Self Fund Residency?

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FaisalResidency said:
Feel free


The vast number of hospitals would love to have the cheap labor associated with federally subsidized 2nd and 3rd year residents, though they're not a profitable in the first year.
Without the Medicare subsidy most will not take on the financial risk of losing in year one to make profitable investments a few years down the line.

The costs of having a program are also inflated due to higher costs for medical directors and physicians to train staff.

Overcompensation of the small existing physician population is creating havoc throughout the system.

I like to have a discourse and not resort to insults, words like dumb etc. I sense so much hubris from many of the existing physicians
that it seems poised to crack.
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don't be jealous of a group you were never qualified enough to become a part of
 
FaisalResidency said:
Feel free


The vast number of hospitals would love to have the cheap labor associated with federally subsidized 2nd and 3rd year residents, though they're not a profitable in the first year.
Without the Medicare subsidy most will not take on the financial risk of losing in year one to make profitable investments a few years down the line.

The costs of having a program are also inflated due to higher costs for medical directors and physicians to train staff.

Overcompensation of the small existing physician population is creating havoc throughout the system.

I like to have a discourse and not resort to insults, words like dumb etc. I sense so much hubris from many of the existing physicians
that it seems poised to crack.
Click to expand...
Feel free to not address anything I posted I guess lol.
 
Law2Doc said:
I didn't say you were dumb. I said you were trying to dumb down a complicated issue in a simplistic and inaccurate way. There's a difference.

Anyhow, I believe aPD directed you to resources that would allow you to educate yourself further on the issue, if you actually want to be informed, rather than buy into your own self serving notions. Making the same point to doctors who don't agree with you is unproductive. Good luck.
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There is a term in psychology called "Incentive Caused Bias". Unfortunately as this is a forum of people that have already become doctors they have a financial and psychological incentive to
keep the ability to practice medicine only in the hands of a few as to artificially increase both their incomes and their position in society.

Having a shortage of physicians exacerbates the problem even the physicians needed to train and teach graduate medical students is limited, shrinking future supply even more.
A higher number of physicians per capita will provide more people to practice in different areas, more people to teach others and more people to research new ways to save lives.


We are currently at a 1 in 300+ people is a physician. As a contrast there are nearly 30% more lawyers in the US than physicians.
 
Mad Jack said:
While the AMA was screwing around, the AOA expanded rapidly, because we have two competing groups of physicians in this country. We should have enough US citizens to fill our own residencies soon enough. As to a physician shortage, again, we don't have one. You are simply misinformed, and willfully so.

http://mobile.nytimes.com/2013/12/05/opinion/no-there-wont-be-a-doctor-shortage.html?_r=0

http://www.npr.org/sections/health-shots/2014/11/18/360145347/doctor-shortage-looming-maybe-not

http://www.rand.org/blog/2013/12/is-there-really-a-physician-shortage.html

You're coming up with a dumb solution to a problem that doesn't exist which would do nothing but harm patient safety and the physician profession. Regardless, feel free to practice wherever you're from- American medicine has no need for those that do not value meritocracy.
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Wow. I've been out-googled. As there are billions of people in the world you'll find 'articles' from nearly every viewpoint that don't reflect the entirety of a problem but at times opinion sections by
those with inherent bias.

I think the Physician profession will be fine going from a million doctors in the US (300 to 1), to 2 million doctors in the US. It would probably spread out physicians to non-cluster areas,
reduce healthcare costs and increase access to healthcare but unfortunately would force some physicians out of nice metropolitan areas and cut their income by a third.

There are ways to have large physicians groups and hospitals better monetize Graduate Medical Education and have it be a profit center and create more of a apprenticeship within
medicine and other professions and not rely on billion in government subsidies that we as a nation can no longer afford.
 
FaisalResidency said:
There is a term in psychology called "Incentive Caused Bias". Unfortunately as this is a forum of people that have already become doctors they have a financial and psychological incentive to
keep the ability to practice medicine only in the hands of a few as to artificially increase both their incomes and their position in society.

Having a shortage of physicians exacerbates the problem even the physicians needed to train and teach graduate medical students is limited, shrinking future supply even more.
A higher number of physicians per capita will provide more people to practice in different areas, more people to teach others and more people to research new ways to save lives.


We are currently at a 1 in 300+ people is a physician. As a contrast there are nearly 30% more lawyers in the US than physicians.
Click to expand...
I agree that there's incentive caused bias here but not the bias you state. YOU clearly have a self serving motivation for more spots so you are biased into thinking the US should create more spots to fix this supposed shortage ... Again good luck and maybe things will pan out for you in the future.
 
FaisalResidency said:
There is a term in psychology called "Incentive Caused Bias". Unfortunately as this is a forum of people that have already become doctors they have a financial and psychological incentive to
keep the ability to practice medicine only in the hands of a few as to artificially increase both their incomes and their position in society.

Having a shortage of physicians exacerbates the problem even the physicians needed to train and teach graduate medical students is limited, shrinking future supply even more.
A higher number of physicians per capita will provide more people to practice in different areas, more people to teach others and more people to research new ways to save lives.


We are currently at a 1 in 300+ people is a physician. As a contrast there are nearly 30% more lawyers in the US than physicians.
Click to expand...
More does not equal better. That would put us at neary 1 physician per 150 people, which is completely unnecessary, and more than double the number of any first world nation. Spain has a nearly 300:1 physician to population ratio and already has issues with physician unemployment- a number as high as you're proposing would likely result in unemployment figures pushing 30% or more.
 
Read Milton Friedman Capitalism and Freedom and his comments on the American Medical Association as the strongest trade union in the US and vigorously restricts
competition and supply of physicians which increases their wages, and raises the overall cost of medical care.

But what does Milton Friedman know!? I'm just a dumb foreigner ;-)
 
FaisalResidency said:
Read Milton Friedman Capitalism and Freedom and his comments on the American Medical Association as the strongest trade union in the US and vigorously restricts
competition and supply of physicians which increases their wages, and raises the overall cost of medical care.

But what does Milton Friedman know!? I'm just a dumb foreigner ;-)
Click to expand...
Actually, the AMA has proved time and again that it is really one of the weakest trade unions for its size. It lost countless battles over the years, to chiropractors, to HMOs, to insurance companies, now to midlevels. As an organization it's like a toothless clawless lion -- it perhaps has a big name, but really no strength behind it. Very few doctors I know even bother to become members any more.
 
FaisalResidency said:
Read Milton Friedman Capitalism and Freedom and his comments on the American Medical Association as the strongest trade union in the US and vigorously restricts
competition and supply of physicians which increases their wages, and raises the overall cost of medical care.

But what does Milton Friedman know!? I'm just a dumb foreigner ;-)
Click to expand...
The AMA is a lobbying group and has no real power. The two entities that do are the ACGME/AOA (residency slots) and state medical boards (control licensing).
 
Law2Doc said:
Actually, the AMA has proved time and again that it is really one of the weakest trade unions for its size. It lost countless battles over the years, to chiropractors, to HMOs, to insurance companies, now to midlevels. As an organization it's like a toothless clawless lion -- it perhaps has a big name, but really no strength behind it. Very few doctors I know even bother to become members any more.
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Especially since you get JAMA whether or not you pay dues...
 
FaisalResidency said:
Wow. I've been out-googled. As there are billions of people in the world you'll find 'articles' from nearly every viewpoint that don't reflect the entirety of a problem but at times opinion sections by
those with inherent bias.

I think the Physician profession will be fine going from a million doctors in the US (300 to 1), to 2 million doctors in the US. It would probably spread out physicians to non-cluster areas,
reduce healthcare costs and increase access to healthcare but unfortunately would force some physicians out of nice metropolitan areas and cut their income by a third.

There are ways to have large physicians groups and hospitals better monetize Graduate Medical Education and have it be a profit center and create more of a apprenticeship within
medicine and other professions and not rely on billion in government subsidies that we as a nation can no longer afford.
Click to expand...
Yeah but the NYTimes, NPR, and the Rand corporation are more reputable sites than most.

Doubling the number of doctors with no other changes is a stupid idea. You'll see exactly what we see with lawyers (since you brought that up). Lots of law school grads can't find jobs as lawyers despite having passed their bar exams. There are lawsuits right now against law schools for saturating the market to a very bad degree. Why would you want to do that to medicine?

If residents could bill for services on their own, we could likely do away with a decent bit of government GME money. I don't see that happening though.
 
FaisalResidency said:
When you can't attack the message, attack the messenger.

Got it.
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Instead of spending time thinking of ways to weasel yourself into a residency program why don't you do some studying to pass the boards with a decent grade to get into a program. Trust me, no matter how much time you waste on this board you won't get into residency with the method your asking for. Or was it for your friend.... LOL
 
FaisalResidency said:
There is a term in psychology called "Incentive Caused Bias". Unfortunately as this is a forum of people that have already become doctors they have a financial and psychological incentive to
keep the ability to practice medicine only in the hands of a few as to artificially increase both their incomes and their position in society.

Having a shortage of physicians exacerbates the problem even the physicians needed to train and teach graduate medical students is limited, shrinking future supply even more.
A higher number of physicians per capita will provide more people to practice in different areas, more people to teach others and more people to research new ways to save lives.


We are currently at a 1 in 300+ people is a physician. As a contrast there are nearly 30% more lawyers in the US than physicians.
Click to expand...

Yeah and look at how well they're are doing. I'm friends with a decent number of people who went to top law schools and I'm seeing them end up in dead end, low paying jobs.

In any case, there is no physician shortage. If you didn't get a residency spot, that's your fault for not being smart or good enough since there are plenty of people from abroad or the caribbean that have managed to obtain residency spots without trying to pay to create them. Feel free to come to terms with this reality while the 1,000,000+ physicians in this country continue to work hard for our patients.
 
This discussion has degenerated into name calling and insults, which is unfortunate, but perhaps not unexpected.

Medical costs in this country can be ridiculously high. Much of that is salaries -- not just physicians but nurses, PT/OT, administrators, drug companies, tech companies, etc. Everyone points to someone else as the primary cause, because it's all complicated and entangled. It's not clear if there is a physician shortage. Increasing the supply of physicians alone won't change costs -- someone would need to change the way that healthcare is paid for, and that's really complicated. Perhaps there is a better way to fund GME. Perhaps Medicare should stop paying for GME, and residents should be able to bill for their services -- and then programs can find a way to make that profitable, or if financially unprofitable can find a way to make being a "teaching hospital" more attractive to patients. Getting any real change will be near impossible -- too much money at stake, and lots of resistance to change for those profiting from the current system. Sadly it will probably take a crisis to induce change -- doubly sad since crises tend to result in poor solutions driven by emotional turbulence.
 
aProgDirector said:
This discussion has degenerated into name calling and insults, which is unfortunate, but perhaps not unexpected.

Medical costs in this country can be ridiculously high. Much of that is salaries -- not just physicians but nurses, PT/OT, administrators, drug companies, tech companies, etc. Everyone points to someone else as the primary cause, because it's all complicated and entangled. It's not clear if there is a physician shortage. Increasing the supply of physicians alone won't change costs -- someone would need to change the way that healthcare is paid for, and that's really complicated. Perhaps there is a better way to fund GME. Perhaps Medicare should stop paying for GME, and residents should be able to bill for their services -- and then programs can find a way to make that profitable, or if financially unprofitable can find a way to make being a "teaching hospital" more attractive to patients. Getting any real change will be near impossible -- too much money at stake, and lots of resistance to change for those profiting from the current system. Sadly it will probably take a crisis to induce change -- doubly sad since crises tend to result in poor solutions driven by emotional turbulence.
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Thanks for the discussion again.

It is my premise that a lack of supply of physicians not only drives up physicians salaries to above market efficient levels but also causes upward pressure on all tangent
services such as PT/OT, research physicians at drug companies, nurses and physician assistants. When physician's are unavailable due to a shortage, the demand on all
tangent service providers rises to fill the service gap in turn increasing their pay.

It is surely not the cut and dry solution to fixing our system in which we have experienced atrocious amounts of healthcare inflation over the last 35 years and now sit
as the country paying nearly the highest amount per capita yet with one of the lowest results in most major healthcare metrics. This is a multifaceted issue and not one
solely on the backs of physicians, but it is part of the problem that we can attempt to solve.

I believe in an apprenticeship model in which every hospital and/or large physician group, surgery center can also be training grounds and it is profitable to these entities
and they have the financial interest to do so and not dependent on government subsidies that tend to have inflationary affects throughout the entire system.
 
Psai said:
Yeah and look at how well they're are doing. I'm friends with a decent number of people who went to top law schools and I'm seeing them end up in dead end, low paying jobs.

In any case, there is no physician shortage. If you didn't get a residency spot, that's your fault for not being smart or good enough since there are plenty of people from abroad or the caribbean that have managed to obtain residency spots without trying to pay to create them. Feel free to come to terms with this reality while the 1,000,000+ physicians in this country continue to work hard for our patients.
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That is a market Psai. If there is a demand for lawyers, then more will be produced and if an excess number are produced then the market will correct itself.
The physician market is never given the opportunity to do so which is my main concern.

The US taxpayer is paying for your and most people's residency spots so its coming out of others pockets FYI. I'm just wondering why it can't be more free and direct.
 
Psai said:
Y If you didn't get a residency spot, that's your fault for not being smart or good enough since there are plenty of people from abroad or the caribbean that have managed to obtain residency spots without trying to pay to create them.
Click to expand...

When the rejection rate rises over a long period of time its not a metric designating people as a whole are more "Stupid" but that either a demand or supply constraint is affecting the market.
 
FaisalResidency said:
When the rejection rate rises over a long period of time its not a metric designating people as a whole are more "Stupid" but that either a demand or supply constraint is affecting the market.
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I'm happy to know that people like you who didn't qualify to become a physician couldn't just buy themselves into becoming a physician 🙂
 
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mpdoc2 said:
I'm happy to know that people like you who didn't qualify to become a physician couldn't just buy themselves into becoming a physician 🙂
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Do people buy their way into Harvard Business School or Yale Law School? No. They pay for the education they're receiving.

If they weren't accepted into Harvard's MBA program they went to many other options all the way down to low quality degrees. Then the market determines who should be
paid more.

Sorry to break it to you but even the AMA and ACGME can no longer protect the rampant costs and admit there is a shortage. The pressure on government spending especially for
entitlement programs is atrocious and with the groups lobbying congress to pass this it eventually will. Congressional pressure was why the GME funding was frozen in the first
place in the 1990's. I really believe in the next 10 years due to this physicians income will drop substantially either through a significant increase in their numbers or through limiting
of their ability to bill patients and rationing.

Meaning physician incomes will drop from $250k a year to probably around $125-$150k if you've been good and deserve a bonus from the businessman that owns the practices.

Then we'll have the people that truly wish to practice medicine for a stable income and altruism, which hopefully will cull the herd of the hubris I'm hearing in this forum.
 
http://www.nytimes.com/2016/05/26/n...attan-will-close-to-rebuild-smaller.html?_r=1

A great example of what I was saying about residencies and hospitals shutting down due to changes in health care. The nation is slowly shifting to a more outpatient based system, which does not favor teaching infrastructure, and will result in a contraction of residencies at some point down the line because you can have all the money in the world, but without hospitals, you can't have decent non-PCP residencies.
 
FaisalResidency said:
https://www.aamc.org/newsroom/keyissues/physician_workforce/
Even the AAMC agrees there is a shortage!

https://www.aamc.org/download/386378/data/07252014.pdf

Obviously the American Medical Association, American Academy of Medical Colleges and American Council of Graduate Medical Education
all believe there is a shortage of physicians but the people here don't!
Click to expand...

You realize of course that this is the same AAMC that in 2005 publically announced that offshore med school training was suspect, and that they would be making it their goal to see that "US med schools should fill all US doctor needs", and then asked all US med schools to voluntarily increase enrollment until they can drive foreign doctors out of the picture, right? I'm not sure these are your allies in your current situation. They really want more residencies for US grads only AFTER you are out of the picture.
 
The AAMC calling for more training spots is a highly biased opinion. Their goal is to make sure that as US medical schools expand (which they have) that spots expand to match, and honestly they would rather push the carib schools out of business if they could ensure that spots = US grads and that the match were changed so that US grads wouldn't get squeezed.

We clearly aren't going to agree on whether there is a doc shortage or not, nor whether increasing the physician supply would decrease medical costs. We agree that the situation is very complicated and that the number of physicians is one of the variables in the equation. You believe that increasing physicians would alter that equation to decrease costs. I believe that by itself it won't, and I don't see other change coming, so I think it would make the situation worse. But it's unprovable either way, so let's let that part of the discussion end at that.

What I'd like to focus on is this statement:
FaisalResidency said:
I believe in an apprenticeship model in which every hospital and/or large physician group, surgery center can also be training grounds and it is profitable to these entities and they have the financial interest to do so and not dependent on government subsidies that tend to have inflationary affects throughout the entire system.
Click to expand...

This idea has been floated before, and in fact is somewhat suggested in the ACA legislation. Would it be a good idea to allow community hospitals, or perhaps even just large outpatient practices to train physicians? Much depends upon what you see the purpose of physician training to be. 95% of everything you do in outpatient (and much of inpatient) medicine is pretty routine. In the outpatient realm, HTN, diabetes, health screening, chronic heart disease management, psych issues, and the management of "minor issues" (mild derm conditions, complaints that you'll do nothing about but follow, etc) make up the vast majority of everything you'll see in practice. Training at a community site will absolutely expose you to all of those things, and honestly can probably teach you quite well how to manage them.

The problem is the rare stuff. This last 2 weeks, we admitted a patient with end stage scleroderma, and had another case of unrecognized miliary Tb (missed at a community hospital...) Those types of cases all get concentrated at an academic medical center as that's where the specialists are, and we have the resources to manage these types of patients. We hope that 3 years of IM training exposes residents to both the routine bread-and-butter cases, but also these more rare cases, along with lots of time working with specialists so that they don't have to get a GI consult on everyone with a GI complaint, can recognize those rare syndromes when they occur, and can manage complex patients with multiple medical issues.

But perhaps I'm old fashioned. Perhaps the time has come for outpatient only training, which could be 2 years long rather than 3.
 
Honestly the only question is whether this is possible. If yes, then people who don't match will definitely take advantage of it since there is almost nothing you can do with an MD without a residency.
 
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tennischamp822 said:
Honestly the only question is whether this is possible. If yes, then people who don't match will definitely take advantage of it since there is almost nothing you can do with an MD without a residency.
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And the answer is a flat out NO.
 
mpdoc2 said:
And the answer is a flat out NO.
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I think that it is an eventual conclusion. The AMA, AAMC, and ACGME all agree we have a shortage and its due to a funding problem in GME.

There is significant pressure on Medicare and subsidizing the education of "wealthy" physicians will not be a priority, which is why in the 1990's
the subsidy basically froze which is why we're in this position in the first place.

The groups that are involved with trying to change this know how to pressure the Congressmen and NGO's and its in everyone's interest to see it happen
except current US physicians which aren't an organized or lobbying group.
 
FaisalResidency said:
I think that it is an eventual conclusion. The AMA, AAMC, and ACGME all agree we have a shortage and its due to a funding problem in GME.

There is significant pressure on Medicare and subsidizing the education of "wealthy" physicians will not be a priority, which is why in the 1990's
the subsidy basically froze which is why we're in this position in the first place.

The groups that are involved with trying to change this know how to pressure the Congressmen and NGO's and its in everyone's interest to see it happen
except current US physicians which aren't an organized or lobbying group.
Click to expand...

It's only an eventuality in your dreams. In the US we always frown upon paying your way to a position where you couldn't qualify for.

I guess this is a bit of a culture shock for Faisal because he got into medschool by bribing some official with daddy's money. Buddy this is not how things work here in America.

I honestly think that the only way you can get into residency by paying for it is to try to bribe some program director to accept you (and good luck with that). Because U.S. law will never change on this subject. We won't accept physicians that just paid to get into residency and get a medical license. If no PD accepts your bribe, if your dream is to some day get into residency by paying for it, the closest you'll get to becoming a physician is working at that Taco Bell I mentioned at the local hospital.
 
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FaisalResidency said:
I think that it is an eventual conclusion. The AMA, AAMC, and ACGME all agree we have a shortage and its due to a funding problem in GME.

There is significant pressure on Medicare and subsidizing the education of "wealthy" physicians will not be a priority, which is why in the 1990's
the subsidy basically froze which is why we're in this position in the first place.

The groups that are involved with trying to change this know how to pressure the Congressmen and NGO's and its in everyone's interest to see it happen
except current US physicians which aren't an organized or lobbying group.
Click to expand...

What is the time frame for this change? That is key.

For example, MO created the Assistant Physician license in 2014, but they are just now accepting applications for it this year (2016).
 
mpdoc2 said:
It's only an eventuality in your dreams. In the US we always frown upon paying your way to a position where you couldn't qualify for.

I honestly think that the only way you can get into residency by paying for it is to try to bribe some program director to accept you. Because U.S. law will never change on this subject. We won't accept physicians that just paid to get into residency and get a medical license. If no PD accepts your bribe, if your dream is to some day get into residency by paying for it, the closest you'll get to becoming a physician is working at that Taco Bell I mentioned at the local hospital.
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So you feel good about the US Taxpayer paying for your education? Why should the US Taxpayer cover $150k to cover your residency costs?

As a professional in an industry with virtually zero unemployment and the highest income levels of any large scale profession in the US and the ability to make that income
for decades, I don't think a government handout is needed to subsidize your education.

Let's use that $15 billion to educate children, feed poor people or reduce student loans to people that make median post-college wages of $40-$70k, not subsidizing the highest paid profession in
the country.
 
FaisalResidency said:
So you feel good about the US Taxpayer paying for your education? Why should the US Taxpayer cover $150k to cover your residency costs?

As a professional in an industry with virtually zero unemployment and the highest income levels of any large scale profession in the US and the ability to make that income
for decades, I don't think a government handout is needed to subsidize your education.

Let's use that $15 billion to educate children, feed poor people or reduce student loans to people that make median post-college wages of $40-$70k, not subsidizing the highest paid profession in
the country.
Click to expand...

As a person who pays a significant amount of taxes (over 200K last year) I would much rather pay for physicians residency training , than be worried that my child is being treated by a doctor who paid to get his medical license and couldn't actually get in to residency on his own merits.
 
mpdoc2 said:
As a person who pays a significant amount of taxes (over 200K last year) I would much rather pay for physicians residency training , than be worried that my child is being treated by a doctor who paid to get his medical license and couldn't actually get in to residency on his own merits.
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So you paid $200k in taxes meaning you probably earned $500,000+ a year and you still believe the government should subsidize your education?

Jeez.
 
FaisalResidency said:
So you paid $200k in taxes meaning you probably earned $500,000+ a year and you still believe the government should subsidize your education?

Jeez.
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For the safety of my children, yes, I wouldn't want someone like you being the physician treating them. Money can't buy competence.
 
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mpdoc2 said:
For the safety of my children, yes, I wouldn't want someone like you being the physician treating them. Money can't buy competence.
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Your emotional maturity within a topic that I have been nothing but conversational about is really striking and disheartening as someone that is supposed to be a provider.
All you've done is insult, when all i've shared are my opinions and situation. Thanks for your compassion Doctor!
 
FaisalResidency said:
Your emotional maturity within a topic that I have been nothing but conversational about is really striking and disheartening as someone that is supposed to be a provider.
All you've done is insult, when all i've shared are my opinions and situation. Thanks for your compassion Doctor!
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I'm glad I've disheartened someone who expects to pay to get a residency position.
 
FaisalResidency said:
https://www.aamc.org/newsroom/keyissues/physician_workforce/
Even the AAMC agrees there is a shortage!

https://www.aamc.org/download/386378/data/07252014.pdf

Obviously the American Medical Association, American Academy of Medical Colleges and American Council of Graduate Medical Education
all believe there is a shortage of physicians but the people here don't!
Click to expand...
The AAMC, AMA, and ACGME all stand to personally gain financially from an increase in medical students, residents, and practicing physicians. Nonpartisan think tanks that have been hired to objectively analyze the situation, such as the RAND corporation, have repeatedly found the shortage to be nonsense when midlevels are thrown into the mix. Furthermore, the organizations you have listed specifically want to increase US medical students to the point that they can fill all available residencies.
 
AdmiralChz said:
This thread isn't really going anywhere... It's essentially everyone against one person for dozens of replies. And that poster is quite indignant.
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True - but it would be a game changer if the OP is able to do this.
 
FaisalResidency said:
Your emotional maturity within a topic that I have been nothing but conversational about is really striking and disheartening as someone that is supposed to be a provider.
All you've done is insult, when all i've shared are my opinions and situation. Thanks for your compassion Doctor!
Click to expand...
It seems like there is some kind of cultural barrier that prevents you from understanding that your mentality is considered detestable by most within the physician community. One is not compassionate when dealing with ideals they find abhorrent, such as those of nepotism and plutocracy.
 
mpdoc2 said:
And the medical community will never allow someone to purchase a residency position. I assure you of this.
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A quote from aProgDirector:

"And last, I'm assuming/hoping you don't need a visa. There is little question in my mind that any setup like this (you pay a third party, who then "funds" your residency, and then those funds are returned to you as salary) would constitute visa fraud for an H visa. The H rules are very clear that your employer needs to pay you a prevailing wage, and this type of setup is unlikely to pass legal muster. The rules for a J visa are less rigid, but I am concerned that the State Dept might still frown on this."

This implies that a residency can be self funded if the person funding it does not require a visa (not sure about the OP, but many US-IMGs/DOs would not need a visa)
 
tennischamp822 said:
A quote from aProgDirector:

"And last, I'm assuming/hoping you don't need a visa. There is little question in my mind that any setup like this (you pay a third party, who then "funds" your residency, and then those funds are returned to you as salary) would constitute visa fraud for an H visa. The H rules are very clear that your employer needs to pay you a prevailing wage, and this type of setup is unlikely to pass legal muster. The rules for a J visa are less rigid, but I am concerned that the State Dept might still frown on this."

This implies that a residency can be self funded if the person funding it does not require a visa (not sure about the OP, but many US-IMGs/DOs would not need a visa)
Click to expand...

As an Attending physician who was involved in starting a residency program I can guarantee you that you cannot fund your own residency position no matter what your visa status may be. My advice for you is if you want to get into a residency position you need to earn it and you can't simply write a check to get into residency. If a program director accepts you based on a promise of funds to the program the program will face shutting down by the ACGME. I'm also fairly sure the institution will fire said program director for doing something so stupid.
 
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If someone pays for their position what incentive is there to ever fire an incompetent resident?
 
There are groups lobbying Congress, Labor groups and the ACGME at this moment to allow this. I think the point some people are missing is that an essential freeze in government funding has artificially inhibited the number of
positions available for MD's to enter a residency program to practice medicine.

If someone offers to pay the tuition at Harvard Business School, Yale Medical School or Stanford Law school are they buying their position?

Not at all. The institution whether a hospital or practice has to interview and assess the individual just as any program would and then decide whether the individual is acceptable.
As there are increasingly limited government funds, Graduate Medical EDUCATION cannot be free to future physicians any longer except to those that receive what I would call
a medicare "scholarship" to their residency.

I hope this clarifies my position that I feel is very logical and is truly a meritocracy but not one limited by cartel type behaviour on the part of institutions that artificially
reduces the supply of qualified physicians that can practice in this country.

And if they fail, they don't come back for year two, just like Med School, Law School etc. Consider Graduate Medical EDUCATION to be an education and not a
job.

Cheers!
 
mpdoc2 said:
As an Attending physician who was involved in starting a residency program I can guarantee you that you cannot fund your own residency position no matter what your visa status may be. My advice for you is if you want to get into a residency position you need to earn it and you can't simply write a check to get into residency. If a program director accepts you based on a promise of funds to the program the program will face shutting down by the ACGME. I'm also fairly sure the institution will fire said program director for doing something so stupid.
Click to expand...

You are correct that this situation is illegal and a program director being bribed would cause ACGME to shut down the program.

What I'm discussing is an entire wholesale change in the funding of Graduate Medical Education to more of an extension of a paid Medical School rather than a job in which an employer has to lose
money unless they're subsidized by the government.
 
Is there a single country in the world that asks its medical school graduates (who are often in significant debt already) to pay to work in a hospital for 80 hours a week for 3-7 years during residency?
 
hello1234! said:
Is there a single country in the world that asks its medical school graduates (who are often in significant debt already) to pay to work in a hospital for 80 hours a week for 3-7 years during residency?
Click to expand...

The reason people accept 80-100 hour weeks is because there is such a shortage of these positions. They're able to abuse to the point of diminishing value their residents.
If it was a more open, competitive system not reliant on one funding source than the quality applicants wouldn't go to programs that treated people in this manner.

People can individually make the determination about the return on investment from their careers which is a byproduct of total allotted investment in capital, opportunity cost of earnings over those
years relative to long-term earnings capacity discounted by potential for gaps in unemployment due to demand and unemployment rates of the profession.

A very basic example:

College Basic Diploma: $120,000 in debt relative to an median income of $45,000 and a 5% unemployment rate

College + Medical School Debt: $300,000 in debt relative to a median income of over $200,000 and a less than .5% unemployment rate. (Current)

College + Medical School + ($150k) Graduate Medical Education: $450,000.

As the median income of a physician is over 4x of the median college graduate plus the continuity of that income with virtually no unemployment
and the understanding that free cash accelerates as income accelerates, I'm sure an excel guy could model out the above equation and even if the
college degree holder made twice as much, the sheer return on investment from practicing medicine even with the additional $150k (approx medicare subsidy amount)
would still be a better investment than virtually any field.
 
FaisalResidency said:
The reason people accept 80-100 hour weeks is because there is such a shortage of these positions. They're able to abuse to the point of diminishing value their residents.
If it was a more open, competitive system not reliant on one funding source than the quality applicants wouldn't go to programs that treated people in this manner.

People can individually make the determination about the return on investment from their careers which is a byproduct of total allotted investment in capital, opportunity cost of earnings over those
years relative to long-term earnings capacity discounted by potential for gaps in unemployment due to demand and unemployment rates of the profession.

A very basic example:

College Basic Diploma: $120,000 in debt relative to an median income of $45,000 and a 5% unemployment rate

College + Medical School Debt: $300,000 in debt relative to a median income of over $200,000 and a less than .5% unemployment rate. (Current)

College + Medical School + ($150k) Graduate Medical Education: $450,000.

As the median income of a physician is over 4x of the median college graduate plus the continuity of that income with virtually no unemployment
and the understanding that free cash accelerates as income accelerates, I'm sure an excel guy could model out the above equation and even if the
college degree holder made twice as much, the sheer return on investment from practicing medicine even with the additional $150k (approx medicare subsidy amount)
would still be a better investment than virtually any field.
Click to expand...

What you dream of will never happen and those you mention lobbying are a bunch of carribean grads with no money and zero lobbying power. What you hope of, to land yourself a spot by buying it, will never happen. I'm done wasting my time on you and this thread.
 
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