salary

[NotAProgDirector]

I was just about to ask people to remain civil also.

Much of the argument in this thread revolves around people arguing several different issues:

1. Medical school is a financial decision. There is a certain cost that can be calculated, and anyone can figure out when they "break even" and how many years of "hard living" they may have. Sure, there are unknowns -- people may assume they will do a residency for 3 years and then choose a field which requires 5 years, but that is in itself a choice -- the student decides that they would rather "pay" the extra cost of a 5 year residency to get the other field (perhaps because of a larger financial payout in the long term, perhaps because they "like" it better.

In this area, I think it's fair to say that:
A. Most students go into this decision with a very poor financial understanding of the future.
B. Medical schools (and undergrad institution) have increased tuition making the financial stress of residency much greater. Plus, many students are doing post-baccs, MPH's, etc all before (or during) med school which jack up the costs and make the financial decision to go to medical school much less inviting.
C. At the current educational costs, going to medical school without financial assistance (scholarships, etc) is likely a poor financial decision for most students.
D. These increased costs could be mitigated against by a higher salary in residency. However, I don't see why I have to pay residents more because medical schools decided to charge people more.

2. Medical residents are underpaid for the work they do.

As I mentioned in my last post, this is very complicated. Residents cannot bill for services in most instances, so their work is supportive of the overall clinical mission. You can try to calculate a resident's worth by calculating the cost of hiring people (NP/PA or faculty) to replace them, but that's complicated as when we remove residents we often restructure systems to make costs decrease.

3. Residents are underpaid as compared to other people working in hospitals who are "similar", like NP and PA's.

This seems to make sense. If NP's and PA's do similar jobs, it seems like residents should be paid at least as much -- especially if the NP/PA covers shifts on a service sometimes covered by residents. However, as I mentioned above, there are differences between the way that NP/PA jobs are set up and resident jobs that make them very different. At specific times, you may be doing similar tasks. However, overall, your jobs are very different. And, as I mentioned above, all elective, research, and outpatient time doesn't have much "financial worth" for the institution.

The problem to both #2 and #3 is that no one is paid on their "worth". People are paid based upon the law of supply and demand. NP/PA's make more than residents because institutions are trying to keep them from leaving and working somewhere else. Residency training distorts a free market, because it's not simply a job. It's training, and one could argue that training requires an intergrated, comprehensive curriculum with longitudunal assessments over the entire training program. Hence, residents are not really free to move from program to program, and salaries don't have much upward pressure to ensure retention.

Arguing worth is also a very slippery slope. Why are all residents paid the same? Maybe some residents are "worth" more than others?

One could argue that surgical residents work more hours than other residents. Why should they not be paid more for that?

Or, perhaps derm procedures / appointments bring in more money than other departments. Since those residents help bring in that income, perhaps they should be paid more.

Or, perhaps residents should all be evaluated by how smart they are. Those with the highest board scores and best grades should get paid more, because they are "worth" more -- perhaps better teachers, etc.

"Worth" is very subjective

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[JackADeli]

Thank you to AProgDir. I think you put a very succinct summary to this. I am going to pose some further discussion points. And, would like your thoughts/input.

...Medical school is a financial decision. There is a certain cost that can be calculated, and anyone can figure out when they "break even" and how many years of "hard living" they may have. Sure, there are unknowns -- people may assume ...choose a field ...but that is in itself a choice -- the student decides...

...I think it's fair to say that:
A. Most students go into this decision with a very poor financial understanding of the future....

I agree with all quoted above. I think there is an unfortunate disconnect between individuals making serious decisions and the ease at which they could at least get a reasonable or at least minimal understanding of what the implications are, i.e. "very poor financial understanding of the future". I am certain college advisors fail to counsel adequately. But, I am also certain, while there are plenty of unknowns in future healthcare policies and/or reimbursement predictions, there is plenty of readily available information. I mean, it is not a secret how long the path is, it is not a secret or difficult algebra to determine what age you can expect to be at the end of residency, it is not a secret what one can expect income wise as a resident, it is not a secret what general income levels have been accross fields and/or at least a minimum salary/income. So, what are your thoughts. Do you think it is the ~"idealism" of pre-meds/med-students that blinds them from a simple google search for some basics in these areas? I have found in undergrad, those specifically choosing to NOT go into medicine have a better understanding of these basics. I heard and hear individuals (choosing against medicine) say, "I don't want to be poor until I'm 35" or "I don't want to be living in a shoebox until I'm 35+" or etc, etc.... I personally regard pre-meds/med-students/physicians as some of the brightest and most educated this country has to offer. I am just surprised at how naive or oblivious they sometimes seem to be. i don't mean that to be inflamatory or insulting. I am just looking at the realities and the claims of "unawareness" and even asking med-students TODAY simple questions, they often are surprised at the education the questions provide!

..However, I don't see why I have to pay residents more because medical schools decided to charge people more...

Agreed.

...NP's and PA's do similar jobs...However, ...resident jobs ...very different. ...you may be doing similar tasks. However, overall, your jobs are very different...

The problem ...is that no one is paid on their "worth". People are paid based upon the law of supply and demand...

Agreed, welcome to Stark and any number of things that cause numerous ATTENDINGS trouble in getting paid..."what I'm worth".

...Medical residents are underpaid for the work they do...that's complicated as when we remove residents we often restructure systems to make costs decrease...

Exactly why it is hard to make a bunch of assumptions and try do simple math and declare you are underpaid. Within the "industry" the vast majority of "factories" (i.e. hospitals) run without residents and often with less support staff (i.e. employees) and thus less overhead then the big teaching institutions. The "product" is being produced, often in higher volume and often more efficiently in the absence of residents. So, simple calculations of dollar signs for "value added" are quite difficult and require much in the way of assumptions.

..."Worth" is very subjective

Agreed. I think, IMHO, the value added for me is that residents stimulate continued learning and can keep you sharp. Without residents, you can do self-directed learning but there is a tendancy to slowly fall behind. I can not say residents speed me up or add efficiency to the care I deliver. I can not say they are "needed" to provide good care. There is actually often a loss of efficiency and thus production. But, The resident worth, IMHO, is not in the healthcare they may or may not be providing. So, as I stated, I expect something far different oout of residents and do not expect them to be ~super mid-levels.

Oh, Forgot this issue too. I think, can't remember if I touched on it earlier in this thread:

...Arguing worth is also a very slippery slope. Why are all residents paid the same? Maybe some residents are "worth" more than others?

One could argue that surgical residents work more hours than other residents. Why should they not be paid more for that?...

During my general surgery residency, the GME actually considered this matter in the face of the, at that time, "new" 80 hours rule. I don't know any aspect of RRC/ACGME in these regards.

They discussed the issue of having an hours based component to income. The issue also came up in reference to "full vestment" in retirement funds and vacation time. The outcry was swift. The Ed apparently had a lesser number of hours/wk cap then surgery. They said it would be unfair. The ED would see a significant difference in income and accrued time off. Also, surgery residents would, based on "full time employment" number of hours be fully vested in about 18 months and ED grads would still be incompletely vested by graduation.

The issue of volume and/or production was briefly discussed too. However, the fact that it should be "about training" and that such a thing would present a "conflict of interest" was immediately brought up. Specific item cited was the IM, Pedes, FM all had in-service "patient caps"; surgery never had any caps! The argument was that any production type system would force these groups to compromise education via protective caps in favor of increased revenue.... But, from the mid-level standpoint, they do have specific differentials in how much they are compensated based on items such as hours/shifts/call vs no call/production/specialty..... Not every mid-level makes the grand numbers cited for some ortho/neurosurgery/etc... PAs.

 

[45408]

D. These increased costs could be mitigated against by a higher salary in residency. However, I don't see why I have to pay residents more because medical schools decided to charge people more.

What percentage of a resident's salary does your institution fund? and how much comes from CMS?

One could argue that surgical residents work more hours than other residents. Why should they not be paid more for that?

Works for me...


For anyone who thinks residents shouldn't be paid MORE, do you think they should be paid LESS? Why or why not?

 

[NotAProgDirector]

What percentage of a resident's salary does your institution fund? and how much comes from CMS?

The institution pays the entire resident salary. Residents are paid by GME. By "why should I have to pay more", I meant the institution. My point was simply that it's crazy to think that because medical schools have gotten away with charging ridiculous tuitions, that now I should be pressured to pay more to residents to help pay off that debt -- when it's the obscene debt that's the problem in the first place.

It's hard to know how much of resident salaries are paid by CMS. Funds from CMS flow into the institution and help defray all of the costs of running residencies. There isn't a line item budget for CMS dollars.

 

[Hernandez]

I am not sure the IRS still holds the position as you describe:
But, based on there proposed and fought rule changes, maybe they do and thus their multiple legal losses.It is not so much what the IRS considers as much as what the courts/law considers. The IRS needs to split the decisions to get to the supremes.

http://findarticles.com/p/articles/mi_m3257/is_1_63/ai_n31297914/

and its official, as far as taxes, were employees, but whe it comes to collective bargaining, we cant because were students. yay government!

 

[NotAProgDirector]

and its official, as far as taxes, were employees, but whe it comes to collective bargaining, we cant because were students. yay government!

That's not correct. Residents are welcome to unionize if they want. CIR is the usual organizer.

What's illegal is for ALL residents to join one big union. That's illegal for anyone.

 

[JackADeli]

and its official, as far as taxes, were employees, but whe it comes to collective bargaining, we cant because were students. yay government!

There are resident unions to my understanding. I believe the University of Michigan has a resident union... I also hear the dues are pricey... not unlike the reality of unions in general. I don't know of attendings unionizing... but I am pretty sure residents have been unionized for over a decade in some places. Oh, and university grad students have unionized for some time too. I was not aware that being a student precluded unionization....

 

[Hernandez]

That's not correct. Residents are welcome to unionize if they want. CIR is the usual organizer.

What's illegal is for ALL residents to join one big union. That's illegal for anyone.

You're over simplifying the situation as I did. The National Labor Relations Board considers us students, and they've taken that argument to court before, as it stands theyve lost once in the BMC case in '99 but it was ne'er appealed because the hospital decided to forego further legal wranglings and negotiated. its unclear what would happen should the National Labor Relations Board push the issue again in the judicial system.

 

[JackADeli]

You're over simplifying the situation as I did. The National Labor Relations Board considers us students, and they've taken that argument to court before, as it stands theyve lost once in the BMC case in '99 but it was ne'er appealed because the hospital decided to forego further legal wranglings and negotiated. its unclear what would happen should the National Labor Relations Board push the issue again in the judicial system.

http://www.umgeo.org/

that is a student union.....

 

[NotAProgDirector]

You're over simplifying the situation as I did. The National Labor Relations Board considers us students, and they've taken that argument to court before, as it stands theyve lost once in the BMC case in '99 but it was ne'er appealed because the hospital decided to forego further legal wranglings and negotiated. its unclear what would happen should the National Labor Relations Board push the issue again in the judicial system.

Thanks for pointing out the controversy. I never have reviewed the entire history.

From what I can see:
1. Whether residents can form unions is both a federal and state law issue.
2. As early as the 1950's, resident unions were formed in NYC as state laws there permitted it.
3. In 11/1999, the Federal NLRB ruled that residents were employee's and had the right to organize into unions. I don't see that the NLRB "lost" the BMC case in 1999. The NLRB commisioners changed, and by a single vote decided to change a prior ruling. Since 1999, it has been federal law that residents can organize,so it seems to me that BMC lost -- and perhaps that's what you mean.
4. This has not stopped hospitals from fighting it. St Barnabas recently petitioned the NLRB with the usual arguments. They got their chain yanked, told to suck it up. Despite that happening 6 months ago, I see no sign of a union there.

So, it appears to me that the law of the land is that residents can unionize. Hospitals/Programs can slow the process down, stretching it out for years. All employers trying to avoid unions have used these tricks, medicine is no different.

My thoughts:

• Any discussion that residents are not employees is foolish. Hospitals that are still trying to make this argument either have their heads in the sand, or have decided that trying to postpone the inevitable as long as possible makes good financial sense.
• Residents should be able to unionize if they'd like. Whether that makes sense or not will depend on each program.
• In General, I expect that most residents would benefit from a union, at least at front. Whether the benefits would outweigh the costs in the long term are unclear.

Possible upsides of a union:

• Better wages (although overall I expect the benefit would be modest)
• Clear leave policies, including sick time.
• Improved grievence procedures.

Possible Downsides:

• Union dues might not be "worth it" in the long run.
• Unions tend to take political stances. CIR/SIEU has already taken a stand on the new ACGME Duty Hour limits -- saying they did not go far enough. Perhaps you agree, perhaps not, but if you disagree your money goes to fund their stand anyway.
• Unions can be abusive and corrupt, just like employers

 

[NotAProgDirector]

Just a comment about your points. While medical school is a financial decision and I agree people should know what they are getting into, it also stands to reason that the changing cost of medical education should be reflected in a changing standard in how things are compensated after words.

I see that as a "wag the dog" type of argument. Let's say I want to go on vacation to Mexico. Let's say that airline prices have gone up, so now I don't have enough money to pay for the hotel room. Is it fair for me to tell the hotel that they have to lower their price, because the airlines raised theirs? If medical schools want to raise tuition, and people are willing to pay, that shouldn't dictate how much I now have to pay people later. Which brings us to your second point...

Otherwise, medicine is going to go the way of law school with way too many grads and not enough jobs in the long run to pay of the debts.

Sort of. The number of jobs is staying about constant, so it's not a jobs/employee imbalance. However, what I am suggesting is that students may come out of medical school heavily in debt, find their income stream is not in balance with that debt load, and this may cause them financial hardship. That I expect would have a recursive effect on medical school -- people would stop being willing to pay so much for it because it wouldn't be "worth it".

It seems as if you are demanding restraint from the student which I would argue is a burden to place on a 18-22 year old when it should be done by those overseeing the situation and regulating things.

Really? I don't see many 18 yo's going to medical school, so mostly we're looking at people in their 20's. But that's not really the issue. Theoretically these are the top 1-5% elite students in our culture. Yes, I do expect they should understand the debt they accumulate and the cost of servicing it in the future. It's not that complicated, really. There are plenty of web based calculators that will do so.

This does not absolve the schools themselves from being complicit in this. I think some truth-in-lending protections are needed for the educational loan industry.

I understand it’s difficult to determine “worth” per se. However, some of your arguments are specialty dependent. For example many residents do not do electives but spend all their time within their department (ex. Rads, Rad Onc, Derm, etc.)

I totally agree, and pointed that out in my post. I can't speak for other fields. That's why it's difficult to measure worth.

While it’s easy to say residents are paid based on supply and demand, they have been put into a situation where supply and demand and a free market were taken away from them with no consent.

That's a complicated statement. I agree that the supply/demand nature of residency and free market are quite corrupted. I disagree that it was "taken away with no consent". I assume that you are talking about the match. In my opinion, low resident salaries are not driven by the match, but more driven by the requirement of graduating medical students to complete residencies to be licensed / boarded, the relative equity between training spots and graduates, and the difficulty of residents moving from one residency to another. All of these issues are important for the safety/quality of our physician workforce (at least to some extent). Balancing them with their effect on the free market is not easy.

If you took only American graduates I would argue supply and demand would be in place and salaries would likely have to go up so that institutions could get the residents they wanted. However, those in power have allowed the residency pool to be flooded IMG/FMG applicants to the point that the residencies looks at residents as disposable cogs more than individuals.

Not exactly, I think. There are more residency spots than american grads. So, we need some IMG's to fill those slots. If we stopped all IMG's, a bunch of residency spots would go unfilled. Those programs would close, until the number of spots equalled the number of grads. And then we'd be right back to where we were -- although I agree there would likely be some upward pressure on salaries while open slots existed, as slots / programs were weeded out, but it would be temporary.

I'm not certain who you mean by "those in power" whom have flooded the market. As I have mentioned before, if you feel that there are too many IMG's, they can be limited by adjusting visa rules. Regardless, as is, I expect that the vast majority of US grads from US medical schools get residency spots (I can't be certain, since it's unknown how many US grads in the scramble get spots).

Also, the current match system has robbed the system of a free market. In a free market, the number #1 student at Harvard with all the credentials in the world would get multiple offers and be able to negotiate a salary. This would then trickle down and a tiered salary system in place. This is decidedly not what is in place at this time. Because of that it seems about inaccurate to make a comparison to the supply and demand/free market v. midlevels.

Agree, resident salaries are not truly a free market. Then again, hospital X may have a salary of $45K and hospital Y may have a salary of $50K, and you might decide to rank Y over X because of that, so there is some free market at work.

Also, the residency job market is (in my opinion) more profoundly non-free-market because of it's basic structure. The number of jobs is close to the number of possible employees. All of the jobs start on the same day. You must get one of these jobs to continue. All jobs contain a significant educational component, requiring close mentoring and supervision. Because of these facts, it's never going to be a free market.

Let's look at your suggestion. Let's say we did let it be a free for all -- what would happen? Since programs have specific numbers of slots, they can do several things:

1. They could decide to only offer exactly the number of spots that they have. In this case, a small minority of students would get most of the offers. They would then choose one, and then programs would then make more offers, and so on. For the top echilon, it's a great win. For the vast majority, it's a complete nightmare. You would never know when you would get an offer. When you finally do get an offer, you wouldn't know if you should take it or wait for something better. If you allow people to change their mind anytime a better offer comes along, the process could go on for months. And, once time drags on, you might be willing to settle for a much lower salary.

2. I might simply send out 5x the offers than I have spots, and tell people that once the spots are gone, that's it. People might hold onto multiple spots. It would be complete mayhem. Of note, we currently call this "the scramble". Is that really what you'd want?

You keep mentioning that the match was forced on students. Students created the match to prevent the insanity that existed in the free-for-all prior.

As noted, the supreme court has once again reaffirmed that residents are employees.

I totally agree with SCOTUS. Arguments that residents are students are inane, and are simply a game to try to make money (by paying less taxes) and perhaps avoiding collective bargaining. That game seems over.

While I agree with you that value of a resident is significantly less at the start and rises to that of near attending level by the time of graduation, I don’t agree that compensation is commiserate with that. Do you really think a PGY-3 IM resident merits about $14 /hour?

My PGY-3 residents do about 4 blocks of call/inpatient work a year, and much of the rest of the time is electives, research, etc. If I was paying them based upon their financial worth to my bottom line, I might not pay them at all for their elective and research time.

Do I think residents are "worth" more than $14 an hour? Of course I do. But if I look at their actual clinical productivity, it's not clear that they earn it. Also, I think the local school teachers are "worth" more than they are paid. Are you willing to double your school taxes to pay them more? If not, how much are they "worth" and how are you going to measure that?

My point, perhaps lost in the rhetoric, is that worth is a very subjective concept. You can measure, objectively, financial worth -- If I generate $300K worth of billing, then I am presumably "worth" that gross minus expenses (and some profit for the hospital). But we all know worth goes well beyond simple numbers, which is where things get complicated.

 

[JackADeli]

...While medical school is a financial decision and I agree people should know what they are getting into...

Correct!

...I don't see many 18 yo's going to medical school, so mostly we're looking at people in their 20's. ...Theoretically these are the top 1-5% elite students in our culture. Yes, I do expect they should understand the debt they accumulate and the cost of servicing it in the future. It's not that complicated, really. There are plenty of web based calculators that will do so.

This does not absolve the schools themselves from being complicit in this. I think some truth-in-lending protections are needed for the educational loan industry...

Yep, presumably some of the "smartest & most educated adults" on the planet. It is not reasonable to try and have it both ways. One can not declare such value and demand respect for your great gifts while all but claiming to be a naive, ignorant, uninformed duped simple or inexperienced person.

they have been put into a situation ...and ...taken away from them with no consent...

Nobody was "put into" and nothing was "taken away... with no consent".

 

[Shikima]

I've been reading this forum pretty carefully getting caught up with the discussion starting back in December. I assume it started in this time frame because of the Christmas shopping/bills were adding up (a little levity! haha!)

Ok, seriously, I'd like to speak personally on a couple of side points which I did not see brought up. I don't mind be educated, being disagreed or even agreeing with my points brought up; I'm bring this up to educate myself with the remaining time in residency I have.

I've come to the point where I've been contemplating having to find a 2nd job outside of residency. My wife hasn't been able to find gainful employment in her area of work much due to the chagrin of our current economic climate. With the cost of living going up for basic necessities (fuel, utilities, food, etc) all increasing without seeing any appreciable increase from my institution to counteract the increases in the cost of living index/CPI which drains my meager salary already. My department cut moonlighting citing "budget gaps" with me hanging there with my mouth wide open bewildered as I was counting on internal moonlighting monies to offset the increased expendatures.

Furthermore, I'm concerned about the entire monies being taken in by X Department. I heard that as residents, we get $100k from Medicare to fund our yearly education -- a portion of that pays our salary and benefits (which I won't discuss how disgusting they are and expensive it is), in addition to the billing we're involved with. We've had "billing classes" to ensure we're billing at the "highest code legally" to ensure the department collects as much money as possible. In addition our institution has, unoffically IIRC, put pressure on residents to see more patients in clinic to cover budget gaps.

I recognize and understand that I'm a resident. But I also have the proverbial mouth to feed. I've been hamstrunged by my department and institution. That's it for my soap box. /rant off.

 

[JackADeli]

...My wife hasn't been able to find gainful employment in her area of work much due to the chagrin of our current economic climate. With the cost of living going up for basic necessities (fuel, utilities, food, etc) all increasing without seeing any appreciable increase from my institution to counteract the increases in the cost of living index/CPI which drains my meager salary already...

It is a tough time out there. You are not alone. There are many at many different levels with lack of income or lack of employment or etc... I wish you the best.

That said, it is important to understand, in residency or any other field or job market, the lack of one's spousal employment is not an indication for you to be paid more. Also, an over all bad economy and/or rising costs of living is a perfect storm. In a bad economy, employers are not just going to start paying out more or having larger compensation increases. Healthcare is a business industry. Granted, it is skewed and unfortunately twisted in numerous ways. Still, I have watched as hospitals unsure if their overall "payor base" is going to be pushed to lower reimbursement levels (i.e. ~medicare/medicaid for all) are hire freezing, slary freezing, etc.... The current omnibus healthcare law has had an impact in the hiring, the offers, and compensation that is far reaching. No one should believe that a resident can expect any significant compassionate raise to combat the economic downturn. That would not make any business sense in any industry but especially in an industry with significant regulations and potential large revenue cuts.

 

[Shikima]

It is a tough time out there. You are not alone. There are many at many different levels with lack of income or lack of employment or etc... I wish you the best.

That said, it is important to understand, in residency or any other field or job market, the lack of one's spousal employment is not an indication for you to be paid more. Also, an over all bad economy and/or rising costs of living is a perfect storm. In a bad economy, employers are not just going to start paying out more or having larger compensation increases. Healthcare is a business industry. Granted, it is skewed and unfortunately twisted in numerous ways. Still, I have watched as hospitals unsure if their overall "payor base" is going to be pushed to lower reimbursement levels (i.e. ~medicare/medicaid for all) are hire freezing, slary freezing, etc.... The current omnibus healthcare law has had an impact in the hiring, the offers, and compensation that is far reaching. No one should believe that a resident can expect any significant compassionate raise to combat the economic downturn. That would not make any business sense in any industry but especially in an industry with significant regulations and potential large revenue cuts.

Thanks for your insight. However, I'd like to disagree with you on some principles not fully addressed. We've entered into training with stringent rules, specifically speaking, the hours. This will soon be changing; Many steps in the process will be strictly monitored for compliance. Now, if a resident is in a system where he is looking to get a 2nd job (moonlighting if he has a full license or delivering pizzas because he doesn't) contributes to the overall time spent "working" and thus is a "violation" of said hours. If the system doesn't support the resident, how is the resident expected to support himself?

This becomes a philosophical debate not of "shoulds" and "entitlements", rather what are the rules and how does said resident remain without violating them. In addition, since we've changed from the Gold standard and have become a credit based economy... any hint in a resident becoming financially destablized is multifactorial in the system as a whole (just like when a resident becomes sick and the service is stretched thinly). Patient, service, hospital, and the potential for liability can occur because of emotional stressors.

Residency is hard enough as it is, but Residents cannot work for free.

 

[JackADeli]

...I'd like to disagree with you on some principles not fully addressed...

This becomes a philosophical debate not of "shoulds" and "entitlements", rather what are the rules and how does said resident remain without violating them...

Residency is hard enough as it is, but Residents cannot work for free.

Sure....

 

[reno911]

For anyone who thinks residents shouldn't be paid MORE, do you think they should be paid LESS? Why or why not?

This argument is not really that hard to make for some residents. If residency were a free market you would find that some residency positions would pay more (higher work load/lower expected income) whereas others would pay much less, pay nothing, or even charge tuition (lower work load/higher expected income).

Since the current system is fairly insulated from ordinary market forces, anyone who claims that they can put an accurate price on what a resident ought to be paid, is really just pulling a number out of thin air.

I think that it's a virtual certainty that in a free market, some residency positions would pay much less than they do now and still have no problem filling at all.

 

[Bombrainiac]

Residents are way underpaid, and way overworked. No debating that.

 

[manutdfan]

just read this thread from start to finish.

Residents are way underpaid, and way overworked. No debating that.

couldn't agree more

 

[lipomas]

Residents are way underpaid, and way overworked. No debating that.

Everyone in the country thinks that they personally are way underpaid and generally overworked. The question is why you think that. Personally, I thought getting paid 50,000 a year + benefits was reasonable for residency given that it was temporary and I was getting an education simultaneously. Others disagree. My specialty is different though (path), although my hours were close to 80 hours many weeks.

Look at other professions though - if you think residents are underpaid and overworked are young lawyers the same? Young bankers? I knew someone who went into investment banking and she worked 16 hours a day 7 days a week for a couple of years. No work hour limit there. Part of entering a career where you are going to get compensated well is paying your dues.

Of course, as physician compensation goes down the equation changes.

 

[Bombrainiac]

Everyone in the country thinks that they personally are way underpaid and generally overworked. The question is why you think that. Personally, I thought getting paid 50,000 a year + benefits was reasonable for residency given that it was temporary and I was getting an education simultaneously. Others disagree. My specialty is different though (path), although my hours were close to 80 hours many weeks.

Look at other professions though - if you think residents are underpaid and overworked are young lawyers the same? Young bankers? I knew someone who went into investment banking and she worked 16 hours a day 7 days a week for a couple of years. No work hour limit there. Part of entering a career where you are going to get compensated well is paying your dues.

Of course, as physician compensation goes down the equation changes.

You're right. It's all relative. BUT, it turns out that young lawyers and I-bankers are also in it, and pardon my generalization, to make money. They're not working hard to help others (again a generalization, for lawyers at least). The motivations are different. And I don't know any lawyers or I-bankers who have to spend 30+ hours awake at a time regularly, or who have to sleep at work, or who don't get a chance to eat, or...well, the list goes on and on. In addition, those guys don't get paid $8 an hour.

I know quite a few docs who were I-bankers and then went into medicine, and they admit that there is no comparison to the "slave labor" of residency. A lawyer or an I-banker are also not as highly trained as a physician. And in the past, docs would be ok with residency and getting paid less than minimum wage, AND getting taxed on what is technically a stipend (never made sense to me why residents have to pay income tax), because there was a proverbial pot of gold at the end of the rainbow and there was quite as much meddling by third parties into the "art" of medicine. Nowadays, with morale so incredibly low amongst physicians and Wall Streeters looting our country, and lawyers who are punch-drunk with malpractice lawsuits, it's hard to convince the "best and the brightest" that medicine will be rewarding for them... especially since there are other, easier, and more healthy ways to earn a buck. Think about why lifestyle specialties like anesthesiology, radiology, dermatology, and ophthalmology are so popular these days... great money for the work done, and you get to leave the hospital. Since when did spending less time at work become so desirable for doctors?

Doctors have to carry the burden of the cost of their education, work through residency under ridiculous wage schemes, and then face a healthcare system that only knows how to cut their reimbursements and leave them out to dry without tort reform. I must have missed the memo, but the last time I checked, doctors are mortal beings, just like the rest of the country. We need to think about treating our doctors as well as we treat our politicians. Actually, we should just start by not paying them minimum wage or close to minimum wage through out their residency. This is especially important for those specialties where residency is very long (i.e. neurosurgery, CT surgery).

Ok. I'm done ranting now. Thanks.

 

[JackADeli]

...BUT, it turns out that young lawyers and I-bankers are also in it, and pardon my generalization, to make money. They're not working hard to help others (again a generalization, for lawyers at least). The motivations are different...

Which is not relavent to the issue. What your personal motivation is has nothing to do with what you should be paid or what you are "worth". What about the military private.... in it for patriotism?

Honestly, if physicians paid a little more attention to the bottom line dollar and stopped trying to play robin-hood giving away healthcare dollars, etc... a good part of wasted healthcare would be solved. There is nothing wrong with being in it for dollars as long as you are doing a good job for those dollars.

If you are in it for ~Mother Theresa reasoning, we wouldn't be having the conversation. Having 150-200K in loans and earning 180k plus full benefits is very doable compared to the average income earning in the USA.... unless you want more. Physicians can not have it both ways. It is hypocrisy to sit back and pretend you are not in it for the money [to some significant degree] and at the same time complain you are worth more, under paid, etc, etc.... So, I think it is time to stop falling on the charity sword. As long as physicians choose the charity argument, hospital CEOs and politicians will continue to use it against us. The number of times I have listened to CEOs tell me, "you will be paid well, but more importantly you will have our support to do the work needed by this community [read as charity/non-collecting service]". Of course, you have to love the president making similar arguments, ~"doctors did not go into medicine to be bean counters they did it to help people [read as I'm going to cut your pay more]".

Yes, I went into it to help people AND make a substantial profit. Now, everyone else say it and mean it.