Study Shows For-Profit Residency Programs Pay Less

[2021Doctor]

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Growth of for-profit involvement in emergency medicine graduate medical education and association between for-profit affiliation and resident salary

Results​

The number of EM programs increased from 117 to 276 from 2001–2021 while the number of for-profit affiliated EM residency programs increased from 1 to 29 during this period. Most (85.7%, [24/29]) for-profit affiliated programs were accredited from 2016–2021. Mean for-profit affiliated program salary ($55,658, n = 24) was $3840 lower than mean nonprofit affiliated program salary ($59,498, n = 203). For-profit affiliation was a significant predictor of lower 2021–2022 PGY1 salary after controlling for other program characteristics using multiple regression ( ß = −1919.88, P = 0.010).

https://onlinelibrary.wiley.com/doi/full/10.1002/aet2.10786

 

[alpinism]

Sadly these hospitals will do everything possible to increase profit margins.

The results will probably be the same if they looked at attending salary.

 

[bravotwozero]

Sadly these hospitals will do everything possible to increase profit margins.

The results will probably be the same if they looked at attending salary.

This might be one area in which residents can have some leverage. More and more EM spots are going to go unfilled every year, which may force them to offer more money or benefits.

If residents choose to band together in residency, they may also be in a strong position to demand wage increases. In the past, this would be a moot issue as the job market and employment prospects were great. Now, people might say 'hey, i might not end up with a decent job, at least give me enough to eat right now, same as other specialty programs in my area..'

 

[VA Hopeful Dr]

This might be one area in which residents can have some leverage. More and more EM spots are going to go unfilled every year, which may force them to offer more money or benefits.

If residents choose to band together in residency, they may also be in a strong position to demand wage increases. In the past, this would be a moot issue as the job market and employment prospects were great. Now, people might say 'hey, i might not end up with a decent job, at least give me enough to eat right now, same as other specialty programs in my area..'

Unfilled in the Match maybe. I would be shocked if there are unfilled spots after SOAP.

 

[Pudortu]

This might be one area in which residents can have some leverage. More and more EM spots are going to go unfilled every year, which may force them to offer more money or benefits.

If residents choose to band together in residency, they may also be in a strong position to demand wage increases. In the past, this would be a moot issue as the job market and employment prospects were great. Now, people might say 'hey, i might not end up with a decent job, at least give me enough to eat right now, same as other specialty programs in my area..'

It will just fill with low quality FMGs who are grateful to have a program and will keep their head down. There are thousands of docs from India who would kill to have any residency at all.

 

[Janders]

My questions were basically— aren’t a ton of these for-profits in FL and other rural/suburban SE states, and thus aren’t they significantly lower on the CoL scale, and thus maybe the lower pay is “appropriate”?

So yeah, the programs are frequently in FL, and do look like they trend towards lower CoL areas… and DESPITE controlling for this they still pay less.

Makes sense, I suspect the attending pay (all in, salary + retirement+ ALL real benefits) would look similar if it could actually be discovered and graphed…

 

[clibby]

The fundamental flaw in this study is that they did not compare PGY salaries at for profit programs to non-profit programs in the same geographic area nor control for other benefits. FL and the southeast, where a ton of these have opened up, pay residents less overall even when compared to similar COL areas. For instance, Jackson in Miami pays ~$3-4,000 less than UC Davis in Sacramento, CA despite having a slightly higher COL index and both are non-profit. The study also doesn't account for state taxes (saving a resident $2-4000 in FL vs CA), benefits, other stipends, etc. All this study proves is that for profit programs are opening in areas where the PGY salaries are lower.

I don't think saving a few thousand dollars on PGY salaries is a big motivator for the for profit hospitals. They would not cut those corners at the expense of higher qualities applicants who will work harder and take less remediation. They are not going to overpay, but they will need to meet market standards to remain competitive. Having happy, motivated residents can replace the need for attendings and NP/PAs during training and if they liked their employer, take lower attending salaries after the fact. Call me a cynic, but they are in it to replace current MD/DO/PA/NP staff and long term drive down attending pay.

 

[alpinism]

The study controlled for cost of living.

In that case it doesn’t matter where the programs are located geographically.

Regardless if you actually look at programs located in the same places you’ll see that For-Profit residencies pay less normally.

For example last year HCA Miami salaries were 4K less than U Miami with benefits.

That’s a lot of money in residency.

 

[clibby]

The study controlled for cost of living.

In that case it doesn’t matter where the programs are located geographically.

Regardless if you actually look at programs located in the same places you’ll see that For-Profit residencies pay less normally.

For example last year HCA Miami salaries were 4K less than U Miami with benefits.

That’s a lot of money in residency.

They controlled by COL based on metro area which could compare Miami to Sacremento, not comparable salary at nearby programs. Miami didn’t get better pay than the surrounding programs until they unionized. Most of the FL HCA programs are affiliated with a university and the residents actually get paid from the university based on state contracts. FL programs in general get paid poorly. Even with Miami’s pay bump thanks to CIR, they get paid less than other similar COL areas in other parts of the country. That is why just relying on COL is not a true reflection of the market forces especially when most new programs skew to one geographic region.

I am no fan of for profit healthcare or private equity, but I don’t think this is focusing on a real problem and the methodology is flawed. If residents want to get paid more, the only way they can stand up to these corporations and large health systems is really to unionize.

 

[alpinism]

They controlled by COL based on metro area which could compare Miami to Sacremento, not comparable salary at nearby programs. Miami didn’t get better pay than the surrounding programs until they unionized. Most of the FL HCA programs are affiliated with a university and the residents actually get paid from the university based on state contracts. FL programs in general get paid poorly. Even with Miami’s pay bump thanks to CIR, they get paid less than other similar COL areas in other parts of the country. That is why just relying on COL is not a true reflection of the market forces especially when most new programs skew to one geographic region.

I am no fan of for profit healthcare or private equity, but I don’t think this is focusing on a real problem and the methodology is flawed. If residents want to get paid more, the only way they can stand up to these corporations and large health systems is really to unionize.

The problem is that when you do find comparable residencies they’re still paid much less at For-Profit residencies.

It’s the same at other HCA sites.

 

[alpinism]

They controlled by COL based on metro area which could compare Miami to Sacremento, not comparable salary at nearby programs. Miami didn’t get better pay than the surrounding programs until they unionized. Most of the FL HCA programs are affiliated with a university and the residents actually get paid from the university based on state contracts. FL programs in general get paid poorly. Even with Miami’s pay bump thanks to CIR, they get paid less than other similar COL areas in other parts of the country. That is why just relying on COL is not a true reflection of the market forces especially when most new programs skew to one geographic region.

I am no fan of for profit healthcare or private equity, but I don’t think this is focusing on a real problem and the methodology is flawed. If residents want to get paid more, the only way they can stand up to these corporations and large health systems is really to unionize.

HCA Jacksonville also has lower salaries compared to UF Jacksonville for example.

 

[alpinism]

Texas is even worse and HCA Houston salaries are 8K less than UT Houston salaries.

 

[The Knife & Gun Club]

They controlled by COL based on metro area which could compare Miami to Sacremento, not comparable salary at nearby programs. Miami didn’t get better pay than the surrounding programs until they unionized. Most of the FL HCA programs are affiliated with a university and the residents actually get paid from the university based on state contracts. FL programs in general get paid poorly. Even with Miami’s pay bump thanks to CIR, they get paid less than other similar COL areas in other parts of the country. That is why just relying on COL is not a true reflection of the market forces especially when most new programs skew to one geographic region.

I am no fan of for profit healthcare or private equity, but I don’t think this is focusing on a real problem and the methodology is flawed. If residents want to get paid more, the only way they can stand up to these corporations and large health systems is really to unionize.

Across the board though you’re seeing the exact same trend - lower salaries from for-profit sites compared with non-profit sites in the same geographic area. Notwithstanding that salaries in Florida are generally lower - they controlled for salaries based on COL.

Besides the reason UM has a union is because it’s a not for profit safety net Hospital where unionization is possible. You think HCA would let residents unionize? Lol.