MD & DO UW resident strike

Burrell College of Osteopathic Medicine
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DrStephenStrange

DrStephenStrange

Neurology PGY-3
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What's up with UW residents going on strikes lately? And UW administering a pay cut as punishment, then residents writing ROS-free notes to mess with billing.
Do UW programs have a history of malignancy, or is that a spur of the moment kind of thing?

in-housestaff.org

The Epidemic We Don’t Talk About: Response to the University of Washington Resident Physician Strike

On September 25, the resident physicians and fellows at the University of Washington (UW) participated in a “strike.” It lasted only 15 minutes, because above all else, they are physicians putting patient care first. So, why are they striking?
in-housestaff.org in-housestaff.org


in-housestaff.org

In Solidarity: Response to the University of Washington Resident Physician Strike

Last week, the resident physicians and fellows of the University of Washington collectively decided to walk off the job for a 15-minute "unity break" in protest of unacceptable working conditions and stalled contract negotiations.
in-housestaff.org in-housestaff.org
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There's a thread in gen res with a little more commentary on this (obviously pro-resident): 450 residents participated in a 15-minute "unity break" outside hospitals across Seattle

I'm not familiar enough with the specifics to take a stance on which side is more justified, but I would say UW is unusual in that they actually have a resident union, so they're actually able to coordinate these kinds of actions in way that wouldn't be possible elsewhere. Most places residents aren't unionized, and in some places they're actually prohibited from doing so.
 
DrStephenStrange said:
What's up with UW residents going on strikes lately? And UW administering a pay cut as punishment, then residents writing ROS-free notes to mess with billing.
Do UW programs have a history of malignancy, or is that a spur of the moment kind of thing?

in-housestaff.org

The Epidemic We Don’t Talk About: Response to the University of Washington Resident Physician Strike

On September 25, the resident physicians and fellows at the University of Washington (UW) participated in a “strike.” It lasted only 15 minutes, because above all else, they are physicians putting patient care first. So, why are they striking?
in-housestaff.org in-housestaff.org


in-housestaff.org

In Solidarity: Response to the University of Washington Resident Physician Strike

Last week, the resident physicians and fellows of the University of Washington collectively decided to walk off the job for a 15-minute "unity break" in protest of unacceptable working conditions and stalled contract negotiations.
in-housestaff.org in-housestaff.org
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They make $58k and get 3wks vacation? Forgive me for not weeping
 
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sb247 said:
They make $58k and get 3wks vacation? Forgive me for not weeping
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From what I read, part of the problem is that UW still had not negotiated new contracts with their residents yet, and that was supposed to be renewed on July 1st.
 
sb247 said:
They make $58k and get 3wks vacation? Forgive me for not weeping
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I get paid considerably more relative to cost of living with more vacation, paid transportation home post call if needed, reasonable meal stipends, and health/dental/eye/disability insurance. I'm very happy with what I have, but I don't think I'd be happy getting what UW gives to live in Seattle
 
7331poas said:
If you are only striking for 15 minutes then you are decidedly NOT at your "breaking point".
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Lol, they only have their break time to strike. They have to prioritized patient safety. What I find funny though is the fact they start writing ROS-free notes as retaliation, which is medically not necessary, but necessary for billing purposes.
 
WheezyBaby said:
I get paid considerably more relative to cost of living with more vacation, paid transportation home post call if needed, reasonable meal stipends, and health/dental/eye/disability insurance. I'm very happy with what I have, but I don't think I'd be happy getting what UW gives to live in Seattle
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My point is UW didn’t trick anyone. If you don’t google rents in town when you apply to residency you are an idiot. The way to change pay is supply and demand of good candidates going elsewhere not agreeing to a deal and then refusing to do your job. The ROS stunt is pretty clever but doing a ROS is part of the job.

Speak up and chase off applicants next year if you want but do your job.

And don’t hide behind childcare. If you have kids you factor it into application season. If you don’t yet and you go somewhere you can’t afford them, buy some birth control
 
sb247 said:
My point is UW didn’t trick anyone. If you don’t google rents in town when you apply to residency you are an idiot. The way to change pay is supply and demand of good candidates going elsewhere not agreeing to a deal and then refusing to do your job. The ROS stunt is pretty clever but doing a ROS is part of the job.

Speak up and chase off applicants next year if you want but do your job.

And don’t hide behind childcare. If you have kids you factor it into application season. If you don’t yet and you go somewhere you can’t afford them, buy some birth control
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I mean, the residents successfully managed to unionize, so just like any other union they're allowed to utilize whatever methods are available to them to negotiate better benefits.

Unfortunately for them, since they're not allowed to strike, their methods are pretty feeble. The ROS is an annoyance, but it just requires the attending to perform their own ROS (which they're supposed to do anyways) and document it in the note. As noted elsewhere it's not really medically necessary, and it's ultimately on the attending physician to check the note for an adequate ROS prior to signing and trying to bill. It's generally expected that residents help attendings by documenting in a manner that facilitates billing, but certainly not required by the ACGME, and I doubt that it's specifically addressed in their contracts.

It *is* crappy to not pay relative to the cost of living or provide the kinds of benefits given at other programs across the country. I know at least in peds, that has resulted in the NY residencies actually being mostly non-competitive, which could eventually happen in Seattle. If all they care about is getting bodies to do the gruntwork rather than getting quality applicants, then maybe that's fine.
 
I'm pretty mixed on this. I'll go to the mat for reasonable requests from our residents. But it's impossible to know what the "real story" is, both sides are spinning. For example, one of the articles mentions that the union's complaint included that some residents are on TANF because their pay is so low. But then in another article, it turns out that it was a single resident (of 1500) and they were not doing clinical training but were on "research", hard to know what this means and it's probably unique and not an issue, yet the union says it for maximum effect. That's just politics, but it makes me ill.

The salaries at UW are well known. You are shown them when you interview there. if you think they are too low, you can go somewhere else.

The oft repeated "residents work 80 hours a week, and have 4 days off a month" is "true", but limited and specialty specific. On some of our inpatient rotations, that may be true (although we target 70 hours as a max). On some inpatient, and all outpatient/elective rotations, it's not true at all -- residents have all weekends off while on elective. Not all specialties will have electives like this, and some will be more work intensive. Again, that's a choice that people have made by matching into those specialties.

I'm not a fan of including "child care" as a benefit. It's something that only a subset of residents need. Childcare is expensive and plenty of people make a similar salary and have to find a way.

Purposefully making notes incomplete which affects billing is unacceptable in my view. Writing a complete note is part of your job. If you don't do your job, that's a huge problem.

15 minute unity break? Fine with me, as long as you don't do something stupid (leave the ICU uncovered, code team unavailable, etc)

Paid transportation home after a 28 hour shift? I fully support this - and it includes a ride back the next day (because presumably your car/bike is here). Distance needs to be within reason, can't take an Uber to Vegas on the hospital's dime. If you decide to live far enough away from the hospital, then perhaps there's a maximum amount that would be reimbursed. If UW doesn't like this, then they can remove 28 hour shifts.

Paid parking? It's fine with me, but if everyone else has to pay it's a political hot potato. Certainly other workers at UW make similar or lower salaries, and they have to pay for parking (I assume).

Getting paid as much as an NP/PA? That's complicated again. NP/PA's don't get elective time. They don't get time to do research, or rotate on various services. They usually are assigned to a single task and just do that task. And once hired and trained they are expected to stay in the job.

So far, all the resident have done by creating a union is anger UW management, and pay union dues. I hope it ends well for them.
 
DrStephenStrange said:
Lol, they only have their break time to strike. They have to prioritized patient safety. What I find funny though is the fact they start writing ROS-free notes as retaliation, which is medically not necessary, but necessary for billing purposes.
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They do not have to prioritize patient safety. The hospitals are more than happy to keep hiring residents who "prioritize patient safety" over their payroll costs.
 
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One of the first things I did while applying to residency was tabulate all the cities into a spreadsheet that would tell me exactly how much it would cost to be a resident in that city. It is fairly easy to do with cost of living index trackers; places like Seattle, SF, LA, DC etc were not going to be a good choice to provide for my wife and kids.

I put all this thought into ending up in cheaper cities so I could somehow come out ahead, and my ultimate strategy completely ignored the most expensive cities like those I just mentioned.

With all this careful strategy I still ended up with a completely random assortment of interviews that made no sense geographically. Then, frustrated, I released my rank list with #1 being a big and relatively expensive city that promised great training and decent perks and a perfect family situation.

The moment I hit submit I told myself I'm a big dumb idiot.

Of course I didn't get #1. Or #2. Or #3. I ended up in the "afterthought" portion of my rank list. Originally my match would involve an expensive relocation with the headache of coordinating (ending) my wife's 12 year career. Our move somehow ended up costing less than $600 due to family helping out. Then with my big balls I jumped into a 3-day panic attack through this fiercely competitive housing market and stole the exact house I needed (within 5 minutes of all my hospitals) that wasn't even listed on the market because it was waiting for me the whole time. Then I settled in a month before starting, rebuilt entire parts of my new house, and figured out how to get my wife settled into a career and then pay for childcare x 2.

Now I'm enjoying my intern year in one of the highest Income:Cost-of-living residencies in the country, and I'm seeing and learning and doing all the incredible things that I could have only expected from my #1 rank. Damn, I'm so good at decision making.

And I guess my point with this diatribe is that if you think happenstance plays second fiddle to choice in this crazy medical system then you need to take a step back and eat your own ass. Even with all the knowledge I obtained from reading hundreds of threads and gleaning from the wisdom of WCI and other financial lords, I still didn't know anything that would have helped me get here if not for just straight ******* luck. So my take on this story on UW residents is if your colleagues say they are suffering, then respect their suffering... It likely had little to do with their life choices, and probably more to do with the general ****tyness of our country's physician training schema.
 
sb247 said:
My point is UW didn’t trick anyone. If you don’t google rents in town when you apply to residency you are an idiot. The way to change pay is supply and demand of good candidates going elsewhere not agreeing to a deal and then refusing to do your job. The ROS stunt is pretty clever but doing a ROS is part of the job.

Speak up and chase off applicants next year if you want but do your job.

And don’t hide behind childcare. If you have kids you factor it into application season. If you don’t yet and you go somewhere you can’t afford them, buy some birth control
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I’m generally a fan of free market arguments, but residency is a clear market failure, in part because the place you are working is also the place that allows you the final training which actually gives value to the expensive schooling you just paid loads of money for.

Yes, there is some choice in the residency selection process, but applicants will rank almost any program because, again, a residency is the key to turning that massive liability into an asset. Once you get there, you’re 8 years of education in but have no bargaining power. The administration can do whatever the **** they want and could basically threaten to fire you for demanding basic things like safe, fair working conditions. You’re also indentured to them for 3-7 years and, without a union, there is usually no actual process for negotiating contracts.

Even if you’re somebody who is a fan of the free market, you should realize that this isn’t actually a free market. This is legislated and bureaucratic occupational gatekeeping that has generated a complex system of perverse incentives and opportunities for coercive business practices.
 
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sloop said:
I’m generally a fan of free market arguments, but residency is a clear market failure, in part because the place you are working is also the place that allows you the final training which actually gives value to the expensive schooling you just paid loads of money for.

Yes, there is some choice in the residency selection process, but applicants will rank almost any program because, again, a residency is the key to turning that massive liability into an asset. Once you get there, you’re 8 years of education in but have no bargaining power. The administration can do whatever the **** they want and could basically threaten to fire you for demanding basic things like safe, fair working conditions. You’re also indentured to them for 3-7 years and, without a union, there is usually no actual process for negotiating contracts.

Even if you’re somebody who is a fan of the free market, you should realize that this isn’t actually a free market. This is legislated and bureaucratic occupational gatekeeping that has generated a complex system of perverse incentives and opportunities for coercive business practices.
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Oh, I get that it’s not a free market. But getting paid the money you were promised up front for the tasks/hours you were aware of upfront isn’t some evil hospital trick.
These people chose seattle with known terms and now are acting like they got ambushed, it’s disingenuous
 
sb247 said:
Oh, I get that it’s not a free market. But getting paid the money you were promised up front for the tasks/hours you were aware of upfront isn’t some evil hospital trick.
These people chose seattle with known terms and now are acting like they got ambushed, it’s disingenuous
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you can say its a choice, but in the end its a match system. the question is would you rather go to uw for 3 years and suffer, or would you rather be jobless with 200k medical debt. perhaps they put UW last, and ended up there. in that case you can say they have nothing to complain about.

but in the end, you can make that argument for many jobs. why raise federal minimum wage if people are willing to work for that wage? but the idea is that its probably a bit inhumane to be treating your doctors like crap, so much so that they cant provide decent care.
 
anbuitachi said:
you can say its a choice, but in the end its a match system. the question is would you rather go to uw for 3 years and suffer, or would you rather be jobless with 200k medical debt. perhaps they put UW last, and ended up there. in that case you can say they have nothing to complain about.

but in the end, you can make that argument for many jobs. why raise federal minimum wage if people are willing to work for that wage? but the idea is that its probably a bit inhumane to be treating your doctors like crap, so much so that they cant provide decent care.
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A resident making $58k can provide decent care, you are being hyperbolic

And I don’t like the minimum wage either so that’s not a good argument for me
 
anbuitachi said:
you can say its a choice, but in the end its a match system. the question is would you rather go to uw for 3 years and suffer, or would you rather be jobless with 200k medical debt. perhaps they put UW last, and ended up there. in that case you can say they have nothing to complain about.
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Come on. You and I both know that's just not the case, plenty of people actively chose UW because it has a good reputation and is in a seemingly attractive part of the country and either didn't fully consider or thought they didn't care about the cost of living. When I made my rank list, I actively moved NYC and most west coast programs down my list just because I knew how expensive those locations are. I'm glad I did.

I see both sides of this argument. On the one hand, UW could likely afford to pay their residents more--I got more in a city with lower cost of living during residency. But the more mature thing to do from the resident standpoint is if you know the pay isn't so good, then rank other locations higher. It's fine I guess if you want to unionize and fight for more, but it's not clear that they can really do anything other than annoy UW, which isn't likely to get the results they're looking for.
 
Maybe I have a different perspective because I come from a poorer area of the country with a low cost of living, but $50k is a lot of money to me and is more than I would have made with a business or accounting degree where I'm from.

As I'm applying to residencies, I'm just glad they're paying us while our dental colleagues have to pay tuition to attend residency.
 
Dantrolene FC said:
I'm just glad they're paying us while our dental colleagues have to pay tuition to attend residency.
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What the heckkkk. How can they do dis? so much moneys.

But for real, based on the hours you work in residency, you're not making much per hour. Add to that the cost of living in some areas (most cities on the east and west coast) being super high and the enormous loans many of us have to begin to pay off during residency, residents are for sure getting the shaft. Really, the pay should be changed in some degree to reflect the cost of living in the area surrounding the program.
 
Seanman111 said:
What the heckkkk. How can they do dis? so much moneys.

But for real, based on the hours you work in residency, you're not making much per hour. Add to that the cost of living in some areas (most cities on the east and west coast) being super high and the enormous loans many of us have to begin to pay off during residency, residents are for sure getting the shaft. Really, the pay should be changed in some degree to reflect the cost of living in the area surrounding the program.
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Pay is supply and demand, not cost of living.

If applicants to UW drop 90% along with applicant quality, pay will be next cycle
 
Pay works differently when talking about residency vs other jobs though, as a large chunk of this funding comes from medicare. The program then is allowed to increase that amount based on the funds available. There are plenty of places with money to burn and high demand that theoretically should be getting paid very highly (ie Penn) but they make the same as Temple which makes the same as Reading. These are 3 totally different tiers, with completely different supply and demand, yet they all get paid the same. There are waaaaay more factors than economics 101 at play here lol.

So much of this has to do with "what is acceptable." If everyone in the system agreed over time to reduce the funding and reverse it to the point that we paid them, do you think that would really decrease the demand to go into medicine? Maybe slightly, but unless you're thinking about that before even applying to med school, it gets hard to turn back the deeper you get invested.
 
Part of this, I imagine, is cultural. What I mean is: the local culture.

I live not too far away, and spent time training in Seattle. What I can tell you is that the general gestalt in Seattle proper is that the city and people are somehow responsible for the cost of living, ergo if you can't afford the cost of living you're somehow entitled to something.

This is the way the city has been managing the massive homeless issue for a number of years now, which is why it has gotten worse and worse over time. "We can't just expect these people to leave, because this is their home. The fact that they can't afford to live there anymore is someone's fault, and that someone has to pay." Unfortunately, the realistic (if not pleasant) answer is that those people just need to leave the city and find work and housing elsewhere. Now, in this case I'm not talking about residents specifically because clearly they're not going to leave residency halfway through. But my point is that there is a wide belief that housing is some sort of evil curse laid upon the city, and that someone needs to equalize it with their money (not ours). I have to imagine that the resident's salary argument is at least in part fueled by the local culture.

That being said: $58g/year would be fairly difficult to live on. Not impossible. it depends upon what you're expecting. 6-7 years ago, I knew residents who owned houses in Seattle. I think that's impossible on a resident salary now, but an apartment is realistic. Apartments can be hard to come by, actually, and so it may make sense for the hospital system to consider dormitories. Or, they could provide an adequate cost of living increase. I don't think any of those demands are unreasonable for discussion. But i completely agree that these kids got what they paid for. They knew the salary. They knew the cost of living in Seattle. They went there anyway because of the reputation, and in many cases because they're from Washington and this is their home. Which, again, is the same argument the city makes for it's horde of unwashed street urchins. Which I don't buy. Go to residency in Nebraska, and then come back if you want.

And on the same token, if UW were to start seeing a decline in the quality and quantity of their residents because they decided to play hard ball with salaries? Well, tough $#!t. Your reputation suffers. That was a bad decision. Amazon and Microsoft and Boeing all keep their rosters filled by paying their people enough to live nearby. You can do the same. Or not. Whatever. UW is constantly expanding services all over the state. I can think of at least two clinics which they have opened, which consistently hemorrhage money, but they keep them open just to "have a presence." So they're not short on cash. They could shrink their footprint a little and probably afford a bit more on the other end. That is, of course, speculation as I don't work for their finance department.
 
HighPriest said:
Part of this, I imagine, is cultural. What I mean is: the local culture.

I live not too far away, and spent time training in Seattle. What I can tell you is that the general gestalt in Seattle proper is that the city and people are somehow responsible for the cost of living, ergo if you can't afford the cost of living you're somehow entitled to something.

This is the way the city has been managing the massive homeless issue for a number of years now, which is why it has gotten worse and worse over time. "We can't just expect these people to leave, because this is their home. The fact that they can't afford to live there anymore is someone's fault, and that someone has to pay." Unfortunately, the realistic (if not pleasant) answer is that those people just need to leave the city and find work and housing elsewhere. Now, in this case I'm not talking about residents specifically because clearly they're not going to leave residency halfway through. But my point is that there is a wide belief that housing is some sort of evil curse laid upon the city, and that someone needs to equalize it with their money (not ours). I have to imagine that the resident's salary argument is at least in part fueled by the local culture.

That being said: $58g/year would be fairly difficult to live on. Not impossible. it depends upon what you're expecting. 6-7 years ago, I knew residents who owned houses in Seattle. I think that's impossible on a resident salary now, but an apartment is realistic. Apartments can be hard to come by, actually, and so it may make sense for the hospital system to consider dormitories. Or, they could provide an adequate cost of living increase. I don't think any of those demands are unreasonable for discussion. But i completely agree that these kids got what they paid for. They knew the salary. They knew the cost of living in Seattle. They went there anyway because of the reputation, and in many cases because they're from Washington and this is their home. Which, again, is the same argument the city makes for it's horde of unwashed street urchins. Which I don't buy. Go to residency in Nebraska, and then come back if you want.

And on the same token, if UW were to start seeing a decline in the quality and quantity of their residents because they decided to play hard ball with salaries? Well, tough $#!t. Your reputation suffers. That was a bad decision. Amazon and Microsoft and Boeing all keep their rosters filled by paying their people enough to live nearby. You can do the same. Or not. Whatever. UW is constantly expanding services all over the state. I can think of at least two clinics which they have opened, which consistently hemorrhage money, but they keep them open just to "have a presence." So they're not short on cash. They could shrink their footprint a little and probably afford a bit more on the other end. That is, of course, speculation as I don't work for their finance department.
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yep, and I just pulled a zillow search, there are a TON of apts for <1200
 
sb247 said:
yep, and I just pulled a zillow search, there are a TON of apts for <1200
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I agree. The issue is swallowing the idea that you're living in a 400-500 square foot apartment. Which, I get, that sucks. But you chose the area. If you lived in NYC you wouldn't think twice. I lived in smaller places during med school. You can suck it up for a few years.
 
HighPriest said:
Amazon and Microsoft and Boeing all keep their rosters filled by paying their people enough to live nearby. You can do the same. Or not. Whatever. UW is constantly expanding services all over the state. I can think of at least two clinics which they have opened, which consistently hemorrhage money, but they keep them open just to "have a presence." So they're not short on cash.
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This is the part where I understand the residents' perspective. I categorically reject the idea that UW *can't* afford to pay residents on par with professionals with similar advanced training in other fields. They *choose* not to because, well, they can get away with it because people will still want to live in Seattle and train at a place that has brand-name recognition like UW. At some point you go past being fiscally responsible and are just pinching pennies out of spite.

That said... if that's how they're going to play it, then prospective residents need to take responsibility for their own fiscal security and factor that into their decisions regarding where to go for training.
 
GoSpursGo said:
This is the part where I understand the residents' perspective. I categorically reject the idea that UW *can't* afford to pay residents on par with professionals with similar advanced training in other fields. They *choose* not to because, well, they can get away with it because people will still want to live in Seattle and train at a place that has brand-name recognition like UW. At some point you go past being fiscally responsible and are just pinching pennies out of spite.

That said... if that's how they're going to play it, then prospective residents need to take responsibility for their own fiscal security and factor that into their decisions regarding where to go for training.
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I agree completely.
 
I go back and forth on this. My initial reaction is to back the residents because 58k in Seattle seems low even to my non-PNW eye, then I think about it and remember many of those residents chose to be at UW despite this salary being public information (it’s highly regarded, we shouldn’t pretend that many people are tumbling down their rank list to get there). I get this is basically what everybody has said.

Ultimately though, in defense of the residents, I think it’s hard to know what it’ll feel like to be at a program until either you’re there or the issues are well-documented in the public domain (above just chatter from the interview trail). After Hopkins IM was documented to have gone over duty hours in the early 2000s, I don’t think a single person kidded themselves and thought “oh this isn’t more intense than other programs,” but before that happened I could imagine people not truly realizing why their call system is actually more intense than the average one (before residency understanding the toll of q3, q4, golden vs silver weekends, etc is difficult in my opinion). Along the same lines, up until this point (at least when I was on the trail) UW had a rep for working residents hard, but I don’t think the cost of living and benefits deficits were really as obvious (especially to people not from the region), so I can’t really say “well the residents knew what they were getting themselves into.” Now, however, if an applicant chooses UW, I think they have to take a bit more ownership of the choice because it is clear UW isn’t providing compensation on par with its peers. I do think that going forward those choosing to match at UW should go in with eyes wide open (still a reasonable choice, I have multiple friends there who are very happy but who do work very hard and make less per hour than the average resident).

With all that said I still stand with residents because residency doesn’t need to be as bad as it is anywhere. The lack of autonomy (not from a medical standpoint, which I don’t expect yet obviously, but from a day to day standpoint), the horrible schedule, the stressful hierarchy that exists in all jobs but seems to be worse in medicine, etc. Better pay, finding a way to finagle more golden weekends for people (perhaps paying moonlighters a few weekends a year on slower services), ensuring coverage for and access to health services, and changing stupid things in the schedule that just bring about stress (like in my opinion continuity clinics during the weeks of busy rotations, though I’m sure this could be debated and is institution specific) are all things I think every program should look into. When >90% of employees think the best part about residency is that it ends, something should change because it doesn’t make sense to be in the business of helping people and then going by ignoring thousands of them.
 
Dantrolene FC said:
As I'm applying to residencies, I'm just glad they're paying us while our dental colleagues have to pay tuition to attend residency.
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This crap again. You can make great money out of dental school without a residency, $140-180k base pay working for the man, and many make way more. You don't need a residency to work as a dentist.
 
I’m a card carrying proud union man but I think these residents are being idiots. Not only did they elect to live in a high priced city but rather than try to work within the system they formed a union with no financial backing or strike power. For what?!

Look at every bond rating site for UW - they are still Aaa for the university at large but outlooks are negative solely because the healthcare part is losing money and they are frantically trying to right the ship. This is not best time to start asking for massive capital outlays! Eliminating COL raises looks like part of an existing cost control measure rather than a punitive action. Handicapping their billing only makes things worse.

The best unions have a good relationship with management but this one seems like they don’t understand the reality of their situation. They’re like the dog that caught the car and now realize they don’t know how to drive.
 
atomheart said:
This crap again. You can make great money out of dental school without a residency, $140-180k base pay working for the man, and many make way more. You don't need a residency to work as a dentist.
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Ehh, that depends on the state. A quick glance says that CA, CT, NY, OH and WA all require a 1-year residency (and there could be more, I just clicked on a couple states). Some general dentistry residencies do pay, however, and AFAIK many to most OMFS residencies pay as well

However, your point still stands in that you could easily go work straight out of dental school in a state that doesn't require residency and be just fine.

Dental Licensure by State Map

See a state’s dental licensure requirements and CE options with the interactive licensure map. Visit the state board's website for the most recent details.
www.ada.org www.ada.org
 
I mean....this isn't a union. I know they say it's a union, but it's not. It's just a bunch of people vying for the same goal. If my friends and I all decide to leave work and get a cheeseburger, we're not a union. We just all want a cheeseburger. They have no power of any kind and ultimately ACGME is a backdoor to their backdoor, if you follow me.

That being said, in Seattle all they really have to do is prick the heart of a single city councilperson, and that councilperson will rain wrath upon UW like the sky has cracked upon if they think someone's "rights" have been trampled.
 
atomheart said:
This crap again. You can make great money out of dental school without a residency, $140-180k base pay working for the man, and many make way more. You don't need a residency to work as a dentist.
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Using the same logic, we could justify making fellows pay for their fellowships since they can make $200k with just a residency.

As physicians, almost all of us will be in the top 5% of income earners. $50k/year is just about the median income nationally. My point is we should be content with what we have.
 
Dantrolene FC said:
As physicians, almost all of us will be in the top 5% of income earners. $50k/year is just about the median income nationally. My point is we should be content with what we have.
Click to expand...

On an individual level, for individual specialties, it's much more appropriate to reframe the horribleness of medical training, and pretty much everyone does it to some degree. I don't agree with this approach of having a large group of residents reframe their own suffering because in this case there's a question of systemic abuse of residents by administrators.
 
JoaoMoutinho said:
Ehh, that depends on the state. A quick glance says that CA, CT, NY, OH and WA all require a 1-year residency (and there could be more, I just clicked on a couple states). Some general dentistry residencies do pay, however, and AFAIK many to most OMFS residencies pay as well

However, your point still stands in that you could easily go work straight out of dental school in a state that doesn't require residency and be just fine.

Dental Licensure by State Map

See a state’s dental licensure requirements and CE options with the interactive licensure map. Visit the state board's website for the most recent details.
www.ada.org www.ada.org
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CT doesn't, you can take a special test offered by a variety of sources OR do a residency of some kind.

I didn't look at any others but it makes me question your statement.
 
VA Hopeful Dr said:
CT doesn't, you can take a special test offered by a variety of sources OR do a residency of some kind.

I didn't look at any others but it makes me question your statement.
Click to expand...
Oops, good catch. I had just seen the "PGY-1" at the top of the page for a couple of states and hadn't noticed the "or". Out of those states I listed above it's just NY that requires a residency, while for the others it's an option instead of the tests like you said.
 
atomheart said:
On an individual level, for individual specialties, it's much more appropriate to reframe the horribleness of medical training, and pretty much everyone does it to some degree. I don't agree with this approach of having a large group of residents reframe their own suffering because in this case there's a question of systemic abuse of residents by administrators.
Click to expand...
What systemic abuse?
 
Gonna chime in and say I didn't even apply to places like this.

NYC? Boston? Seattle? Great programs, but miss me with that joke of a lifestyle. Living with 3 strangers in a 1000 sqft apartment or by myself in a tiny apartment in the ghetto for 2700 a month is pathetic when you consider all the damn work everyone has put in to get this far.

I hope people keep applying to these "cool" places while invites from solid programs in cheaper cities continue flowing in for me.

/endrant
 
atomheart said:
I disagree that it's fairly straightforward. It blends into political culture, and it's a trap and you know it.
Click to expand...
you made a pretty big and very inflammatory claim, time to justify it. I'm openly admitting that I doubt you can articulate "Systemic abuse" because even the strikers haven't done that but I'm more than willing to hear you out.

Let's go through your claims
 
sb247 said:
you made a pretty big and very inflammatory claim, time to justify it. I'm openly admitting that I doubt you can articulate "Systemic abuse" because even the strikers haven't done that but I'm more than willing to hear you out.

Let's go through your claims
Click to expand...

How is it inflammatory? Seems subjective.
 
VA Hopeful Dr said:
Not from me, if there's systemic abuse I want to hear about it.
Click to expand...

Then read the news article and form an opinion like everyone else. I would not attack a person that feels that they are suffering in this system, or blame their suffering on a confluence of their own life decisions.
 
atomheart said:
Then read the news article and form an opinion like everyone else. I would not attack a person that feels that they are suffering in this system, or blame their suffering on a confluence of their own life decisions.
Click to expand...
So I read all the articles posted in the General Residency forum. I didn't see anything about abuse. It seems their complaints mainly center around pay and child care.

Their pay is above what I see where I'm located so the issue is really COL. I have some sympathy, but only some. If you're worried about that, go somewhere cheaper. I did that, its not hard.

Child care - my program didn't have any child care support whatsoever. Plenty of places don't.
 
VA Hopeful Dr said:
So I read all the articles posted in the General Residency forum. I didn't see anything about abuse. It seems their complaints mainly center around pay and child care.

Their pay is above what I see where I'm located so the issue is really COL. I have some sympathy, but only some. If you're worried about that, go somewhere cheaper. I did that, its not hard.

Child care - my program didn't have any child care support whatsoever. Plenty of places don't.
Click to expand...

Yeah, I agree, and I already laid out my story. I knew exactly what I was getting into, and I'm very happy in my residency. I was very lucky I didn't marry someone inside of medicine or who would have a schedule that conflicted with the work hours I knew I should expect, and I do my best to take care of my family when I can--I do not think I would ever put anyone else through this if I did not believe it would eventually get better. But I will be the first to admit how lucky I've been to get through this situation unscathed so far.

Do I believe residents are being abused to the point where it is causing systemic problems? In my opinion the answer is no, though some have argued it could be linked to depression and SI in our profession. It's hard to prove, and multifactorial.

Is there a question that there is some abuse of residents? Absolutely. That is why this thread exists. I think the fact that so many here have already admitted that they specifically avoided these cities is telling--we know we're not going to be given special circumstantial care in these markets, so we avoid them. None of us are surprised that this is happening to residents in an expensive market like Seattle. That's evidence to me.

In my opinion it is incorrect to apply a one-size-fits-all training package without reasonable consideration of the market where training takes place. It is on residency administrators to make sure residents are taken care of to a minimum standard that they are able to perform their job duties:

II.D. Resident Salary and Benefits: The Sponsoring Institution, in collaboration with each of its ACGME-accredited programs and participating sites, must provide all residents/fellows with financial support and benefits to ensure that they are able to fulfill the responsibilities of their ACGME-accredited program(s).
Click to expand...
https://www.acgme.org/Portals/0/PFA...equirements2018.pdf?ver=2018-02-19-132236-600

I have heard about special rules that determine actual resident salary, but I have yet to read a legal document that makes this issue transparent as to what determines variability in salary and benefits between programs in different cities. It would seem logical that some officer should take into account COL, and make yearly adjustments. Yet I when I read this, I get the feeling that this program is mismanaged:

In their last three-year contract, UW agreed to 3% annual raises. This time they're only offering 1% raises for the first two years and then 0% for the third.
Click to expand...
https://www.thestranger.com/slog/20...nts-will-strike-for-15-minutes-this-wednesday

3% has been a standard inflationary rate for every market in the US for decades. Even my medical school tuition followed a minimum yearly 3% inflation. Maybe someone could show me the books of this program that makes a 3% raise impossible for residents at UW. As for my own program, we have a 1.7% yearly increase, which is substantial and takes care of inflation in my market.
 
Last edited:
atomheart said:
Yeah, I agree, and I already laid out my story. I knew exactly what I was getting into, and I'm very happy in my residency. I was very lucky I didn't marry someone inside of medicine or who would have a schedule that conflicted with the work hours I knew I should expect, and I do my best to take care of my family when I can--I do not think I would ever put anyone else through this if I did not believe it would eventually get better. But I will be the first to admit how lucky I've been to get through this situation unscathed so far.

Do I believe residents are being abused to the point where it is causing systemic problems? In my opinion the answer is no, though some have argued it could be linked to depression and SI in our profession. It's hard to prove, and multifactorial.

Is there a question that there is some abuse of residents? Absolutely. That is why this thread exists. I think the fact that so many here have already admitted that they specifically avoided these cities is telling--we know we're not going to be given special circumstantial care in these markets, so we avoid them. None of us are surprised that this is happening to residents in an expensive market like Seattle. That's evidence to me.

In my opinion it is incorrect to apply a one-size-fits-all training package without reasonable consideration of the market where training takes place. It is on residency administrators to make sure residents are taken care of to a minimum standard that they are able to perform their job duties:

https://www.acgme.org/Portals/0/PFA...equirements2018.pdf?ver=2018-02-19-132236-600

I have heard about special rules that determine actual resident salary, but I have yet to read a legal document that makes this issue transparent as to what determines variability in salary and benefits between programs in different cities. It would seem logical that some officer should take into account COL, and make yearly adjustments. Yet I when I read this, I get the feeling that this program is mismanaged:

https://www.thestranger.com/slog/20...nts-will-strike-for-15-minutes-this-wednesday

3% has been a standard inflationary rate for every market in the US for decades. Even my medical school tuition followed a minimum yearly 3% inflation. Maybe someone could show me the books of this program that makes a 3% raise impossible for residents at UW. As for my own program, we have a 1.7% yearly increase, which is substantial and takes care of inflation in my market.
Click to expand...
What abuse do you have a question about? “Abuse” is a serious accusation
 
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