This year's unfilled positions

[BlondeDocteur]

The big report said there were 51 unfilled categorical residency slots this year. So since it's a slow day in the lab, I went through the state-specific report to see where they were. In parentheses are # of open spots.

University of South Alabama (1)
Harbor-UCLA (1)
USC (2)
UC Davis (2)
Danbury Hospital, CT (2)
George Washington (1)
University of Florida (1)
University of South Florida (2)
Loyola- Chicago (2)
Rush (3)
University of Chicago (1)
LSU Shreveport (1)
Tulane (3/3 open)
Brigham & Womens CP-only (2/2 in the match open)
University of Minnesota (1)
University of Mississippi (4/4 open)
St Louis University (2)
University of Missouri Kansas City (2/2)
Rutgers-NJMS (1)
North Shore-LIJ (1)
Case Western (1)
Cleveland Clinic (2)
Penn AP/CP (3: 6/9 filled)
Puerto Rico (1)
Univ of South Dakota (1)
Univ of Tennessee (1)
U Texas- San Antonio (1)
UT Houston (1)
Univ Utah (1)
Virginia Commonwealth (2)
West Virginia Univ (2)

which only adds up to 49 for me but whatever, maybe I missed one.

Thoughts? I was really surprised at Penn having a whopping three spots open, and both of the Brigham's CP-only *in the match* spots being open. I would have thought if anybody had MD-PhD future-K-award CP-only types it would be them.

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[Grace82]

Wow..also really surprised about Upenn! This was a really rough year for path programs. Where did you find this information? I couldn't find it on the nrmp website.

 

[gbwillner]

Yeah, Penn with 3 unfilled is very surprising. I thought their program had made marked improvements with their new chair. I wonder if any of these may have been CP slots.

CP only slots often fail to fill because they are vanity projects for the most part. Programs can be very selective about who they take, because those residents aren't really filling necessary roles like they are in AP. They'd rather have no one than just anyone.

 

[BlondeDocteur]

@gwb no they were AP/CP spots. Their CP-only spots were separate.

 

[2021Doctor]

Anyone have a link to the big report?

 

[BlondeDocteur]

Grace, it's under "my reports" when you log into the NRMP website. It's only visible to this year's applicants (both matched and unmatched).

 

[xlilangel713x]

well Penn had a total of 13 spots....that's a ton to fill

 

[path24]

What I see is a list of positions to cut.

13 spots a year...definitely doesn't care about the poor job market.

 

[BlondeDocteur]

USC *never* fills. They always leave at least one spot open, presumably to pick up scramblers who failed to match into competitive specialties. I wonder how many other programs do the same, or if the ones that are completely unfiltered are just that bad.

 

[Thrombus]

What I see is a list of positions to cut.

13 spots a year...definitely doesn't care about the poor job market.

path24 that is 2.5-3 million dollars for the program. That works out to 10-12 million every year for the program courtesy the US Taxpayer. Plus the program gets free labor and doesn't have to hire PA's, Lab techs, and Histotech's.

 

[Johnny Sunshine]

path24 that is 2.5-3 million dollars for the program. That works out to 10-12 million every year for the program courtesy the US Taxpayer. Plus the program gets free labor and doesn't have to hire PA's, Lab techs, and Histotech's.

Exactly. As long as they can continue to get funding for residents, programs will continue to churn out as many residents as they can.

I doubt waiting around for programs or national leadership to cut back on resident training would be productive. We probably have to catch the ears of those political sources who have the power to pull the rugs.

 

[Poeppel]

path24 that is 2.5-3 million dollars for the program. That works out to 10-12 million every year for the program courtesy the US Taxpayer. Plus the program gets free labor and doesn't have to hire PA's, Lab techs, and Histotech's.

Could you explain the calculations for this, specifically the funding source(s), please? Seems like this is a major reason for continued oversupply, and I want to understand it clearly. Thanks.

 

[Thrombus]

Could you explain the calculations for this, specifically the funding source(s), please? Seems like this is a major reason for continued oversupply, and I want to understand it clearly. Thanks.

Residency programs get a specified amount from CMS (Medicare) to train each resident. This is usually in the 150-300K range. It is a major source of income for programs and is THE major reason for oversupply. It is a dirty little secret and is why they want as many residents as possible and why they will attempt to mask any job difficulties and write papers about an upcoming shortage, despite no economics backgrounds and no attempt to disclose their conflict of interest.

 

[Thrombus]

Once programs start losing specimens due to pathology oversupply and increased competition, they make up for the lost revenue by adding more residency positions. Its a miserable positive feedback cycle.

 

[BlondeDocteur]

Now thrombus, you know better than that. A program can't add positions ad libitum. They're approved by the Path RRC for a set number of slots, full stop. Even if they fudge the numbers a bit for one year (like say someone dropped down to AP-only in a 7-slot program, so one year 8 people graduate) the 5-year moving average still has to be the # of spots they're approved for.

 

[Thrombus]

No but they can apply for more at any given time. They have $$ NEGATIVE incentive to drop positions; they $$ incentive to lobby for more; they have $$ incentive to write influential papers about needing more residents.

 

[Substance]

Now thrombus, you know better than that. A program can't add positions ad libitum. They're approved by the Path RRC for a set number of slots, full stop. Even if they fudge the numbers a bit for one year (like say someone dropped down to AP-only in a 7-slot program, so one year 8 people graduate) the 5-year moving average still has to be the # of spots they're approved for.

The individual programs do not have to fill the spots, but they do, because there is a perverse financial incentive to do so.
The path RRC might profit a bit from the current arrangement.

 

[Sulfinator]

Our program will likely be trimming a few spots in the next year or so. Our chair has stated that it will save the department money that can be spent elsewhere. I'm expecting this to be a roughly 25% reduction.

 

[BlondeDocteur]

A lot of places save money by cutting fellowships before cutting primary residency slots, especially the non-ACGME fellowships.

 

[Sulfinator]

A lot of places save money by cutting fellowships before cutting primary residency slots, especially the non-ACGME fellowships.

I was specifically referring to cutting residency spots. Our chair seems committed to it.

 

[BlondeDocteur]

How many do you have in a year? Do you think the way your program is structured, you could easily absorb the extra work?

 

[Sulfinator]

How many do you have in a year? Do you think the way your program is structured, you could easily absorb the extra work?

I think so, yes. The chair is also adamant about having more support staff (PAs, etc.). He swears up and down the residents cost the department money. And I think he would rather have a few less residents and a couple more fellows.

 

[Johnny Sunshine]

The chair is also adamant about having more support staff (PAs, etc.). He swears up and down the residents cost the department money.

I don't pretend to know enough about departmental finances to understand this, but I'm seriously wondering how residents can "cost the department money". I know attending physicians get a slight bump in their pay if the department has a residency program, as they are assumed to be taking on increased duties in contributing to resident education, but I'm sure the overall CMS payment per resident more than makes up for that, especially when you consider the added free labor residents provide.

 

[Sulfinator]

I don't pretend to know enough about departmental finances to understand this, but I'm seriously wondering how residents can "cost the department money". I know attending physicians get a slight bump in their pay if the department has a residency program, as they are assumed to be taking on increased duties in contributing to resident education, but I'm sure the overall CMS payment per resident more than makes up for that extra "expense", especially when you consider the added free labor residents provide.

I agree that it runs contrary to what most people say about the cost of residents versus the CMS funding they bring in. Nevertheless, he is quite clear in stating that he thinks the department would save money with fewer residents.

Interestingly, I have also been to a couple of AAMC meetings within the last year. At both of these meetings I attended seminars in which academic deans indicated that decreasing clinical revenues are forcing them to cut residency positions at their institutions. Granted, these are not pathology-specific (or specific to any department), but it does highlight the fact there is more at play than just CMS funding when it comes to whether or not residency positions are profitable for an institution.

 

[Johnny Sunshine]

...I have also been to a couple of AAMC meetings within the last year. At both of these meetings I attended seminars in which academic deans indicated that decreasing clinical revenues are forcing them to cut residency positions at their institutions. Granted, these are not pathology-specific (or specific to any department), but it does highlight the fact there is more at play than just CMS funding when it comes to whether or not residency positions are profitable for an institution.

Hm. My program has recently expanded its number of residency spots, and during that process I heard various higher-ups mentioning that they needed to convince CMS that they could support the additional residents, in order to secure funding for those additional residents.

This suggests to me that some programs may be taking on more residents than their workload can justify. In those cases, perhaps CMS is only providing funding for a subset of the resident number. If that is the case, it's clear how residents are costing the department money!

 

[gbwillner]

I don't think departments really make money off residents. Think about it. Even if they get $150K/ resident, what is it costing them? 50-75K goes to salary, another 25-50K goes to benefits. Some of that money is probably also siphoned off to the medical school. That maybe leaves the department with 25-50K. Maybe. And that money is to offset their costs associated with teaching the resident. Now what does the resident add? 4 hrs of grossing per day? Not to mention piss-poor job of it for about a year? Since they can't bill for anything a resident does, there are no further revenues really coming off the resident's back. Plus the attendings have to spend their time teaching instead of working. How much more work could an attending do if they didn't have to spend 2-4 hrs per day with a resident? That is the opportunity cost of a resident.

 

[BlondeDocteur]

OK, here is my understanding on how residency spots are funded.

1) A program is approved by the specialty's RRC for a set number of residents based on specific criteria for each specialty. I have no idea what the criteria are in path but in surgery it was based on caseload # and complexity-- to graduate you have to have 750 cases across a very specific distribution of organ systems & complexity, and the program had to provide evidence that it could do that for X number of residents to be approved. It's also based on the practice setting and the # of faculty you have overseeing you.

2) Medicare provides tax-based DME (Direct Medical Education) payments to each hospital to fund resident salaries. In addition, hospitals are given IME (Indirect Medical Education) payments if they are teaching hospitals which admit a certain # or %age of Medicare patients each year.

3) the funding level and funding # for DME have remained frozen for the last decade. Any increase in resident complement approved by the specialty's RRC has the salary support come from the hospital, the pathology department, or the IME payments. People also use Medicaid money (they have a small pool of GME payments) and and state/local funds to pay for new positions.

In general, having residents at a hospital is a break-even position. You get cheaper labor, but that labor much be highly supervised and there is increased liability for trainees' mistakes. Adding a new position does not mean you get new salary support from Medicare's DME-- you have to come up with the cash for salary, benefits and indemnification each time you hire someone.

 

[Sulfinator]

This is turning into one of the more informative and worthwhile discussions I have seen on this board in a while. Of course, I may just be feeling that way because I am part of the conversation.

 

[BlondeDocteur]

So maybe, Sulfinator, your department chair wants fellows instead of residents because their supervision needs and maybe even their indemnification will be less. Since they're BE/BC they can sign out independently and supervise residents, so they earn their keep a little better.

 

[Sulfinator]

So maybe, Sulfinator, your department chair wants fellows instead of residents because their supervision needs and maybe even their indemnification will be less. Since they're BE/BC they can sign out independently and supervise residents, so they earn their keep a little better.

That may be. The independent signout, of course, can apply only to fellows in non-ACGME positions, though (which is where our program will likely be expanding).

 

[Johnny Sunshine]

...redacted.

 

[ratherbefishing]

The big report said there were 51 unfilled categorical residency slots this year. So since it's a slow day in the lab, I went through the state-specific report to see where they were. In parentheses are # of open spots.
ed one.

Thoughts? I was really surprised at Penn having a whopping three spots open, and both of the Brigham's CP-only *in the match* spots being open. I would have thought if anybody had MD-PhD future-K-award CP-only types it would be them.

1) MD-PhD's, like everyone else, are aware of the job prospects facing graduating pathologists.
2) Doing CP-only is risky in terms of marketability for jobs.
3) Doing AP-CP only adds an additional year to the overall training (see #2).
4) There just aren't as many MD-PhDs to fill all the spots in some of these programs. Many go to MGH/BWH, etc. Many graduates from my program go to one of those places or to a desired location due to personal reasons (eg family).

 

[BU Pathology]

OK, here is my understanding on how residency spots are funded.

1) A program is approved by the specialty's RRC for a set number of residents based on specific criteria for each specialty. I have no idea what the criteria are in path but in surgery it was based on caseload # and complexity-- to graduate you have to have 750 cases across a very specific distribution of organ systems & complexity, and the program had to provide evidence that it could do that for X number of residents to be approved. It's also based on the practice setting and the # of faculty you have overseeing you.

2) Medicare provides tax-based DME (Direct Medical Education) payments to each hospital to fund resident salaries. In addition, hospitals are given IME (Indirect Medical Education) payments if they are teaching hospitals which admit a certain # or %age of Medicare patients each year.

3) the funding level and funding # for DME have remained frozen for the last decade. Any increase in resident complement approved by the specialty's RRC has the salary support come from the hospital, the pathology department, or the IME payments. People also use Medicaid money (they have a small pool of GME payments) and and state/local funds to pay for new positions.

In general, having residents at a hospital is a break-even position. You get cheaper labor, but that labor much be highly supervised and there is increased liability for trainees' mistakes. Adding a new position does not mean you get new salary support from Medicare's DME-- you have to come up with the cash for salary, benefits and indemnification each time you hire someone.

Very nice analysis, this is pretty close to accurate. Please allow me to add some more information.

1) The dollars that an institution obtains is determined by two factors. The first is the negotiated dollars per resident. As stated, this has not increased in years. The second factor is the percentage of beds occupied by Medicare patients (Medicaid is virtually nothing). The negotiated amount per resident ranges from $80,000 to $135,000 (I last reviewed the tables about 5 years ago so my numbers may not be fully accurate).

2) For a typical example, the Medicare negotiated rate is $100,000, and Medicare patients occupied 25% of the beds occupied in the past year. The institution will receive 25% x $100,000 = $25,000 for each resident. That is correct, the institution does not receive sufficient funds for the full cost of the resident.

3) IME payments are also provided, to pay for the administrative costs of running a residency program, but these do not typically cover the full costs.

4) Some other considerations - most institutions have a cap on the number of residents. This is the total number of residents of all specialties. Your institution may have a cap of 400 residents which receive support from Medicare, but there may be 500 residents. This means that the institution does not receive any Medicare funding for those 100 residents who are over the cap.

5) Finally, the Department does not receive the money from Medicare, it goes to the institution. The institution uses those funds to partially pay for the cost of the residents.

The AAMC has a very nice booklet of information:
https://members.aamc.org/eweb/upload/Medicare Payments for Graduate Medical Education 2013.pdf


Daniel Remick, M.D.
Chair and Professor of Pathology and Laboratory Medicine
Boston Medical Center and Boston University School of Medicine

 

[BU Pathology]

Very nice analysis, this is pretty close to accurate. Please allow me to add some more information.

1) The dollars that an institution obtains is determined by two factors. The first is the negotiated dollars per resident. As stated, this has not increased in years. The second factor is the percentage of beds occupied by Medicare patients (Medicaid is virtually nothing). The negotiated amount per resident ranges from $80,000 to $135,000 (I last reviewed the tables about 5 years ago so my numbers may not be fully accurate).

2) For a typical example, the Medicare negotiated rate is $100,000, and Medicare patients occupied 25% of the beds occupied in the past year. The institution will receive 25% x $100,000 = $25,000 for each resident. That is correct, the institution does not receive sufficient funds for the full cost of the resident.

3) IME payments are also provided, to pay for the administrative costs of running a residency program, but these do not typically cover the full costs.

4) Some other considerations - most institutions have a cap on the number of residents. This is the total number of residents of all specialties. Your institution may have a cap of 400 residents which receive support from Medicare, but there may be 500 residents. This means that the institution does not receive any Medicare funding for those 100 residents who are over the cap.

5) Finally, the Department does not receive the money from Medicare, it goes to the institution. The institution uses those funds to partially pay for the cost of the residents.

The AAMC has a very nice booklet of information:
https://members.aamc.org/eweb/upload/Medicare Payments for Graduate Medical Education 2013.pdf

Daniel Remick, M.D.
Chair and Professor of Pathology and Laboratory Medicine
Boston Medical Center and Boston University School of Medicine

Some additional information

The actual payments for education may be found at this link. For 2010, institutions received, on average, $30,000 per resident per year.
Medicare Payment Advisory Commission. Report to the Congress: Aligning Incentives in Medicare. Available at: http://www.medpac.gov/documents/jun10_entirereport.pdf

A nice discussion of DGME and IGME may be found at this website.
http://university.asco.org/sites/university.asco.org/files/TPDBreakfast2011_SSMihalich.pdf

The link to cost reports for institutional GME payments
http://www.cms.hhs.gov/CostReports/02_HospitalCostReport.asp#TopOfPage

 

[BlondeDocteur]

Thank you, Dr Remick!

 

[rollwithit]

Nice to see some facts brought to the table. There is some high quality ownage in this thread. 300k a resident. Hilarious. Nice job, alarmists. Hyperbole is no way to get people to take you seriously.

 

[Substance]

It is certainly not 300k/resident given the information BD and BU Path have listed, and I do believe them.

It is still probably more affordable for a program to hire a few residents rather than PAs though. I can't see how it would be otherwise.

I don't know what to believe. Do I believe the CAP and the alarmists who continue to harp about a coming shortage of pathologists, even though I recall reading in a "what medical residency do you want to do?" book from the late 1970s mentioning that the job market in path was pretty bad even then, and the ASCP surveys saying, along with other members of this board, that they're doing two fellowships to get jobs that are fairly undesirable if they can find any at all. Or do I believe the alarmists on the other side of the pile, saying that pathology is a no-man's-land and all the good opportunities were taken 20 years ago, while a lot of the reasons given by them are quite hyperbolic.

I think this is one topic that deserves a well-funded workforce analysis by a third-party firm that specializes in such things. It would finally put an end to this tireless, and frankly tiresome, debate.

 

[Kilgoretrout 65]

But in general I feel the amount of effort attendings give towards resident education is largely overestimated.

But the demands of the ACGME are only going up. The clinical competency committees will be pouring over charts trying to fill in little checkmark boxes of where all the residents are in PC-4 etc.
The PD's will be spending time thinking of ways to create PI projects that residents will do, supervising handoffs and doing handoff evaluations etc etc. None of this sounds like it generates income.
Hell, it doesn't even sound like education.

 

[Inez2000]

This thread is a good example of the overall problem. The people at the top like Dr. Remerick feel like they are doing the right thing, and quote numbers to back it up, while the graduating residents have only their anecdotal experience with trying to find a job. My experience as an top 20 AMG and top 20 residency graduate with good evaluations, is that there are no jobs available to persons without on the job experience, and I have applied to every listed job I could find nationwide.

 

[gbwillner]

Funny, because my anecdotal experience was different.

 

[Ruination]

I'm a first year attending at an academic center . I sign out cases on average 3 weeks/month, a large proportion of that with residents/fellows (~80%) and a small proportion where I sign out cases without a resident or fellow involved. I can't speak to the financial aspects of funding that others have addressed above, but residents (mainly PGY1s/2s and many PGY3s/4s) add a considerable amount of inefficiency to the sign out process, some of which I expected (extra time spent teaching at the scope, going back to the bucket for additional sections/clarification of gross findings, etc) and some of which I didn't (residents not ordering stains/forgetting to order stains that I ask to; not proof reading reports; not looking up the clinical history or knowing the clinical context for the procedure; not calling clinicians with new malignant diagnoses when I have asked them to, which I then end up doing a day later; not putting down the correct diagnosis after signout!?, etc.). We have a 3 day schedule allowing for adequate preview time, ability to order stains, look up clinical history, etc. and its just amazing what doesn't get done. When the cases come directly to me on day 2 I finalize them on day 2 (day 3 if I need IHC, levels, more sections, etc) whereas when I sign out with trainees, everything is extended by 1, 2 or sometimes 3 days. You'd expect a lot of these inefficiencies for 1st/2nd years, but it still happens a lot of times with the upper level residents.

There is no question that if my department got rid of all the residents and hired 3 more PAs that my TATs would drop considerably, histology and IHC would run more efficiently and probably with reduced economic cost, and I could spend more of my time working on projects and handling my administrative responsibilities. My day is significantly longer than my friends in private practice, hands down, and its not because my volume is necessarily that much more. I really enjoy teaching which is why I wanted to stay in academics and expected a lot of what I've experienced, but I don't know how anyone believes that trainees don't add more inefficiency to the system. For me personally, these trade offs are worth it because I get to teach residents and fellows some of the pearls that were given to me by my mentors and work in what I think is a stimulating practice environment.

As someone who had a modest amount of success in the job market last year, I think that academia has a duty to closely monitor trends in hiring and not to produce an "oversupply" of graduates. No one who is adequately trained and doesn't have personal/professional red flags should struggle to find a good job. I don't have a solution as to what metrics we should use to evaluate supply/demand, "success" in the job market, or what a "good" job is, but from a common sense perspective I agree that residency slots in pathology do not need to be expanded and some degree of contraction is in order.

 

[pongo]

One of my all time favorite threads. I'm sure the conspiracy theorists will be back at it soon enough. I suspect most students reading these discussions realize that internet forums are enriched with the disgruntled. Make sure you talk with live pathologists before you put much stock into anything you read here.

 

[BlondeDocteur]

It is still probably more affordable for a program to hire a few residents rather than PAs though. I can't see how it would be otherwise.

I think this might be true in clinical, long-hours specialties, but I suspect it isn't true in pathology. Besides grossing, no attending actually needs a resident to do work. Attendings can flip through cases, dictate and sign their reports, perfectly well-- and much, much more quickly-- independently. This is in sharp contrast to the clinical fields where the sheer volume of physical work means having extra hands around is necessary. Someone needs to admit, round on, write notes on, do minor procedures on, see in clinic, discharge, code, etc all the patients on a service, in addition to things like providing assistance in the OR, etc. It's far beyond the capability (or at least the desired capability) of the attendings on that service. Hiring midlevels to do the work of a resident team, given the # of nights/early mornings/weekends/holidays that we work-- to provide true 24-7-365 in-house coverage-- would be extremely costly, and inefficient.

I say might be true because even in the clinical specialties where the residents perform a great number of mundane tasks independently, their inexperience still slows things down dramatically. Clinic runs at least 2-3x slower when every patient has to be presented to and seen with an attending. The OR runs twice as slow (and nothing is as expensive as OR time!) with anesthesia and surgery residents in the mix. The ER can't churn through and dispo patients when every single one is seen by a student, resident and attending. The only way I think clinical residents conceivably earn their keep is by providing the aforementioned 24-7-365 in-house coverage.

In pathology, though, where there isn't a need for true full in-house 24-7-365 coverage, hiring PAs to gross, and letting attendings sign out unhindered would probably be more time and cost-efficient. Especially in light of the sorts of experiences Ruination et al share.

 

[yaah]

Funny, because my anecdotal experience was different.

Your anecdotes don't count, kind of like anecdotes about acupuncture or reflexology that don't make the patient feel better. Anecdotes only count when they support your opinion.

In regards to the other thread, PAs are vastly more efficient than residents. Anyone ever seen a well-trained and competent PA gross? They can gross for 8 hours and do more work than probably 3-4 residents would do at the same time. And residents almost never are grossing for a full day anyway. Residents also tend to submit more tissue.

 

[turtle1966]

I'm a first year attending at an academic center . I sign out cases on average 3 weeks/month, a large proportion of that with residents/fellows (~80%) and a small proportion where I sign out cases without a resident or fellow involved.

The matter of "per resident" pecuniary benefit to a training program is a silly distraction to debate about oversupply.

"Dollar amount" per resident is not a good measure of benefits that Academics derive from residents. The pattern of work in academic centers are geared up for publishing and professional glory of those in tenure track and the residents are an essential integral part of that structure. Try giving your residents a collective vacation for a month and see how well your department will function. Academic centers (except for Mayo and Cleveland Clinics and the likes) are not set up for service work and need cheap resident labor. I laugh when I see the case volume and number of staff at some of the university centers.

I DO hope that regulatory and financing climate for residency programs become evermore uncomfortable and cumbersome, except for the finest ones.

What Dr. Remick should have addressed is why there is such a wide divergence in perception of job market between him and us. One of us must be in a state of denial. For us in private practice, we know and feel the effect of over-supply daily.

 

[turtle1966]

Your anecdotes don't count, kind of like anecdotes about acupuncture or reflexology that don't make the patient feel better. Anecdotes only count when they support your opinion.

In regards to the other thread, PAs are vastly more efficient than residents. Anyone ever seen a well-trained and competent PA gross? They can gross for 8 hours and do more work than probably 3-4 residents would do at the same time. And residents almost never are grossing for a full day anyway. Residents also tend to submit more tissue.

Then I conclude that PDs are business-obtunded. They should do us all a HUGE favor by firing all residents and hiring PAs instead.

 

[yaah]

Well, lots of programs (most, these days?) have both PAs and residents. Where I trained there were I think 4 PAs. Residents couldn't handle the work load and learn at the same time.

 

[path24]

So an educated individual (with essentially their own funding for salary, benefits...etc.) walks into a department to be trained to be a practicing physician (which apparently the department doesn't even do that....hence multiple fellowships) and provides NO overall value to the department (their actual work of 40-80 hrs per week, hiring other staff...etc.).

Wow, a place can lose money by having free educated labor walk through the door. And yet a private facility will supposedly pay 125 an hour for their skills. Your department or company or whatever sucks.

Wouldn't residency spots be decreasing if this was true? Why aren't they? These departments are all about the "greater good" and taking the hit?

Attending quote from a few years back "residents are a lot cheaper than a PA".

Sorry, not buying it.

 

[icpshootyz]

My residency program in Boston had 32 residents (plus around 12 fellows) and 0 PA's for 55K surgicals a year. My private group has 4 fully trained PA's that do all the grossing for approximately the same number of surgicals.

 

[2121115]

You all are comparing apples to oranges. It isn't about efficiency it is about $$$, and in an academic center the two are not necessarily related (as they are in real life). A PA costs the department salary and benefits, whereas a resident does not (government/GME funded). The business managers in an academic department could care less if having residents means a longer workday for the attendings or a longer turn around time. Those specimens are not going anywhere (academic centers are a captive audience, all specimens stay in house) so there is no potential to lose $$ by having worse service/longer turnaround time. And the attendings are plug-and-play (if you quit because you're day is too long, they just hire the next junior attending in line, and both of you already generate way more AP revenue than you get paid).