The gov't does not want to fund residency programs anymore

[toughlife]

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http://www.asahq.org/news/asanews062807.htm

I guess the government doesn't want to pay for medical education anymore. Hmm, maybe they do believe that midlevels are good enough to do the job.

 

[urgewrx]

Good! I don't know why they started paying to begin with. Now they should eliminate the whole "residency" concept. When a Nurse/PT/PA starts working out of school they get full pay even though they have to be trained for a while. How come physicians have to take measly pay and work double the hours to get trained? And on top of that the hospital gets 150k/year/resident? Why? I don't get it. The way I see it is if you want to be an orthopod, shadow one(accredited by ACGME) for 4 years, 40hr/week, at General Practitioner pay. Overtime pay if you work longer. No more bull crap from nurses treating you like sht. You are the GP from the service and you should be treated with respect. Screw all the programs that see residents as piggy banks.

 

[GassiusClay]

Why spend money on something that matters?

We have a war created by neo-cons and supported by rednecks (lookin at you red state lovers), a bridge being built to go to nowhere, and a wall proposed to block less than 1/2 of the border.

Majority of stupid citizens + some length of time = dumb government = hard working people get screwed.

 

[urgewrx]

Why spend money on something that matters?

Spend it or not, people are going to be trained. So, why spend it?

 

[dara678]

Honestly, if that happens, I am leaving medicine. I'll go into consulting or something. Or be a trophy wife. NOTHING is worth working 80 hrs + a week and not getting paid for 3-5 years.

 

[Planktonmd]

Good! I don't know why they started paying to begin with. Now they should eliminate the whole "residency" concept. When a Nurse/PT/PA starts working out of school they get full pay even though they have to be trained for a while. How come physicians have to take measly pay and work double the hours to get trained? And on top of that the hospital gets 150k/year/resident? Why? I don't get it. The way I see it is if you want to be an orthopod, shadow one(accredited by ACGME) for 4 years, 40hr/week, at General Practitioner pay. Overtime pay if you work longer. No more bull crap from nurses treating you like sht. You are the GP from the service and you should be treated with respect. Screw all the programs that see residents as piggy banks.

So, let's say they cancel the residency system as you suggested, why would the teaching hospital want to hire these GP's (future specialists), while they could hire Nurse practitioners and PA's to do the same job for less money?

 

[GeddyLee]

We don't need MD's and DO's anymore. Don't you know we can train midlevels for the job!. A 2-3 year masters degree after college should be all it takes to train the vast majority of specialists. My vision of the future of medicine in the USA is one where PA's train to do specific tasks. We could have lap chole/hernia repair guys, joint replacement specialists, etc, etc.

It doesn't take 4 years college + 4 years med school + 5 years gen surg + 2 years research + 2 years CT surg to to bypass and valve surgery! 4 years college plus a expedited 3-4 year tech school is more than sufficient...and much cheaper! General practice PAs will tend to the medical problems post-op.

This is the ways things will ultimately go in the future. The american public has a love-hate relationship with physicians. They respect us to some degree, but they think that we are all fat pigs rolling in money, and somehow forget that we sacrifice well beyond most professionals to obtain our training.

Of course no one wants to use tax money to train us big fat pig physicians...I routinely bath in all the money I make...but hey...that would be a good thing!!!

If tax money didn't pay for our training, there would be one less reason for the government to cram socialized medicine down our throats! As of now, the feds can easily say that they payed to train us, so they control us. I would love to see residency funding from the government stopped.

What the heck happens to that 150K our programs recieve to train us?? There's a missing 110K somewhere. Is it just fattening the pockets of the academic physicians? I'm certain I dont see that much money going into my training.

 

[amyl]

I don't know if its true or not but I have been told that some of the money goes to cover malpractice. Anyone know for sure?

 

[SexPanther]

We don't need MD's and DO's anymore. Don't you know we can train midlevels for the job!. A 2-3 year masters degree after college should be all it takes to train the vast majority of specialists.

Why that much education? I think a graduate of any quality community college could be trained to do what we do! Who wouldn't want that?🙄

 

[pd4emergence]

I am surprised that anyone on this forum would think that decreased resident funding for post-graduate medical education is a good thing. Even with current funding, resident education is pretty much a money losing or at best a break even proposition. Think about the number of staff in you institution and the number of cases your institution does in a day. Now if those staff are supervising you then they can only supervise two rooms b/c of our current deal with medicare (which is trying to be changed). Now if you were not there and they were supervising 4 rooms all day long then they could do the same number of cases with 1/2 to a 1/3 less staff anesthesiologists. If you wonder where the other 110k goes, it goes to employ a large attending staff to keep the OR's running. Think about what would happen to regulation. The whole reason programs listen to regulatory commissions (like the ACGME) is for federal dollars. Do you think they care how many hours you work. No way, the post above that said that residents should be paid as GP's and only have to work 40 hours a week, why should they pay you at all? I wonder if anybody knows where the term "resident" comes from? It comes from the good old days when there was no regulation, hospitals paid residents zero, and they were called residents because they literally lived at the hospital in which they were training and never left. I have heard stories from old timers (and I mean really old timers) who used to have their families eat every meal at the hospital cafeteria because that was the only thing they could afford and that was the only time the got to see them. If anyone wants to go back to that the that is fine with me because I have already finished my training.

 

[Taurus]

If the government doesn't want to pay for residencies, then the hospitals will. The highest profit margin services at hospitals are after all provided by medical specialists, not some NP doing a physical. The hospitals need a constant pipeline of doctors, so they have a strong incentive to fund residencies.

I actually like the idea of the govt getting out of funding residencies and letting the free market control it. If that happens, then:
1) the number of residency positions in each field is determined by market demand not by the govt
2) resident salaries will be determined by the quality of the resident and how competitive that position is

Our system is broken if a midlevel is able to function independently as a physician and yet pay 1/10th of the malpractice. The free market is being held back. We need to unleash it.

 

[urgewrx]

So, let's say they cancel the residency system as you suggested, why would the teaching hospital want to hire these GP's (future specialists), while they could hire Nurse practitioners and PA's to do the same job for less money?

If they want to hire the cheapest provider, let them hire and train the cheapest provider. Let the programs with real interest in education train the future attendings. I'm tired of seen MD's as cheap labor/slaves because of some Hopkins idiot's idea 100 years ago.

 

[urgewrx]

I don't know if its true or not but I have been told that some of the money goes to cover malpractice. Anyone know for sure?

Not true ACGME covers malpractice. The hospital does not spend a cent in your malpractice.

I have heard stories from old timers (and I mean really old timers) who used to have their families eat every meal at the hospital cafeteria because that was the only thing they could afford and that was the only time the got to see them. If anyone wants to go back to that the that is fine with me because I have already finished my training.

The good old days, which weren't really that good.

If you are a General Practice physician you should be paid like so. Why are we the only profession in the whole world that has to go through this sht?? In fact I would even pay, rather than being paid, to specialize. This way residents would work whatever they feel comfortable and make a lot of demands on their education.

What the heck happens to that 150K our programs recieve to train us?? There's a missing 110K somewhere. Is it just fattening the pockets of the academic physicians? I'm certain I dont see that much money going into my training.

I asked one of my attendings, who happened to be on the management board, that same question while I was a resident. His reply was "residents waste a lot of money because they don't know what they are doing" That would be in my case a 100 angio caths, 3 central line kits and 10 epidural trays= 450k?? And they get in return the equivalet of a CRNA working 70hrs/week who does preops , takes only 30 min for lunch, takes all the sht from attendings, and cannot complain for 50k/year *3years???

BS

Thats revenue for them. Why do you think every crap hospital in the US has a residency? There are not that many people who care about your education. Like 5 years ago, medicare said to some NY hospitals "you are training to many foreign doctors", so medicare decided to pay hospitals for not taking foreign grads. Do you think the hospitals stopped hiring foreign grads? Of course not, otherwise they would have to hire like 2 or 3 PA's/Nurses for every resident they had.

Our training system is very wrong. I would love to see it go to hell.

 

[urgewrx]

Even with current funding, resident education is pretty much a money losing or at best a break even proposition. Think about the number of staff in you institution and the number of cases your institution does in a day. Now if those staff are supervising you then they can only supervise two rooms b/c of our current deal with medicare (which is trying to be changed). Now if you were not there and they were supervising 4 rooms all day long then they could do the same number of cases with 1/2 to a 1/3 less staff anesthesiologists.

Teaching institutions are OBLIGATED to accept medicare because they pay for the residents. The 1/2 pay rule when cases are done by one attending with 2 residents is called PAYBACK.

Medicare pays surgeons for doing 2 cases because if not the surgeons would only do one. But if the surgeon wants to 2 at the same time because he can double his billing, anesthesia is not going to say NO. This way medicare gets the most patients treated for the minimum money. Realize that medicare will never pay full fee for 2 anesthesia residents.

In fact, medicare and the social security system where a scam since the beginning. It was created in the 1930's and they stipulated that people would get paid at 65 yrs old. Back then only about 10% of the population made it to 60's!!! Why do you think they chose 65? Because almost everybody would be dead and they wouldn't have to pay. That's why they spent that money on other stuff, without realizing that the average lifespan would be longer than 65. Now there is no money and there is a lot of old people. The whole purpose of SS was/is to tax people without them knowing it. SS/medicare is not your friend.

 

[supercut]

What the heck happens to that 150K our programs recieve to train us?? There's a missing 110K somewhere. Is it just fattening the pockets of the academic physicians? I'm certain I dont see that much money going into my training.

Nope, it's certainly not going to anyone who does anything useful, like patient care. Perhaps to the administrators who haven't seen a pt in > 5yrs. At my institution, speculation is that it funded an expansion of the parking garage (which residents aren't allowed to park in!)

When I was an intern, one of our chiefs at the time gave a talk on GME funding. He made a valiant effort to determine where the money went, but met with nothing but resistance. Every department he contacted told him either they didn't know (yeah, right) or that the information is confidential.

since when is the expendure of our tax dollars confidential?

 

[leaverus]

If they want to hire the cheapest provider, let them hire and train the cheapest provider. Let the programs with real interest in education train the future attendings. I'm tired of seen MD's as cheap labor/slaves because of some Hopkins idiot's idea 100 years ago.

I can't believe we've come to the point that we think of "midlevels" as alternate "providers". They are not providers of anything. We are the doctors and have put in much work and sacrificed many years of our lives and much money to earn the privilege to diagnose and treat patients; we should be the sole providers and no one else. Everyone else is ancillary staff. *SIGH*

As for the the comments that the public view us as "fat pigs rolling in dough" - how sad it is that we are viewed this way despite the intense schooling and training we endure. The public seems to care more for their entertainment (movies & sports) than their own health. No wonder obesity is such a huge problem.

 

[rmh149]

I can't believe we've come to the point that we think of "midlevels" as alternate "providers". They are not providers of anything. We are the doctors and have put in much work and sacrificed many years of our lives and much money to earn the privilege to diagnose and treat patients; we should be the sole providers and no one else. Everyone else is ancillary staff. *SIGH*

As for the the comments that the public view us as "fat pigs rolling in dough" - how sad it is that we are viewed this way despite the intense schooling and training we endure. The public seems to care more for their entertainment (movies & sports) than their own health. No wonder obesity is such a huge problem.

Its the arrogance that the public doesnt like. They even make TV shows about it.... Its fun to watch. But it really isnt good for the overall image of doctors.

 

[urgewrx]

I can't believe we've come to the point that we think of "midlevels" as alternate "providers". They are not providers of anything. We are the doctors and have put in much work and sacrificed many years of our lives and much money to earn the privilege to diagnose and treat patients; we should be the sole providers and no one else. Everyone else is ancillary staff. *SIGH*

I didn't mean cheapest providers (midlevels) to be trained for independent practice. I meant that if an orthopod is busy and needs help he could either hire a PA for PA salary or hire a MD for GP salary to help him. The PA gets a job, the MD gets a salary and training to eventually practice by him/herself. Let only the people with real interest hire and train the MD's.