- Joined
- Jul 29, 2007
- Messages
- 7,009
- Reaction score
- 4,495
Double post sry
What is the purpose of The Match?
- Thread starter FunnyDocMan1234
- Start date
- Joined
- Dec 21, 2007
- Messages
- 2,085
- Reaction score
- 2,947
If we could negotiate salaries, the bottom 20% would have to work for free. And all the ultra-competitive specialties.
- Joined
- Jul 27, 2013
- Messages
- 38,604
- Reaction score
- 76,028
Financial aid could easily be offered up front. It would keep schools honest about what they could offer as well, as they would know that they don't have a shot of trying to woo applicants once the hypothetical Match would be over. Not that I really think this is a necessary thing, just saying it could work for the same reason it works for residencies. They put their best show on, make their best offers, and do everything they can to get themselves ranked as highly as possible.
Only downside I could see is the AACOMAS doing their match sooner and forcing people to choose whether to rank DO before having the chance at MD, much as currently happens with DOs in residency with the AOA/ACGME split matching system.
- Joined
- Oct 11, 2006
- Messages
- 10,677
- Reaction score
- 15,423
Mostly false. Resident salaries are largely independent of the matching process. In fact, salaries at most academic institutions are non-negotiable for those starting out. We have a standardized starting salary, asking for more (as an attending) gets you nothing. Salaries are usually set by the GME office -- that's why all interns (IM, ortho, ophthal, psych, etc) make the same salary.
Plus, the match is new to the IM fellowships in the last few years. Salaries are completely unchanged. Prior to the match, there was no negotiation -- it was a take-it-or-leave-it situation.
I'm not arguing that resident salaries are low -- I'm pointing out that the match isn't the cause of it.
- Joined
- Jul 30, 2014
- Messages
- 779
- Reaction score
- 832
What is the cause of it?
- Joined
- Jul 30, 2014
- Messages
- 779
- Reaction score
- 832
How would they do this? Unless a person is independently wealthy, how could they afford to work 3-5 years for free on top of having med school debt? How would they pay the bills?
- Joined
- Jun 28, 2011
- Messages
- 3,477
- Reaction score
- 1,676
Loans.
I mean if you have to in order to practice, then you almost have no choice. An MD without a license is a BS with 250k of debt attached to it.
- Joined
- Jul 30, 2014
- Messages
- 779
- Reaction score
- 832
250k in loans is a huge burden as is, if you had to take out more loans to do residency, I think a medical career would quickly become financially unsustainable. If you had to compete with people offering to work for free in residency, I think most people would stop going to med school, and that would end up driving residency salaries up and med school tuition down to attract people back into medicine.
- Joined
- Jul 30, 2014
- Messages
- 779
- Reaction score
- 832
Isn't monopoly collusion illegal?
- Joined
- May 14, 2010
- Messages
- 1,189
- Reaction score
- 359
Jung et al. (http://www.nacua.org/documents/Jung_v_AAMC.pdf) alleged conspiracy in a case against the AAMC, NRMP, ACGME, et al. The case was essentially rendered moot by the Congressional passage of an exemption to federal antitrust scrutiny:
15 U.S.C. § 37b: Confirmation of antitrust status of graduate medical resident matching programs - See more at: http://codes.lp.findlaw.com/uscode/15/1/37b#sthash.H8s3V4Eo.dpuf
- Joined
- Apr 25, 2014
- Messages
- 4,509
- Reaction score
- 4,134
the fact that you're not actually producing value for the hospital.
- Joined
- Jul 30, 2014
- Messages
- 779
- Reaction score
- 832
That's not true at all. Residents do a lot of work for the hospital that has to get done. To get the same amount of work done by a PA or NP (even a fresh grad), they'd have to pay more. Or they'd have to hire more attendings, which would cost a LOT more.
- Joined
- Jul 30, 2014
- Messages
- 779
- Reaction score
- 832
Wow, they got a congressional exception to the anti-trust laws. Why am I not surprised...
- Joined
- Apr 25, 2014
- Messages
- 4,509
- Reaction score
- 4,134
residents slow down productivity, not enhance it. it's pretty intuitive why the fed gov has to fund their salaries
- Joined
- Jun 5, 2014
- Messages
- 1,098
- Reaction score
- 2,112
He's right you know...
- Joined
- Jul 30, 2014
- Messages
- 779
- Reaction score
- 832
Absolutely, residents, especially senior ones, are a huge source of high quality, dirt cheap labor. A resident in the last year, for example, is almost an attending, yet being paid less than a midlevel. Residents are definitely cash cows. Residents don't magically switch from losing the hospital money to making it big money the minute they finish, lol.
Last edited:
If your argument is that the match is too stressful and causes too much anxiety, I hate to say it, but if you can't deal with the anxiety of the match during your MS4 year, you are screwed when it comes to residency.
The match sucks for anybody with a low USMLE score. It is good for everyone else.
- Joined
- Oct 11, 2006
- Messages
- 10,677
- Reaction score
- 15,423
It's hard to make big generalizations, because each program and field is different.
Residents probably are profitable, although I doubt they are "cash cows". Private groups like Kaiser and Banner may have residency programs because it increases their market share -- patients (often) want see teaching hospitals as superior to non-teaching ones. Once you include all of the costs of administering a program (PD's require at least 50% salary support, need at least 1 administrator, recruitment costs, etc) it may be more of a break even. Again, this totally depends upon how a program is structured -- perhaps I'm on one end of the curve, but we have faculty in house at night and heavily supervising our teams, such that the replacement cost (additional faculty needed if residents were removed) would not be that much -- but I totally agree that it would be more expensive.
Residents can't bill, so they do change dramatically when they graduate.
In any case, the initial question asked was what, if not the match, keeps resident salaries where they are. My thoughts:
The problem is this: Residents probably deserve better salaries for the hours they put in and the work they do. No argument there. But resident salaries are driven mostly by market forces, and there's no pressure to increase them. Residents must complete a residency to work as a physician, and residencies are not trying to steal residents from each other. Hence, the force in the regular employment universe that pushes salaries up (an employer trying to keep someone from changing employers) doesn't play a role. Plus, residents choose programs mostly for prestige, quality of training, and location. Salary is usually much lower on the list. So, if I increase salaries, I'm unlikely to get any better residents or lose any of the one's I have.
Residents probably are profitable, although I doubt they are "cash cows". Private groups like Kaiser and Banner may have residency programs because it increases their market share -- patients (often) want see teaching hospitals as superior to non-teaching ones. Once you include all of the costs of administering a program (PD's require at least 50% salary support, need at least 1 administrator, recruitment costs, etc) it may be more of a break even. Again, this totally depends upon how a program is structured -- perhaps I'm on one end of the curve, but we have faculty in house at night and heavily supervising our teams, such that the replacement cost (additional faculty needed if residents were removed) would not be that much -- but I totally agree that it would be more expensive.
Residents can't bill, so they do change dramatically when they graduate.
In any case, the initial question asked was what, if not the match, keeps resident salaries where they are. My thoughts:
The problem is this: Residents probably deserve better salaries for the hours they put in and the work they do. No argument there. But resident salaries are driven mostly by market forces, and there's no pressure to increase them. Residents must complete a residency to work as a physician, and residencies are not trying to steal residents from each other. Hence, the force in the regular employment universe that pushes salaries up (an employer trying to keep someone from changing employers) doesn't play a role. Plus, residents choose programs mostly for prestige, quality of training, and location. Salary is usually much lower on the list. So, if I increase salaries, I'm unlikely to get any better residents or lose any of the one's I have.
- Joined
- Jul 30, 2014
- Messages
- 779
- Reaction score
- 832
Seems strange that residents can't bill. They should at least be able to bill like midlevels do. Can't a freshly graduated PA bill? Then why not a resident?
Regarding salaries for residents: In the old old days ( 1950's and earlier ) residents were given room and board ( they lived in the hospital, hence "residents" ) and got a small stipend. They basically worked for free. They were not allowed to be married, so presumably they didn't need more money or their own place to live.
If salaries were negotiable, then most residents would be working for nothing. If someone's dream ortho or derm program offered them a spot on the condition that they work for free, I'm sure most students would take that offer. After all, you paid $45,000 for each year of med school. Working for free would be a raise compared to paying tuition.
As far as residents providing cheap labor is concerned, when I was a resident, I was sure that the hospital couldn't have survived without me. However, as an attending, I much prefer being without residents. In my experience, the residents that I had working for me, from a top 10 program, were way more trouble than they were worth. That, of course, is based on my own experience and opinion. Do keep in mind, however, that while all medical students and residents trained at hospitals with residents, the overwhelming number of hospitals don't have residents and they manage just fine.
As to why Kaiser has residents, I think that's for the same reason that most non-university hospitals do. Not for cheap labor, but rather to do their share to educate young doctors, and perhaps to increase the prestige and reputation of their hospitals as well. Also, perhaps they hope to identify the best residents to recruit for their hospitals.
If salaries were negotiable, then most residents would be working for nothing. If someone's dream ortho or derm program offered them a spot on the condition that they work for free, I'm sure most students would take that offer. After all, you paid $45,000 for each year of med school. Working for free would be a raise compared to paying tuition.
As far as residents providing cheap labor is concerned, when I was a resident, I was sure that the hospital couldn't have survived without me. However, as an attending, I much prefer being without residents. In my experience, the residents that I had working for me, from a top 10 program, were way more trouble than they were worth. That, of course, is based on my own experience and opinion. Do keep in mind, however, that while all medical students and residents trained at hospitals with residents, the overwhelming number of hospitals don't have residents and they manage just fine.
As to why Kaiser has residents, I think that's for the same reason that most non-university hospitals do. Not for cheap labor, but rather to do their share to educate young doctors, and perhaps to increase the prestige and reputation of their hospitals as well. Also, perhaps they hope to identify the best residents to recruit for their hospitals.
1. Exploding offers
2. Hospitals with residency programs, especially extensive programs (i.e. university and county programs) generally rely on residents in order for the hospital to operate.
3. Exploding offers.
You're welcome to go be a resident at the hospital that starts out at 100k/year for interns.
Oh, wait... that describes zero programs? Hmm... because all physicians need to go through residency to be licensed and board certified.
- Joined
- Jul 30, 2014
- Messages
- 779
- Reaction score
- 832
The bigger issue is the monopoly that has been established for residency training, as was previously mentioned.
- Joined
- Oct 22, 2013
- Messages
- 25,430
- Reaction score
- 39,283
You are not just unlikely to ever work in your desired field ever, the desire of doctors aside they are unlikely to ever work again in SOCIETY'S DESIRED FIELD, PCP gettting people healthier and back to work via primary care fields like FM/IM
Medical students slow down productivity, in fact, they are ZERO productivity. Oh wait, except they pay. Oh wait, except they don't REALLY pay, like 99% (I made up a number) are getting students loans, government ones in fact, so actually the taxpayer is is paying for med students to add zero value. Oh wait, the med student will become a resident, and then a full-fledged doc. Now they're at 100% productivity and paying back all those student loans.
The main differences between med students and residents:
Med student
costs govt student loans
but will pay them back (supposedly, realistically only if residency completed)
cannot provide billable care
but as a result little in malpractice as they are not responsible
tuition offsets a lot of that
COST: loans from society BENEFIT: trained up to be doc and pay back
NET VALUE: mostly intangible in MD caring for population but only if they complete residency otherwise loans a waste
Resident
salary is not a loan
costs govt investment in resident training (not paid back like loans)
does provide billable care
but ARE responsible, therefore could cost a ****-ton in malpractice
fed govt offsets that with GME funding
COST: GME funding, higher malpractice BENEFIT: more than med student, less than attending in providing care, pay back MS loans but not GME funding
NET VALUE: After residency, pay back loans, provide quality care for population (increases GDP possible), and greater taxes
The med student is seems to pay for themself but to society a massive money drain and wasted opportunity
The resident costs money, but is the only way to bring it all to fruition
Medical students that don't match:
COST: unpaid student loans, worthless medical degree so no care provided
BENEFIT: none
NET VALUE: this is a massive loss to society, probably millions of dollars worth of QALYs when you factor in their suicide and doc shortage of gen pop
However, investing in resident training is the best way to ever get any of the investment put into the med student back
As Perrotfish mentioned (I love that guy, Whedon fan?) the current NRMP process and "all in" and GME funding
results in a collusion where unmatched med students and resigned residents might as well light their MD diploma on fire and die in the flames
what society saves itself by refusing to pay more for GME funding, stopping the collusion so the docs getting trained, is lost by unpaid student loans
sure you can just bring in IMGs, just more outsourcing American jobs
it never pays to have one of your own citizens jobless or in a lower quality job
so let's not pretend for a minute that residents, AMG or IMG aren't worth their weight in gold as far as investments go
the difference is they are valuable to a society that is stingy to pay to train them
and costly/not very valuable to a hospital bottom line
They may not be the hospital's cash cow, but they are society's goose with the golden egg, just waiting to pop out of their cloaca when they get 3-5 years old, and keep laying after that. Other threads get into why midlevels vs doctors, you can't just settle for the midlevel all the time.
Not exactly financially feasible, working for free is still not free because someone has to pay your malpractice. As it was pointed out, while residents are not cash cows, and while they are less productive, even working for free and providing care they are probably not offsetting the malpractice enough. So working "for free" not even borrowing money to live on a la med school, would not be a raise for anyone, except maybe the taxpayer. But then we won't have docs for them so everyone loses.
Everybody is better off with attendings without residents until there are no replacements in the physician workforce. This is why residency exists, and it's not for the reason you say below
I talked about this above
NONONONONONO
No hospital, especially community vs public funded academic medical center, has residents "for prestige and reputation" and to do their "share" while lowering the bottom line
First of all, the general population generally shows up to whatever f*ing hospital their insurance tells them to
Second of all, the general population is generally unaware of a teaching hospital vs regular hospital
Third of all, the general population doesn't really know the difference between a resident physician or attending
Fourth of all, the general population when told a resident is a "doctor-in-training", may find that a delightful concept to help out, however, most, especially if they learn that they are working 80 hr/wk and maybe on their 27th hour of shift, ARE HORRIFIED, so most of the time residents are using patients as guinea pigs by taking advantage of their general ignorance to the process
Fifth of all, given the above, the hospital is not using residents as a selling point for their hospital
Sixth of all, this is why GME and why it's so tight: govt has to spend enough to make the resident free/cheap/making money for the hospital, NOW they are rendered cheap labor, however, still not a cash cow because the govt isn't spending this making and spreading it think to dump loads of money into the hospital, the hospital is being bribed to take indentured servants
Yes, a lot of the community hospitals are religious-associated non-profits, so in that case while there is some lip service to mission, a hospital is always looking at the bottom line, even non-profits have to keep a roof
Kaiser, like Medicare this way, needs to see its own patients, they pay attendings, and are not above the handout that is GME and residents
I went through all of the above to say what I hate about the system:
No MD with $250K of the taxpayer money blown should worry about
how to pay enough NRMP application and interview costs
to have a residency, a roof, food, medical care
when they are clearly willing to be indentured servants and work for pennies if anyone is willing to pony up a residency slot
What sucks a la this thread regarding NRMP is the collusion that results in such high application costs for anyone that needs to try again for a residency
I couldn't give a **** less about the lack of negotiating power the NRMP gave residents if it meant they could rest assured somewhere would train them without breaking them mentally and physically
- Joined
- Jan 2, 2014
- Messages
- 11,384
- Reaction score
- 24,027
What do you mean taxpayers pay? I'm getting a loan at a very high interest rate compared to risk with a loan fee taken out before I even see a cent. My loans are well into the 6 figures and I will be paying back every cent thank you very much.
- Joined
- Jul 30, 2014
- Messages
- 779
- Reaction score
- 832
Well, loans have to be paid whether they match or not. I don't think you get your loans forgiven if you fail to match.
- Joined
- Oct 22, 2013
- Messages
- 25,430
- Reaction score
- 39,283
Income based repayment.
If you don't work, income 0, payment 0.
If you do work, it's something like 10% of your "disposable" income above some percent of Federal poverty line.
Other threads address the disaster that is non-clinical jobs, but at earning potentials less than $100,000 with IBR, with the high rates as you say ballooning up that debt at the end of 25 years that all goes unpaid, and you've paid back a small fraction.
People talk about working in underserved area loan forgiveness wiping the slate and little being paid back and it's such a loss to society, but it's horse crap because in that case society gets a doc in underserved area for 10 years, then pay with attending salary the next 15, actually IBR and loan forgiveness policies at attending salaries makes the 25 year write off a pipe dream.
In the former case, lots more written off. Society doesn't have a clinician, and you don't pay big taxes or pay that loan down.
Those MDs have **** quality of life between the job they can get and what they have to put towards those loans.
One doc down hundreds thousands down the hole.
The only way society sees back the money on those loans is if without a residency your MD gets you attending salary.
Unmatched MDs aren't just in the ****ter with the debt alone, they take that money down with them despite "having" to pay. You can get back money someone doesn't have, no matter how hard you try to get it.
If you don't work, income 0, payment 0.
If you do work, it's something like 10% of your "disposable" income above some percent of Federal poverty line.
Other threads address the disaster that is non-clinical jobs, but at earning potentials less than $100,000 with IBR, with the high rates as you say ballooning up that debt at the end of 25 years that all goes unpaid, and you've paid back a small fraction.
People talk about working in underserved area loan forgiveness wiping the slate and little being paid back and it's such a loss to society, but it's horse crap because in that case society gets a doc in underserved area for 10 years, then pay with attending salary the next 15, actually IBR and loan forgiveness policies at attending salaries makes the 25 year write off a pipe dream.
In the former case, lots more written off. Society doesn't have a clinician, and you don't pay big taxes or pay that loan down.
Those MDs have **** quality of life between the job they can get and what they have to put towards those loans.
One doc down hundreds thousands down the hole.
The only way society sees back the money on those loans is if without a residency your MD gets you attending salary.
Unmatched MDs aren't just in the ****ter with the debt alone, they take that money down with them despite "having" to pay. You can get back money someone doesn't have, no matter how hard you try to get it.
Well then society needs to ensure that every MD grad will always have a guaranteed residency spot, including the IMGs that they give loans to...
- Joined
- Jan 18, 2008
- Messages
- 12,729
- Reaction score
- 4,901
Because the taxpayers are giving the money to train you.
I get what you're saying. But the money to educate you in the here and now comes from outside your pockets: tax payers. Hence why I joke about buying nursing/staff breakfast as a "tax reimbursement" to them.
The taxpayers really should be covering the entire cost of his education because a physician is something every human being needs. God knows how many government projects taxpayers pay for that they never see any benefit out of. Straddling our doctors with massive debt while useless politicians enjoy themselves with our tax money is pretty much the definition of injustice.
- Joined
- Jan 2, 2014
- Messages
- 11,384
- Reaction score
- 24,027
It's a loan, not a gift
- Joined
- Apr 25, 2014
- Messages
- 4,509
- Reaction score
- 4,134
giving money? dude we're paying like 8 percent interest . sign me up for where I can "give" someone money and receive 8 percent interest, with a rate as good as med students graduating and paying back loans
