of bad timing of my 2nd kid, unsold house and now possibly no ability to make up the difference, hell, it'd would only take 1-2 12 shifts a month to keep me afloat and making ends meet, and im concerned that if i foreclose on my house I wont be able to get the funds I'll need later to open my own practice, but thats down the road. sure id love more money so i could work less on the side, but even now I'm not working excessively on the moonlighting front. but to have that threatened to have it completely taken away is definitely the last thing i need.

That's life and it is based on a great deal of voluntary personal decisions. One chooses to get married or not. One chooses to have kids or not. Yes, things change, but in general most new residents go from a 30-60K tuition expenditure to a 30-60k/yr income plus benefits circumstance. I am all for people making money.

so you advocate completely putting life on hold until after residency then? my personal situation was well planned, it's the hospitals "possible" "likely" policy of completely doing away with moonlighting thats thrown me for a loop,as this is completely new and i was told that moonlighting was encouraged even when i interviewed. i guess it doesn't even bother them that it costs me 20k/year in interest alone that's accumulating on my student loans to attend it, as well,

 

[JaggerPlate]

you're missing the boat big time, first off, not many residents are "an added cost" since most programs are funded by the government, and i think it was the now banned expcm who argued that residencies made the hospital money, at the very least thety break even unless they're footing the whole bill themselves.

I'll be honest, my biggest financial stress now is an unsold house that just isn't moving on the market, i matched for fellowship before the market went to crap, but now im stuck with it. personally that's fine, and you won't hear me arguing that they should be boosting my pay by 20-30k/year, but the hospital where i work's impending policy of absolutely NO moonlighting is asinine and will likely be the final straw that breaks me financially as its the nexus of bad timing of my 2nd kid, unsold house and now possibly no ability to make up the difference, hell, it'd would only take 1-2 12 shifts a month to keep me afloat and making ends meet, and im concerned that if i foreclose on my house I wont be able to get the funds I'll need later to open my own practice, but thats down the road. sure id love more money so i could work less on the side, but even now I'm not working excessively on the moonlighting front. but to have that threatened to have it completely taken away is definitely the last thing i need.



so you advocate completely putting life on hold until after residency then? my personal situation was well planned, it's the hospitals "possible" "likely" policy of completely doing away with moonlighting thats thrown me for a loop,as this is completely new and i was told that moonlighting was encouraged even when i interviewed. i guess it doesn't even bother them that it costs me 20k/year in interest alone that's accumulating on my student loans to attend it, as well,

Do you think the 'no moonlighting' policy is really going to spread? Also, just to play devil's advocate here/satisfy my own curiosity ... what would happen if you were caught moonlighting? I mean, I understand that you sign a contract and, clearly, this would be a breach of the contract, but would you be fired? Would whoever caught you really turn you in? Granted, I know it's far to much to risk on that assumption, but if you're in fellowship ... you're a residency trained physician, and in your situation, it seems like being able to practice this training and keep your family afloat are crucial. I really do wish you the best of luck!

 

[Holderlin]

The issue is that Medicare is paying the hospital to train you. Medicare is not particularly interested in paying twice (once for the hospital and once for what you bill them) for the same thing. It is so not interested that it leveled millions of fines against hospitals that were billing Medicare based on resident work. Hence the sea change in certain specialties regarding attending supervision.

Plenty of my fellow residents had a wife (usually stay at home) and (less commonly until our last year) a child. Live middle class, understand your debt burden will likely increase, and moonlight if given the opportunity.

Okay, making even more sense now, but not everyone's on Medicare. Maybe they could bill all other insurances? It would be better than nothing.

 

[Holderlin]

you're missing the boat big time, first off, not many residents are "an added cost" since most programs are funded by the government, and i think it was the now banned expcm who argued that residencies made the hospital money, at the very least thety break even unless they're footing the whole bill themselves.

I'll be honest, my biggest financial stress now is an unsold house that just isn't moving on the market, i matched for fellowship before the market went to crap, but now im stuck with it. personally that's fine, and you won't hear me arguing that they should be boosting my pay by 20-30k/year, but the hospital where i work's impending policy of absolutely NO moonlighting is asinine and will likely be the final straw that breaks me financially as its the nexus of bad timing of my 2nd kid, unsold house and now possibly no ability to make up the difference, hell, it'd would only take 1-2 12 shifts a month to keep me afloat and making ends meet, and im concerned that if i foreclose on my house I wont be able to get the funds I'll need later to open my own practice, but thats down the road. sure id love more money so i could work less on the side, but even now I'm not working excessively on the moonlighting front. but to have that threatened to have it completely taken away is definitely the last thing i need.



so you advocate completely putting life on hold until after residency then? my personal situation was well planned, it's the hospitals "possible" "likely" policy of completely doing away with moonlighting thats thrown me for a loop,as this is completely new and i was told that moonlighting was encouraged even when i interviewed. i guess it doesn't even bother them that it costs me 20k/year in interest alone that's accumulating on my student loans to attend it, as well,

[YOUTUBE]http://www.youtube.com/watch?v=QqMiigy92qU&feature=player_embedded[/YOUTUBE]

 

[gutonc]

Do you think the 'no moonlighting' policy is really going to spread? Also, just to play devil's advocate here/satisfy my own curiosity ... what would happen if you were caught moonlighting? I mean, I understand that you sign a contract and, clearly, this would be a breach of the contract, but would you be fired?

Probably yes.

Also, many (not all, but many) moonlighting gigs, even some outside gigs, require approval of your PD before they'll let you work. So it might theoretically be your own moonlighting job that rats you out.

 

[wine thief]

what would happen if you were caught moonlighting? I mean, I understand that you sign a contract and, clearly, this would be a breach of the contract, but would you be fired? Would whoever caught you really turn you in?

i know an excellent chief surgical resident who was placed on probation after his PD found out he was moonlighting.

 

[Hernandez]

Do you think the 'no moonlighting' policy is really going to spread? Also, just to play devil's advocate here/satisfy my own curiosity ... what would happen if you were caught moonlighting? I mean, I understand that you sign a contract and, clearly, this would be a breach of the contract, but would you be fired? Would whoever caught you really turn you in? Granted, I know it's far to much to risk on that assumption, but if you're in fellowship ... you're a residency trained physician, and in your situation, it seems like being able to practice this training and keep your family afloat are crucial. I really do wish you the best of luck!

i hope not, but if you see the other thread where the CIR petitioned OSHA to look into work hours, its likely a foregone conclusion especially once the government decides to stick its nose into work hours.

but there is the real possibility that one could be fired or unapproved moonlighting the way many contracts are worded, granted that would make for piss poor publicity for a program to fire a resident who's just trying to make ends meet.

 

[JackADeli]

First, let me say that I honestly do wish you all the best. I am not holding some "uphill both ways in the snow, I had it bad" mentality. But, IMHO, a great deal of the arguments are contradictory and really sound like people wanting everything and wanting it both ways.

...first off, not many residents are "an added cost" since most programs are funded by the government...at the very least thety break even unless they're footing the whole bill themselves...

As far as I know, all ACGME accredited programs in general are federally funded. The issue is the number of positions that are funded. With the advent of numerous specialties, there are many institutions that have far more positions then are actually funded. I know numerous programs have unbalanced funding as the advent of Emergency medicine did NOT equate to additional residency funding, etc.... As noted by others, numerous hospitals without residents have individual attendings running the same service that 4 residents and an attending run in a teaching setting. So, it depends on how you cut the numbers as to if you believe residents are such money makers.

...I'll be honest, my biggest financial stress now is an unsold house that just isn't moving on the market, i matched for fellowship before the market went to crap, but now im stuck with it. personally that's fine, and you won't hear me arguing that they should be boosting my pay by 20-30k/year, but the hospital where i work's impending policy of absolutely NO moonlighting is asinine and will likely be the final straw that breaks me financially as its the nexus of bad timing of my 2nd kid, unsold house and now possibly no ability to make up the difference, hell, it'd would only take 1-2 12 shifts a month to keep me afloat and making ends meet, and im concerned that if i foreclose on my house I wont be able to get the funds I'll need later to open my own practice, but thats down the road. sure id love more money so i could work less on the side, but even now I'm not working excessively on the moonlighting front. but to have that threatened to have it completely taken away is definitely the last thing i need...

And, I feel for you like I do the guy down the street that lost his career and pension and house in the current market. Plenty of folks with children too. He waited until he actually started his career to have kids. now the factory went under, etc.... It is unfortunate.

But, most of my trainee colleagues rented and did not buy a house. Yes, many were scorned about how renting was a waste of money. I even knew plenty of undergrads that bought houses... Those are all individual personal choices. I don't see them relavent what so ever as to what your "job" should pay you as a trainee. you can buy a house during school, med-school, residency, etc... It is a choice. You can get married or not and have kids or not, again, choices.

...so you advocate completely putting life on hold until after residency then? my personal situation was well planned, it's the hospitals "possible" "likely" policy of completely doing away with moonlighting thats thrown me for a loop,as this is completely new and i was told that moonlighting was encouraged even when i interviewed. i guess it doesn't even bother them that it costs me 20k/year in interest alone that's accumulating on my student loans to attend it, as well,

I advocate awareness that you are making these choices. Many people say the purchase of the house was "well planned" with the caveat being a belief that everything would work the way they wanted....

But, back to my original point on wanting everything and both ways too. The ACGME has cracked down on hours for "safety" and "education" with quite a large support by medical students and residents! Most charging a need for controls on work place and hours to improve education, rest, and study time.

Unfortunately, the studies generally do not find the residents using the additional time off for study or rest. On top of that, now we have some claiming, with less hours, should be paid upwards of 75k + full benefits/yr. To put some additional sprinkles on-top of that cake, individuals want to use that additional free time for moonlighting....

So, we have the ACGME shortening training hours. We have the majority of med-students and residents unwilling to accept additional years of training to compensate for the decrease in actual time spent training each year. We have med-students and residents wanting their stipends in some cases doubled! And, coup de gras, we have individuals not using this extra time for the purpose of study but rather for more work to obtain more money.....

 

[JaggerPlate]

i hope not, but if you see the other thread where the CIR petitioned OSHA to look into work hours, its likely a foregone conclusion especially once the government decides to stick its nose into work hours.

but there is the real possibility that one could be fired or unapproved moonlighting the way many contracts are worded, granted that would make for piss poor publicity for a program to fire a resident who's just trying to make ends meet.

Thanks for all the replies (and for putting up with my clueless-ness towards the subject). One more question though ... I don't understand why working less hours would equate to no more moonlighting? Wouldn't working 60 hours a week instead of 80 actually give you more time to moonlight? Or is it a contractual sort of 'if we can't have you, nobody can' sort of thing?

 

[gutonc]

Thanks for all the replies (and for putting up with my clueless-ness towards the subject). One more question though ... I don't understand why working less hours would equate to no more moonlighting? Wouldn't working 60 hours a week instead of 80 actually give you more time to moonlight? Or is it a contractual sort of 'if we can't have you, nobody can' sort of thing?

The latter. If the argument is that 80 hours is too much work and so "actual" work hours are being cut to 60 (or whatever) then 60 (program) + 20 (moonlighting) is also too much.

 

[Hernandez]

First, let me say that I honestly do wish you all the best. I am not holding some "uphill both ways in the snow, I had it bad" mentality. But, IMHO, a great deal of the arguments are contradictory and really sound like people wanting everything and wanting it both ways

You're right, people want it both ways.....if you combine my posts with other peoples posts and then imagine that we're somehow all arguing for less hours, more base salary and all the time to moonlight that we want. How about you actually quit being an argumentative poster and answer me with a straight face a single question. all finances aside, why can't a resident who's in good educational standing not be allowed to moonlight even within the 80 hours/week duty hour rules? and especially why not when the financial situation is tight?

.As far as I know, all ACGME accredited programs in general are federally funded.

That's the same thing I basically said, and to bring you back to the point, there are plenty of threads on speculation and references on how much residents make for hospitals.

As noted by others, numerous hospitals without residents have individual attendings running the same service that 4 residents and an attending run in a teaching setting. So, it depends on how you cut the numbers as to if you believe residents are such money makers.

So how does this scenario constitute a loss for a hospital? Their getting funding for the residents and an attending is billing for the same services as he would solo.

And, I feel for you like I do the guy down the street that lost his career and pension and house in the current market. Plenty of folks with children too. He waited until he actually started his career to have kids. now the factory went under, etc.... It is unfortunate.

Yet below you would seem to advocate waiting on all choices until completely stable, well life isn't stable, given the same set of circumstances, I'd make the same ones, I'm not complaining about the market, or the inability to sell, simply that the rules are being changed mid-stream and likely going to leave me high-and-dry.

But, most of my trainee colleagues rented and did not buy a house. Yes, many were scorned about how renting was a waste of money. I even knew plenty of undergrads that bought houses... Those are all individual personal choices. I don't see them relavent what so ever as to what your "job" should pay you as a trainee. you can buy a house during school, med-school, residency, etc... It is a choice.

This is a debate for another thread, but I ran the numbers, and frankly, unless I take more than a $10k loss on the house, I have another year of mortgage payments before I start loosing money when compared to renting something that was comparable, and I'm just now loosing money compared to renting a simple 2 bedroom apartment.

You can get married or not and have kids or not, again, choices.I advocate awareness that you are making these choices. Many people say the purchase of the house was "well planned" with the caveat being a belief that everything would work the way they wanted....

You don't hear me complaining about the bad market, only the willful denying me of the ability to make sure I can stay afloat, hell, any other person in the US can work as many jobs as they can hold, but heaven forbid if I wanted to work 1-2 shifts a month then it's taboo since I've clearly signed my life away to medical training.

But, back to my original point on wanting everything and both ways too. The ACGME has cracked down on hours for "safety" and "education" with quite a large support by medical students and residents! Most charging a need for controls on work place and hours to improve education, rest, and study time.

oh please, the old system was downright abusive in many ways, and the old timers had the benefit of having less than $10,000 debt from medical school despite their harsh conditions, and I know my current PD did some crazy moonlighting despite their "rough" residency. but again, where did I put forth any of these arguments?

Unfortunately, the studies generally do not find the residents using the additional time off for study or rest. On top of that, now we have some claiming, with less hours, should be paid upwards of 75k + full benefits/yr. To put some additional sprinkles on-top of that cake, individuals want to use that additional free time for moonlighting....

Quit dragging other peoples arguments into your points addressing my posts. I have not complained about the duty hours here, nor have I complained about my base salary here, what I am complaining about is that I'm not a wet behind the ears intern wanting to buy an expensive italian sports car, I'm wanting the rightful ability to make sure my bills and obligations as a father and home owner are met. The rules of the game are likely going to be changed mid-stream on me when I've met my obligations to my pts and my education and my program, hell, I'm a published author, a board certified Internist, and have been doing well in fellowship with no complaints about my knowledge base or technical abilities, so what's legitimate argument do you have that I should not be allowed to moonlight to make sure my financial obligations are met?

So, we have the ACGME shortening training hours. We have the majority of med-students and residents unwilling to accept additional years of training to compensate for the decrease in actual time spent training each year. We have med-students and residents wanting their stipends in some cases doubled! And, coup de gras, we have individuals not using this extra time for the purpose of study but rather for more work to obtain more money.....

so you're being a contrarian butt. basically if I listen to you, I should be single, live in a tiny apartment, eat only ramen, not consider the possibility of kids or do anything that might require more of me or my time since clearly my whole life should be dedicated to my training.

 

[Hernandez]

Thanks for all the replies (and for putting up with my clueless-ness towards the subject). One more question though ... I don't understand why working less hours would equate to no more moonlighting? Wouldn't working 60 hours a week instead of 80 actually give you more time to moonlight? Or is it a contractual sort of 'if we can't have you, nobody can' sort of thing?

one of the big changes to the new work hours rules is that the 80 hours includes all moonlighting activity, which to me isn't a big deal, my previous program already had that rule and I abided by it for 2 years without any issues and easily stayed under the 80 hours, moonlighted, and paid my bills. but the changing to 80 hours with NO moonlighting is hypocritical on the old fart docs who are passing the regs as they had next to no debt when the graduated, moonlighted like crazy, made mad money during the boom of medicine, and yet somehow things that were good for them aren't ok for us.

 

[Holderlin]

Thanks for all the valuable information.

Sorry for encroaching on your forum, but it's the only way to get solid information about what is certainly the most formidable obstacle to becoming a physician.

I hope at the very least the moonlighting continues, and I guess I'll be happy with the 40-50k and make sure to match Rads with an IR fellowship🙂

 

[NotAProgDirector]

Any "no moonlighting" rule is local. The ACGME only requires that all hours (including moonlighting) be included in the limit of 80/week.

In general, I expect programs will limit moonlighting during call blocks. Remember that if you moonlight and that makes you go over the 80 hour limit, it's the program's neck on the line. They could remove you from the service to keep you under 80, and fire you for being irresponsible. But I expect that most programs already prohibit moonligting on busy months.

I remain amazed that it's legal to limit moonlighting. I simply don't understand it. How can one employer tell their employee that they are not allowed to work another job? Programs can certainly limit internal moonlighting all they want, but external moonlighting is none of my business. As mentioned above, if your external moonlighting affects your ability to work in my residency program (because you're too tired, or you go over 80 hours, or you're late to work, or you score poorly on your ITE, etc) then that's my business -- but only as to require improved performance on your part in my program.

There is no way this is legal, not even close. Of course, being the "test case" to prove this in court might be very ugly (for you).

 

[Hernandez]

Any "no moonlighting" rule is local. The ACGME only requires that all hours (including moonlighting) be included in the limit of 80/week.

In general, I expect programs will limit moonlighting during call blocks. Remember that if you moonlight and that makes you go over the 80 hour limit, it's the program's neck on the line. They could remove you from the service to keep you under 80, and fire you for being irresponsible. But I expect that most programs already prohibit moonligting on busy months.

I remain amazed that it's legal to limit moonlighting. I simply don't understand it. How can one employer tell their employee that they are not allowed to work another job? Programs can certainly limit internal moonlighting all they want, but external moonlighting is none of my business. As mentioned above, if your external moonlighting affects your ability to work in my residency program (because you're too tired, or you go over 80 hours, or you're late to work, or you score poorly on your ITE, etc) then that's my business -- but only as to require improved performance on your part in my program.

There is no way this is legal, not even close. Of course, being the "test case" to prove this in court might be very ugly (for you).

at least there are reasonable people out there still, sadly there is a lot of saber rattling at my institution due to impending structure change, hopefully they don't go as far as they say they are going to.

 

[JackADeli]

You're right, people want it both ways.....if you combine my posts with other peoples posts and then imagine that we're somehow all arguing for less hours, more base salary and all the time to moonlight that we want. How about you actually quit being an argumentative poster and answer me with a straight face a single question. all finances aside, why can't a resident who's in good educational standing not be allowed to moonlight even within the 80 hours/week duty hour rules? and especially why not when the financial situation is tight?...

That's cute. The question/s have been posted on a general online chat forum. The rules that are in place are there as a result of numerous individuals with numerous concerns. But, since you want a specific answer that is specific to your issues.... I suggest you not put it on a general forum and instead ask those that can give you a direct answer.... thus ask your residency or fellowship. Otherwise, we are discussing a topic in general.

...That's the same thing I basically said, and to bring you back to the point, there are plenty of threads on speculation and references on how much residents make for hospitals....So how does this scenario constitute a loss for a hospital? Their getting funding for the residents and an attending is billing for the same services as he would solo..

Again, you believe residents are a net gain ? great. don't come to an online forum chat if want all these specifics. Go and ask a hospital and look up some published info.

...Yet below you would seem to advocate waiting on all choices until completely stable, well life isn't stable, given the same set of circumstances, I'd make the same ones, I'm not complaining about the market, or the inability to sell, simply that the rules are being changed mid-stream and likely going to leave me high-and-dry...

Then, to avoid discussing generalities and not being 100% specific to your needs, I suggest you ask your fellowship and make your case to them. Tell them changing the rules is unnacceptable. As for waiting on all choices.... No, waiting is a making a choice. Each individual makes the choices of their choosing.

...This is a debate for another thread, but I ran the numbers, and frankly, unless I take more than a $10k loss on the house, I have another year of mortgage payments before I start loosing money when compared to renting something that was comparable, and I'm just now loosing money compared to renting a simple 2 bedroom...

I have plenty of friends in healthcare and out of healthcare that have taken a loss on selling their homes. Again, that's life. Some supposedly took lossed by paying 1500/month on rent for five years and others take losses buy selling in a crap market.

...You don't hear me complaining about the bad market, only the willful denying me of the ability to make sure I can stay afloat, hell, any other person in the US can work as many jobs as they can hold, but heaven forbid if I wanted to work 1-2 shifts a month then it's taboo since I've clearly signed my life away to medical training...

Yes, you have signed and agreed to certain requirements as part of your residency/fellowship. This is a choice you have made. There are law schools that have rules on how much work you can do while a student... again that is what it is. The rules on 80 hours, moonlighting, etc... have arisen from... oops, I almost stated writing about what others have brought up and you are not interested.

oh please, the old system was downright abusive in many ways, and the old timers had the benefit of having less than $10,000 debt from medical school despite their harsh conditions, and I know my current PD did some crazy moonlighting despite their "rough" residency. but again, where did I put forth any of these arguments?...

Can't really answer this question as the rules and changes were put into effect as a result of numerous others... and since you did not participate in those discussions, you should apparently be exempt and have only answers specific to your needs...

...Quit dragging other peoples arguments into your points addressing my posts. I have not complained about the duty hours here, nor have I complained about my base salary here, what I am complaining about is that I'm not a wet behind the ears intern wanting to buy an expensive italian sports car, I'm wanting the rightful ability to make sure my bills and obligations as a father and home owner are met. The rules of the game are likely going to be changed mid-stream on me when I've met my obligations to my pts and my education and my program, hell, I'm a published author, a board certified Internist, and have been doing well in fellowship with no complaints about my knowledge base or technical abilities, so what's legitimate argument do you have that I should not be allowed to moonlight to make sure my financial obligations are met?...

Can't give you an argument because you don't want the arguments that created the rules. If you are a board certified anything, you should be able to look a little further and have a better understanding of the rules and their origins. As to your family and finances, in the big picture, those are not the main concerns of a fellowship or any employer in general. They provide some compensation for some labor in accordance with whatever governing body they answer to.... General rules are made.

...so you're being a contrarian butt. basically if I listen to you, I should be single, live in a tiny apartment, eat only ramen, not consider the possibility of kids or do anything that might require more of me or my time since clearly my whole life should be dedicated to my training.

No. Myself and plenty of others enjoyed residency, two bedroom apartments or rental houses, went out to dinner, went places on vacation, etc.... I never needed to live like a poor person in a shoebox. I just budgeted and made my choices. Usually, waiting another 3-5 years to have children is not such a disaster. But, for those that couldn't wait, I had plenty of colleagues that had 2 kids during residency and also did not live like impoverished, starving laborers. And, they didn't moonlight.

Not speaking to you directly, as you want specifics to you and your arrangements... which can only be made via you discussing with your program and reviewing your contract.... but:


ACGME rules and restrictions were not some set of guidelines established by rich old hypocritical physicians that made their bundle of cash and now want to torture everyone. (I know very few attendings that had only 10k in student loans. For those kind of numbers, you probably need to look at 30+years into practice attendings. That group has been turning over).

The rules came into effect as a result of a great deal of politics, especially from individuals outside of medicine. They were then propelled by many within medicine, particularly medical students and residents. When the first 80hr thing came out, I could definately find very few if any "old" attendings that smiled and said, "yeh, let's hold them down and keep them broke". Residents are just not going to get it both ways. As for legal test cases and such... residency is regarded as a training program and does fall into some unusual classifications within the law. Thus, the recent rulings resulting in tax refunds, etc... to residents.

Any "no moonlighting" rule is local. The ACGME only requires that all hours (including moonlighting) be included in the limit of 80/week...

There is no way this is legal, not even close. Of course, being the "test case" to prove this in court might be very ugly (for you).

Not a lawyer. But, residency does "enjoy" a certain position in the legal world. Given the malpractice and patient safety issues, the politics that created the 80hr thing, etc... I think hospitals may very well be able to make a case that in order to train you and allow you access to patients, they can ask you to contractually agree to these limits.

 

[gutonc]

at least there are reasonable people out there still, sadly there is a lot of saber rattling at my institution due to impending structure change, hopefully they don't go as far as they say they are going to.

If you already have an outside moonlighting gig (or do before the end of this year), I can't imagine they'd be able to "catch" you. For the two outside gigs I've had in the past, once the PD signed off on my being in good standing, there was no more communication between that hospital and my program so they'd have no idea how much I did, or didn't work.

 

[Arcan57]

Okay, making even more sense now, but not everyone's on Medicare. Maybe they could bill all other insurances? It would be better than nothing.

It's definitely been thought about. Not necessarily in terms of upping resident salaries, but in terms of keeping the hospital (in this case the Med, but Grady, Charity, Cook, etc. would also apply) from closing.From 2007:

Potential financial impact of first assistant billing by surgical residents.
Madan AK, Fabian TC, Tichansky DS.

Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA. [email protected]

Abstract
General surgery residency involves a mixture of 1) education of residents and 2) service by residents. The service that residents provide is not directly reimbursed in our current healthcare system by private healthcare insurance companies. This investigation characterizes the amount of reimbursement a typical resident would be able to collect if residents were allowed to collect for their services as a first assistant. The case logs of residents who graduated over 2 years from our general surgery residency program were reviewed. Data from each resident's last 2 years (post-graduate years 4 and 5) were included in this study. Relative value units (RVUs) for each Current Procedural Terminology code were reviewed. Collections were calculated by multiplying the Medicare conversion factor of $36.7856/RVU, the corresponding RVU, and a "standard" collection rate of 16 per cent for first assistants. There were 13 general surgery residents. These residents provided first assistant help with 91,473 RVUs over 2 years. A total amount of $535,380 could have been collected on first assistant fees for the last 2 years of their residency. Each resident would have been able to collect an average at least $41,414 just for first assistant operative fees. Resident assistance in the operating room provides significant savings for private healthcare insurance companies each year by reducing the need for first assistants. The data demonstrate that private insurance companies receive a considerable amount of pro bono service from residents. Changes in the financing of the current healthcare system in the United States will require educators to examine other sources (i.e., private insurance companies) for support of graduate medication education.

 

[Smurfette]

As to your family and finances, in the big picture, those are not the main concerns of a fellowship or any employer in general. They provide some compensation for some labor in accordance with whatever governing body they answer to.... General rules are made.No. Myself and plenty of others enjoyed residency, two bedroom apartments or rental houses, went out to dinner, went places on vacation, etc.... I never needed to live like a poor person in a shoebox. I just budgeted and made my choices. Usually, waiting another 3-5 years to have children is not such a disaster. But, for those that couldn't wait, I had plenty of colleagues that had 2 kids during residency and also did not live like impoverished, starving laborers. And, they didn't moonlight.

👍👍 Exactly. It's a livable salary (although I will say that in areas with really high housing expenses like SF it is probably very tight). The average household (household, not individual) income in the US is about $50K/yr, which is right around what residents make. Usually going into residency people find that they suddenly have money (after not having money for years) and start to spend because they can, not because they 'need'. You can defer your loans in residency....so you have a few years of 'low' income compared to what you will make post-residency; but your 'low' income is what average Americans (with houses, spouses, kids, etc.) make every year. You need to live within your means and budget. Maybe your spouse needs to get a job if it's a big problem. Yes, it would be nice if residents could make more money, but the system is not going to change as it is government funded.

I don't think anyone on SDN really thinks moonlighting is innately evil and should be banned. It's a choice. However, the powers that be can say "if you aren't allowed to work more than 80 hours due to fatigue, then working another job in addition to residency adds to the fatigue and is therefore detrimental to patient care" and ban their residents and fellows from doing it. It was in our contracts very clearly in my program that we were not allowed to moonlight. It wasn't an issue in my program (no time to moonlight anyhow). Violating your contract can result in all sorts of penalties, many of which may need to be reported when applying for licensing or privileging (if you get put on probation or suspended for a time), or could result in getting fired. If you really want to moonlight talk to your PD and get written permission; sometimes an explanation of your situation and a guarantee that you can only moonlight on 'off weekends' or something similar is all they need to hear. Also, if moonlighting is not addressed in your contract, I am not sure if they can stop you legally from doing so...but they could make your life miserable.

 

[JelloBrain]

Third, PAs & NPs can bill and their work is reimbursable... that is just a reality. Fourth, I never said all the work a resident does is purely educational... but it is supposed to be primarily educational. Fifth, you can't have it both ways. Residents enjoy the umbrella of claiming the attending is in charge and primary decision maker in patient care... because "you" are just a resident. You are either supervised or your not. If you are and primary liability falls on the hospital and attending and your malpractice coverage is provided under those terms/agreement... that is what it is.

JAD, I agree with most of what you say that we make our choices, and have to live with the consequences. It is not our employer's job to pay us for the choices we make-whether it is to have a non-working spouse, kids, own house, 2 cars, etc.

However I would like some clarification on the above point please. AFAIK, PAs and NPs also practice under the attending's umbrella, with the ultimate responsibility of decision making in patient care being that of the attending's, and the hospital covers their malpractice too. So why then should they be paid so much more for being less qualified and knowledgeable and working less hours than a resident, and shouldering far less responsibility?

Once someone has an unrestricted license (after passing Step 3), and is a senior resident, PGY4 onwards maybe, shouldn't their salary be at par, if not more, than the NPs and PAs, in that specialty at least? By that time, most residents would be reasonably, if not more, competent than the mid-levels in dealing with most presentations in their specialty. Can the difference in the salary structure via Medicare funds not be made up by allowing senior residents' work to be billable and hence reimbursable? That seems like a fair trade-off in equalizing the disparity between senior residents and mid-levels.

Has this ever been tried? Maybe a small pilot program in a specialty that uses a lot of mid-levels could consider doing this? Anyone have any thoughts on this?

If I am mistaken in thinking that the PAs and NPs are not as independent as attendings and do not cover their own malpractice, then of course my suggestion is moot. But to my knowledge, the buck stops with the attendings.

 

[JackADeli]

👍👍 Exactly. It's a livable salary ...The average household (household, not individual) income in the US is about $50K/yr, which is right around what residents [i.e. indiviodual] make...

Yep, not bad, especially as a "trainee"!

...I would like some clarification ...AFAIK, PAs and NPs also practice under the attending's umbrella, with the ultimate responsibility of decision making in patient care being that of the attending's, and the hospital covers their malpractice too. So why then should they be paid so much more for being less qualified and knowledgeable and working less hours than a resident, and shouldering far less responsibility?...

I understand your concern and question/s. I even appreciate the perspective. The issue is, a licensed PA/NP is a "fully trained professional" AND are "career employees" AND can bill for their work/production/etc.... A resident is NOT fully trained. A resident can NOT bill for services. Residents are paid through GME and some amount of federal funding... again, it depends on the institutions training positions vs funded positions ratio (often, not a 1:1 ratio). One last point, that could start some flame wars... some PAs & NPs are far more knowledgeable and skilled on their service then many 3rd year residents. A resident MD has a broader scope and foundation of education. But, it is through residency/specialty training that refines you into a fully functioning physician. Jus because one graduates and gets an MD does not equate you to being far more qualified or even equally qualified to the mid-level that has been working and caring for complex patients on a particular service under the guidance, and yes, ongoing education from senior physicians for some years!

So, if an attending hires a PA/NP and uses them effectively, they ADD additional revenues to the practice, hopefully to cover their expenses (i.e. salary, benefits, malpractice) and more to increase profits for practice. finally, there is in all states some degree of independence to mid-levels conduct. But, in the eyes of coursts/lawyers/etc... a resident is a resident which is a "trainee". Residents can and often do hide behind that fact and get removed from malpractice suits. There has been an outcry of horror in recent years as some attendings are getting removed from suits and claiming residents acted "independently"!!!

...Once someone has an unrestricted license (after passing Step 3), and is a senior resident, PGY4 onwards maybe, shouldn't their salary be at par, if not more, than the NPs and PAs, in that specialty at least? ...Can the difference in the salary structure via Medicare funds not be made up by allowing senior residents' work to be billable and hence reimbursable? That seems like a fair trade-off in equalizing the disparity between senior residents and mid-levels...

So, a few things... First, medicare is not going to pay you billable as a "trainee" since they are already paying you to be a trained. In the "real world" as an attending, there are plenty of laws and rules not the least of which is "Stark". To give you an example, physicians can and a whole lot are receiving per diem compensation for taking ER on-call and/or trauma. However, it has to be handled very carefully that you don't get paid to take call and then bill for services provided when a patient comes in.... So, structures get complicated. Second, think about the conflicts that would develop with senior residents being billable. I know plenty will say, "I am not that way, I wouldn't do that, etc...". But, human nature being what it is, residents would start competing for certain cases and avoiding cases because of their "billables"....and God forbid the uninsured patient! Hell, I have watched residents try to avoid complex cases for fear a complication was guaranteed to happen and they would be stuck presenting the M&M! An M&M can be painful but is usually at most an hour presentation. Can you imagine if the issue in question is the difference between 500, 1000, 5000 dollars? Can you imagine if attendings got to play favorites and direct the "lucrative" cases to the seniors they liked?

So, billable and moonlighting needs a "firewall". Thus, moonlighting is in most situations extra and completely seperate from your primary training institution. Thus removing all these potential conflicts.

However, we then bump into all the crying about education, fatigue, new daytime "napping" rules, etc:

...I don't think anyone on SDN really thinks moonlighting is innately evil and should be banned. It's a choice. However, the powers that be can say "if you aren't allowed to work more than 80 hours due to fatigue, then working another job in addition to residency adds to the fatigue and is therefore detrimental to patient care" and ban their residents and fellows from doing it. It was in our contracts very clearly in my program that we were not allowed to moonlight...

So, these are just realities to becoming a physician. yes, you will be a "trainee" longer then most. You will be paid relatively more as a trainee then many career employees in this country. You are far less likely, as a "well paid trainee" to be laid off in this economy then any other career employee!

 

[Holderlin]

It's definitely been thought about. Not necessarily in terms of upping resident salaries, but in terms of keeping the hospital (in this case the Med, but Grady, Charity, Cook, etc. would also apply) from closing.From 2007:

Potential financial impact of first assistant billing by surgical residents.
Madan AK, Fabian TC, Tichansky DS.

Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA. [email protected]

Abstract
General surgery residency involves a mixture of 1) education of residents and 2) service by residents. The service that residents provide is not directly reimbursed in our current healthcare system by private healthcare insurance companies. This investigation characterizes the amount of reimbursement a typical resident would be able to collect if residents were allowed to collect for their services as a first assistant. The case logs of residents who graduated over 2 years from our general surgery residency program were reviewed. Data from each resident's last 2 years (post-graduate years 4 and 5) were included in this study. Relative value units (RVUs) for each Current Procedural Terminology code were reviewed. Collections were calculated by multiplying the Medicare conversion factor of $36.7856/RVU, the corresponding RVU, and a "standard" collection rate of 16 per cent for first assistants. There were 13 general surgery residents. These residents provided first assistant help with 91,473 RVUs over 2 years. A total amount of $535,380 could have been collected on first assistant fees for the last 2 years of their residency. Each resident would have been able to collect an average at least $41,414 just for first assistant operative fees. Resident assistance in the operating room provides significant savings for private healthcare insurance companies each year by reducing the need for first assistants. The data demonstrate that private insurance companies receive a considerable amount of pro bono service from residents. Changes in the financing of the current healthcare system in the United States will require educators to examine other sources (i.e., private insurance companies) for support of graduate medication education.

Here's some good data.

So it looks like surgical residents are definitely worth some $$$$$$. So if they were to say split the 41k with the hospital, that would bump them up to 60-70k, and that would be soooo much better🙄

 

[Hernandez]

👍👍 Exactly. It's a livable salary (although I will say that in areas with really high housing expenses like SF it is probably very tight). The average household (household, not individual) income in the US is about $50K/yr, which is right around what residents make. Usually going into residency people find that they suddenly have money (after not having money for years) and start to spend because they can, not because they 'need'. You can defer your loans in residency....so you have a few years of 'low' income compared to what you will make post-residency; but your 'low' income is what average Americans (with houses, spouses, kids, etc.) make every year. You need to live within your means and budget. Maybe your spouse needs to get a job if it's a big problem. Yes, it would be nice if residents could make more money, but the system is not going to change as it is government funded.

you do realize that the economics change after you have been out a little while, right?. and that one you get past 3 years out, the loan companies no longer have to defer/forebear your/unsubsidized private loans, right? and not all companies allow you to, so straight out my unsubsidized loans are $1500/month, and on the graduated payment they are $600/month. daycare $1000/month, rent $1000/month throw in food and utilities and you'll hit the $3000 a month you bring home quickly. im not saying it isn't a livable wage, as it is, but things happen especially when you factor in city/state/cross-country moves for fellowship, or the mandated and barely funded conferences i have to go to, or he'll, $5000 worth or car repair bills for stupid Japanese made cars. and again, in the end, if it weren't for a gamble on the house, id be fine, but crap happens and economies tank, and again, im not complaining about that, i made my choice, but in the end, a $1000 extra a month to pay for that until it sells isns something huge to ask, especially when i can theoretically double my take home pay with only 40 hours of moonlighting a month, yeah,

life happens, thankfully mine didn't come in the form of $20k in medical debt, and yet again, im not complaining about it, im complaining that a reactionary hopital thinks that taking away my ability to make my ends meet until my house sells is a great idea. actually, would you like to know what their reasoning is for doing away completly? because they can't keep track of the moonlighting hours so they are just going to do away with it all together.

I don't think anyone on SDN really thinks moonlighting is innately evil and should be banned. It's a choice. However, the powers that be can say "if you aren't allowed to work more than 80 hours due to fatigue, then working another job in addition to residency adds to the fatigue and is therefore detrimental to patient care" and ban their residents and fellows from doing it. It was in our contracts very clearly in my program that we were not allowed to moonlight. It wasn't an issue in my program (no time to moonlight anyhow). Violating your contract can result in all sorts of penalties, many of which may need to be reported when applying for licensing or privileging (if you get put on probation or suspended for a time), or could result in getting fired. If you really want to moonlight talk to your PD and get written permission; sometimes an explanation of your situation and a guarantee that you can only moonlight on 'off weekends' or something similar is all they need to hear. Also, if moonlighting is not addressed in your contract, I am not sure if they can stop you legally from doing so...but they could make your life miserable.

so if 80 hour is ok, why is moonlighting that stays under the 80 hours bad? and i have permission to moonlight, but next july is when its supposedly going away,

 

[JackADeli]

Here's some good data.

So it looks like surgical residents are definitely worth some $$$$$$. So if they were to say split the 41k with the hospital, that would bump them up to 60-70k, and that would be soooo much better🙄

I wouldn't exactly say it's "good data". It is interesting and is based on quite a few assumptions and presumptions. However, much of the care we provide outside of teaching centers, without residents goes un-reimbursed. Again, residents do not get reimbursed for their labors as they are funded under a seperate system. And, again, while the abstract may help people feel they are worth more, imagine the decisions of who gets to scrub on the insured vs the uninsured vs the well paying vs the not so well paying cases. Many of the private practice cases with an operative assistant, the insurance company does not reimburse for the assistant.

So, the abstract is a gross generalization manuscript of numbers that makes everyone feel good about a resident's worth.... However, wait until you graduate and are looking for a job... and believe you are now trained and worth something!

Final points, residencies to be accredited have to pay for certain infrastructures, i.e. most require a certain amount of "office space" for residents, a certain amount of library & IT, and surgery programs are requiring "simulation centers" with the required support staff. Now, the labors of the secretaries and program coordinators are NOT reimbursed. The labors of the the support staff and IT staff in sim centers, etc are not reimbursed. A patient that comes to a university for gall bladder out does not pay for the operative assistant, the PAs and and the other three residents and med-student on the service......

So, abstract is interesting, and if you know anything about the illustrious and "efficient" working of UT Memphis.... well, you would take their little number crunching with a big grain of salt.

 

[NotAProgDirector]

Not a lawyer. But, residency does "enjoy" a certain position in the legal world. Given the malpractice and patient safety issues, the politics that created the 80hr thing, etc... I think hospitals may very well be able to make a case that in order to train you and allow you access to patients, they can ask you to contractually agree to these limits.

Neither am I. So I could be completely wrong.

The new rules count all moonlighting in the 80 hour total, so now all will be held to 80 hours max. However, I fail to see the difference between A) I make a resident work 75-80 hours a week based upon our program's schedule; and 2) A resident is scheduled to work 40 hours per week on an elective, and they choose to moonlight another 20-30 hours. In the end it's the same 70-80 hours per week, and if it was "OK" when it was in my program I can't see how it's not OK when it's somewhere else.

Sure, the resident is in training and hence is not fully trained / competent. But if they can find a moonlighting position for which they are competent, have a full license, and take the risk of working on their own, that's their business. At least, that's how I see it. It only becomes my business when their performance in my program suffers. To be fair, when that happens it becomes a big problem for me, and could get the resident fired. So, one could argue that "moonlighting controls" are needed to help keep residents out of trouble -- but that seems like a stretch to me.

 

[Holderlin]

I wouldn't exactly say it's "good data". It is interesting and is based on quite a few assumptions and presumptions. However, much of the care we provide outside of teaching centers, without residents goes un-reimbursed. Again, residents do not get reimbursed for their labors as they are funded under a seperate system. And, again, while the abstract may help people feel they are worth more, imagine the decisions of who gets to scrub on the insured vs the uninsured vs the well paying vs the not so well paying cases. Many of the private practice cases with an operative assistant, the insurance company does not reimburse for the assistant.

So, the abstract is a gross generalization manuscript of numbers that makes everyone feel good about a resident's worth.... However, wait until you graduate and are looking for a job... and believe you are now trained and worth something!

Final points, residencies to be accredited have to pay for certain infrastructures, i.e. most require a certain amount of "office space" for residents, a certain amount of library & IT, and surgery programs are requiring "simulation centers" with the required support staff. Now, the labors of the secretaries and program coordinators are NOT reimbursed. The labors of the the support staff and IT staff in sim centers, etc are not reimbursed. A patient that comes to a university for gall bladder out does not pay for the operative assistant, the PAs and and the other three residents and med-student on the service......

So, abstract is interesting, and if you know anything about the illustrious and "efficient" working of UT Memphis.... well, you would take their little number crunching with a big grain of salt.

You hate residents

 

[45408]

The "salary" of a resident is supposed to technically be a stipend. A resident never was intended to be viewed as a longterm "career employee". The original intent was to provide adequate income to allow payment of basic living supplies to support the individual trainee during training. Frankly, I find it ludicrous for resident compensation to continue to rise upwards of 85K while fully trained and board certified primary care physicians are fight for incomes in the 200k range..... It is a slipperry slope and soon we will hear more and more about how much family support undergrads should receive!

The original intent was stupid then. Why should I have to eke out a few shekels for "basic living supplies" after spending nearly a decade in post-secondary education?

 

[45408]

5. Most undergrads and grads students are apparently able to fund themselves on financial aid and summer jobs... but are paying for their education. It seems as if plenty of people go from the negative income of medical school to the positive income of residency and suddenly need daycare money, vacation, etc....

Surprise, surprise, most college students don't have children and houses, but many residents certainly do. Many people are also living off the Bank of Mom & Dad, but when they're 26-30, it seems rather unreasonable for that bank to keep on giving. I also need vacation because I work much more than I did in college. You don't need vacation when you have 3 months off every summer and one month off every winter

Also, financial aid = loans. That's the equivalent of income for a college student.

 

[45408]

You are not trying for a career as a resident. Your are training for a career as a physician. Residency is not the place to plan on growing families and 401ks. Make your decisions wisely and then be prepared to live with it.

Disagree. Life comes at you fast, and putting children off until you're an attending is asking too much for many people. If you're willing to wait, that's great, but it shouldn't be obligatory. My program does pay enough for all of us who are married to have children, and I think that's how all places should do it.

 

[JackADeli]

Surprise, surprise, most college students don't have children and houses, but many residents certainly do...

Not sure of what all your points are trying to say... But, you having a spouse or not, having kids or not, owning a house or not, are all decisions you choose to make. They are not the choices of the residency program and not the responsibility of the residency program.

...Most undergrads and grads students are apparently able to fund themselves on financial aid and summer jobs... but are paying for their education. It seems as if plenty of people go from the negative income of medical school to the positive income of residency and suddenly need daycare money, vacation, etc...

...Also, financial aid = loans. That's the equivalent of income for a college student.

Again, not sure of what the point is. I understand undergrad and grad/med-school income is largely represented by loans. Hence, I made the point of, "...people go from the negative income of medical school to the positive income of residency...".

...I That's life and it is based on a great deal of voluntary personal decisions. One chooses to get married or not. One chooses to have kids or not. Yes, things change, but in general most new residents go from a 30-60K tuition expenditure to a 30-60k/yr income plus benefits circumstance. I am all for people making money. Good luck. But, some of your anger and arguments sound pretty hollow. Again, I encourage students to think long and hard and understand the reality of their future earnings as best you can. You are not trying for a career as a resident. Your are training for a career as a physician. Residency is not the place to plan on growing families and 401ks. Make your decisions wisely and then be prepared to live with it...

Disagree. Life comes at you fast, and putting children off until you're an attending is asking too much for many people. If you're willing to wait, that's great, but it shouldn't be obligatory. My program does pay enough for all of us who are married to have children, and I think that's how all places should do it.

I'm not sure exactly what you are disagreeing with. Nobody has said it is obligatory to wait until you are completely trained and have a longterm job (though we ~say that to HS students, undergrads, and even grad students...). What I said is,

"Residency is not the place to plan on growing families and 401ks. Make your decisions wisely and then be prepared to live with it".

Can you use residency as a step-off? Yes. Can you save during residency? yes. But, IMHO, residency is just that a stepping stone. Many programs, you may not even be fully vested in whatever retirement plan they have! So, get married and have kids during residency if you like. But, understand that it is your decision and your responsibility.

The programs longterm planning is not about you, the 5 year (or less) transient. It is about the longevity of the program and assuring reproducible and consistent training results. They need to successfully train a resident to practice a specific specialty and achieve board certification. That is their goal and that needs to be their priority.

Too many residents have lost focus on why they are in residency. Yes, some can have an excellent balance and have a family. Unfortunately, I have seen too many, "it's unfair" moments. I have watched residents crying how they need to get the Christmas break over the single guy because they are married with kids ; or, the cries of getting these weekends off, etc, etc.... Too often I have seen it implied or stated that if someone wants something they should be married too.... thus arguing special privilege and by default mandating marriage for the benefit. But, in the end, you are in residency for a short time of your career. It is not your career but a preparation for your career. Get married & have kids if you like, but understand, those are your decisions and responsibilities and it is innapropriate to make those decisions and expect all from fellow residents to the program to assume responsibility and make sacrifices for you to have your family.

You may be happy where you are and believe every program should be geared around your family desires and/or needs. That just is not the reality in the world or in numerous jobs accross the country. They pay a wage and provide certain amounts of benefits in order to get what they need to achieve the production they need. Plenty of people in this country make less then $40k and probably with worse health benefits then residents.

Finally, and a little rhetorical... You write, "My program does pay enough for all of us who are married to have children, and I think that's how all places should do it...". Ok, so then who decides what "enough" is? Should it be "enough" for just a spouse? a spouse and a kid? maybe a spouse and a kid a year? a spouse, kid/s, in an apartment? maybe home ownership? Or is it up to the individual residents? i.e. you decide you want to own over rent and the program should provide more to enable you to do so? you decide to own, should there be alotted time off for home shopping, mortgage counseling, banking, etc...? Should there be a graduated pay system so residents that are single have "enough" with less then is given to those making a family? We should "means test" residents to determine their incomes....

This really can not be the focus of residencies. While we are making residency so comfortable and warm and fuzzy that nobody wants to leave, physicians are taking pay cuts and the money for books, loupes, board review courses, conference attendance, simulation programs, and/or other things are cut. That is the dollars for training and career level compensation are being cut so our trainees can feel oh so good about their lives. And, that, IMHO, represents a loss of mature understanding and awareness of why you are in the residency. You are there to be trained. Everything else is on you, not the program, not the attendings, and not your fellow residents. Your choices and your responsibilities.

 

[45408]

Not sure of what all your points are trying to say... But, you having a spouse or not, having kids or not, owning a house or not, are all decisions you choose to make. They are not the choices of the residency program and not the responsibility of the residency program.

Yes? I'm aware of that.

Again, not sure of what the point is. I understand undergrad and grad/med-school income is largely represented by loans. Hence, I made the point of, "...people go from the negative income of medical school to the positive income of residency...".I'm not sure exactly what you are disagreeing with.

It's not negative income when you're receiving money in the mail. It's a debit against your future income, not negative income, which is very different. You still have money to buy things with, which is why what you're getting as an intern does not feel like a $100,000 raise over an M4.

Too many residents have lost focus on why they are in residency. Yes, some can have an excellent balance and have a family. Unfortunately, I have seen too many, "it's unfair" moments. I have watched residents crying how they need to get the Christmas break over the single guy because they are married with kids ; or, the cries of getting these weekends off, etc, etc.... Too often I have seen it implied or stated that if someone wants something they should be married too.... thus arguing special privilege and by default mandating marriage for the benefit. But, in the end, you are in residency for a short time of your career.

You're also in college for a short four years, and a quick four years in med school, and a brief 1-2 years of research, and then just a short fellowship, and suddenly your "brief period" is actually encompassing about a third of an adult's potential working period.

Your dramatic image of a resident sobbing for Christmas really isn't necessary, because I'm not arguing for special privilege as a family man, nor has anyone else in this thread.

This really can not be the focus of residencies. While we are making residency so comfortable and warm and fuzzy that nobody wants to leave, physicians are taking pay cuts and the money for books, loupes, board review courses, conference attendance, simulation programs, and/or other things are cut. That is the dollars for training and career level compensation are being cut so our trainees can feel oh so good about their lives. And, that, IMHO, represents a loss of mature understanding and awareness of why you are in the residency. You are there to be trained. Everything else is on you, not the program, not the attendings, and not your fellow residents. Your choices and your responsibilities.

And there it is. We've all gone soft. The hot flames of residency used to steel the residents into mighty weapons. Now we're just plastic swords.

 

[JackADeli]

...You're also in college for a short four years, and a quick four years in med school, and a brief 1-2 years of research, and then just a short fellowship, and suddenly your "brief period" is actually encompassing about a third of an adult's potential working period...

Your time in college is your choice and not the issue for the residency, nor is your choices of research, or future fellowship. My primary education emcompassed 18 years, and what? should I have felt undergrad should pay me? Maybe, adding med-school to that, it encompasses 21/22 years, should med-school pay me, enable me to have a family??? Depending on the choices you make, you can be working as an attending by age 35 or less. You can then work until 70 if you like.

...This really can not be the focus of residencies. While we are making residency so comfortable and warm and fuzzy that nobody wants to leave, physicians are taking pay cuts and the money for books, loupes, board review courses, conference attendance, simulation programs, and/or other things are cut. That is the dollars for training and career level compensation are being cut so our trainees can feel oh so good about their lives. And, that, IMHO, represents a loss of mature understanding and awareness of why you are in the residency. You are there to be trained. Everything else is on you, not the program, not the attendings, and not your fellow residents. Your choices and your responsibilities.

...And there it is. We've all gone soft. The hot flames of residency used to steel the residents into mighty weapons. Now we're just plastic swords.

If you want to read it that way fine. My point isn't even talking directly about decreasing training hours, call, etc... It is talking about the issues of increased income and the commentary that suggests an individuals family making decisions should be in some way the obligation of the residency. There are numerous residencies around the country. An individual should shop wisely. But, your career/specialty choice and family choices are really yours and yours alone.

 

[medpsych1]

First, let me say that I honestly do wish you all the best. I am not holding some "uphill both ways in the snow, I had it bad" mentality. But, IMHO, a great deal of the arguments are contradictory and really sound like people wanting everything and wanting it both ways.As far as I know, all ACGME accredited programs in general are federally funded. The issue is the number of positions that are funded. With the advent of numerous specialties, there are many institutions that have far more positions then are actually funded. I know numerous programs have unbalanced funding as the advent of Emergency medicine did NOT equate to additional residency funding, etc.... As noted by others, numerous hospitals without residents have individual attendings running the same service that 4 residents and an attending run in a teaching setting. So, it depends on how you cut the numbers as to if you believe residents are such money makers.And, I feel for you like I do the guy down the street that lost his career and pension and house in the current market. Plenty of folks with children too. He waited until he actually started his career to have kids. now the factory went under, etc.... It is unfortunate.

So, we have the ACGME shortening training hours. We have the majority of med-students and residents unwilling to accept additional years of training to compensate for the decrease in actual time spent training each year. We have med-students and residents wanting their stipends in some cases doubled! And, coup de gras, we have individuals not using this extra time for the purpose of study but rather for more work to obtain more money.....

Blatantly false. The federal government does not fund all acgme accredited residency programs. Many states provide residency funding either through direct funding or by matching medicaid GME funds. For instance the Texas state government spends millions per year to fund residency positions.
http://www.tafp.org/news/TFP/10No1/graph.asp
http://www.residencyfacts.com/RESID...10/10/4_states_cut_funding_for_residency.html

Also pharmaceutical companies are now funding 30 dermatology residency positions (10 PGY-2, 10 PGY-3, and 10 PGY-4) every year.
Faced with a work-force shortage and no new federal funding for resident training, the American Academy of Dermatology is expanding residency slots by using pharmaceutical company donations.
AAD leaders say enough safeguards are in place to prevent conflicts of interest that could arise from the relationship, but critics say such funding compromises the medical profession and leaves it beholden to for-profit corporations.
The academy's goal is to increase dermatology resident positions by up to 10% -- about 30 new slots -- per year. A pilot program will fund an initial 10 slots at $60,000 per slot per year for three years starting in July 2006.
Corporate sponsors contributing to the $1.8 million needed to fund the pilot are 3M Pharmaceuticals, Amgen and Wyeth Pharmaceuticals, Delasco Dermatologic Lab and Supply Inc., Galderma Laboratories and OrthoNeutrogena. The AAD also committed to contributing $1 million annually to the fund if pharmaceutical gifts fall short but declined to say how much of its own funds, if any, were being invested in the pilot.
David Pariser, MD, an AAD board member and chair of the pilot task force, detailed the measures the academy is taking to nip possible conflicts of interest in the bud. Members of the Assn. of Professors of Dermatology vetted the pilot and helped draw up guidelines. Corporate contributions are combined in a general fund, and the grants are assigned to specific programs to avoid having individual residents singled out as beneficiaries.
The APD and AAD jointly selected 10 institutions for the pilot from 24 applicants. Pharmaceutical donors were excluded from the selection process. Dr. Pariser said the pilot will not be expanded until the AAD evaluates the results.
http://www.ama-assn.org/amednews/site/free/prl20718.htm

Your quote that residents and med students are not willing to accept additional years of training is laughable. The fact is that the federal and state governments are not willing to fund additional years of training. Why fund additional years of residency training when they can get more providers cheaply by supporting the expansion of NPs and PAs. All these calls and threats that residencies will be lengthened as a result of work hour rules is a joke. There is no money available to lengthen residencies. You stated that many EM slots are not funded right now and yet you think there is a chance they will fund an extension of residencies - absolutely no way.