"The Residents Rise Up: How Congress and colluding hospitals take advantage of doctors in training"

Discussion in 'Allopathic' started by NickNaylor, 05.20.14.

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  1. NickNaylor

    NickNaylor Daisy the Dog Lifetime Donor 7+ Year Member

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  3. maxxor

    maxxor 7+ Year Member

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    There's a huge reddit conversation on this article.
     
  4. NickNaylor

    NickNaylor Daisy the Dog Lifetime Donor 7+ Year Member

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    Indeed, it's where I got the article from.
     
  5. TheWeeIceMan

    TheWeeIceMan And like that... *poof*... he's gone. 7+ Year Member

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    What do you guys think would be a fair resident wage? Would it vary by specialty or would we just make it a standard pay raise across the board?
     
  6. BurghStudent

    BurghStudent lurker 7+ Year Member

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    The comments section :mad:
     
  7. Anastomoses

    Anastomoses secretly an end artery Banned Account on Hold 2+ Year Member

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    Well, Mr Sunshine doesn't seem to be proposing anything concrete? Also, I thought residents make 50k - 60k across the country. Did I misunderstand the figures in the article?

    Hm. I'd like more physician unity so I'd prefer it be standard across the specialties. Yet...some specialties require so many more years than others. I guess that pans out for competitive specialties in the end?
     
  8. StIGMA

    StIGMA Doctor Professor 7+ Year Member

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  9. dyspareunia

    dyspareunia

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    Depends if residents have to pay malpractice or not.

    It should vary with specialty. Residents should get X percentage of what an attending makes per billable encounter/procedure. Partial competence = partial pay.
     
  10. dyspareunia

    dyspareunia

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    Pretty sure it's more like 48-53k
     
  11. TheRobin

    TheRobin 2+ Year Member

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    Agreed.

    Two wonderful gems (sarcasm intended):

    Also, any comment section wouldn't be complete without mentioning NPs either.

     
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  12. BurghStudent

    BurghStudent lurker 7+ Year Member

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    Some considerations: why is tuition increasing at such a rapid rate? Is it because loans have become so easily obtainable? Also, do we need to re-evaluate American medical education, and see if there is fat to trim- personally, I think the entire process is a little bloated.
     
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  13. touchpause13

    touchpause13 nolite te bastardes carborundorum 2+ Year Member

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    Can u post a link? I'd be interested to read that but I don't want to search around reddit trying to find it
     
  14. alpinism

    alpinism Give Em' the Jet Fuel 5+ Year Member

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    Ideally it should increase each year commensurate with the resident's increasing level of responsibility.

    Something along the lines of 60K -->80K -->100K for PGY1-3.
     
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  15. BurghStudent

    BurghStudent lurker 7+ Year Member

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    I'm liking this trend for 7 year residencies.
     
  16. DermViser

    DermViser 5+ Year Member

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  17. jsmith1

    jsmith1 2+ Year Member

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    If I make more as a resident than an attending can I go back to residency?
     
  18. dyspareunia

    dyspareunia

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    They should consider capping fellow pay though. It's a way to keep IM in primary care.
     
  19. MeatTornado

    MeatTornado 7+ Year Member

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    Some of this is disingenuous. You get the contract during your interview and wages vary very significantly across the country and among programs in the same region or city. Nothing is stopping you from applying to programs that pay the best or have the best perks and then making your rank list based on those criteria. Among the 10 or so IM programs in the northeast I interviewed at there was a $15,000+ difference in salary with various perks like subsidized housing in addition. Add to that variation in cost of living and you have some huge differences. But typical med students don't pick their residency program based on compensation though nothing is stopping them from doing so. Instead they usually look at academic prestige and location among other things.
     
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  20. Anastomoses

    Anastomoses secretly an end artery Banned Account on Hold 2+ Year Member

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    You and the comments section. :) Give us some lovelies.

    At Pritzker I believe it's 55k and incrementally moves to 65k and you of course get all your healthcare. Not much more than that.

    I haven't seen those figures anywhere! Really?
     
  21. TheWeeIceMan

    TheWeeIceMan And like that... *poof*... he's gone. 7+ Year Member

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    You just know the gov't is going to see this and then go the opposite direction and cut resident pay.

    I don't know how much undercutting there is among residents of different specialties, but I bet it isn't as bad as with attendings. Maybe residents actually have a chance to fight for a common goal.
     
  22. maxxor

    maxxor 7+ Year Member

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  23. SouthernSurgeon

    SouthernSurgeon Lifetime Donor 7+ Year Member

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    Really?

    I interviewed in the NE, NYC, West Coast, Midwest, and South. I don't remember nearly as much salary variation from place to place.

    The AAMC Backs this up: https://www.aamc.org/download/359792/data/2013stipendsurveyreportfinal.pdf

    25th percentile - 48.5, 75th percentile - 52.5

    That's a pretty tight salary distribution.

    Now I will say the places that adding in a living stipend potentially changes the equation some, but that was pretty exclusively a New York thing at least where I interviewed.
     
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  24. Psai

    Psai ヽ(´ー`)ノ Account on Hold 2+ Year Member

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    I really don't understand why people love comparing doctors to the median American wage. Since when are doctors anywhere near the median? Compare us to our professional peers at the very least. We work much harder with longer hours with a higher level of education compared to the median American.

    "Oh, and an experienced nurse practitioner will run circles around a second year resident, and probably save the lives of a few people the resident nearly kills."
    lol what a false equivalent. An experienced attending will run circles around an experienced nurse practitioner. A second year resident will run circles around a second year DNP student. A second year medical student will run circles around a second year nursing student. Please.

    Also wtf:
    "So excuse me if I don't shed any tears for this guy, who also appears to be stupid enough to pay $20,000 a year in daycare "tuition" for a 2 year old."
    He said 40% of take home pay, not base pay. This is a fundamental misunderstanding by someone who has obviously never earned a paycheck in their entire life and does not realize that salary is not the same thing as disposable income. This is on par with the premeds who do those ridiculous calculations to project their future earnings and loan payback period.
     
    Last edited: 05.21.14
  25. NickNaylor

    NickNaylor Daisy the Dog Lifetime Donor 7+ Year Member

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    Agreed. I think it's important to keep in mind physician salaries with respect to the broader context of society, but then again the average person isn't a doctor. Unfortunately we can't have a situation where the cost of training is extremely high while earnings from the work are low. It's just not reasonable. That ignores the issue of whether or not physicians "deserve" the compensation they do. I personally think they do, but if you're a guy who make $70k a year and looks at WebMD and concludes that that's what being a doctor is like, perhaps it makes sense why people think the things they do (despite how delusional they may be).


    Sent from my iPhone using Tapatalk
     
  26. HopefulReapp

    HopefulReapp 2+ Year Member

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    After living on a total of <36k in a two person household, 50k in one salary seems remarkable. I have to be honest though when I say I have no clue how much childcare would come out to be.
     
  27. maxxor

    maxxor 7+ Year Member

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    Populism.

    Somehow, CEOs are considered "special" and deserve high compensation lest an organization can't recruit and keep quality people. Why haven't these arguments been applied to doctors?

    Oh wait, it's because the Save the World Brigade has made it unsavory for doctors to talk about money.
     
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  28. MeatTornado

    MeatTornado 7+ Year Member

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    The programs in DC paid around $45k for pgy-1 and then you have NSLIJ in Long Island that paid around $62k plus subsidized housing. In terms of cost of living DC is probably more expensive than Long Island. Especially with with subsidized housing.

    Sure, there is a pretty tight distribution for the majority of programs but there are quite a few outliers.
     
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  29. Dires

    Dires Banned 2+ Year Member

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    Interesting topic. based on a 50k salary, 77.5 hour work week and 50 weeks of work I calculated a $13/hour wage. Considering most occupations receive overtime, and a much higher hourly I'd say we have an argument.
     
  30. DoctwoB

    DoctwoB 5+ Year Member

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    The resident-hospital dynamic is an interesting one.

    On the one hand, we absolutely need residency positions for our career and as an individual we can almost always be replaced with another graduate eager to take our spot (especially at top programs or in competitive specialties). I believe that if we had to individually negotiate contracts then many residents would make less or even pay tuition like dental residents, as there would always be a less competitive applicant or IMG wiling to undercut you for that derm/uro/ENT/top IM spot.

    On the other hand, hospitals are completely dependent on our labor and would quite literally shut down in the short-term without residents, or run at much higher expense in the long-term due to increased need for mid-levels and attending time. A resident strike would cost a hospital system many millions of dollars.

    Despite this co-dependence, hospitals have the upper hand because (1) they have free license to collude to set prices (2) there is a greater supply of residency applicants then desirable residency spots, and (3) The main tool that even collectively bargaining residents have against management would be to threaten to strike. This would jeopardize patient care and be something that most resident physicians would refuse to do out of principle.

    There is some precedent for resident unions/housestaff associations winning small concessions. University of Michigan has a resident union and gets a relatively better deal then most programs (Salary on the high end of programs despite lower cost of living, 4 weeks PTO instead of 3, extra pay for holiday coverage). It's not a huge difference, but it's a big start, and more could be achieved if residents collaborated across multiple institutions.
     
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  31. DoctwoB

    DoctwoB 5+ Year Member

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    Id argue that receiving lashes in the public square would be a better deterrent to fellowship. 30 lashes if you want to become a greedy cardiologist or gastroenterologist, 20 lashes for slightly less greedy heme/oncs and pulm/cc and a brief period in the stockade for endocrine, rheum, and ID.






    Or we could . . .you know . . . try to make primary care a better job by removing ridiculous regulatory oversight/paperwork demands and increasing pay. Crazy talk, I know.
     
  32. syoung

    syoung MS-3 5+ Year Member

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    I just saw this article, and I'm glad that they are trying to set up a large coalition to try to get residents and ourselves in the future a larger say in the process.

    @MeatTornado I would argue that we do not get much choice once we have received our match. There is no SAY in that part. Yes we can choose to apply nearly anywhere (depending on specialty) to any city.

    I do hope that slate has a large enough readership + reddit that this gets more public attention
     
  33. dyspareunia

    dyspareunia

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    Public attention is probably not going to help much. People think doctors are overpaid as it is.
     
  34. syoung

    syoung MS-3 5+ Year Member

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    Public attention is the only way to pressure Congress to change this... Hospitals probably won't.
     
  35. dyspareunia

    dyspareunia

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    You need lobbyist support to pressure Congress.
     
  36. tco

    tco 7+ Year Member

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    I definitely took finances into account. What an idiot I am for wanting to make more money in a city with a lower cost of living, but at a program with a bit lower "prestige value," right? :)

    Sent from my SCH-I535 using Tapatalk
     
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  37. Frazier

    Frazier turtle in a rabbit race Lifetime Donor 7+ Year Member

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    In regards to warranted compensation, they aren't remotely the same job.

    The CEO of my hospital system is captain of the ship. He, with the help of his board/committee, not only keep the boat afloat, but also need to steer the boat -- avoiding debris/icebergs in the water -- and win the regatta that they are simultaneously in with other hospital systems.

    Big deal, right?

    Well, the boat also happens to be worth 10 billion dollars and have over 62,000 workers on board (i.e. the rowers under the deck that keep the boat moving forward).

    The captain leads the ship and gets to eat as much food from the pantry that it can withstand. Rowers are largely replaceable. Whether you get fed up with small rations and jump ship, or they decide to throw you overboard -- you can be replaced with a viable replacement rower who will happily take the job and enjoy the meal you turned down.

    There's still the option for you to build your own boat and set sail. However, the trend seems to be that the tiny dinghies are just getting run over or overturning in the wake of other larger ships.
     
    Last edited: 05.21.14
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  38. Mt Kilimanjaro

    Mt Kilimanjaro

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    I am sympathetic to this movement, but they need to formulate a path forward in order to be viable.

    The money issue is important, but hard to get public traction for that when you recognize that all of those poor, downtrodden residents are guaranteed ~500% raises when they finish residency.

    Being classifed as an "employee" rather than a trainee or whatever they are now would be clutch, however, because that would imply federally-guaranteed perks that janitors, nurses, and NP's get but residents don't -- like bathroom breaks, time to eat lunch, sick days, etc.
     
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  39. alpinism

    alpinism Give Em' the Jet Fuel 5+ Year Member

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    Exactly.

    Its because nowadays CEOs are considered leaders in healthcare while doctors are just part of an "interprofessional team" of techs, nurses, PAs, and NPs who all play an equal role in patient care.
     
  40. alpinism

    alpinism Give Em' the Jet Fuel 5+ Year Member

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    Ironically, hospitals are willing to do this everyday for the sake of making a few extra bucks.
     
  41. maxxor

    maxxor 7+ Year Member

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    And you've summed up why doctors being employed by the hospital system is a bad thing. Looks like it's time to start manipulating my way into administration.
     
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  42. dyspareunia

    dyspareunia

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    It's not necessarily a bad thing. I for one will be happy to land a job in an academic hospital where all I need to do is keep my head down and do my job.
     
  43. Anastomoses

    Anastomoses secretly an end artery Banned Account on Hold 2+ Year Member

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    Keep a seat warm for me.
     
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  44. NickNaylor

    NickNaylor Daisy the Dog Lifetime Donor 7+ Year Member

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    Indeed. Either that or put yourself in a position such that you're the captain of your own small ship.
     
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  45. Psai

    Psai ヽ(´ー`)ノ Account on Hold 2+ Year Member

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    There's a problem when groups get too big and control too much. Healthcare is supposed to be about individuals taking care of communities, not billion dollar hospitals treating their staff as replaceable and doing their best to increase their personal wealth
     
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  46. @JackShephard

    @JackShephard

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    We need a union.

    Physicians are getting screwed.

    Everything things we make too much but they also treat us like slave labor for a decade.

    We're irreplaceable and they know it, that's why they have all these laws against us.
     
  47. DermViser

    DermViser 5+ Year Member

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    Aided and abetted by med students (who are on the NRMP board) who write for the WSJ about how great the match is, and by the AMSA crowd. Apparently, an MD is a complete moron on graduation, but an NP/PA graduate is a valuable commodity.
     
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  48. DermViser

    DermViser 5+ Year Member

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    Hospitals are actively working against doctors. See their response to Stephen Brill's "Bitter Pill" article: http://www.aha.org/content/13/settingrecordstraight.pdf
     
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  49. maxxor

    maxxor 7+ Year Member

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    This one chaps my ass so hard. It's 100% due to the nonsense imposed by billing rules. We need to change the billing rules so Residents can bill Medicare/Medicaid. If an NP or PA are sufficiently trained after less than 500-1000 hours of clinical experience, a graduated medical student who has more than 4000 hours of clinical experience should be able to bill independently.

    At the bare minimum, let us bill for the same 85% reimbursement that NPs and PAs can do.
     
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  50. DermViser

    DermViser 5+ Year Member

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    What's scary is that some attendings believe this (not in Derm), due to the way things have been. NP/PAs are quite powerful considering if they're unhappy they can just get up and leave. Residents can't. Hence the power differential.
     
  51. maxxor

    maxxor 7+ Year Member

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    Are there any experts in History of Medicine about why people don't do 1 year internships and then set up shop as GPs anymore? I know something happened in the 70s which led to the creation of Family Medicine as a "specialty". Is it just the increased push for specialization or some other nonsense which has led to this cultural belief that med students are incompetent but PAs/NPs are somehow fully trained?
     

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