leilam364

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Hi everybody,
I know that residency salary varies berween 34000-52000$ per year.Does anybody know how much of these salary should be given back as tax?
 

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Tired Pigeon

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You will fill out some IRS form when you start (W2? W4?) where you list things like your number of dependents, deductions, or whatever -- the payroll department will withhold an appropriate amount based on the expected amount you will owe.

And yes, it's depressing.:(
 

EctopicFetus

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You will fill out some IRS form when you start (W2? W4?) where you list things like your number of dependents, deductions, or whatever -- the payroll department will withhold an appropriate amount based on the expected amount you will owe.

And yes, it's depressing.:(

Look at the bright side. Part of your hard earned money goes to people who dont work and are truly a drain on society. Why not expand this to national healthcare! :smuggrin:
 

f_w

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Look at the bright side. Part of your hard earned money goes to people who dont work and are truly a drain on society. Why not expand this to national healthcare! :smuggrin:

The goverment giveth, the goverment taketh away.

(Your 'hard earned money' as a resident is actually a goverment handout.)
 

Adam_K

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(Your 'hard earned money' as a resident is actually a goverment handout.)

While it is true that resident salaries originate from government medicare/medicaid subsidies, I think that characterizing them as a government handout to residents is plainly mistaken.

Unlike most recipients of government handouts, my impression is that residents are expected to work for their salary, at least at most residency programs.
 

f_w

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Unlike most recipients of government handouts, my impression is that residents are expected to work for their salary, at least at most residency programs.

The money is showered on the hospital regardless of whether you do any productive work or not. You are educating yourself, and while it seems like work it is not.

So before people get all high and mighty 'small goverment and no handouts to poor people' on us here, it is helpful to remember that your residency stipend comes from the goverment. (I come from a place where residents are paid out of hospital patient care revenue, there residents have to do actual billable work to the detriment of their education).
 

Adam_K

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The money is showered on the hospital regardless of whether you do any productive work or not.

Perhaps, but just about every resident I have seen is engaged in some amount of productive work.

You are educating yourself, and while it seems like work it is not.

Come again?

So before people get all high and mighty 'small goverment and no handouts to poor people' on us here, it is helpful to remember that your residency stipend comes from the goverment. (I come from a place where residents are paid out of hospital patient care revenue, there residents have to do actual billable work to the detriment of their education).

The problem with your argument is that residents in the US are specifically prohibited from billing for their work on medicare/medicaid patients. It is their attendings (and hospitals) that profit from this arrangement.
 

f_w

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Come again?

While I liked to think that I was doing productive work as a resident, looking back it turns out that that was not the case. There are plenty of hospitals that function quite well (at lower cost) without residents 'working' there.


It is their attendings (and hospitals) that profit from this arrangement.

If the goverment wouldn't hand out the money for medical education, residents in the US would either:
A. Not get paid (like some dental residents today, or like medical residents before medicare)
OR
B. Not get educated (like residents in the 95% of countries that don't have a similar medical education funding system)

So, its the residents that benefit from the GME $$s (and the system as a whole by having highly qualified physicians available to take care of the patients in goverment programs).
 

Adam_K

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While I liked to think that I was doing productive work as a resident, looking back it turns out that that was not the case. There are plenty of hospitals that function quite well (at lower cost) without residents 'working' there.

Yes and we've covered this argument on another thread quite recently. There are huge problems with methodologies when comparing teaching hospitals to non-teaching hospitals.

If the goverment wouldn't hand out the money for medical education, residents in the US would either:
A. Not get paid (like some dental residents today, or like medical residents before medicare)
OR
B. Not get educated (like residents in the 95% of countries that don't have a similar medical education funding system)

So, its the residents that benefit from the GME $$s (and the system as a whole by having highly qualified physicians available to take care of the patients in goverment programs).

This argument rests on current medical licensing practices in the US. Without that, I think it would be a whole different enchilada.

Presently, thanks in part to the subsidy along with licensing restrictions, residents are often used as low level indentured servants. The other thread also covers this pretty well.
 

f_w

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Yes and we've covered this argument on another thread quite recently. There are huge problems with methodologies when comparing teaching hospitals to non-teaching hospitals.

Well, you walked by the issue in a rambling thread and stated this as a fact. Not exactly 'covered' in my book.


This argument rests on current medical licensing practices in the US. Without that, I think it would be a whole different enchilada.
Last thing I know, in most states as a US graduate you still need 1 year of post-graduate education in order to put up your shingle as 'general practicioner'. The rest is strictly voluntary.

Presently, thanks in part to the subsidy along with licensing restrictions, residents are often used as low level indentured servants. The other thread also covers this pretty well.

Indentured servants would actually make the master money, residents don't.

We do residencies because we hope for the big payday afterwards, not because the evil goverment forces us. Believe it or not, if you are a GP, medicare will reimburse you for performing a anterior spinal fusion (if you are so inclined to do so in your office). There is no requirement by the goverment payors to be board certified, eligible or anything else. The requirements for finishing a residency and passing the boards is based on voluntary associations of physicians (individual hospital medical staff associations) and on requirements set by malpractice insurers.
 

Adam_K

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Well, you walked by the issue in a rambling thread and stated this as a fact. Not exactly 'covered' in my book.

Please show me how to control between the differences in a teaching and non-teaching hospital, as until you do, your comparison lacks validity.

Last thing I know, in most states as a US graduate you still need 1 year of post-graduate education in order to put up your shingle as 'general practicioner'. The rest is strictly voluntary.

First off, this is a curious argument, considering that we are both IMGs and require on average 2.5 years of PGME for licensure (unweighted average of state licensing requirements).

Second, considering that the ACGME has a monopoly granted by Congress to accredit residency programs for allopathic physicians, along with the aforementioned subsidy there is no other pathway to specialization for allopathic physicians. Allopathic state boards have helped this along by allowing only for ACGME trained residents to become licensed and some even limit the title of specialist.

Indentured servants would actually make the master money, residents don't.

Medicare/Medicaid GME payments do not make the master money? Perhaps in your specialty, but certainly not in mine.

We do residencies because we hope for the big payday afterwards, not because the evil goverment forces us.

Partly, but also do so, because we do not have a choice outside the ACGMEs cookie cutter residencies and the match. As mentioned before, there is no other pathway to specialization. The guild (AMA/LCME/ACGME/ABMS) leaves us no other options.
 

GATC

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While I liked to think that I was doing productive work as a resident, looking back it turns out that that was not the case. There are plenty of hospitals that function quite well (at lower cost) without residents 'working' there.




If the goverment wouldn't hand out the money for medical education, residents in the US would either:
A. Not get paid (like some dental residents today, or like medical residents before medicare)
OR
B. Not get educated (like residents in the 95% of countries that don't have a similar medical education funding system)

So, its the residents that benefit from the GME $$s (and the system as a whole by having highly qualified physicians available to take care of the patients in goverment programs).



Dude are you kidding me? Who else would the government get to do what residents do for almost minimum wage. Someone would have to pick up the slack and I can wager that no one would do that job for our salaries.

Also, the government has forced our current residency system upon us. There is no other way of getting licensed...
 

f_w

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Please show me how to control between the differences in a teaching and non-teaching hospital, as until you do, your comparison lacks validity.

You just state that it is not possible to correct for the differences as a fact. Fact is that a patient who has his gallbladder out at a community hospital will cost less than a patient at the teaching place.

First off, this is a curious argument, considering that we are both IMGs and require on average 2.5 years of PGME for licensure (unweighted average of state licensing requirements).

FMGs are a special case.

Second, considering that the ACGME has a monopoly granted by Congress to accredit residency programs for allopathic physicians, along with the aforementioned subsidy there is no other pathway to specialization for allopathic physicians.

Again, specialization is voluntary.

Medicare/Medicaid GME payments do not make the master money? Perhaps in your specialty, but certainly not in mine.

They are a subsidy, just like the conservation reserve program payments to farmers. The hospital will get money for the residents whether they lock them up in a basement or whether they see patients.
In the heydays of the GME payment fleecing (early 90s), hospitals had 'paper residents', people that only existed on paper. After they found out that the goverment would cut them a cheque just based on the number of FTEs they reported, the 1997 omnibus budget reconciliation act put an end to that.
 

f_w

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Also, the government has forced our current residency system upon us. There is no other way of getting licensed...

Be happy and cheerful about that system, it is the best we got.

I come from a place where the goverment doesn't pay for your post-graduate education and as a result residents work for even less money than here and are forced to do endless residencies because they don't manage to finish the requirements for the boards otherwise.
 

f_w

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Dude are you kidding me? Who else would the government get to do what residents do for almost minimum wage. Someone would have to pick up the slack and I can wager that no one would do that job for our salaries.

At non-teaching hospitals nurses play a much more autonomous role and liberal use of midlevels allows the community docs to run the place without residents. And sure, there is rationing going on. If you don't have insurance, you just won't get that fem-far bypass because there is still a fellow who needs one on his list.
 

Adam_K

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You just state that it is not possible to correct for the differences as a fact. Fact is that a patient who has his gallbladder out at a community hospital will cost less than a patient at the teaching place.

So, all you've proven is that a teaching hospital can charge more. This could be due to lots of factors. Here's one: as in any service industry, some providers can (and do) charge more because they have a better reputation.

FMGs are a special case.

You, me and nearly 27% of the resident pool.

Again, specialization is voluntary.

As we are not going to convince each other on this point, I think that I'll simply agree to disagree.

They are a subsidy, just like the conservation reserve program payments to farmers.

On this point, we agree.

The hospital will get money for the residents whether they lock them up in a basement or whether they see patients.
In the heydays of the GME payment fleecing (early 90s), hospitals had 'paper residents', people that only existed on paper. After they found out that the goverment would cut them a cheque just based on the number of FTEs they reported, the 1997 omnibus budget reconciliation act put an end to that.

Nevertheless, they need residents in the hospital basement (at the very minimum) for the masters to make money.
 
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