URGENT: Save Medical Residency from Sequestration Cuts

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A related question: Could residencies survive without federal GME funds? Are residents enough of a value that all expenses associated with their training could be covered by the hospital/health system/university? Would it be smaller programs that take the biggest hit, while residencies in larger programs could survive?

I think these are interesting questions in a time where funds will need to be increasingly defended and fought for... this problem will not be going away anytime soon and is likely to get worse, IMO.
 
Decreasing the saturation of doctors in the field, I don't see the problem with this at first glance.
 
Anigma07 said:
Go ahead and explain...
It may be bad for society as a whole and for academic medicine but for practicing doctors, i.e. us, might not be so bad.
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I don't want to turn this into a midlevel thread since so many topics on this forum turn into that. But if you have a shortage of physicians to the extent that access to care is very difficult, that creates a perfect situation for midlevel providers to train and gain more independence to provide that care - probably not in the best long-term interest of physicians.

Additionally, the gap between the number of American medical graduates and the current number of residency positions is quickly narrowing. Creating a situation where many medical students are going without residency positions would be disastrous.
 
Or, if you can only think short term, what if they keep the same number of residency spots and decrease residency salary across the board?

Either way this is not good.
 
xrevision said:
Or, if you can only think short term, what if they keep the same number of residency spots and decrease residency salary across the board?

Either way this is not good.
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Well, that was a terrible response. No one is going into medicine for the high salaries of residency...you might be though. By short term I mean our generation, you can go play with the idea of residency salaries in a corner.

The midlevel argument might make sense but that I don't see that affecting our generation, especially in more specialized fields. For those that want to specialize less saturation=better.
 
You lose sight of the long term picture again, whether saving money for retirement, or paying down your student loan, or for those with families in residency -- a salary matters.
 
xrevision said:
You lose sight of the long term picture again, whether saving money for retirement, or paying down your student loan, or for those with families in residency -- a salary matters.
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Yep. At the very least the salary can help you avoid adding more to your debt burden besides the interest that is already accruing...

I would hope that most people have some sense of stewardship towards their profession which would hopefully make the "less physicians=more $$ for me" argument just a minor mention in this discussion.
 
xrevision said:
You lose sight of the long term picture again, whether saving money for retirement, or paying down your student loan, or for those with families in residency -- a salary matters.
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Your hypothetical is just ridiculous, residency salary is already close to minimum wage (paying for a family would be short term, btw). You might as well have said what if the gov also made residency 4 years longer....

Our topic is less doctors in the field. If you want to make a list of what else gov can do go make another thread. Less doctors is less competition, end of story.
 
Say you have a family and you match to a program in California. You need at least
1000 for rent
100 for electricity + gas
150 for water and trash
40 for internet
120 Cell phones for 2
150 Car payment
70 Insurance
400 Food
200 IBR
200 for Gasoline

Thats approximately ~2300/month of take home pay you'd need, or at the very least a salary of 40000,
and that doesn't leave you a lot of room to save for any incidental things that may come up.
 
Anigma07 said:
Your hypothetical is just ridiculous, residency salary is already close to minimum wage (paying for a family would be short term, btw). You might as well have said what if the gov also made residency 4 years longer....

Our topic is less doctors in the field. If you want to make a list of what else gov can do go make another thread. Less doctors is less competition, end of story.
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don't feed the troll
 
Anigma07 said:
Your hypothetical is just ridiculous, residency salary is already close to minimum wage (paying for a family would be short term, btw). You might as well have said what if the gov also made residency 4 years longer....

Our topic is less doctors in the field. If you want to make a list of what else gov can do go make another thread. Less doctors is less competition, end of story.
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True...they should just make residents work for free, mandatory across the board. Better yet, why not charge residents instead since they're still in training - 3 more years of tuition instead. They'll only have $450k in loans to start their actual career at the age of 30.

I can't wait to be a practicing physician some day. Take weird pleasure in making life ****tier for younger physicians instead of making things better for everyone. I'm going to say they need to be recertified every 2 years, just to torture them a bit more. Also, I vote making residency 5 years instead (this is of course after I'm done). After all, the more residency the better, right?
 
xrevision said:
Say you have a family and you match to a program in California. You need at least
1000 for rent
100 for electricity + gas
150 for water and trash
40 for internet
120 Cell phones for 2
150 Car payment
70 Insurance
400 Food
200 IBR
200 for Gasoline

Thats approximately ~2300/month of take home pay you'd need, or at the very least a salary of 40000,
and that doesn't leave you a lot of room to save for any incidental things that may come up.
Click to expand...

Tell the spouse to get a job.
 
CDI said:
Tell the spouse to get a job.
Click to expand...

Edit: After re-reading your posts, I'm wondering if this was sarcastic. So consider this a response to those who would actually say this...


Wow, I'm glad you thought of that! That never would have occured to me or anyone else. Then again, my spouse's takehome pay would be about the same amount as daycare costs for us. Oh and would also bump our IBR amount way up. For people with young children a cut in residency pay could be catastrophic. We only made it through med school because of loans and because I worked.

So what would you suggest then? Should I just take out more loans? Should I get a 2nd job during residency that I can work on my one day off per week? Changing the rules in the middle of the game would be insanely unfair, especially considering that residents pretty much make minimum wage anyway. I would probably just quit, go get a job as a high school teacher, and do PSLF for 10 years.
 
Anigma07 said:
Your hypothetical is just ridiculous, residency salary is already close to minimum wage (paying for a family would be short term, btw). You might as well have said what if the gov also made residency 4 years longer....

Our topic is less doctors in the field. If you want to make a list of what else gov can do go make another thread. Less doctors is less competition, end of story.
Click to expand...

Well you're probably right. I mean, afterall, the major shortage of primary care physicians has been great for that field! Salaries are huge and midlevels can't even imagine taking over the field. Oh wait....
 
Mr. Hat said:
Edit: After re-reading your posts, I'm wondering if this was sarcastic. So consider this a response to those who would actually say this...


Wow, I'm glad you thought of that! That never would have occured to me or anyone else. Then again, my spouse's takehome pay would be about the same amount as daycare costs for us. Oh and would also bump our IBR amount way up. For people with young children a cut in residency pay could be catastrophic. We only made it through med school because of loans and because I worked.

So what would you suggest then? Should I just take out more loans? Should I get a 2nd job during residency that I can work on my one day off per week? Changing the rules in the middle of the game would be insanely unfair, especially considering that residents pretty much make minimum wage anyway. I would probably just quit, go get a job as a high school teacher, and do PSLF for 10 years.
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Also don't match in California or other areas with high cost of living. File separate taxes so IBR payment doesn't bump.
 
Residency salary has nothing to do with this conversation, whoever brought it up initially needs reading comprehension classes.

Less doctors in specialized fields is not a bad thing for the practicing physicians. For those that want a saturated marked, go ahead and open up a practice close to another doctor doing the same thing. See how welcome you are there and how well you would do.
 
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Anigma07 said:
Residency salary has nothing to do with this conversation, whoever brought it up initially needs reading comprehension classes.

Less doctors in specialized fields is not a bad thing for the practicing physicians. For those that want a saturated marked, go ahead and open up a practice close to another doctor doing the same thing. See how welcome you are there and how well you would do.
Click to expand...

You want to cut the number of residency spots in this country?

I very rarely say this. I hope that you don't match in whatever specialty you want to go into because of a few residency spots that were eliminated due to the GME cuts.

It's people like you and your selfish and self-righteous beliefs that have cost the physician profession the most, more than all the other issues swirling around at this time.
 
evilbooyaa said:
You want to cut the number of residency spots in this country?

I very rarely say this. I hope that you don't match in whatever specialty you want to go into because of a few residency spots that were eliminated due to the GME cuts.

It's people like you and your selfish and self-righteous beliefs that have cost the physician profession the most, more than all the other issues swirling around at this time.
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You have the fear of a child. If you are a competitive applicant, you're going to get the few positions available and then be better off later on. I don't have to hope you don't match because you're lack of confidence shows that you are not able to match on your own. If you're a weak applicant, this probably doesn't even apply to your field of interest. Maybe you should just consider nursing, I hear they have a lot of open training spots.
 
CityLights said:
Your reading comprehension seems to be lacking...
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You're overall comprehension seems to be lacking. Don't be mad, there's probably more than one nursing spot open so you can also join in.

To all you losers that can't catch on this is a joke. Man up and get into the residency you want instead of whining like little b**t$&es....or like mentioned go into nursing.
 
xrevision said:
Say you have a family and you match to a program in California. You need at least
1000 for rent
100 for electricity + gas
150 for water and trash
40 for internet
120 Cell phones for 2
150 Car payment
70 Insurance
400 Food
200 IBR
200 for Gasoline

Thats approximately ~2300/month of take home pay you'd need, or at the very least a salary of 40000,
and that doesn't leave you a lot of room to save for any incidental things that may come up.
Click to expand...

some of these estimates are way off IMO...
 
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So, 26 posts in, does anyone know if GME funding is actually in the sequester? Or if it's still up for debate for next year? I still can't find anyone reporting on it more recently than Augest.
 
PatchAdamsFan said:
http://www.cap.org/apps/cap.portal?...tml&_state=maximized&_pageLabel=cntvwr#Story3

Yes, GME funds were indeed a part of the sequester. The AMA has an ongoing petition to prevent these cuts, yet there really isn't any legislation controlling how these funds are spent, thus placing them under suspicion in the first place.
Click to expand...

The AMA can go straight to hell. First they support unprecedented government overreach into healthcare with the PPACA, and now they b*tch about the ball not rolling their way. Well, surprise, surprise - you're not calling the shots anymore. Useless organization.
 
Not going to support or reject the usefulness of the AMA, but they are trying to help steady the GME funds. Granted, these funds aren't necessarily pumped directly to neither residents nor residency program admins, and as I stated earlier they can be managed far better, they are a huge thread that keeps many residencies open.
 
As to the whole "will spots decrease or salaries go down" argument, the answer is probably both.

Some programs, likely smaller ones, will already be on the brink of financial solvency and this will push them over the edge. Most will probably keep their residency program but cut salaries.

It's worth noting, however, that hospitals need residents badly. Without interns running the floors, services would have to hire many PAs/NPs/moonlighting docs. A late-year intern at 45k/year for 80hrs/week is a bargain compared to a PA/NP at 80k for 40hrs with weekends off.

Likewise, while attendings could certainly do all the operations the residents do, they would also require a large number of PAs/NPs to first-assist. They would also not be able to run multiple rooms as they can where they essentially supervise seniors/chiefs like they can now.

Of course, PAs/NPs wouldn't require the time cost of didactics and teaching sessions, so there is that.

I'd be curious to see if anyone has ever done a true cost-benefit analysis of residents in a hospital (regardless of GME contribution). I'd honestly be shocked if residents were a net cost compared to the alternative.
 
The whole mentality of let the spots decrease as long as it doesnt affect me is the type of thinking thats destroying many specialties.

Just take a look at how Anesthesiologists are stuck with AMCs and CRNA encroachment because the older folks were just looking to turn a few bucks before retiring.
 
DoctwoB said:
It's worth noting, however, that hospitals need residents badly. Without interns running the floors, services would have to hire many PAs/NPs/moonlighting docs. A late-year intern at 45k/year for 80hrs/week is a bargain compared to a PA/NP at 80k for 40hrs with weekends off.
Click to expand...

Yes, but they don't need to PAY us anything. Medicine functions as a trust and they know that, since they collude to make sure a fired resident has few if any chances to become a practicing physician, residents don't have any other options other than to finish, no matter how crappy the conditions. The only reason they pay us anything at all is because it doesn't cost them anything. the DME portion of GME funding is a 1:1 reimbursement for what they pay you. They can't even pocket the money and refuse to pay it out, since the reimbursement matches the disbursed salary. So they shrug their shoulders, pay residents a living wage, and tell us how generous the hospital is.

If GME funding ever goes away entirely resident salaries will drop to zero overnight. The number of slots won't necessarily decrease, as other have pointed out we're extremely cheap labor, but residency could very easily become free labor. Or even a tuition paying educational experience, like medical school. This is not something to root for.

http://www.cap.org/apps/cap.portal?_...=cntvwr#Story3

Yes, GME funds were indeed a part of the sequester. The AMA has an ongoing petition to prevent these cuts, yet there really isn't any legislation controlling how these funds are spent, thus placing them under suspicion in the first place.
Click to expand...

BTW all I'm seeing at this link is what I've read before: Medicare is making cuts, and GME is part of medicare. There's no guidance yet as to what gets cut. So GME is either part of the sequester... or not.
 
My understanding of the Sequester is that it was a pay cut across the board. That's what made it so painful. The actual cuts were a few cents on the dollar, but there was no mechanism to let programs/admins choose how to make the cuts. The cuts had to be across the board. So if Medicare is cut and GME is part of medicare, GME will be cut as well at the same percentage rate.
That's my understanding of the sequester - sources are a religious watching of Sunday talk shows (Meet the Press or This Week had on Leon Panneta a few weeks ago and he made the same point about the defense department - it's not the amount, its' the inability to decide how the amount is arrived at)


Perrotfish said:
Yes, but they don't need to PAY us anything. Medicine functions as a trust and they know that, since they collude to make sure a fired resident has few if any chances to become a practicing physician, residents don't have any other options other than to finish, no matter how crappy the conditions. The only reason they pay us anything at all is because it doesn't cost them anything. the DME portion of GME funding is a 1:1 reimbursement for what they pay you. They can't even pocket the money and refuse to pay it out, since the reimbursement matches the disbursed salary. So they shrug their shoulders, pay residents a living wage, and tell us how generous the hospital is.

If GME funding ever goes away entirely resident salaries will drop to zero overnight. The number of slots won't necessarily decrease, as other have pointed out we're extremely cheap labor, but residency could very easily become free labor. Or even a tuition paying educational experience, like medical school. This is not something to root for.



BTW all I'm seeing at this link is what I've read before: Medicare is making cuts, and GME is part of medicare. There's no guidance yet as to what gets cut. So GME is either part of the sequester... or not.
Click to expand...
 
Perrotfish said:
Yes, but they don't need to PAY us anything. Medicine functions as a trust and they know that, since they collude to make sure a fired resident has few if any chances to become a practicing physician, residents don't have any other options other than to finish, no matter how crappy the conditions. The only reason they pay us anything at all is because it doesn't cost them anything. the DME portion of GME funding is a 1:1 reimbursement for what they pay you. They can't even pocket the money and refuse to pay it out, since the reimbursement matches the disbursed salary. So they shrug their shoulders, pay residents a living wage, and tell us how generous the hospital is.

If GME funding ever goes away entirely resident salaries will drop to zero overnight. The number of slots won't necessarily decrease, as other have pointed out we're extremely cheap labor, but residency could very easily become free labor. Or even a tuition paying educational experience, like medical school. This is not something to root for.
Click to expand...

While I agree that salaries would certainly drop, I disagree with your assessment of hospital-resident power dynamics. While we certainly need hospitals/programs given licensing/insurance requirements, they need us for the day to day functioning of the hospital. A resident strike would be catastrophic, for example (and likely unethical given patient safety, but thats another issue).

Furthermore, hospitals want to attract the best possible residents to their programs to boost their program/hospital prestige as well as improve hospital function/outcomes. Right now, there is very little price competition between hospitals, but create an environment in which some hospitals are paying 50k, some are paying 10k, and some are charging tuition, and you'll see which one attracts the top applicants. Any mid-tier PD could make their program a top-tier by offering higher salaries.
 
Anigma07 said:
Well, that was a terrible response. No one is going into medicine for the high salaries of residency...you might be though. By short term I mean our generation, you can go play with the idea of residency salaries in a corner.
Click to expand...

This is an idiotic post.

As was pointed out, decreasing an already meager salary when most people have anywehre from $150-350,000 in debt (not counting ridiculous amounts of interest accruing), residency salary is a very important consideration.
 
GuyWhoDoesStuff said:
This is an idiotic post.

As was pointed out, decreasing an already meager salary when most people have anywehre from $150-350,000 in debt (not counting ridiculous amounts of interest accruing), residency salary is a very important consideration.
Click to expand...

They should just waive residency salaries all together. Let the student take out another high interest "residency loan"...during their training, and increase the number of positions. Problem solved.
 
CDI said:
They should just waive residency salaries all together. Let the student take out another high interest "residency loan"...during their training, and increase the number of positions. Problem solved.
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Haha! In all seriousness, the glaring solution to this trend is to streamline medical education and training - that's definitely gonna happen.
 
Dave89 said:
Haha! In all seriousness, the glaring solution to this trend is to streamline medical education and training - that's definitely gonna happen.
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Just cut the damn 3rd year off of primary care specialties. It's like 4th yr of med school...all about dat cash!
 
CDI said:
Just cut the damn 3rd year off of primary care specialties. It's like 4th yr of med school...all about dat cash!
Click to expand...

Perhaps. But I think the lower-hanging fruit are undergrad and med school. A year could be trimmed off each. Or it could be converted to a 5/6-year track.
 
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Dave89 said:
Haha! In all seriousness, the glaring solution to this trend is to streamline medical education and training - that's definitely gonna happen.
Click to expand...

If they made residency unattractive enough we could easily start seeing more Internship trained grads going out into the workforce. Unlike medical school and Intern year there is no legal force behind the rest of residency. Any licensed physician is licensed to practice any kind of medicine. Resideny and fellowship board certifications are like college degrees: credentials which are valuable because of their percieved value by industry, but which do not actually give you any additional legal rights to work beyond what you already had.

If they started asking us to pay 70K/year for an FP residency I'm sure more than a few docs would say 'F- it' and just go be an FP after Intern year. Or we might start seeing alternative, competitive residency training programs set up by private industry for less time and cost. If they made us pay for a Neurosurgery residency then why go through all the stress and cost of a traditional seven year residency when Kaplan offers a neurosurgery residency that you can complete in two?

Perhaps. But I think the low-hanging fruit are undergrad and med school. A year could be trimmed off each. Or it could be converted to a 5/6-year track
Click to expand...

You could maybe trim a year of medical school (I think the education would suffer, actually) but you could easily trim 3.5 off of Undergrad.
 
Perrotfish said:
If they made residency unattractive enough we could easily start seeing more Internship trained grads going out into the workforce. Unlike medical school and Intern year there is no legal force behind the rest of residency. Any licensed physician is licensed to practice any kind of medicine. Resideny and fellowship board certifications are like college degrees: credentials which are valuable because of their percieved value by industry, but which do not actually give you any additional legal rights to work beyond what you already had.

If they started asking us to pay 70K/year for an FP residency I'm sure more than a few docs would say 'F- it' and just go be an FP after Intern year. Or we might start seeing alternative, competitive residency training programs set up by private industry for less time and cost. If they made us pay for a Neurosurgery residency then why go through all the stress and cost of a traditional seven year residency when Kaplan offers a neurosurgery residency that you can complete in two?



You could maybe trim a year of medical school (I think the education would suffer, actually) but you could easily trim 3.5 off of Undergrad.
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True no legal rights are gained by completing residency, but some places won't hire without board certification. Also, some procedures require certification in order to be able to bill for them e.g. TEE.

I do agree that there is room to trim parts of undergrad or med school. It wasn't too long ago that med school was only 3 years long.
 
Perrotfish said:
BTW all I'm seeing at this link is what I've read before: Medicare is making cuts, and GME is part of medicare. There's no guidance yet as to what gets cut. So GME is either part of the sequester... or not.
Click to expand...

That is true, but you will absolutely not find the exact data at this point in time. There is no official data released yet, but it is increasingly likely that GME is cut.
 
PatchAdamsFan said:
That is true, but you will absolutely not find the exact data at this point in time. There is no official data released yet, but it is increasingly likely that GME is cut.
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Ask and you shall recieve: this just hit the web:
https://www.aamc.org/newsroom/reporter/march2012/276736/budget.html

10% cut to Medicare IME, and the complete elimination of children's hospital IME. No cuts at all to DME.

I don't know how I feel about this. IME has always seemed like kind of a scam to me, I'm not sure what expenses there that hospitals need to meet on top of our salaries. On the other hand I feel like when a resident is merely free labor, rather than free labor and a free $100,000/year on top of that, it could make residency an even more hostile enviornment than it already is.
 
GuyWhoDoesStuff said:
This is an idiotic post.

As was pointed out, decreasing an already meager salary when most people have anywehre from $150-350,000 in debt (not counting ridiculous amounts of interest accruing), residency salary is a very important consideration.
Click to expand...

No one is in favor of decreasing residency salary, idiot. Are you dumb? Why would a med student want to decrease their salary during any point of their life?

Think a little before you post or just don't post and go back to being a loser and whining all day.
 
Anigma07 said:
No one is in favor of decreasing residency salary, idiot. Are you dumb? Why would a med student want to decrease their salary during any point of their life?

Think a little before you post or just don't post and go back to being a loser and whining all day.
Click to expand...

If you're gonna troll, at least try to be subtle about it. That's what separates quality trolls from little girls whose parents just recently stopped monitoring their online usage.
 
GuyWhoDoesStuff said:
If you're gonna troll, at least try to be subtle about it. That's what separates quality trolls from little girls whose parents just recently stopped monitoring their online usage.
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Quality trolls? You must be the coolest guy in your class....
No one was in favor of cutting salaries and you made a ridiculous comment. I would be in favor of cutting your salary, maybe that would stop you from buying all your blow up dolls.
 
Anigma07 said:
Quality trolls? You must be the coolest guy in your class....
No one was in favor of cutting salaries and you made a ridiculous comment. I would be in favor of cutting your salary, maybe that would stop you from buying all your blow up dolls.
Click to expand...

You've been obnoxious throughout this thread, and it's really beginning to tick us all off.
 
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