Should surgical residents get more compensation than other residents?

[thedrjojo]

The most recent annals of surgery has this interesting article I stumbled across (looking for a journal club article, sadly, this one isn't appropriate for it)... basically, we average much more hours per week than many other residencies, but hospitals pay all residents equivalent based on PGY year, meaning that we are definitely getting screwed. It's an interesting thought, but would sadly never get any traction, especially in a place like where I am at where we are represented by CIR which is ruled by those other specialties that don't put in as many hours on average...

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[anonperson]

Interesting article. I was hoping they would have put in OB GYN average hours. I feel they are somewhere inbetween IM and Gen Surg. Where I finished my training, the surgery residents put in the most hours followed by OB and then the IM/FM residents.

But I think the article is a little simplistic equating more hours to more pay. Another aspect that needs to be addressed is the cost of training a certain specialty. A general surgery/neurosurgery/OB etc resident would need a greater level of supervision than some of the specialties listed in the article which incurs greater cost to the institution. The other issue is the malpractice liability that institutions take on with procedural specialty training that is going to be significantly higher in surgery or OB versus derm or IM. If one were to take that into account I don't know if one could argue that one type of resident deserves more than the other.

 

[balaguru]

A better way to look at it wound be to analyze wRVU or total accounts receivable per department and divide by the number of residents. As residents we did the billing within Epic and this information was easily available. We usually had at least 2 and sometimes 3 OR's running at the same time with one supervising surgeon. Also the volume of E&M that we did would not have been possible without residents.

 

[Smurfette]

A better way to look at it wound be to analyze wRVU or total accounts receivable per department and divide by the number of residents. As residents we did the billing within Epic and this information was easily available. We usually had at least 2 and sometimes 3 OR's running at the same time with one supervising surgeon. Also the volume of E&M that we did would not have been possible without residents.

You did billing during residency? Wow. We never got taught any of that and I never saw an attending do it during residency either; I think their office staff did it for them. We also weren't allowed to dictate op reports due to concerns about billing.

 

[balaguru]

Yeah. We did the billing for cases for nearly all of the services. Burns was the only service that did their own billing and dictating because of how important documenting and coding surface area was. Many of the faculty on surg onc dictated their own op notes, because I presume they were unsatisfied with how residents did it in the past but we did the billing. We billed E&M in clinic but not on the ward. The hospitals had their own coders to do this. We would get emails from the coders to addend documentation for various reasons. Knowing what I know now about E&M, I'm pretty sure our documentation did not support the E&M that we billed in clinic. I bet the hospital coders adjusted the E&M. We had a yearly mandatory billing compliance lecture that most people slept through. The billing system was modified to automatically upload our cases to the ACGME case log system. As residents we hated it because it seemed to be unreliable: cases never getting logged or randomly disappearing. I think I lost a panc case or 2.

 

[thedrjojo]

Wow, that sounds like a pita and great. We never see the billing stuff here, and dictate most cases

 

[Beargryllz]

Residents should just bill for everything they do

 

[SLUser11]

A better way to look at it wound be to analyze wRVU or total accounts receivable per department and divide by the number of residents. As residents we did the billing within Epic and this information was easily available. We usually had at least 2 and sometimes 3 OR's running at the same time with one supervising surgeon. Also the volume of E&M that we did would not have been possible without residents.

That is simultaneously awesome for resident education and awful for attending compensation. I can't imagine how much money was left on the table due to under-coding.

I really want to get the residents involved in coding, etc, but there's no good opportunity. Whenever I do talk to them about it, narrating as I do it or giving coding tips, they seem disinterested, which is bad as well.


To answer the OP's question: No, surgical residents should not be paid more than other residents, and I don't think it's appropriate to base resident compensation on production, as it is in opposition to the educational mission to be focused on RVUs instead of trying to learn to be a surgeon. Imagine a system where resident salaries could be reduced due to decreased productivity......

I do believe, however, that it would be entertaining to see how work hour logging would change if residents were paid hourly.

 

[balaguru]

That is simultaneously awesome for resident education and awful for attending compensation. I can't imagine how much money was left on the table due to under-coding.

I really want to get the residents involved in coding, etc, but there's no good opportunity. Whenever I do talk to them about it, narrating as I do it or giving coding tips, they seem disinterested, which is bad as well.


To answer the OP's question: No, surgical residents should not be paid more than other residents, and I don't think it's appropriate to base resident compensation on production, as it is in opposition to the educational mission to be focused on RVUs instead of trying to learn to be a surgeon. Imagine a system where resident salaries could be reduced due to decreased productivity......

I do believe, however, that it would be entertaining to see how work hour logging would change if residents were paid hourly.

Aside from the automatic integration with the ACGME case log I was appreciative of the insight this gave me. Of course, there was no shortage of the "woe is me" belly aching from some residents who felt this was yet another way to exploit them. It wasn't so bad for attendings. They could change the billing for cases and/or addend the op note if they wanted. I don't think many really cared. In fact, I can only remember one who seemed to know anything about E&M. He wrote his own notes which included all sorts of CPT jargon. Their pay became more RVU based during my chief year so maybe this has since changed. Also the hospital coders went through it all to make sure CPT's were supported by the documentation or to ask residents for additional documentation if they thought something was billable and wasn't submitted.

I'd like to say that your residents will one day care about coding but the trend is to seek out guaranteed income over income more closely tied to productivity. As this trend continues complacency will push physicians in the dark about how much they are actually bringing in. One of the reasons I use the ACS case log system is to track this sort of thing. Every once in a while I think about tracking my E&M too since I do quite a bit of it with my trauma patients.

I agree that basing pay only on hours doesn't sound like a great idea. When I was a resident sitting through billing compliance lectures I always thought that hospitals should pay us a bonus for writing notes that satisfied higher levels of service since this translated directly into revenue for them. There really is no incentive for a busy junior resident 10 consults deep to make the effort.

 

[thedrjojo]

Aside from the automatic integration with the ACGME case log I was appreciative of the insight this gave me. Of course, there was no shortage of the "woe is me" belly aching from some residents who felt this was yet another way to exploit them. It wasn't so bad for attendings. They could change the billing for cases and/or addend the op note if they wanted. I don't think many really cared. In fact, I can only remember one who seemed to know anything about E&M. He wrote his own notes which included all sorts of CPT jargon. Their pay became more RVU based during my chief year so maybe this has since changed. Also the hospital coders went through it all to make sure CPT's were supported by the documentation or to ask residents for additional documentation if they thought something was billable and wasn't submitted.

I'd like to say that your residents will one day care about coding but the trend is to seek out guaranteed income over income more closely tied to productivity. As this trend continues complacency will push physicians in the dark about how much they are actually bringing in. One of the reasons I use the ACS case log system is to track this sort of thing. Every once in a while I think about tracking my E&M too since I do quite a bit of it with my trauma patients.

I agree that basing pay only on hours doesn't sound like a great idea. When I was a resident sitting through billing compliance lectures I always thought that hospitals should pay us a bonus for writing notes that satisfied higher levels of service since this translated directly into revenue for them. There really is no incentive for a busy junior resident 10 consults deep to make the effort.

The mentality is if you feel you get compensated well enough on a salary, you lose the hassle associated with the hustle, and I think it brings a little more simplicity... You can hand stuff off without feeling like you are losing out on pay, not feel like you should pick up that extra call, etc etc. I go back and forth about which system I'd rather be in, although I'm going to have little say in the matter

 

[DoctwoB]

While I agree that residents in harder working programs may "deserve" higher pay, I see no real practical way to administer that without having residency become a "clock-in" and "clock-out" job, which is not the kind of attitude I think we should foster. Furthermore, unless there is a source of funds suddenly willing to increase resident pay (I'm not holding my breath), then any increase in salary would have to accompany a decrease in salary for other residents. Somehow I just don't see our derm and PM&R colleagues acknowledging our hard labor and offering up some of their paycheck.

One alternative would be for surgery programs to offer more non-salary perks e.g. housing allowances, more book money, etc. so that all residents could have the same salary but with de-facto pay differences. Of course the problem here is that these funds would have to come from the department, and given that surgery programs are currently having no difficulty in recruiting qualified residents, there is no incentive for them to do so.

Finally I'll go ahead and say it: We knew what we were getting ourselves into. Sure a little extra cash would be nice, but it's not like these long hours come as a surprise. If I were to support a resident cause, it would be that all residents are underpaid and to support resident collective bargaining rather then trying to pit ourselves against non-surgical colleagues in a zero-sum game.

 

[Gastrapathy]

If market forces were in full effect for residency slots, I wonder if you would have to pay tuition for surgical residency. I'd probably have had to pay for GI fellowship.

 

[DermViser]

Somehow I just don't see our derm and PM&R colleagues acknowledging our hard labor and offering up some of their paycheck.

Or any other specialty for that matter. Why not ask Urology, ENT, Plastics, or some of the surgical subspecialty lifestyle fellowships? Part of the problem is your field is just way too long in it's training - 5 years.

 

[DoctwoB]

Or any other specialty for that matter. Why not ask Urology, ENT, Plastics, or some of the surgical subspecialty lifestyle fellowships? Part of the problem is your field is just way too long in it's training - 5 years.

Because the notion that Urology, ENT, and Plastics have easier lifestyles during residency is way overblown. It will obviously vary from program to program but at the places I've seen they are as hard working as the general surgeons. After residency tends to be another story, however . . .